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*^  7  /  '  / 

The  Medical  Record. 


3.  tUcckltj  ^foimml  of  ilTcMcinc  anb  Suvgcin, 


EDITED    BT 


GEORGE    P.    SHRADY,   A.M.,   M.D., 

Surgeon  to  the   Presbyterian  and   St.  Fiiancis  Hospitals,  New  York,  and  Consulting 
Surgeon  to  the  Hospital  for  Ruptured  and  Crippled,  New  York. 


iJolumc  21. 

JANUARY   7,  1SS2— JUNE 

-'■i, 

1882. 

10/ 

' 

NEW   YORK: 

WILLIAM    \VOOr)    &    COMPANY. 

1882. 

Trow's 

Printing  and  Bookbinding  Company, 

201-213  ^"'^   '^M  St., 

NEW  YORK. 


LIST  or  CONTRIBUTORS  TO  VOL.  XXL 


Abbe,  Dr.  Robert,  Xew  York. 

Agnew,  Dr.  C.  R.,  New  Yoik. 

Ai-i-EN,  Dr.  Ai.MON  S.,  Brooklyn.  N.  Y. 

Atkins,  Dr.  Francis  H.,  Fort  Stanton,  New  Mexico. 

Bai-lert,  Dr.  G.  H..  Paterson,  N.  J. 

Barrows,  Dr.  Chas.  C,  Willet's  Point,  N.  Y.  H. 

Baruch,  Dr.  S.,  New  York. 

Beard,  Dr.  George  M.,  New  York. 

Bexnet,  Dr.  .J.  Henry,  Mentone,  France. 

Beyer,  Dr.  H.  G.,  U.  S.  Navy. 

Bigelow,  Dr.  Horatio  R.,  Wasliington,  D.  C. 

Block,  Dr.  J.,  Kansas  City,  Mo. 

Bodenramer,  Dr.  William,  New  York. 

BoswoRTH.  Dr.  F.  H.,  New  York. 

Br.\dley,  Dr.  Wm.  L.,  New  Haven,  Conn. 

BR.A.DNER,  Dr.  W.  B.,  Warwick.  N.  Y. 

Brewer.  Dr.  E.  P.,  Norwicli,  Conn. 

Brewer,  Dr.  George  E.,  Buffalo,  N.  Y. 

Brown.  Dr.  N.  F.,  Detroit,  Mich. 

Browne,  .1.   Cricuton,  London.  Eng. 

Burke,  Dr.  Martin,  New  York. 

Burr,  Dr.  Geo.,  Binghamton,  N.  Y. 

Bdrrall,  Dr.  F.  A.,  New  York. 

Carpenter,  Dr.  W.  M.,  New  York. 
Carroll,  Dr.  A.  L.,  New  Brighton,  N.  Y. 
C.^stle,  Dr.  F.  A.,  New  York. 
Chase,  Dr.  Meios,  Oneonta,  N.  Y. 
CaEESM.'iN,  Dr.  W.  S.,  .Auburn,  N.  Y. 
Co.MiNGS,  Dr.  A.  F.,  Parsons,  Kan. 
Corning,  Dr.  J.  Leonard,  New  York. 
Corrigan,  Dr.  J.  F.,  South  Orange,  N.  .1. 
Crothers,  Dr.  T.  D.,  Hartford,  Conn. 
Cutter,  Dr.  Ephraim.  New  York. 
Cutter,  Dr.  Geo.  R.,  New  York. 

D ALTON,  Dr.  John  C,  New  York. 
Dana,  Dr.  Chas.  L.,  New  York. 
Dawson,  Dr.  W.  W.,  Cincinnati,  O. 

Ely,  Dr.  Edward  T.,  New  York. 

Fblton,  Dr.  Lucius  E.,  Potsdam,  N.  Y. 
Flynn,  Dr.  .1.  W.,  New  York. 
Fox,  Dr.  Geo.  Henry,  New  York. 
French,  Dr.  .1.  M.,  Simsbury,  Conn. 
Fuller,  Dr.  Robert  M.,  New  York. 

Garrigues.  Dr.  Henry  J.,  New  York. 
Geddings,  Dr.  W.  H.,  Aiken,  S.  C. 
Gibney,  Dr.  V.  P..  New  York. 
Grah.vm,  Dr.  A.  C,  Dallas,  Texas. 
Grainger,  Dr.  W.  H.,  Boston,  Mass. 


Gray,  Dr.  L.\ndon  Carter,  Brooklyn,  N.  Y. 

Green,  Traill 

Gregg,  Dr.  Rollin  R.,  Buffalo,  N.  Y. 
GuNN,  Dr.  J.  H.,  Calera,  Ala. 

Halderm.^n,  Dr.  Davis,  Columbus,  O. 
Hall.  Dr.  A.   L.,  Fairliaven.  N.  Y. 
Hamilton,  Dr.  Allan  McL.,  New  York. 
Harrison,  Dr.  J.  M.,  Mimieapolis,  Minn. 
Hart,  Dr.  Charles  A.,  Plainfield,  N.  .J. 
Harvey,  Dr.  P.  F.,  Fort  Snelling,  Minn. 
Hinsdale,  Dr.  Guv,  Philadelphia,  Pa. 
Houston,  Dr.  Thomas  F.,  Clarkesville,  Ga. 
Hunt,  Dr.  S.  H.,  Long  Branch,  N.  J. 

•LiCKSON,  Dr.  Geo.  T.,  New  York. 
Jarvis,  Dr.  Wm.  C.  New  York. 
Jervis,  Dr.  D.  H.,  Lone  Pine,  Pa. 
.Jones.  C.  Handfield,  F.R.S.,  London,  Eng. 
.Jones,  Dr.  Nelson  E..  Circleville,  O. 
Jones,  Dr.  Talbot,  St.  Paul,  Minn. 
Judkins,  Dr.  Wm.,  Cincinnati,  O. 

Kales.  Dr.  J.  W.,  Union  Springs,  N.  Y. 
Kane,  Dr.  H.  H.,  Fort  Washington,  N.  Y. 
Knapp,  Dr.  Herman,  New  Yoik. 

LaRoe,  Dr.  J.wiEs  G.,  Greenpoint,  L.  I.,  N.  Y. 
Lewis,  Dr.  Daniel,  New  York. 

Maclean,  Dr.  Donald,  Ann  Arlior,  Micb. 
Markoe,  Dr.  Thomas  M.,  New  York. 
Martin.  Dr.  H.  A..  Boston.  Mass. 
McClkllan,  Dr.  George,  Philadelphia,  Pa. 
Mendei.son,  Dr.  Walter.  Leipzig,  Germany. 
Milne,  Dr.  T.  Clarke.  Massilon,  O. 
Milton,  Dr.  M.,  Bradford,  Pa. 
Morgan,  Dr.  Wilbur  P.,  Baltimore,  Md. 

Newton,  Dr.  R.  C,  U.  S.  Army,  Fort  Stanton,  N.  M. 

Otis,  Dr.  F.  N.,  New  York. 

Fallen,  Dr.  Montrose  A.,  New  York. 
Peck,  Dr.  Edward  S.,  New  York. 
Peters,  Dr.  George  A..  New  York. 
Peters,  Dr.  John  C.  New  York. 
Pilcher.  Dr.  Lewis  S.,  Brooklyn,  N.  Y. 
Pitkin,  Dr.  IjEonard  F..  Newark,  N.  J. 
Polk,  Dr.  Wm.  M.,  New  York. 
Po.meroy,  Dr.  Oren  D.,  New  York. 
Post.  Dr.  A.  C.  New  York. 
Post,  Dr.  Geo.  E..  Beirut,  Syria. 
PuTZEL,  Dr.  L.,  New  York. 


Contributors  to  Vol.    XXL 


Rafter,  Dr.  J.  A.,  Whitingr,  Kansas. 
Rankin,  Dr.  Francis  H.,  Newport,  R.  I. 
Raymond,  Dr.  II.  J.,  U.  S.  A.,  Alcatras  Island,  Cal. 
Read,  Dr.  II.  II.,  Halifax,  N.  S. 
Ripley,  Dr.  John  II.,  New  York. 
BoBERTS,  Dr.  M.  .Iosiah,  New  York. 
Rockwell,  Dr.  A.  D. ,  New  York. 
RoosA,  Dr.  D.  B.  St.  John,  New  York. 
Root,  Dr.  P.  S.,  Monroe,  Mich. 

Sands,  Dr.  H.  B.,  New  York. 
SATTERTmvAiTB,  Dr.  T.  E.,  New  York. 
ScHCLTZE,  Dr.  K.  C. ,  New  York. 
Searcy,  Dr.  J.  T.,  Tuscaloosa,  Ala. 
Sexton,  Dr.  Samdel.  New  York. 
Shaffer,  Dr.  Newton  M.,  New  York. 
Shrady,  Dr.  Geo.  F.,  New  York. 
Simmons,  Dr.  Duane  B.,  Yokohama,  Japan. 
Speer,  Dr.  A.  T..  Newark.  O. 
Spitzka,  Dr.  E.  C,  New  York. 
Starr,  Ur.  M.  Allen,  New  York. 
Sternberg,  Dr.  Geo.  M.,  Siirnjeon,  U.S.A. 
Stickler,  Dr.  J.  W.,  Orange,  N.  J. 
Stillman,  Dr.  Cuas.  F.,  New  York. 


Tait,  Lawson,  F.R.C.S.,  Birmingham,  Eng. 
Taylor,  Dr.  J.  B.,  New  York. 
Thomson,  Dr.  Jos.  C,  Canton,  China. 
Tyndale,  Dr.  J.  Hilgard,  New  York. 

Valentine,  Dr.  Ferdinand  C,  New  York. 
Vance,  Dr.  Ar  Morgan,  Louisville,  Ky. 


Wendt,  Dr.  E.  C,  New  York. 
Whittaker,  Dr.  James  T.,  Cincinnati,  O. 
Williams,  Dr.  Cornelius,  New  York. 
Wood,  Dr.  IIalsey  L.,  Michigan. 
Woodside,  Dr.  John  S.,  Flatbush,  L.  I.,  N.  Y. 
Wyeth,  Dr.  John  A.,  New  York. 

Institutions   and   Societies   from   which    Reports   hav» 
been  received. 

American  Medical  Association. 

Bellevde  Hospital. 

Cincinnati  Academy  of  Medicine. 

Cincinnati  Medical  Society. 

Connecticut  Medical  Society. 

Cook  County  Hospital,  Chicago,  III. 

German  Congress  for  Internal  Medicine. 

Hospital  of  the  UNivERsrrY  op  Pennsylvania. 

Manhattan  Eye  and  Ear  Hospital. 

Materia  Medica  Society.     CNew  York.) 

Medical  and  Ciiiruhgical  Faculty  op  the  State 

OF  Maryland. 
Medical  Society  of  the  County  of  New  York. 
Medical  .Society  of  the  State  of  New  Jersey. 
Medical  Society  of  the  State  of  New  Tork. 
Medical  Socieiy  of  the  State  of  Pennsylvania. 
New  York  Academy  of  Medicine. 
New  York  Pathological  Society. 
New  York  Society  of  German  Physicians. 
New  York  Surgical  Society. 
Practitioners'  Society  op  New  York. 
Queen    Charlotte's    Lting-in    Hospital,  London, 

Eng. 
St.  Francis'  Hospital,  New  York. 


The  Medical  Record. 


Vol.  XXI. 


JANUARY  7,  1882. 


No.  1. 


(Drigiiml  Commimicotions. 


A  PLEA  FOR  niPRO^^ED  VACCINATION. 
Bt  S.  BAKUCH,  M.D., 


A  KECE><T  editorial  in  this  journal  presents  a  succinct 
view  of  the  merits  of  vaccination,  and  answers  some 
of  the  arguments  of  the  anti-vaoeinationists  ■with  the 
irrefragable  "  logic  of  facts."  The  writer  says  :  "It 
is  becoming  somewhat  tiresome  to  have  to  reiter- 
ate the  truths  of  vaccination,  and  it  wiU  sometimes 
occur  to  US  that  the  best  way  after  all  would  be  to 
leave  the  question  alone  and  let  the  people  find  out 
the  facts  themselves.  But  both  humanity  and  a 
pride  in  our  jirofession  forbid  that  anti-vaccination 
arguments  should  go  unanswered,  when  poijular  ig- 
norance is  plainly  being  imposed  upon  by  them." 

It  is  gratifying  to  note  that  an  influential  journal 
calls  attention  to  the  imjoortance  of  heeding  the 
influence  of  these  peojjle  upon  the  public,  who  are 
so  readily  entrapi^ed  by  pseudophilanthropists  of  all 
stripes.  The  busy  practitioner  is  too  prone  to  be- 
lieve that  he  has  done  his  whole  duty  when  he  has 
obtained  pure  (?)  bovine  wus  and  inserted  it  into 
the  arms  of  all  the  babies  in  his  clientele.  He  regards 
with  contempt  the  anti-vaccination  agitation,  char- 
acterizing it  as  the  otispring  of  ignorance  and  fa- 
naticism, and  refrains  from  studying  their  argu- 
ments and  statistics  because  he  is  satisfied  that  the 
experience  of  the  profession  sustains  him  in  con- 
tinuing the  much-abused  practice.  In  the  course  of 
a  thorough  study  of  the  subject  of  vaccination,  \vn- 
dertaken  while  Chairman  of  the  State  Board  of 
Health  of  South  Carolina,  I  had  occasion  to  canvass 
the  arguments  of  the  auti-vaccinationists,  and  I  con- 
fess that  some  of  their  claims  are  not  without  sub- 
stantial basis.  It  can,  for  example,  not  be  denied 
that  a  very  large  proportion  of  admissions — a  large 
majority  in  some  small-pox  hospitals — are  cases  bear- 
ing vaccine-marks  upon  their  arms,  and  that  many 
of  these  cases  succumb  to  the  disease.  Like  all  ex- 
tremists, the  anti-vaccination  peojjle  claim  to  receive 
from  such  statistics  confirmation  of  their  assertion 
that  Jenner's  grand  discovery  has  proved  unavail- 
ing. But  they  ignore  the  fact  that  Jenner  claimed 
only  the  same  immunity  for  the  vaccinated  which 
was  possessed  by  those  who  had  passed  through 
small-pox.  There  is,  however,  much  food  for  reflec- 
tion in  statistical  tables.  My  recent  investigation  of 
this  subject  demonstrated  clearly  to  my  mind  not 
only  the  protective  influence  of  vaccination  against 
small-pox  invasions,  but  also  its  ameliorating  eft'ect 
lipon  the  type  of  the  disease  when  contracted,  and 
the  diminution  of  the  mortality  thus  wrought  by  it. 
No  fair-minded  person  could  deny  the  latter  esj^e- 
cially.  pBut  I  was  also  surprised  to  discover  um^ovght 
evidence  upon  another  point.  A  critical  examina- 
tion of  all  the  records  of  small-pox  from  1818  to 
1880  brought  out  the  fact  that,  in  the  epidemics  (of 
which  we  have  reliable  data)  from  1818  to  1870,  the 


average  mcrrlalUy  among  vaccinated  patients  iras  4.32 
per  cent.,  while  in  the  more  recent  epidemics,  from 
1870  to  1880,  the  average  tnorlaliti/  among  raccinated 
patients  was  Vl.bl  pel- cent.  The  Prussian  and  Eng- 
lish records,  although  not  ottering  so  great  a  differ- 
ence, will  sei-ve  to  illustrate  this  i^oint.  From  1848 
to  1859  there  were  reported  in  Prussia  46,898  cases  of 
small-pox,  among  which  there  was  a  mortality  of  (! 
percent,  among  the  vaccinated.  But  in  the  records 
from  1871  to  1872,  of  the  Berlin  small-pox  hospitals, 
I  find  an  average  mortality  of  14. .55  per  cent,  among 
the  vaccinated.  Again,  the  London  small-pox  hos- 
pitals report,  from  1836  to  1856,  9,(l(i0  cases,  among 
which  there  was  5  per  cent,  mortality  among  the 
vaccinated,  while,  from  1871  to  1878,  they  report 
9,158  cases  with  a  mortality  of  10.93  per  cent,  among 
the  vaccinated.  What  is  the  cause  of  this  increased 
mortality  among  the  vaccinated  during  the  past  de- 
cade? To  the  unbiassed  student  of  the  history  of 
the  recorded  epidemics  one  jire-eminent  cause  must 
present  itself,  viz.,  the  neglect  rf  Jenner's  teachings. 

During  Jenner's  active  work,  and  in  the  years  im- 
mediately succeeding,  the  "  golden  rules  "  of  the  i!- 
Itistrious  discoverer  were  scrupulously  followed. 
His  influence  swayed  the  medical  mind  long  after 
his  labors  were  brought  to  a  close.  Filled  with  the 
recollection  of  the  dread  scourge  from  which  he  was 
liberating  the  world,  medical  men  regarded  his 
every  rule  as  imperative.  Arm-to-arm  vaccination, 
with  lymph  carefully  chosen  from  eighth-day  jjus- 
tules,  was  the  rule,  and,  without  questioning  its  in- 
fallibility, it  was  obeyed.  As  the  tenific  night- 
mare, which  had  brooded  over  the  profession  until 
.Tenner  disjielled  it  and  infused  hope  in  its  stead, 
faded  fi-om  their  i-ecollection,  and  when  the  enemy 
seemed  bereft  of  his  power,  their  vigilance  relaxed. 

Modifications  were  introduced,  various  methods  of 
obtaining,  preserving,  and  propagating  lymph  v\'ere 
adopted ;  mothers  and  nurses  regarded  themselves 
competent  to  perform  this  operation  seemingly  so 
trifling.  It  was  not  long  ere  the  consequences  of 
neglect  and  indifference  made  themselves  felt.  Hold- 
ing the  view  that  the  inadequacy  of  vaccination  in 
recent  years  is  the  cause  of  the  imperfect  protection 
afforded,  I  will  enforce  it  by  reference  to  several  re- 
cent reports  of  committees. 

In  1860  to  1864,  Drs.  Stevens,  Buchanan,  and 
Sanderson  reported  to  the  British  Government 
("Reynolds'  System  of  Medicine,"  vol.  i.,  171,  Sea- 
ton),  "that  an  examination  of  half  a  million  vaccinated 
children  revealed  the  startling  fact  that  not  more 
than  one  child  in  eight  was  foimd  to  be  so  vaccinated 
as  to  have  the  highest  degi'ee  of  protection  that  vac- 
cination is  cai:iab]e  of  affording ;  not  one  in  three 
could,  on  the  most  indulgent  estimate,  be  considered 
well  protected.  On  page  151,  Dr.  Marson  says  : 
"  Cases  of  small-pox  have  kept  gi-adually  increasing 
in  numbers  until  they  now  amount  to  four-fifths  (!) 
of  the  admissions  into  small-pox  hospitals."'  On 
page  152,  Dr.  Marson  also  demonstrates  that,  out  of 
544  cases  having  four  or  more  vaccine-marks,  only 
one-half  of  one  per  cent,  died  of  small-pox,  and  that 
the  mortality  increased  in  an  invei-se  ratio  to  the 
number  and  quality  of  the  scar.'^. 

In  the  "  Eeport  of  the  Briti.?h  Army  Medical  De- 


THE  MEDICAL  RECORD. 


partment  for  1877  "  (p.  229),  Surgeon-Major  Archer, 
who  took  great  pains  to  investigate  and  note  the 
marks  of  all  recruits  examined  by  him,  proves  that 
"rt  lai-f/e  proportion  of  ad  nil  a  of  the  preHCnt  rjenerdlion 
are  imperfectly  vaccinated.  Foi-ly  per  cent,  of  the  young 
recruits  were  insufficiently  protected.  He  also  shows 
that  the  liability  to  small- pox  bears  a  distinct  rela- 
tion to  the  qwdity  of  the  vaccination. 

The  same  result  has  been  shown  by  the  "  Report  of 
the  Hampstead  and  Homerton  Small-Pox  Hospital." 
Dr.  Bridges,  in  his  rcjDort  to  the  Local  Government 
Board,  divides  the  cases  registered  into  four  classes. 

Hampstead  Hospital,  from  1876  to  1878. 

Class  I. — Patients  bearing  marks  of  good  vacci- 
nation. The  death-rate  was  -57  per  1,000 ;  ranging, 
however,  from  31  per  1,000  in  patients  with  four 
marks  or  more,  to  95  per  1,000  in  patients  with  one 
mark  or  more. 

Class  II. — Patients  bearing  marks  of  indifferent 
quality.  The  death-rate  in  this  class  was  11.3  per 
1,000 ;"  ranging  from  58  per  1,000  in  patients  with  four 
or  more  such  marks,  to  143  per  1,000  in  patients  with 
one  or  more  such  marks. 

Class  III. — Patients  stated  to  have  been  vacci- 
nated, but  showing  no  evidence.  The  death-rate 
was  320  per  1,000. 

Class  IV. — Unvaccinated  patients.  Death-rate 
468  per  1,000. 

Homerton  Hospital,  froin  1871  to  1878,  same  classifi- 
cation. 

Class  I.  showed  a  death-i-ate  of  33  per  1,000 ;  rang- 
ing from  15  per  1,000  in  patients  with  four  good 
marks,  to  39  per  1,000  with  one  mark. 

Class  II.  showed  a  death-rate  of  111  per  1,000  ; 
ranging  from  55  per  1,000  to  patients  with  four  marks, 
to  158  per  1,000  in  those  with  one  mark. 

Class  III.  gave  a  death-rate  of  272  per  1,000. 

Class  IV.  gave  a  death-rate  of  -152  per  1,000. 

Here  we  have  carefully  collated  data,  which  jjrove 
conclusively  that  the  influence  of  vaccination  upon 
the  mortality  of,  and  pari  passu  upon  the  liability  to 
small-pox,  is  in  an  unmistakably  direct  ratio  to  the 
quality  of  lite  vaccination,  diminishing  with  the  im- 
perfect and  increasing  with  the  perfect  manner  in 
which  this  operation  has  been  done. 

It  behooves  every  physician  to  ask  himself  what 
share  ho  bears  iu  the  perpetuation  of  the  imperfect 
vaccination  whii'h  has  evidently  been  practised  dur- 
ing the  past  twenty  or  thirty  years.  How  many 
medical  men  do  now  devote  the  time  and  attention 
necessary  to  the  selection  of  the  lymph,  the  exami- 
nation of  the  vaccinee,  the  proper  inoculation  of  the 
lymph,  the  inquiry  regarding  the  result,  and  the  re- 
vaccination  of  imperfectly  matured  cases  and  cases 
whose  protection  is  rendered  doubtful  by  complicat- 
ing inflammatory  conditions  ? 

I  do  not  know  a  single  physician  who  is  a  true  dis- 
ciple of  .Tenner  in  this  respect,  or  who  carefully  fol- 
lows ^arson's  and  Soaton's  directions,  so  ably  and 
earnestly  inculcated  in  their  works  on  this  subject. 
Glaring  deviations  from  health  in  the  infant  are  not 
overlooked,  but  there  are  some  obscure  ailments 
which  8ho\ild  be  inquired  after.  So  trifling  a  trou- 
ble, for  instance,  as  intertrigo,  is  regarded  by  Seaton 
as  a  bar  to  vaccination  (unless  in  the  presence  of 
small-pox  exposure).  Many  infants  presenting  a 
robust  apjiearanco  are  affected  by  this  ailment  in 
the  lower  part  of  the  body,  where  it  is  hidden  from 
the  eye  of  the  physician.  To  the<:iareful  phvsician's 
inquiry  regarding  tlie  health  of  the  babe,  the  mother 


points  with  pride  to  its  well-developed  limbs  and 
rounded  outlines,  deeming  the  intertrigo  a  matter  of 
no  consequence — a  trouble  which  is  "  natural  to  fat 
babies."  I  do  not  propose  to  enter  into  this  subject 
as  fully  as  its  imj)ortaiice  demands,  because  the 
literature  of  vaccination  abounds  with  precise,[mi- 
nute,  and  reliable  data.  Eegarding  the  selection  of 
lymph,  sufficient  care  is  not  exercised.  Scabs  are 
frequently  used.  These  not  rarely  contain  pus  or 
blood,  or  are  obtained  from  inflamed  surfaces,  all  of 
which  not  only  offer  serious  impediments  to  suc- 
cessful vaccination,  but  may  also,  as  is  well  known, 
excite  constitutional  or  local  distairbance  of  grave 
character.  In  these  days  of  mercenary  traiBc  in  all 
things,  human  life  is  but  too  often  regarded  as 
naught  when  placed  in  the  scale  against  profit.  The 
tottering  tenements,  the  rotten  ships,  the  rusty 
boilers  and  frail  bridges  which  have  sent  their|vic- 
tims  into  eternity,  bear  witness  to  this  fact.  Is  it  not 
possible — yes,  probable — that  this  mercenary  spirit 
has  touched  the  dealers  in  "  vaccine  viriis  "  and  ren- 
dered them  careless  regarding  the  maintenance  of 
its  purity  and  efficiency  ?  When  we  remember  the 
extreme  care  necessary  for  the  preservation  of  the 
human  and  the  cultivation  of  the  animal  "  virus," 
the  skill  and  familiarity  with  the  entire  siibject  de- 
manded of  those  who  are  engaged  in  this  work,  we 
cannot  be  too  careful  with  reference  to  the  source 
of  our  supply.  In  this  matter  we  are  at  the  mercy 
of  the  dealers,  among  whom  there  are  doubtless 
many  who  realize  its  impoi'tance,  and  who  are  .scru- 
pulously honest  in  the  recommendation  of  their 
wares ;  and  yet  I  have  observed  that,  out  of  thirty- 
five  vaccinations  made  by  myself  last  winter,  with 
bovine  "  vinis"  inirchased  from  one  of  the  most  re- 
liable drug-houses  in  this  city,  I  had  no  less  than 
ten  "  irregular  "  vesicles,  which  took  on  an  inflam- 
matory action,  resulting  in  filninous  deposits  and 
extensive  erysipeloid  blush  over  arm  and  shoulder. 
I  have  a  vivid  recollection  of  two  babes  whose  arms 
and  shoulders  were  enormou.sly  swollen,  brawny, 
tense,  and  in  one  of  whom  constitutional  disturbance 
was  alarming.  These  children,  who  had  befn  in 
perfect  health  up  to  the  time  of  vaccination,  were 
vaccinated  by  experienced  and  justly  distingiiished 
physicians,  who  would  neglect  no  precaution  with 
reference  to  the  purity  of  the  "  virus  "  or  its  careful 
insertion.  In  the  majority  of  cases  referred  to 
there  was  no  other  cause  to  which  the  systemic  and 
local  disturliances  could  be  charged  but  some  de- 
fect in  the  "  virus."  All  phy.sicians  will  readily 
recall  similar  instances  in  their  own  experience. 
According  to  Seaton,  "a  vaccination  presenting  any 
deviation  from  the  perfect  character  of  the  reside  and 
the  regular  development  of  the  ai-eola  is  not  to  he  relied 
on  as  protective  agaijist  small-po.r."  "A  spoiled  and 
broken  appearance  of  the  vesicle,  which  is  frequently 
on  the  eighth  day  ascribed  to  rubbing  or  mechani- 
cal irritation,  is  often  really  an  irregularity  arising 
from  one  or  other  of  these  causes  (either  the  use  of 
lymph  not  well  chosen,  or  to  something  amiss  in  the 
state  of  the  child  vaccinated)."  How  many  of  our 
vaccinations  approach  in  their  results  the  stajidard 
of  this  authority?  And  yet,  his  large  experience, 
sustained  by  others  of  equal  eminence,  induces  him 
to  lay  down  the  above  "  one  important,  practical 
fact."  How  many  physicians  resort  to  revaccina- 
tion  in  cases  of  inflamed  or  otherwise  irregular 
vesicles?  I  know  not  one  who  would  have  the 
hardihood  to  propose  revaccination  to  the  mother 
of  a  child  which  has  recently  passed  through  illness 
of  three  or  four  weeks,  produced  by  vaccination  of 


THE  MEDICAL  RECORD. 


"  pure  (?)  virus."  The  mother  having  a  fear  of  the 
reiJetition  of  sleepless  nights  and  anxious  clays  with 
her  fretting  babe  before  her,  will  almost  surely  de- 
cline. I  have  heard  mothers  say  they  would  risk 
a  liatiility  to  small-pox  rather  than  expose  their 
children  to  a  repetition  of  the  ordeal. 

With  I'egard  to  the  method  of  operating,  I  need 
not  dwell  upon  the  well-known  fact  that  mothers 
and  nurses  often  take  upon  themselves  this  work, 
deeming  it  only  necessaiT  to  scratch  the  surface  and 
apply  the  "virus,"  and  regarding  the  efficiency  of 
the  procedure  in  exact  proportions  to  the  amount  of 
irritation  and  the  size  of  the  vesicle  they  have  pro- 
duced. Nor  Tare  physicians  as  careful  with  this 
seemingly  trifling  procedure  as  its  real  importance 
demands.  We  are  too  prone  to  lose  sight  of  the  fact 
that  the  imperfect  execution  of  this  operation  may 
at  some  future  time  result  in  loss  of  life  and  destruc- 
tion of  happiness,  which  the  imperfect  jjerformance 
of  any  one  of  the  capital  oj^erations  could  not  ap- 
proach in  direness.  Jenner,  Seaton,  and  others  de- 
vote page  upon  page  to  the  description  of  this 
seemingly  slight  operation,  to  pointing  out  the 
causes  of  failure  and  modes  of  avoiding  the  latter. 
And  yet  how  many  students  are  taught  these  in- 
valuable lessons  ?  Marson  says  with  much  feeling  : 
"Great  care  is  given  to  teaching  and  learning  the 
capital  operations,  as  they  are  called,  which  not  one 
practitioner  in  twenty  through  the  whole  country 
ever  performs  ;  no  care,  or  next  to  none,  to  teach- 
ing and  learning  the  other  (vaccination),  which 
nearly  all,  when  in  practice,  will  hav§  to  perform 
frequently.  As  medical  and  surgical  practitioners, 
our  object  should  be  to  save  all  the  lives  we  can  by 
our  art,  no  matter  by  what  means ;  and  if  a  little 
operation — little,  ajjparently,  in  pi-actice,  but  very 
important  in  its  results — well  performed  can  save 
many  lives,  as  most  certainly  it  can,  and  prevent 
much  suffering  and  sorrow,  it  should  surely  always 
be  done  with  the  greatest  care  and  in  the  best  known 
way.  The  success  of  all  operations  depends  on  nice 
care  and  management.  Operations  for  hernia  and 
for  stone,  for  instance,  if  roughly,  carelessly,  and 
badly  done,  end  badly ;  so  it  is  with  vaccination ; 
and,  so  far  as  the  public  are  concerned,  it  is  quite  as 
objectionable  to  them,  no  doubt,  to  die  of  small-pox, 
because  they  have  been  carelessly  and  badly  vacci- 
nated, as  it  would  be  to  them  to  die  of  hemia  or 
stone,  becaiise  the  operations  for  these  complaints 
respectively  had  been  badly  j^erformed.  In  the  lat- 
ter case  the  day  of  retribution  woiild  come  imme- 
diately ;  in  the  former,  unfortunately  for  its  correc- 
tion, it  is  delayed  joerhaps  for  twenty  years  or  more  ; 
otherwise  it  would  soon  be  .set  right." 

I  have  quoted  somewhat  at  length  from  this  ex- 
cellent writer,  because  his  life  has  been  spent  in  the 
eftbrt  to  counteract  the  evils  of  bad  vaccination.  It 
would  appear  from  the  writings  of  Seaton  that  the 
degeneration  which  has  been  attributed  to  the  "vi- 
rus," on  account  of  its  long  descent  through  the 
human  body,  is  really  a  myth,  and  that  this  charge 
of  degeneration  belongs  more  justly  to  the  technique 
of  vaccination. 

Marson  and  Seaton  affirm  that  they  have  found 
virus  of  undoubted  Jennerian  descent,  successful  in 
the  production  of  true  .Tennerian  vesicles  after  trans- 
mission through  a  period  of  fifty  years.  I  do  not 
propose  to  enter  the  lists  against  the  advocates  of 
bovine  virus.  Far  be  it  from  me,  for  this  substitute 
for  the  humanized  lymph  is  extremely  useful  for 
preservation  and  transportation,  and  affords  good 
protection  when  genuine  and  carefully  guarded  and 


inoculated.  But  I  do  hold  that  the  good  old  Jen- 
nerian plan  of  arm-to-arm  vaccination  should  be  re- 
sorted to  whenever  practicable.  That  it  is  often 
practicable  to  the  painstaking  physician  no  one  will 
doubt. 

The  remedies  for  the  existing  imperfect  protec- 
tion against  smaU-pox  would,  in  my  judgment,  be 
found  : 

J'^irsf. — In  renewed  attention  to  the  selection  of 
proper  eighth-day  lymph,  more  careful  cultivation 
of  bovine  "  virus,"  greater  care  in  both  cases  to 
scrutinizing  and  tracing  it  to  a  pure  source.  Each 
supply  should  be  tested  on  one  healthy  vaccinee 
before  it  is  extensively  inoculated.  Especially  is  this 
precaution  needed  in  the  use  of  bovine  "  virus," 
which  not  rarely  produces  local  irritation,  whose 
efi'ect  is  pernicious  upon  the  protective  influence 
aflbrded  by  it. 

Second. — Too  much  attention  cannot  be  given  to 
the  methods  of  vaccination  now  in  vogue- — the  tech- 
nique of  this  simple  procedure.  Those  who  are  not 
familiar  with  the  writings  upon  this  subject  by  Mar- 
son and  Seaton,  would  do  well  to  study  their  valu- 
able suggestions  and  elaborate  direction.s,  especially 
with  reference  to  the  watchfulness  necessary  when 
the  vesicle  is  maturing  or  matured.  The  care  pre- 
cision, and  attentive  regard  for  minutiae  which  the 
men  of  Jenner's  day  and  the  time  immediately  suc- 
ceeding bestowed  upon  this  seemingly  trivial  work, 
may  be  profitably  emulated  by  the  present  genera- 
tion of  medical  men,  if  they  would  protect  their 
fellow-men  against  the  terrible  scourge  which  now 
and  then  invades  our  cities  and  populous  country 
districts. 

Third. — A  more  thorough  instruction  of  medical  . 
students  in  the  details  of  obtaining  supi^lies  of  vac- 
cine material,  in  the  methods  of  its  propagation,  in 
the  technique  of  vaccination,  in  the  diagnosis  of  the 
true  from  the  spurious  vaccine  vesicle,  is  impera- 
tivelv  demanded.  The  medical  student  cannot  be 
too  deeply  impressed  with  the  idea  that  this  opera- 
tion, slight  as  it  may  seem,  will  confer  greater  bene- 
fits to  the  people  under  his  care  than  all  the  skill  he 
may  acquire  in  surgery.  The  admirable  instructions 
on  vaccination,  written  by  Mr.  Simon,  for  guidance  of 
"  vaccinators  under  contract,"  by  order  of  the  Privy 
Council,  July  29,  1871,  are  a  model  upon  which 
teachers  may  succe.ssfully  construct  their  lectures 
on  this  .subject.  No  medical  student  should  be  al- 
lowed to  graduate  who  does  not  exhibit  a  full  aj]- 
preciation  of  the  importance  of  vaccination  and  a 
thorough  knowledge  of  all  its  details. 

Foiirth.—l  would  suggest  the  inauguration  of  a 
new  specialtv.  The  "vaccinator"  would  in  our 
large  cities  (which  are  the  habitat  of  most  special- 
ists) prove  far  more  useful  to  the  public  than  many 
of  the  specialists  who  now  minister  to  its  numerous 
"  special  ills."  A  vast  deal  of  good  would  be  accom- 
plished by  men  who,  like  Marson  and  Seaton,  have 
studied  the  subject  of  vaccination  in  all  its  details, 
and  who  would  relieve  the  general  practitioner  of  all 
care  in  this  important  matter.  A  large  number  of 
educated  physicians  may  devote  themselves  to  this 
branch  of  study  and  practice  with  credit  and  profit 
to  themselves' and  to  the  profession.  As  it  new 
stands,  the  general  practitioner  obtains  but  little 
thanks,  frequently  not  even  compensation  (for  it  seems 
to  be  by  many  regarded  as  a  complemenl  to  the  labor 
case),  for  this  work.  The  opprobrium,  on  the  con- 
trary, resulting  from  the  insufficient  protection  due 
to  various  causes  over  which  the  busy  doctor  has 
but  little  control,  is  unstinting.     The  gi-eatest  bene- 


THE  MEDICAL  RECORD. 


fit,  however,  would  accrue  from  this  departure.  Just 
as  in  other  departments  vast  results  have  been 
acliieveJ  by  special  study,  so  will  iu  time  be  accu- 
mulated large  stores  of  statistical  information  and 
practical  improvements  in  the  methods  of  cultivat- 
ing the  vaccine-lymph  and  transmitting  the  vaccine 
disease  in  its  purity  and  genuine  type.  Let  if  be 
borne  in  mind  that  the  grand  aim  of  medicine,  the 
"stamping  out  "  of  small-pox,  has  thus  far  not  been 
reached.  On  the  contrary,  we  are  confronted  daily 
by  failures,  and  taunted  by  the  frequent  recurrence 
of  small-pox  epidemics.  .  This  failure  of  vaccination 
to  accomplish  its  alleged  mission  is  converting  a 
credulous  public  to  the  doctrines  of  the  anti-vacoi- 
uationists,  and  thus  adding  fuel  to  the  disease.  I 
have  attempted  to  demonstrate  the  cause  of  failure 
and  to  point  out  the  remedy.  The  immeasurable 
importtince  of  this  subject  demands  earnest  and  im- 
mediate action  on  the  part  of  the  medical  profession. 

14-1  West  FonxY-THiRD  Street.  New  Tore.  ^ 


EEPOET  OF  CASES  OF  PHTfflSIS 

Treated  Dtjbing  1880-1881. 

By  W.  H.  GEDDINGS,  M.D., 


(Continued  from  The  Medical  Ukcord,  Kovomber  15,  1870,  October 
.30  and  November  C,  ISSO.) 

Of  the  cases  described  in  my  report  for  1878-7SI, 
and  1879-80,  a  few  returned  to  Aiken,  and  thus  af- 
forded me  the  opportunity  of  presenting  the  contin- 
uation of  their  case  histories. 

Case  II. — Succumbed  to  his  disease  after  having 
passed  seven  seasons  at  Aiken  with  more  or  less  im- 
provement. 

Case  V. — The  improvement  noted  in  this  case  has 
continued,  but,  being  of  a  rather  nervous  tempera- 
ment, could  not  be  induced  to  submit  to  an  exami- 
nation. He  has  now  enjoyed  good  health  since  May, 
1879. 

Case  VI. — This  patient  returned  to  Aiken,  but  did 
not  consult  me.  Slie  presents  the  appearance  of  a 
girl  in  perfect  health,  and  her  mother  reports  that 
she  is  doing  well. 

Case  XV. — Continues  to  enjoy  perfect  health. 

Case  XVII. — November  15th,  pulse  92, temperature 
99.4.  Cough  slight,  with  a  small  amount  of  expec- 
toration. There  is  still  diminished  resonance  over 
the  upper  portion  of  the  left  chest,  extending  from 
clavicle  to  third  rib.  Kespiration  somewhat  feeble, 
with  an  occasional  s(iucak,  the  result  of  an  acute 
bronchial  catarrli  (contracted  during  the  journey 
South.  Posteriorly,  there  is  dulness  over  suprascap- 
ular region,  the  respiration  being  'roughened,  with 
prolonged  expirium. 

May  4th. — Has  passed  the  winter  without  any  re- 
lapse. Her  color  is  fresh  and  ruddy  ;  her  flesh  is 
firm,  and  her  weight  VW},  pounds,  wliich  is  more  than 
she  ever  weighed  in  ])erfei't  health.  The  only  re- 
minder of  her  former  disease  is  an  occasional  hack. 
The  old  area  of  dulness  over  the  left  apex  is  still 
present,  but  the  more  recent  one  to  the  outer  side 
of  the  heart  has  entirely  disappeared.  No  change 
in  the  condition  of  the  lung  posteriorly.  This  pa- 
tient has  purchased  a  residence  at  Aiken,  and  intends 
making  it  her  future  home. 

Cask  XXIIL— Wintered  in  Aiken,  but  did  so  well 
that  ho  did  not  require  the  advice  of  a  physician. 
He  looked  quite  robust,  and  appeared  to  be  in  per- 
fect lieallh. 


Case  XXIX. — Went  to  Colorado,  expecting  to  es- 
tablish himself  in  business  there  ;  but,  finding  that 
the  climate  disagreed  with  him,  returned  to  Aiken, 
where  he  passed  the  winter. 

April  28th.— Pulse,  88  ;  temperature,  98° ;  weight, 
134}.  Has  had  no  relapse,  goes  about  without  re- 
gard to  weather,  and  has  the  appearance  of  a  perfectly 
healthy  man.  On  the  right  side  there  is  still  dul- 
ness over  the  upj^er  third  of  the  scapula  and  over 
the  corresponding  inter.scapular  space.  Respiration 
somewhat  jerking,  but  in  other  resijects  normal. 

Case  XLI. — Passed  the  summar  in  West  Virginia, 
where  she  was  exposed  to  inten.se  heat,  combined  with 
a  high  degree  of  relative  humidity,  which  cause<l 
her  to  lose  much  of  what  she  had  gained  at  Aiken. 
On  her  arrival  (November  19th)  she  was  pale,  thin, 
and  decidedly  cachectic  in  appearance.  Pulse,  102  ; 
temperature  ranging  from  99"  in  the  morning  to  101 
in  the  evening.  Over  the  upjier  portion  of  the  riglit 
lung  there  is  diminished  resonance  in  front,  with 
dulness  behind  over  the  upper  two-thirds  of  the 
scapula.  Kesijiration  bronchial,  with  prolonged  ex- 
pirium. 

May  13th. — Patient  had  a  slight  hemorrhage  in 
February,  and  in  April  an  attack  of  diarrhoea.  In 
every  other  respect  slie  has  done  well  and  is  much 
improved.  Pulse,  96 ;  temperature  ranges  from 
98.50"  to  99.2  '.  Cough  is  slight,  and  the  expectora- 
tion does  not  exceed  one  ounce  in  twenty-four  hours. 
Over  the  right  front  there  is  dulness  above  and 
under  the  clavicle,  with  harsh  respiration,  but  with- 
out nlles.  Behind  there  is  diminished  resonance 
half  down  tlie  scapula,  with  feeble  respiration. 

Result. — It  will  be  observed  that  this  patient  re- 
gained much  of  what  she  had  lost  dtiring  the  sum- 
mer, increasing  in  weight  and  improving  in  strength, 
together  with  diminution  in  the  extent  of  the  dis- 
'  ease. 

Case  XLIII. — This  patient,  in  whorh  the  disease 
has  remained  quiescent  for  years,  had  some  littli- 
twinging  of  sputa  in  February,  but  remains  quite- 
well  and  pursues  her  accustomed  avocations. 

Case  XLIV. — Passed  the  winter  in  .-iiken,  but  did 
not  report  until  January  7th.  His  temi^erature  was 
normal,  and  his  weight  had  increased  to  135  pounils. 
a  gain  of  9  pounds.  His  face  had  the  ruddy  hue  of 
health,  and,  with  the  exception  of  a  limited  area  of 
dulness,  there  were  no  evidences  of  disease.  '  In  a  let- 
ter from  him,  dated  October  23,  18S1,  he  states  that 
during  the  last  three  months  he  has  tilled  the  ardu- 
ous duties  of  cashier  in  a  large  mercantile  establish- 
ment in  Massachusetts,  -without  losing  a  single  day 
through  sickness.  He  still  i-emains  free  from  cough. 
This  patient  was  sent  to  Aiken  as  a  ilenriei-  reasor/,  his 
physician  stating  tliat  he  might  possibly  improve, 
but  iutiniatiiiK  tliat  his  case  was  a  desjierate  one. 

Case  XIjVII. — Peturned  to  Aiken,  but  failed  to 
present  himself  for  examination.  His  appearance 
was  that  of  a  well  man,  and  his  physician  informs 
me  that,  with  the  excejition  of  one  hemorrhage,  he 
has  had  no  trouble  since  his  departure  from  Aiken 
the  previous  spring. 

Case  LI. — Passed  the  summer  at  Bethlehem. 
N.  H.,  where  he  remained  quite  well,  and  returned 
to  Aiken  in  November.  His  color  was  good,  his 
pulse  and  temperature  normal,  and  his  weight  142 
pounds.  Cough  very  slight,  with  a  trifling  amount 
of  expectoration  in  tlie  early  morning.  Physical  ex- 
amination revealed  no  symptoms  of  disea.se  other 
than  a  liniitcil  amount  of  dulness  over  the  right  su- 
praclavicular region. 

May  1st. — Has  gone  through  the  winter  without 


THE   MEDICAL  RECORD. 


any  relajise.  He  sometimes  has  an  occasional  back 
in  the  morning,  but  there  are  no  evidences  of  dis- 
ease other  than  diminished  resonance  over  the  outer 
half  of  the  sui^raclaviciilar  space.  Has  not  been 
confined  a  single  day  to  his  room  dvuing  the  whole 
winter. 

C.V.SE  LIX. — Encouraged  by  her  improvement  at 
Aiken,  this  patient  concluded  to  remove  to  Santa 
Fe,  X.  M.,  where  she  had  relatives.  Xot  liking  the 
social  aspects-  of  that  place,  she  went  to  Colorado 
Springs ;  but  while  there  a  valvular  aSection  of  the 
heart,  of  which  symptoms  had  been  observed  at 
Aiken,  became  so  aggravated  by  the  altitude  as  to 
necessitate  her  return  to  her  home  in  Washington. 

January  14th. — Looks  strong  and  healthy,  but  is 
harassed  with  almost  incessant  cougli,  the  result  of 
laryngeal  catarrh,  the  vocal  cords  and  surrounding 
parts  being  much  congested.  Pulse,  02  ;  temjjera- 
ture,  99^.  Still  some  dulness  in  the  left  side,  be- 
tween the  clavicle  and  second  rib,  but  the  pulmo- 
nary disease  is  evidently  at  a  standstill.  She  passed 
the  winter  without  any  material  change  in  the  lung 
disease,  but,  owing  to  the  cardiac  and  laryngeal 
complications,  she  is  much  troubled  with  cough. 

Case  LXIII. — Soon  after  her  return  to  Aiken  it 
was  discovered  that,  in  addition  to  the  pulmonary  af- 
fection, she  was  sutiering  with  parenchymatotis  ne- 
phritis. She  died  of  the  latter  affection  a  few  weeks 
after  her  arrival. 

Case  LXr\'. — Passed  the  sarmmer  at  Bethlehem, 
N.  H.,  where  he  continued  to  improve. 

November  26th. — Pulse,  94;  temperature,  98.7'. 
Has  a  good  color,  weighs  124  pounds,  walks  four 
miles  without  being  fatigued,  coughs  a  little,  bring- 
ing up  a  small  quantity  of  mucopurulent  expecto- 
ration. Over  the  right  side  the  area  of  dulness  ex- 
tends in  the  fi-ont  to  the  third  rib,  and  behind  over 
the  suprasjiinous  fossa.  Expiratory  miirmur  pro- 
longed over  the  upper  portion  of  the  lung. 

May  2d. — Has  been  very  impnident,  going  out  at 
all  hours,  and  taking  but  little  care  of  himself;  but, 
notwithstanding  this,  he  continued  to  improve. 
Pulse  and  temperatui'e  are  normal.  The  cough, 
■which  for  two  weeks  had  disappeared  entirely,  has 
returned  in  consequence  of  imprudent  exposiire. 
The  dulness  in  front  is  unchanged,  but  behind  there 
is  no  trace  of  it.  His  appearance  is  that  of  a  man 
in  perfect  health. 

On  looking  over  the  above  cases  it  will  be  seen 
that  the  improvement  has  been  more  or  less  perma- 
nent in  the  great  majority  of  them,  and  that  periods 
ranging  from  one  to  six  years  have  passed  without 
any  relapse.  Many  others  are  doing  well  at  their 
homes,  but,  as  they  did  not  return  to  Aiken,  are 
omitted  in  this  report. 

Case  LXX. — Male,  fortv-six  years  of  age,  patient 
of  Dr.  A.  B.  Whitney  and'jno.  T.  Metcalfe,  of  New 
York.  Hereditary  tendency,  mother  and  one  aunt 
having  died  of  phthisis.  Six  years  ago  had  dian-ha^a 
for  sis  months,  and  has  had  a  simOar  attack  every 
year  since  that  period.  In  the  autumn  of  1S79  he 
began  to  cough  at  night,  but  it  was  not  until  July 
of  the  following  year  that  it  became  persistent. 
Hemorrhage  on  August  5th  of  the  same  year.  Has 
had  night-sweats,  and  has  lost  sixteen  pounds  in 
weight. 

November  1st. — Pulse, 92;  tempei-ature,100;  weight, 
132.  Color  pale,  digestion  wretched,  and  can  take 
but  little  in  the  way  of  food  or  medicine.  Has  tried 
malt  and  cod-liver  oil,  but  has  never  been  able  to 
continue  their  use  longer  than  a  day  or  so  at  a  time. 
Even  the  preparations  of  the  hypophosphites  have 


disagreed  with  him.  Expectorates  eiglit  ounces,  but 
can  lie  on  both  sides.  Kight  front  dull  frcm  clavicle 
to  third  rib,  with  bronchial  respiration  and  i)ro- 
longed  expirium,  at  one  point  cavernous  in  charac- 
ter. Marked  bronchophony.  Bight  back  dull  un- 
der upper  half  of  scapula  and  over  corresjjonding 
interscapular  space.  Eespiration  bronchial,  with 
vei-y  distinct  bronchophony.  In  addition  to  his  pul- 
monary disease  the  patient  sutlers  with  nervous 
prostration  and  is  much  depressed  in  spirits. 

January  17th. — Pulse,S6;  temperature,98.fi;  weight, 
138  pounds,  a  gain  of  6  pounds.  In  addition  to 
the  area  of  dulness  previously  mentioned  as  extend- 
ing in  front  to  the  third  rib,  there  is  diminished 
resonance  lower  down.  Posteriorly  there  is  now  no 
evidence  of  dulness  below  the  spine  of  the  scajjula. 

March  1st. — Pulse,  104;  temperature,9S.8  ;  weight, 
140|  pounds,  an  increase  of  8J  pounds  since  his  first 
examination,  of  OJ  pounds  since  his  arrival  in  Aiken. 
The  dyspepsia  and  dianhtea,  which  had  greatly  im- 
proved, are  again  troul)lesome. 

April  26th. — Pulse,  84;  temperature,  98.7";  weight, 
140J  pounds.  Physical  symptoms  have  undergone 
no  change  since  January  17th. 

Besult. — Marked  improvement,  diminution  in  the 
extent  of  the  infiltration,  and  an  increase  in  weight 
of  8J^  pounds  since  his  first  examination,  and  of  9f 
pounds  since  his  arrival  in  Aiken. 

Case  LXXI. — A  young  lady,  nineteen  years  of 
age,  patient  of  Dr.  North,  of  Waterbury,  Conn.,  con- 
sulted me  at  Bethlehem,  N.  H.,  in  September,  and 
by  my  advice  came  to  Aiken.  Her  father  died  of  con- 
sumption, and  she  herself  has  had  repeated  attacks 
of  bronchial  catarrh.  Has  also  sufi'ered  with  mala- 
rial poisoning.  Has  had  cough  for  some  time  Jiast, 
and  has  lost  twenty  pounds  in  weight,  and  her  ap- 
pearance is  decided)!'  chlorotic. 

November  9th. — Pulse,  96  ;  temperature,  100.4° ; 
weight,  139  poimds.  Has  some  cough  and  expecto- 
rates two  drachms  of  greenish  yellow  sputa,  all  of 
which  floats.  Bight  front  dull  from  clavicle  to  the 
upper  border  of  third  rib. 

Eespiration  bronchial,  with  prolonged  expirium. 
Eight  back  dull  under  supraspinous  fossa.  Eespi- 
ration as  in  front.     Bruit  de  (liable  over  jugular  vein. 

January  28th. — Pulse,  96;  temperature,  98.6  ; 
weight,  150  pounds,  a  gain  of  11  pounds  since  her 
arrival  in  Aiken,  and  of  17  pounds  since  treatment 
was  commenced.  Cough  reduced  to  a  few  hacks 
in  the  morning,  without  any  expectoration.  Color 
much  improved.  The  area  of  dulness  in  front  is  re- 
duced to  a  triangular  space,  with  the  clavicle  as  the 
base,  and  the  junction  of  second  rib  and  sternum  as 
the  apex.  RespiratoiTr  murmur  feeble,  with  aiulible 
expirium.  Posteriorly  the  only  evidence  of  disease 
is  somewhat  diminished  resonance  under  the  supra- 
spinous fossa. 

February  13th. — Weight,  153  poimds,  a  gain  of  14 
pounds  in  as  many  weeks. 

May  9th. — Witli  the  warm  weather  of  spring  there 
has  been  a  slight  reduction  in  weight,  but  she  still 
weighs  151i  pounds.  In  every  other  respect  the 
improvement  above  noted  has  been  maintained. 

Resulf. — General  improvement,  amounting  to  ar- 
rest of  the  process  :  diminution  in  the  extent  of  the 
infiltration  ;  cessation  of  the  cough—  the  occasional 
hack  in  the  morning  scarcely  desei'ving  that  name — 
and  great  increase  in  weight. 

Case  LXXII. — Male,  twenty-eight  years  of  age.  Dr. 
Wm.  C.  Eavenel,  Charleston,  S.  C.  Very  pronounced 
hereditary  predisposition,  father,  brother,  ond  other 
relatives  having  died  of  consumption.     Began  to 


THE  MEDICAL  EECOED. 


cough  in  the  winter  of  1877-78  ;  spent  the  following 
summer  at  Asheville,  X.  C,  where  he  improved. 
Returned  to  Charleston,  and  there  relapsed.  Has 
lost  from  twenty  to  twenty-five  pounds.  Has  had 
several  slight  hemorrhages.  Has  been  in  Aiken  three 
weeks  and  has  im23roved  in  strength,  but  has  gained 
nothing  in  other  respects.  Had  an  attack  of  dengue 
a  month  ago,  and  was  greatly  prostrated. 

November  5th. — Pulse,  128  ;  temperature,  101.8°; 
present  weight,  98  pounds ;  is  greatly  emaciated  ; 
looks  wretchedly,  and  is  evidently  in  the  last  stages 
of  the  disease.  Extensive  infiltration,  involving  the 
upper  portion  of  the  right  lung  and  extending  as 
low  as  the  sixth  rib  in  front,  and  to  the  angle  of  the 
scapula  behind.  Has  no  appetite  for  food,  and  suf- 
fers with  severe  colicky  pains  after  eating.  This  case, 
evidently  a  hopeless  one,  declined  steadily,  and  ter- 
minated fatally  on  January  2d. 

Case  LXXIII. — A  young  colored  man,  twenty- 
three  years  of  age,  of  phthisical  family  and  dissi- 
pated habits,  began  to  cough  last  winter,  but  did 
not  relinquish  his  occupation,  that  of  a  hotel-waiter, 
until  the  following  spring.  He  lost  flesh  rapidly, 
but.  instead  of  seeking  medical  advice,  dosed  himself 
with  various  (juack  medicines.  Cough  has  been  per- 
sistent, and  has  had  profuse  night-sweats. 

October  27th. — Very  pale  ;  greatly  emaciated  ; 
finger-nails  clawed ;  cough  very  troublesome,  with 
abundant  expectoration,  a  large  proportion  of  which 
sinks  to  the  bottom  when  the  vessel  contains 
water.  He  is  so  weak  as  to  be  unable  to  cross  the 
room  without  assistance.  His  general  appearance 
seems  to  indicate  a  fatal  termination  within  a  week, 
or,  at  the  utmost,  a  fortnight.  The  tmfavorable  out- 
ward aspect  of  the  case  was  more  than  confirmed  by 
jihysical  examination.  On  le^  side,  dulness  from 
clavicle  to  thii'd  rib,  with  bruit  de  j^ot  fele;  resjjira- 
tion  cavernous,  with  moist  r;11es  over  the  apex,  and 
distinct  metallic  tinkling.  Eight  side  :  I'esiiiration 
harsh,  with  prolonged  expirium.  The  case  was  so 
unpromising  that  I  hesitated  about  subjecting  him 
to  any  regular  treatment,  and  it  was  only  at  the 
urgent  request  of  his  mother  that  something  should 
be  done,  that  I  prescribed  the  usual  remedies. 

December  8th. — Has  improved  in  color ;  has 
gained  10  pounds  in  weight,  and  is  able  to  take 
long  walks  in  the  adjacent  woods  ;  coughs  less,  and 
with  corresjjondiug  diminution  in  the  amount  ex- 
pectorated. Lulled  into  security  by  his  mai-ked  im- 
provement, he  soon  began  to  grow  careless  and 
neglected  himself.  I  did  not  see  him  again  until 
April  .3d.  He  was  then  very  weak,  and  died  within 
a  few  days  after  my  visit.  This  case  is  worth  noting 
as  affording  proof  of  the  beneficial  effects  of  treat- 
ment, even  in  seemingly  desperate  cases.  I  re- 
member well  his  stating  that  he  felt  better  from  the 
time  he  took  tlie  first  doses  of  the  hypophosphite  of 
lime.  There  is  but  little  doubt  that  with  more 
favorable  surroundings  his  life  might  have  been 
prolonged  for  several  years. 

Case  LXXIV. — A  young  man,  nineteen  years  of 
age.  Dr.  F.  P.  Porolier,  Charleston,  S.  C.  '  Father 
died  of  phthisis.  Had  in  August,  while  residing  in 
a  malarial  region,  on  the  coast  of  South  Carolina, 
what  was  supposed  to  be  remittent  fever,  but  which 
was  attended  with  cough,  sweats,  and  rapid  emaci- 
ation. On  his  arrival  in  Charleston,  was  examined 
by  Dr.  Porcher,  who  is  reported  to  have  pronounced 
it  to  be  a  case  of  pulmonary  infiltration,  with  pleu- 
ral effusion.  His  temperature  has  ranged  from 
lor  to  \nV,  with  occasional  chills,  without  any 
regularity  in  their  occuiTeuce. 


September  21th. — Pulse,  88  ;  temperature,  102'. 
Has  persistent  cough,  with  muco-purulent  sputa. 
On  the  right  side  there  is  dulness  in  fi-ont,  extend- 
ing from  one  inch  below  to  mamma  to  the  liver. 
The  superior  border  of  this  area  of  dulness  extends 
across  the  axilla  to  a  point  coiTesponding  to  the 
angle  of  the  scapula.  The  percussion-sound  is  de- 
cidedly dull,  but  not  flat  as  in  pleuritic  exudation, 
nor  does  change  of  posture  cause  any  alteration  in 
the  character  of  the  dulness.  Intercostal  spaces  well 
defined,  and  without  the  bulging  observed  in  fluid 
exudations.  I  accidentally  omitted  to  note  the 
character  of  the  respiration,  but  remember  that  the 
resjjiratory  murmur  was  distinctly  audible,  although 
more  faintly  so  than  on  the  left  side.  During  Octo- 
ber the  fever  gradually  declined,  and  toward  the 
middle  of  the  month  the  cough  abated,  and  finally 
ceased  altogether.  The  area  of  dulness  remained 
unchanged,  but  there  was  a  marked  improvement 
in  his  general  health,  his  weight  rapidly  increasing 
from  119  pounds  on  the  19th  to  131*  pounds  on  the 
28th,  a  gain  of  12+  pounds  in  nine  days,  or  at  the 
rate  of  over  a  pound  a  day. 

November  19th. — Pulse,  which  has  hitherto  ranged 
from  104  to  112,  is  now  only  88,  and  the  temperature 
has  declined  to  99  \  He  eats  enormously,  and  his 
weight  has  steadily  increased,  being  to-day  147 
pounds,  a  gain  of  28  pounds  in  one  month.  The 
dulness  in  front  is  imchanged,  but  behind  it  has 
dropped  to  a  line  one  inch  below  the  angle  of  the 
scapula.  The  respiratory  mui-mur  over  the  region 
of  dulness  is  feebler  than  on  the  left  side.  From 
this  time  to  the  date  of  his  departure  there  was  but 
little  change  in  his  condition,  except  a  gradual 
dimimition  in  the  extent  of  the  dulness.  When  last 
examined  (May),  the  upper  border  of  dulness  in 
front  had  receded  to  the  seventh  rib,  while  behind 
it  had  disappeared  entirely. 

Remarks. — The  rapid  improvement  of  the  patient 
and  the  rather  xmusual  location  of  the  dulness  would 
at  first  sight  leail  one  to  suppose  that  the  diagnosis 
of  phthisis  in  this  case  was  incorrect,  and  that  it 
was  either  a  pleuritic  exudation  or  some  disease  of 
the  liver.  The  fact  that  the  dulness,  although  well 
marked,  was  by  no  means  flat,  and  that  the  respira- 
tory murmur,  noted  as  feeble,  was,  nevertheless, 
audible  over  the  whole  of  the  base  of  the  lung,  are 
sufficient  to  exclude  any  fluid  accumulation,  or  any 
great  enlargement  of  the  liver  or  tumor  of  that  organ. 
Besides  this,  the  location  of  the  dulness  was  not 
influenced  by  change  from  the  erect  to  the  recum- 
bent posture.  There  was  no  icterus  or  any  other 
evidence  of  hepatic  disease. 

Case  LXXV. — Female,  aged  twenty-nine.  Drs. 
Craig,  of  Manchester,  O.,  and  Mui-phy,  of  Cincinnati. 
Maternal  heredity  —  her  gi'andfather,  a  brother, 
and  a  sister,  having  died  of  phthisis.  Has  had 
a  persistent,  hacking  cough  since  last  February, 
with  little  or  no  expectoration  until  two  weeks 
ago.  It  has  since  then  been  once  streaked 
with  blood.  Previous  to  the  beginning  of  the 
cough  she  had  been  greatly  reduced  by  ntu'sing  a 
sick  sister. 

November  5th. — Pulse,  82  ;  temperature,  100.7°  ; 
weight,  1.30  pounds  ;  quite  pale.  Cough  troublesome, 
with  foiu-  ounces  muco-purulent  expectoration,  all 
of  which  floats.  On  the  right  side  there  is  dulness 
extending  in  front  from  the  clavicle  to  thii-d  rib. 
Kesi>iration  Vironohial,  with  })rolonged  expirium ; 
conducted  heart-.sounds.  Behind,  the  dulness  is 
confined  to  the  suprascapular  region. 

December  13th.— Pulse,  84  ;  temperature,  98.7° ; 


THE   MEDICAL  RECORD. 


weight,  140  pounds.     Cough,  which  had  nearly  dis- 
appeared, has  returned,  but  is  not  severe. 

JanuaiT  27,  1881.— Pulse,  Si;  temperatm-e,  98.5  ; 
weight,  141  pounds,  a  gain  of  11  pounds.  Walks 
two  miles  without  experiencing  fatigue.  Has  a 
fail-  appetite  and  good  digestion.  Cough  reduced 
to  an  occasional  hack,  and  withoiit  any  exjiectora- 
tion.  The  dulness  in  front  extends  only  to  the 
upper  border  of  the  second  rib.  Over  the  back  it  is 
still  evident  over  the  suprascapular  region.  Respi- 
ration rough,  with  prolonged  expirium.  Up  to  this 
date  she  had  improved  steadily,  had  gained  eleven 
pounds  in  weight,  her  color  had  returned,  the 
cough  had  all  but  ceased,  and  there  was  every  reason 
to  hope  that  the  disease  had  been  arrested.  During 
the  month  of  February  she  imprudently  exposed 
herself,  brought  on  an  attack  of  partial  pleuritis, 
followed  by  increase  of  cough,  fever,  etc.,  and  in 
the  course  Jof  a  few  weeks  lost  all  she  had  previ- 
ously gained,  and  upon  examination  it  was  found 
that  the  disease  had  extended. 

Result. — Marked  imjirovement  during  first  three 
months,  with  subsequent  relapse  and  extension  of 
the  disease. 

Case  LXXVI. — A  recently  married  lady,  aged 
tiventy-one,  patient  of  Dr.  J.  D.  Kenyon,  of  Provi- 
dence, K.  I.  Mother  died  of  phthisis.  Disease 
began  in  June,  1870,  with  sharp,  iileuritic  pain  and 
loss  of  flesh  to  the  extent  of  nine  j^ounds.  Hremop- 
tysis  on  July  '28th,  with  return  of  pain  and  loss  of 
flesh  to  the  extent  of  nine  jiounds. 

December  4th. — Pulse,  92;  temperature,  98.5". 
Of  small  stature  and  delicate  appearance.  Has  never 
had  cough.  On  the  left  side  there  is  distinct  dulness, 
extending  from  the  clavicle  to  the  fifth  rib  in  front, 
and  also  in  the  axiUary  line  to  a  point  on  a  level  with 
the  angle  of  the  scapiila.  Respiration  bronchial, 
with  distinctly  audible  expiratory  murmur.  Pos- 
teriorly the  dulness  reaches  as  low  as  the  angle  of 
the  scapula.  I  did  not  have  an  opportunity  of 
making  another  examination  ;  but  when  she  left,  in 
the  spring,  she  was  much  improved. 

C.\sE  LXXVII. — Married  ;  thirty- two  years  of  age. 
Dr.  Fisher,  of  Hoboken,  X.  J.  Has  lost  one  brother 
and  two  sisters  with  consumption.  When  seventeen 
years  of  age  she  had  typhoid  fever,  and  ever  since 
then  has  been  subject  to  repeated  attacks  of  co\igh. 
In  August,  1880,  the  cough  became  persistent.  Has 
lost  fifteen  pounds  in  weight. 

November  17th. — Pulse,  100  ;  temperature,  101.6' ; 
weight,  104  pounds,  three  of  which  she  has  gained 
since  her  arrival  in  Aiken.  Very  ana-mic  ;  is  exces- 
sively nervous,  and  suffers  with  dyspepsia;  has 
cough,  and  expectorates  one  ounce,  consisting  chiefly 
of  mucus,  most  of  it  being  brought  up  in  the  morn- 
ing. Dull  on  the  right  side  from  the  collar-bone  to 
third  rib,  with  diminished  resonance  thence  down- 
ward. Behind,  there  is  a  limited  area  of  dulness  in 
the  interscapular  space  between  the  middle  of  the 
shoulder-blade  and  the  vertebral  column.  The  res- 
piratory murmur  is  feeble  over  both  front  and  back. 
Over  the  left  lung  a  few  sibilant  rales  are  audible. 

December  27th. — Patient  has  had  an  attack  of 
articular  rheumatism,  lasting  three  weeks,  with  high 
temperature  and  loss  of  appetite,  and  is  evidently 
much  weaker  and  more  emaciated.  From  this  date 
there  was  some  improvement  in  her  general  health, 
l>ut  no  change  in  the  character  or  condition  of  the 
local  symptoms. 

Case  LXXVni. — Female  ;  fortv-one  vears.  Dr. 
J.  F.  M.  Geddings,  of  Charleston,  S.  C.  Mother  and 
husband  died  of  phthisis.      Has  had  more  or  less 


laryngeal  catai-rh  for  several  years,  but  no  serious 
trouble  imtil  1880,  when  she  was  attaclced  with  in- 
fluenza, which  was  then  epidemic.  Since  that  time 
the  cough  has  been  persistent,  and  has  been  accom- 
panied with  loss  of  weight  (twelve  pounds),  night- 
sweats,  and  pleuritic  pains.  In  the  month  of  June 
she  visited  Bethlehem,  where  I  examined  her.  Pulse, 
100;  temperature,  99.8°.  There  was  dulness  over 
the  upper  portion  of  the  right  lung,  between  the 
clavicle  and  third  rib  in  front  and  under  the  supra- 
spinous fossa  behind.  The  respiration  was  bron- 
chial, with  prolonged  expirium.  Her  weight  at  this 
time  was  9G  pounds.  She  imjiroved  rapidly,  and  at 
the  time  of  her  departure  she  had  gained  four  and 
three-fourths  pounds.  Instead  of  going  to  some  dry 
station  in  the  interior,  she  remained  a  month  in  New 
York,  gaining  a  little  more  weight  at  first,  but  soon 
losing  it  again.  The  cough  became  more  trouble- 
some, and  the  night-sweats  returned. 

November  20th. — Pulse,  9G  ;  temjierature,  100° ; 
weight,  102.  Cough  not  very  frequent,  with  a  moder- 
ate amount  of  muco-purulent  sputa,  all  of  which 
floats.  Voice  is  a  little  husky.  The  area  of  dulness 
is  unchanged,  but  under  the  second  rib  the  respii-a- 
tion  is  cavernous,  with  pectoriloquy. 

April  8th. — Pulse,  Ofi ;  temperature,  98.5° ;  weight, 
108  poimds,  a  gain  of  6  pounds  since  her  arrival 
in  Aiken,  and  of  12  pounds  since  she  began  treat- 
ment. Notwithstanding  this  improvement  in  her 
general  health,  there  has  been  a  slight  extension  of 
the  disease  downward,  the  lower  border  of  the  in- 
filtration now  extending  to  the  fourth  rib. 

Uesiil/. — General  health  improved.  Extension  of 
the  pulmonary  afl'ection. 

Ca.se  LXXIX. — A  young  lady,  twenty-one  years  of 
age,  a  patient  of  Dr.  Chapman,  of  New  Haven.  One 
brother  and  a  sister  have  died  of  phthisis.  Has  had 
cough  since  August,  1880,  diu'ing  which  time  she  has 
lost  nine  pounds  in  weight. 

November  22d. — Pulse,  130 ;  temperature  not 
noted;  weight,  110  pounds.  Very  fair  complexion, 
with  slender  figure  and  delicate  appearance.  The 
appetite  is  good  and  the  digestion  fair.  Walks 
two  miles  without  becoming  fatigued.  Cough  not 
troublesome ;  mucopurulent  in  character ;  about 
one  oimce  in  twenty-four  hours,  all  of  which  floats. 
Has  night-sweats.  Right  side  diill  from  clavicle  to 
third  rib.  Respiration  bronchial  over  the  area  of 
dulness,  except  below  the  clavicle,  where  it  is  cavern- 
ous. Behind,  there  is  dulness  over  sui)rascapu]ar 
region,  with  diminished  resonance  lower  down.  In 
this  situation  the  respiration  is  bronchial.  The  his- 
toiw  of  this  case  is  one  of  slow,  but  uninterrupted  de- 
cline. When  she  left  Aiken,  in  the  month  of  May, 
she  had  lost  eleven  and  three-fourths  pounds  ;  cough 
and  expectoration  had  increased ;  the  dulness  had 
extended  over  the  gi-eater  portion  of  the  front  of  the 
chest,  while  behind  it  reached  to  within  an  inch  of 
the  angle  of  the  scapula. 

Eestill. — Extension  of  the  disease,  with  loss  of 
weight  to  the  extent  of  eleven  and  thiee-fourths 
pounds. 

Case  LXXX.  —  Male,  twenty-four  years  of  age. 
Drs.  Max  Brock  and  Carl  Heitzmann,  of  New  York. 
No  hereditary  predisposition  to  consumption.  Dis- 
ease began  with  bronchitis,  in  June,  1877,  but  cough 
did  not  become  persistent  \intil  September,  1880. 
Went  to  Sullivan  Co.,  N.  Y.,  and  returned  ajipar- 
ently  well,  but  soon  relapsed.  Has  had  three  at- 
tacks of  hasmoptysis,  and  has  lost  twenty  pounds. 

November  22d. — Pulse,  102 ;  temperature,  100.2° ; 
weight,  1.34  pounds.  Slight  exertion,  such  as  ascend- 


THE  MEDICAL  RECORD. 


iug  stairs,  causes  dyspnoea.  Appetite  and  digestion 
good.  Cough  slight,  with  four  ounces  of  muco- 
purulent expectoration.  Has  night-sweats.  Ou  the 
ri<iht  side  there  is  dulness  jiosteriorly  over  the  supra- 
scapular and  over  half  of  the  scapular  region.  On 
that  side,  over  both  back  and  front,  the  respiration 
is  bronchial.  Over  the  upper  portion  of  the  If/I  lung 
there  is  another  area  of  dulness  occupying  the  supra- 
clavicular, the  clavicular  and  mammary  regions,  as 
low  as  the  third  rib,  with  diminished  resonance  to 
the  sixth.     Kespiration  bronchial. 

May  19th.— Pulse,  84 ;  temperatm-e,  98°.  Patient's 
improvement  has  been  almost  uninterrupted.  He 
has  the  ruddy  hue  "of  health,  and  his  weight  has  in- 
creased to  140A  pounds.  Appetite  and  digestion  are 
excellent.  The  cough  has  greatly  improved,  and  the 
expectoration  is  reduced  to  one  ounce,  or  to  one- 
fourth  of  what  it  was  at  his  first  examination.  Walks 
five  miles  without  being  fatigued.  On  the  right  side 
the  suprascapular  and  upper  half  of  the  scapular 
region  have  become  resonant,  the  dulness  being  now 
confined  to  the  lower  half  of  the  scapular  and  corre- 
sponding portion  of  the  interscapular  i-egions.  The 
respiration  has  lost  its  bronchial  character.  On  the 
left  side  the  dulness  has  entirely  disappeared,  but  the 
respiration  is  still  bronchial.  He  remained  at  Aiken 
fourteen  days  longer  without  any  further  change 
other  than  the  loss  of  a  couple  of  pounds,  caused  by 
the  increasing  heat  of  spring. 

Result. — Great  improvement  in  the  general  as  well 
as  local  symptoms,  cessation  of  all  activity  in  the 
diseise,  as  evidenced  by  the  absence  of  any  rise  in 
temperature  above  the  normal  during  the  last  three 
months  of  his  residence.  Clearing  up  of  the  left 
lung  and  diminution  in  the  extent  of  the  disease  in 
the  right  lung.  A  gain  of  six  and  one-half  pounds  of 
flesh,  increased  strength,  and  great  improvement  in 
cough,  with  coiTesponding  reduction  in  the  amount 
expectorated. 

Case  LXXXI. — Male,  twenty-nine  years  of  age ; 
single.  Dr.  H.  O.  Marcy,  of  Cambridge,  Mass. 
Strong  hereditary  predisposition  on  both  sides — 
grandfather,  father,  two  aunts  on  the  father's  side, 
and  one  maternal  uncle,  having  died  of  phthisis. 
His  brother  also  had  the  same  disease  and  i-emoved 
to  Minnesota.  Patient,  who  resembles  his  father,  is 
slightly  built,  and  presents  a  pale,  unhealthy  look. 
In  October,  1879,  he  had  an  attack  of  pleuritis.  The 
effusion  was  absorbed,  but  he  continued  to  cough 
and  lost  rtesh  to  the  extent  of  twenty  pounds. 

December  13th. — Pulse,  108  ;  temperature,  99.7°  ; 
weight,  114J^  pounds.  He  looks  very  ill,  and  the 
slightest  exertion  causes  dyspnoea.  Appetite  poor 
and  digestion  not  very  good.  Cough  at  times 
troublesome  ;  expectoration  one  and  one-half  ounce 
in  twenty-four  hours.  Extensive  disease  of  the  right 
lung,  the  dulness  in  front  extending  to  the  third  rib, 
and  behind  to  the  angle  of  the  scapula.  Kespiration 
bronchial,  with  abundant  moist  rales.  The  left  lung 
is  also  afiected,  Ijut  not  so  extensively  as  the  right, 
the  area  of  dulness  being  confined  to  the  apex  above 
tlie  second  ril).  Mucous  rfdos  everywhere  audible. 
The  strong  hereditary  predisposition  in  this  case, 
the  great  extent  of  the  disease,  and  tlie  poor  general 
health  of  the  patient,  ])recluded  all  hopes  of  arresting 
the  disease.  On  leaving  for  home,  on  April  21st, 
he  had  lost  five  pounds  more.  In  addition  to  the 
dulness  observed  over  tlie  anterior  surface  of  the  left 
lung,  an  area  of  diminished  resonance  had  developed 
itself  over  the  scapular  region.  On  the  right  side 
the  symittonis  are  uiu-hangod. 
Case  LXXXII.— .\  married  lady,  a  patient  of  Dr. 


Holcomb,  of  Lennox,  Mass.,  twenty-four  years  ol 
age,  whose  father  died  of  consumption.  Had  diph- 
theria seven  years  ago,  and  ever  since  then  has  suf- 
fered with  cough  dm-ing  the  winter.  Since  last  June 
the  cough  has  been  persistent,  and  has  been  attended 
with  high  temperature,  night-sweats,  and  loss  ot 
flesh  to  the  extent  of  twenty-five  pounds. 

November  21st. — Temjierature  in  the  forenoon, 
97.5°,  but  very  high  later  in  the  day  ;  pulse,  112.  Is 
very  i^ale  and  moves  about  with  great  diiBculty. 
the  slightest  exertion  causing  shortness  of  breath. 
The  thorax  is  very  small,  with  jirominent  sternum 
(chicken-breasted).  Both  lungs  extensively  diseased. 
Her  general  ajipearance  is  that  of  a  person  in  the 
very  last  stage  of  the  disease.  Xotwithstanding 
her  unfavorable  symptoms,  the  change  of  air  pro- 
duced a  marked  improvement  in  her  condition.  The 
fever  declined,  the  strength  improved,  and  the  coaigh 
became  less  trouldesome.  With  the  exception  ot 
occasional  slight  tinging  of  the  expectoration,  she 
did  well  until  toward  the  close  of  January,  when  she 
began  to  decline,  and  died  a  few  weeks  later. 

Case  LXXXIII. — Male,  aged  forty- eight.  Dr. 
Kaney.  Family  history  not  noted.  Has  had  an  oc- 
casional cough  for  twenty-seven  years.  Four  years- 
ago  it  became  persistent.  Had  an  attack  of  pleuro- 
pneumonia in  January,  1879.  Has  at  times  observed 
a  few  specks  of  blood  in  his  sputa.  Has  had  night- 
sweats. 

November  29th. — Pulse,  108  ;  temperature,  100°  ; 
weight,  147  pounds.  Slight  exertion  causes  dyspnaa ; 
appetite  fair,  and  digestion  good.  Expectorates 
about  four  ounces  of  niuco-purulent  matter.  Over 
the  right  lung  there  is  dulness  in  front  from  the  cla- 
vicle to  second  rib,  with  diminished  resonance  to 
fourth.  Behind,  the  dulness  is  confined  to  the  supra- 
scapular region.  Respiratory  murmiir  feeble.  This 
patient  improved  rajiidly,  but,  after  remaining  in 
Aiken  six  weeks,  thinking  that  he  could  do  still 
better,  went  farther  south.  The  move  proved  a 
most  disastrous  one.  On  his  return  in  the  month 
of  March,  his  condition  was  most  deplorable :  his- 
weight  had  declined  to  143  lbs. ;  his  pulse  had  risen 
to  116,  and  his  temj^erature  to  102.2".  His  dysi^Eoea 
had  increased,  the  cough  had  become  more  trouble- 
some, and  the  expectoration  more  profuse.  Physical 
examination  showed  that  the  disease  had  extended,, 
antl  that  a  cavity  had  formed.  He  afterward  rallied,, 
but  up  to  the  time  of  his  departure  did  not  regain 
what  he  had  lost  by  his  ill-advised  trip. 

BesiiU.  —  Improvement  —  relapse  —  renewed  im- 
provement. 

Case  LXXXTV. — A  married  lady,  aged  forty-two. 
Dr.  A.  H.  Nichols,  of  Boston.  Hereditary  predis- 
position. Last  August  she  began  to  cough,  had 
daily  chills,  followed  by  fever,  and  lost  flesh  rapidly. 
On  examination,  it  was  found  that  the  apices  of  both 
lungs  were  affected.  She  visited  Kye  Beach,  and 
while  there  improved  rapidly,  but  lost  ground  again 
on  her  return  to  Boston. 

December  2d. — Pulse,  124;  temperature,  102°; 
weight,  110  pounds.  Looks  wretchedly ;  skin  sallow 
and  almost  bloodless.  Is  excessively  nervous,  and  so 
weak  that  the  slightest  exertion  causes  attacks  of 
dyspntea.  Has  daily  exacerbations  of  fever,  from 
whicli  she  is  only  free  diiring  a  few  hours  in  the  morn- 
ing. Ciiugli  troublesonie.  with  jirofuse  exiH'ctcU'fttion. 
Left  side  dull  from  aliove  the  clavicle  to  third  rib  in 
front,  and  under  suprasjiinous  fossa  behind.  Kespira- 
tion bronchial,  with  prolonged  expiriuni.  Kight  side„ 
diminished  resonance  in  front  and  dulness  over  the- 
scapular   and   interscapular   space,    with   bronchial' 


THE   MEDICAL  EECORD. 


breathing.  This  case,  from  the  iii'st  a  hopeless  one, 
gradually  grew  weaker,  and  after  a  residence  of  ten 
weeks  it  was  decided  to  take  her  home. 

Kestill. — (jradual  decline. 

Case  LXX.XV. — A  naval  officer,  thirty-two  years 
of  age,  from  Norwich,  Vt.  Family  history  not  noted. 
On  the  return  of  his  shi]i  from  the  tropics,  he  was 
exposed  to  rough,  cold  weather  in  New  York  har- 
bor, which  brought  on  an  attack  of  broncho-puen- 
mouia.  He  lost  over  ten  pounds,  and  had  several 
hemorrhages. 

December  5th. — Pulse,  106;  temperature,  101'; 
weight,  114  pounds.  Is  very  thin,  and  presents  the 
appearance  of  a  very  sick  man.  There  is  marked 
duhiess  over  the  whole  right  lung  in  front,  and  pos- 
teriorly over  the  upper  two-thirds.  In  front  the 
respii'ation  is  bronchial,  except  under  the  second  rib, 
where  it  is  distinctly  cavernous.  On  the  left  side  no 
dulness,  but  loud,  sonorous  ronchi,  intermingled  with 
moist  rCdes.  Cough  very  troublesome  and  almost 
incessant. 

February  17th. — This  unpromising  case,  after  two 
months'  continemeut  to  his  room,  during  which  he 
sutit'ered  terribly  with  his  cough,  began  to  improve 
about  the  end  of  Januaiy.  His  pulse  is  now  98,  and 
his  temperature  normal.  His  color  is  fresh  and 
healthy  ;  his  strength  is  so  much  imj^roved  that  he 
walks  three  miles  in  the  course  of  the  day  withoTit 
experiencing  any  fatigue,  and  mounts  two  flights  of 
stairs  without  becoming  short-breathed.  Coughs 
but  little,  and  tlien  only  in  the  early  morning,  at 
which  time  he  raises  only'a  few  pellets  of  mucus. 
In  front  there  is  no  change  in  the  ijhysical  symp- 
toms, but  behind  the  upper  portion  of  the  lung  has 
cleared  up  and  is  now  resonant. 

Blay  20th. — Pulse,  96  ;  temperatui-e,  98.5  \  The  im- 
provement noted  above  has  continued.  Patient 
looks  remarkably  well,  and  is  in  excellent  spirits.  He 
now  weighs  125i  pounds,  a  gain  of  llj  pounds  ;  has 
gradually  extended  his  promenades,  and  can  now  walk 
two  mdes  consecutively.  Coughs  only  a  little  in  the 
morning,  while  dressing.  The  improvement  in  the 
case  was  aU  the  more  remarkable  on  account  of  its 
being  due  to  climate  alone,  as  he  took  neither  oil, 
malt,  hyijophosphites,  or  any  medicine  other  than 
such  as  was  administered  to  allay  his  troublesome 
cough. 

Eesidl. — Great  improvement  in  a  case  in  which, 
from  the  extent  of  the  disease  and  the  unfavoraUe 
condition  of  the  patient,  thei'e  was  no  rational  gi-oimd 
to  expect  anything  other  than  a  speedy  decline. 

Case  LXXXVI. — A  young  lady  patient  of  Dr. 
Dearborn,  of  Nashua,  N.  H.,  and  of  Dr.  F.  I.  Knight, 
of  Boston  ;  twenty-seven  years  of  age,  and  of  a  con- 
sumptive family,  her  mother  and  sister  having  lately 
died  of  pulmonary  phthisis.  Commenced  coughing 
last  May ;  had  fever,  night-sweats,  and  lost  six 
pounds  in  weight.  She  visited  Bethlehem,  N.  H., 
and  while  there  improved  and  gained  ten  pounds. 

December  7th.  —  Pulse,  88 ;  temperatui'e,  99  ; 
weight,  126  pounds.  Has  been  losing  ground  since 
she  left  Bethlehem.  Looks  badly  and  is  much  de- 
pressed. Over  the  right  front  there  is  diminished 
resonance,  and  behind  an  area  of  dulness  corre- 
sponding with  the  lower  half  of  the  scapula  and 
extending  toward  the  axillary  line.  Kespiration 
feeble,  with  prolonged  expirium  ;  conducted  heart- 
sounds  distinctly  audible.  Posteriorly,  in  addition 
to  these  symptoms,  there  are  sibilant  and  moist 
rrdes.  On  the  left  side  there  is  dulness  over  the 
suprascapular  region,  with  muooiis  rales  in  front 
and  feeble  respiration  behind. 


December  23d. — Has  improved  in  general  appear- 
ance, and  has  gained  four  and  one-half  pounds. 

April  2d. — Did  well  until  the  middle  of  January, 
at  which  time  the  digestive  organs  became  deranged 
and  she  began  to  lose  in  weight.  The  pidse  became 
more  frequent,  and  the  temperature  higher.  Since 
then  she  has  continued  to  grow  worse.  Physical  ex- 
amination i-eveals  extension  of  the  disease  in  the 
right  lung. 

Bexiilt. — Extension  of  the  disease  and  loss  of 
weight. 

(To  be  continued. ) 


SPASMODIC   NEUKALGIA 

Of  Neaely  Theee  Years'  Standing,  Relieved  by 
Correction  of  Sp.\sii  of  the  Ciliary  Muscles 
and  by  Circtimcxsion. 

By  FRANCIS  H.  RANKIN,  M.D., 


The  importance  of  removing  peripheral  irritation  is 
so  markedly  shown  in  a  case  which  has  recently  been 
under  my  care,  that  I  deem  it  of  suiflcient  interest 
to  present  it  to  your  readers. 

The  case  about  to  be  detailed  is  that  of  a  little 
patient  belonging  to  a  very  neurotic  and  highly  cid- 
tivated  family.  His  father  died  from  apojjlexy ;  his 
sister  died  suddenly,  after  suflfering  for  .several  weeks 
from  severe  neuralgia  about  the  head  ;  a  brother  was 
at  one  time  an  inmate  of  an  insane  asylum  ;  an  uncle 
is  at  present  in  a  similar  institution  ;  and  other 
members  of  the  family  show  strong  neurotic  ten- 
dency. With  a  knowledge  of  this  diathesis  in  the 
family  of  our  patient,  we  can  readily  comprehend  the 
eli'ect  produced  ujjon  him  by  perijiheral  irritation. 

He  is  twelve  years  of  age,  a  bright,  intelligent, 
handsome  little  fellow,  with  every  appearance  of 
Ijeing  in  the  mo.st  robust  health.  A  little  more 
than  three  years  ago  he  had  typhoid  fever,  and 
three  mouths  after  recovering,  lie  began  to  suft'er 
from  neuralgic  headaches,  which,  four  months  sub- 
sequent, developed  into  neuralgia  of  veiT  intense 
character,  affecting  at  first  the  head,  then  extending 
to  the  back,  through  the  diaphragm,  stomach,  and 
other  parts  of  the  body,  accompanied  by  sharp 
lancinating  pain  in  the  eyeball,  with  marked  con- 
gestion of  the  ocular  conjunctiva.  The  little  pa- 
tient was  confined  to  the  house  during  the  greater 
part  of  the  winter  of  1878-79,  the  neuralgia  being  of 
almost  daily  occurrence,  and  at  times  of  the  most 
agonizing  and  seemingly  alarming  form.  He  was 
seen  by  several  of  our  most  prominent  New  York 
physicians,  who  pronounced  the  neuralgia  to  be  of 
malarial  origin,  and,  so  far  as  I  am  informed,  treated 
it  as  such,  using,  in  addition  to  the  anti-malarial 
treatment,  galvanism. 

The  following  eighteen  months  were  spent  in 
Europe,  during  which  time  he  was  rarely  free  for 
more  than  a  day  at  a  time  from  some  neuralgic  pain 
in  his  head  or'back,  and  while  in  Paris  he  had  an 
alarming  seizure. 

In  the  fall  of  1880  he  returned  to  New  York,  and, 
shortly  after  his  arrival,  the  neuralgia  became  of 
more  frequent  occurrence  and  much  more  severe  in 
character.  The  eyes  were  markedly  congested,  and 
the  little  fellow  was  unable  to  read  on  account  of 
the  pain  which  it  produced.  For  this  condition, 
quinine  in  large  doses  was  given.  During  the  win- 
ter, notwithstanding  frequent  and  severe  attacks, 
the  patient's  general  health  was  excellent ;  he  was 


10 


THE  MEDICAL  RECORD. 


bright  and  lively,  and  able  to  go  about  when  not 
Buflfering.  The  attacks  would  keep  him  in  bed  for 
several  hours,  and  were  generally  relieved  by  one  of 
the  bromides.  When  a  particularly  severe  attack 
was  threatened,  he  would  take,  in  addition,  eighteen 
grains  of  quinine  in  the  course  of  a  day. 

Early  in  the  past  spring  he  came  to  Newj^ort,  and 
at  first  appeared  not  to  suffer  to  any  greater  degree 
than  in  New  York.  His  appetite  was  good,  he  slept 
well,  and  he  was  bright  and  playful. 

On  June  5,  1881 ,  I  saw  him  for  the  first  time 
professionally.  I  found  him  in  bed,  suffering  with 
the  most  excruciating  pain  in  the  back,  running 
through  the  stomach,  causing  him  to  assume  the  po- 
sition of  marked  opisthotonos,  and  which  then  would 
shoot  up  into  the  head,  neck,  and  right  eye.  The 
seizures  were  of  a  spasmodic  character,  lasting 
from  fifteen  to  twenty  seconds  ;  they  were  followed 
by  visions  of  terror,  when  he  saw  devils  and  other 
terrible  things,  from  which  he  shrank  in  the  great- 
est fear,  and  clung  for  protection  to  those  near  him. 
This  fear  lasted  for  a  few  seconds,  and  was  immedi- 
ately followed  by  visions  of  splendor,  in  which  he 
saw  angels  and  everything  beautiful.  Then  a  con- 
dition of  relaxation,  or  apparent  collapse,  would  set 
in,  during  which  time  he  appeared  not  to  breathe. 
On  coming  out  of  this  he  would  gasp  for  breath,  ask 
to  be  fanned,  give  a  long  sigh,  and  then  feel  per- 
fectly well.  During  this  visionary  stage,  he  was 
perfectly  oblivious  to  everything  about  him,  and  on 
returning  to  consciousness  had  no  recollection  of 
his  visions.  This  whole  seizure  lasted  one  and  one- 
half  to  two  minutes,  and  was  followed  by  a  period 
of  from  two  to  five  minutes  of  perfect  comfort,  with 
the  exception  of  great  nausea.  The  eyes  were  highly 
congested;  the  temperature  was  normal  ;  pulse  a  lit- 
tle accelerated,  but,  even  during  the  periods  of  pain 
and  unconsciousness,  was  always  regular  and  good ; 
tongue  coated  ;  breath  foul ;  stomach  irritable,  with 
frequent  and  profuse  vomiting.  The  condition  of 
his  stomach  seemed  to  depend  upon  a  vicious  diet 
in  which  he  was  allowed  to  indulge.  These  seiz- 
ures, just  described,  continued  for  three  days,  with 
the  exception  of  a  few  hours  at  a  time  while  under 
the  influence  of  morphine.  Bromide  of  potassium, 
which  the  patient  had  taken  formerly  in  large 
doses  for  similar  attacks,  could  not  be  given  by  the 
mouth  on  account  of  the  irritability  of  the  stonaach. 
Chloral  and  bromide  were  given  by  the  bowels, 
but  they  produced  so  much  discomfort  that  they 
were  not  frequently  repeated.  This  whole  attack 
ceased  almost  magically  after  a  dose  of  calomel,  gr. 
vii.,  with  soda  bicarbonate,  gr.  xx.,  which  produced 
free  purgation,  with  entire  .subsidence  of  all  the 
above-mentioned  symptoms.  There  was,  through- 
out the  seizure,  a  very  marked  hysterical  element. 
We  found  it  necessary  to  exclude  all  members  of  the 
family,  as  tlieir  presence  intensified  a  seizure,  or 
brought  one  on  if  he  wore  in  repose. 

Dr.  Wm.  T.  Lusk  kindly  saw  the  patient  with 
me,  and  assisted  very  materially  in  attending  the 
little  sufferer,  who  required  almost  hourly  attention 
during  the  three  days. 

Subsequent  to  this  attack,  his  diet  was  regulated, 
and  strychnine  and  Fowler's  solution  ordered.  Dur- 
ing the  next  two  weeks  he  liad  only  a  slight  amount 
of  pain.  Three  weeks  from  tlie  last  outburst  an- 
other seizure  occurred,  which  was  promptly  clieekod 
by  calomel  and  soda,  as  before,  and  then,  iii  addition 
to  giving  the  stryclmino  and  arsenic,  I  applied  gal- 
vanism to  the  spine.  While  making  liis  visits  to 
my  office,  I  discovered  grave  defects  in  the  patient's 


vision,  and  then  it  occurred  to  me  that  the  neu- 
ralgic condition  miglit  be  due  to  reflex  irritation, 
and  not  to  malaria  or  central  lesion.  The  former 
cause — malaria — I  had  doubted  from  the  first,  al- 
though it  had  unquestionably  been  an  important 
factor  in  creating  a  great  nerve-disturbance  in  this 
very  neurotic  patient,  and  the  peripheral  irritation 
about  to  be  described  had  prevented  the  nervous 
system  from  regaining  its  balance.  On  finding  this 
defectof  vision,  which  apparently  depended  upon  an 
error  of  i-efraction,  I  requested  that  Dr.  D.  B.  St. 
John  Roosa,  who  was  at  that  time  in  Newport,  should 
see  the  patient. 

While  consulting  with  Dr.  Koosa,  we  discovered 
that  the  patient  had  considerable  irritability  about 
the  glans  penis — an  itching,  as  he  described  it — 
which  caused  him  to  put  the  member  occasionally 
in  water.  An  examination  revealed  an  elongated 
prepuce,  which  could  be  retracted  over  the  glans 
only  with  difticulty,  and  with  considerable  pain  ;  the 
glans  itself  was  of  an  olive  shape,  with  a  decided 
redness  of  the  meattis.  I  then  gave  my  opinion  to 
the  family  tliat  circumcision  was  necessary,  and  that 
the  neuralgic  pain  was  caused  by  the  irritation  at 
the  penis,  together  with  the  eri'or  of  refraction,  Dr. 
Roosa  and  I  supposing  that  the  defective  vision  was 
due  to  spasm  of  the  ciliary  muscles. 

Dr.  Roosa  reports  upon  the  case  as  follows : 
"  When  Dr.  Rankin  and  I  examined  the  patient, 
as  to  his  eyes,  we  found  an  apjiarent  myoijia.  The 
ophthalmoscope,  however,  did  not  bear  out  this 
diagno.sis.  He  seemed,  on  the  use  of  the  ophthal- 
moscope, to  be  myojiic  in  one  meridian,  and  hyper- 
opic  in  the  other  (mixed  astigmatism).  On  the  use 
of  atropia  —  a  four-grain  solution  —  we  discovered 
that  the  true  error  of  refraction  was  hyi^eropic  as- 
tigmatism, which  was  corrected  so  that  his  vision 
became  J".  Before  the  use  of  atropia  his  vision 
was  ...fin.  This  was  somewhat  increased  by  concare 
glasses.  The  patient,  therefore,  was  found  to  be 
suffering  from  spasm  of  accommodation,  and  this 
of  a  high  degree.  The  use  of  atropia  and  of  the 
glasses  was  of  marked  service  in  diminishing  the 
redness  and  pain  in  the  eyes,  and  in  producing 
general  comfort.  But  the  effect  of  the  drug  was  not 
sufficient  to  enable  us  to  say  that  the  boy  was  well. 
When  we  discovered  the  phymosis,  on  first  exami- 
nation of  the  refraction,  we  supposed  that  it  had 
some  part  in  causing  the  neuralgic  seizures.  The 
relaxation  of  the  ciliary  muscle  was  only  one  of 
the  factors  necessary  to  be  set  at  work  for  a  cure. 
The  other  proved  to  be  the  relief  of  the  phymosis, 
and,  with  it,  of  the  uretlu-al  irritation." 

At  the  request  of  the  family.  Dr.  John  P.  Gray,  of 
Utica,  saw  the  patient,  with  Dr.  Roosa,  Dr.  Lusk, 
and  the  writer,  and  it  was  unanimously  agreed  that 
circumcision  was  highly  important. 

The  operation  was,  however,  delayed  for  some 
time  till  the  en-or  of  refraction  was  corrected,  and 
while  waiting,  another  seizure  of  neuralgia  occurred, 
and  two  days  subsequently  (August  12th),  with  the 
kind  assistance  of  Dr.  Roosa  and  Dr.  Lusk,  I  per- 
formed circumcision.  The  wound  healed  kindly, 
and  in  little  moi-o  than  a  week  the  ]iatient  was  bath- 
ing in  the  ocean,  and  feeling  perfectly  well. 

Since  the  operation,  the  jiatient  has  felt  brighter 
and  stronger  than  lie  has  in  three  years,  and  a  very 
marked  change  in  the  l)oy's  bearing  has  been  noticed 
by  his  family.  He  is  now  taking  no  medicine,  and 
since  the  day  circumci.sion  was  performed,  he  has, 
with  the  exception  of  two  days,  when  he  suffered  a 
return  of  his  old  pain,  after  an  exposure  on  the  water 


THE  MEDICAL  RECORD. 


11 


all  day  ia  a  hot  sun,  which  brought  on  marked  con- 
junctivitis, been  entirely  free  from  his  former  neu- 
ralgic seizures. 

Jiemnrks. — From  a  review  of  this  case,  two  promi- 
nent points  are  noticed :  1st,  that  cessation  of  the 
general  neuralgia  followed  the  relief  of  the  ciliary 
spasm  by  the  use  of  atropia ;  2d,  that  this  free- 
dom from  neuraliria  did  not  continue,  and  was  not 
complete,  tiU  after  the  operation  of  circumcision. 
We  might  also  add  two  other  noticeable  facts.  They 
are  the  following  :  1st,  before  the  operation,  and  the 
correction  of  the  error  of  refraction,  whenever  there 
was  an  unusual  outburst  of  neuralgia,  there  was  al- 
ways great  gastric  disturbance,  on  the  relief  of 
which  there  would  be  a  cessation  of  the  neuralgia ; 
2d,  a  fact  which  is  perhaps  not  shown  clearly 
enough  iu  the  account  given,  that  the  little  patient 
has  an  unusually  sensitive  and  sympathetic  tempera- 
ment, and  in  all  the  seizures  there  was  a  marked 
hysterical  element. 

The  anatomical  conditions,  phymosis  and  astig- 
matism, were  present  in  this  case  in  a  highly  neu- 
rotic jjitient.  They  were  apparently  sufficient  in 
his  case  to  decidedly  affect  the  general  system. 

That  the  same  defects  might  exist  in  other  boys 
who  had  not  a  neurotic  diathesis,  without  inducing 
similar  results,  is  not  denied. 

December,  IJI^^l. 


Ueport0  of  i^ospitals. 


Rupture  op  the  Omentum  with  Stkangulation 
OF  the  Intestines. — Dr.  W.  E.  Guthi'ie,  of  Bloom- 
ington,  ni,,  sends  us  the  history  of  the  following 
unique  case  : 

"A  large,  robust  man,  aged  forty  years,  who  had 
been  healthy,  except  for  two  previous  attacks  of 
peritonitis,  was  taken,  October  14th,  with  intense 
pain  in  the  epigastric  and  umbilical  regions.  Vom- 
iting occurred  early,  and  the  third  day  became  ster- 
coraoeous  in  character,  and  so  remained  till  death. 
Tenderness  upon  pressure  was  at  first  confined  to 
the  umbilical  region,  but  two  days  later  became 
general  over  the  abdomen.  Tympanitis  marked. 
He  lost  strength  and  emaciated  I'apidly,  and  after 
eight  days  of  severe  suffering,  died.  The  question 
of  gastrotomy  was  several  times  broached  ;  but,  as 
the  symptoms  were  almost  entirely  those  of  intussus- 
ception of  some  portion  of  the  small  intestine,  the 
operation  was  not  considered  justifiable. 

Autopsy  showed  the  following  conditions  :  The 
peritoneum  was  largely  congested.  The  omen- 
tum was  about  one-half  its  usual  length,  very  thin, 
and  its  lower  border  irregular  and  in  shreds,  giv- 
ing evidence  of  having  been  toa-n.  This  caused  a 
search  for  the  remaining  portion,  which  was  found 
adherent  to  the  peritoneum  in  the  lumbar  region 
and  to  the  right  of  the  mesentery.  Through  two 
apertures  in  the  detached  portion  of  the  omentum 
had  passed  loops  of  the  ileum,  the  latter  being  gan- 
grenous at  tlie  i^oints  of  constriction,  and  its  free 
portions  largely  distended  with  gas." 

Dr.  Guthrie"  queries  whether  the  omentum  did 
not  become  attached  to  the  lumbar  peritoneum  in 
the  first  attack  of  peritonitis,  and  being  then,  in 
the  second  attack  torn  asimder. 

Pbescribing  for  Croit?  by  Telephone. — A  phy- 
sician of  North  Adams.  Mass.,  is  said  to  have  suc- 
cessfully diagnosed  and  treated  a  case  of  croup,  two 
miles  away,  by  the  help  of  the  telephone.  The 
croupy  cough  of  the  child  was  distinctly  trans- 
mitted. 


THE    USE   OF    PLASTEK-OP-PAEIS  IN 
FRACTUKES. 

Plaster,  either  in  the  form  of  a  bandage  enveloping 
the  fractured  part,  or  in  the  form  of  a  distinct  s])lint, 
is  used  quite  extensively  in  the  various  hospitals  of 
this  city.     In  fact,  aU  "other  things  being  equal,  it 
is  given  the  preference  over  other  forms  of  appara- 
tus usually  employed  in  such  injuries.     Particularly 
is  this  the  case  with  fractui-es  of  the  leg,  which  are 
treated   now  almost  exclusively  by   this   bandage. 
The  fracture-box  is  rarely  used,  and  only  in  excep- 
tional cases,  where  there  is  great  swelling,  and  under 
conditions  of  extensive  injury  of  the  skin,  in  which 
it  is  necessary  for  the  parts  to  be  exposed  during 
treatment.     Generally  this  open  method  is  only  em- 
ployed  untU  such  time  as  it  is  safe  to  apply  the 
plaster-of-Paris  bandage,  as  shown  by  the  disajipear- 
ance  of  the  swelling  and  the  healing  of  the  abrasions. 
No  time  is  lost  in  so  doing,  as  generally  the  parts  are 
made  fit  for  the  immovable  apparatus  before  the  bony 
union  commences.     In  compound  fracture  the  limb 
is  generally  placed  at  once  in  the  plaster  apparatus, 
openings  being  made  in  the  latter  corresponding 
with  the  injuries  of  the  soft  parts,  for  the  purpose  of 
establishing   thorough   drainage.      As   a   rule,   and 
when,  of  course,  there  is  no  special  contra-indication 
in  the  shape  of  undue  swelling,  etc.,  all  fractures  in 
which  i:)laster-of-Paris  is  to  be  employed  are  "put 
up  "  at  once.     A  general  description  of  the  method 
of  procedure  may  apply  to  that  to  be  employed  in 
any  case  of  fractiu-e  in  any  region  of  the  body.    The 
part  is  enveloped  in  a  thin  layer  of  cotton  and  the 
bandages,  immersed  in  water  sufficiently  long  to  be 
permeated,  are  applied  directly   over    the    cotton, 
care  being  taken  to  exert  slight  and  uniform  pres- 
sure.    Each  layer  of  bandage  is  carefully  moulded 
to  the  inequalities  of  the   surface,  and   made  per- 
fectly smooth  before  the  next  layer  is  applied.     If 
the  bandages  are  properly  prepared,  without  sizing, 
and  have  been  kept  in  a"  dry  place,  the  plaster  will 
commence  to  "set"  before  "the  second  bandage  is 
applied.  Generally  three  layers  of  bandage  are  suffi- 
cient for  a  fracture  where'  ordinary  support  is  re- 
quu-ed.    Four,  with  suitable  reinforcements,  may  be 
required  in  other  cases.     .Wter  the  dressing  is  com- 
plete, it  is  exposed  to  the  air,  and  hardens  suffi- 
ciently in  two  or  three  hours  to  allow  the  limb  to  be 
moved.  .  . 

The  plaster  apparatus  is  generally  kept  m  position 
during  the  whole  period  of  treatment.  If  undue 
swelling  occurs,  the  envelope  is  slit  in  the  long 
axis  of  the  limb  by  a  Hays  saw,  or  by  a  scissors  for 
the  purpose,  and  "thus  a"  splint  is  formed  which  is 
kept  in  position  by  outside  bandages. 

Some  surgeons  prefer  to  dispense  with  cotton 
altogether,  and  use  a  well-fitted  silk  or  gauze  stock- 
ing or  jacket  as  the  foundation  for  the  plaster. 
There  is,  however,  gi-eater  care  and  skill  required 
in  this  method,  as  any  undue  pressure  at  any  one 
point  would  be  more  apt  to  produce  swelling  in  the 
parts  bevoud.  Yet  still,  when  properly  applied,  this 
makes  the  most  comfortable  and  lightest  dressing 
that  can  be  used,  and  gives  the  perfection  of  sup- 
port and  gi-eatest  accuracy  of  adjustment  to  the  in- 
jured parts. 


12 


THE   MEDICAL  RECORD. 


progress  of  ilUtJical  Scicncf. 


Seat  of  the  Parasites  in  Lepbost  or  Elephanti- 
asis Gr.ecorom. — MM.  Comi  and  Suchard  {U>iio» 
Medicale,  Septemljer  29,  1881)  have  published  the 
results  of  their  researches  in  regard  to  the  character 
and  seat  of  the  parasite  iijion  which  the  pathological 
processes  constituting  elephantia.sis  depend.  Their 
investigations  were  made  upon  specimens  taken 
from  living  leprous  patients,  and  examined  before 
decomposition  had  begun.  They  found  the  leprous 
tubercles  to  consist  of  an  infiltration  of  the  papill;« 
and  of  the  cutis  vera  with  very  abundant  round, 
spheroidal,  or  lenticular  bodies,  that  were  hypertro- 
phied  white  blood-corpuscles.  In  the  middle  of  the 
tubercles  the  papillre  were  indistinct,  while  the 
sweat-glands  and  hair-follicles  were  gi'eatly  atro- 
phied. The  epidermis  was  thinned  and  smooth. 
The  vascular  walls  were  hyi^ertrophied,  particularly 
in  their  intima.  With  a  magnifying  power  of  500 
or  1,000  diameters,  small  ovoid  or  elongated,  highly 
refraetile,  rose-colored  bodies  were  seen  in  the  pro- 
toplasm of  the  hypertrophied  lymphoid  cells  of 
specimens  colored  with  carmine.  These  are  the 
parasites  associated'^'with  leprosy.  They  may  be 
studied  in  a  fresh  piece  of  the  tubercle,  removed 
from  the  liviBg  patient  and  teased  apart  in  water. 
They  are  either  spherical  or  rod-shaped,  and  propel 
themselves  iu  curved  lines.  Permanent  specimens 
are  prepared  by  successively  placing  thin  sections 
in  a  forty  per  cent,  solution  of  alcohol,  in  absolute 
alcohol,  and  in  a  one  and  one-half  per  cent,  coloi-ing 
solution  of  methyl-violet.  The  sections  are  then 
treated  with  a  one  to  four  per  cent,  solution  of  bi- 
carbonate of  sodium,  with  absolute  alcohol  and  the 
oil  of  cloves,  after  which  they  are  preserved  in 
Canada  balsam.  In  successfully  prepared  speci- 
mens the  parasites  in  the  cells  are  colored  deep 
blue,  while  the  jirotoplasm  of  the  cells  and  the  con- 
nective-tissue corpuscles  are  colorless.  Immersion 
objectives  are  preferred  for  the  study  of  these  speci- 
mens. The  rod-shaped  parasites  are  aiTanged  in 
bundles.  This  is  due  to  the  action  of  the  alcohol. 
The  spheroidal  parasites  are  aggregated  or  isolated. 
Very  few  parasites  are  found  outside  the  cells.  The 
epidermal  cells,  although  thinned,  contain  no  para- 
sites, and  seem  to  offer  an  almost  impenetrable 
barrier  to  their  progi-ess.  The  authors  believe  the 
slightly  contagious  nature  of  the  disease  to  be  refer- 
able to  this  fact. 

SpoNiiE-GRAFTiNG.— In  a  paper  "On  the  Process 
of  Healing,"  by  D.  J.  Hamilton,  M.B.,  published  in 
the  Joi/ni'il  of  Aunlomii  and  Physiology,  volume  xiii., 
1879,  the  author  advanced  the  view,  substantiated 
experimentally  and  otherwise,  that  thrf blood-vessels 
of  a  gi-anulating  surface  are  not  newly  formed,  but 
are  simply  the  displaced  superficial  capillaries  of  the 
part.  In  making  these  investigations,  his  attention 
was  arrested  by  the  similarity  of  the  process  of  vas- 
cularization as  it  is  witnessed  on  gianulating  sur- 
faces, and  as  it  takes  place  during  the  organization 
of  fibrinous  exudation  and  bloud-clot.  Starting 
with  the  idea  that  blood-clot  and  fibrinous  lymph 
play  merely  ii  mechanical  or  passive  part  in  any 
situation  wiiere  they  become  replaced  by  a  fibrous 
cicatrix,  that  their  vascularization  is  due  to  a  dis- 
placement and  pushing  inward  of  the  surrounding 
blood-vessels,  and  that,  before  organization,  thev  are 


so  much  dead  matter  in  the  tissue,  he  resolved  to 
experiment  with  some  dead  porous  animal  tissue  in 
order  to  determine  whether  this  might  become  vas- 
cularized and  replaced  by  cicatricial  tissue.  Sponge 
properly  cleaned,  carbolized,  and  deprived  of  its 
siliceous  and  calcareous  salts,  was  selected  as  best 
answering  the  required  conditions.  A  series  of 
experiments,  executed  both  upon  human  subjects 
and  animals,  demonstrated  the  ti-uth  of  Mr.  Hamil- 
ton's assertions.  In  one  instance  .sponge-grafting 
was  performed  on  an  ulcerated  wound,  probably 
specific,  situated  on  the  outside  of  the  left  leg,  cir- 
cular in  shape,  and  measuiing  five  inches  in  diameter, 
and  from  one-half  to  three-fourths  of  an  inch  in  dejith. 
Several  pieces  of  sponge  were  introduced,  and  made 
to  accurately  fill  up  the  wound  ;  antiseptic  dressings 
were  employed,  and  antiseptic  precautions  observed 
in  the  treatment. 

After  six  months,  during  which  potassium  iodide 
was  administered,  the  sponge  had  entirely  disap- 
peared, and  there  remained  merely  a  superficial, 
typically  healthy  suppurating  surface,  measuring  one 
and  one-half  inch  in  diameter.  In  this  experimenfit 
was  proved  that,  if  a  sjionge  be  placed  over  a  granu- 
lating surface,  its  vacuoles  will  in  the  course  of  time 
become  filled  with  blood-vessels  and  cicatricial  tissue, 
and  ultimately  the  whole  sponge  will  disajipear  in  the 
wound,  leaving  an  organizing  mass  of  new  tissue  in 
its  place.  The  vacuities  of  the  sponge  appear  to  be 
particularly  adapted  for  allowing  this,  and  the  frame- 
work of  keratode  affords  sujiport  to  the  young  ves- 
sels formed  within  it.  It  was  demonstrated  fur- 
thermore, that  even  a  puti-escent  condition  of  the 
wound  will  not  prevent  organization.  Putrefaction 
destroys  a  blood-clot,  but  does  not  seem  to  affect 
the  firmer  texture  of  the  sponge.  After  detailing  his 
highly  interesting  experiments,  and  considering,  in 
a  masterly  way,  the  process  of  organization  as  it  oc- 
curs in  l)iood-clot,  fibrinous  lymph,  sponge,  etc.,  the 
author  offers  some  practical  suggestions.  The  po- 
rosity of  the  body  employed  as  the  medium  for  the 
construction  of  new  tis.sue  must  be  such  that  all  the 
canals  freely  communicate.  Sponge  answers  this 
requirement,  but  the  author  thinks  charcoal  or  cal- 
cined bone  might  be  used  in  certain  cases,  especially 
where  the  prevention  of  cicatricial  construction  is 
aimed  at,  a  solid  framewoilv  must  be  employed.  A 
dead  body  thus  incorporated  with  the  tissue  is  not 
of  itself  an  irritant,  but  only  becomes  so  by  its  in- 
jurious apitlicatiou,  or  the  introduction  with  it  of 
septic  matter.  A  solid  framework  would  lie  partic- 
ularly useful  in  the  formation  of  bone.  Sponge  or 
other  framework  must  only  be  Tised  for  plting  a  va- 
ciiili/,  else  it  will  cause  intlammation,  as  when  it  is 
thrust  between  two  portions  of  a  muscle  without  a 
portion  of  the  muscle  being  excised.  Again,  it  should 
always  be  rendered  antiseptic.  The  only  objection 
against  its  adoption,  which  the  author  perceives,  is 
the  somewhat  long  time  required  to  organize  it,  but 
he  thinks  that,  after  the  sponge  had  become  fixed, 
the  patient  might  be  allowed  to  go  about,  if  practi- 
cable, and  that  this  in  certain  cases  might  actually 
exert  a  beneficial  influence  upon  the  organizing 
power  of  the  tissTies. — Edinburgh  Med.  Jour.,  No- 
vember, 1881. 

A  Case  of  Excessts-ely  High  Temperati-re. — 
At  a  meeting  of  the  Clinical  Society  of  London,  on 
October  liS,  1881,  Dr.  Stephen  Mackenzie  rejiorted  a 
case  of  excessively  high  temperature.  The  patient 
was  a  woman,  aged  forty-two.  who.  in  1878,  had  sus- 
tained an  amputation  of  the  left  thigh,  at  its  lower 


THE  MEDICAL  RECORD. 


13 


third,  for  necrosis  and  inteactable  ulcer  of  the  leg. 
On  February  "25,  1879,  she  was  readmitted  for  pain- 
ful affection  of  the  stump.  During  her  illness  rery 
elevated  temperatures  were  observed,  111°  F.,  in  tli'e 
axilla,  being  tlie  highest.  She  was  treated  and  dis- 
charged .  cured  in  Augiist.  In  October,  1879,  she 
once  more  entered  the  hospital  for  pain  in  the 
stump.  Operative  procedmes  were  again  adopted, 
and  on  December  31,  1879,  .she  came  under  the  ob- 
servation of  Dr.  Mackenzie.  It  was  ascertained  that 
she  had  taken  opium  for  twelve  years.  On  January 
13,  1880,  she  had  a  slight  rigor,  and  the  temperature 
was  found  to  be  109.2'.  The  pulse  was  72  and  the 
respiration  24.  Then  followed  a  series  of  elevated 
temperatures,  and  on  January  22d,  the  highest  re- 
corded, 120.8"  was  reached.  On  April  5th,  113  was 
recorded.  The  patient  was  discharged  on  July  3d. 
On  August  llJth  she  was  readmitted,  and  remained 
until  September  24th.  On  August  19th.  a  tempera- 
ture of  100  was  recorded.  Dr.  Mackenzie  exjiressed 
his  belief  that  the  temperatures  were  fictitious,  ujion 
the  following  grounds  :  1.  The  patient  was  a  neu- 
rotic woman,  and  "  an  educated  hospital  patient," 
i.e.,  knew  the  importance  attached  to  high  tempei'- 
'atures.  2.  That  when,  on  one  occasion,  the  tem- 
perature was  taken  simultaneously  in  the  mouth, 
rectum,  and  axilla,  the  temperatures  in  the'  mouth 
and  rectum  corresponded,  and  were  normal,  whilst 
that  in  the  axilla  was  six  degrees  higher.  3.  That 
when  two  thermometers  were  simultaneously  placed 
in  the  same  axilla,  there  was  as  much  as  from  one  to 
four  and  one-half  degrees  difference.  4.  That  there 
was  no  correlation  between  the  high  temperatures, 
the  pulse,  and  the  respiration.  5.  That  on  no  oc- 
casion when  the  thermometer  was  held  in  the  axilla, 
or  the  patient  closely  watched,  was  an  excessively 
high  temperature  obtained.  The  patient  denied  ab- 
solutely ha^-ing  caused  the  high-temperature  read- 
ings. The  author  stated  that  he  did  not  wish  to 
imply  that  all  the  recorded  instances  of  high  tem- 
perature were  of  the  same  kind.  The  fact  that  some 
cases  recorded  by  good  observers  were  genuine,  ren- 
dered it  desirable  that  a  fictitious  one  should  be  ex- 
posed, to  piit  the  profession  on  its  guard. 

Dr.  Teale  was  also  inclined  to  doubt  the  reality  of 
the  majority  of  cases.  As  a  rule,  the  patients  are 
hyi5er<T?sthetic  and  neurotic.  He  had  obtained  the 
report  of  a  case  in  which  temperatures  of  133  and 
127.6   were  said  to  have  been  reached. 

Dr.  Mahomed  mentioned  a  case  in  which  a  pa- 
tient utilized  the  respiratory  movement  to  drive  np 
the  mercurv. — Medical  Press  and  Circular,  Novem- 
ber 12,  1881. 

Tbeatmest  op  Htdeocei/E  axb  Sebofr  Cysts  in 
Genekai.  Br  THE  IX.JECTIOX  OP  Cabbolic  Acid. — Dr. 
Levis  states  that  he  has  been  experimenting,  with  a 
view  of  determining  what  substance  may  best  se- 
cure the  obliteration  of  the  secreting  surface  and 
the  adhesion  of  the  walls  of  the  cyst  with  the  most 
certainty  and  the  greatest  freedom  from  suffering 
and  danger.  Having  selected  carbobc  acid  as  an 
agent  which  would  provoke  simply  a  plastic  inflam- 
mation, he  injected  one  drachm  of  the  deliquesced 
crystals  into  the  sac  of  a  large  hydrocele.  The  new 
procedure  was  entirely  painless.  A  sense  of  numb- 
ness alone  was  experienced,  and  no  inconvenience 
was  felt  until,  on  the  next  day,  the  desired  inflam- 
matory process  was  developed.  A  nine  years'  hos- 
pital and  private  experience  leads  the  author  to  be- 
lieve that  this  method  is  the  most  satisfactory  for 
the  object.     For  the  purpose  of  injection,  crystal- 


lized carbolic  acid  is  maintained  in  a  liquefied  state 
by  a  five  or  ten  per  cent,  solution  of  either  water  or 
glycerine ;  the  crystals  are  to  be  reduced  to  the 
fluid  state  with  no  more  dilution  than  may  be  neces- 
sai-y  for  this.  After  the  usual  tapi^ing,  he  injects 
the  liquefied  ci-ystals  with  a  syringe  having  a  nozzle 
sufficiently  slender  and  long  enough  to  reach  en- 
tirely through  the  canula.  He  has  never  been  able 
to  detect  any  general  toxic  effects  upon  the  system, 
but  believes  that  the  action  of  strong  carbolic  acid 
on  surfaces  secreting  albuminous  fliiids  is  to  seal 
them,  to  shut  them  off'  from  the  system  in  such  a 
manner  that  absoii:)tion  cannot  readily  take  place. 
The  occluding  influence  of  strong  carbolic  acid  he 
regards  as  an  important  surgical  resource  in  certain 
cases  of  comijound  fracture,  destructively  lacerated 
wounds,  and  ulcerating  surfaces,  where  sejjtic  infec- 
tion is  inevitable.  All  forms  of  serous  cysts  which 
are  usually  subjected  to  any  form  of  operative  treat- 
ment, on  the  principle  of  producing  plastic  adhesion 
of  their  walls,  may  be  deemed  amenable  to  the  treat- 
ment indicated. 

Ekgot  in  Lead-Palsy. — Dr.  Stites,  of  Belmont, 
Nevada,  in  a  communication  to  the  Therapeutic  Ga- 
zette, states  that  about  fifty  per  cent,  of  a  physician's 
practice  in  his  locality  consists  of  lead-poison  cases. 
The  greater  -part  of  the  male  poi>u]ation  is  at  work 
in  the  sUver  mines,  and  liable  to  be  affected  by  the 
lead  contained  in  the  silver  ore.  Wrist-drop  is  a 
vei'y  frequent  symptom,  and  i^ai'alysis  of  other  forms 
— even  hemiplegia  or  paraplegia — is  not  an  infre- 
quent complication.  The  milder  manifestations  of 
these  .symptoms  are  usually  removed  in  a  few  days 
liy  a  cathartic  of  epsom  salts,  followed  by  iodide  of 
potassium.  Persons  who  abstain  from  alcohol,  keep 
their  bowels  open,  and  lead  regular  lives,  are  much 
less  liable  to  suffer  from  lead-poisoning.  In  hemi- 
plegia and  paraplegia  due  to  lead-poisoning.  Dr. 
Stites  finds  that  the  combination  of  ergot  and  iodide 
of  jjotassium  yields  extremely  satisfactory  results. 
He  prescribes  the  following : 

1} .     Potass,  iodid I  ij. 

Ext.  ergot fl.  5  j- 

Ext.  nuc.  vomicfe A-  3  ]• 

Tr.  cardamom,  co 3  j. 

Syrup q.  s. 

Aq ad.  2  iv. 

Sig. — A  tablespoonful  night  and  morning. 

He  prefers  the  above  to  the  iodide  alone,  or  elec- 
tricity, or  tonics  and  nux  vomica.  Power  is  usually 
restored  in  a  month.  Under  other  medication  recov- 
eiy  does  not  take  place  under  three  months.  The 
efficacy  of  ergot  is  attributed  to  its  effect  on  non- 
striated  muscular  fibre.  No  danger  attends  the. 
therapeutical  application  of  the  drug. — Medical  mid 
Surgical  Reporter;  November  19,  1881. 

Ablation  of  Fibroid  TraoRs  or  the  I'TEErs.— 
At  the  Academie  de  Medicine,  M.  Gueniot  made 
some  observations  recently  on  the  different  methods 
employed  in  the  ablation  of  uterine  fibroids.  He 
prefers  excision  by  the  constrictor  or  sen-e-nceud, 
on  account  of  its  simplicity  and  security.  He  con- 
siders it  superior  to  Chassaignac's  ecraseur,  as  fun- 
dal  polypi  can  be  reached  without  pre\-ious  traction 
on  the  organ.  The  operation  is  as  bloodless  as  that 
performed  by  the  ecraseur,  and  the  peduncle  is  cut 
cleanlv  across. — Medical  Press  and  Circular,  Novem- 
ber 9,' 1881. 


14 


THE  MEDICAL  RECOED. 


The  Medical  Record: 

^  lUccklg  lonvnal  of  illcbiciue  ani)  Suvgein. 


GEORGE  F.  SHRADY,  A.M.,  M.D.,  Editor. 


PUBLISHED   BY 
wn,  WOOD  &  CO.,  No.  27  Great  Jones  SI.,  !V.  \, 


New  Yorlt,  January  7,  18S3. 

THE  STATE  IMEDICAL  SOCIETY  AND  ITS 
NEW  PR0.TEC;T  of  caring  for  THE 
ZNTANTS  OF  THE  POOR. 

At  the  meeting  of  the  Medical  Society  of  the  State  of 
New  York,  held  on  February  4,  1880,  it  was  resolved  : 
"  That  the  president  appoint  a  committee,  consist- 
ing of  five  members,  to  co-operate  with  the  New 
York  Society  for  the  Prevention  of  Cnielty  to  Chil- 
dren in  all  things  pertaining  to  the  physical  and 
moral  welfare  and  safety  of  Lufants  and  children, 
and  report  at  the  next  annual  meeting." 

Such  a  committee  was  ajiijoiuted,  and  we  have  its 
report  now  before  ns.  From  it  we  leam  that  on 
January  31,  1881,  the  iwesident  of  the  Society  for 
the  Prevention  of  Cruelty  to  Children  addressed  a 
letter  to  Dr.  A.  Jacobi,  as  vice-president  of  the 
State  Medical  Society,  suggesting  certain  points  for 
the  consideration  of  this  latter  society. 

The  first  tojiic  suggested,  as  deserving  inquiry, 
was  that  of  wet-nurses.  Mr.  Gerry  referred  to  the 
fact  that  many  poor  mothers  hired  themselves  out 
in  this  capacity  to  the  gieat  physical  harm  of  their 
own  children.  Wet-nurses  are  also,  as  Sir.  Gerry 
believed,  not  unfrequently  engaged  who  have  a  stru- 
mous or  syphilitic  constitution.  It  was  sugge.sted 
that  there  should  be  in  each  county  a  standing  com- 
mittee of  medical  men  to  examine  and  license  wo- 
men desirous  of  serving  in  siach  capacity. 

The  second  point  raised,  was  that  of  the  employ- 
ment of  children  in  occu])ations  injurious  to  their 
health.  The  sorting  and  rolling  of  tobacco  leaves 
for  the  jmrpose  of  making  cheap  cigars,  was  espe- 
cially referred  to,  and  the  opinion  of  the  medical 
l)rofD8sion  as  to  tlie  injuriousness  of  this  and  other 
employments,  was  asked  for.  Mr.  Gerry  cites  the 
recent  French  statutes  forbidding  the  employment 
of  children  in  a  number  of  manufactures. 

The  industries  thus  vetoed  are  the  manufacture  of 
aniline,  benzine,  collodion,  nitrate  of  methyl,  sul- 
phuret  of  arsenic,  sulphuret  of  sodium,  and  of  blis- 


ter-leaves ;  in  the  textiles,  of  rag-sorting,  and  the 
scouring  of  skins  and  woollen  waste  with  petroleum 
or  other  hydrocarburetted  oils  ;  in  the  metal  trades, 
the  galvanizing  of  iron.  Children  are  also  not  al- 
lowed to  be  employed  in  places  where  chemical 
allumettes  are  stored,  nor  in  those  processes  of  their 
manufacture  where  the  mixture  is  prepared  or  the 
matches  put  up  into  packets.  A  partial  employment 
only,  under  certain  conditions,  is  allowed  in  indus- 
tries where  sulphuric  acid  is  engaged,  .such  as  in 
wool  and  silk  bleaching,  as  well  as  in  those  where 
unwholesome  dusts  are  given  ofl",  as  in  the  prepara- 
tion of  tow  for  rope,  and  the  manufacture  and  clean- 
ing of  bladders  for  toy  balloons. 

Finally,  the  necessity  of  compulsory  medical  care 
for  children  is  sometimes  very  great.  An  instance 
is  given  of  a  child,  in  this  citj-,  who  was  suft'eiing 
from  a  frightful  ulcer  of  the  leg,  with  necrosis  of  the 
bone.  It  was  scarcely  furnished  the  necessities  of 
life  by  its  parents,  who  absolutely  refused  to  allow 
any  medical  treatment. 

The  report  of  the  committee  appointed  by  the 
State  Medical  Society  is  essentially  a  reply  to  and  dis- 
cussion of  the  points  thus  raised  by  President  Gerry. 

Regarding  the  first  topic.  Dr.  Jacobi,  speaking 
for  the  committee,  states  that  the  plan  of  licensing 
wet-nurses,  or  of  procuring  eft'ective  medical  super- 
intendence, would  hardly  be  feasible.  Instead  of 
making  any  such  attempt,  the  committee  submit 
another  plan,  which  is  novel,  and  certainly  deserves 
careful  consideration.  This  plan  consists  in  estab- 
lishing places  in  New  I'ork  where  the  children  of 
the  poor  may  be  supplied  with  simple,  though  suf- 
ficient, articles  of  food. 

Such  articles,  in  the  case  of  infants  and  young 
children,  are  powdered  barley,  powdered  oatmeal, 
sugar,  milk,  and  eggs.  They  should  be  supplied  in 
about  the  following  quantities  :  Powdered  barley,  a 
package  of  one-half  pound  to  a  child  under  one 
year  of  age  every  week  ;  two  such  packages  for  a 
child  of  from  one  to  two  years  of  age.  When  oat- 
meal is  required,  it  may  be  suj^plied  in  the  same 
quantity  as  barley.  Eggs,  seven  a  week  for  a  baby 
a  year  old  or  less  ;  fourteen  a  week  for  a  baby  over 
a  year  old.  Sugar,  half  a  pound  a  week.  Milk, 
twelve  ounces  for  a  baby  under  a  year,  twice  daily ; 
twenty  ounces  for  a  child  over  a  year,  twice  daily. 

During  the  four  months  from  May  15th  to  Sep- 
tember 15th,  there  should  be  added  to  the  list  of 
foods  for  sale,  one  ounce  of  brandy  or  whiskey  per 
week. 

"  There  is  no  food  on  which  children,  of  whatever 
class,  thrive  so  well,"  says  the  writer,  "  as  on  the  few 
above  enumerated.  No  patent  foods  are  necessary, 
or  are  recommended." 

Tlie  various  details  for  can-yiug  out  the  project 
thus  suggested  are  fully  discussed.  We  cannot  go 
into  them  here.     But  it  is  to  be  hoped  that  a  pro- 


THE   MEDICAL  RECORD. 


15 


ject  which  seems  so  feasible  and  useful  will,  at  least, 
be  given  a  fair  trial. 

With  regard  to  the  second  point  raised  by  Mr. 
(rerry,  the  committee  announces  itself  in  full  accord 
with  his  views.  It  will  co-oi)erate  with  the  Society 
for  the  Prevention  of  Cruelty  to  Children  in  trying 
to  secure  laws  protecting  children  from  the  dangers 
of  improper  employment. 

The  rights  of  children  who  are  diseased  to  re- 
ceive proper  medical  treatment,  despite  briital  and 
indifferent  parents,  are  heartily  acknowledged.  The 
committee  proposes,  therefore,  to  the  State  Society 
the  following  resolution  :  "  That  a  committee  be  ap- 
pointed by  you,  who,  in  connection  with  the  Xew 
York  Society  for  the  Prevention  of  Cruelty  to  Chil- 
dren, shall  apply  to  the  Legislature  for  an  act  pro- 
viding for  the  helpless  sick  children  whose  health 
and  life  are  endangered  by  those  who  ought  to  be 
their  natural  guardians,  but  who  prove,  by  their  acts, 
their  enemies." 


THE    BILLS    FOR   MEDICAL   SER\aCES. 

If  from  feelings  of  personal  delicacy,  or  from  other 
equally  unreasonable  considerations,  the  physician 
has  deferred  sending  his  bill  for  sei'vices  rendered 
to  his  patients,  the  time  has  arrived  when  the 
accounts  for  the  year  must  be  settled  in  some  way 
or  other.'  He  knows  full  well  that  the  general  sen- 
timent of  the  i^eople  whom  he  has  attended  is  ad- 
verse to  the  prompt  settlement  of  medical  bills,  anil 
that  too  generally  the  latter  are  paid  ever.tually  un- 
der protest.  While,  according  to  the  general  law 
of  domestic  economy,  the  physician  must  live  as 
well  as  the  butcher  and  baker,  each  debtor  to  the 
doctor  would  much  prefer  to  change  places  with 
any  others  who  were  free  from  such  obligations. 
Thus,  the  medical  man  is  often  imjiliedly  placed 
in  the  position  of  one  who  is  tolerated  rather  than 
encouraged,  who  is  supposed  to  belong  to  the  class 
of  individuals  whose  pay,  in  great  part,  should  be 
taken  in  the  mere  consciousness  of  doing  good  to 
his  suffering  fellows.  These  are  priveleges  denied 
to  many,  but  in  order  to  be  properly  appreciated  by 
the  physician  he  should  be  a  trifle  beyond  want 
himself.  These  are  our  higher  humanities,  which 
can  never  attain  their  full  function  with  an  empty 
stomach.  The  smell  of  the  lily  maybe  a  reasonable 
dessert  after  a  hearty  meal,  but  is  not  specially 
tempting  to  the  man  who  is  forced  to  descend  to 
the  prose  of  an  ordinary  bread-and-butter  struggle. 
Physicians,  as  a  class,  are  too  often  tempted  to 
look  on  the  soft  side  of  charity,  and  suffer  in  conse- 
quence. Hence  the  practical  business  man  makes 
allowance  for  him,  and  is  ever  ready  in  a  patroniz- 
ingly considerate  way  to  take  advantage  of  him. 
Of  com-se  this  is  the  fault  of  the  doctor  as  well 
as  his  debtor.  The  readiness  with  which  deduc- 
tions   are    made   from   medical   biUs    proves    this. 


There  is  no  doubting  the  fact  that  the  prevalence  of 
the  practice  has  helped  to  create  the  too  widely  en- 
tertained impression  that  medical  services  have  no 
positive  value,  and  that  they  should  be  paid  for  only 
after  a  heavy  discount  has  been  allowed. 

All  these  general  considerations  must  have  their 
bearing  ujjon  the  medical  men  who  are  now  making 
out  their  bills,  and  should  help  them  to  deter- 
mine the  amount  of  charges  in  given  cases. 
I  It  is  well  to  recollect,  while  due  allowance  should 
be  made  for  those  who  can  pay  little  or  noth- 
ing, that  the  maximum  charges  should  be  reason- 
ably high.  Physicians,  as  a  rale,  do  not  place 
enough  pecuniary  value  on  their  services.  Gener- 
ally they  are  considered  by  their  patrons  worth  no 
more  than  the  small  sum  usually  asked  for  them. 
The  rich,  as  a  rule,  are  of  this  opinion,  and  are  usu- 
ally disappointed  in  theii-  estimate  of  the  real  value 
of  the  services  of  a  doctor  if  a  comparatively  small 
bill  is  presented. 

High  charges  are  generally  the  only  means  by 
which  the  value  of  services  rendered  can  be  proven 
to  such  as  are  able  to  pay  for  them.  There  is  far 
less  likelihood  of  charging  these  persons  too  little 
than  too  much.  An  opportunity  for  i^racticaUy 
testing  this  point  is  doubtless  presenting  itself  to 
many^of  our  readers  engaged  in  bill-rendering. 

Another  matter  worth  considering  in  connection 
witb.  the  sqiiaring  of  accounts  for  the  year,  is  how 
few  patients  shall  be  placed  on  the  free  list.  Every 
physician  has  a  greater  or  less  number  of  patrons 
whom  he  is  not  in  the  habit  of  charging,  who  occupy 
toward  him  the  anomalous  position  of  being  his 
friends  so  long  as  they  can  use  him  to  their  advan- 
tage, or  who,  jjossibly,  in  consideration  of  some  slight 
service  rendered  by  them,  give  them  a  claim  upon 
his  good  will  and  good  deeds.  It  goes  without  the 
saying  that  these  jjatients  are  the  most  troublesome 
and  least  profitable  [of  the  entire  clientele  of  the 
lihysician. 

The  best  friends  to  the  practitioner  are  those  who 
pay  him  for  what  he  does  for  them,  and  the  sooner 
aU  services — no  matter  to  whom  rendered — can  be 
placed  on  a  cash  basis,  the  better.  It  is  quite  easy 
to  anticipate  what  may  be  the  effect  of  cutting  off 
worthless  hangers-on  by  a  formal  biU.  If  they  dis- 
charge theii-  doctor  in  consequence  of  the  insult  of 
receiving' his  bill,  they  are  the  only  ones  that  can 
possibly  suffer  by  the  change.  At  least  the  physician 
is  relieved  from  the  obligation  of  spending  his  time 
and  his  energies  for  naught. 

MrscTLAB  Hekn-u.  Cured  by  Maetin's  Bandage. — 
Dr.  C.  E.  Grovesteen,  of  this  city,  sends  us  the  re- 
port of  a  case  of  muscular  hernia  on  the  upper  and 
inside  of  the  calf  of  the  leg,  of  five  months'  duration, 
caused  by  a  fall  upon  the  toes,  and  cured  by  the  use 
of  a  compress  and  Martin's  bandage,  and  the  exter- 
nal application  of  ChurchiU's  tincture  of  iodine. 


16 


THE  MEDICAL  KECORD. 


Heoicius  nnti  Uoticcs  of  fioolis. 


IliLUSPTKATIONS  OP  DISSECTIONS  IN  A  SeBIES  OP  ORI- 
GINAL CoLOKED  Plates,  Representing  the  Dis- 
SErnoN  OF  the  Human  Body.  By  George  Viner 
Ellis,  Professor  of  Anatomy,  University  College, 
London,  and  George  H.  Ford,  Esq.  Vol.  I.,  Janu- 
ary, 8vo,  ])p.  232.  Second  edition.  New  York : 
William  Wood  &  Co.     1882. 

This  is  the  first  volume  of  the  series  of  twelve  of 
Wood's  Medical  Librai-y  for  the  year  1882,  and  is  a 
new  departure  in  the  scheme  worthy  of  special  no- 
tice. As  its  title  indicates,  it  is  a  work  of  illustrated 
anatomy,  with  descriptive  text.  The  plates,  which 
are  handsome  chromo-lithographs  in  many  colors, 
are  reduced  on  a  uniform  scale  from  the  Life-sized 
drawings  of  the  original  English  edition,  and  are  re- 
produced in  fac-simile  with  striking  excellence  and 
faithful  detail.  Each  jilate  occupies  a  full  page  and 
represents  the  actual  appearance  of  a  dissected 
region  of  the  body,  showing  all  the  organs  in  their 
relative  positions,  the  anatomical  characters  being 
thus  brought  before  the  eye  at  one  and  the  same 
time.  In  the  present  volume,  which  is  one  of  two, 
there  are  twenty-eight  plates,  representing  different 
regions  of  the  head  and  neck,  and  of  the  upper  ex- 
tremities. Tliese  portions  illustrate  the  various  as- 
pects of  difl'erent  parts  of  the  same  limb,  and  show 
the  layers  of  organs  and  tissue  in  the  natural  order 
of  succession  in  a  manner  that  is  thoroughly  satis- 
factory and  eminently  praiseworthy.  Not  only  are 
the  appearances  described  with  necessary  detail,  but 
the  number  and  value  of  the  remarks  on  the  i^rac- 
tical  applications  of  the  anatomical  facts  to  surgical 
operations  make  the  work  of  especial  value  for  the 
study  and  consultation  of  such  geneval  practitioners 
as  are  called  upon  to  perform  sui'gical  operations. 
Unlike  the  London  edition,  this  one  contains  the 
plates,  reduced  in  size,  and  bound  \\-ith  the  text. 
This  has  a  convenience  of  arrangement  wliich,  for 
purpose  of  easy  consultation,  more  than  oftsets  the 
apparent  advantage  of  larger-sized  drawings.  The 
striking  features  of  the  work,  however,  are  the  num- 
ber, beauty,  and  accuracy  of  its  plates  and  the  sur- 
prisingly low  price  at  which  it  is  published.  If  the 
other  works  of  the  series  are  equal  in  style  of  typo- 
graphy and  value  of  contents,  the  library  must  in- 
crease in  popularity  with  the  practical  workers  in 
the  profession,  and  become  a  duly  recognized  fea- 
ture in  medical  publication.  To  the  practitioner  who 
cannot  afford  the  expense  of  the  larger  atlases,  these 
volumes  must  become  not  only  a  luxury  but  a  neces- 
sity. The  general  style  of  binding  is  somewhat 
changed  from  the  last  series  of  the  library,  but  is 
substantial  and  neat,  and  will  make  a  tasteful  ap- 
pearance upon  the  book-shelf. 

The  Applied  Anatomy  op  the  Nervous  System  : 
Being  a  Study  of  this  Portion  of  the  Human 
Body,  from  a  Standpoint  of  its  General  Interest 
and  Practical  Utility.  Designed  for  use  as  a  Text- 
book and  a  Work  of  Reference.  By  .\mt)uose  L. 
Ranney,  A.m.,  M.D.,  with  numerous  Olustrations. 
New  York  :  D.  Appleton  &  Co.    1881.  | 

The  general  practitioner  now-a-days  will  confess 
very  readily  to  an  ignorance  of  any  special  knowl- 
edge of  the  nervous  system.  A  vast  deal  has  been 
contributed  to  its  anatomy,  pliysiology,  and  patho- 


logy within  a  few  years ;  so  much,  indeed,  that  it  is 
rather  discouraging.  To  sit  down  and  battle  with 
Quain  and  Strieker,  with  Foster  and  Hermann,  and 
the  host  of  untranslated  French  and  German  ■m'iters, 
requires  no  ordinary  courage. 

Dr.  Ranney  has  done  a  most  useful  and  praise- 
worthy task  in  that  he  ^vill  have  saved  many  of  the 
profession  from  the  choice  of  going  through  the 
work  we  have  indicated,  or  remaining  in  ignorance 
of  many  things  most  essential  to  a  sound  medical 
knowledge. 

The  book  before  us  is  a  digest  of  the  principal 
facts  in  the  anatomy  and  physiology  of  the  nervous 
system.  It  contains  also  as  much  of  pathology  and 
of  clinical  symptoms  as  are  suggested  by  the  physio- 
logical points  given.  There  is,  indeed,  as  much 
physiology,  practically  applied,  as  there  is  of  ana- 
tomy. 

Every  one  who  treats  of  so  Viroad  a  field  as  the 
neiwous  system,  must  draw  veiT  lai-gely  on  the  work 
of  others.  Dr.  Ranney  has  done  this  more  con- 
spicuously than  is  tisually  the  ease.  Nevertheless, 
the  facts  are  industriously  collated,  the  imi^ortant 
points  are  clearly  and  systematically  set  forth,  and 
the  author  has  shown  a  genuine  talent  in  his  mode 
of  presenting  and  analyzing  difficult  subjects. 

The  book  does  not  attempt  to  go  into  the  minuter 
anatomical  or  physiological  details ;  it  shows  some 
evidences  of  progressive  cramming ;  there  are  quite 
a  number  of  minor  errors,  and  there  is  in  some  parts 
a  lack  of  the  usual  good  judgment  in  presenting 
coherently  the  different  points. 

These  are  all  defects,  however,  which  can  be 
easily  remedied  in  subseqaient  editions,  and  do  not 
seriously  impau'  the  value  of  the  work. 

The  book  is  divided  into  four  parts,  which  treat 
resj)ectively  of  the  brain,  the  cranial  nerves,  the 
spinal  cord,  and  the  spinal  nerves. 

An  analysis  of  the  chapters  on  the  spinal  cord, 
which  are  among  the  best  in  the  book,  wiU  give  an 
idea  of  the  author's  treatment  of  this  subject.  There 
is  first  given  a  description  of  the  cord,  its  anatomy, 
functions,  and  clinical  bearings.  Then  follow  de- 
scriptions of  the  ceiwical  and  lumbar  enlargements, 
of  the  fissui'es  and  columns,  the  roots  of  the  neiwes, 
the  membranes,  the  cerebro-spinal  fluid,  the  appear- 
ance of  transverse  section  of  the  cord,  with  its  patho- 
logical and  ishysiological  subdivisions. 

The  functions  of  the  spinal  cord  are  then  discussed 
in  detail.  A  chajjter  on  the  clinical  points  relating 
to  the  cord  follows,  and  then  a  full  description  of 
the  systematic  and  uon-.systematic  lesions,  according 
to  classification  of  Seguin. 

The  book  is  most  profusely  illustrated  with  cuts 
from  various  anatomical  and  physiological  works. 
We  can  only  repeat  that  its  author  has  rendered  a 
great  service  by  making  so  many  facts  clear  and 
accessible  to  the  profession. 


Another  Educational  Adv.ance  has  been  made 
by  the  Medical  Department  of  the  University  of 
Pennsylvania.  We  are  informed  by  the  Medical  Times 
that  a  course  pre))aratory  to  medicine  has  been 
created.  It  gives  the  student  an  opportunity  to 
study  zoology,  botany,  biology,  chemistry,  physics, 
and  the  languages.  The  course  lasts  one  or  two 
years  and  leads  to  no  degree.  While  not  so  desir- 
able as  a  regular  scientific  or  classical  course,  one 
can  easily  see  that  it  will  supi)ly  a  want  felt  by  many 
young  men. 


THE   MEDICAL  RECORD. 


17 


IHevovts  of  Societies. 


NEW  YORK  ACADEMY  OF  ]MEDICINE. 

Staled  Meetiny,  Becemher  15,  1881. 
Dr.  E.  F.  Weik,  Vice-Pkesident,  in  the  CiLA^rK. 

rR.VN.SIENT  AiBUMINDKIA  AS  IT  OCCUBS,  PAIiTICU- 
LAKLY  IX  CHILDREN  AND  ADOLESCENTS,  IN  APPARENT 
HE.VLTH. 

Dr.  Frank  P.  Kr>ixicuTT  read  a  paper  on  the  above 
subject,  iu  which  he  first  alluded  to  the  practical 
importance  of  the  occurrence  of  transient  albumi- 
nuria, to  which  esijecial  attention  had  been  directed 
during  the  past  few  years  by  Sir  William  GuU, 
George  Johnson,  Saundby,  Moxou,  and  others,  and 
then  gave  a  resume  of  the  various  theories  which, 
fi-om  time  to  time,  have  been  offered  in  exi'lanation 
of  this  phenomenon. 

Tliat  which  the  author  of  the  paper  suggested  as 
the  most  probable  was  the  following :  The  transient 
albuminuria  in  persons  apparently  healthy  is  due 
to  slowing  of  the  blood-current  in  the  glomerular 
vessels,  dependent  upon  temporary  vaso-motor  dis- 
turbances, with  alteration,  also  temporary,  in  the 
glomerular  epithelium.  He  farther  believed  that 
the  real  source  of  irritation  was  to  be  found  in  the 
temporary  presence  of  imperfectly  oxygenized  mat- 
ters in  the  renal  circulation — in  other  words,  tran- 
sient oxahu'ia  and  lithuria. 

Dr.  Kiunicutt  then  reviewed  the  cases  of  transient 
albuminiu'ia  which  have  been  reported  by  various 
observers.  In  1873,  Sir  William  Gull  said  that,  in 
his  experience,  it  occurred  in  young,  growing  men 
and  boys  almost  as  frequently  as  spermatorrhoea.  In 
1878,  Moxon,  in  "  Guy's  Hospital  Reports,"  reported 
nineteen  cases.  Dr.  Clement  Dukes,  in  the  British 
J)[i'dical  Journal,  November,  1878,  rei^orted  several 
cases,  which,  in  many  respects,  differed  from  those 
given  by  Dr.  Moxon  ;  and  in  the  same  joiu-nal  tor 
November  10, 1881,  Dukes  had  reversed  his  opinion, 
and  stated  that  he  regarded  albuminuria  as  evidence 
of  true  Bright's  disease.  Dr.  George  Johnson  also, 
in  the  British  Medical  Journal,  had  directed  atten- 
tion to  the  question  of  temporary  albuminuria,  and 
had  expressed  the  opinion  that  the  smallest  trace 
was  always  pathological  and  never  physiological. 
Keference  was  also  made  to  oases  reported  by  Saund- 
by, of  Manchester,  and  others. 

Dr.  Kinnicutt  then  gave  a  brief  sketch  of  each  of 
his  own  cases.  The  first  three  patients  were  young 
men,  aged  twenty-three,  twenty-one,  and  seventeen 
respectively.  In  each  case  there  was  a  large 
amount  of  albumen  found  in  the  urine,  together  with 
oxalate  of  lime  and  uric  acid  crystals.  The  chief 
subjective  symptoms  were  :  sense  of  weariness,  las- 
situde, inaptitude  for  either  mental  or  physical  la- 
bor, headache  slightly  in  the  morning,  imjjairment 
of  appetite,  etc.  Exercise  in  the  open  air  and  min- 
eral waters  wei-e  presci-ibed,  together  with  regula- 
tion of  diet,  occupation,  and  Habits,  and  both  the 
subjective  and  the  urinary  symptoms  disappeared 
permanently.  The  histories  of  several  other  cases 
were  given,  occurring  in  patients  whose  ages  varied 
from  five  to  twenty-two. 

His  own  observations  seemed  to  show  that  tem- 
porary albuminuria,  as  it  occurs  in  children  and 
adole.scents  in  apparent  health,  may  be  traced,  in  a 
large  number  of  instances,  to  a  transient  oxaluria  or 


lithuria,  and  he  suggested  that  the  sequence  of 
events  in  the  causation  of  the  albuminuria  is  as  fol- 
lows : 

First. — The  temporary  presence  of  a  large  amount 
of  imperfectly  oxygenated  matter  in  the  circulation. 

Second. — Disturbances  of  the  general  nervous  sys- 
tem, in  which  the  vaso-motor  system  of  the  kidney 
shares,  or  one  confined  to  the  vaso-motor  system  of 
the  kidney  in  its  elimination  of  these  products  of  a 
faulty  digestion. 

Third. — A  transient  dilatation  of  blood-vessels  in 
the  kidney,  and  a  retardation  of  the  blood-current 
in  the  glomerular  vessels,  with  possibly  consequent 
alteration  in  the  functions  of  the  glomerular  epithe- 
lium, also  of  a  temporary  nature. 

The  paper  being  before  the  academy  for  discus- 
sion. Dr.  William  H.  Draper  spoke  as  follows  :  It 
seems  to  me,  Mr.  President,  that  Dr.  Kinnicutfs  in- 
teresting paper  presents  two  or  three  points  which 
are  especially  worthy  of  consideration.  The  first  of 
these  is  the  question  as  to  the  essential  cause  of  al- 
buminuria. Dr.  Kinnicutt  lias  considered  this  ques- 
tion very  fully,  and  we  find  that  there  are  various 
opinions  held  as  to  the  es.sential  cause  of  the  trans- 
udation of  blood-serum  into  the  urine.  I  think  that 
it  must  be  evident  to  any  one  who  lias  had  much 
clinical  ex2)erience,  that  the  theory  of  lilood-pressure 
is  not  sufficient  to  explain  the  presence  of  albumen 
in  the  urine,  for  it  is  certain  that  we  find  in  health 
very  gi'eat  variations  in  blood-pressure,  which  are 
not  followed  by  the  presence  of  albumen  in  the  urine. 
The  variation  in  the  quantity  of  urine  in  health  is 
considerable,  and  such  variation  must  coincide  with 
the  variations  in  blood- pres.sure  in  the  kidney.  Again, 
if  transudation  were  dependent  solely  ujjon  blood- 
pressure,  I  think  we  should  find,  in  those  diseases  in 
which  blood-pressure  is  seriously  altered,  the  pres- 
ence of  albumen  in  the  urine  much  more  constant 
than  it  is.  We  know,  for  example,  that  in  a  con- 
tracted kidney,  in  which  we  commonly  have  hyper- 
trophy of  the  heart,  and  iu  which  there  is  great 
arterial  tension,  the  2^resence  of  albumen  in  the  urine 
is  by  no  means  constant.  When  albumen  does  pre- 
sent itself,  we  also  know  that  it  is  transient,  and  in 
small  quantities.  Then,  if  we  take  diseases  of  the 
heart  in  which  there  is  obstruction  to  the  return 
circulation,  where  the  blood-pressure  is  sometimes 
very  much  reduced,  and  possibly  there  is  con- 
gestion of  viscera,  I  am  quite  certain,  from  a  con- 
siderable experience,  that  the  presence  of  albumen 
in  the  urine,  under  these  circumistances,  is  a  very 
variable  phenomenon.  You  will  find,  sometimes, 
that  there  is  considerable  congestion  of  the  lungs 
and  a  well-marked  systemic  congestion,  and,  at  the 
same  time,  there  is  no  albumen  in  the  urine.  It 
seems  to  me  that  hyperremia  alone,  whether  active 
or  passive,  fluxionary  or  dejiendent  upon  venous 
obstruction,  is  not  a  suificient  explanation  of  the 
l^resence  of  albumen  in  the  urine.  I  believe  that  we 
must  invoke  some  other  condition  to  explain  this 
23henomena.  Dr.  Kinnicutt,  in  his  paper,  alludes  to 
the  ojjinion  esiDressed  by  German  observers,  and 
pretty  generally  accepted,  that  albuminous  transu- 
dation does  not  take  place  in  the  kidney  unless 
there  is  destruction  or  deterioration  of  glandular 
epithelium.  We  know  very  well,  that  in  the  chronic 
Bright's  diseases,  especially  in  the  parenchymatous 
varieties,  in  which  the  presence  of  albumen  is  most 
constant  and  most  pronounced,  the  glandular  epithe- 
lium is  degenerated,  and,  to  a  very  considerable 
extent,  in  the  later  stages  of  the  disease,  destroyed. 
These  diseases,  therefore,  would   seem   to   furnish 


18 


THE  MEDICAL  RECORD. 


proof  that  this  condition  is  one  favorable  for  the 
transudation  of  blood-serum.  There  is  another  con- 
dition, however,  and  it  is  one  Dr.  Kinnicutt  has 
dwelt  upon,  which  by  itself,  or,  perhaps,  by  inducing 
the  changes  in  the  glandular  epithelium,  may  give 
rise  to  the  presence  of  albumen  in  the  urine.  There 
can  be  no  doubt  as  to  the  association  of  urates  and 
crystals  of  uric  acid  and  oxalate  of  lime  in  the  cases 
of  transient  albuminuria  occurring  in  adolescents 
and  children,  and  it  seems  to  me,  that  if  we  consider 
som3  of  the  morbid  conditions  in  which  albumen  is 
found  in  the  urine,  we  shall  find  them  corroborative 
of  this  suggestion,  that  the  presence  of  imperfectly 
oxidized  material  in  the  blood  may  give  rise  to 
albuminuria.  It  is  a  common  observation  that  the 
urine  of  persons  suffering  from  fever  may  contain 
albumen.  I  think  it  is  the  rule  in  pneumonia  to 
find  a  certain  quantity  of  albumen  in  the  iirine  ; 
certainly  in  typhus  fever  it  is  present  almost  invari- 
ably ;  also,  it  may  exist  in  tyjjhoid,  and,  in  fact, 
whenever  we  have  high  temjjerature  and  rapid  ema- 
ciation, and  the  blood  is  necessarily  loaded  with  the 
debris,  so  to  speak,  which  results  from  rapid  meta- 
morphosis of  tissue.  Here,  then,  we  have  not  only 
the  condition  which  has  been  spoken  of  as  essen- 
tial to  the  presence  of  albumen — hyperiemia  of  the 
kidney — but  we  have  hypenemia  combined  with  the 
presence  in  the  blood  of  considerable  irritative 
matter. 

As  to  the  vasomotor  theoiy,  which  is  the  most 
popular  just  at  the  present  time,  whether  it  is  suffi- 
cient to  exjjlain  the  presence  of  albuminuria  in  chil- 
di'en  and  in  adolescents,  I  do  not  know.  There  is 
one  question  which  certainly  will  suggest  itself  in 
considering  this  theory,  and  it  is  this  :  Wliy,  if  the 
imperfectly  oxygenized  nitrogenous  matters  produce 
this  temporary  albuminuria,  by  giving  rise  to  vaso- 
motor paralysis  in  the  kidney,  should  it  occur  so 
seldom,  considering  the  great  frequency  of  such 
changes  in  the  urine?  I  suppose  all  of  us  have, 
more  or  less,  lithfemia,  and  pass  urine  which  con- 
tains lithates  in  abnormal  quantity,  and  yet,  I  am 
sure,  the  occurrence  of  albuminuria  under  these  cir- 
cumstances is,  to  say  the  least,  in  adults,  and  also  in 
adolescents  and  young  children,  not  a  common 
event.  Why  is  it  that  in  a  few  cases  these  changes 
produce  vaso-motor  paralysis,  while  in  a  great  ma- 
jority of  cases  such  a  condition  is  not  produced? 
You  may  say  that  it  depends  upon  a  certain  vulnera- 
bility of  the  kidney  in  different  persons.  This  also  is 
a  convenient  theory.  It  is  true  that  the  skin  is  vul- 
nerable in  some  people,  and  the  mucous  membi-anes 
or  kidneys  in  others,  and  it  is  possible  that  this  is 
a  reasonable  explanation,  l)ut  still  it  does  not  seem 
to  me  altogether  satisfactoi-y. 

There  is  one  other  point  to  which  I  will  direct  at- 
tention, and  that  is  the  general  significance  of  albu- 
minuria. We  have  seen,  from  the  cases  presented  by 
Dr.  Kinnicutt,  that  albumen  in  large  quantities  has 
appeared  in  the  urine  of  young  children  and  adoles- 
cents, and  it  lias  seemingly  been  a  very  innocent  cir- 
cumstance. It  may  be  so.  I  have  no  doubt  that  in 
his  cases  it  was  so,  but,  at  the  same  time,  I  think  it 
always  suggests  suspicion  of  possible  kidney  disease. 
I  do  not  believe  that  it  is  safe,  under  any  circum- 
stances where  it  has  occurred  not  to  look  upon  it 
with  a  certain  amount  of  suspicion  and  interest,  but 
I  believe  that  if  we  regard  this  symptom  as  we 
should,  as  only  a  single  one,  and  if  we  study  it  as 
we  should  in  connection  with  other  evidence  of  dis- 
ease, we  shall  not  often  go  asti-ay  in  onr  a])procia- 
tion  of  its  true  significance.     We  all   know  that  a 


heart-murmur  is  not  necessarily  an  indication  of  or- 
ganic vahnilar  disease,  and  in  making  this  statement 
I  do  not  allude  simply  to  the  ordinary  blood-mtu- 
murs,  but  to  murmurs  which  ai-e  not  to  be  explained 
in  this  manner.  By  this  I  mean  to  say  that  we  do 
not  always  consider  them  sufficient  evidence  of  the 
existence  of  organic  vahnilar  disease.  We  should 
always  consider  the  murmur  in  connection  with 
other  symptoms.  So,  I  think,  albuminuria  should 
never  be  considered  by  itself,  and  a  false  signifi- 
cance attached  to  it  possibly  by  considering  it  alone. 
This  leads  me  to  remark,  that  the  only  safe,  sure, 
and  certain  way  of  appreciating  the  proper  signifi- 
cance of  the  jjresence  of  albumen  in  the  urine,  is  to 
consider  it  in  connection  with  an  estimation  of  the 
functional  power  of  the  kidney.  We  may  have 
transient  albuminuria  not  significant  of  stnictural 
disease,  or,  at  least,  only  temporary  change,  or  we 
may  have  transient  albuminuria  significant  of  or- 
ganic disease,  the  latter  being  the  rule  in  the  history 
of  the  contracted  kidney  ;  and,  in  order  to  estimate 
the  true  value  of  the  albuminuiia  in  both  instances, 
we  must  estimate  the  functional  power  of  the  kid- 
ney. This  we  can  do  by  estimating  the  daily  quan- 
tity of  urine  and  its  solids,  and  in  this  way  avoid 
error  in  our  appreciation  of  the  significance  of  the 
presence  of  albumen  in  the  urine. 

Dr.  a.  Jacobi  :  I  had  the  opportunity,  Mr.  Presi- 
dent, to  hear  only  a  part  of  Dr.  Kinnicutt's  paper, 
but,  from  what  I  did  hear,  and  from  the  general 
remarks  made  by  Dr.  Diaper,  I  have  been  led  to 
understand  that  albumen  can  show  itself  temporarily 
in  the  urine  of  children  and  adolescents  in  api)arent 
health.  I  should  say,  from  a  general  point  of  view, 
that  when  albumen  appears  in  the  urine,  it  is  due 
either  to  a  fault  of  the  blood,  or  to  a  fault  of  the 
muscular  apparatus  propelling  the  blood,  or  to  a 
faulty  condition  of  the  blood-vessels,  or  to  a  condi- 
tion of  the  kidneys.  With  regard  to  the  blood,  I 
do  not  believe  that  it  has  anything  to  do  with  it, 
as  we  know  that  its  condition  has  nothing  to  do  with 
hemorrhages,  which  are  always  due  to  changes  in 
the  blood-vessels  or  of  the  heart,  or,  perhaps,  are 
due  to  innervation.  I  shall  add  nothing  to  what  I 
have  heard  already,  excejjt  one  point,  which  has,  I 
think,  not  been  alluded  to  in  the  etiology  of  tempo- 
rary albuminuria,  and  that  is  the  condition  of  the 
blood-vessels  in  certain  cases.  I  have  seen  two  pa- . 
tients  in  whom  I  found  well-marked  albuminuria 
associated  with  disease  of  the  blood-ve.ssels.  In 
one  instance  of  lui'moglobinuria  occurring  in  an 
adult  man,  who  had  always  been  well,  but  had  been 
exposed  for  one  or  two  days  to  cold  and  wet,  it  was 
suddenly  noticed  that  the  urine  was  dark-colored,  and 
it  soon  became  absolutely  black.  This  condition  of 
things  passed  away  in  about  a  week.  Some  weeks 
afterward  the  same  thing  occurred  again,  and  the 
patient  lost  a  considerable  tiuantity  of  blood.  The 
same  condition  of  his  urine  ap]>eared  a  number 
of  times  at  varying  intervals.  Nothing  was  neces- 
sary to  bring  the  luematuria  on,  excejit  exposure  to 
cold  air  or  rain.  I  found  a  number  of  times  when 
he  was  apparently  well,  that  his  urine  showed  the 
presence  of  albumen,  and,  at  the  same  time,  there 
was  no  blood  or  pus  in  it.  In  this  case  I  regarded 
the  presence  of  albumen  in  the  urine  as  certainly 
due  to  the  diseased  condition  of  the  blood-vessels, 
and  primarily  so.  Cases  of  this  kind  have  to  be  ex- 
plained by  the  faulty  condition  of  the  blood-vessels, 
in  the  same  way  as  do  certain  cases  of  ]>uriiura,  or 
morbus  maculosus.  ,\  girl,  seven  or  eight  years  of 
age,  came  under  my  observation,  wlio  had  been  the 


THE  MEDICAL  RECORD. 


subject  of  purpura  a  number  of  years.  It  was  not 
known  that  she  had  been  a  bleeder  from  birth,  nor 
was  there  any  history  of  h.Tmophilia  in  the  family. 
Purpura  first  developed  at  three  or  four  years  of 
age,  and  with  her  was  quite  a  common  occurrence. 
She  had  as  many  as  two  or  three  attacks  in  the 
course  of  a  year.  Sometimes  the  quantity  of  blood 
lost  would  be  very  slight,  at  other  times  larger ; 
sometimes  the  attack  would  last  a  week,  at  other 
times  three  or  four  days,  and  be  attended  with 
the  appearance  of  albumen,  without  blood  or  pus, 
in  the  urine.  It  was  usually  not  long  after  an  attack 
of  purpura  before  she  was  fully  recovered,  and  when 
well  there  was  no  blood  or  albumen  to  be  found  in 
the  urine.  I  judge,  from  two  such  cases,  that  one 
of  the  causes  of  temporary  albuminuria  is  a  defective 
condition  of  the  blood-vessels,  which  favors  the  oc- 
currence of  hemorrhage ;  and  where  there  is  no 
hemorrhage,  a  condition  remains  sulEcient  to  allow 
the  serum  to  ooze  through  the  walls  of  the  vessels. 
This  tempoi'ary  albuminuria  should  not  l>e  over- 
looked, and  I  think  that  iu  a  few  cases  it  will  be  found 
complicated  with  a  tendency  to  morbus  maculosus. 
With  reference  to  the  literature  of  the  subject,  I 
would  direct  attention  to  a  most  valuable  article, 
written  by  Dr.  Ellis,  of  Harvard  College,  and  pub- 
lished in  the  Boslun  Medical  and  Snrgicid  Journal. 
which  contains  complete  references  to  everything 
th.\t  has  been  written  upon  this  subject,  up  to  the 
date  of  its  publication. 

Dr.  William  H.  Thomson  :  I  am  not  aware,  INIr. 
President,  of  having  made  any  observations  which 
will  quite  illustrate  the  particular  class  of  cases  re- 
ferred to  in  Dr.  Kinnicutt's  interesting  pajjer,  but 
I  may  say  that  I  have  had  a  number  of  cases  of  tran- 
sient albuminuria  occurring  among  children,  several 
of  whom  I  watched  carefiiUy,  and  in  which  I  ascribed 
the  condition  exclusively  to  malarial  attacks.  I  was 
led  to  this  conclusion  first,  by  observing  a  case  of 
intermittent  hiematuria  occurring  in  a  child  three 
years  of  age.  There  was  no  evidence  of  purpura, 
and  the  hfematuria  lasted  two  or  three  weeks,  and 
then  distinct  symptoms  of  intermittent  fever  devel- 
oped. The  intermittent  hiematuria  disappeared  en- 
tirely, but  for  two  years  afterward  albuminuria  made 
its  appearance  now  and  then,  and  promptly  yielded 
to  the  administration  of  quinine.  This  case  led 
me  to  examine  the  urine  in  others  where  I  sus- 
pected malarial  infection,  and  I  could  produce  the 
notes  of  at  least  twelve  cases,  occiu-ring  among 
children,  where  there  was  no  hrematuria,  and  yet 
where  there  was  albuminuria,  and  I  have  regarded 
it  as  temporary,  due  to  a  transient  renal  congestion 
produced  by  a  malarial  affection.  My  attention  at 
that  time  had  not  been  especially  directed  to  one 
of  the  causes  which  Dr.  Kinnicutt  has  mentioned, 
and  it  may  be  said  that  the  albuminuria  and  the 
htematuria  in  these  cases  were  the  result  of  con- 
siderable lithuria,  as  we  all  know  that  that  condi- 
tion is  exceedingly  common  in  children  from  three 
to  ten  years  of  age  ;  but  if  transient  alliuminuria 
is  a  frequent  accompaniment  of  lithuria,  I  sliould 
regard  it  as  due  to  a  temporary  tubal  catan-h,  pro- 
duced by  local  irritation  from  crystals  of  oxalate  of 
lime  and  uric  acid,  which  are  of  themselves  neces- 
sarily initant,  rather  than  to  bring  in  the  hypothet- 
ical view  that  it  depends  upon  some  affection  of  the 
vaso-motor  system  of  nerves.  I  was  very  much  in- 
terested in  the  paper,  and  at  the  same  time  it  lias 
served  to  deepen  an  impression  which  has  been 
growing  in  my  mind  for  a  number  of  years,  which 
is,  that  we  do  not  know  what  the  causes  of  albu- 


minuria are,  in  the  sense  of  being  able  to  reduce 

them  to  one  or  two  ])rinciples ;  that  we  are  constantly 
brought  in  contact  with  cases  in  which  albuminiuia 
occurs  without  any  of  the  causes  whicli  are  ordinarily 
sujjposed  to  operate  in  its  production,  and  also  we  are 
as  constantly  brought  face  to  face  with  exceedingly 
serious  and  fatal  disorders  of  the  kidney,  in  which  al- 
buminuria has  never  been  a  prominent  featiire  of  the 
disease.     I  say  never  advisedly.     I  wDl  mention  in 
illustration  two  such  cases  of  an  opposite  kind.     In 
one  of  them  there  was  transient  albuminuria,  which 
afterward  became  permanent.     It  occuiTed  in  the 
practice  of  Dr.  Mourraille,  by  whom  I  was  called  to 
see  the  patient,  in  consultation  with  Professor  Flint. 
A  gentleman,  about  sixty  years  of  age,  awakened  one 
night  in  the  summer,  suffering  from  a  severe  attack 
of  dyspntea.    The  attending  physician  examined  the 
patient's   urine,   and   found   it   highly  albuminous. 
The  doctor  then  stated  that  he  had  attended  this 
gentleman  for  some  weeks,  during  which  time  there 
was  albumen  in  the  urine,  but  that  it  gradually  de- 
creased in  quantity,  and  then  entirely  disappeared. 
On  one  occasion  the  urine  was  examined  and  no 
albumen  was  found,  and  within  half  an  hour  the 
patient   had  a  severe  attack   of  dysjjnoea.     It  was 
then  again  examined,  and  was  found  to  be  exceed- 
ingly albuminous.    Dr.  Flint  and  myself  both  agreed 
that  the  dyspncea  was  ur;emic  in  character,  and  each 
of  us  thought  it  most  likely  that  the  iJatient  had  had 
renal  disease  for  some  time  without  being  aware  of 
it,  and  that  this  was  a  transient  exacerbation,  which 
finally  disappeared  and  then  recun-ed.     But  I  was 
struck  with  the  fact  that  there  was  no  tension  of  the 
piilse,  no  change  in  the  condition  of  the  arteiies,  but 
that  they  were  much  softer  than  they  commonly  are 
in  persons  of  that  age.    I  watched  the  case  very  care- 
fully, and  the  albumen  disappeared  in  the  course  of 
eight  days.     The  urine  had  been  examined  carefully 
and  repeatedly,  and  I  had  made  several  examina- 
tions of  it  myself,  and  yet.  within  ten  hours  from  the 
last  which  I  had  made,  I  was  called  to  see  the  patient 
in  an  attack  of  severe  dyspnu-a,  which  was  followed 
by  free  pleuritic  effusion  on  the  right  side.    Here  we 
had  all  the  symptoms  of  ur:emic  dyspnoea  and  alliu- 
minuria developed,  at  one  time,  within  a  half-hour, 
and  then  intermittent  attacks  of  dyspnoea  occurred, 
and  finally  a  severe  attack,  with  effusion  into  the 
pleuritic  cavity,  and  albuminuria  within  te»  hours  of 
the  last  examination  of  the  urine.     Finally  the  albu- 
minuria became  permanent,  with  abundant  epithe- 
lial and  fatty  casts,  and  in  the  course  of  eighteen 
months  the  patient  died,  with  all  the  symptoms  of 
chronic  Bright's  disease. 

On  the  other  hand,  occurs  a  case  within  the  pres- 
ent vaar.  .\  young  married  lady,  always  perfectly 
healthy,  became  pregnant.  The  jjregnancy  pro- 
gressed without  any  of  the  ordinary  symptoms.  At 
the  end  of  the  sixth  month  I  began  to  examine  the 
urine,  and  found  no  changes  in  it,  either  chemically 
or  microscopically,  up  to  the  close  of  the  seventh 
month  and  the  beginning  of  the  eighth,  when  I  dis- 
covered that  the  specific  gravity  was  falling,  while 
the  mine  was  abundant  in  quantity.  Tlie  specific 
gravity  fell  from  the  normal,  until  it  reached  1,010- 
]  8-6-4,  'and  yet  there  was  not  the  slightest  trace  of 
albumen.  The  only  other  peculiar  ])hysical  appear- 
ance which  it  presented  was  the  absence  of  color. 
The  simple  fact  of  the  diminished  specific  gi-avity, 
made  me  very  apprehensive  of  an  imfavorable  ter- 
mination of  the  case,  and  I  felt  that  I  should,  per- 
i  haps,  bring  on  premature  labor.  The  only  symptoms 
I  fi-om  which  the  patient  suffered  were  slight  head- 


20 


THE  MEDICAL  RECORD. 


aches  in  the  morning,  and  occasionally  some  nervous- 
ness, but  not  at  all  marked.  I  was  called  one  morning, 
suddenly,  to  see  this  patient  in  a  convulsion,  which 
killed  her  at  once.  Not  a  trace  of  albumen  was  found 
in  the  urine  from  the  beginning  to  the  end  of  the  case, 
although  daily  examinations  were  made  for  a  month. 
There  were  no  casts.  The  only  changes  in  the  urine 
were  the  lowered  specific  gravity  and  the  absence  of 
color,  and  yet  the  condition  was  one  in  which  we 
would  very  naturally  expect  albumen  in  the  urine  to 
be  present,  due  to  pressure  upon  the  return  circula- 
tion inciilent  to  pregnancy.  I  mean,  therefore,  this :  a 
case  like  the  first,  that  in  which  a  man  suffered  from 
attacks  of  extreme  dysjjniea,  with  transient  alljumi- 
nuria,  the  attacks  of  dyspnrea  recurring,  and  the 
transient  albuminuria  iinally  becoming  permanent 
and  associated  with  disorganization  of  the  kidney ; 
and  a  case  like  the  second,  in  which  a  condition 
occurs  which,  in  accordance  with  the  mechanical 
theory,  is  supposed  to  be  dependent  upon  pressure, 
and  yet  tliere  is  no  albuminuria  whatever,  only  sus- 
tains me  in  the  belief  that  we  have  not  yet  reached 
the  ultimate  cause  of  albumen  in  the  urine.  In  both 
of  these  cases  we  have  theories  contradicted  by  clini- 
cal experience,  and  hence  I  do  not  see  that  we  have 
yet  a  single  explanation  of  albuminuria  which  is  sat- 
isfactory in  anything  more  than  a  certain  proportion 
of  cases.  On  that  account  none  of  our  hyjjotheses 
rise  higher  than  mere  hypotheses,  else  we  should 
not  liave  these  extraordinary  escei^tions  to  them.  I 
do  not  see  how  we  can  appeal  to  vaso-motor  paraly- 
sis, either  transient  or  permanent,  to  explain  the 
presence  of  albumen  in  the  urine,  for  we  have  many 
cases  of  vaso-motor  paralysis  in  which  there  is  no 
albumen  in  the  urine.  So,  again,  with  regard  to  in- 
creased blood- pressure :  when  it  is  presented  to  us 
in  its  typical  form,  in  the  high  tension  of  the  pulse 
in  the  granular  kidney,  it  is  TisTxally  not  accomjjanied 
with  albuminuria,  but  the  reverse. 

Dr.  E.  C.  Se«uin,  in  support  of  the  theory  ad- 
vanced by  Br.  Kinnioutt,  that  nric  acid  and  oxalate  of 
lime  and  urates  proddce  irritation  of  the  kidney,  and 
in  a  reflex  way  cause  vaso-motor  jjaralysis  of  the 
associated  vascular  system  of  the  organ,  referred 
to  a  classical  experiment  performed  by  Eanviei", 
twelve  years  ago.  It  consisted  in  tying  the  vena  cava 
ascendens  of  a  dog,  following  which  there  was  no 
oedema  observed  in  the  lower  extremities.  He  then 
cut  the  sciatic  nerve  on  one  side,  and  there  ensued 
an  ffidema  of  the  paralyzed  member,  the  other  hmb 
remaining  normal.  This  experiment  would  go  to 
show  that  a  vaso-motor  paralysis  was  necessary  to 
transudation  of  the  liquid  elements  of  the  blood 
into  the  tissues.  The  same  result  has  also  been  ob- 
tained in  attempting  to  produce  Basedow's  disease 
experimentally.  It  was  found  that  neither  ligation 
of  the  internal  jugular  veins,  nor  yet  section  of  the 
sympathetic  nerve,  when  done  separately,  produced 
it ;  but  it  was  left  for  a  pupil  of  Bonders,  Boddaert 
in  1872,  to  show  that  by  a  combination  of  the  two 
operations  a  very  remarkable  resemblance  of  the  dis- 
ease is  produced,  including  projection  of  the  eyeball. 
If  now  wo  take  into  consideration,  on  the  one  hand, 
the  clinical  points  in  connection  with  the  contracted 
kidney,  as  well  brought  out  by  Dr.  Draper,  the  high 
arterial  tension,  which  is  chai-acteristic  and  yet  no 
transudation  of  the  albiimen  ;  and,  on  the  other  hand, 
the  fact  that  where  blood-tensjon  is  lowered  from 
renal  or  general  disease,  and  albuminuria  exists, 
these  two  sets  of  facts,  with  the  experiments  above 
referred  to,  rally  considerably  in  support  of  Br. 
Kinnicutt's  explanation,  and  do  not  interfere  with 


that  given  by  Dr.  .Jacobi.  It  may  be  that  the  lesion 
of  the  blood-vessels,  to  which  he  refers  as  the  cause 
of  the  transudation,  is  relaxation  and  separation  of 
their  muscular  cells  through  vaso-motor  paralysis. 

Dr.  E.  Br.\dley  referred  to  cases  of  temporary 
albuminuria  occumng  in  young  persons  addicted  to 
the  exces.sive  use  of  cigarettes. 

Dr.  J.\cobi  :  I  did  not  mean  to  say  that  my  expla- 
nation was  for  every  case.  It  was  simply  put  for- 
wai'd  as  one  of  the  causes  of  albuminuria. 

Dr.  KrxNicuTT,  in  closing  the  discussion,  said  he 
had  endeavored  to  show  in  his  paper  that  albu- 
minuria could  not  be  explained  on  the  groimd  either 
of  high  or  low  ai'terial  tension  alone.  He  had  also 
endeavored  to  show  that  filtration  of  albumen 
through  an  animal  membrane  is  a  comparatively 
slow  process ;  that  a  condition  of  such  filtration  is, 
that  the  albumen  remains  a  comparatively  long  time 
in  contact  with  the  wall  of  the  vessel,  and  such  pro- 
longed contact  can  be  obtained  only  by  retardation 
of  the  blood-current.  He  had  suggested  that  such 
retardation  was  brought  about  by  disturbance  of  the 
vasomotor  system  within  the  kidney.  He  also  stated 
that  he  did  not  claim  that  his  explanation  was  suffi- 
cient for  all  cases  of  albuminuria  occurring  in  chil- 
dren and  adolescents  ;  he  believed  that  its  more 
frequent  occurrence  then  than  at  a  later  period  of 
life  was  due  to  the  gi-eater  mobility  of  the  nervous 
system  which  obtained  at  these  periods.  The  ex- 
planation a.sked  by  Drs.  Draper  and  Thomson,  of 
the  occurrence  of  a  temporary  alliuminxiria  in  only 
a  small  proportion  of  cases  of  lithiemia  in  children 
and  adolescents,  he  thought  might  be  found  in  the 
supposition  of  an  indivldnal  mobiUty  of  the  nervous 
system  in  such  cases.  In  this  connection,  he  would 
ask  them  the  explanation  of  the  comparative  infre- 
quenoe  of  general  nervous  symptoms  in  cases  ef 
lithremia — symptoms  which  were  well  recognized 
as  occurring  in  a  certain  number  of  siieh  cases. 
Again,  why  it  was  that  one  indi^adual  developed  an 
eczema  or  an  urticaria,  and  another  an  affection  of 
the  mucous  membranes  under  such  circumstances? 

The  absence  of  structural  change  in  the  glandular 
epithelium, it  seemed  to  him,  was  demonstrated  by  the 
very  transient  nature  of  the  albiiminuria  in  the  cases 
which  he  had  observed  and  reported.  He  had  sug- 
gested, as  one  of  the  factors  in  its  production,  a  tem- 
porunj  diatnrhed  tiiitrition  of  the  epithelium,  depend- 
ent upon  altered  nutrition,  also  of  a  temporary 
nature.  If  Nussbaum's  conclusions  were  accepted, 
and  they  had  been  reached  by  a  careful  series  of  ex- 
periments, that  the  glomerular  vessels  were  the  seat 
of  the  transudation  of  albumen,  then  the  suggestion 
offered  by  Br.  Thomson,  that  in  these  cases  there 
is  transient  tubal  catarrh,  would  not  apply.  Dr. 
Thomson  luid  also  sj^oken  of  the  absence  of  albumi- 
nuria in  tlie  case  of  ophthalmic  goitre.  A  number  of 
cases,  however,  had  been  observed,  in  which  the  al- 
buminuria had  only  appeared  with  the  develojiment 
of  this  affection,  disajipearing  with  its  cessation.  To 
determine  whether  albuminuria  was  present  or  not 
in  a  case  of  exophthalmic  goitre,  it  was  necessary  to 
examine  the  urine  not  only  every  day,  but  at  differ- 
ent times  in  the  same  day,  as  in  the  cases  re))orted. 
The  fact  had  been  brought  out  very  prominently  that 
a  great  variation  in  its  occurrence  was  the  rule. 
Cases  of  this  kind  had  been  reported  by  Dr.  Begbie. 
and  coiToborated  by  Dr.  George  .Johnson. 

Dr.  Kinnicutt  tliought  that  Br.  .Tacobi's  sugges- 
tion might  be  accepted  in  ex]>Iaiiation  of  certain 
oases  of  a  transient  albuminuria,  although  in  his 
own  the  disease  mentioned  could  be  excluded. 


THE  MEDICAL  RECORD. 


21 


With  regard  to  the  existence  of  malaria  as  the 
cause  of  albuminuria,  he  believed  that  it  could  also 
be  excluded  from  his  cases,  inasmuch  as  they  had 
been  under  constant  observation,  and  during  the  en- 
tire period  there  had  been  none  of  the  ordinary 
manifestations  of  malarial  poisoning. 

The  academy  then  adjourned. 


CorrcspontifucE. 


LETTER  FROM  WASHINGTON— A  DAY 

^Y^^H  guiteau. 

To  TUE  Editor  of  The  Medical  Becobd. 

Sir  :  We  arrived  early  Thursday  morning,  and  drove 
at  once  to  the  Tremont  House,  where  Mr.  Scoville 
boards.  Our  cards  were  sent  up.  While  I  was  wait- 
ing in  the  ottice,  a  small,  neatly  dressed  man  came  up 
to  me  and  said  his  name  was  Guiteaii,  and  that  Mr. 
Scoville  would  be  down  soon.  Having  associated 
the  name  of  Guiteau  with  everything  grim  and  de- 
moniacal, it  was  something  of  a  shock  to  find  so  in- 
otfensive-appearing  an  individual  presenting  it.  The 
gentleman  was  Mr.  .J.  W.  Guiteau.  He  appears  like  a 
polite  and  "  every- day  young  man  "^nothing  more. 
Mr.  Scoville  soon  came  in.  He  is  gray  and  bald, 
but  vigorous  in  manner,  and  shows  no  signs  of  age. 
His  face  is  somewhat  pale  and  his  eyes  red,  as 
though  from  over-use.  He  talked  to  us  very  freely 
about  the  trial.  He  was  very  sanguine,  and  expects 
to  convince  some  of  the  jury  at  least  that  Guiteau  is 
insane.  He  referred  to  the  unfavorable  comments 
made  upon  his  hypothetical  question.  He  said, 
however,  that  he  put  in  it  only  what  he  expected, 
and  was  really  obliged  to  jjrove  before  the  jury.  Ho 
thought  he  could  convince  the  jury  of  the  truth  of 
most  of  his  assumptions.  Speaking  of  his  not  cross- 
questioning  the  first  experts  for  the  defence — i.e., 
Drs.  Godding,  Nichols,  Folsom,  and  others — he  said 
that  he  expected  to  be  able  to  prove  by  cross-ex- 
amining the  experts  for  the  defence  all  the  i:)oints 
necessary.  Mr.  Scoville,  at  the  early  part  of  the 
trial,  thought  that  almost  all  the  experts  would  come 
over  to  his  side.  He  was  too  optimistic,  however. 
He  discussed  the  conduct  of  the  Government  experts 
very  freely,  though  not  unkindly.  They  had  met, 
and  had  finally  all  agreed  to  go  over  to  the  prosecu- 
tion, and  stand  by  each  other,  as  it  was,  in  a 
measure,  their  interest  to  do,  being  all  asylum 
superintendents.  It  was  a  kind  of  "  psychological 
contagion  of  non-expertness,"  as  Dr.  Beard  had 
called  it.  This  is  hardly  a  fair  way  to  put  it,  I 
think,  as  some  had  undoubtedly  made  up  their 
minds  independently  before  or  after  arrival  at 
Washington. 

Mr.  Scoville  refen-ed  to  Dr.  Hamilton's  testimony 
as  being  unnecessarily  positive  in  character.  He 
showed  us  the  measurements  of  Guiteau's  cranium, 
made  by  that  witness.  They  were  taken  in  the 
nsual  way.  but  it  so  hapj^ened  that  the  configura- 
tions of  the  median  line,  of  the  auriculo-bregmatic 
line,  and  of  the  circumference  just  above  the  external 
angular  process,  do  not  show  the  irregularities  as 
they  really  exist,  but  only  a  slight  bulging  on  the 
right  side.  I  enclose  them  here  for  your  use  if  you 
wish.  The  fact  is  that  there  is  a  decided  bulging 
near  the  left  parietal  eminence  (the  posterior  vertical 


line  described  by  Topinard  would  pass  through  it), 
and  a  depression  almost  corresponding  on  the  right 
side.  I  examined  the  cast  of  the  head  carefully.  It 
does  not  show  the  irregularities  so  well  as  the  head 
itself,  but  one  can  see  an  obliquely  directed  ridge  of 
bone  passing  from  aliout  the  left  parietal  eminence 
backward,  downward,  and  toward  the  right  till  it 
reaches  the  vicinity  of  the  right  ear.  This  ridge  i» 
two  or  three  inches  wide.  Most  of  it  is  on  the  left 
side,  and  it  makes  the  skull  noticeably  asymmetrical. 
I  took  a  strip  of  lead  and  adapted  it  to  a  line  on  the 
skull,  passing  from  the  left  ear  over  the  occijait  to 
the  right  ear.  In  this  way  I  got  a  trustworthy- 
tracing  proving  in  quite  a  striking  manner  the  de- 
gree of  asymmetry  of  the  skull.  I  also  saw  a  tracing: 
made  by  the  hatter.  But  this  configuration  is  too 
low  down  to  indicate  anything.  A  tracing  made  at 
about  the  same  height  by  Dr.  Hamilton  sho^  s  only 
a  slight  bulging  on  the  right  side.  Another  cir- 
cumferential measurement  made  parallel  to  the 
alveolo-condyloid  plane,  about  one  inch  lower  than' 
the  bregma,'  just  above  the  frontal  iirominences,. 
.shows  better  than  any  other  the  apparent  fact  that 
there  is  less  brain  on  the  right  than  the  left  side. 
This,  combined  with  the  deficient  innervation  of  the 
left  side  of  the  face,  and  the  turning  of  the  tongue 
to  the  left,  may  or  may  not  indicate  something. 
Most  likely  the  facts  are  of  no  importance  at  all. 

We  went  up  to  the  Court  House,  and  I  obtaiuecJ 
a  seat  close  by  the  dock,  so  near  that  I  could  touch 
the  prisoner  as  he  sat  there.  I  was  not  rid  of  the 
idea  that  something  massively  brutal  and  fifudish 
was  to  be  expected  in  the  appearance  of  President 
Garfield's  assassin.  There  was  consequently  a  mix- 
ture of  surprise  and  disappointment  on  first  seeing 
the  prisoner.  He  is  a  puny,  white-l'aced,  insignifi- 
cant little  fellow,  with  a  peculiar  look  in  his  eyef, 
and  a  rather  anxious  expression  on  his  face.  He  sat 
down  in  the  dock,  but  at  once  began  an  appeal  to 
the  judge  to  have  his  usual  guard  of  policemen.  I 
watched  him  narrowly  for  the  two  hours  ensuing. 
He  seemed  to  be  in  a  state  of  nervous  tension  all 
the  time,  with  his  mind  keenly  awake  to  every  inci- 
dent of  the  trial.  He  did  not  seem  to  be  feigning 
anything,  but  he  did  api?ear  annoyed  and  anxious  at 
times.  He  read  the  newspapers  ;  there  is  no  doubt 
of  that,  for  I  could  see  his  eyes  move  from  time  to 
time.  It  is  a  mistake  to  suppose  that  his  intenup- 
tions  are  all  well-timed  and  useful  to  himself.  He 
exults  when  a  point  is  made  for  him,  and  loses  no 
chance  of  getting  a  hit  at  Corkhill  or  Porter ;  but 
he  abused  his  counsel  roundly  for  putting  in  a  let- 
ter applying  to  Cameron  for 'S500— a  letter  which,, 
if  sincerely  written,  is  a  most  extraordinary  docu- 
ment. There  is  nothing  like  a  circus  display  in  the 
court-room,  as  has  been  intimated,  but  there  is  not 
unfrequently  slight  laughter  at  the  remarks  of  the 
prisoner.  It  is  diificult  to  conceive  the  intensity 
and  bitterness  of  feeling  against  Guiteau  sho-nn  by- 
the  prosecuting  attorneys.  Corkhill  seems  to  be  in 
a  state  of  constant  irritation  toward  him  :  Judge 
Porter  never  interposes  a  remark  without  atttmpt- 
ing  some  dramatic  efiect  for  the  benefit  of  the  juiy.. 
Mr.  Davidge  and  Judge  Cox  are  more  fair.  On  the 
other  side,  Mr.  Scoville  battles  away,  doing  his  best, 
and  doing  vei-y  well.  He  refuses  to  be  imposetl 
upon,  and  is  showing  a  better  appreciation  of  the 
points  that  he  must  make  as  the  trial  proceeds.  He 
is  profoundly  convinced  of  the  insanity  of  Guiteau, 
and  ap])ears'to  be  only  amused  at  the  abuse  heaped 
upon  him.  Mr.  Keed  is  a  sharp  lawyer,  but  not  an 
extraordinary  or  particularly  brilliant  one.    I  doubt 


22 


THE  MEDICAL  EECORD. 


if  he  has  a  very  great  knowledge  of  insanity  in  any 
of  its  relations. 

It  is  apparent,  on  the  whole,  that  the  prosecution 
is  working  its  Yery  utmost — not  to  discover  the  real 
mental  condition  of  Guiteau,  but  to  have  him  hung 
as  soon  as  possible.  On  the  other  hand,  the  de- 
fence tries  simply  to  convince  the  jury  that  Guiteau 
was  insane  on  the  2d  of  July,  and  did  not  at  that 
time  know  the  difference  between  right  and  wrong, 
Of  course,  to  one  looking  at  the  matter  from  a  scien- 
tific point  of  view,  the  whole  trial  is  a  ridiculous 
farce.  Bitterness  and  passion  are  at  the  bottom,  and 
reason  is  used  only  in  so  far  as  it  helps  on  the  de- 
sires of  the  heart.  The  minds  of  the  Washing- 
toniaus  are  drenched  with  this  same  hate  of  Guiteau. 
I  met  no  one,  male  or  female,  who  was  able  to  dis- 
cuss the  question  of  Guiteau's  sanity  without  inter- 
jecting a  wish  that  he  should  be  hung.  It  is  possible 
that  the  experts  felt  somewhat  the  influence  of  this 
feeling.  In  those  whom  I  heard  examined  there  is 
no  question  that  they  strained  a  little  in  order  to 
increase  the  effect  of  their  testimony.  Thus,  one 
gentleman,  Dr.  Kempster,  testified  in  a  way  which 
would  lead  the  listener  to  think  that  heredity  was  a 
very  insignificant  element  in  the  causation  of  in- 
sanity. An  impression  was  given  also  that  delusions 
of ''inspiration"  came  always  through  suggestions 
from  without,  and  were  rapid  and  instantaneous  in 
their  development  and  action.  A  few  of  the  experts 
testified  to  a  belief  in  Guiteau's  feigning.  I  can  un- 
derstand how  such  a  suspicion  would  arise,  but  I 
could  not  convince  myself  that  it  was  a  fact.  Gui- 
teau is  certainly  sane  enough  now  not  to  want  to  be 
hung,  and  he  tries  in  an  anxious  and  blundering  way 
to  help  his  cause.  It  is  plain,  I  think,  that  his  case 
would  be  better,  on  the  whole,  if  he  had  kept  still. 
I  would  not  wish  to  intimate  that  the  exjjerts  for  the 
defence  are  not  perfectly  sincere  in  the  views  they 
testify  to.  But  it  seems  to  me  tliat  it  would  be 
almost  impossible  to  live  in  Washington  for  five 
weeks  and  not  catch  some  of  the  sanguinary  spirit 
afloat  there. 

The  real  issue  of  course  is  :  Is  Guiteau  insane  ? 
The  methods  used  in  the  trial  to  obtain  a  .settlement 
of  that  question  are  to  the  last  degree  farcical.  The 
experts  are  used  by  the  lawyers  simply  to  serve  their 
«nds  ;  and  opinions  or  views  that  would  not  be  likely 
to  affect  the  jury  are  treated  with  indifterence. 

After  the  close  of  the  afternoon  session  we  took  a 
carriage  and  drove  over  to  the  jail,  where  we  were 
conducted  to  Guiteai's  cell.  This  is  the  last  of  a 
long  row  of  cells,  and  the  largest  and  best  of  them. 
Oaiteaii  was  seated  at  a  table, 'engaged  in  his  never- 
ending  writing.  He  rose  to  receive  us,  and  said  he 
was  rather  busy,  but  would  be  willing  to  talk  to  us. 
He  has  been  rather  over-interviewed,  and  does  not 
enjoy  it  as  he  once  did.  However,  he  treated  us 
courteously,  offered  us  seats,  and  answered  our  ques- 
tions, for  the  most  part,  in  a  mild  and  pleasant  tone 
of  voice.  My  companion  asked  him  if  he  was  a 
Christian.  "  Yes,"  he  said,  "  I  hoi)e  so — indeed,  I 
know  80— of  cour.se."  We  questioned  him  al)out  his 
inspiration.  He  thought  it  was  like  that  of  the 
apostles.  He  thought  his  book  "  Truth  "  was  in- 
spired, just  as  the  Bible  was.  He  told  us  about  the 
hard  work  he  had  put  upon  it.  The  book  is  out  of 
print  now.  I  asked  him  if  he  thought,  supposing 
ho  were  let  out,  that  he  would  be  liable  to  have  an 
inspiration  again  like  tliat  wliich  cau.sed  the  assas- 
sination. "  No,"  said  he,  "  of  course  not ;  I  don't 
wish  to  talk  about  that."  He  got  a  little  surly,  and 
agiin  a  little   excited,  when  talking   about   jmblic 


opinion,  which,  he  was  convinced,  was  turning  in  his 
favor.  He  dwelt  iipon  this  a  great  deal.  I  asked 
him  what  his  feelings  were  after  he  removed  the 
President.  He  said  that  after  he  had  been  safely 
placed  in  jail  he  never  felt  happier  in  his  life.  He 
was  pleased  and  satisfied  with  the  progress  of  the 
trial,  and  did  not  allow  it  to  worry  him  after  he  got 
back  to  jail.  I  imagine  that  it  did  worry  him  a  lit- 
tle, however.  He  said  he  did  not  sleeij  very  well ; 
he  slept  for  about  four  hours,  then  awoke  and  dozed 
irregularly  until  morning.  Guiteau's  face  is  pale ; 
his  eyes  have  a  peculiar  look,  to  which  I  have  re- 
ferred, and  which  is  due,  in  part,  to  the  white  and 
almost  cedematous  lids,  reddened  margins,  and  suf- 
fused conjunctiva. 

The  tongue,  when  protruded,  turns  very  noticeably 
to  the  left — not  only  the  tip,  but  the  whole  organ. 
The  experts  have  stated  that  this  is  not  rare  or 
unusual.  It  so  happens  that  in  my  experience  I 
have  never  seen  a  tongue  so  deviated  in  a  healthy 
person  ;  hence  I  was  struck  by  it.  There  is  a  verti- 
cal furrow  on  the  right  side  of  the  forehead,  but 
none  on  the  left.  Of  the  two  furrows  on  each  side 
of  the  mouth,  that  on  the  left  is  deeper.  The  left 
eye,  that  is,  its  palpebral  fissure,  seems  smaller. 
By  watching  very  closely  one  can  notice  a  slightly 
less  active  movement  of  the  muscles  of  the  left  side 
of  the  face.  This  is  very  slight  indeed.  In  smiling 
the  lips  appeared  to  be  drawn  out  .symmetrically. 
On  the  whole,  tlie  evidences  of  physical  defect  in 
Guiteau  are  slight. 

Guiteau's  appearance  was  mild  and  inoffensive. 
I  could  hardly  realize  that  I  was  standing  in  the 
presence  of  a  person  who  had  done  an  act  which 
aroused  a  great  nation,  altered  so  many  destinies, 
and  turned  the  eyes  of  the  whole  world  upon  him ; 
a  man  who,  if  sane,  is  a  greater  monster  than  ever 
was  conceived  by  the  weirdest  imagination  of  Sue 
or  Dumas. 

I  went  to  Washington  thinking  that  society  ought 
to  consider  Guiteau  a  sane  man.  It  is  difficult  not 
to  feel  now  that  the  theory  that  he  is  insane  best 
harmonizes  and  makes  clear  his  actions.  If  I  were 
an  expert  (which  I  am  not)  and  obliged  to  testify,  I 
would  say  that  I  did  not  know — a  position  at  once 
safe,  scientific,  and  impregnable. 

Yours,  etc.,  C.  L.  D. 

New  York,  December  31,  1881. 


Ovariotomy  during  Pregnanct. — E.  P.  Bennett, 
M.D.,  reports  the  following  : 

"  In  the  summer  of  1880  I  was  called  to  see  a 
young  married  lady  whose  abdomen  had  been  en- 
larging for  over  a  year,  and  who  was  jirouounced 
pregnant,  and  so  sure  was  this  physician,  that  he  de- 
clared he  could  hear  the  tic-tac  of  the  fetal  heart 
for  at  least  a  month  before  my  visit.  On  examina- 
tion I  readily  diagnosed  ovarian  cyst,  but  as  she  had 
not  menstruated  for  three  months  I  admitted  that 
she  might  be  pregnant,  lint  not  so  far  advanced  as 
to  hear  the  fetal  lioart.  I  operated,  remo\-ing  a 
large  cj-st  weighing  about  fifty  pounds.  She  ))ro- 
gressed  favorably  for  ten  days,  when  she  aborted  with 
a  very  small  foetus.  The  abortion  jiroduced  no  un- 
favorable results,  and  she  rapidly  recovered  with- 
out a  single  unfavorable  symptom.  In  my  own 
mind  I  am  .satisfied  that  no  such  favorable  result 
would  have  been  obtained  by  tapi>ing  and  leaving 
pregnancy  to  take  its  natural  course,  as  every  tap- 
ping would  have  reduced  her  general  strengtli,  and 
this  with  the  drain  made  upon  her  by  nourishing 
the  fietus  would  have  been  too  much  for  her." 


THE  MEDICAL  RECORD. 


23 


A   WORD   FOE   TRUTH. 

To  THE  Editor  of  The  Medical  Record. 

Sir  :  Dr.  William  A.  Hammontl,  in  a  letter,  headed 
"  A  Word  for  Dr.  Beard,"  wliicli  appeared  iu  your 
issue  of  October  loth,  sees  tit  to  ajiply  some  rather 
strong  language  to  the  ohserrations  which  I  thought 
it  my  duty  to  make  on  Dr.  Beard's  hypnotic  demon- 
strations, which  came  to  so  abrupt  an  end  during 
the  meeting  of  the  International  Congress  in  Lon- 
don, in  August  last.  The  letter  containing  these  ob- 
servations is  pronounced  "  intemperate,"  the  ques- 
tions which  I  put  to  Dr.  Beard  are  called  "  insulting," 
my  treatment  of  him  is  said  to  have  been  "grossly 
unfair,"  my  ignorance  of  the  subject  on  which  I 
write  is  characterized  as  "  absolute,"  and  my  mo- 
tives in  overwhelming  Dr.  Beard  are  rejiresented  as 
not  being  above  reproach.  I  do  not  refer  to  these 
vigorous  epithets  for  the  purpose  of  comjilaining  of 
them,  but  rather  to  congratulate  myself  on  having 
fallen  under  Dr.  Hammond's  disjjleasure,  and  merited 
some  selections  from  his  vocabulary  of  invective. 
When  I  consider  the  character  and  probable  effects 
of  his  defence  of  Dr.  Beard,  I  am  reconciled  to  his 
unfavorable  opinion  of  me,  and  sincerely  trust  that  I 
shall  never  enjoy  his  advocacy. 

And  Dr.  Hammond's  outspoken  candor  has  another 
advantage  besides  assuring  me  of  freedom  from  his 
equivocal  patronage  and  that  is  that  it  justifies  me 
in  using  jjlain  terms  in  replving  to  him,  and  in 
telling  him  at  once  what  I  propose  to  prove,  that 
his  letter  is  sophistical  and  evasive. 

Before  dealing  in  order  with  the  several  claiises 
of  Dr.  Hammond's  letter,  I  may  just  say  that  the 
questions  which  I  put  to  Dr.  Beard  in  the  ljrili.<h 
Medical  Journal,  and  which  Dr.  Hammond  repeats, 
may  appear  somewhat  contumelious  if  viewed  aj^art 
from  my  description  of  Dr.  Beard's  hypnotic  demon- 
strations, to  which  they  are  merely  an  appendix. 
When  it  is  borne  in  mind,  however,  that  I  had  given 
an  account  of  a  series  of  experiments  submitted  by 
Dr.  Beard  to  a  professional  audience,  which  were 
not  failures,  as  Dr.  Hammond  calls  them,  but  impo- 
sitions, and  that  vei'v  unpleasant  inferences  were 
liable  to  be  drawn  fi-om  Dr.  Beard's  relation  to  these 
experiments,  and  from  the  attitude  which  he  as- 
sumed when  their  mendacity  was  exposed,  it  will  1)6 
allowed,  I  think,  that  such  questions  were  necessary 
and  not  affronting.  They  took  for  granted  that  Dr. 
Beard  had  done  himself  injustice  in  the  chagrin  and 
confusion  of  finding  his  elaborate  "  trancoidal " 
structure  suddenly  collapse  and  they  afforded  him 
an  opportunity  of  setting  himself  right  with  his 
professional  brethren,  by  admitting  that  he  had  been 
deceived,  and  reijudiating  certain  compromising  al- 
legations made  by  his  trained  subject  or  pet  patient. 
Dr.  Beard  has  not  availed  himself  of  this  opportu- 
nity, but  Dr.  Hammond  has  stepped  forward  to  vin- 
dicate his  fair  fame  and  to  champion  the  hypnotic 
creed,  in  which  it  seems  he  too  is  a  devout  believer. 

I  have  been  bold  enough  to  say  that  Dr.  Ham- 
mond's letter  is  sophistical  and  evasive,  and  I  think 
that  assertion  is  wai-ranted  by  the  way  in  which  he 
meets  my  first  interrogation,  which  asks  whether 
Dr.  Beard  knew,  when  he  brought  his  trained  suli- 
ject  to  this  country,  that  he  was  passing  under  an 
assumed  name,  and  whether  he  withlield  the  knowl- 
edge of  that  fact  fi-om  several  parties  of  medical 
men  who  had  witnessed  his  experiments,  and  from 
the  meeting  on  the  sixth  of  August,  until  it  was 
elicited  bv  cross-examination?     Ignoring  the  cir- 


cumstances under  which  the  assumption  of  a  ficti- 
tious name  by  Dr.  Beard's  trained  subject  had  taken 
place,  and  under  which  it  was  detected.  Dr.  Ham- 
mond lays  stress  on  the  obvious  truths,  that  two 
names  may  lie  borne  by  the  same  jierson  innocently 
enough,  and  that,  in  many  scientific  investigations 
the  cognomen  of  the  human  suViject  experimented 
on  is  a  matter  of  no  moment.  But  everything  de- 
pends on  the  motives  and  circumstances  under 
which  a  sui^plementary  api^ellation  is  adopted  and 
used.  It  is  no  discredit  to  Lord  Lytton  that,  with 
the  sensitive  modesty  of  a  young  literary  aspirant, 
he  first  came  before  the  world  as  Owen  Meredith, 
but  it  was  very  much  to  the  disadvantage  of  a  lady 
now  undergoing  penal  discipline  in  this  country, 
that  she  was  proved,  while  seeking  her  fortunes  as 
an  adventuress,  to  have  x'assed  as  Mabel  Wilber- 
force  and  Mrs.  Trenefidi.  A  royal  personage  may 
travel  incognito  without  incuning  suspicion  ;  but  a 
book  canvasser,  which  Dr.  Beard's  trained  subject 
confessed  to  be,  can  scarcely  take  the  road  under 
an  alias  without  attracting  the  attention  of  the  po- 
lice. Had  Dr.  Beard's  trained  subject  been  exhib- 
ited to  illustrate  a  malady  recognizable  by  olijective 
symptoms  alone,  such  as  tumor  of  the  cerebellum, 
or  mitral  stenosis,  it  would  have  been  of  no  conse- 
quence whether  he  had  twenty  names  or  no  name, 
but  as  he  was  exhibited  to  illustrate  a  condition 
recognizable  by  subjective  symptoms  alone,  and 
which  might  be  physiological,  pathological,  or  crimi- 
nal, his  style  and  designation  become  facts  of  ex- 
treme significance  in  relation  to  the  inquiry  in  hand. 
Everything  depends  on  the  x^nrpose  with  which  a 
counterfeit  name  is  put  on,  and  on  the  situations  in 
which  it  is  employed  ;  and  Dr.  Hammond  cannot  be 
allowed,  by  the  ingenioiis  introduction  of  cases  that 
are  in  no  sense  analogous,  to  divert  attention  from 
the  exact  circumstances  under  which  Dr.  Beard's 
trained  subject  was  proved  to  be  sailing  imder  false 
colors. 

The  trained  subject  was  brought  to  this  coimtry 
to  exemplify  the  phenomena  of  artificial  trance, 
which  are  attributable  either  to  an  abnormal  condi- 
tion of  the  nervous  system  or  to  fi'aud.  In  deciding 
to  which  of  these  sources  the  phenomena  were  to  be 
traced,  it  was  surely  of  paramount  im]iortance  to 
determine  whether  the  man  exhibiting  them  was  a 
person  likely  to  lend  himself  to  fraudulent  iiretences, 
or  was  of  such  unimpeachable  moral  character  that 
there  was  no  probability  of  his  condescending  to  de- 
cejition.  The  jjroof  that  his  character  was  good 
would  not  have  established  the  genuineness  of  such 
unusual  phenomena,  but  the  proof  that  it  was  bad 
would  have  created  the  strongest  possible  presump- 
tion that  they  were  spurious.  Character  is,  indeed, 
the  es.sential  point  in  an  inquiry  of  this  kind.  When 
a  man  throws  himself  into  an  ecstatic  posture, 
squints,  and  delivers  sonorously  some  sentences  of  a 
temperance  lecture,  and  then  declares  that  he  spoke 
unconsciously  and  in  a  trance,  I  know  not  what  test 
can  be  applied  to  his  statement  except  a  reference 
to  his  general  credibility.  His  statement  is  at  va- 
riance with  common  experience.  If  it  be  made  by  a 
man  of  known  probity  and  truthfulness  it  may  be 
entitled  to  some  credit,  but  if  it  be  made  by  a  noto- 
rious rogue  it  may  be  tossed  aside  as  worthless. 
Character  is,  therefore,  the  very  touchstone  of  such 
a  statement,  and  a  name  is  the  label  that  guides  to 
the  investigation  of  character.  Those  whose  char- 
acters win  not  bear  investigation  often  carry  two  or 
three  such  labels  about  with  them,  and  the  fact  that 
Dr.  Beard's  trained  subject  was  found,  when  searched. 


24 


THE  MEDICAL  RECORD. 


to  be  in  possession  of  two,  naturally  awakened  dis- 
trust. It  was  of  course  possible  that  he  might  have 
satisfactory  and  blameless  reasons  for  having  changed 
his  name,  but  it  is  to  be  noted  that  while  he  offered 
at  one  time  confidentially  to  disclose  his  real  name 
to  two  members  of  the  company,  he  instantly  with-, 
drew  that  otter  when  informed  that  his  communica- 
tion would  be  made  use  of  for  the  purpose  of  inquir- 
ing into  his  antecedents.  When  asked  pointedly 
whether  he  had  ever  been  an  inmate  of  any  hospi- 
tals, asylums,  or  gaols  he  vouchsafed  no  reply.  It  is 
still  possible  that  Dr.  lieard's  Mr.  Baker  (for  that 
was  the  name  he  was  introduced  by)  may  be  a  man 
of  unsullied  reputation,  a  Nathaniel  in  whom  is  no 
guile,  but  if  so  why  is  his  incognito  still  jjreserved  ? 
Why  is  his  jjast  history  not  spread  out  before  us  like 
an  open  book,  on  the  pages  of  which  might  be  read 
the  confusion  of  those  who  have  dared  to  believe 
that  such  an  one  could  condescend  to  practice  trick- 
ery? Until  we  know  Mr.  Baker's  true  name  and 
history  we  are  bound  to  hold  that  he  is  not  the  sort 
of  witness  in  whose  testimony  respecting  the  occult 
phenomena  of  hypnc'tism  any  confidence  can  be 
placed. 

I  have  said  that,  in  the  investigation  of  hypnotic 
phenomena,  evidence  of  the  good  faith  of  the  per- 
son displaying  them  is  of  paramount  importance  ; 
but  I  should  have  qualified  that  statement  by  add- 
ing when  the  phenomena  themselves  are  not  ob- 
viously simulated.  It  was  at  the  outset  of  the  Jer- 
myn  Street  seance,  when  Dr.  Beard's  trained  subject 
had  given  one  demonstration — that  of  the  temperance 
lecture,  the  true  character  of  which  could  only  be 
settled  by  a  reference  to  credibility — that  the  dis- 
covery was  made  as  to  his  assumed  name.  And  at 
this  point  the  discovery  seemed  of  such  vital  signifi- 
cance, that  most  of  those  pre.sent  desired  to  proceed 
no  farther  with  the  experiments,  believing  that  they 
would  be  all  of  the  temperance-lecture  class,  and 
capable  of  being  tested  only  in  the  same  way.  For- 
tunately, however,  they  were  allowed  to  25roceed,  un- 
der protest,  and  as  they  went  on,  the  importance  of 
the  disoovei-y  of  the  assumed  name  diminished 
much,  for  the  experiments  themselves  were  unmis- 
takably stamped  with  deception.  Had  the  trained 
subject  been  proved  to  be  the  identical  boy  who 
never  told  a  lie,  and  the  bearer  of  an  ancient  and 
stainless  name,  his  performances  would  still  have 
been  regarded  as  hollow  mockeries.  "Not  all  the 
blood  of  the  Howards "  could  redeem  them  from 
their  inherent  vices,  about  which  Dr.  Hammond  has 
nothing  to  say.  He  overlooks  the  fact  that  the 
trained  subject,  while  engaged  in  muscle-reading, 
and  pretending  to  interpret  the  delicate  movements 
of  the  hand  of  one  gentleman  pressed  against  his 
forehead,  was  shown  to  have  followed  tlie  indica- 
tions given  by  the  fixed  gaze  of  the  eyes  of  another 
gentleman  with  whom  the  owner  of  tlie  hand  had 
just  been  in  conference.  He  forgets  that  the  trained 
subject  was  proved  to  have  heard  what  was  said  at  a 
time  when  he  pr<)f(>sseil  to  have  been  unconscious, 
and  he  omits  to  notices  that  his  alleged  freedom  from 
vertigo  during  rotation  was  demonstrated  to  have 
very  narrow  limits,  and  his  opisthotonic  spasm  to 
be  only  voluntary  effort. 

Having  establislied  tliat  credibility  depends  on 
moral  character  ;  that  a  mania  is  a  key  to  moral  char- 
acter ;  and  that  Dr.  Beard's  trained  subject  declined 
to  hand  over  that  key  to  those  who  were  investigat- 
ing his  hypnotic  performances,  which  turned  out 
mere  clum.sy  imposition. 

I  must  next  ask  whether  Dr.  Beard  was  justified 


in  concealing  from  his  professional  brethren,  whom 
he  had  assembled  together  to  witness  "  the  most  re- 
cent discoveries  in  this  dej^artment  of  psychology," 
the  fact  that  his  trained  subject  was  passing  under 
an  assumed  name.  The  trained  subject  said  "Dr. 
Beard  knows  well  enotigh  I  am  not  travelling  under 
my  own  name ; "  and  Dr.  Beard,  who  had  presented 
him  as  William  Baker,  did  not  then  deny  the  asser- 
tion, and  has  not  since  denied  it.  Was  he  warraEted 
then,  in  withholding  his  knowledge  of  the  fact?  Dr. 
Hammond  answers  yes,  and  argues  that  if  Baker's 
true  name  was  mentioned  to  Dr.  Beard  in  confidence, 
he  was  bound  to  keep  it  secret.  No  fine  sense  of 
ethical  propriety  is  i-equired  to  jjerceive  Dr.  Ham- 
mond's error  and  the  obligation  that  lay  on  Dr. 
Beard  if  he  exhibited  this  trained  subject  at  all,  to 
divulge  either  his  real  name,  or  the  fact  that  he  was 
passing  under  an  assumed  one.  The  fact  of  the  as- 
sumed name  was  not  a  trifling  or  irrelevant  detail, 
but  was  material  to  the  issue  submitted  to  the 
meeting,  and  to  suppress  or  omit  a  fact  material  to 
the  issue  in  a  medical  inquiry,  is  to  ofi'end  against  a 
well  understood  code  of  professional  honor.  It  be- 
hoved Dr.  Beard  not  only  to  mention  that  Baker 
was  passing  under  an  alias,  but  to  state  exjilicitly 
the  inducements  offered  to  him  to  abandon  his  or- 
dinary means  of  livelihood,  and  honor  the  Inter- 
national Medical  Congress  with  his  presence.  All 
possible  springs  of  action  should  be  disclosed  when 
complicated  improbabilities  have  to  be  scientifically 
analyzed.  Drs.  I5eard  and  Hammond  aver  tliat  moral 
character  is  of  no  consequence  in  relation  to  hypno- 
tism, but  they  must  surely  have  done  this  imrefiect- 
ingly.  Every  writer  on  the  subject  knows  that  it  is 
of  the  essence  of  the  inqniiy.  Mr.  Romanes,  in  de- 
fending Heidenheim's  experiments  which  I  venture 
to  think  are,  in  many  respects  fallacioiis,  advances, 
as  the  strongest  argument  in  their  favor,  that  a  great 
many  of  them  were  performed  on  his  own  brother, 
"  who,  to  say  the  least,  would  not  be  likely  to  stiil- 
tify  his  distingiiished  kinsman ; "  and  Dr.  Ham- 
mond, in  spite  of  what  he  says  himself,  displays  a 
keen  ajipreciation  of  the  importance  of  character 
where  credibility  is  concerned.  At  the  beginning  of 
his  letter  he  thinks  it  well  to  bestow  an  encomium 
on  the  moral  attributes  and  mental  methods  of  Dr. 
Beard.  That  gentleman,  it  appears,  has  always  "  had 
the  good  sense "  to  take  Dr.  Hammond's  animad- 
versions "with  kindness,  and  in  the  true  scientific 
spirit,"  and  he  will,- perhaps,  therefore  submit  with 
becoming  meekness  to  what  many  would  regard  as 
the  gross  indignity  of  having  it  certified  in  a  pro- 
fessional journal,  tliat  his  august  censor  has  "  never 
observed  in  him  the  slightest  tendency  to  dis- 
honesty." 

My  second  question  to  Dr.  Beard,  whether  he 
knew  that  his  trained  subject  had  taken  part  in 
mesmeric  and  spiritualistic  performances,  and  wheth- 
er he  withheld  the  knowledge  of  that  fact  from  his 
audience  at  Jermyn  Street,  is  met  by  Dr.  Hammond 
with  a  direct  denial.  He  is  "  very  positive,  as  a  mat- 
ter of  fact"  that  the  trained  subject,  with  whose 
career  he  seems  to  bo  curiou.sly  familiar,  "  never  did 
take  part  in  mesmeric  or  spiritualistic  performances." 
Well,  Dr.  Hammond  and  the  putative  ^Ir.  Baker 
must  settle  that  i)oint  between  them.  The  latter 
distinctly  told  the  meeting  in  .Terniyn  Street  that  he 
had  been  "  in  the  mesmeric  line,"  and  had  also  taken 
part  in  spiritualistic  reunions,  though  he  refused  to 
name  the  medium  with  whom  he  had  performed. 
And  not  only  so,  but  he  clearly  betrayed  liis  spiritu- 
alistic experiences,  when,  much  to  the  disgust  of  Dr. 


THE   MEDICAL  RECORD. 


25 


Beard,  he  interfered  with  the  proceedings  when  they 
were  not  going  quite  smoothly,  to  tell  those  present 
that  he  could  not  show  them  his  full  powers  unless 
they  were  in  sympathy  with  him,  that  an  atmosphere 
of  doubt  was  fatal  to  hypnotism,  and  that,  if  his 
manifestations  were  to  be  carried  out,  all  those 
around  him  must  put  implicit  faith  in  him,  advice 
which  it  was  difficult  for  the  audience  to  follow  in 
full  view  of  his  somewhat  unpreposessing  counte- 
nance. By  a  slight  error  loci,  Mr.  Baker  used  the 
language  of  Mr.  Sludge,  the  medium  in  the  lecture- 
room  of  Dr.  Beard ;  and,  with  no  undue  leaning  to 
put  blind  trust  in  Mr.  Baker,  I  am  inclined  to  ac- 
cept his  statement  that  he  had  graduated  in  spiritii- 
alism  before  commencing  the  study  of  the  higher 
branches  of  hypnotism.  "  But  supposing,"  says  Dr. 
Hammond,  "  that  he  had  done  this  ( which  I  positively 
deny),  what  beai-ing  would  it  have  on  his  hypnotic 
demonstrations  ?  "  And  here  one  is  in  courtesy  bound 
to  credit  Dr.  Hammond  with  just  a  little  of  that 
"natural  obtuseness"  to  which  he  diifidently  lays 
claim,  in  order  to  avoid  a  less  complimentary  ex- 
planation of  the  position  which  he  takes  uji.  To 
argue  that  a  previous  history  of  spiritualism  should 
not  influence  one's  judgment  of  a  jierson  professing 
to  exhibit  hypnotic  phenomena,  is  equivalent  to 
maintaining  that  a  previous  conWction  of  forgery  is 
irrelevant  in  the  case  of  a  comparative  stranger  ap- 
jjlying  for  a  loan  of  a  hundred  i^onnds.  Spiritualism 
is  a  school  of  demoralization  or  superstition,  and 
those  who  have  been  educated  in  it  are  not  the  kind 
of  witnesses  to  whose  evidence  respecting  hypnotism 
piMctical  physicians  would  be  willing  to  attach  any 
weight.  Had  Dr.  Beard  told  his  audience  at  Jermyu 
Street,  at  the  outset,  that  his  trained  subject  was  a 
retired  medium,  or  a  runaway  apprentice  of  spiritu- 
alism, it  is  certain  that  a  large  majority  of  them 
would  have  refused  even  to  look  at  his  hyjanotic  ab- 
surdities, and  it  can  scarcely  be  doubtful,  I  think, 
that  he  was  not  justified  in  withholding  a  fact  the 
knowledge  of  which  would  have  so  powerfully  influ- 
enced his  guests,  supj)osing,  of  course,  that  he  was 
acquainted  with  it. 

My  third  question  to  Di'.  Beard  is  especially  ob- 
noxious to  Dr.  Hammond,  who  calls  it  "  an  intimation 
of  fraud,"  and  an  attempt  to  "  confuse  "  Dr.  Beard 
"and  prejudice  "  the  case  against  him.  The  question 
runs  thus  :  Had  he  never,  until  the  exposure  of  the 
6th  of  August  took  place,  had  any  suspicion  that  any 
part  of  his  trained  subject's  performance  was  a  mere 
piece  of  acting?  and  the  inquiry  seems  natural 
enough,  considering  that  the  whole  of  his  perform- 
ance on  the  6th  of  August  was  pronounced  a  mere 
piece  of  acting  by  a  highly  competent  tribunal.  Dr. 
Beard's  perceptive  faculties  are  acute,  and  it  seemed 
singular  that,  having  watched  the  trained  subject  for 
months,  he  should  never  have  suspected  what  was 
patent  to  everybody  at  one  interriew  at  Jermyn 
Street.  But  in  several  nervous  disorders,  simula- 
tion goes  hand-in-hand  with  the  genuine  symptoms 
of  disease,  and  I  submit,  therefore,  that  there  was 
nothing  disrespectful  in  requesting  Dr.  Beard  to  say 
whether  he  had  seen  reason  to  surmise  such  a  mix- 
ture in  this  particular  case,  and  if  so,  to  define  what 
was  in  his  eyes  really  hypnotic,  and  what  mere  his- 
trionic exaggeration.  He  teaches,  I  understand, 
that  personation  is  one  of  the  symj^toms  of  hyjino- 
tism,  and  it  is  but  fair  that  he  should  he  called  on 
to  distinguish  hypnotic  from  ordinary  personation. 

Turning  to  my  fourth  question  to  Dr.  Beard  ;  Did 
he  inform  his  audience  that  he  had  exhibited  his 
experiments  before  the  Academy  of  Medical  Science 


at  New  York  ;  and  was  that  statement  promptly  and 
emphatically  contradicted  by  Dr.  Adams,  the  Secre- 
tary of  the  Academy,  who  happened  to  l)e  ))resent? 
I  find  that  Dr.  Hammond  gets  rid  of  it  in  a  juggle  of 
names.  But  I  cannot  ])erniit  it  to  be  disjjoscd  of 
in  that  way.  Dr.  Beard  told  the  meeting  that  he 
had  exhibited  his  experiments  to  a  .society  in  Kew 
York,  which  I  understood  him  to  call  the  Academy 
of  Medical  Science,  but  which  I  now  gather  from 
Dr.  Hammond  he  must  have  called  the  Academy  of 
Medicine.  But  whatever  he  called  it,  his  statement 
was  flatly  contradicted  by  Dr.  Adams,  and  Dr. 
Beard  had  not  then  a  word  to  say  for  himself,  but,  in 
plain  English,  stood  abashed  before  the  meeting, 
which  indulged  in  an  emotional  exj^ression,  some- 
thing between  a  pish  and  a  jishaw  !  Had  reporters 
been  present,  the  word  "  sensation  "  would  have  been 
introduced  at  this  point  in  their  account  of  the  -pro- 
ceedings. 

My  fifth  and  last  question  to  Dr.  Beard  was  as 
follows  :  Was  he  invited,  after  the  failure  of  his 
trained  subject  to  secure  confidence,  to  join  the 
meeting  in  expressing  satisfaction  that  a  gross  case 
of  deception  had  been  exposed,  and  did  he  refrain 
from  making  any  response  to  that  api^eal  ?  That 
the  invitation  was  extended  to  Dr.  Beard,  and  that 
he  did  not  embrace  it,  is  undoubted,  but  that  em- 
barrassment and  American  nervousness  might  have 
prevented  him  from  doing  so  was  possible,  and  so 
it  seemed  well  to  recall  the  matter  and  afl'ord  him 
in  calmer  moments  a  chance  of  gi-acefully  following 
the  example  of  Mr.  Houblier,  who,  when  his  pupil 
Mile.  EmClie,  a  wonderful  hypnotist  in  her  day,  was 
convicted  by  the  French  Academy  of  Medicine  of 
being  a*v]  miserable  trickster,  acknowledged,  with 
grief  and  shame,  that  he  had  for  four  years  been  the 
dupe  of  an  artful  woman. 

Having  commented  on  Dr.  Hammond's  criticisms 
on  the  catechism  which  I  prepared  for  Dr.  Beard, 
and  of  which  he  has  taken  no  notice,  I  shall  not 
here  discuss  the  former  gentleman's  assertions  re- 
specting hypnotism,  which  are  scattered  through 
the  letter  that  has  appeared  in  your  columjis.  Hyp- 
notism is  a  name  covering  some  real  facts  and  an 
infinite  deal  of  falsehood.  I  do  not  pretend  to  know 
what  has  been  done,  or  not  done,  in  the  name  of 
hypnotism  by  Dr.  Hammond  in  New  York  (his 
professional  brethren  on  the  spot  are  best  able  to 
judge  of  his  experiments  there),  but  this  I  do  know, 
that  the  phenomena  of  hypnotism,  submitted  to  the 
medical  profession  in  this  country  by  the  physician 
whom  Dr.  Hammond  indicates  as  its  most  profound 
student  and  accomplished  exponent,  were  transpa- 
rent humbug.  If  Dr.  Hammond  can  give  no  better 
proofs  of  the  faith  that  is  in  him  than  those  ad- 
duced by  Dr.  Beard,  I  shall  be  comi^elled  to  believe 
that  his  laborious  inquiries  into  hypnotism  are  an- 
alagous  to  the  Scotch  Hallow'een  pastime  of  win- 
nowing three  weights  of  nothing,  in  the  hope  of 
seeing  an  illusion.  He  and  Dr.  Beard  have  yet  to 
prove  that  they  possess  the  most  elementary  and 
essential  qualification  for  a  successful  student  of 
hypnotism — a  power  of  weighing  evidence'in  relation 
to  such  obscure  questions,  and  of  discriminating 
between  chicanery  and  plain  dealing.  Until  they 
repudiate  some  of  their  ridiculous  heresies,  such  as 
the  belief  that  a  hypnotized  person,  with  his  eyes 
securely  bandaged,  can  read  a  book  through  the  skin 
of  his  forehead,  it  is  almost  a  waste  of  time  and  loss 
of  dignity  for  any  man  of  science  to  argue  with  them 
on  this  topic. 

Dr.  Hammond,  I  presume,  through  hypnotic  lu- 


26 


THE  MEDICAL  RECORD. 


ciditj-  and  penetration  of  tliought,  knows  exactly  the 
motives  with  which  I  went  to  Dr.  Beard's  meeting, 
and  these  lie  elegantly  sumsnp  as  an  "  overpowering 
intention  to  bring  him  to  grief."     There  was  a  deep- 
laid  scheme.  Dr.  Hammond  surmises,  to  overthrow 
Dr.  Beard,  whatever  he  might  say  or  do.     Now,  my 
motives  are  of  no  great  interest  to  any  one,  but  as 
they  have  been  referred  to,  I  may  just  say  that  my 
presence  at  the  meeting  was  an  accident,  as,  until  a 
few  minutes  before  I  found  myself  there,  I  had  not 
thought  it  possible  for  me  to  avail  myself  of  the  in- 
vitation which  had  been  sent  to  me.      I  went  to  the 
meeting  with  no  unfriendly  feeling  toward  Dr.  Beard, 
for  I  had  had  some  pleasant  intercourse  with  him 
at  Cambridge,  and  had  been  favorably  impressed  by 
the  suggestiveness  of  such  of  his  writings  as  I  had 
read,  and  with  no  conception  that  it  would  be  requi- 
site to  make  a  stand  for  scientifio  truth.     My  sus- 
picions were  first  aroused  by  a  hint  from  Dr.  Ho- 
ratio Donkin,  who  had  arrived  before  me,  and  whose 
quick  insight  had  at  once  perceived  the  true  nature 
of  the  performance  with  which  we  were  to  be  fa- 
vored, but  it  was  what  actually  took  place  at  the 
meeting  that  animated  me,  as  it  did  many  more  who 
were  present,  to  oifer  unflinching  resistance  to  my.s- 
tification  when  brought  forward  as  new  revelations 
in  the  science  of  psychology.     Preconceived  notions 
did  not  influence  our  action.     Preparation  for  the 
expose  there  was  none.     Had  we  had  an  inkling  of 
what  was  to  take  place,  and  five  minutes  in  which 
to  arrange  our  plans,  the  demolition  of  Dr.  Beard's 
hypnotism  would  have  been  more  final  and  com- 
plete than  it  was.      Perhaps,  however,  there  is  no 
cause  to  repine.      On  the  spur  of  the  moment  a 
■wound    was  inflicted   on  it  which,  like  Mercutio's 
wound,  although  not  "  so  deeji  as  a  well,  nor  so  wide 
as  a  church  door,"  will  prove  "  enough — 'twill-serve." 
It  is  an  ungracious  task  to  refute  error  and  un- 
mask deception,  but  it  is  a  needful  one  in  these 
days,  and  one  peculiarly  incumbent  on  those  prac- 
titioners of  medicine  who  love  and  honor  their  pro- 
fession, and  desire  to  secure  for  it  a  large  measure 
of  public  usefulness  and  respect.   In  no  way  can  the 
profession  of  medicine  be   more   surely   degraded 
than  for  those  who  follow  it  to  exhibit  a  childish 
credulity  or  countenance  the  arts  of  the  charlatan. 
Empiricism  is  the  sin  that  doth  most  easily  beset  it, 
and  it  behooves  the  profession,  therefore,  jealously 
to  guard  itself  against  any  teachings  or  practices 
that  tend  in  that  direction.     That  the  teachings  and 
practices  of  hypnotism  may  have  that  tendency  will 
scarcely  be  gainsaid,  and  hence  the  duty  imposed 
on  the  medical  profession,  to  keep  a  vigilant  eye  on 
hypnotic  manifestations,  and  to  repudiate  at  once 
any  sympathy  or  connection  with  the  vagaries  and 
cheats  and  quackeries,  that  are  apt  to  gather  round 
the  small  central  nucleus  of  established  hypnotic 
facts.    Ample  toleration  must  be  shown  to  the  widest 
diversities  of  honest  and  intelligent  belief,  but  no 
(piarter  must  be  given  to  the  delusions  of  the  weak- 
minded,  the  whims  of  the  superstitious,  unworthy 
pretensions  of  those  who  are  in  too  gi-eat  haste  to 
grow  rich. 

I  am,  sir,  your  obedient  servant, 

J.  Cbichton  Browne. 

7  CCMBERLASD    TEfinACE,  IIEGEST3  P.IRB,  LONDO.S. 


ARMY  NEWS. 

Official  List  of  Changes  of  Staticms  and  Duties  of  Offi- 
cers of  the  Medical  Department,  United  States  Armii, 
from  December  25,  1881,  to  Decembei-  31,  1881. 

SuM5EERs,  Jno.  E.,  Lieut.-Colonel  and  Surgeon, 
Medical  Director  Dept.  of  the  Platte.  The  leave  of 
absence  granted  him  in  par.  6,  S.  O.  123,  Dept.  of 
the  Platte,  December  1,  1881,  is  extended  one 
month.  S.  O.  135,  Mil.  Div.  of  the  Missouri,  De- 
cember 28,  1881. 

Havaep,  v.,  Capt.  and  Asst.  Surgeon.  Now  en 
route  from  Fort  Davis  to  San  Antonio,  Texas,  as- 
signed to  temf)orary  duty  at  Headquarters  Dept.  of 
Texas,  and  to  report  to  the  Medical  Director  for  in- 
structions. S.  O.  151,  Dept.  of  Texas,  December  12, 
1881. 


ilUiicftl  3tems   antr  lleujs. 


Contagious  Diseases  —  Weekly  Statement.  — 
Comparative  statement  of  cases  of  contagious  diseases 
reported  to  the  Sanitary  Bureau,  Health  Department, 
for  the  two  weeks  ending  December  31,  1881. 


Week  Ending 

■Isj 

ft 

i 

St 
s 

.S.S 

II 

1 

3 

i 

1 

1 

H 

H 

m 

o 
7 

115 

Q 

137 

24 

(H 

Deo.  24,  1881. 

0 

22 

255 

0 

Dec.  31,  1881. 

1 

6 

833 

9 

184 

152 

28 

0 

Queen  Victori.v  has  donated  her  old  linen  to  St. 
George's  Hospital.  This  mark  of  royal  favor  is  no 
doubt  duly  appreciated. 


Db.  Edward  Reynolds,  the  oldest  physician  in 
Boston,  died  December  26th,  at  the  age  of  eighty- 
nine  years.  He  was  graduated  from  Han-ard  Col- 
lege in  1811,  and  was  a  class-mate  of  the  late  Edward 
Everett,  the  late  Chief-Justice  Dunkin,  of  South 
Carolina,  and  the  late  Chief -Justice  Lane,  of  Ohio. 

Extra-Uterine  Pregnancy  in  a  Quail. — Dr.  G. 
Frank  Lydston,  of  Chicago,  formerly  house  surgeon 
to  Charity  Hospital,  B.  I.,  sends  us  a  unique  con- 
tribution to  comparative  i^athology. 

"  In  dressing  a  quail,  a  tumor  was  found  in  the 
abdominal  cavity,  free  from  adhesions  at  any  part. 
It  measured  about  seven  inches  in  circumference, 
and  weighed  two  and  one- fourth  ounces.  Section  re- 
vealed a  number  of  laminsr,  composing  the  walls  of 
a  cyst  about  as  large  as  an  almond.  The  cyst-walls 
were  arranged  in  layers,  the  two  internal  being  dis- 
tinct from  those  external,  and  separated  from  them 
by  a  layer  of  grumous  material  resembling  the  yolk 
of  an  egg  after  partial  cooking.  The  cyst  itself  was 
empty.  Microscopically  the  laminiv  were  shown  to 
consist  of  connective  tissue,  and  the  grumous  mat- 
ter of  oil-globules,  granular  matter  and  epithelial 
cells. 

"Ths  external  layer  of  the  sac  was  rough  and  of  a 
brownish  color. 

"  The  tumor  was  evidently  an  abortive  ovum  which 
failed  to  enter  the  oviduct,  and  falling  into  the  ab- 
dominal cavity  had  become  encysted  by  successive 
layers  of  fibrinous  deposit." 

Dr.  Lydston  has  heard  of  one  similar  case  in  a 
domestic  fowl. 


THE  MEDICAL  RECORD. 


27 


CuKiors  Relation  between  Diththeria,  Eczema, 
AND  EiiTsrPELAS. — Dr.  G.  H.  Felton,  of  Lvnn,  Mass., 
relates  the  followiug  history  :  "  t)n  the  15th  of  Xo- 
vemlier,  a  hoy,  eight  years  of  age,  after  an  iUness 
of  five  days,  died  of  hu-yngeal  dijihtheria.  One 
week  later  I  was  called  to  see  his  brother,  about 
eighteen  months  old.  This  child  had  been  for  some 
months  suffering  from  aggravated  eczema  of  the 
scalji,  and  during  my  attendance  upon  the  previous 
case  his  head  was  covered  with  crusts,  though  he 
was  said  to  be  much  better  than  previously,  .^.t  this 
time  he  was  a  strong,  well-nourished  child,  with 
good  appetite,  and,  with  the  exception  of  the  eczema 
and  a  bronchitis  of  a  few  weeks'  standing,  appar- 
ently in  vigoroiis  health.  I  was  sent  for  on  account 
of  a  swelling  under  the  jaw,  which,  under  the  cir- 
cumstances, the  parents  feared  might  be  diphtheria. 
The  eczema  was,  at  the  same  time,  becoming  con- 
siderably aggravated.  I  foiand  that  the  swelling 
extended  around  the  neck,  being  quite  as  marked 
posteriorly  as  elsewhere,  and,  on  examination,  could 
find  no  evidence  of  diphtheria,  and  so  informed  the 
parents.  Struck,  however,  by  the  suspicion  of  an 
erysijjelatous  inflammation,  remembering  also  the 
diphtheritic  contagion  to  which  the  child  had  been 
exposed,  and  in  view  of  the  occasional  association 
of  the  two  diseases,  I  pi-escribed  tr.  ferri  chloridi  in 
liberal  doses  with  potassium  chlorate.  The  case 
grew  continually  worse,  however,  and  three  days 
later  his  head  was  immensely  swollen,  one  eye  closed 
and  emitting  a  sanguino-purulent  discharge.  The 
swelling  jiosteriorly  extended  down  to  the  nates,  the 
face  and  neck  presented  the  appearance  of  erysipe- 
las, while  the  scalp  was  a  mass  of  corrujjtion.  The 
cough  was  loose  and  the  secretion  abundant ;  but, 
while  an  examination  of  the  throat  was  now  impos- 
sible, there  was  no  more  evidence  of  diphtheria 
than  at  my  first  visit.  The  child  died  the  next  morn- 
ing, no  new  symptoms  having  intervened." 

Dr.  Felton  offers,  in  explanation  of  these  clinical 
facts,  the  plausible  theory,  that  the  poison  of  diph- 
theria in  the  first  patient  acted  upon  the  eczematous 
scalp  of  the  second,  producing  an  erysiiJelatous  in- 
flammation. This  idea  is  in  harmony  with  current 
views  regarding  the  relation  of  the  diphtheritic  and 
erysipelatous  poisons. 

The  iNTEKN.iTIONAI/   GERMAN   EXHIBITION   FOR  Ht- 

GBENE  .\ND  LiEE-SAViNG. — We  have  already  published 
some  facts  regarding  this  proposed  exhibition,  which 
is  to  take  place  at  Berlin  next  yeai',  lasting  from 
June  1st  to  October  1st. 

We  are  in  receipt  of  a  letter  and  circular  calling 
our  attention  to  some  of  the  special  features  of  the 
exhibition.  Thus  it  is  not  intended,  we  are  told,  to 
arrange  the  exhibits  in  groups,  strictly  after  the 
classification  laid  down.  They  will  be  distributed 
in  such  a  manner  that  objects  relating  to  each  other 
stand  in  mutual  connection.  One  part  of  the  build- 
ing, for  instance,  represents  a  battle-field  with  plas- 
tic figures  of  wounded  soldiers,  surgeons,  etc. 

Americans  are  cordially  invited  to  co-operate  in 
this  exhibit. 

The  Wisconsin  State  Vaccine-Farm. — The  Wis- 
con.sin  •  State  Board  of  Health  runs  a  vaccine-farm 
near  Fond  du  Lac,  under  the  charge  of  its  President, 
Dr.  E.  L.  Griffin,  of  that  city.  During  two  weeks 
Dr.  Griffin  has  produced  from  sixty  thousand  to 
seventy  thousand  points,  which  have  been  distri- 
buted throughout  the  Northwest,  where  the  small- 
pox excitement  exists.  At  the  Wisconsin  farm,  Dr. 
Griffin  and  his  associates  have  vaccinated  about  one 


thousand  heifers  since  they  commenced  their  work 
of  production.  The  most  successful  operations  are 
upon  the  light-haired  heifers,  those  dark  in  color  al- 
ways having  tough  skins.  From  some  animals  one 
thousand  points  are  taken,  while  others  produce 
none  at  all. 

Another  Case  op  PENDULors  Uteris. — Dr.  J.  W. 
Brown,  of  Mottsville,  N.  Y.,  relates  the  history  of  a 
case  of  pendulous  uterus,  somewhat  similar  to  one 
recoi'ded  bv  the  same  observer  in  the  Kecord  of 
April  12,  1879. 

The  patient  was  a  large-framed  Irish- woman,  aged 
thirty-seven,  in  her  seventh  labor.  The  pains  had 
lasted  about  eight  hours  when  Dr.  Brown  was 
called  in.  He  found  her  feeling  weak  and  tired,  with 
frequent  non-expulsive  pains.  L'pon  placing  his 
I  hands  upon  her  abdomen  he  was  surprised  not  to  feel 
the  uterus,  but  on  examination  it  was  found  com- 
pletely retroverted  ;  the  fundus,  from  the  stretching 
of  abdominal  muscles  lying  upon  the  thighs,  midway 
to  the  knees  when  in  erect  posture.  Vaginal  exami- 
nation revealed  os  fully  dilated,  with  head  engaged 
in  superior  straight.  Vagina  hot  and  dry.  The 
uterus  was  reijlaced  by  gradual  external  manipula- 
tion and  the  apijlication  of  a  sheet  made  into  a  band- 
age (cravat-like),  and  gradual  "cinching"  about  the 
shoulders.  Pains  became  as  a  consequence  more 
exjiulsive,  but  after  patiently  waiting  about  an  hour 
and  finding  head  was  so  wedged  that  no  advance- 
ment was  made,  the  long  forceps  were  applied  and 
a  living  female  child  was  delivered.  Flooding  was 
profuse,  but  by  grasping  the  fundus  uteri  and  ad- 
ministration of  Squibb's  ergot,  and  allowing  jilacenta 
to  plug  the  uterine  orifice,  he  succeeded  in  control- 
ing  it.  Placenta  was  normal  in  appearance  and  size, 
and  came  away  with  gentle  traction  in  the  course  of 
an  hour.     There  were  no  bad  after-symptoms. 

Stncope  from  Catheterization.  —  At  a  recent 
meeting  of  the  St.  Louis  Medico-Chirurgieal  Society, 
Dr.  Hodgen  stated  that  a  patient  once  came  into  his 
office  complaining  of  a  stricture.  He  introduced  a 
sound  very  gently,  but  the  man  almost  died  on  the 
table,  the  heart  ceased  beating,  and  respi^-ation  was 
ari-ested  ;  hypodermic  injections  of  sulphuric  ether 
stimulated  the  action  of  the  heart,  and  in  a  few 
moments  he  recovered;  but  the  doctor  did  not 
make  another  attempt  to  pass  a  sound  for  several 
months,  during  which  time  the  patient  was  kept 
upon  tonics,  and  his  allowance  of  stimulants  was  cut 
down,  as  he  was  a  free  drinker.  After  several  months 
of  such  treatment,  another  attemjit  was  made  to 
pass  an  instrument.  There  was  a  very  great  depres- 
sion, similar  to  that  produced  before,  though  less 
marked  than  at  that  time. — St.  Louis  Courier  of 
Medicine. 

Quebracho  in  Emphysema  and  Dilated  Bronchi. 
— Dr.  Jas.  H.  Low,  of  this  city,  relates  the  history 
of  a  patient  who  for  several  years  had  suffered  from 
what  had  been  considered  phthisis.  Dr.  Low,  how- 
ever, diagnosed  emphysema  with  bronchiectasis. 
He  placed  the  patient  on  cod-liver  oil  and  iron. 
After  some  improvement  had  followed,  he  prescribed 
quebracho  in  twenty  minim  doses,  twice  daily,  in- 
creasing this  dose  gi-adually.  Dr.  Low  thinks  that 
the  remedy  has  done  some  good. 

Meat  Extracts. — From  analysis  by  C.  T.  George, 
reported  in  "Pi-oceedings  of  Penn.sylvania  Phaima- 
ceutical  Association,"  it  appears  that  '-Valentine's 
Meat  Juice  "  contains  but  a  trifling  amount  of  albu- 
men.    The  total  amount  of  dry  extract  in  a  dollar 


-^8 


THE  MEDICAL  RECORD. 


bottle  is  about  six  draclims.  "Johnson's  Fluid  Beef  " 
■contains  thirty  per  cent,  of  dry  extract  soluble  in 
water,  thirty-three  per  cent,  of  dry  muscular  fibre, 
ten  per  cent,  of  ashes  It  contains  no  albumen.  The 
objection  to  this  otherwise  excellent  preparation, 
says  Mr.  George,  is  the  fact  that  it  is  packed  in  tins. 
The  extract  acta  upon  this,  and  in  that  part  near 
the  sides,  tin  was  found. 

Free  Qoinine. — The  drug  journals  state  that  the 
firm  of  White  .t  Co.,  of  this  city,  manufacturers  of 
quinine,  has  f.ailed  on  account  of  quinine  being  free, 
while  the  agents  used  in  its  manufacture  are  not. 
It  is  noticeable  that  there  is  a  much  stronger  demand 
that  the  duty  be  reimposed  on  quinine,  than  that  it 
be  taken  off  the  article  used  in  its  manufacture. 

Abttficial  QnxsrNE. — There  have  been  rumors  for 
some  time  that  artificial  quinine  could  be  made,  and 
was  indeed  being  largely  manufactured.  The  pro- 
cess was  aj^i^arently  one  of  childlike  simplicity,  and 
consisted  only  in  bringing  together  dihydrolepidiu, 
dehydroethylpyridin,  and  the  chloranhydride  of 
chloropropinic  acid.  A  substance  obtained  in  this, 
or  some  similar  way,  and  called  chiuolin  tartrate  or 
artificial  quinine,  has  been  used  by  Dr.  Schapringer 
in  the  .Jewish  Hospital,  Philadelphia.  It  was  found 
to  have  slight  antiperiodic  i^roperties,  but  to  be 
far  inferior  to  quinine. 

In  Belgium  there  are  2,111  medical  men  and 
2, 130  midwives,  the  population  of  the  country  being 
•5,.500,000.  This  makes  about  one  doctor  and  one 
midwife  to  every  thousand  of  the  population. 

A  New  Phtsiolooical  Station  in  the  Bois  de 
Boulogne  has  been  given  to  M.  Marey,  to  allow  him 
to  study  the  functional  movements  of  various  ani- 
mals. 

The  Bacillus  of  Typhoid  Fbver  is  a  new  micro- 
organism which  Eberth,  of  Zurich,  has  recently  de- 
scribed.    He  considers  it  the  cause  of  that  disease. 

Another  Special  Bacteriuji  is  that  described  by 
M.  Gibier  as  being  the  cause  of  acute  pemphigus. 
The  organism  consists  of  a  series  of  individuals  ar- 
ranged in  strings.  These  are  Tir'tn  mm.  wide  and 
TTiViT  to  tJuu  nim.  long.  The  disease  is  not  conta- 
gious. 

The  Germ.in  TlNrvEKSiTiEs,  twenty-one  in  number, 
contain  four  thousand  eight  hundred  and  eighty- 
three  students  of  medicine,  surgery,  and  pharmacy 
the  present  year. 

A  Case  of  Ovarlvn  Pre(5nancy— Autopsy. — Dr. 
S.  Mitchell,  Jr.,  of  Hornellsville,  N.  Y.,  sends  the 
following  history  of  a  case  of  ovarian  pregnancy,  in 
which  the  trouble  was  not  diagnosed  before  de.ath  : 

"Tlie  patient,  a  married  lady,  aged  thirty-four, 
one  year  before  had  begun  to  sufl'erfrom  a  tumor 
in  the  right  ovarian  region.  She  ceased  to  mon- 
strnate  and  had  no  return  of  the  same  until  five 
months  afterward,  when  she  again  became  regular 
and  remained  so  until  her  death.  At  this  time  tlie 
alidomen  was  of  the  size  to  indicate  about  the  fifth 
month  of  pregnancy,  but  the  absence  of  motion  and 
the  return  of  the  menses,  convinced  her  and  her 
friends  that  pregnancy  did  not  exist. 

"  Two  weeks  previous  to  her  death  she  was  in- 
duced to  seek  the  advice  of  a  female  physician  of 
Buffalo  ;  she  was  also  seen  by  Drs.  ^'an  Payner  and 
Harrington  of  the  same  city."  On  the  afternoon  of 
August  5th,  the  latter  of  the  physicians   explored 


the  enlargement  of  the  abdomen  with  the  needle  of 
a  hypodermic  syringe,  and  drew  off  some  fluid,  which 
was  found  to  be  pui-e  and  laudable  pus.  What  their 
diagnosis  was  I  do  not  know. 

"The  patient  suffered  considerable  shock  from 
this  operation,  followed  liy  pain  and  all  the  symji- 
toms  of  moderate  peritoneal  inflammation,  which 
was  so  far  controlled  by  treatment  as  to  allow  her 
to  return  home  at  the  end  of  three  days,  ninety  miles, 
on  the  cars.  The  week  following  she  continued  to 
suffer  pain  at  intervals,  but  was  comparatively  com- 
fortable, and  so  expressed  herself  on  retiring  Mon- 
day evening.  She  was  awakened  toward  morning 
by  a  severe  pain  in  the  hypogastric  region,  which  she 
described  as  'tearing  and  griping,'  with  the  sensa- 
tion of  something  giving  way.  This  was  followed 
by  the  symptoms  of  collapse,  and  death  ensued  in  a 
few  hours. 

"  An  autopsy  was  made  by  Dr.  Mitchell,  forty-two 
hours  after  death,  in  the  presence  of  Drs.  Baker, 
Mitchell,  Look,  and  Parkhill.  An  incision  through 
the  abdominal  wall  disclosed  peritonitis.  Adhering 
to  the  jjeritoneum  was  a  fleshy-looking,  membran- 
ous sac,  situated  above  and  completely  covering  the 
uterus  and  bladder.  It  contained  nearly  three 
quarts  of  thick,  creamy  pus,  and  was  found  to  be 
ruptured  at.  its  apex,  the  contents  flowing  into  the 
abdominal  cavity.  The  sac,  l)y  its  attachments, 
proved  to  be  the  right  ovary,  and  after  it  was  evacu- 
ated and  turned  inside  out,  there  was  found  a  large 
incisor  tooth,  a  small  piece  of  bone,  and  a  piece  of 
haii-y  scalp,  all  attached  to  the  inner  surface  of  the 
sac  by  means  of  a  triangular,  fleshy  mass,  resembling 
a  rudimentary  placenta. 

"  The  pus  was  found  flUed  with  loose,  floating 
hairs,  some  of  which  were  ten  inches  in  length." 

The  Mathematical  Co>rvoLUTioNS. — Bert  Wagner, 
of  Fort  Wayne,  111.,  asks  :  "  If  a  clot  were  found 
in  the  post-mortem  in  the  convolution  or  convolu- 
tions immediately  under  the  anterior  superior  angle 
of  the  i^arietal  bone,  and  it  was  known  that  the 
deceased  had  been  an  accountant  or  mathematician, 
and  had  been  rendered  unfit  to  have  charge  of  his 
books  or  class  in  mathematics,  could  it  not  be  said 
with  proi^riety  (other  experiments  and  observations 
showing  the  same  result),  that  those  convolutions 
were  the  seat  or  origin  of  mathematical  calculation?" 

To  which  we  answer,  certainly  not — and  refer  our 
correspondent  to  any  standard  worlc  on  nervous  dis- 
eases :  Hammond,  Kosenthal,  Hamilton,  Boss,  etc. 

A  Caution  to  Pulmonary  Gyjinasts. — Dr.  D.  F. 
Powell,  of  La  Crosse,  Wis.,  sends  us  the  following 
useful  hints.     He  writes  : 

"  Ten  years  ago  my  chest  measurement  during  full 
forced  inspiration  was  thirty-seven  inches.  By  sys- 
tematically iiilniling  and  distending  the  air-cells  as 
recommended  by  Xienieyer  (and  Smith,  in  Mepical 
Kecord  of  October  '29,  1881),  I  have  increased  chest 
measurement  to  forty-four  inches,  and  have  wonder- 
fully developed  the  pectoral  and  intercostal  muscles. 
I  write  this  to  warn  those  who  may  adopt  pulmo- 
nary gymnastics,  against  inspiring  air  at  too  low  a 
temperature,  as  I  have  on  several  occasions  sufi'ered 
from  acute  bronchitis,  brought  on  by  the  forced  in- 
halation of  "  raw  "  cold  air.  I  find  that  deep  inspi- 
rations of  pure  air,  at  a  temjierature  of  from  GO  to 
80°,  are  of  marked  benefit  in  nearly  all  incipient 
lung  diseases.  I  also  freely  use  air  medicated  with 
carbolic  acid,  tar,  iodine,  bromine,  nitrate  of  pot- 
ash, etc.,  as  indicated,  and  believe  that  no  other 
treatment  equals  it  as  a  remedial  agent." 


Vol.   XXI.-No.  2.1 
Jan.  14,  1882.     f 


THE  MEDICAL  RECORD. 


29 


NON  -  SPECIFIC  GOXOEEH(EA  —  REFLEX 
lERTTATION  PKODUCIX(i  SYIIPTOMS  OF 
STONE  IX  THE  BLADDEll. 

A  Clixicaij  Lectuke, 
By  FESSENDEN  KOTT  OTIS,  M.D., 


NON-SPECIFIC    GOXORRHOSA   IN   A   CHILD. 

Gentlemen  :  I  have  an  opiiortunitv  to-day  to  show 
you  a  case  which  goes  to  prore  that  we  may  have  a 
gonorrhoea  of  a  non-specitic  origin.  Yon  will  remem- 
ber that  on  a  former  occasion  I  spoke  of  what  seemed 
to  me  a  most  important  fact,  namely,  the  possibility 
of  an  inflammation  of  the  mucous  membrane  of 
the  vagina  in  young  children,  identical  with  gonor- 
rhoea, and  yet  without  any  suspicion  of  venereal  con- 
tact, but  being  ajiparently  the  result  of  an  iri'itation 
reflected  from  a  distance,  as,  for  examj^le,  from  the 
rectum  by  the  presence  of  ascarides.  Now,  to  those 
who  are  accustomed  to  dispute  everything,  and  ad- 
mit nothing  but  absolute  proof,  it  might  be  diflicult 
to  show  that,  in  the  cases  on  record,  care  had  been 
taken  to  exclude  every  jjossible  cause  of  the  disease 
other  than  the  one  named,  viz.,  ascarides  in  the  rec- 
tum. It  might  be  difficult  to  prove  that  there  had 
been  no  i50ssil)le  chance  of  conveying  the  material 
from  a  specific  urethritis  or  inflammation — for  ex- 
ample, conjunctivitis  to  the  vagina,  by  means  of  the 
hands  or  some  other  medium.  But  when  we  have 
repeated  instances  of  inflammation  of  the  vaginal 
mucous  membrane,  taking  on  all  the  characteiistics 
of  an  inflammation  of  a  specific  chaiacter,  in  which 
there  was  no  known  or  suspected  specific  cause,  the 
only  common-sense  way  of  accepting  the  matter  is 
to  do  as  eminent  authorities  have  done,  attribute 
its  origin  to  irritation  reflected  from  inflamed  neigh- 
boring organs.  Such  a  cause  I  consider  capable  of 
setting  up  an  inflammation  which  we  may  accept  as* 
a  gonorrhoea  capable  of  communicating  an  acute 
purulent  conjunctivitis  which  is  not  at  all  less  in 
grade  than  that  which  comes  from  a  well-known 
gonoiThceal  source — an  inflammation  which  can  be 
communicated  to  the  healthy  male  urethra,  which 
may  extend  from  thence  to  the  ej^ididymis,  as  in  or- 
dinary gonoiThceal  trouble,  as  in  the  case  reported 
by  Dr.  "Robert  Watts,  and  referred  to  at  our  last 
sjssion. 

This  little  child  was  sent  to|{us  from  one  of  the 
dispensaries,  to  obtain  an  opinion  of  the  character 
ol'  a  vaginal  discharge  which  has  been  present.  My 
opinion  coincides  entirely  with  that  of  the  doctor 
who  sent  the  child  to  us — that  there  was  a  vaginitis 
which  had  resulted  in  a  profuse  discharge  of  jnis, 
such  as  we  are  accustomed  to  associate  with  an  or- 
di'iary  contagious  vaginitis,  being  a  little  greenish  in 
cnlor,  but  in  other  respects  not  differing  from  an 
or  Unary  leucorrhcea.  The  question  was  as  to  its 
c.\use.  I  suggested  its  probable  origin  from  a  knowl- 
eilge  of  the  manner  in  which  such  cases  have  been 
known  to  occur,  as  previously  related  to  you,  namely, 
as  the  result  of  the  i^resence  of  ascarides  in  the  rec- 
tum. The  mother  was  directed  to  make  injections 
oi'  lime-water  into  the  rectum,  and  watch  for  the 
escape  of  ascarides.  This  was  done,  and  the  mother 
now  says  that  she  found  in  each  passage  plenty  of 


little  worms  which  looked  like  white  threads— a 
pretty  good  description  of  the  ascarides.  I  think, 
therefore,  we  may  accept  the  origin  of  the  vaginitis 
in  this  case  to  be,  as  was  claimed,  from  the  pres- 
ence of  ascarides  in  the  rectum.  The  vagina  has 
been  kei)t  clean,  and  the  inflammation  has  subsided 
considerably,  and  at  present  the  purulent  discharge 
has  almost  ceased. 

Gonorrha'al  inflammation  does  not  differ  in  its 
characteristics,  whether  it  afiects  the  mucous  mem- 
brane of  the  urethra  in  the  male,  or  the  mucous 
membrane  of  the  \-ulva  or  of  the  vagina  in  the  female. 
The  jjroducts  of  the  inflammation  are  the  same,  and 
its  progress  in  the  female  may  be  said  to  be  similar 
to  that  in  the  male,  being  liable  to  extend  from  the 
vagina  to  mucous  tracts  connected  therewith,  so  that 
in  the  female  we  may  have  as  complications  of  speci- 
fic inflammation  of  the  vagina  a  gonoi-rhcea  of  the 
urethra,  the  uterus,  the  Fallopian  tubes,  and  of  the 
ovaries.  It  is  true  some  of  these  are  rare  complica- 
tions, but  they  may  occur.  For  reasons  which  you 
can  readily  appreciate,  the  rectum  is  seldom  the 
seat  of  gononhoea,  but  is  so  occasionally.  I  have 
had  the  opi^ortunity  of  seeing  several  cases  of  rectal 
gonorrhcea— one  in  my  practice  which  I  was  aUe  to 
watch  from  beginning  to  end.  It  occurred  from  con- 
nection per  rectum.  A  gentleman  had  a  gonon-hreal 
discharge,  and,  wishing  to  avoid  giving  his  wife 
gonorrhoea,  had  connection  by  the  rectum,  the  result 
of  which  was  that  she  had  a  gonorrhipa  of  the  rec- 
tum which  continued  for  three  or  four  weeks,  and 
was  attended  with  the  ordinary  .symiJtoms,  inflam- 
mation and  mucous  discharge,  with  straining  and 
great  discomfort  on  defecation. 

The  treatment  in  these  cases  of  female  gonorrhoea 
does  not  difl'er  greatly  from  that  we  employ  in  the 
male.  Of  course,  we  have  greater  advantages  in  ap- 
proaching the  mucous  -surfaces  of  large  channels,  like 
the  vagina  and  rectum,  and  can  make  our  applica- 
tions with  comj^arative  ease,  and,  conseqiiently,  after 
the  highly  inflamed  stage  of  the  disease  has  passed, 
we  derive  benefit  from  tolerably  frequent  astringent 
injections.  During  the  acute  stage,  the  introduction 
of  instruments  into  the  vagina  is  very  painful,  and 
aggravates  the  difficulty,  but  we  can  almost  always 
introduce  a  small  syringe,  and  bathe  the  surface  with 
some  bland,  unirritating  fluid  of  a  slightly  astringent 
character,  using  perhaps  three,  four,  or  five  grains 
of  alum  to  an  ounce  of  water.  As  the  acuteness  of 
the  attack  passes  off,  more  active  treatment  may  be 
employed,  and  I  have  seen  chi'onic  cases  veiT  much 
benefited  by  strong  solutions  of  nitrate  of  silver,  five 
or  ten  grains  to  the  ounce.  There  is  not  that  danger 
attending  the  use  of  injections  of  this  kind  in  the 
vagina  which  attends  their  use  in  the  urethra.  I 
have  been  in  the  habit,  in  some  cases,  of  taking  a 
solution  of  nitrate  of  silver,  five,  or  even  ten  grains 
to  the  ounce,  in  cases  in  which  the  discharge  is  j^er- 
sistent,  and,  having  passed  in  the  speculum,  pour 
the  solution  into  it,  and  gradually  witlidraw  it  in  a- 
manner  to  bring  the  solution  in  contact  with  every 
part.  Astringents  and  absolute  cleanliness  play  the 
chief  jjart  in  the  cure  of  gonorrhoea  of  the  female. 
Internal  remedies,  such  as  cojjaiba,  etc.,  are  worse 
than  useless. 

The  disease  in  the  female,  just  as  in  the  male, 
usually  lasts  four  or  five  weeks,  and  if  carefully  man- 
aged is  not  likely  to  continue  a  much  longer  time, 
but  unless  applications  are  made  to  every  part  of 
the  mucous  membrane  it  sometimes  lasts  indefinitely. 
The  sensitiveness  of  these  parts  is  not  at  all  great 
in  the  subacute  form,  so  that  patients'  attention  is 


30 


THE  MEDICAL  RECORD. 


not  drawn  to  it,  and  they  often  go  on  communicating 
gonorrhoea  to  others  without  being  aware  of  having 
it  themselves.  In  the  later  stages  of  the  disease  the 
inflammation  may  be  entirely  absent  from  the  vulva 
and  lower  portion  of  the  vagina,  and  yet  linger  in 
the  deeper  portions  of  tlie  canal,  unknown  to  the 
patient  herself. 

REFLEX   IKRITATION   PRODUCING   SYMPTOMS   OF   STONE. 

This  man,  gentlemen,  has  some  of  the  symptoms 
of  stone,  and  was  examined  therefor  a  month  ago. 
The  history  of  the  case  reads  as  follows  :  "  He  com- 
plains of  frequent  and  painful  urination,  pain  being 
present  both  before  and  after.  There  is  occasion- 
ally a  whitisli  discharge  at  the  meatus  urinarius.  A 
No.  .30  sound  was  passed,  and  he  was  ordered  dilu- 
ents and  alkalies.  September  1.5th,  analysis  of  the 
nrine  showed  amorphous  urates  in  abundance,  but 
nothing  else.  October  13th,  pain  in  the  penis,  rises 
at  night  to  urinate.  Connection  increases  the  sore- 
ness in  urethra.  He  denies  all  pi-evious  venereal 
disease.  He  was  then  given  nitro-muriatic  acid  and 
something  to  relieve  dyspeptic  disturbance  which 
was  probably  cause  of  irritant  qualities  in  the  urine." 

The  patient,  in  rei^ly  to  my  questions,  says  that 
about  four  years  ago  he  had  constant  pain  about 
the  left  iliac  region,  which  continued  four  or  live 
months  ;  tliat  a  year  and  a  half  ago  he  had  to  uri- 
nate as  many  as  tifteen  times  dui-ing  the  day  and  a 
dozen  times  during  the  night ;  that  he  was  exam- 
ined for  stone  twice  before  he  came  to  this  clinic  ; 
that  he  had  pain  at  the  head  of  the  jienis,  and  that 
on  one  occasion  lie  passed  a  clot  of  blood  in  his 
urine.  Riding  in  a  wagon  causes  him  pain  and 
makes  his  symptoms  worse.  He  thinks  th.at  the 
medicines  whicli  he  has  been  taking  during  the  past 
month  have  benefited  him. 

There  are  so  many  symptoms  in  this  case  which 
point  to  the  presence  of  stone  in  the  bladder  that  it 
is  desirable  we  should  make  another  exploration. 
The  history  of  pain,  referred  to  the  region  of  the 
left  groin,  existing  for  some  time,  would  certainly 
be  a  suspicious  circumstance,  although  it  is  not  the 
history  of  an  ordinary  attack  of  nephritic  colic,  one 
which  oome.^  on  suddenly,  pursues  a  tolerably  rapid 
course,  getting  through  in  the  course  of  a  few  hours, 
and  ending  with  a  sudden  cessation  of  all  the  symp- 
toms. It  is  possible  that  in  his  case  the  stone  was 
small  enough  to  pass  down  the  ureter,  but  so  large, 
however,  as  to  pass  very  slowly,  being  months  in 
doing  so,  but  finally  reaching  the  bladder.  I  SU25- 
pose  a  stone  might  be  an  indefinite  time  passing 
down  the  ureter,  blocking  it  up,  and  yet  giving  no 
very  great  amount  of  trouble.  Within  the  last 
month  in  consultation  I  saw  a  case  of  obscure  trou- 
ble which  was  referable  particularly  to  the  region  of 
the  liver,  this  organ  apparently  being  enlarged,  and 
the  lower  anterior  portion  of  tlie  right  lobe  tlie  site 
of  considerable  tenderness,  which  led  us  to  suppose 
there  was  an  inflammatory  process  going  on  in  the 
liver.  There  was  some  evidence  of  suppuration,  in 
the  presence  of  fever,  sweating,  etc.  There  was  no 
evidence  of  disease  of  the  kidneys  or  of  any  organ 
but  the  liver.  The  case  went  on  for  a  while,  when 
suddenly  there  was  retention  of  urine,  which,  when 
it  was  relieved,  was  found  to  have  accompanied  a 
discharge  of  pus  into  the  bladder.  There  had  been, 
as  before  said,  no  suspicion  of  any  trouble  of  the 
kidneys  ;  the  urine  had  been  examined  repeatedly 
and  was  found  normal,  and  there  had  been  no  pain 
which  could  direct  suspicion  to  trouble  in  this  re- 
gion.    To  make  brief  the  history  of  the  case  (which 


in  several  other  respects  was  a  very  interesting  one), 
death  occurred  from  ursemia  in  the  course  of  two  or 
three  weeks,  and  at  the  jjost-mortem  examination 
the  entu-e  secreting  substance  of  the  kidney  was 
found  to  be  destroyed  and  its  place  occupied  by  a 
sac  fiUed  with  urine,  which  could  not  escape  through 
the  ureter  on  account  of  the  presence  of  a  uric  acid 
calculus.  I  mention  this  case  to  show  that  it  is  quite 
possible  for  the  kidney  to  be  seriously  dis.abled  with- 
out causing  symptoms  which  would  direct  your  at- 
tention to  that  organ. 

In  this  patient's  case  we  have  the  history  of  con- 
stant pain,  existing  for  four  months  in  the  region  of 
the  left  kidney,  and  extending  down  in  the  direction 
which  the  iireter  pursues  to  enter  the  bladder,  and 
followed  later  by  symptoms  of  stone  in  the  bladder, 
such  symptoms  as  pain  at  the  head  of  the  penis, 
blood  oceiu'ring  in  the  urine  on  one  occasion,  fre- 
quent urination,  and  aggi'avation  of  the  symptoms 
on  motion.  These  facts  point  very  strongly  to  the 
existence  of  stone  in  the  bladder  at  the  present  time. 
In  a  former  case  at  this  clinic  you  will  remember 
that  I  examined  for  stone  in  the  bladder  and  could 
detect  none,  but  that  on  a  subsequent  occasion  the 
stone  was  found.  This  illustrated  the  fact  that 
stones  sometimes  become  secreted  and  may  be  lodged 
in  a  sulcus  in  the  bladder,  or  over  the  pubes,  and  can- 
not for  the  time  being  be  detected. 

I  will  now  first  examine  this  patient  while  he  lies 
down,  raising  the  hips  so  that  the  stone,  if  any  be 
present,  may  roll  to  the  fundus  of  the  bladder.  I 
jjass  the  sound  down  the  urethra  with  the  greatest 
gentleness,  allowing  it  as  it  were  to  find  its  own  way 
down  ;  and  now,  having  introduced  it,  if  it  strikes 
against  a  stone  I  will  recognize  that  fact  by  the 
clicking  noise  which  it  will  make,  just  as  it  would 
do  if  the  stone  were  strack  by  the  metallic  sound 
outside  of  the  bladder.  You  observe  that  I  move  the 
sound  gently  back  and  forth,  and  from  side  to  side, 
but  I  am  unable  to  detect  the  pi'esence  of  a  stone.  I 
also  fail  to  detect  its  presence  since  he  has  assumed 
the  standing  posture.  As  I  introduce  my  finger 
into  the  rectiim,  I  fail  to  find  any  aid  to  the  diagno- 
sis ;  there  seems  to  be  a  little  induration  of  the 
prostate  on  one  side,  but  notliing  else  abnormal. 

It  is  not  impossiVile,  therefore,  that  these  symp- 
toms are  due  to  some  contraction  of  the  urethra, 
probably  within  a  short  distance  of  the  external 
meatus,  for  I  have  known  all  the  symptoms  of  stone 
in  the  bladder  to  exist  for  months  and  even  years, 
when  no  stone  at  all  was  present,  and  the  symptoms 
were  entii-ely  due  to  contraction  of  the  urethra,  with- 
in half  an  inch  of  the  orifice,  this  fact  being  demon- 
strated by  the  occunence  of  complete  relief  imme- 
diately following  division  of  the  stricture.  I  had  a 
case  of  that  kind  about  ten  yeai-s  ago,  a  gentleman, 
sixty  years  of  age,  had  sufiered  from  frequency  of 
urination  for  ten  years,  making  his  water,  as  he 
said,  every  hour  in  the  day,  and  not  quite  so  fre- 
quently during  the  night.  For  six  months  previous 
to  the  time  I  saw  him  he  had  made  his  water 
every  half  hour  when  he  followed  his  inclination. 
and  for  the  three  days  he  had  urinated  every  tifteen 
minutes,  but  without  pain.  When  I  saw  him  he  w.as 
sitting  on  a  hot  poultice,  which  had  been  advised  by 
his  wife's  medical  attendant,  who  was  a  homcvopiith, 
and  was  also  taking  a  preparation  of  belladonna.  By 
bis  bed  was  the  pot  de  ckamhre,  two-thirds  full  of 
urine,  pus,  and  blood.  From  this  fact  I  supposed  it 
was  a  case  of  prostatic  trouble  in  an  old  man 
with  stone  in  the  bladder,  .\lthough  the  patient 
was  sixty  years  of  age,  I  found  absolutely  no  enlarge- 


THE  MEDICAL  RECORD. 


31 


ment  of  the  prostate.     I  was  also  unable  to  detect 
any  stone  in  the  bladder.     Turning  my  attention  to 
his  urethra,  I  found  the  orifice  about  Xo.  2-t  French,   ' 
and  as  the  circumference  of  the  penis  was  about  three   ] 
and  one-half  inches,  it  indicated  a  contraction  of  about   i 
ten  millimetres.  Dr.  .T.  Marion  Sims,  who  was  a  friend 
of  the  patient  and  had  sent  him  to  me,  W'as  sent  for   i 
to  consider  with  me  the  propriety  of  dividing  the   I 
orifice.    The  jiatient  objected  to  any  operation  what-   | 
ever,  but  Dr.  Sims  accepted  my  statement  as  to  the  j 
absence  of  prostatic  trouble  and  stone,  and  expressed 
his  opinion  as  to  the  possibility  of  the  trouble  being 
caused   by  contraction  at  the  orifice   from  having  I 
himself  seen  similar  reflex  difiiculties  in  his  special  ' 
practice,  as.sociated  with  uterine  diseases.     The  pa-  I 
tient   finally  consented   to   an   operation.     He  was   ! 
etherized,  the  stricture  was  thoroughly  divided,  a   t 
large-sized  instrument  was  passed  into  the  bladder.    I 
A  further  examination  was  made  both  by  myself  and 
Dr.  Sims  for  stone,  but  with  a  negative  result.     The   I 
result  was  that  there  immediately  began  to  be  relief  t 
from   the   frequency   of  urination,   so   that   within   | 
twenty-four  hours  the  intervals  had  increased  from 
ten  or  fifteen  minutes  to  two  hours  and  a  half ;  with-   I 
in  three  or  four  days  the  intervals  increased  to  three   j 
and  more  hours  ;  and  within  ten  days,  without  any   1 
internal  medication  whatever,  so  far  as  I  remember, 
the  patient  was  about  his  business,  travelling  several 
mUes  to  and  from.     He  remained  well  for  a  year  or 
longer,  when  he  was  again  attacked  in  the   same 
manner.     I  was  called  to  him,  and  found  that  there 
had  been   recontraction  several  millimetres,  and  I 
also  found  a  small  stone,  not  larger  than  a  large- 
sized  pea.  I  jileaded  in  vain  for  the  privilege  of  remov- 
ing it,  but  I  divided  the  reconti-acted  stx-ictui'e  and 
the  ojieration  proved  quite  as  successful  as  on  the 
previous  occasion,  when  I  found  nothing  to  account 
for  his  trouble  but  the  contraction  at  the  orifice. 

What  I  wish  to  imjjress  esjiecially  by  this  case  is 
the  fact  that  the  symptoms  of  stone  in  the  bhidder 
may  be  kept  up  for  a  long  time,  simply  by  a  contrac- 
tion of  the  orifice  of  the  urethra,  more  especially  a 
contraction  not  at  the  orifice,  but  half  an  inch  farther 
back.  I  could  relate  many  cases  similar  to  the  one 
just  mentioned,  and  show  that  it  is  our  duty  when 
symptoms  of  stone  in  the  bladder  are  present,  to 
examine  into  the  condition  of  the  urethra  for  the 
possible  cause. 

Before  proceeding  to  examine  the  calibre  of  this 
man's  urethra,  I  will  take  the  measurement  of  the 
circumference  of  the  penis,  for  the  proportionate  re- 
lationship between  these  two  measurements  I  insist 
upon,  after  ten  years'  experience,  is  a  point  of  great 
value  in  diagnosis.  I  have  never  yet  found  a  case 
in  which  this  proportion  did  not  hold  sufficiently 
true  to  be  a  valuable  guide  to  the  surgeon.  Now, 
we  have  an  instrument,  the  urethrometer,  by  which 
anybody  can  measure  the  urethra  for  himself,  and 
determine  whether  this  question  is  con-ect  or  incor- 
rect ;  he  does  not  have  to  take  anybody's  word  for 
it,  but  can  test  it  for  himself,  and  having  made 
measurements  in  twenty  or  thirty  cases,  he  will  be 
convinced  that  the  relation  between  the  size  of  the 
urethra  and  of  the  penis  is  a  mechanical  fact. 

I  find  this  man's  jjenis  to  measure  three  and  three- 
fourths  inches,  which,  according  to  the  proportionate 
relation  mentioned,  woirld  call  for  a  urethra  No.  36, 
French.  You  will  remember  what  I  have  said  be- 
fore, that  the  urethra  is  more  Hkely  to  over-measure 
than  to  under-measure  in  this  proportion,  and  so  I 
find  in  this  case  that  the  urethra,  for  a  distance  of 
two  inches  at  the  bulbo-membranous  portion,  meas- 


ures forty.  Forward  of  this  we  find  a  little  contrac- 
tion, being  due  to  folds  into  which  the  mucous 
membrane  is  thrown  at  the  pendulous  portion  of  the 
canal.  Thes-e  folds  and  the  ajiparent  contraction 
disappear  when  the  penis  is  erect,  as  I  had  the  op- 
portunity of  demonsti-ating  once  at  Bellevue  Hos- 
pital, the  patient  having  an  erection  during  my  ex- 
amination. 

Making  very  gentle  traction  on  the  urethrometer, 
we  find  it  coming  along  at  40,  37,  3(5,  3.0,  '64,  and 
finally,  for  a  distance  of  about  three-fourths  of 
an  inch,  it  comes  down  to  30,  being  at  that  point, 
back  of  the  meatus,  contracted  about  five  millimetres 
below  the  normal  proportion.  Ihis  case  also,  then, 
goes  to  show  that  a  definite  relation  between  the 
size  of  the  penis  and  its  canal  does  exist.  Since  the 
patient  is  not  prepared  to  have  an  operation  done 
to-day,  at  a  future  time  we  will  divide  this  stric- 
ture in  the  anterior  portion  of  his  urethra,  and  see 
it  it  will  not  relieve  him  of  the  symi^toms  from 
which  he  is  suffering. 

While  upon  the  subject  of  reflex  irritation  I  will 
take  occasion  to  relate  a  case  which  I  expect  to  see 
immediately  after  the  clinic.  Some  seven  years  ago 
I  was  called  to  see  a  patient  who  was  making  his 
water  eveiy  few  minutes,  and  I  found  evidence  in 
the  chamber  of  the  existence  of  acute  cystitis.  The 
urine  passed  in  exceedingly  small  quantities,  and 
for  some  hours  he  had  been  unable  to  urinate  at  all. 
There  was  a  history  of  stricture,  for  which  he  had 
been  treated,  more  or  less,  during  a  number  of  years. 
He  had  had  gonorrhoea,  and  was  under  the  impres- 
sion that  he  had  a  close  stricture.  It  must  have  been 
seven  years  ago,  for  I  introduced  Voillermier's  di- 
vulsor,  a  kind  of  instrument  which  I  have  not  used 
since,  at  least  as  many  years  back  as  that.  I  was 
about  to  di\-ulse  the  urethra,  supposing,  of  course, 
that  it  was  contracted,  when,  to  my  utter  surprise, 
the  instrument  passed  on  into  the  bladder  withoiit 
the  least  resistance.  I  remarked  to  my  assistant 
that  I  did  not  believe  the  case  was  one  of  stricture 
of  an  organic  nature,  but  probably  of  a  reflex  origin. 
The  patient  recovered  fi-om  his  trouble,  and  had  no 
return  of  it  until  about  three  years  ago,  W'hen  he 
sent  for  me,  and  I  found  that,  although  there  was  not 
complete  retention,  he  had  to  make  his  tirine  very 
frequently  and  in  a  very  small  stream.  There  was  a 
contraction  at  the  orifice  of  about  five  millimetres, 
which  I  divided  and  then  passed  an  instrument,  full 
size.  No.  3.0,  into  the  bladder,  without  the  least  dif- 
ficulty. He  was  directed  to  pass  an  instrument  once 
in  a  while,  which  he  did,  and  remained  jierfectly  free 
from  his  trouljle  until  recently.  Two  days  ago  he 
came  to  my  office,  saying  that  he  suflered  from  great 
frequency  of  urination,  passing  a  small  stream,  and 
from  symptoms  of  cystitis.  Pus  was  present  in  the 
urine.  I  attempted  to  pass  an  instrument  into  his 
bladder,  but  it  was  resisted  at  the  bulbo- membra- 
nous junction.  Having  held  it  a  few  moments  to 
see  if  it  would  not  pass,  and  finding  it  did  not,  I 
desisted  from  further  attempts  through  fear  of  start- 
ing up  too  much  iri-itation,  and  directed  the  patient 
to  return  and  again  I  would  examine  for  stone  under 
the  influence  of  ether.  But  that  afternoon  I  saw  him 
again,  and  he  was  able  to  pass  his  water  in  larger 
quantity  and  not  oftener  than  once  in  three  hours, 
and  during  the  night  he  had  to  micturate  but  three 
times.  At  ten  o'clock  the  next  morning,  however, 
frequency  of  urination  came  on  again,  apparently 
without  cause.  In  the  afternoon,  yesterday,  I  di- 
vided a  stricture  of  five  millimetres,  after  which  I 
passed  a  sound,  No.  30,  easily  into  the  Viladder.    Dr. 


32 


THE  MEDICAL  RECORD. 


Bangs  has  seen  the  patient  since,  and  he  was  per- 
fectly comfortable,  passing  his  urine  only  once  in 
three  or  four  hours.  His  symptoms,  therefore,  must 
ba  referred  to  the  large  stricture,  and  their  relief, 
in  one  instance,  simply  to  passing  a  sound,  and  in 
the  last  case  to  div-ision  of  the  stricture. 

Now,  if  the  two  cases  which  I  have  related  stood 
alone,  we  should  still  have  reason  for  taking  into 
consideration  the  existence  of  stricture  near  the  ori- 
fice when  trying  to  account  for  the  existence  of  the 
symptoms  mentioned,  but  I  could  show  the  record 
of  at  least  a  hundred  cases  in  which  these  symp- 
toms were  produced  by  reflex  ii-ritation,  set  up  from 
contraction  at  or  near  the  meatus  urinarius. 


©rlqinal  Commumcatlons. 


NOTES   OF   TWO   SUEGICUj   CASES. 
By  DONALD  MACLEAN,  M.D., 


SCRGEltT  AND 


OP   MICHIGAN. 

Case  L — Large  Pihroun  Tumor  of  Scarpa's  Trinngh;, 
Involving  the  Femoral  Vessels — Removal — Death  from 
Pneumonia  Thirti/four  Days  after  Oj:>eration. — Mrs. 
A.  B ,  aged  forty-four;  widow;  admitted  Feb- 
ruary 21,  1877.  Fifteen  months  previously,  patient 
discovered  a  hard  tumor  at  the  upper  part  of  the 
left  thigh.     It  was  then  about  the  size  of  a  large 


orange,  and  was  somewhat  painful,  especially  during 
menstruation,  which  had  continued  to  be  regular. 
For  three  months  the  pain  had  been  much  more 
severe,  and  the  tumor  had  increased  rapidly  in  size. 
The  pain  is  now  continuous  day  and  night,  and  re- 
sembles the  sensation  of  "  hot  knives."  Until  three 
months  ago  i)atient  had  been  able  to  walk,  so  that 
nothing  peculiar  was  noticeable,  but  since  that  time 
had  been  unable  to  do  so  without  assistance. 

The  movements  of  the  dift'erent  articulations  of 
the  limb  are  unimpaired.  Patient  has  been  subject 
to  occasional  attacks  of  sick  headache,  also  to  leu- 
corrhoea  ;  otlierwise  has  l)een  healthy.  The  sprin" 
before  the  tumor  appeared  in  the  thigh,  patient  in- 
jured her  loft  hip  slightly  by  a  fall,  and  suflerod 
more  or  less  pain  in  it  all  that  summer. 


On  admission,  patient  was  somewhat  anaemic  in  ap- 
pearance, and  complained  of  a  feeling  of  debility, 
with  mental  depression.  The  tumor  now  measured 
thirty-tive  and  one-half  inches  at  its  base.  It  ex- 
tended from  Poupart's  ligament  to  within  four  inches 
of  the  knee,  and  occui^ied  the  whole  of  the  inner  and 
anterior  surfaces  of  the  thigh.  The  limb  at  the 
most  prominent  part  of  the  tumor,  measured  thirty- 
five  and  one-half  inches  ;  the  opposite  one,  twenty- 
two  inches.  The  skin  over  the  growth  presented 
the  natural  ajipearance.  On  careful  maniijulation, 
the  tumor  was  found  to  be  quite  solid.  It  seemed 
to  lie  somewhat  intimately  attached  at  Poupart's 
ligament,  but  elsewhei'e  it  was  evidently  unattached, 
either  to  the  skin  over  it  or  to  the  bone  and  deep 
textures  underneath  it. 

The  dimensions  and  relations  of  the  tumor  are 
veiy  well  shown  in  the  woodcut,  which  was  copied 
from  a  photograph  taken  before  the  operation. 

The  most  imi:iortant  ju-oblem  to  solve,  before  de- 
termining as  to  the  proper  course  to  pursue,  was  the 
relation  of  the  tumor  to  the  great  femoral  vessels. 
The  most  careful  examination  failed  to  give  the  de- 
sired information.  The  vessels  certainly  did  not  lie 
oner  the  tumor.  Whether  they  passed  through  it, 
or  were  beneath  and  behind  it,  I  was  not  able  to  de- 
termine before  operation.  Of  course  I  hoped  that 
they  did  not  pass  through  it.  I  had,  however,  ob- 
served that  the  venous  circulation  at  the  back  of  the 
thigh  and  hip  was  vastly  increased.  Large  veins 
coiled  up  over  these  jiarts,  and  led  to  the  belief  that, 
in  one  way  or  other,  the  natiual  circulation  was 
gi-eatly  impeded,  and,  in  consequence,  the  collateral 
circulation  was  proportionately  increased. 

I  therefore  determined  to  excise  the  tumor,  taking 
care,  if  the  vessels  were  found  behind  it,  to  avoid 
wounding  them,  but  I  also  determined,  in  the  event 
of  their  being  found  passing  through  it,  to  either 
dissect  them  out  of  their  bed  in  the  tumor  and  save 
them,  or,  if  that  were  found  impossible,  to  cut  them 
away,  trusting  to  the  greatly  increased  collateral 
circulation  to  maintain  the  nutrition  of  the  limb. 
The  great  solidity  of  the  new  giowth  led  me  to  hope 
that  if  the  vessels  did  pass  through  it  they  would  be 
so  diminished  in  size  as  to  be  practically  of  little 
conseqiience. 

The  enlarged  collateral  circulation  which  was 
clearly  visible,  gave  reasonable  countenance  to  this 
hope. 

The  patient  was  kept  in  hospital  for  a  week  be- 
fore the  operation  was  performed,  during  which 
time  she  took 

B .   Fen-i  et  quinio  cit 3  j. 

Tinct.  calumb 5  iij. 

Sig. — One  teaspoonful  three  times  a  day. 

She  also  took  an  anodyne  at  bedtime,  consisting 
of  twelve  grains  each  of  bromide  and  Dover's  pow- 
der. On  February  7,  1877,  in  the  presence  of  the 
whole  medical  class  and  with  the  assistance  of  my 
colleague,  Professor  Frothingham,  I  exci.sed  the  tu- 
mor, the  patient  being  under  the  influence  of  chloro- 
form, Esmarch's  bandage  was  applied  from  the  toes 
up. 

On  dividing  the  skin  and  fascia,  I  found  the  sar- 
torius  muscle  spread  out  over  the  surface  of  the 
tumor,  constituting  a  thick  muscular  covering  for  it. 

I  laid  the  whole  mass  bare  with  one  long  incision, 
extending  from  Poupart's  ligament  almost  to  the 
inner  condyle  of  the  femur.  I  then  commenced  to 
separate  the  tumor  from  its  deep  attachments,  and 
at  once  divided  the  femoral  vessels  close  to  Pou- 


THE  MEDICAL  RECORD. 


33 


part's  ligament,  where  they  passed  right  into  the 
mass  of  the  tumor.  The  vessels  were  instantly  liga- 
tured with  strong  silk  threads.  The  tumor  was  then 
rapidly  turned  out  of  its  bed  from  above  downward, 
and  the  femoral  vessels  again  divided  and  ligatured 
at  the  lower  end  of  the  tumor  close  to  Htmter's 
canal.  Other  vessels  were  found  and  tied,  so  that,  in 
all.  eighteen  ligatures  were  used.  The  walls  of  the 
VList  chasm  were  drawn  accurately  together  with 
iloep  silk  sutures ;  the  whole  limb  was  enveloped  in 
sheet  wadding  and  supported  by  a  flannel  roller,  and 
the  patient  placed  in  bed. 

The  following  notes  of  the  case  are  condensed 
from  the  hospital  case-book,  and  were  written  by 
the  hoiise  surgeon,  the  late  Dr.  Curiw  : 

February  7th,  1  p.m. — Patient  rallied  well ;  com- 
plains of  pain  ;  pulse,  120 ;  tempei-ature,  104 ^\ 
Administered  hypodermic  injection,  morphia,  gr.  i. 
7  P.M. — \o  pain  ;  temperature  of  limb  natural :  pa- 
tient has  slept  for  two  hours,  and  has  taken  a  little 
oyster  soup  and  3  ij.  brandy.  10  p.m.. — Pulse,  Hi, 
t'ull  and  soft ;  temperature,  102° ;  expression  of 
iMuntenanee  good  ;  feels  very  well. 

February  8th,  6  a.m. — Has  slept  more  than  half 
of  the  time  since  last  note.  Pulse,  100;  tempera- 
ture, 102^  10.30  A.M.— Pulse,  lOO ;  temperature, 
103°.  Catheter  passed  and  one  quart  of  urine  drawn 
oflf.  Very  little  pain  ;  limb  warm.  Patient  has  taken 
more  nourishment;  countenance  and  spirits  good, 
stomach  still  irritable  from  the  ansesthetic.  2  p.m. — 
Pulse,  112;  temperature,  103° ;  respiration,  30.  Soon 
after  the  note  at  10.30,  patient  presented  more  se- 
vere symptoms  of  shock  than  at  any  time  since  the 
operation.  A  hypodermic  injection  of  i  gr.  morphia 
was  administered,  since  which  patient  has  felt  bet- 
ter, has  rested  a  good  deal,  and  has  taken  3  viii.  iced 
milk,  and  retained  it.  9  p.m. — Pulse.  110  ;  tempera- 
ture, 102^.  Gave  a  turpentine  enema,  which  moved 
the  bowels  slightly,  and  brought  away  a  gi-eat  quan- 
tity of  flatus. 

February  9th,  1  p.m. — Pulse,  120 ;  temperature, 
102i°.  2  P.M.— Pulse,  128  ;  temperature,  103°.  9 
P.M. — Pulse,  116 ;  temperature,  102°.  Besting 
quietly.  Slight  arterial  hemorrhage,  which  stopped 
spontaneously.  Morphine,  i  gr.,  hypodermically ; 
catheter  still  required. 

February  11th. — Eating  and  sleeping  well.  Pulse, 
100;  temperature,  102°.  Wound  discharging  freely ; 
two  ligatures  withdrawn. 

February  12th. — Patient  slept  well  last  night, 
having  taken  morphia,  gr.  \,  hyjiodermically.  Pulse, 
99  ;  temperature,  102°.     Wound  healing  rajoidly. 

February  13th. — Pulse,  100;  temperature,  101°. 
Slept  well  all  night,  appetite  good,  eight  ligatures 
removed  ;  feels  well. 

February  14th. — Pidse,  110;  temperature.  101'. 
Doing  well. 

February  1.5th. — Pulse,  108  ;  temperatiu-e,  101\ 
Continues  to  do  well  to  all  appearance. 

The  reports  continue  about  the  same  till  the  18th, 
when  the  pulse  went  up  to  120.  and  the  temperatiu'e 
to  104',  and  suppuration  was  detected  in  the  laaee- 
joint,  and  was  evacuated  by  free  incision,  after  which 
pulse  and  temperature  gradually  subsided,  so  that 
on  Fel^ruary  22d,  at  6  a.m.,  the  temperature  was  99° 
and  the  pulse  106. 

The  last  of  the  ligatures,  viz.,  those  closing  the 
femoral  vessels  at  Poupart's  ligament,  came  away  on 
March  6th,  just  one  month  after  operation.  Pulse 
was  then  100  and  temperature  100^  The  wound 
had  opened  up  again  to  some  extent,  after  having 
been  almost  completely  healed.      Nourishing  diet 


and  stimulants  were  freely  administered,  but  she 
continued  to  complain  of  weakness  ;  symptoms  of 
pneumonia  appeared  March  lOtli,  and  increased  in 
severity,  she  gradually  grew  weaker  till  {he  14th, 
when  she  sank,  exhausted,  thirty-four  days  after  the 
operation. 

Note. — The  length  of  time  this  patient  lived,  and 
the  whole  history  .subsequent  to  the  operation,  de- 
monstrates couchisively  that  the  views  regarding 
the  condition  of  tlie  circulation,  on  which  the  ojjera- 
tion  was  based,  were  correct.  Death  resulted  from 
accidental  causes,  such  as  are  liable  to  occur  after 
any  common  operation. 

The  patient  was  by  no  means  a  good  subject  for 
operation.  She  was  from  the  first  anaemic,  debili- 
tated, apprehensive,  and  despondent,  and  when  the 
dangerous  eomiilication  of  pneumonia  arose,  her 
chances  were  greatly  lessened  liy  the  fact  that  Dr. 
Curry,  who  had  up  to  that  time  given  her  the  most 
enthusiastic  care,  was  known  to  be  dying  from  an 
acute  and  painful  disease. 

The  important  practical  suggestions  so  clearly 
taught  by  this  unique  ease,  have  always  seemed  to 
me  to  demand  its  being  placed  on  record,  notwith- 
standing that  it  involves  the  publication  of  a  fatal 
case. 

Here,  if  ever,  it  might  be  said  that  "although  the 
patient  died,  the  operation  was  success/ul." 

Case  II. — Traumatic  Anem-ism  of  the  Common 
Femoral    Artery. — Ligature  of  the    External    Iliac 

Arten-y — Recovery. — R.  T ,   aged  fourteen  years, 

Allegan,  Mich.  On  April  2, 1881,  patient,  while  play- 
ing with  a  companion,  was  shot  in  the  upper  part 
of  the  right  thigh  by  a  pistol  bullet,  the  weapon 
being  in  the  hand  of  his  friend.  The  accident  was 
attended  with  hemoiThage  so  profuse  as  to  induce 
fainting. 

Pressure  appUed  by  the  thumb  of  a  bystander 
effectually  and  permanently  arrested  the  bleeding. 
The  external  wound  healed  rapidly.  The  Irt'.llet  has 
never  been  extracted.  In  the  latter  part  of  June, 
1881,  patient  was  brought  by  his  father  to  the  Uni- 
versity Hospital.  An  aneiirism  as  large  as  a  hen's 
egg  was  found  at  the  seat  of  the  injury. 

The  wound  was  completely  healed,  but  there  was 
a  distinct  scar  at  the  point  of  entrance  of  the  bullet. 
This  scar  was  situated  just  one  and  one-half  inch 
fi'om  Poupart's  ligament. 

The  tumor  pulsated  very  strongly  and  presented 
all  the  characteristics  of  aneui'ism,  and  there  seemed 
no  reasonable  doubt  that  the  vessel  affected  was  the 
common  femoral  artery. 

The  patient  complained  a  good  deal  of  pain,  he 
was  somewhat  emaciated,  and  was  unable  to  use 
his  limb  either  in  walking  or  standing.  On  inquiry 
it  was  ascertained  that  pressure  by  flexion,  as  well 
as  digital  and  instrumental,  had  been  very  thor- 
oughly tried  by  his  medical  attendant.  Dr.  Amsden, 
of  Allegan,  but  without  any  beneficial  elfect. 

In  view  of  the  patient's  low  state  of  health,  as 
well  as  the  great  heat  of  the  weather,  I  advised  him 
to  return  to  his  home  in  the  meantime,  and  to  apply 
a  soft  rubber  bandage  from  the  toes  aip,  with  a  grad- 
uated compress  over  the  aneurismal  swelling. 

He  was  also  assured  that  in  the  event  of  his  re- 
turning in  the  autumn  still  unrelieved  a  radical 
operation  would  be  performed. 

On  October  4th  he  reappeared  at  the  hospital  and 
the  most  careful  examination  failed  to  detect  any 
material  improvement  in  the  aneurism,  although  his 
general  health  was  decidedly  better  than  on  the  oc- 
casion of  his  former  visit.     After  careful  reflection 


34: 


THE  MEDICAL  RECORD. 


I  determiaed  to  resort  to  the  Hunterian  operation, 
and  to  place  a  ligature  upon  the  external  iliac 
artery.  Had  there  been  a  reasonable  hope  of  the 
wound  being  in  the  superficial  femoral  one  or  two 
inches  below  the  jjrofunda  I  should  have  preferred 
the  old  operation  as  applied  by  Syme  to  cases  of 
traumatic  aneurism,  or  had  the  external  wound  been 
unhealed  or  in  any  danger  of  opening  iip  again  I 
should  have  felt  compelled  to  cut  into  the  aneuris- 
mal  sac  and  treat  the  case  as  one  of  a  wounded 
artery,  applying  a  jiroximal  adistal  and  ligature  to 
tlie  atiected  vessel. 

As  it  was,  the  situation  of  the  scar  excluded  all 
hope  of  the  sujjerficial  femoral  being  the  wounded 
vessel,  in  the  next  place  the  external  jjarts  were 
as  perfectly  healed  as  if  they  had  never  been  di- 
vided. 

The  aneurism  was  comparatively  small  and  well 
defined,  and  therefore,  although  in  reality  a  false 
aneurism,  caused  by  an  external  wound,  it  had  come 
to  correspond  very  closely  to  a  true  aneurism,  at 
least  in  so  far  as  the  question  of  treatment  was 
concerned,  and  therefore  the  Hunterian  opera- 
tion seemed  the  best,  and  indeed  the  only  alter- 
native. 

October  10th.— The  patient  being  under  the  influ-. 
ence  of  chloroform,  the  operation  of  tying  the  ex- 
ternal iliac  was  performed  before  the  class.  No 
difiioulty  was  encountered,  and  the  patient  was  only 
a  few  minutes  on  the  table.  My  colleagues,  Profes- 
sors C.  L.  Ford,  W.  J.  Herdman,  and  Dr.  T.  J.  Sul- 
livan, were  present.  The  ligature  used  was  of  catgut, 
prepared  by  Young,  of  Edinburgh.  It  was  cut  off 
close  to  the  knot.  Pulsation  in  the  aneurism  ceased 
instantaneously,  and  has  never  returned.  The  limb 
was  at  once  enveloped  in  sheet  wadding,  and  a  soft 
rubber  bandage  was  applied.  The  further  history  of 
the  case  is  summed  up  in  the  following  notes  from 
the  hospital  case  book  : 

October  10th.  —  3  p.m.  :  Pulse,  130 ;  tempera- 
ture, 10U°.  7.30  I'.M. :  Pulse,  120 ;  temperature, 
101". 

October  llth— 7.  .\.m.  :  Pulse,  140;  temperatur  , 
104i°.  9  .\.M.  :  Pulse,  142 ;  temperature,  105  ^. 
1.20  P.M.  :  Pulse,  140  ;  temperature,  104^°.  <J  p.m.  : 
Pulse,  140;  temperature,  102^°. 

October  12th.— 7  a.m.  :  Pulse,  IIG ;  temperature, 
101 J  .  Ordered  quiniie  sulph.,  gi:  x.,  ter  in  die. ;  also 
acid,  salicylic!,  gr.  x.,  ter  in  die.  3.30  p.rl  :  Pulse, 
100  ;  temperature,  lOir.  7  p.m.  :  Pulse,  112 ;  tem- 
poratnre,  103°.  Ordered  hypodermic  injection  morph. 
gr.  i. 

October  13th.— 7.30  a.m.  :  Pulse,  100;  temperatui-e, 
101'.     4  P.M.  :  Pulse,  102  ;  temperature,  102°. 

Bowels  moved  naturally.  One  suture  removed, 
giving  vent  to  a  little  jms. 

October  14th.— Pulse,  106  ;  temperature,  102f '. 

October  15th.— Pulse,  82 ;  temperature,  lOOA  . 

October  Kith. — Pulse,  81 ;  temperature,  i)9.f'. 

October  17th.— Pulse,  02  ;  temperature,  09i  . 

October  18th.— Pulse,  90;  temperature,  99''. 

October  19th.— Pulse,  82 ;  temperature,  100°. 

October  20tli.— Pulse,  90;  temperature,  99°. 

October  21st.— Pulse,  95;  temperature,  09.}'. 

October  25th.— Pulse,  78  ;  temperature,  98V. 

Slight  discharge  of  healthy  pus  from  surface  of 
wound.     Patient  dressed  and  sitting  up  in  chair. 

October  31st.— Pulse,  75  ;  temperature,  98*. 

Wound  completely  healed;  anenrismal  swelling 
much  diminished ;  no  pulsation,  and  no  bruit.  Pa- 
tient walking  about  the  ward,  aiul  permission  given 
to  go  iiomo  at  any  time. 


REPORT  OF  C^SES  OF  PHTHLSIS 

Treated  During   1880-1881. 

Br  W.  H.  GEDDINGS,  M.D., 

AIKEN,    S.    0. 

(Continued  from  The  Medical  Recobd.  November  15,  1S71I,  Octolnr 
SU  and  Novc-mlicr  B,  ISiiU,  mid  Janu.^^y  7.  INS'i.) 

Case  LXXX"S1I.— A  young  lady,  twenty-eight  year.^ 
of  age,  from  New  York,  both"  of  whose  maternal 
grandparents  died  of  phthisis.  Began  to  cough  in 
July,  and  in  September  had  an  attack  of  pleuritis 
Expectoration  has  been  occasionally  tinged. 

December  llth.— Pulse,  88;  temperature,  99.8" 
Very  anaimie,  with  the  peculiar  sallow  color  so  often 
seen  in  phthisical  patients.  Cough  troublesome, 
with  about  four  ounces  of  expectoration,  aU  of  which 
floats.  Left  side  dull  in  front  from  first  to  fourth 
ribs.  Behind  the  dulness  extends  as  low  as  the  angle 
of  the  scapula,  and  also  occupies  the  corresponding 
interscapular  space.  Moist  rales  (crackling)  audible 
over  the  greater  portion  of  the  lung.  C!oiiiplains  of 
pleuritic  pains  at  the  base  of  the  lung,  the  result  of 
a  cold  taken  during  the  journey  south.  There  was 
no  marked  change  in  the  physical  symptoms  during 
the  winter,  but  her  general  health  deteriorated,  so 
that  when  she  started  for  home,  her  condition  was 
wor.se  than  at  the  time  of  her  arrival. 

Result. — Steady  decline. 

Case  LXXXVIII. — Telegraph  operator,  twenty- 
eight  years  of  age.  Dr.  James  C.  Wilson,  of  Phila- 
delphia. No  hereditary  tendency  to  phthisis.  Dis- 
ease began  with  an  attack  of  croupous  pneumonia  in 
January,  1877  ;  persistent  cough  since  Julv  of  that 
year. 

December  llth.— Pulse,  110;  temperature,  100°; 
weight,  120  pounds.  Fair  complexion  and  slender 
figure.  Fair  appetite  and  good  digestion.  Cough 
moderate,  with  two  ounces  of  muco-purulent  sputa, 
all  of  which  floats.  Dulness  over  right  front  to  thii-d 
rib,  with  diminished  resonance  to  sixth.  Respira- 
tion bronchial,  with  jn-olonged  expirium.  Posteri- 
orly, no  dulness,  but  feeble  respiratory  murmur. 

April  llth. — Improved  at  first,  but,  having  no 
means  of  support,  was  obliged  to  accept  a  position 
in  the  telegraph  oflice,  where  the  confinement  soon 
caused  an  aggravation  in  his  symptoms.  His  pulse 
is  now  114,  his  temperature  99.2°,  and  his  weight 
has  declined  to  118  pounds.  In  addition  to  the 
symptoms,  as  given  above,  there  is  now  an  area  of 
dulness,  with  bronchial  breathing,  over  two-thirds  of 
the  .scapula  and  intei-scapular  space. 

Result. — Extension  of  the  disease. 

Case  LXXXIX. — A  widowed  lady,  sixty-four  years 
of  age,  whose  husband  and  sister  have  died  of  con- 
sumption. Dr.  Allyn  P.  Smith,  of  Baltimore.  Dis- 
ease began  with  bronchial  catarrh  in  ,Tune,  1880; 
had  vesperal  fever  and  lost  twenty-six  pounds.  Has 
improved  since  her  anival  in  Aiken  a  month  ago. 

December  10th.— Pulse,  104  ;  temperature,  100.2°. 
Is  quite  pale,  and  cannot  lie  on  the  left  side  or  on  the 
back  without  coughing.  On  the  left  side  tliere  is  an 
area  of  dulness  extending  from  above  the  clavicle  to 
the  sixth  rib.  Posteriorly  there  is  also  dulne.ss  under 
the  scapula.  Kespiration  bronchial,  with  prolonged 
expirium.  This  patient  improved  a  little  in  general 
health,  but  without  any  marked  change  in  the  physi- 
cal symptoms. 

Case  XC— Male,  single.  Patient  of  Dr.  D.  E. 
Kissein.  of  Brooklyn.  No  hereditary  i>redispo8i- 
tion.  Slight  hamioptysis  in  June,  with  a  series  of 
profuse  hemorrhages  in  September.    Has  had  cough 


THE   MEDICAL  RECORD. 


35 


since  July,  with  occasioDal  night-sweats.  Of  late, 
has  had  hemorrhages  almost  every  other  day. 

December  2()th. — Pulse,  9(5;  temperature,  98.5°; 
WL'ight,  I'lii  pounds.  Presents  a  very  an;emic  ap- 
pearance. Dull  on  the  right  side  from  the  clavicle 
to  the  third  rib  in  front,  and  over  the  npjjer  portion 
of  the  scajjula  behind.  Respiration  feeble,  with 
occasional  ronchi  ;  conducted  heart-sounds  veiy  dis- 
tinct. 

January  l.^th. — The  hemorrhages,  which  were  so 
frequent  at  home,  have  not  recurred  during  the  last 
three  weeks.     General  appearance  improved. 

February  3d. — Had  two  slight  hemorrhages  in 
January,  but  has  continued  to  improve.  Pulse,  76 ; 
temperature,  98.5' ;  has  a  healthier  color  and  is 
much  stronger. 

April  18th. —Pulse,  100;  temperature,  98.3'; 
weight,  135  pounds,  which  is  a  gain  of  8A  pounds. 
Coughs  only  five  or  six  times  a  day.  No  return  of 
the  hemorrhages  during  the  past  live  weeks.  Kight 
side  dull  from  the  cla^■icle  to  the  second  rib  in  front, 
and  over  suj^rascapular  region  behind.  Kespiration 
bronchial  in  front,  feeble  behind,  with  occasional 
moist  rales. 

Jiesiill. — Improvement  in  general  health,  decrease 
in  the  area  of  dulness,  and  a  gain  of  8;  pounds. 

C.\SE  XCI. — A  middle-aged  phvsiciau  from  New 
York. 

December  28th. — Temperature  not  exactly  noted, 
but  a  little  above  the  normal.  Previous  history  not 
stated.  Dull  over  left  front,  from  the  clavicle  to 
the  fifth  rill,  and  also  at  the  base  of  the  liing.  Res- 
piration bronchial.  Posteriorly  there  is  dulness 
over  the  lower  half  of  the  scapula. 

AprU  3d. — Temperature,  98.5';  grew  worse  at 
first,  and  then  improved.  In  front  the  dulness  has 
receded  to  the  third  rib  ;  behind,  remains  unchanged; 
respiration  bronchial,  and  in  one  place  amphoric, 
with  occasional  moist  rules ;  weight  not  noted. 

Besu/t. — Slight  improvement  in  general  health, 
ami  some  lessening  in  the  extent  of  the' infiltration. 

C-iSE  XCU. — A  young  medical  student,  nineteen 
years  of  age,  a  patient  of  Dr.  A.  G.  Keed,  of  Phila- 
delphia. Xo  phthisis  in  the  family.  Cough  began 
in  March,  and  lasted  two  months  ;  recurred  in  June, 
and  continued  to  September.  Visited  Mexico,  with 
negative  results. 

December  31st. — Pulse,  78  ;  temperature,  98' ; 
weight,  125  pounds.  Figure  slender,  with  sallow 
ciimplexion.  Good  appetite,  with  fair  digestion. 
Riiiht  side,  dulness  over  supraclavicular,  clavicular, 
and  infraclavicular  regions,  with  diminished  reso- 
nance to  fourth  rib.  Behind,  diminished  resonance 
over  the  scapular  region. 

March  27th. — Pulse,  84  ;  temperature,  98'.  Has 
passed  through  the  winter  without  any  return  of 
cough,  and  has  increased  6  pounds  in  weight.  In 
front  there  is  now  no  dulness,  and  the  area  of  di- 
-Kiinished  resonance  has  receded  to  the  second  rib  ; 
the  suprascapular  region  has  become  resonant. 

Result. — Complete  arr(!st  of  the  disease,  with  a 
gain  of  6  pounds  in  weight. 

Case  XCIII, — A  Catholic  priest,  from  Marylamt, 
aged  forty-three  years.  Had  pulmonary  phthisis 
when  twenty-seven ;  recovered,  and  remained  well 
until  the  autumn  of  1880,  when  he  had  what  was  sup- 
posed to  be  malarial  fever,  but  which  eventually 
proved  to  be  a  return  of  the  old  disease. 

January  3d. — Pulse,  90  ;  temperature,  99'.  Has 
gained  2+  pounds  since  his  ai-rival  in  Aiken,  and 
now  weighs  116^  pounds  ;  cachectic  appearance  ; 
expectorates  half  a  teacupful  in  twenty-four  hours. 


Kight  apex  dull  in  front  to  second  rib,  and  behind 
to  within  nn  inch  of  the  angle  of  the  scapula,  also 
in  the  axillary  region.  Resj>iration  bronchial,  with 
prolonged  expirium,  especially  over  the  back. 

Februaiy  13th — Pulse,  10-t,  but  is  usually  only  81  ; 
weight,  124  pounds,  a  gain  of  10  pounds.  The  area 
of  dulness  behind  has  become  more  resonant. 

April  22d. — Did  well  until  the  latter  half  of  March, 
at  which  time  he  had  an  acute  attack  of  gastro- 
duodenal  catarrh  with  fever,  which  reduced  him 
considerably.  At  present  his  pulse  is  88,  his  tem- 
perature, 98.7  ,  and  his  weight,  118  pounds.  Is 
much  stronger,  and  has  a  better  color.  Coughs  only 
a  few  times  in  the  morning  and  evening,  bringing 
up  a  few  pellets  of  mucus. 

.ffes»?A— Improvement  in  the  general  and  local 
symptoms,  great  diminution  in  the  frequency  of  the 
cough  and  in  the  quantity  of  expectoration,  and  a 
gain  of  10  pounds  in  weight,  of  which  he  subse- 
quently lost  6  pounds. 

Case  XCn'.— Male,  single.  Dr.  Carey  of  Euth- 
erfurd,  N.  J.  Grandfather  on  mother's  side  died  of 
consumption.  Had  an  attack  of  hicmoptysis  in  Sep- 
tember, 1880,  and  since  then  has  had  two  profuse 
hemorrhages.  Has  lost  7  pounds,  and  has  had  night- 
sweats. 

January  9th. — Pulse,  100  ;  temperature,  99.5' ; 
slender  figure,  with  fair  complexion ;  finger-nails 
clawed ;  weight,  133  pounds  ;  cough  moderate,  with 
one  drachm  of  muco-purnlent  expectoration.  Good 
appetite  and  fair  digestion.  Kight  side  dull  from 
above  the  clavicle  to  the  third  rib,  and  over  supra- 
scapular region.  Kespiration  feeble,  with  prolonged 
expirium  ;  conducted  heart-sounds  i|uite  distinct. 
(I  April  21st. — Improved  during  the  first  two  months 
of  his  residence,  gaining  5  pounds.  During  the 
month  of  March  he  had  several  hemorrhages,  and 
has  since  then  gi-adually  lost  gi-ound.  Pul.se,  104  ; 
temperature,  97.5°:  weight,  131 J  pounds.  Cough 
still  moderate,  but  the  amount  of  expectoration  has 
increased.  Slight  extension  of  the  area  of  dulness 
behind.     Kespiration  has  become  bronchial. 

Result. — Improvement  at  first,  followed  by  relajise 
and  extension  of  the  disease. 

Case  XCV. — A  young  mamed  lady — my  own  case. 
Family  consumptive.  Four  weeks  she  has  had 
cough,  with  severe  pleuritic  pains  on  the  right  side. 
Has  had  more  or  less  fever,  with  some  perspiration 
at  night. 

January  11th. — Pulse,  104  ;  temperature,  99'.  Pale 
and  quite  delicate  in  appearance.  Diminished  res- 
onance over  the  upper  portion  of  the  right  lung  in 
front,  with  dulness  over  scajjular  and  interscapular 
spaces.  Respuation  bronchial,  ^-ith  prolonged  ex- 
pirium. 

April  6th. — Is  greatly  improved,  and  has  been 
able  to  resume  her  rather  arduous  duties  of  house- 
keeper of  a  large  boarding-house.  Still  coughs  a 
little.  Can  detect  no  dullness  in  front,  but  it  is  still 
apparent  over  the  suprascapidar  and  corresponding 
interscapular  regions. 

Result. — Great  improvement  in  general  health  and 
diminution  in  the  extent  of  the  infiltration. 

Ca.sb  XCVI. — A  nianied  lad;:,  aged  thirty-four. 
Dr.  Lusk,  of  New  York.  Her  grandfather  and 
grandmother,  as  well  as  several  brothers  and  sisters, 
have 'died  of  phthisis.  Disease  began  with  bron- 
chial catanh  in  February,  1875.  She  visited  Algiers 
and  made  a  partial  recovei-y.  Has  lost  19  pounds. 
Has  had  one  very  slight  hemorrhage. 

January  13th.— Pulse,  96;  temper.ature,  99';  weight, 
117  pounds.     Slender  figure  and  brunette  in  color. 


36 


THE  MEDICAL  RECOKD. 


The  appetite  is  poor,  but  the  digestion  is  fail-.  Has 
slight  niglit-sweats.  Cough  troublesome,  with  about 
two  ounces  of  mucopurulent  expectoration.  Walks 
cue  mile  without  fatigue.  On  the  right  side  there 
is  diminished  resonance  above  the  clavicle,  with  pro- 
nounced dulness  thence  to  third  rib.  Behind,  the 
area  of  dulness  occupies  the  suprascajjular  regioti, 
and  extends  two  inches  below  the  sijine  of  the 
scapula,  as  well  as  over  the  corresponding  inter- 
scapular space.  The  re.spiratory  murmur  is  feeble, 
with  jjrolonged  expirium.  Over  the  left  side  no 
dulness,  but  harsh  respiration,  with  prolongation  of 
the  expiratory  murmur.  Conducted  heart-sounds 
audible. 

Api'il  "ii^d. — Pulse,  80  ;  temperature,  98' ;  weiglit, 
124  pounds,  which  is  her  normal  weight.  Has  had 
no  cough  for  several  weeks  past,  and  walks  three 
miles  without  becoming  fatigued.  Her  color  is 
fresh  and  ruddy,  and  her  apjjearance  is  that  of  a 
person  in  perfect  health.  In  front  the  dulness  has 
receded  to  the  second  rib,  while  behind  there  is  no 
dulness  except  over  a  limited  space  above  the  spine 
of  the  scapula.  Respiration  aSords  no  indication  of 
disease  other  than  prolongation  of  the  expiratory 
murmur  in  front. 

C.4.SE  XCVII. — Male,  aged  seventy-three.  Dr.  O. 
F.  Rogers,  of  Dorchester,  Mass.  No  hereditaiy 
tendency  to  pulmonary  disease.  Began  to  cough 
in  October,  1880,  and  in  December  it  was  discovered 
that  the  left  apex  was  affected. 

January  14th. — Pulse,  88;  temperature,  98.9': 
weight,  135  pounds.  Sallow  comijlexion,  is  qiiite 
weak,  and  suffers  with  dyspnoea  upon  the  slightest 
exertion.  Cough  is  moderate,  with  one  ounce  of 
mucopurulent  expectoration.  Is  somewhat  hoarse, 
and  articulates  with  difficulty.  Extensive  infiltra- 
tion of  the  upper  portion  of  the  left  lung,  as  evi- 
denced by  dulness  on  percussion  and  bronchial 
respiration  This  patient  gradually  lost  ground, 
and  died  March  18th. 

Case  XCVIII.— Married  lady,  aged  forty.  Dr.  L. 
Pilcher,  of  Brooklyn.  Her  father,  father's  sister, 
mother's  sister,  and  former  husband,  all  died  of 
phthisis. 

Disease  began  in  January,  1880,  with  bronchial 
catarrh.  Visited  the  White  Mountains  without 
deriving  any  benefit  from  the  trip.  Has  lost  live 
pounds  in  flesh. 

January  21st. — Pulse,  100;  temperature,  99"; 
weight,  121 J  pounds.  Expectorates  one  ounce  of 
mucopurulent  matter.  Right  side,  dulness  from  the 
clavicle  to  the  third  rib,  and  behind  over  the  lower 
two-thirds  of  the  scapula,  with  bronchial  respiration. 
Left  side,  duU  to  third,  with  diminished  resonance 
to  fourth,  also  over  the  suprascapular  region.  Res- 
piration bronchial,  with  crackling. 

May  4th. — Pulse,  92  ;  temperature,  99.4' ;  weight, 
125  pounds,  a  gain  of  3}  pounds.  Improved  steadily 
after  her  arrival,  tlie  temperature  declining  to  98", 
and  the  cough  diminishing  in  frequency.  In  April, 
after  over-exertion  and  imprudence,  she  had  a  slight 
relapse,  which  lasted  about  three  weeks.  .Since  then 
she  has  again  improved,  and  now  looks  remarkablv 
well.  On  the  right  side  the  dulness  is  now  confined 
to  the  outer  third  of  the  clavicular  region,  with  dimin- 
ished resonance  to  the  second  rib.  No  trace  of  it 
behind.  Respiration  on  that  side  a  little  harsh. 
On  the  left,  in  front,  the  dulness  has  receded  to  the 
second  rib,  with  disappearance  of  the  area  of  dimin- 
ished resonance  wliich  had  been  noted  lower  down. 
There  is  still  dulness  over  tlie  suprascapular  region, 
and  the  respiration  remains  bronchial. 


Result. — Remarkable  improvement,  with  lessening 
in  the  extent  of  the  infiltration  in  both  kings. 

Case  XCIX. — Male,  twenty-five  years  of  age.  Dr. 
Hayes,  of  Great  Falls,  N.  H.  Mother  had  hemor- 
rhages, and  was  considered  consumptive,  but  re- 
covered. Disease  began  in  August,  1878,  with  an 
attack  of  h;emoptysis.  Has  had  fourteen  hemor- 
rhages, twelve  of  which  were  very  profuse.  Visited 
Minnesota,  where  he  improved  at  first,  but  subse- 
quently grew  worse.  Also  went  into  the  Adiron- 
dacks,  with  the  same  i-esults,  and  had  six  severe 
hemorrhages  while  there.  Has  also  had  night- 
sweats. 

February  3d.  —  Pulse,  92 ;  temperatiire,  98.9° ; 
weight,  146  pounds.  Is  tall  and  slender.  The 
fingernails  are  bent  over  in  the  manner  peculiar  to 
consumptives.  Has  cough,  and  expectorates  one 
and  one-lialf  ounce.  The  only  i^hysical  signs  of 
I)ulmonary  disease  are  diminished  resonance  over 
the  riglit  interscapular  space,  with  bronchial  breath- 
ing in  front,  and  feeble  respiratorv  murmur  behind. 
April  22d.— Pulse,  88  ;  temperature  98.3" ;  weight, 
145  jjounds.  Has  had  no  return  of  the  bleeding  since 
his  aiTival  in  Aiken.  Is  much  stronger,  and  can  now 
walk  three  miles  without  being  fatigued.  The  chest- 
walls  are  everywhere  resonant,  and,  with  the  excep- 
tion of  the  bronchial  breathing  and  feebleness  of 
respiration,  there  is  no  physical  evidence  of  disease. 
Resv-ll. — Improvement. 

Case  C. — Male,  thirty-tnree  years  of  age ;  patient 
of  Dr;  A.  Y.  P.  Garnett,  of  Washington.  Disease 
began  with  cough,  in  the  summer  of  1877,  and  a 
hemorrhage  in  the  following  December.  Came  to 
Aiken,  lost  his  cough,  and  when  he  left  had  quite 
recovered,  having  gained  twelve  pounds  during  his 
stay.  Went  to  Atlanta,  where  he  gained  three  pounds 
additional.  During  the  following  summer  he  visited 
the  Greenbrier  W^hite  Sulphur  Springs,  where  an 
injudicious  cold  bath  caused  a  relapse.  Passed  the 
next  winter  at  Thomasville,  Ga.,  but  failed  to  de- 
rive any  benefit,  the  disease  remaining  stationai-y. 
He  went  to  Colorado  the  following  Sej)teralier,  but 
suffered  so  much  from  the  effect  of  the  altitude  that 
he  concluded  to  return  to  Aiken,  and  again  im- 
proved. This  winter  he  determined  to  give  Florida 
a  trial,  and  during  the  first  weeks  of  his  stay  there 
did  well,  but  afterward  had  a  succession  of  hemor- 
rhages, which  induced  him  to  return  to  Aiken. 
These  continued  to  recur  for  a  few  days  after  his 
arrival,  but  then  ceased,  and,  with  the  exception  of 
one  slight  attack,  did  not  return  during  the  remain- 
der of  his  stay.  Owing  to  the  constantly  reoun-ing 
bleeding,  no  examination  coiild  be  made  during  the 
first  week  of  his  residence  here  ;  and  later,  when  it 
did  become  practicable,  I  accidentally  omitted  to 
record  the  result.  At  the  close,  however,  of  his  last 
visit  to  Aiken,  there  was  disease  of  both  lungs.  At 
the  final  examination,  made  March  21st,  his  ptilse 
was  9(),  and  his  temperature  98°.  His  color  was  good, 
and  his  general  appearance  that  of  one  in  fair  health. 
Thei-e  were  unmistakable  evidences  of  disease  in  the 
left  lung,  but  on  the  right  side  the  only  sym])tom 
indicative  of  pulmonary  lesion  was  a  little  bronchial 
respiration  over  the  lower  portion  of  the  lung. 
Result. — Improvement. 

Case  CI. — Blale,  twenty-one  veal's  of  age  ;  jiatient 
of  Dr.  Heaton,  of  Detroit,  Mich.  His  grandfather, 
two  grandaunts,  and  father  died  of  consumption, 
while  his  mother  (Case  XCVIII.)  is  now  under  treat- 
ment for  that  disease.  While  serving  as  a  clerk  in 
a  dam  J)  hardware  store,  in  February,  1880,  he  con- 
tracted a  coiigh,  which  disappeared  the  following 


THE  MEDICAL  RECORD. 


£7 


Augnist,  but  returned  with  the  advent  of  cold  weather, 
and  has  continued  ever  since.  Two  weeks  ago  ves- 
peral  fever  set  in,  with  sweats.  He  emaciated  to  the 
extent  of  eighteen  pounds. 

February  12th.  —  Pulse,  88;  temperature,  99°; 
weight,  110  pounds.  Figure  slender;  poorly  de- 
veloped thorax.  Cachectic  in  appearance,  and  quite 
feeble.  There  is  dulness  on  the  right  side,  over  the 
supraclavicular  and  clavicular  regions ;  also  over 
the  interscapular  sjiaces,  with  diminished  resonance 
below  the  spine  of  the  scapula.  Bronchial  respira- 
tion in  front,  and  feeV)le  respiratory  murmur  behind. 

May  6th. — Pulse,  106 ;  temperature,  105°.  Pa- 
tient's progress  has  been  retarded  by  a  miserable 
stomach  and  the  persistence  of  vesperal  fever.  Not- 
withstanding these  unfavorable  symptoms,  he  is 
stronger,  coughs  less,  and  has  increased  in  weight. 
Physical  signs  unchanged. 

Result. — Improvement,  with  a  gain  of  3j  pounds. 

Case  CII. — Female,  twenty-nine  years  of  age. 
Dr.  J.  C.  Mullhol,  of  St.  Louis.  One  paternal  aunt 
and  a  brother  died  of  phthisis.  Loss  of  iiesh  for 
several  years,  with  cough  since  the  autumn  of  1879. 
Visited  the  Adirondacks  and  improved  there. 

December  9th. — Pulse,  108  ;  temperature,  99° ; 
weight,  120i  pounds,  5^  pounds  of  which  she  has 
gained  since  her  arrival  in  Aiken.  Cough  moderate, 
with  one  and  one-half  ounce  of  expectoration.  Has 
a  good  appetite  and  fair  digestion,  and  walks  half 
a  mile  without  fatigue.  Left  lung  dull  from  clavicle 
to  thii'd  rib,  and  over  suprascapular  space.  Kes- 
piratory  murmur  feeble. 

May  lOtli. — This  patient  improved  steadily,  her 
weight  in  January  being  125  pounds,  a  total  gain  of 
10*  pounds.  She,  however,  unfortunately  located 
herself  in  the  country,  where  it  was  impossible  to 
furnish  her  with  proper  food.  In  February  she  com- 
menced growing  worse,  and  gradually  lost  all  she 
had  gained.  Her  weight  is  now  113J  pounds,  pulse 
104,  and  temperature  101.5".  Cough  moderate,  with 
one-ounce  expectoration.  Physical  symptoms  un- 
changed. 

Result. — Improvement  at  first,  with  subsequent  re- 
lapse. 

Case  CHI. — Male,  forty-two  years  of  age.  Dr.  A. 
H.  Nichols,  of  Boston,  Mass.  No  inherited  tendency. 
Disease  began  with  bronchial  catarrh  in  March,  1880. 
Had  fever  and  night-sweats,  and  lost  10  pounds. 

February  ITth. — Pulse,  100  ;  temper.ature,  99.6° ; 
weight,  143  pounds.  Color  good  and  figure  slender. 
Cough  not  frequent,  but  expectorates  half  a  tea- 
cupful  in  twenty-four  hours.  Has  night-sweats. 
On  the  left  side  dulness  from  the  clavicle  to  fourth 
rib  over  the  suprascapula  and  two-thu'ds  of  the  scap- 
ular region,  and  to  a  corresponding  extent  over  the 
interscapular  space.  Respiration  cavernous  over 
the  upper  jjortion  of  the  lung,  and  bronchial  below. 
Bronchial  behind,  also  over  the  axillary  region. 

April  20th. —Pulse,  96;  temperature,  90.5°; 
weight,  147  pounds — a  gain  of  12  pounds.  Physical 
signs  unchanged  in  front,  but  behind  the  diilness  is 
now  confined  to  the  region  above  the  spine  of  the 
scapula. 

ResuU. — Improvement,  with  elimination  of  the 
area  of  infiltration,  and  a  gain  of  4  pounds. 

Case  CIV. — A  young  lady,  twenty-two  years  of 
age,  from  Providence,  R.  I.  Great  grandmother, 
grandfather,  and  several  grandaunts  and  uncles  on 
the  maternal  side  have  died  of  phthisis.  She  has 
had  two  slight  hemorrhages,  and  has  lost  23  pounds. 
February  28th. — Pulse,  104  ;  temperature,  100.8  , 
but  is  much  higher  in  the  evening.     Skin  pale,  with 


bright  red  spots  on  the  cheeks.    Is  very  weak,  the 

slightest  exertion  causing  fatigue  and  faintness. 
Bight  side,  dulness  in  front  from  the  clavicle  to 
third  rib,  with  bronchial  respiration.  Condition  of 
the  posterior  portion  of  the  lung  not  noted.  This 
patient  improved  for  a  few  weeks,  and  then  declined 
rapidly.  At  the  time  of  her  departure  tliere  were 
evidences  of  the  extension  of  the  disease,  with  soften- 
ing of  the  right  apex. 

Case  CV. — Male,  thirty-four  years  of  age.  Dr. 
Ruggin  Buckler,  of  Baltimore,  Md.  No  hereditary 
predisposition  to  consumption.  Disease  began  with 
a  slight  hemorrhage  in  February,  1880.  Has  had 
several  since  then,  and  has  lost  4  pounds.  Came  to 
Aiken  in  November,  grew  better  and  went  to  Gaines- 
ville, Fla.,  where  he  improved  at  first,  but  subse- 
quently lost  ground. 

March  3d. — Pulse,  68  ;  temperature,  97.5°  ;  pale, 
with  slender  figure  ;  weight,  147+  pounds ;  appetite 
poor,  but  with  good  digestion.  Has  cough,  and  ex- 
pectorates one-half  ounce  of  mucopurulent  matter. 
Can  walk  two  miles  without  feeling  fatigued.  On 
the  right  side,  dulness  from  the  clavicle  to  the  thii-d 
rib  and  over  the  suprascapular  region  ;  also  over 
the  axillary  region.  Auscultation  aftbrds  no  evidence 
of  disease  other  than  occasional  ronchi,  excei:)t  over 
the  interscapular  space,  where  it  is  distinctly  bron- 
chial. 

April  5th. — "With  the  exception  of  sUght  haemop- 
tysis, a  few  days  after  his  arrival,  he  has  steadily 
improved.  Pulse,  72  ;  temperature,  98.5° ;  weight, 
155a  pounds — a  gain  of  8  pounds.  Appetite  has 
improved  and  the  digestion  is  good.  Can  now  walk 
six  miles  without  being  tired.  No  change  in  the 
condition  of  the  diseased  lung  in  front,  but  behind 
and  in  the  axilla  the  dulness  is  less  marked.  He 
remained  a  couple  of  weeks  longer  in  Aiken,  suffered 
with  the  heat,  and  lost  If  pound  of  what  he  had 
gained. 

Result. — Improvement,  with  a  gain  of  6J  pounds. 

Case  CVI. — A  single  lady,  thirty-one  years  of  age, 
a  patient  of  Drs.  H.  M.  Wilson  and  Christopher  John- 
ston, of  Baltimore,  Md.  Two  maternal  uncles  and 
one  aunt  died  of  phthisis.  The  disease  was  ushered 
in  with  a  hemorrhage  in  April,  1879.  Since  then 
she  has  bled  twelve  times,  often  very  profusely. 

March  2d. — Pulse,  120 ;  tempei'ature,  99.7°.  Has 
lost  11  pounds.  Color  fresh  and  bright ;  does  not 
show  her  emaciation.  Present  weight,  116  pounds. 
Appetite  and  digestion  not  very  good.  Coughs  and 
raises  about  one  drachm  of  muco-purulent  matter. 
Right  lung  diseased  from  the  clavicle  to  third  rib. 
My  records  of  the  subsequent  history  of  this  case 
are  very  imperfect,  but  show  a  return  of  the  hemor- 
rhages, with  rise  of  temperature  and  some  loss  ot 
flesh. 

Case  CVII. — A  young  Swiss,  twenty-four  years  of 
age.  Dr.  Wetzel,  of  New  York.  No  history  of  phthi- 
sis. Aboiit  a  month  ago  began  to  cough  ;  had  night- 
sweats  and  lost  15  pounds. 

March  9th. — Pulse,  96 ;  temperature,  98.5°;  weight, 
125f  pounds.  Has  cough  and  sweats  at  night.  The 
chest  is  everywhere  resonant,  excejit  under  the  mid- 
dle third  of  the  scapula  on  the  left  side,  where  there 
is  distinct  dulness.  Respiration  decidedly  bronchial, 
with  prolonged  expirium  over  both  front  and  back. 

April  28th.— Pulse,  100;  temperature,  98.5".  Pa- 
tient has  steadily  improved.  Coughs  now  only  in 
the  morning,  after  rising.  The  sweats  have  ceased, 
i  and  his  weight  is  131i  pounds.  Dulness  as  at  the 
time  of  first  examination,  but  the  respiration  is  now 
normaL 


38 


THE  MEDICAL  RECORD. 


BesuU. — Marked  improvement,  with  a  gain  of  5\ 
pounds. 

Case  CVIII. — An  Englishman,  thirty-four  years 
of  age.  Dr.  Z.  Y.  Dillenbaugh,  of  Cleveland,  O. 
Xo  history  of  consumption  in  his  family,  but  his 
wife  died  of  that  disease,  and  he  may  have  con- 
tracted it  from  her.  Began  to  cough  in  the  winter 
of  1879,  and  has  lost  .50  pounds  in  weight. 

March  10th. — Pulse,  99;  temperature,  101.5'; 
weight,  133^  pounds.  Slender  figure,  very  pale,  and 
flesh  quite  flabby.  Has  night-sweats.  Coughs  and 
expectorates  half  a  teacupful.  Kight  side  dull  from 
claric.ila  to  third  rib,  with  feeble  respiration  above, 
and  bronchial  over  mammary  region.  There  is  also 
an  extensive  area  of  dulness  occupying  the  supra- 
scapular, scapular,  and  interscapular  regions  to  the 
angle  of  that  bone,  as  well  as  the  supra-axillary 
region,  with  full  respiratory  murmm'. 

May  18th.— Pul.se,  84;  "temperature,  99.2  .  Is 
greatly  improved  in  appearance,  and  has  gained  8 
pounds.  The  cough  is  diminished  in  frequency  and 
tie  expectoration  is  reduced  one-half.  The  night- 
sweats  have  also  ceased.  No  change  in  the  dulness 
in  front,  but  behind  it  extended  only  to  one  side  below 
the  spine  of  the  scapula,  and  disappeared  entirely 
from  the  axillary  region.  The  respiration  has  lost 
its  bronchial  character. 

Resttll. — Marked  improvement  in  general  health, 
with  reduction  in  the  size  of  the  infiltration,  and  a 
gain  of  8  pounds  in  weight. 

Case  CIX. — .\  student,  twenty-three  years  of  age, 
patient  of  Dr.  Smith  White,  of  District  of  Columbia. 
No  hereditary  tendency  to  phthisis.  Disease  began 
with  bronchial  catarrh,  in  February,  1880,  followed 
by  fever  and  emaciation  to  the  extent  of  15  pounds. 
Visited  Aiken,  and  while  there  improved  and  gained 
8  pounds. 

March  10th.— Pulse,  104;  temperature,  100.2  ; 
weight,  108  pounds.  Pale  and  cachectic  in  appearance; 
very  slender  and  flesh  quite  flabby.  Ungues  adunci. 
Cough  moderate  in  frequency,  with  hall  an  ounce  of 
expectoration.  On  the  right  side  there  is  dulness 
above,  under,  and  below  the  clavicle,  with  feeble  ex- 
piratory murmur.  On  the  left  side  the  dulness  is 
much  more  extensive,  reaching  in  front  to  the  third 
rib,  and  behind  over  the  suprascapular  region.  The 
respiration  on  that  side  is  feeble,  with  prolonged 
expirium. 

April  28th. —  Pulse,  100;  temperature,  100.1; 
weight,  lOSi  pounds.  With  the  exception  of  a 
slight  increase  in  weight,  the  condition  of  the  pa- 
tient has  undergone  no  material  change. 

Case  CX. — A  married  lady  from  Brooklyn,  thirty- 
seven  years  of  age,  the  name  of  whose  physician  was 
not  noted.  No  heredity  on  either  side.  Had  a 
slight  hemorrhage  on  October  15,  1875,  followed  by 
occasional  cough,  which,  since  December,  1880,  has 
become  persistent. 

M:irch  14th.— Pulse,  100  ;  temperature,  98.5'.  No 
emaciation.  Dulness  on  right  side  from  the  clavicle 
to  third  rib,  and  from  the  spine  of  the  scapula  to  its 
angle.  Respiration  bronchial,  with  prolonged  ex- 
piratory murmur. 

Ajirii  30th.— Pulse,  102;  temperature,  98.5'.  Not- 
withstanding several  acute  catarrhal  attacks,  patient 
has  improved  in  appearance,  and  has  a  fresher  and 
brighter  color.  The  cough,  which  had  grown  less 
fre  juent  and  with  a  smaller  amount  of  expectora- 
tion, has,  within  a  day  or  two,  again  increased  in 
consequence  of  imprudent  exposure  to  cold.  The 
dulness  in  front  has  receded  to  the  second  rib,  and 
behind   occupies   only  two  inches  of  the  scapular 


space.  Eespiration    harsh  in  front    and  bronchial 
behind. 

Result. — Improvement  in  general  and  local  symp- 
toms. 

Case  CXI. — Male,  thu-ty-seven  years  of  age,  the 
name  of  whose  physician  was  not  noted,  from  Cin- 
cinnati. Mother  and  sister  died  of  cousumjation, 
and  one  brother  has  "  weak  lungs."  Cough  began 
in  1879,  and  was  followed  by  loss  of  flesh.  He  re- 
covered from  this,  but  has  had  similar  attacks  every 
winter.  In  January,  1880,  while  returning  from 
New  Orleans,  he  was  seized  with  acute  pneumonia ; 
has  coitghed  ever  since,  and  has  lost  27  pounds. 

March  15th. —Pulse,  106;  temperature,  98.7'; 
weight,  110  pounds.  Very  pale  and  weak,  sufiiers 
with  dyspnoea  on  the  slightest  exertion,  and  presents 
the  appearance  of  a  very  ill  man.  Left  side  dull  in 
front  from  clavicle  to  third  rib,  with  harsh  respira- 
tion behind ;  dull  over  supraspinous  fossa,  ■with 
harsh  resjiii-atory  murmur.  Right  side  dull  from 
the  clavicle  to  the  thii-d  rib  in  front,  and  over  the 
suprascapular  and  over  scapular  region  to  the  angle 
of  the  shoulder-blade.  Eespiration  oyer  both  front 
and  back  loud  and  bronchial  in  character. 

May  24th.— Pulse,  100  ;  temperatm-e,  98.8°.  Has 
improved  in  every  respect,  has  a  fresher  color,  and 
is  in  excellent  spirits.  At  the  time  of  his  arrival  in 
Aiken,  he  could  scarcely  walk  a  block  without  fa- 
tigue, while  now  he  walks  thi-ee-fourths  of  a  mile 
with  ease.  His  weight  is  118i  pounds,  a  gain  of  8i 
pounds.  Has  only  an  occasional  hack  throughout 
the  day,  rarely  at  night,  his  sleep  being  sound  and 
uninterrupted.  All  evidences  of  disease  have  dis- 
appeared from  the  left  lung,  the  percussion-sound 
being  resonant,  and  the  respiratory  murmur  vesicu- 
lar. On  the  right  side  the  dulness  has  also  disap- 
peared fi'om  the  front,  and,  although  still  aj^paront 
behind,  is  confined  to  the  suprascapidar  region 
and  the  corresijonding  interscapular  space.  The 
respiration  on  that  side  is  still  bronchial,  with  occa- 
sional moist  rales. 

Result. — General  improvement,  less  cough  and  ex- 
pectoration, increased  strength,  with  less  dyspnoea  ; 
a  gain  of  8  pounds,  and  disappearance  of  all  signs 
of  disease  in  the  left  lung,  and  diminution  in  the 
area  of  dulness  on  the  other  side. 

Case  CXII. — A  young  lady  from  New  York,  with 
hereditary  predisposition  to  pulmonary  disease  on 
both  sides,  her  paternal  grandfather  and  uncle  hav- 
ing died  of  phthisis.  Disease  began  with  a  bron- 
chial catarrh  in  March,  1880,  which  was  followed  by 
rapid  emaciation.  Has  improved  since  her  arrival 
in  Aiken,  and  has  already  gained  10  pound.s. 

March  17th. —Pulse,  9G ;  temperatui-e,  98.6°: 
weighs  118  pounds.  Over  the  left  lung  there  is  di- 
minished resonance  from  the  clavicle  to  the  rib, 
with  dulness  thence  downward  to  the  base  of  the 
lung.  There  is  also  dulness  over  the  whole  back, 
but  much  more  distinct  toward  the  base.  The  res- 
piration is  feeble,  with  occasional  moist  rales.  The 
dulness  does  not  shift  with  change  of  ]iosition,  nor 
is  there  any  bulging  of  the  intercostal  spaces. 

May  6th. — Pulse,  98  ;  temperature,  98.8°  ;  weight, 
115J  pounds.  Has  a  good  color  and  is  much  im- 
proved in  general  appearance.  The  diminished 
resonance  lias  disappeared  from  the  upper  portion 
of  the  lung  in  front,  hut  there  is  still  dulness  from 
the  fifth  ril)  to  the  base  of  the  lung.  Behind  there  is 
no  dulness,  and  the  respiratory  murmur  is  vesicular. 
Result. — Great  improvement  in  general  health, 
with  a  gain  of  7.^  pounds  and  diminution  in  the  ex- 
tent of  the  infiltration. 


THE  MEDICAL  RECORD. 


39 


Cask  CXIII. — Married  lady,  aged  thirty-flve.  Dr. 
Wright,  of  Buffalo.  Mother  died  of  consumption. 
Began  to  cough  in  September,  1879 ;  had  night- 
sweats,  and  lost  2.3  pounds  in  weight. 

March  31st.— Pulse,  108;  temperature,  100.4°. 
Is  very  pale  and  cachectic  in  appearance ;  is  quite 
weak,  and  moves  about  with  great  difficulty.  Cough 
troublesome,  with  about  four  ounces  of  expectora- 
tion. There  is  dulness  over  the  whole  of  the  left 
lung,  with  bronchial  respiration,  in  one  place  cavern- 
ous, with  pectoriloquv. 

May  6th.— Pulse,  116  ;  temperature,  100.5°.  The 
cough  has  been  better  and  the  expectoration  less. 
Although  improved  in  general  health,  there  has  been 
no  change  in  the  physical  symptoms. 

Tabular  Statement  of  Case.s  op  Phthisis  Treated 
AT  Aiken,  S.  C,  during  the  Winter,  1880-81. 


LXX.. 

LXXI... 

LXXII. 

LXXIII 

LXXIV. 

LXXV. . 

LXXVI ,     .. 

LXXVII I    F. 

LXXVIII I    F. 

LXXIX 1    P. 

LXXX I    M. 

LXXXI I    M. 

LXXXII... 
LXXXIII.. 

Lxxxn'.. 

LXXX^^... 

LXXXVI,. 
LXXXVII. 
LXXXVI  II 
LXXXIX,. 


Term  of 

residence  ir 

Aiken. 


XC 

XCI 

XCII 

XCIII 

XCIV 

xcv 

XCVI 

XCVll.... 
XOVIIX . . . 
XCIX 


01... 
CII.. 

cm . 

CIV.. 


cvi... 

CVII.. 

cvni. 
cix... 


CXI... 

CXII.. 
CXIII. 


M. 


Bight. 

Right. 

Right. 

Both. 

Right. 

Right. 

LeJt. 

Right. 

Kicht. 

Right. 

Bon. 

Both. 

Both. 

Right. 

Both. 

Right. 

Both. 

Left. 

Right. 

Left. 

Right. 

Left. 

Right. 

Right. 

Right. 

Right. 

Ribjht. 

Left. 

Both. 

Right. 

Both. 

Right. 

Left. 

Right. 

Right. 

Right. 

Right. 

Left. 

Right. 

Both. 

Right. 

Both. 

Left. 

Left. 


6  months. 

6  months. 
2  months. 

7  months. 

4  months. 

5  months. 
\5X  months. 
|5  months, 
.5  months. 
'5  months. 

4  months. 
2  months. 

2  months. 

3  months, 
months. 

4  months. 

3  months. 

4  months. 

3  months. 

4  months. 
3X  months. 

3  months, 
months. 

4  months. 
Resident. 
4  months. 
3  months. 
3^'  months. 
3  months. 


3  months. 

5  months. 
2  months. 
2  months. 

mths. 
2  months. 

2  months. 

6  weeks, 
fi  weeks. 
•2H  months 
2  months. 
6  weeks. 


Improved. 
Arrest. 
Death. 
'Death. 
Arrest. 
Grew  worse. 
Improved. 
Unchanged. 
^Grew  worse. 
Grew  worse. 
j  Improved. 
Grew  worse. 
Death. 
■  Improved. 

Improved. 
iGrew  worse. 
jGrew  worse. 

Improved, 
'improved. 
^Improved. 
lArrest. 
I  Improved. 
I  Grew  worse. 
[Improved. 

Improved, 

Improved. 

Improved. 

Improved. 

Grew  worse. 

Improved. 

Improved. 

Grew  worse. 

Improved. 

Improved. 

Unchanged. 

Improved. 

Improved. 

Improved. 

Unchanged. 


83^  pounds. 
12.?^  pounds, 


55.1  ponnds, 
6  pounds. 
^i  pound. 


SUMMABT. 


Per- 

Per- 

Per- 

Per- 

centage 

centage. 

centage. 

ceniage. 

of  three 

Arrested 

B 

I9..3 

■  7 

19.2 

4 

9.3 

17 

15.2 

Improved 

13 

41.9 

1H 

42.1 

21 

48.8 

5U 

44.8 

Unchanged 

4 

12.8 

3 

7.9 

3 

B.7 

lU 

8.8 

Grew  worse... 

1 

22.6  ■ 

111 

2f).3 

12       27.8 

29 

25.9 

Died..       . 

1 

3.2 

2 

5.1 

4         9.3 

■1 

6.2 

31 

38j 

44 

113 

In  estimating  the  value  of  the  above  results  it 
should  be  remembered  that  the  season  of  1880-81 


■was  characterized  by  the  most  unfavorable  weather 
ever  experienced  at  Aiken,  an  unusually  high  tem- 
perature having  Ijeen  followed  by  the  severest  cold 
ever  recorded  at  that  station.  In  addition  to  the 
unfavorable  meteorological  conditions,  there  was 
among  the  invalids  an  unusually  large  number  of 
desperate  cases,  many  in  the  very  last  stage  of  the 
disease,  and  others  in  whom  the  infiltration  had 
assumed  such  proportions  as  to  jireclude  the  pos- 
sibility of  any  lasting  improvement ;  sucli,  for 
instance,  were  cases  LXXI.,  LXXIV.,  LXXX., 
LXXXII.,  LXXXIV.  Aiken,  being  the  most  con- 
veniently accessible  of  all  the  Southern  health  re- 
sorts, naturally  receives  an  unusually  large  propor- 
tion of  cases,  which,  on  account  of  the  advanced 
stage  of  the  disease  and  extreme  weakness,  physi- 
cians would  not  dare  to  subject  to  the  fatigue  of  a 
longer  journey. 

Medical  men  have  frankly  stated  to  me  that  they 
have  sent  to  the  mountains  only  those  jjatients  ofler- 
ing  fair  chances  of  recovery,  utilizing  the  Southern 
resorts  as  a  sort  of  forlorn  hope  for  the  more  des- 
perate of  their  cases. 

Notwithstanding  the  fact  that  we  are  compelled 
to  accept  and  treat  so  many  unfavorable  cases,  the 
results  acliieved  at  Aiken  not  only  compare  favor- 
ably with  those  of  other  celebrated  i  esorts,  but  sur- 
pass most  of  them  in  the  number  of  cases  benefited. 
According  to  Herman  Weber,  one  of  the  most  recent 
authorities  on  this  subject,  41.2  of  his  cases  at  Ma- 
deira improved,  17.6  remained  unchanged,  while  42.1 
grew  worse.  On  the  Kiviera  da  Ponenta  his  results 
were  as  follows:  47.6  improved,  11.75  remained  un- 
changed, and  34.9  grew  worse.  Adding  together  the 
Cises  in  which  the  disease  was  arrested  (15.2),  and 
those  which  improved,  44.6,  we  have  59.8  benefited 
or  18.6  more  than  at  Madeira,  and  12.6  more  than 
on  the  Kiviera. 


HYDEANGEA   AEBORESCENS    IN    EENAL 

.  CALCLT^US. 

Bt  N.  F.  BEOWN,  M.D., 

DETBOrr,    MICH. 

Having  been  much  interested  in  Dr.  Edson's  article 
upon  "  Hydrangea  in  Renal  Calculus,"  and  as  I 
have  used  the  remedy  in  several  cases  of  renal  cal- 
culi, I  will  also  report  my  experience. 

C.1SE  I. — October,  1868,  while  I  was  located  in 
Port  Huron,  I  was  called  to  visit  a  grocer,  about 
thirty-eight  years  of  age,  and  found  him  suffering 
severely  with  a  sudden  attack  of  nephritic  colic.  This 
was  my  first  professional  acquaintance  with  him, 
and  he  informed  me  that  for  several  years  i^ast  he 
had  had  occasional  attacks,  varying  in  degree,  Vjut 
that  he  had  not  been  attended  by  regular  physicians, 
and  that  a  correct  diagnosis  in  his  case  had  not  been 
made. 

This  attack  being  unusually  severe,  he  concluded 
to  pass  by  his  "  doctor  druggist "  and  try  some  one 
else. 

The  diagnostic  features  here  were  well  marked  : 
the  pain  commenced  in  the  right  lumbar  region, 
from  which  it  diverged,  and  especially  along  the  line 
of  the  ureter  the  j)ain  was  intense  ;  the  testicle  was 
drawn  upward  almost  to  the  ring,  and  the  coiTe- 
sponding  side  of  the  scrotum  contracted.  The  groans 
and  shrieks,  with  cold  persi^iration  and  pinched 
features,  portrayed  the  great  suffering  of  the  pa- 
tient. 

I  ordered  at  once  sulphate  of  irorphia  internally. 


40 


THE  MEDICAL  RECORD. 


and  fomentations  to  the  abdomen  and  groin ;  and  in 
two  hours  the  pain  and  tenesmus  were  decidedly 
lessened  ;  this  was  at  4  i>.M.,  when  he  commenced 
taking  the  fluid  extract  of  hydrangea  in  3  ss.  doses 
every  three  hours,  and  early  next  morning  the  pain 
suddenly  ceased,  and  in  a  few  minutes  he  passed  a 
large  quantity  of  water  containing  pus,  blood,  and 
abundant  concretions  of  uric  acid.  From  this  time 
on  ho  improved  rapidly,  aud  in  thi-ee  days'  time  was 
able  to  be  about  aud  attend  to  light  duties,  although 
in  this  case  I  believe  that  there  was  inflammation  of 
the  bladder. 

The  result  was  gratifying  to  all  parties  concerned, 
especially  to  the  patient ;  he  questioned  me  in  refer- 
ence to  the  remedies  used,  asserting,  in  a  very  posi- 
tive way,  that  no  such  medicine  had  ever  been  given 
him  in  previous  attacks.  His  general  health  rapidly 
improved,  and  he  expressed  the  opinion  that  he  was 
a  "new  man." 

The  following  spring  I  located  in  this  city,  and 
did  not  see  the  gentleman  again  till  foui'  years  later, 
when  I  met  him  at  a  friend's  hou.se  in  the  city,  and 
he  informed  me  that  after  I  left  Port  Huron,  in  the 
summer,  he  had  a  severe  attack  ;  that  he  had  my  pre- 
scription duplicated,  and  that  relief  was  prompt  in  a 
few  hours,  x'assing  "plenty  of  gravel."  He  also  in- 
formed me  that  he  kept  the  remedy  on  hand,  and 
occasionally  took  a  dose,  and  that  he  had  not  had 
any  more  "  trouble  with  the  gravel." 

Case  II. — In  August,  1870,  I  was  called  late  one 
evening  to  visit  a  young  man  "  dying  with  inflamma- 
tion of  the  bowels,"  so  stated  by  the  messenger  who 
came  for  me. 

The  patient  was  twenty-one  years  of  age,  of  good 
habits  and  industrious ;  he  was  employed  as  a 
"  whip-sawyer  "  in  one  of  the  ship-yards  of  the  city, 
and  is  to  this  day  employed  in  the  same  yard  and 
in  the  same  capacity.  Entering  his  room,  1  found 
him  in  the  dorsal  decubitus,  with  the  right  leg  flexed 
upon  the  thigh  ;  expression  denoting  great  anxiety  ; 
tremor  and  cold  perspiration  ;  found  the  right  tes- 
ticle drawn  ujiward,  severe  pain  jn  the  groin  and 
thigh,  with  dift'use  abdominal  tenderness — the  pain 
originating,  as  in  Case  I.,  in  the  lumbar  region. 
This  was  his  first  attack,  and  when  I  gave  him  my 
opinion  of  his  case,  he  and  his  friends  doubted  my 
diagnosis,  and,  as  I  was  a  stranger,  called  in  the 
emergency,  ho  did  not  take  the  remedies  as  ordered, 
but  early  in  the  morning  sent  for  the  family  physi- 
cian, who  upon  arrival  also  disagreed  with  my  diag- 
nosis, because  tha  patient  was  somewhat  relieved 
during  the  night  by  the  use  of  morphia. 

Being  dismissed  from  the  case,  I  do  not  know 
what  the  treatment  was,  but  remember  that  the  pa- 
tient did  not  resume  his  work  for  about  two  weeks, 
and  in  three  or  four  weeks  after  he  commenced 
work  another  attack  came  on,  and  again  I  was 
called.  I  had  informed  him  in  the  previous  attack 
of  tho  probable  apijearaiice  of  the  urine  when  passed 
freely,  and  remembering  that  my  conjecture  was 
true,  ho  was  anxious  that  I  should  treat  him  in  this 
second  attack.  The  diagnostic  features  of  the 
second  attack  were  as  well  marked  as  in  tho  first. 
The  treatment  was  commenced  with  sidphate  of  mor- 
phia internally,  and  fomentations  to  the  abdomen 
and  groin.  Bismuth  was  also  given  in  this  case,  as 
there  was  considerable  nausea.  The  fluid  extract  of 
hydrangea,  in  oiio-lialf  drachm  doses,  with  a  few 
drops  of  tincture  liyoK<>yaini,  were  given  every  three 
hours,  aud  when  four  or  five  doses  were  taken  tlie 
urine  jiassed  freely,  containing  uric  acid  concretions 
in  considerable  quantity,  with  a  few  drops  of  blood. 


I  gave  sulphate  of  morphia  hypodennically,  and 
chloroform  liy  inhalation,  as  the  suffering  was  as 
great  as  I  ever  witnessed  under  any  circumstances. 
The  hydrangea  was  given  in  one-half  drachm  doses, 
every  two  hours,  and  at  the  exjjiration  of  sis  hours 
the  patient  was  perceptibly  better,  aud  in  two  hours 
more  was  completely  relieved  by  a  copious  discharge 
of  lu-ine  containing  "  red  sand  "  in  abundance.  No 
blood  or  pus  were  discovered  in  this  discharge, 
neither  had  there  been  any  dribbling  of  urine,  as  in 
the  previous  attacks.  It  was  astonishing  how  quickly 
he  rallied  from  this  attack.  In  less  than  a  week  he 
was  at  work  again. 

This,  the  last  attack,  occurred  shortly  after  mar- 
riage, and  whether  that  was  an  exciting  factor  I  do 
not  un<lertake  to  say ;  but  I  do  know,  from  personal 
observation,  that  since  that  time  he  has  enjoyed 
good  health,  and  that  he  has  had  no  urinary  or  renal 
trouble. 

Case  III.^ — June,  1874.  A  married  woman,  five 
months  advanced  in  pregnancy,  apparently  in  good 
health,  was  suddenly  seized  with  a  sharp  pain  in  the 
right  lumbar  and  sacral  regions,  and  w  hen  I  saw  her, 
in  a  short  time  after  the  beginning,  she  was  sufl'ering 
severely  with  i^ain  and  fright.  As  she  had  never  ex- 
perienced anything  of  this  character  before,  I  was 
guarded  in  my  diagnosis.  Her  treatment  at  first 
was  sulphate  of  morphia  and  bicarbonate  of  potash. 
These  were  given  in  the  evening  and  ordered  con- 
tinued through  the  night.  Calling  early  next  morn- 
ing, I  found  that  the  severe  pain  had  changed  from 
the  back  and  side  to  the  upper  site  of  the  ureter, 
where  a  slight  prominence  was  plainly  discernible, 
and  very  tender  to  the  touch. 

I  then  informed  her  that  prnbally  a  stone  was 
passing  from  the  kidney  through  the  ureter  to  the 
bladder,  and  subsequent  events  proved  the  correct- 
ness of  that  supj)osition.  I  prescribed  tho  fluid  ex- 
tract of  iiydrangea  with  the  potash,  aud  gave  the 
morphia  with  Dover's  powder.  The  progress  of  the 
stone  through  the  ureter  could  be  traced  day  by  day, 
for  it  took  three  days  for  its  passage,  and,  as  the 
stone  had  neared  the  bladder,  I  feared  that  it  was 
permanently  arrested,  and  that  suppuration  might 
ensue,  as  it  remained  in  that  position  for  at  least  fif- 
teen hours. 

I  gave  chloroform  by  inhalations ;  fomentations 
used  freely,  with  tincture  of  opium. 

During  one  of  those  terrible  paroxysms  of  pain 
the  patient  shouted,  "I  am  better  now,"  and  at  once 
arose  from  the  bed,  sat  upon  the  vessel,  and,  while 
the  urine  was  flowing  freely,  the  stone  fell  into  the 
vessel  with  a  click  that  was  distinctly  heard  in  the 
room.  Blood  and  pus  were  discharged  with  the 
stone. 

I  secured  the  gravel,  which  was  smooth  and  tri- 
angular in  appearance.  The  stone  was  accidentally 
lost,  and  no  chemical  examination  made  of  it,  but  it 
was  probably  phosphatic.  Premature  labor  was 
threatened  before  the  stone  passed,  as  I  could  feel 
the  contraction  of  the  nterus  under  my  hand  ;  but  it 
was  averted,  and  in  due  time  I  delivered  her  of  a 
healthy  male  child.  Her  getting  wy  was  good,  and 
while  she  remained  in  Detroit,  wliii  h  was  for  three 
years  after,  she  had  no  symptoms  of  giavol,  passing 
through  another  pregnancy  and  delivery  at  the  end 
of  two  years. 

I  am  well  aware  that  this  result  might  have  been 
reached  without  tho  use  of  tho  hydrangea,  and  I  do 
not  claim  that  the  drtig  frt(  ilitated  the  j>assage  of  the 
stouo  through  the  ureter;  but,  afterward,  she  took 
occasional  doses  of  tho  drug,  which  relieved  her 


THE  MEDICAL  RECORD. 


41 


backache,  and,  she  believed,  saved  her  from  another 
severe  attack.  Since  mv  first  experience  with  hy- 
drangea, in  1S()8,  I  have  frequently  ))rescril)ed  it  in 
renal  and  urinary  disorders,  and  generally  -nith  very 
gratifying  results,  and  would  not  hesitate  to  pre- 
scribe it  in  most  aftections  of  these  organs,  avoiding 
acute  inflammation  of  the  kidneys.  In  chronic  ne- 
phritis, in  the  prostatic  troubles  of  eldei'ly  gentle- 
men, and  in  hysteria  with  retention  of  the  urine,  I 
have  had  pleasing  resixlts  with  hydrangea  abores- 


|Jro0ressi  of  iHcliicftl  Scifucc. 


Administration  op  the  Mubiated  TrscTtrRE  op 
Iron. — As  a  harmless  and  tasteless  mode  of  exhibit- 
ing the  muriated  tincture  of  iron,  Dr.  J.  H.  Grimes 
proposes  that  it  be  administered  in  Planten's  cap- 
sules of  juJTibe  paste  or  gelatine.  He  directs  his 
patients  to  drop  into  the  cup  of  the  capsule  as  manv 
drops  of  the  pure  tincture  as  have  been  prescribed'; 
the  cap  is  then  to  be  replaced,  and  the  capsule 
swallowed  in  the  usual  way  with  water.  His  patients 
are  much  pleased  with  this  new  mode  of  taking  the 
tincture,  and  the  security  offered  to  the  teeth  at 
once  gains  their  ready  co-operation.  The  question, 
however,  arises,  whether  it  would  be  wise  to  allow 
the  undiluted  tincture  to  come  in  contact  with  the 
mucous  membrane  of  the  stomach,  as  it  does  when 
administered  in  this  manner.  In  some  conditions  it 
would  certainly  be  too  irritating. — Medical  and  Sur- 
gical Reporter,  November  26,  1881. 

Ajrri,  XriTiiTE  in  Tevnttus  ArrRirrM. — Dr.  J.  Dana 
Littlefield  (Med.  and  Surg.  Hep.,  November  2(5, 
1881)  states  that  he  has  used  the  nitrite  of  amyl  in 
his  own  case  for  tinnitus  aurium.  He  poured  a  small 
quantity  of  the  remedy  into  a  two  drachm  vial,  and 
put  on  his  handkerchief,  for  inhalation,  as  much  as 
■would  be  likely  to  come  out  from  suddenly  inverting 
the  vial  upon  and  immediately  compressing  the  hand- 
kerchief On  inhalation,  the  character  of  the  sound 
became  modified  (lighter),  longer  intervals  of  ease  en- 
sued, and,  finally,  a  decided  sense  of  inexpressible  re- 
lief, with  a  feeling  of  positive  change  on  the  affected 
side.  The  dose  (about  ten  minims)  was  followed  by 
no  discomfort  or  untoward  symptoms,  but,  on  the  con- 
trary, by  an  increased  exuberance  of  spirits,  perhaps 
due  in  part  to  the  achievement  of  a  happy  relief. 
Dr.  Littlefield  states  that  he  finds  no  authority  for 
this  therapeutic  use  of  the  nitrite  of  amyl,  other  than 
this  one  successful  case.  He  has  his  own  theory  in 
regard  to  the  action  of  the  drug,  but  is  awaiting 
reports  from  the  profession. 

WooL-SoETEiis'  Disease. — Mr.  Spear  has  recently 
published  his  official  report,  which  establishes  the 
identityof  the  wool-sorters' disease  with  anthrax.  The 
symptomatology  and  anatomy  of  this  affection  are 
fully  discussed,  and  cei-tain  interesting  observations 
are  advanced  in  regard  to  its  pathology.  The  usual 
classifieation  of  anthrax  into  an  "  external "  and 
"  internal "  form  is  observed  throughout  the  report. 
In  many  instances,  however,  there  is  a  wide  diver- 
gence from  the  development  and  progress  of  typical 
cases.  The  malignant  pustule  may  appear,  not  as 
an  initial  lesion,  but  as  a  local  manifestation  of  con- 
stitutional infection,  and  a  "  minor  pustule  "  is  apt 
to  attack  the  hands  of  those  working  on  infectious 
material,  a  pustule  very  different  from  the  tyijical 
form,  but  closely  resembling  the   lesion   resulting 


from  only  partially  successful  inoculation  of  anthrax 
vims  upon  camivorons  animals,  and  similar  to  that 
produced  by  Pasteur's  "  iittennated  virus  "  in  the 
herbivora.  In  the  other  variety  of  the  disease,  the 
anthrax  fever,  stiU  more  important  deviations  from 
the  accepted  type  are  described,  and  although  the 
German  and  French  observers  look  upon  the  affec- 
tion as  almost  always  fatal,  Mr.  Spear  concludes  that 
only  a  moderate  number  of  cases  terminate  unfavoi- 
ably.  Again,  while  one  man  may  be  .stricken  down  \>j 
a  rapidly  fatal  malady,  his  comrade,  working  in  the 
same  material,  may  also  be  affected,  but  by  a  form 
of  the  disease  which  stops  short  of  the  severer  .symp- 
toms, and  nltimately  goes  on  to  recovery.  The  his- 
tories of  long-continued  malaise,  also,  among  wool- 
sorters  are  numerous.  The  symptoms  are  much 
like  those  of  the  prodromal  stage  of  acute  infection 
— headache,  depression,  nausea,  dimness  of  sight, 
cramps,  restless  sleep,  with  the  occasional  appear- 
ance of  cutaneous  eruptions,  petechioe,  boils  or 
herpes.  At  times  an  apparent  periodicity  is  ob- 
served in  the  subjective  symptoms.  Such  manifesta- 
tions may  occasionally  occur  as  prodromata  of  pn 
acute  attack  of  the  di.sease ;  more  often,  however, 
they  disappear  spontaneously.  The  author  admits 
the  possibility  of  a  chronic  anthracoid  i^oisoninp, 
the  analogue  of  which  may  be  found  in  malarial  dif- 
ease.  The  operation  of  the  virus  from  its  very  incep- 
tion is  peculiarly  inconstant.  Incubation  maybe  df- 
feiTed  by  long  periods  of  latency  :  full  development 
may  be  delayed  by  prolonged  and  intermittent  pro- 
dromata ;  often  the  disease  aborts.  At  first,  and  for  a 
variable  time,  the  virus  is  "  barely  able  to  prolong  its 
existence;"  either  the  removal  of  unknown  obsta- 
cles, however,  or  the  addition  to  the  blood,  or  secre- 
tions, of  agents  promoting  the  development  of  the 
poison,  or  both  these  contingencies,  enables  the  in- 
fectious material  to  exert  its  full  sway,  and  the  dis- 
ease to  run  its  fatal  course.  To  explain  the  unequal 
receptivity  to  the  poison,  Mr.  Spear  revives  an  old 
theory,  that  of  the  eating  of  more  or  less  crude  vege- 
tables and  fruit.  Guided  by  the  well-known  predi- 
lection of  this  contagium  for  herbivorous  animals, 
and  by  the  fact  that  ilesh-fed  rats  prove  refractory 
to  inoculation  with  anthrax  virus,  while  the  same 
rats  fed  on  vegetables  quickly  siiccnmb.  the  author 
was  led  to  inquire  into  the  alimentation  of  the  wool- 
sorters  who  had  suffered  from  acute  attacks  of  an- 
thrax fever.  He  found  that  in  neaily  every  case  in 
which  information  was  obtainable,  the  development 
of  urgent  symptoms  had  snpei-vened  upon  the  in- 
gestion of  an  unusual  quantity  of  vegetable  food  ia 
some  form  or  other.  Again,  in  several  cases  of  re- 
mission of  the  symptoms,  a  relapse  .ceemed  to  follow 
the  eating  of  vegetable  food.  In  Constantinople 
also,  where  the  external  form  of  the  disease  is  well 
known,  the  eating  of  vegetables  and  fruit  during  an 
attack  is  regarded  as  "  especially  dangerous."  The 
evidence  appears  to  be  strong  and  circumstantial 
so  far  as  such  evidence  can  be.  The  experiments  of 
Feser  are  now  very  generally  accepted  liy  continentsl 
authorities  as  indicating  that  the  relative  immu- 
nity of  the  carnivora  is  not  inherent  to  the  genus, 
but  is  influenced  by  the  nature  of  their  food.  The 
immunity  of  the  foetus  is  now  regarded  as  dependent 
on  the  fact  that  it  is  really  a  carnivorous  animal, 
not  on  any  filtering  action  of  the  placenta.  As  Mr. 
Spear  says  :  "  It  is  conceivable  that  alimentary  sub- 
stances may  bring  about  in  the  body  such  chemical 
or  morphological  changes  as  will  render  its  fluids 
a  richer  field  for  the  proliferation  of  disease-germs." 
—British  Medical  Journal,  November  5,  1881. 


43 


THE  MEDICAL  RECORD. 


Electro-Therapy  in  Opacitt  of  the  Vitreous 
Body. — M.  Teulon,  in  writing  uijon  opacities  of  the 
vitreous  boJy,  and  their  treatment  by  electro-therapy, 
yives  the  results  in  twenty-four  cases  observed  by 
him,  and  treated  by  the  continued  current ;  he  reck- 
oned twenty-two  as  radically  cured.  He  employs  a 
very  small  number  of  elements,  and  applies  the  pos- 
itive pole  upon  the  closed  eyelids,  and  the  negative 
upon  the  mastoid  process,  or  upon  the  superior 
cervical  ganglion.  The  application  lasts  only  two 
or  three  minutes.  In  conclusion,  M.  Tenlou  ob- 
served that  in  every  opacity  of  the  vitreous  body, 
no  matter  what  be  its  degree  or  extent,  provided  that 
its  development  had  not  assumed  the  confirmed 
form  of  hypertrophy,  he  considered,  from  experience, 
the  constant  continued  current  as  the  most  effica- 
cious treatment. — Medical  Press  and  Circular,  No- 
vember 9,  1881. 

Jaborandi  IK  Croup. — Dr.  W.  N.  Ames,  having 
obtained  gratifying  results  from  the  use  of  jaborandi 
with  yerba  santa  and  grindelia  robusta,  in  catarrhal 
croup,  determined  to  try  the  same  treatment  for 
every  case  met,  to  prove  the  remedy.  On  October 
12th,  he  was  called  to  see  a  girl,  seven  years  of  age, 
siiflfering  with  croup.  Sedatives  and  quinine  were 
first  given,  until  the  fever  subsided  ;  immediately 
after,  the  administration  of  fluid  exttact  of  jabo- 
randi, in  twenty-drop  doses,  every  two  hours,  was 
begun.  As  the  remedy  produced  nausea  and  vomit- 
ing, it  was  given  by  the  teaspoonful  in  an  enema, 
until  physiological  eflects  were  produced.  Quinine 
having  removed  the  malarial  influence,  treatment 
with  jaborandi  was  fairly  commenced  on  the  second 
day.  The  dyspncea  and  the  dry,  brassy  cough  were 
superseded  by  almost  natural  breathing  and  moist, 
croupy  cough.  By  placing  the  patient  on  her  back,  so 
that  she  could  swallow  the  saliva,  it  was  thought  that 
the  influence  of  the  remedy  would  be  protracted. 
Nausea  and  vomiting  were  relieved  by  appropriate 
means.  .Jaborandi  was  given  every  two  hours,  night 
and  day,  for  nearly  two  weeks.  A  gentle  salivation, 
with  moistness  of  the  larynx  and  pharynx,  was  kept 
np.  Occasional  collapses  were  experienced.  Ox- 
alate of  cerium  relieved  catarrh  of  the  stomach. 
Subsecjuently,  pilocarpine  was  administered  instead 
of  the  flviid  extract.  On  the  third  day  of  treat- 
ment, a  piece  of  membrane  three  inches  long, 
tubular,  and  exhibiting  a  coat  of  the  trachea,  was 
detached  and  coughed  up.  Later,  smaller  pieces 
of  membrane  were  expectorated.  Dusart's  lacto- 
phosphate  of  lime,  with  sulphur,  was  then  adminis- 
tered, alternating  with  the  jaborandi.  Atomized 
lime-water  and  lactic  acid  inhalations  were  also 
employed.  Jaborandi,  according  to  Dr.  Ames,  evi- 
dently cured  the  disease,  as  it  relieved  the  urgent 
symptoms  after  the  first  few  doses,  acted  on  the 
salivary  and  faucial  glands,  keeping  the  inflamed 
larynx  and  trachea  bathed  with  their  secretion,  and 
arresting  the  further  formation  of  the  membrane. 
The  syrup  and  the  sulphur  may  have  aided  in  bring- 
ing about  a  favorable  issue. — Medical  and  Sitrgical 
Reporter,  November  26,  1881. 

OvARioTojrY. — The  November  number  of  the 
American  Practitioner  contains  a  series  of  practical 
remarks  on  the  subject  of  ov.iriotomy,  made  by 
Dr.  Thomas  Kiiith,  in  the  course  of  an  interview. 
This  distinguished  ovariotomist  had  observed  sev- 
eral instances  of  carbolic  acid-poisoning  occurring 
in  patients  upon  whom  ho  had  operated  under  anti- 
soptic  precautions,  and  had  himself  been  injuriously 
affscted  by  this  agent.   Since  March  ho  had  stopped 


the  spray  altogether.  Practically,  he  states,  he  has 
not  used  antiseptics  since,  in  the  proper  sense  of 
the  word.  Sometimes  he  does  use  very  weak  car- 
bolic solutions,  but  not  as  a  spray  ;  at  other  times 
he  uses  water  alone.  He  doubts  very  miich  whether 
the  spray  is  of  any  use  whatever  in  ovariotomy  op- 
erations, and  does  not  favor  the  adoption  of  new 
antiseptics,  such  as  the  eucalyptus,  etc.  As  he  has 
had  no  fatal  issues  to  record  since  abandoning  the 
spray,  no  ba.sis  is  afforded  for  the  comi^arison  of 
death-rates  with  and  without  its  use.  From  March 
to  the  date  of  the  interview,  twenty-six  operations 
were  performed  without  antiseptics — at  any  rate 
without  the  spray — each  with  happy  issue.  In 
twenty-six  cases  operated  upon  before  he  began 
antiseptics.  Dr.  Keith  lost  one  patient.  There  was, 
then,  one  death  in  a  total  of  fifty-two  cases  done 
without  antiseptics.  Thirteen  of  these  patients, 
furthermore,  were  operated  upon  in  the  hospital, 
where  they  were  specially  liable  to  suffer  from  septic 
and  other  injurious  influences.  Since  this  interview. 
Dr.  Yandell  states,  in  a  note,  that  Dr.  Keith  has 
done  twelve  other  ovariotomies  without  a  death. 
Subsequent  to  discarding  the  spray,  temperatures 
anything  like  103'  were  never  observed  ;  100  was 
rarely  passed,  and  ice-bags  used  but  once.  Dr.  Keith 
now  drains  more  cases  than  when  he  operated  under 
antiseptics.  He  prefers  ether  to  chloroform.  Speak- 
ing of  fibroids,  he  stated  that  the  operation  for  their 
removal  had  become  a  fashion,  and  was  performed 
too  often  ;  the  only  ones  that  should  be  removed 
were  rapidly  growing  fibroids  in  young  women. 
Five  of  his  cases  were  done  successfiilly  without  an- 
tiseptics ;  of  four  done  under  the  spray,  one  died  of 
carbolic  poisoning. 

Ner\-e  Sutube. — In  forty-three  reported  cases  of 
suturing  divided  nerves,  Wolberg  found  twelve  in 
which  the  restoration  of  function  could  be  explained 
only  on  the  hypothesis  of  union  by  first  intention. 
The  results  of  the  experiments  conducted  by  the 
author  led  to  the  following  conclusions :  1.  Primary- 
union  of  nerves  is  possible.  2.  The  ends  of  a  di- 
vided nerve  should  be  sutured  together  in  all  recent 
cases ;  the  operation  should  be  undertaken  in  old 
cases  only  when  called  for  by  the  importance  of  the 
paralyzed  functions,  and  when  all  other  methods  of 
treatment  have  proved  fruitless.  3.  Direct  are  pre- 
ferable to  paraneurotic  sutures,  the  former  being 
not  only  equally  free  from  danger  and  as  easily  ex- 
ecuted "as  the  latter,  but  also  afibrding  more  accurate 
coaptation.  (Filkenheim  recommends  paraneurotic 
sutures  whenever  these  suffice  to  bring  the  divided 
ends  in  jierfeet  aiiposition,  vide  Medical  EEroRD, 
Vol.  XX.,  No.  20,  p.  5i5).  4.  Even  when  primary 
union  is  not  obtained,  the  process  of  regeneration 
is  hastened  by  suture. — Ceiiti-alblatt  fuer  Chirurgie, 
September  24,  1881. 

Hypnotism. — The  Philadelphia  Medical  Times  of 
November  10,  1881,  contains  a  paper  on  "Hypnot- 
ism." read  by  Dr.  Charles  K.  Mills  before  the  Phila- 
delphia County  Medical  Society.  The  author  therein 
detailed  his  experiments  made  upon  two  subjects. 
Among  the  phenomena  observed  were  diminution  or 
loss  of  consciousness,  increase  in  i)ulse  and  respira- 
tion, highly  marked  analgesia,  automatism  at  com- 
mand, tremor,  contracture,  and  neuro-muscular 
hyper-excitability.  The  almost  constant  increase  in 
the  rapidity  of  breathing  is  attributed  by  Heidon- 
lieim  to  a  stimulation  of  the  respiratorj-  centre.  "  Tho 
neuro-muscular  hyjier-excitability,"  says  the  author, 
"  is  simply  a  phase  of  exaggerated  reflex  excitability." 


THE  MEDICAL  RECORD. 


43 


lie  regards  the  views    of   Heidenheim  relating  to 

til.-  hypnotic  phenoraeua  as  the  most  reasonable,  al- 
t  Imiigh  not  altogether  free  fr'om  objection.  According 
t  1  the  latter,  the  cause  of  these  phenomena  lies  in  the 
inhibition  of  the  activity  of  the  ganglion  cells  of  tlie 
i-erebral  cortex,  the  inhibition  being  brought  about 
by  gentle  prolonged  stimulation  of  the  sensory 
ii.'ives  of  the  face,  or  of  the  auditory  or  oj^tic  nerve. 
I  If.  Mills  believes  that  hypnotism  has  a  limited,  liut 
li'f,'itimate,  therapeutic  application,  and  that  its  judi- 
ciiius  employment  would  be  of  benetit  in  certain  forms 
(if  neuralgia,  spasm,  tremor,  and  palsy.  The  hypnotic 
tremor,  he  states,  may  afford  some  indication  as  to 
the  nature  of  some  of  the  cases  of  tremor  which  pre- 
sent themselves  to  the  physician  for  diagnosis  and 
treatment.  The  author  mentions  a  case  of  hystero- 
epilepsy  in  which  one  of  the  most  striking  manifesta- 
tions was  a  persistent  tremor  of  the  upper  extremity, 
simulating  that  of  sclerosis  of  cerebral  or  spinal  ori- 
i-'in.  It,  however,  disappeared  with  the  cessation  of 
the  spasmodic  attacks.  A  persistent  tremor,  he 
siys,  closely  resembling  that  seen  in  grave  cerebro- 
s|iitjal  disease,  may  be  due  to  causes  as  teui])orary 
as  those  which  bring  about  the  ti-ansienfc  conditions 
"f  hypnosis.  In  the  discussion  which  followed.  Dr. 
lUackwood  stated  that  he  considered  the  efl'eet  of 
liypnotic  sleep  to  be  injurious  to  the  brain,  and  not 
justifiable  as  a  therapeutic  measure,  especially  as 
tlie  trancoidal  state  was  more  readily  obtained  in 
hysterical  and  already  weak-minded  persons,  who, 
111'  conceived,  were  more  likely  to  be  injured  than 
b 'iieflted  by  such  proceedings.  Di\  Thomas,  how- 
ever, thought  this  condition  might  jirove  of  service 
in  hysterical  paralysis  ;  for  if,  during  hypnotism, 
exercise  of  the  parts  could  be  made  under  the 
physician's  control,  they  might  afterward  be  moved 
by  conscious  volition.  Dr.  Woodbury  remarked 
that,  since  the  lecturer  had  called  attention  to  the 
increase  in  tremor  in  the  right  arm  of  one  of  his 
hypnotized  patients,  he  would  say  that  the  con- 
nection between  tremor  and  paralysis  was  so  close, 
that  possibly  hyjmotism,  instead  of  benefiting  this 
patient,  might  aggravate  her  disease.  In  coarse 
lesions  hyijnotism  might  do  damage  to  already  weak- 
ened brain-functions,  an  accident  which  has  already 
happened.  Dr.  Mills,  in  closing  the  discussion,  ad- 
mitted that  the  condition  was  a  pathological  rather 
than  a  physiological  one,  and  that  harm  might  be 
done  by  incautious  experimentation.  Grave  hysteria 
might  often  be  regarded  as  a  more  or  less  pro- 
noimced  condition  of  hypnosis.  He  stated  that  a  case 
of  brachio-crural  neuralgia  had  been  cured  by  passes, 
and  that  Esdaile  had  performed  sixty  or  seventy  sur- 
gical operations  upon  hypnotized  patients. 

NmiEKATiox  OP  Red  Blood-Cortuscles.  —  To- 
niessen  and  Penzoldt  have  conducted  a  series  of  ob- 
servations to  determine  the  corpuscular  richness  of 
the  blood  in  various  pathological  conditions,  and 
have  found  that  in  most  diseases  there  is  a  diminu- 
tion below  the  normal  average  of  5,000,000  to  the 
cubic  millimetre.  In  one  case,  where  peritoneal 
transfusion  was  practised  with  the  result  of  a]5par- 
ently  improving  the  patient's  condition,  no  material 
increase  in  the  number  of  corpuscles  was  noted,  the 
average  of  several  observations  before  transfusion 
being  4,450,000,  as  against  4,509,000  after  it.  In  a 
case  of  pneumonia,  with  high  fever,  there  was  a  con- 
siderable deci-ease  in  the  number  of  red  corpuscles, 
but  baths,  given  to  I'educe  the  temperature,  always 
served  to  bring  aboiit  a  favorable  change  ;  thus,  with 
a  temperature  of  39.7'  C,  the  number  of  corpuscles 


was  noted  to  be  3,690,000,  while  after  a  bath  the 
temperature  fell  to  38.9°,  at  the  same  time  that  the 
number  of  corpuscles  rose  to  4,690,000.  In  a  cer- 
tain class  of  cases  a  condition  of  hyperglobulosis 
was  observed.  These  were  all  instances  of  congeni- 
tal or  acquired  cardiac  disease  in  a  state  of  insuffi- 
cient compensation.  Among  these  were  two  cases 
of  congenital  stenosis  of  the  pulmonary  ostium, 
with  a  corjni.scular  richness  of  7,500,000  and  8,820,- 
000  respectively.  Where  the  compensatory  hyper- 
trophy was  sniBcient,  there  was  no  departure  from 
the  normal  standard.  Moreover,  in  two  cases  with 
insufficient  compensation,  where  the  patient's  condi- 
tions were  quickly  ameliorated  by  digitalis,  there 
was  observed  a  corresponding  change  from  hyper- 
globulosis to  the  normal.  From  these  observations, 
Toniessen  and  Penzoldt  conclude  that  in  all  cases 
of  obstructed  systemic  circulation,  the  blood  in  the 
peripheral  vessels  is,  so  to  speak,  concentrated.  In 
one  individual,  the  authors  made  examinations  to 
determine  the  average  richness  in  corpuscular  ele- 
ments of  the  blood  on  either  side  of  the  body.  The 
case  was  one  of  well-marked  atheromatous  degenera- 
tion, with  occasional  inequality  in  the  volumes  of 
the  radial  piilses,  giving  rise  to  the  STispicion  of  the 
]iresence  of  aneurism  of  the  arch  of  the  aorta.  In 
this  patient  there  was  a  constantly  present,  though 
varying  preponderance  in  the  number  of  cori^uscles 
on  the  right  side  of  the  body,  the  difference  amount- 
ing at  one  time  to  as  much  as  two  and  one-half  mil- 
lions. The  idea  of  aneurism  was  abandoned  after 
further  observation,  but  the  authors  discovered  that 
the  patient  was  affected  with  right  hemiparesis,  as 
the  result  of  an  aijoplectic  seizure  sustained  many 
years  previously.  In  this  case  the  excess  of  corpus- 
cles on  the  right  side  was  attributed  to  the  same 
cause  as  that  given  for  malcompen.sated  cardiac  dis- 
ease, namely,  obstructed  circulation  on  the  diseased 
side  ;  in  the  paralyzed,  or  paretic  parts,  the  venous 
circulation  is  sluggish  becaiise  of  insufficient  muscu- 
lar action,  the  parts  often  being  cyanotic,  perspiring 
more  freely  than  the  sound  side,  etc.,  circumstances 
which  favor  an  increased  evaporation  of  moisture 
from  and  a  relative  increase  of  corpuscles  in  the 
vessels  of  the  diseased  part.  Lyon's  experiments 
and  observations  (Virchow's  Archiv.,  vol.  Ixxxiv.,  p. 
207)  were  principally  directed  to  the  numeration  of 
red  corpuscles  in  cases  of  traumatic  anaemia.  It  was 
found  that  in  all  cases  of  abstraction  of  blood,  there 
was  a  perceptible  decrease  in  the  average  number  of 
red  coi-puscles  during  and  immediately  after  hemor- 
rhage, whenever  the  latter  equalled  two  per  cent,  of 
the  weight  of  the  animal.  A  continuance  of  the  ex- 
]ieriment  induced  a  further  decrease.  During  the  first 
few  days  succeeding  the  loss  of  blood,  the  corpuscular 
richness  sank  still  lower,  after  which  there  was  a 
gradual  return  to  the  normal  standard.  "Where  the 
abstraction  of  blood  amounted  to  3.5  to  4.5  per  cent, 
of  the  weight  of  the  animal,  a  period  of  from  nine- 
teen to  thirty-four  days  was  required  before  restitu- 
tion was  complete ;  a  shorter  period  elajised  in 
milder  cases  of  anremia.  During  and  immediately 
after  venesection  the  number  of  white  blood-corpus- 
cles increased  but  slightly,  but  during  the  following 
few  days  there  was  a  marked  absolute  increase  in 
their  number,  which  lasted,  however,  only  a  few 
days,  while  their  relative  number  remained  gi-eater 
than  normal  for  a  much  longer  time.  Observations 
made  in  a  few  cases  of  traumatic  anaemia  in  human 
beings  yielded  similar  results,  but  were  carried  out 
with  verv  great  difficultv. — Med.  Chirurg.  Rundschau, 
September,  1881. 


44 


THE  MEDICAL  RECORD. 


The  Medical  Recoed: 

51  lllceklji  lournal  of  illcbidnt  anli  Surgera- 


GEORGE  F.  SHRADY,  A.M.,  M.D.,  Editor. 


PDBLISHED   BY 
WM.  IVOOD  &  CO.,  No.  27  Great  Jones  St.,  N.  Y. 


New  York,  January  14,  1882. 

FOKCED  RETIREIMENT  FROM  THE  AEMY. 

The  bill  now  pending  in  Congress  to  retire  all 
officers  on  their  reaching  sixty -two  years  of  age,  con- 
templates some  important  changes  in  the  present 
organization  of  our  army,  and  is  likely  to  improve  the 
morale  and  increase  the  efficiency  of  the  different 
corps  accordingly.  It  is  to  be  expected  that  any  ac- 
tive opposition  to  its  passage  must  come  from  such 
officers  as  are  past  the  specified  age.  But  the  com- 
paratively small  number  of  older  gentlemen  who 
may  be  temporarily  damaged  by  the  order,  is  more 
than  balanced  by  the  larger  number  of  more  active 
workers  who  will  fill  the  vacant  places  by  closing 
np  in  the  line  of  promotion.  It  must  be  conceded 
that  the  rate  of  promotion  in  our  army  is  exceedingly 
slow.  The  chief  reason  for  this  is  the  fact  that,  by  a 
mistaken  delicacy  on  the  part  of  Government,  many 
of  the  officers  whose  periods  of  real  usefulness  have 
passed,  and  whose  abilities  for  active  service  have 
ceased,  are  retained  in  position,  and  are  thus  allowed 
to  permanently  clog  the  advancement  of  younger 
and  more  efficient  men.  It  is  quite  true  that  the 
number  of  senior  officers  who  occupy  this  position  is 
comparatively  small,  but  their  indefinite  continuance 
in  office  is  a  permanent  and  effectual  bar  to  progress 
along  the  entire  line.  Tims  the  members  of  the  en- 
tire corps  grow  old  together,  without  the  usual  op- 
portunities for  developing  latent  energies,  or  of 
satisfying  tlie  ordinary  tendencies  of  legitimate  am- 
bition. It  is  by  no  means  difficult  to  see  how  the 
maintenance  of  this  system  to  the  extent  it  has  re- 
cently been  carried  in  our  army,  must  paralyze  the 
best  energies  ever  ready  in  the  younger  officers. 
Compul.sory  retirement  at  a  flyed  age,  as  contem- 
plated in  the  bill  under  consideration,  would  apiiear 
to  bo  the  only  feasible  i>lan  for  obviating  these  ob- 
stacles to  legitimate  promotion.  It  is  true  any 
officer,  old  or  young,  is  liable  to  be  retired  on  the 
,  ground  of  physical  unfitness  for  duty,  but  this  is 


seldom  done,  save  in  extreme  cases.     Besides,  there 

is  inseparably  connected  with  such  a  necessity,  a 
feeling  of  more  or  less  mortification  on  the  part  of  the 
gentleman  who  is  the  subject  of  it.  The  proposed 
law  will  certainly  have  the  advantage  over  what 
may  be  called  the  present  custom,  in  that  a  forced 
retirement  cannot  always  be  directly  associated  with 
disqualification  for  service  on  account  of  mere  phy- 
sical or  mental  disability. 

There  is  no  doubt  that  some  men  are  fit  for  the 
most  active  military  duty  at  sixty-two,  and  even  be- 
yond that  age,  but  such  exceptions  are  so  rare  that  a 
rule  implying  the  contrary  could  safely  be  enforced 
without  injury  to  very  many. 

Certainly  any  such  ser\-ices  as  may  be  performed 
by  one  of  such  officers  can  hardly  be  proved  so  in- 
dispensable to  an  army  as  to  militate  against  any 
general  law  demanded  for  the  benefit  of  the  service, 
and  the  greatest  amount  of  good  to  the  larger  num- 
ber of  young,  active,  and  capable  officers. 

Of  course  the  bill  will  affect  the  medical  as  well  as 
other  officers  of  the  corps,  and  will  cause  the  retire- 
ment of  four  or  five  surgeons  who  have  long  and 
faithfully  sei-ved  their  country  in  camp  and  in  the 
field,  and  who  have  won  for  themselves  high  and 
distinguished  positions  in  the  ranks  of  their  profes- 
sion. But  it  will  behove  them,  with  others  of  their 
class,  to  gracefully  acknowledge  the  justness  of  a 
measure  which  must  tend  to  the  increase  of  the  effi- 
ciency of  the  general  service.  "With  all  these  gentle- 
men, it  should  be  a  matter  of  congratulation  that 
they  have  attained  their  present  age  without  phy- 
sical disqualification  for  duty,  and  that  the  remainder 
of  their  lives  can  be  passed  in  the  ease  well  earned 
by  long  and  faithful  work. 

But  there  is  one  other  aspect  in  which  this  ques- 
tion should  be  viewed  in  the  interest  of  all  con- 
cerned. While  the  army  should  not  be  inconven- 
ienced by  the  inefficiency  of  its  officers,  the  latter  in 
their  turn  should  not  be  made  to  suffer  by  the  enforced 
retirement,  in  so  far  at  least  as  it  may  be  accom- 
panied in  the  usual  allowance  of  half-pay.  It  would 
seem  to  be  no  more  than  a  matter  of  simple  justice 
that  the  long  and  honorable  service  which  must  be 
given  to  the  country  before  the  age  for  retirement 
arrives,  should  be  suificient  to  warrant  the  continu- 
ance of  pay  for  the  comparatively  few  ycni-s  of  life 
that  may  remain.  Especially  would  sudi  a  course 
be  considered  proper  in  view  of  a  law  making  retire- 
ment compulsory  at  such  an  age.  This  is  the  least 
reward  that  should  be  due  to  such  gentlemen  as  may 
come  under  the  general  provisions  of  the  bill  in 
question. 


THE   ASSOCIATION  FOB  THE  PROTECTION  OP  THE  INSANE. 

We  are  in  receipt  of  a  circular  announcing  the  an- 
nual meeting  of  the  .\ssociation  for  the  rrotection 
of  the  Insane  and  Prevention  of  Insanity,  which  is 
to  be  held  at  Municipal  Hall,  in  this  city,  .January 


THE  MEDICAL  RECORD. 


45 


20fch.  We  have  also  the  report  of  the  secretary, 
Miss  A.  A.  Chevaillier,  giving  an  account  of  what 
the  association  has  already  accomplished  and  of  the 
objects  for  which  it  is  still  striving.  This  document 
is  an  admirable  presentation  of  the  subject,  and 
testifies  incontrovertibly  to  the  good  which  the 
association  has  already  done,  as  well  as  to  the  great 
possibilities  befoi'e  it. 

The  association  has  by  its  active  agitation  helped 
to  arouse  asylum  sui^erintendonts  and  oflicials  from 
their  conservative  ways.  Keforms  in  care  and  treat- 
ment have  been  introduced. 

Many  of  the  medical  profession  and  of  the  laity 
have  been  taught  better  ideas  regarding  the  needs 
and  treatment  of  the  insane. 

The  association  has  won  the  confidence  of  some 
of  the  best  asylum  sui^erintendents,  nearly  a  dozen 
of  whom  have  joined  its  ranks. 

It  has  printed  and  circulated  numerous  lunacy 
documents,  and  has  assigned  work  to  various  ex- 
perts, who  will  report  at  the  coming  meeting.  The 
secretary  of  the  association,  in  the  same  line  of  work, 
is  commissioned  to  compile  an  abstract  of  all  the 
laws  relating  to  lunacy  in  each  State. 

From  the  foregoing  statements  it  can  be  seen  that 
the  association  has  already  worked  industriously  and 
not  without  results. 

What  has  already  been  done  shows  sincere  and 
intelligent  effort,  and  gives  promise  of  the  highest 
future  usefulness. 

The  coming  meeting  of  the  association  deserves 
attention  and  interest  from  the  profession. 


RECENT   ESPERHIENIS   WITH   CARTILAGE. 

A  SERIES  of  experiments  in  the  transplantation  of 
cartilage  has  been  made  almost  simultaneously  on 
each  side  of  the  Atlantic.  The  experimenters,  Dr. 
Leopold,  of  Leipsic,  and  Dr.  Michael  T.  Prudden,  of 
this  city,  were  seeking  the  solution  of  entirely  diii'er- 
ent  problems,  viz.,  that  of  the  origin  of  tumors,  and 
that  of  the  i^athology  of  inflammation.  The  methods 
adopted,  however,  were  in  many  respects  similar, 
and  may  with  profit  be  describetl  together. 

Dr.  Leopold,  whose  researches  are  published  in 
Virchow's  ArcJu'ves,  August,  1881,  aimed  to  obtain 
some  facts  which  should  substantiate  Cohnheim's 
theory  as  to  the  origin  of  tumors.  All  tumors,  ac- 
cording to  Cohnheim,  are  derived  from  small  resi- 
dues of  embiTonic  tissue  which  remain  undeveloped 
in  the  general  growth  of  the  body.  When,  later  in 
life,  these  small  residues  receive  the  proper  stimulus, 
they  develop  and  constitute  tumors.  It  may  be 
easily  supposed  that  this  theory,  however  seductive 
to  the  imagination,  must  be  very  difficult  of  demon- 
stration. 

No  one  has  ever  seen  these  undeveloped  nests  of 
possible  neoplasms,  and  doubtless  no  one  ever  will. 
At  any  rate,  all  attempts  to  supjjly  any  sohd  data  for 
the  support  of  the  theory  have  been  directed,  not  to 


searching  for  the  hjrpothetical  embryonal  tissue,  bnt 
in  another  way,  that  of  transplanting  living  cells 
from  one  animal  to  another.  The  history  of  these 
attempts,  as  given  in  the  British  Medical  Journal, 
shows  that  two  series  of  experiments  of  this  sort  had 
been  made  previously  to  those  of  Leopold  now  to  be 
described.  Cohnheim  and  Maas  introduced  into  the 
jugular  vein  of  an  animal,  pieces  of  periosteum  from 
the  tibia  of  rabbits,  dogs,  or  fowls.  These  jiassed 
into  the  limgs,  became  vascularized  there,  and  in 
about  two  weeks  develojjed  into  cartilage,  and  then 
into  true  bone.  This  bone,  however,  always  disap- 
peared again  within  a  week  or  two.  The  exjieri- 
ments  had  but  little  significance. 

In  1878,  Zahn  introduced  into  the  jugular  veins  of 
rabbits,  bits  of  hyaline  cartilage  from  adult  animals. 
No  growth  followed.  When,  however,  he  substituted 
pieces  of  embryonic  cartilage,  the  lungs  were  found, 
after  a  time,  to  contain  numerous  small  cartilaginous 
nodules  with  calcified  centres. 

In  imitation  of  Zahn,  Leopold  used  the  embryonic 
cartilage  of  a  rabbit.  Bits  of  this  were  inserted  into 
the  anterior  chamber  of  the  eye,  others  were  placed 
in  the  abdominal  cavity.  Sixty-one  experiments 
were  performed  in  all,  the  majority  of  them  being 
upon  the  eye.  Here,  in  a  certain  proportion  of 
cases,  the  transplanted  cartilage  grew  to  two  or 
three  hundred  times  its  original  size.  In  this  way 
Dr.  Leopold  claims  to  have  produced,  artificially,  a 
true  enohondroma.  He  concludes  that  the  admis- 
sibility of  Cohnheim's  hypothesis  is  now  made  good. 
This  will  by  no  means  be  conceded. 

Dr.  Prudden's  experiments,  as  recorded  in  the 
American  Journal  of  Medical  Scietices,  were  made  with 
the  view  of  throwing  some  light  upon  the  origin  of 
the  pus-cells  in  an  acute  inflammatory  process.  It  is 
still  uncertain  in  any  given  case  whether  the  rapidly 
accumulating  cells  in  an  inflamed  area  are  derived 
chiefly  from  local  proliferation,  or  are  cells  which 
"wander"  in  from  the  blood-vessels  or  elsewhere. 
It  is  apparent  that,  if  a  multiplication  of  cells  were 
observed  in  the  centi-al  parts  of  cartilage,  away  from 
the  blood-vessels,  the  increase  would  have  to  be  as- 
cribed to  local  proliferation.  For  cartilage  is  not 
only  non-vascular,  but  the  minute  channels  in  its 
substance  (if  they  exist)  are  too  small  to  allow  the 
entrance  of  outside  wandering  cells. 

Dr.  Prudden's  exi^eriments  were  very  numerous, 
and  were  carried  out  with  most  intelligent  and 
laborious  exactness.  More  than  two  hundred  bits 
of  hyaline  cartilage  were  inserted  into  the  subcu- 
taneous tissue  of  living  rabbits.  These  were  allowed 
to  remain  for  periods  varying  from  one  to  three 
hundred  and  ninety-nine  days.  They  were  then  re- 
moved, if  not  absorbed ;  their  sections  were  made, 
and  the  microscopic  appearances  were  stiidied.  In 
most  cases  the  cartilage  was  transplanted  while 
living. 

The  fate  of  the  tissue  in  its  new  environment  va- 


46 


THE  MEDICAL  RECORD. 


ried.  At  first  the  pieces  became  sTirroundecl  with 
granulation  tissue.  After  this,  in  some  cases  the 
cartilage  was  aVisorbed,  in  other  instances  it  became 
encapsuled,  in  which  condition  it  would  remain  for 
a  long  period  of  time.  In  only  one  instance  was 
there  a  new  formation  of  hyaline  cartOage.  Here 
the  new  cartilage  was  very  slight  in  amount  and  was 
embryonal  in  character. 

From  a  microscopic  study  of  the  changes  in  the 
cells  and  basement  substance  of  the  living  trans- 
planted cartilage,  the  experimenter  drew  the  follow- 
ing conclusions  :  1st,  that  the  cells  of  cartOage 
transplanted  alive  may  live  on  unchanged  for  many 
"months ;  or,  2d,  that  they  may  lead  to  the  formation 
of  embryonal  cartilage ;  or  3d,  that  they  may,  on  ab- 
sorption of  their  basement  substance,  change  their 
shape  and  size  ;  or  4;th,  that  they  may  undergo  ac- 
tive proliferation  and  take  part  directly  in  the  forma- 
tion of  young  forms  of  connective  tissue,  similar  to 
those  produced  by  cells  from  other  sources. 

It  cannot  be  said  that  these  conclusions  embody 
anything  that  had  not  been  either  known  or  very 
confidently  assumed  before.  Nevertheless  they  are 
valuable,  because  they  stamp  with  so  much  definite- 
ness  our  knowledge  of  the  life-history  of  one  particu- 
lar class  of  cells. 

As  regards  the  origin  of  tumors.  Dr.  Prudden's  in- 
vestigations, though  not  performed  with  embryonal 
cartilage,  negative  to  a  certain  extent  Dr.  Leoiwld's 
experiments.  For  the  second  conclusion  of  the 
former  gentleman  means  in  efiect  that  an  enchon- 
droma  may  be  develoiJed  from  the  mature  cartilage 
as  well  as  embryonal. 

The  disproval  of  Cohnheim's  hyjiothesis,  however, 
is  rather  a  work  of  supererogation.  No  data,  expe- 
rimental or  otherwise,  have  yet  been  secured  which 
furnish  demonstrative  evidence  of  its  tenability. 


THE   RESPONSrBILITS   OP   GUirEAU. 

The  arguments  at  Washington  over  the  question  of 
Guiteau's  responsibility  have  been  anything  but 
satisfactory  to  those  interested  in  medico-legal  sci- 
ence. The  old-fashioned  legal  test  has  been  pre- 
sented by  tlie  proseciition.  The  real  question, 
whether  the  crime  was  caused  by  disease,  has  been 
ignored.  There  has  also  been  much  talk  about 
striking  the  death-blow  to  moral  insanity. 

All  this  shows  that  the  trial  is,  from  a  scientific 
standjioiut,  carrying  us  backward  instead  of  forward. 

The  question  of  responsibility  is  beset  with  difii- 
culties  and  complexities  of  many  kinds.  There  is 
no  doubt  that  a  man  may  bo  a  moral  as  well  as  an 
intellectual  imbecile.  There  are  effective  insanities 
as  surely  as  there  is  a  disease  called  ejiilepsy.  So- 
ciety dare  not,  however,  call  moral  imbeciles,  or 
those  who  are  organically  criminal,  anything  but 
wicked.  Again,  there  are  some  insane  who  can  and 
do  restrain  themselves  from  vicious  conduct,  or  who 
knowingly   and   maliciously   do   wrong.     This  has 


given  rise  to  the  somewhat  novel  view  that  a  person 
may  be  insane  and  yet  punishable. 

In  the  case  of  Guiteau,  the  wrongfulness  and  ille- 
gality of  his  action  was  undoubtedly  intellectually 
understood,  but  it  was  only  feebly  felt.  Guiteau's 
crime  was  the  result  of  a  depraved  ambition  work- 
ing in  a  brain  not  perfectly  sound.  But  it  was 
wickedness  which  was  the  predominant  factor. 
The  brain,  if  not  entirely  healthy,  yet  had  not  dis- 
ease enough  ever  itself  to  have  caused  the  crime. 
It  is  Guiteau's  iirevious  life,  not  his  last  murderous 
act,  that  may  hang  him. 


Hjtports  of  SoctetUsf. 


NEW  YOEK  PATHOLOGICAL  SOCIETY. 

Stated  Meeting,  Decmnber  14,  1881. 
Db.  T.  E.  Satteethwatte,  President,  in  the  CHAnt 
The  President  presented,  in  behalf  of  a  candidate, 
a  specimen  of. purpura. 

REMOVAL     OF     A     CYST    OF    THE     PANCREAS    WEIGHINi; 
TWENTY   AND   ONE-HALF   POUNDS. 

Dr.  N.  Bozeman  presented  a  specimen  accompa- 
nied by  the  following  histoiy :  it  was  interesting 
with  reference  to  three  particulars ;  first,  as  having 
been  removed  from  the  pancreas  of  a  li'i'ing  woman  ; 
second,  as  having  been  mistaken  for  an  ovarian  cyst ; 
and  third,  as  being  the  first  operation  of  the  kind 
upon  record.  The  patient  was  the  wife  of  a  j^romi- 
nent  physician  of  Texas,  forty-one  years  of  age,  tall 
and  robust,  weighing  neai'ly  two  hundred  pounds, 
and  perfectly  healthy  up  to  seven  years  ago,  except 
occasional  attacks  of  dyspepsia.  Seven  years  ago 
she  had-,  for  the  first  time,  jiain  in  the  right  iliac 
region,  extending  down  the  right  thigh  and  occa- 
sionally attended  with  numbness.  Five  years  ago 
the  abdomen  began  to  enlarge,  slowly  at  first,  but 
gradually  increased  in  size  upon  the  left  side,  witli 
a  corresponding  flatness  upon  the  right  side.  The 
point  at  which  the  enlargement  was  first  noticed 
was  higher  than  would  naturally  be  expected  for  an 
ovarian  cyst.  At  that  time  no  special  importance 
was  attached  to  the  enlargement  of  the  abdomen, 
either  by  herself  or  husband,  who  frequently  exam- 
ined the  tumor.  It  progressed  in  the  ordinary  way 
up  to  six  or  seven  months  ago,  when  it  suddenly  be- 
gan to  grow  rapidly,  and  finally  the  entire  abdomen 
was  distended  symmetrically.  At  the  same  time  the 
patient  began  to  lose  flesh.  The  case  was  diagnos- 
ticated as  one  of  ovarian  cyst  by  Professor  Eichard- 
son,  of  New  Orleans,  who  advised  the  jiatient  to 
consult  Dr.  Bozeman.  On  November  19,  1881,  the 
patient  having  entered  the  Woman's  Hospital,  Dr. 
Boeeman  examined  hor  and  diagnosticated  ovarian 
cyst.  She  was  also  examined  by  his  colleagues, 
Drs.  Thomas  and  Emmet,  both  of  whom  confirmed 
his  diagnosis.  An  operation  was  decided  upon,  and 
it  was  performed  on  the  second  day  of  December, 
under  Li.sterism,  Nothing  unusual  presented  itself 
in  the  early  stage  of  the  operation.  When  the  tu- 
mor was  reached  throngh  an  incision  below  the  um- 
bilicus, its  appearance  was  nearly  that  presented  by 
an  ordinary  unilocular  ovarian  cyst,  except,  perhaps, 
it  had  a  little  deeper  pearlish  color.     It  was  tapjied 


THE  MEDICAL  RECORD. 


ami  two  and  one-half  gallons  of  fluid  were  removed. 
After  the  greater  part  of  the  fluid  was  drawn  ofi", 
;\liout  two- thirds  of  the  cyst  was  drawn  through  the 
al . Jomiual  opening,  and  then  for  the  tu-st  time  Dr. 
]'..v/.eman  susi^ected  that  it  was  not  ovarian.  He 
tl  It'll  passed  his  hand  into  the  peritoneal  cavity  and 
found  the  uterus  and  both  ovaries,  and  also  deter- 
tiiiued  that  the  cyst  had  an  origin  somewhere  in  the 
upper  part  of  the  abdomen.  The  abdominal  inci- 
sion was  extended  upward  two  inches  above  the  um- 
bilicus. The  stomach  was  then  found  crowded 
iiLt.iinst  the  diaphragm,  and  the  bowels  were  deep  in 
t  iiu  abdominal  cavity  below  the  cyst.  Tlie  cyst  had  an 
txtensive  attachment,  apparently  to  the  transverse 
mesocolon.  After  some  manipulation  he  finally 
reached  the  pancreas,  where  he  discovered  a  large 
vi'in,  subsequently  determined  to  be  the  splenic, 
which  was  very  tortuous,  and  ofiered  considerable 
obstruction  to  the  operation,  owing  to  its  close  rela- 
tionship to  the  pedicle.  Finally  he  traced  the  cyst 
down  until  he  reached  the  tail  of  the  pancreas,  which 
\ias  turned  up  on  the  side  of  the  cyst,  and  firmly  ad- 
herent to  it  to  the  extent  of  two  inches.  He  then 
]iroceeded  to  separate  the  extremity  of  the  pancreas 
from  the  cyst  by  dissection,  and  when  completely 
>  parated  the  i^ancreas  sjjread  out  and  presented  it's 
natural  appearance.  The  attachment  of  the  cyst 
was  at  the  junction  of  the  oiiter  with  the  inner  two- 
thirds  of  the  organ,  and  it  had  a  pedicle  three-fourths 
of  au  inch  in  length  and  about  three-fourths  of  an 
iuL-h  in  diameter.  The  veins  of  the  pedicle  were 
\  ery  large.  Having  faii'ly  reached  the  i^edicle,  he 
transfixed  it  with  a  needle,  ligated  it  in  the  usual 
•Si  ay,  and  cut  it  off.  The  result  was  that  he  cut  out 
tlio  bottom  of  the  cyst,  as  shown  in  the  specimen. 
'J' he  portion  of  the  cyst,  however,  which  remained 
attached  to  the  pedicle  was  subsequently  completely 
i.' moved  by  di.ssection.  The  artery  which  supi^lied 
the  growth  was  doubtless  a  branch  of  the  splenic, 
and  it  had  attained  a  very  large  size — as  large 
as    the   brachial.      The   loss  of   blood   was    small, 

1  not  a  single  bleeding  vessel  required  a  ligature, 
fluid  which  the  cyst  contained  was  of  a  light 

wnish  color,  its  specific  gravity  was  1020,  and  it 
L.  id  an  acid  reaction,  in  that  resjject  dift'ering  from 
t  1.'  fluid  removed  from  the  ordinary  ovarian  cyst, 
iilii>h  is  alkaline.  The  gh'th  of  the  jjatient  before 
til  II  >.itron  was  forty-one  inches,  and  both  oblique 
111  -  I.  ments,  from  the  anterior  superior  spinous 
■  :e>ses  of    the  ilia  to  the  umbilicus,  were  the 

lie— nine   inches.      The   tumor,   with   the  fluid, 

i.uhed  twenty  and  one-half  ijounds. 

Xlie  specimen  was  also  interesting  in  another  re- 
spect, namely :  with  reference  to  the  point  of  at- 
tacliment,  which  was  almost  precisely  in  the  posi- 
tion occupied  by  the  bullet  in  the  late  case  of  our 
deceased  President.  The  patient  underwent  special 
preparation  for  the  operation.  She  took  salicin,  fif- 
teen grains  three  times  a  day  for  two  weeks.  On 
the  morning  of  the  day  on  which  the  operation  was 
perfoi-med  she  received  fifteen  grains  of  quinine  with 
one  of  opium,  and  when  she  went  upon  the  table 
she  was  thoroughly  cinchonized.  The  patient  ral- 
lied from  the  anassthetic  and  from  the  operation 
without  any  shock  whatever.  After  the  operation 
she  took  by  the  rectum,  at  intervals  of  six  hours,  ten 
grains  of  quinine  with  two  ounces  of  beef-juice,  half 
a  drachm  of  liquor  opii  comp.,  and  two  drachms 
of  brandy.  On  the  third  day  the  temperatiire 
reached  its  highest  point,  101.5  F.,  but  the  jnilse 
never  rose  above  98.  Subsequently  the  pulse  fell  to  j 
80,  and  the  quantity  of  quinine  was  gradually  less-  j 


ened,  but  on  the  eighth  day  after  stopping  the  qTii- 
nine  the  temperature  rose  to  102.8'  F.  The  quinine 
was  again  resumed,  ten  grains  every  six  hours,  and 
the  temperature  in  the  course  of  thuty-six  hours 
fell  to  !t9.5  F.,  and  subsequently  the  patient  had 
progressed  in  the  most  satisfactory  manner,  and 
there  was  every  prospect  of  a  complete  recovery. 

Dk.  AViia.iAM  Hknkt  Poster  presented  specimens 
from  a  case  of 

CATARRHAL   PHTHISIS— PLECRIST    WITH   EFFUSION — EM- 
PHYSEMA— CARNIFICATION   OF   THE   LUKG. 

The  patient  was  first  admitted  to  the  service  of 
Dr.  A.  Hadden,  at  the  Presbyterian  Hospital,  with 
the  following  history :  F.  B — '-,  sixteen  years  of  age, 
bom  in  Ireland,  single,  and  a  bartender,  was  ad- 
mitted December  15, 1877.  Family  history  strongly 
phthisical.  Pievious  histoi-y  free  from  syphilis. 
Present  illness  commenced,  one  month  before"  admis- 
sion to  hospital,  with  a  severe  h»moi)tysis,  which 
was  followed  by  mild  attacks.  The  hemon-hage 
yielded  to  ergot.  On  January  29th  iiatient  devel- 
oped a  pleuro- pneumonia  of  left  side  o'f  a  mild  type, 
which  was  followed  by  slight  efiusion  of  fluid  into 
the  same  pleural  sac.  From  the  pneumonia  he 
readily  recovered,  but  evidence  of  the  fluid  still  le- 
mained.  March  16th  he  felt  so  well  that  he  was,  at 
his  own  request,  discharged. 

The  patient  returned  to  his  business,  which  he  fol- 
lowed imtil  September  8,  1878,  when  he  was  read- 
mitted to  the  hospital  with  all  the  rational  symptoms 
of  phthisis.  Physical  examination  of  the  right  side 
revealed  phthisis,  but  on  the  left  side  gave  evidence 
of  a  chest  full  of  fluid.  The  patient  was  first  placed 
upon  a  tonic  and  diuretic  treatment.  This,  however, 
did  not  diminish  the  quantity  of  fluid  in  the  left 
Ijleural  sac.  September  16,  1878,  the  patient  was 
aspirated,  and  one  hundred  ounces  of  fairly  clear 
fluid  withcUawu  from  the  chest-cavity.  This  gave 
temporary  relief,  but  the  chest  soon  refilled.  Phys- 
ical examination  gave  evidence  of  rajiidly  progress- 
ing phthisis  on  the  right  side,  displacement  of  the 
heart  to  right,  so  that  the  apex-beat  was  nearly  in 
the  median  line.  November  8,  1878,  a  free  incision 
was  made  into  the  left  pleural  sac,  between  the  sixth 
and  seventh  ribs,  and  one  hundi-ed  and  twenty 
ounces  of  stinking  pus  withdrawn.  At  the  time  of 
the  operation  a  flexible  catheter  was  introduced  into 
the  chest-cavity.  From  November  8th  until  the  time 
of  his  death  the  cavity  was  thoroughly  cleansed 
twice  daily  with  disinfecting  fluid.  After  the  free 
opening  into  the  chest  the  patient  improved  for 
several  weeks,  but  finally  sank  graduallv,  and  died 
March  16,  1879. 

Kecrropsy,  thirty-two  and  one-half  hours  after  death. 
— Body  much  emaciated.  Eigor  mortis  marked. 
One  bed-sore  over  the  trochanter  major  on  the  right 
side.  Drainage-tube  projecting  from  left  side.  When 
the  anterior  wall  of  the  chest-cavity  was  removed,  a 
large,  empty  sj^ace  presented,  in  place  of  the  left 
lung  or  fluid.  The  pericardium  and  breast  were  in 
the  median  line.  The  right  lung  filled  the  right 
side  of  the  chest-cavity.  There  was  not  more  than 
four  ounces  of  fluid  in  the  left  pleural  cavity.  The 
whole  chest-wall  was  in  a  sloughing  condition,  and 
in  many  jslaces  all  the  soft  tissues  were  entirely 
destroyed,  lea^aug  only  bare  bone.  The  pericardial 
sac  and  heart  did  not  present  anything  specially  ab- 
normal.    Heart  was  anaemic  (?). 

The  left  lung  was  compressed  to  a  small  mass,  not 
larger  than  a  man's  fist,  ilany  of  the  bronchi  pro- 
truded beyond  the  surface  of  the  compressed  lung. 


48 


THE  MEDICAL  RECORD. 


Although  sealed  at  their  protruding  ends,  they  had 
apparently  been  open  during  life.  This  lung  was  un- 
doubtedly in  a  state  of  complete  carnitication,  both 
air-vesioles  and  blood-vessels  being  obliterated  to  a 
marked  degree.  The  right  lung  was  one  mass  of 
large  and  small  cavities,  surrounded  by  zones  of 
cheesy  masses.  The  spleen  was  waxy,  and  weighed 
seven  and  one-half  ounces.  The  kidneys  were  en- 
larged, and  the  seat  of  the  ordinary  chronic  paren- 
chymatous degeneration  of  phthisis.  The  left  kid- 
ney was  the  seat  of  several  large,  cheesy  masses. 
There  was  no  intestinal  ulceration.  Nearly  all  the 
mesenteric  glands  were  markedly  enlarged.  The 
liver  was  enlarged  and  fatty. 

The  specimens  were  of  interest  because  they 
showed  the  ditference  between  a  oarnified  lung  and 
simple  compression,  in  that  the  bronchi  resist  de- 
structive changes  longer  than  does  the  jjulmonary 
tissue,  and  may  protrude  beyond  the  sru-face  of  the 
lung  and  open  into  an  empty  chest-cavity.  The 
case  was  also  interesting  as  one  showing  that  a  free 
opening  into  a  pleural  cavity  which  contains  pus 
may  relieve  the  suffering  of  the  patient  and  prolong 
life. 

PRIMAKY   SABCOSIA   OP   THE   KIDNET. 

Dr.  Porter  also  presented  a  primary  sarcoma  of  the 

left  kidney,  with  following  history  :    Mrs.   K , 

twenty-live  years  of  age,  about  five  months  prior  to 
death  gave  birth  to  an  apparently  healthy  chdd. 
One  month  later  she  noticed,  for  the  first  time,  a 
tumor  in  the  right  side  of  the  abdomen.  This  pro- 
trusion rapidly  enlarged.  One  week  before  death 
she  came  to  tue  Presoyterian  Hospital  for  surgical 
relief.  As  she  was  not  a  fit  subject  for  operative  in- 
terference, she  was  transferred  to  the  medical  side, 
under  the  care  of  Dr.  McBride,  to  whom  he  was  in- 
debted for  the  specimen.  As  she  seemed  so  near 
death,  no  acciu'ate  history  was  obtained.  Unilateral 
oedema,  however,  was  noticed,  affecting  the  left 
limb.     The  patient  died  a  few  day  after  admission. 

Necropsy  by  Dr.  Simpson,  house  physician,  twenty- 
four  hours  after  death. — Kigor  mortis  marked. 
Body  rather  spare.  There  was  a  decided  protrusion 
of  the  abdomen  in  the  left  lumbar  region. 

Thoracic  cdcity. — The  pericardial  sac  was  normal. 
The  heart  was  unusually  small,  but  was  not  weighed, 
as  the  heart  and  lungs  were  removed  en  masse. 
There  was  a  small,  whitish  spot  in  the  substance  of 
the  left  ventricle,  about  the  size  of  a  hazel-nut.  This 
new-growth,  apparently  of  the  same  character  as  that 
in  the  kidney,  involved  the  whole  thickness  of  the 
ventricular  wall ;  aside  from  this,  the  heart  was  nor- 
mal throughout.  The  apex  of  the  heart,  however, 
was  in  the  median  line,  due  to  the  presence  of  one 
hundred  and  fifty  ounces  of  serous  fiuid  in  the  left 
pleural  cavity.  The  left  lung  was  consequently  com- 
pressed to  a  very  small  mass  and  covered  with  a  fibro- 
plastic exudation,  but  admitted  both  air  and  blood — 
differing  in  that  respect  from  the  truly  carnitied  lung. 
The  diaphragm  was  thickened  by  an  infiltration  of 
the  sarcomatous  growth,  made  up  principally  of  nor- 
mal connective-tissue  corpuscles  embedded  in  a  ho- 
mogeneous matrix. 

Aodoniinal  Carity. — The  points  of  special  interest 
were  in  the  abdominal  cavity,  which  contained  about 
fifty  ounces  of  fluid.  The  left  kidney  was  found 
to  be  the  seat  of  a  new-growth  which  had  con- 
verted it  into  a  tumor  weighing  three  pounds.  The 
capsule  was  very  much  thickened.  The  pelvis  was 
partially  obliterated,  the  remaining  cavity  being 
tilled   with   a   grnmous   matter.      The    ureter  was 


slightly  dilated,  and  its  wall  very  much  hypertro- 
jjhied.  Upon  microscopical  examination  very  little 
renal  tissue  was  met  with,  but  the  mass  of  the 
growth  was  sound  connective-tissue  corpuscles  em- 
bedded in  a  homogeneous  matrix.  The  right  kidney 
also  contained  three  masses  of  new-growth  of  the 
same  nature.  About  one-half  of  the  renal  tissue  re- 
mained. The  retro-peritoneal  glands  were  not  in- 
volved. The  alimentary  tract  was  nearly  normal, 
excepting  the  duodenum  and  stomach.  The  left 
side  of  the  second  portion  of  the  duodenum  was 
firmly  adherent  to  the  left  kidney,  the  growth  impli- 
cating the  coats  of  the  gut  to  such  an  extent  that  the 
mucous  membrane  at  that  point  presented  a  white 
patch  of  the  same  consistency  as  the  tumor  itself. 
The  splenic  flexure  of  the  colon  was  adherent  to 
the  growth  and  displaced  downward,  but  was  not  in- 
filtrated by  the  neoplasm.  The  stomach  was  dis- 
placed, the  greater  curvature  carried  down  and 
forward.  The  stomach  was  enormously  dilated,  evi- 
dently due  to  a  twisting  of  the  duodenum,  which 
partially  occluded  its  lumen.  The  posterior  wall  of 
the  stomach  was  against  the  tumoi  of  the  left  kidney 
and  firmly  bound  to  it,  but  was  not  invaded  by  it. 
The  mucous  membrane  was  soft  and  boggy,  and 
the  seat  of  a  number  of  ulcers  varying  in  size,  the 
largest  being  about  the  size  of  a  one-cent  piece. 
At  seventeen  places  the  mucous  membrane  was  com- 
pletely destroyed.  There  was  no  obstruction  at  the 
pyloric  opening.  The  ovaries  were  slightly  enlarged 
and  the  seat  of  numerous  small  cysts. 

The  case  was  of  interest  on  account  of  the  variety 
of  this  form  of  tumor  in  the  kidney ,  with  regard  to  i 
its  extension  to  the  opposite  kidney  and  through  ; 
the  diaphragm,  while  the  stomach  and  colon  which 
were  equally  as  adherent,  were  not  involved ;  also,  i 
as  bearing  upon  comparative  pathology  and  in  con- 
nection with  a  specimen  of  sarcoma  of  the  kidney 
in  a  cow,  presented  at  one  of  the  meetings  last  win- 
ter, by  Dr.  T.  E.  Satterthwaite. 

Dr.  Porter  also  presented  a  specimen — 

CARCIKOIIA   OF  THE   BLADDER, 

which  he  removed  from  a  horse.  There  were  sec- 
ondaiy  deposits  in  the  rctro-jjeritoneal  glands. 
Gray  gelding,  sixteen  or  eighteen  years  old.  Thin 
in  flesh.  The  animal  had  been  in  poor  health  for 
one  year  previous  to  death.  Duiing  this  time  he 
had  been  subject  to  repeated  attacks  of  colic,  and 
for  that  reason  the  animal  was  tiu-ned  out  to  grass. 

About  three  years  ago  the  horse  had  turns  of  stand- 
ing with  outstretched  legs,  apparently  straining  with 
a  desire  to  micturate.  From  these  symptoms,  how- 
ever, he  apparently  recovered.  Prior  to  October 
14,  1881,  the  horse  had  been  treated  by  a  veterinary 
quack. 

On  October  1-lth,  Dr.  George  H.  Parkinson,  of 
Middletovm,  to  whom  Dr.  Porter  was  indebted  for 
both  the  history  and  the  specimen,  first  saw  the  case, 
and  learned  that  the  previous  treatment  had  con- 
sisted simply  in  the  administration  of  diuretics. 

Symptoms,  October  14th. — Pulse,  40,  and  very  fee- 
ble. Respirations  not  disturbed.  Abdomen  dis- 
tended, the  animal  having  just  drank  a  large  quan- 
tity of  water.  Edematous  swelling  of  the  sheath 
and  of  the  tissues  on  either  side  of  linea  alba  to  the 
posterior  limit  of  the  sternum. 

There  was  a  discharge  from  the  nostrils ;  their 
mucous  membrane  was  of  a  bluish  or  copper  color ; 
appetite  poor.  It  was  noticed  that  the  animal  fre- 
quently attempted  to  micturate,  passing  each  time 
only  a  very  small  quantity  of  bloody  urine,  with  a 


THE  MEDICAL  RECORD. 


49 


tew  small  coagula.  The  passage  of  the  urine  and 
clots  caused  the  animal  great  pain. 

A  rectal  examination  was  made,  but  the  bladder 
could  not  be  found  ;  but  in  place  of  a  partially  dis- 
tended bladder,  commonly  felt  in  rectal  examina- 
tions, there  was  a  large  mass  or  tumor,  situated  to 
the  right  of  the  median  line,  and  anterior  to  the 
symphysis  pubis.  "When  the  mass  was  pressed  the 
horse  groaned  as  if  fi-om  pain,  and  passed  a  small 
quantity  of  bloody  urine  containing  several  small 
clots. 

A  diagnosis  of  malignant  growth,  probably  car- 
cinomatous in  character,  was  made,  and  an  unfavor- 
able prognosis  given. 

No  treatment  was  instituted  except  rest  in  pas- 
ture. 

October  '2.5th. — The  animal  became  so  weak  that 
he  could  not  get  upon  his  feet,  and  was  killed. 

yecropsi/,  a  few  hours  after  death. — The  abdomi- 
nal cavity  was  well  filled  with  fluid,  having  a  strong, 
urinous  odoi'.  Both  the  parietal  and  visceral  layer 
of  the  peritoneum  were  studded  with  tubercle-like 
masses,  varying  in  size,  and  probably  enlarged  re- 
tTo-peritoneal  glands.  The  mesentery  and  omen- 
tum appeared  to  be  a  solid  mass  of  these  new-for- 
mations. 

The  liver  and  spleen  were  both  much  enlarged, 
and  also  had  several  small  masses  upon  their  sur- 
face, resembling  those  in  the  mesentery.  The  liver 
was  pigmented,  and  slightly  cirrhotic  on  microscopic 
examination.  The  stomach  was  full  of  fluid,  and  it 
also  contained  a  little  grass.  The  mucous  mem- 
brane was  of  a  deep  yellow  color,  probably  fi'om 
post-mortem  bile-staining.  The  inguinal  glands 
were  enlarged,  and  where  cut  open  showed  points 
of  fatty  degeneration. 

Microscnjncal  examination  of  this  tumor  of  the  blad- 
der and  the  enlarged  glands. — The  new-growths  were 
made  up  of  dense  masses  of  fibrillated  connective 
tissue,  forming  niimerous  alveolar  spaces,  which 
were  filled  with  lai-ge,  irregularly  shaped,  nucleated 
epithelial  corpuscles.  There  was  no  .special  order 
of  arrangement  of  the  epithelial  elements.  The  sec- 
tions closely  resembled  the  conditions  commonly 
met  with  in  the  scirrhous  carcinoma  of  the  breast. 
The  specimen  is  of  interest  in  connection  with  com- 
parative pathology,  which  is  rapidly  gaining  promi- 
nence in  all  countries. 

PEEHISTOEIC   STTHLLIS — A   TIBIA. 

Db.  F.  N.  Otis  presented  a  tibia  sent  to  him  by 
Dr.  D.  L.  Huntington,  assistant  curator  of  the  Army 
Medical  Museum  at  Washington,  which  had  been 
received   from   'Dr.   Bickley,  who  found  the  bone, 
with  others,  in  one  of  the  ancient  Indian  mounds 
near  Alexanderville,   O.     It  was  supposed  that  it 
possibly  might  possess  some  interest    with   refer- 
to  prehistoric  svphilis,  and  therefore  had  been  sent 
to  Dr.  Otis  for  examination.     Attention  had  been 
called  to  this  Vione  in  an  article  on  prehistoric  syph- 
ilis, by  Dr.  Gustare  Briihl,  in  the   Cincinnati  Lancet 
of  May,   1880.     Tlie  specimen  presented   was   evi- 
dently of  great  antiquity,  and,  in  view  of  instituting 
some  comparison  between  it  and  bones  known  to  be 
affected  with  syphilitic  disease,  Dr.  Otis  had  made   j 
three  sections  of  well-authenticated  syphilitic  bones.   | 
in  order  that  it  might  be  compared  with  these,  and   j 
also  with  iierfectly  normal  bone,  of  which  he  also   j 
presented  specimens.     He  believed  it  was  tolerably   I 
well  settled  at  the  present  time,  among  scientific  in- 
vestigators, that  there  was  nothing  specific  to  be   | 
found  in  syphilitic  bones ;   that  the   inflammatory   i 


processes  were  in  the  line  of  ordinary  pathological 

changes ;  that  periostitis,  ostitis,  caries,  and  necro- 
sis were  pi'ecisely  the  same,  so  far  as  the  constitu- 
ents of  the  diseased  bone  were  concerned,  when 
associated  with  syphilis,  as  when  caused  by  injuries 
or  by  non-specific  disease.  He  believed,  however, 
that  we  might  occasionally  decide,  with  probability 
of  being  correct.  For  instance,  where  the  ossific  de- 
jjosits  or  nodes  were  multiple  and  symmetrical,  as 
when  occurring  on  both  tibite,  and  esjjecially  when 
associated  with  bony  deposits  at  points  protected 
from  ordinary  injury,  as  on  the  inner  tables  of  the 
skull.  Such  coincidences  would  give  strong  sup- 
port to  the  conclusion  that  the  origin  of  the  trouble 
was  syphilitic.  But  when  it  is  considered  that  rheu- 
matism, rachitis,  traumatism,  and  other  causes  of 
periostitis  may,  equally  with  syphilis,  produce  the 
ebumated  variety  of  exostosis,  it  is  readily  seen  how 
difficult  an  absolute  diagnosis  may  become. 

In  the  present  specimen  there  was  no  exostosis — 
simply  a  hypertroijhy,  partly  of  the  cancellous  and 
partly  of  tlie  eburnated  varieties — just  what  is  seen 
in  parenchymatous  ostitis  from  simple  causes.  Dr. 
Otis  could  not  see  in  the  specimen  anything  which 
would  lead  fiim  to  suppose  that  the  diseased  condi- 
tion present  was  of  syphilitic  origin. 

He  believed  that  only  one  form  of  bone  disease 
had  been  recognized  which  was  truly  characteristic 
of  syphilitic  disease,  namely,  that  which  Virchow 
had  called  dry  caries,  and  specially  found  in  syphi- 
litic disease  of  the  bones  of  the  skull.  In  these  cases 
there  is  a  deposit  of  gummy  material,  the  bone  struc- 
ture is  absorbed,  perhaps  both  the  external  and  the 
internal  table,  sometimes  completely.  "Where  the 
external  table  is  destroyed,  the  integument  may  not 
be  involved  at  all,  and  the  disease  often  exists  with- 
out the  consciousness  of  the  patient,  without  pain, 
etc.  He  had  seen  a  case  in  which  the  disease  was 
characterized  simply  by  depressions  found  upon  dif- 
ferent parts  of  the  skull.  That  form  of  bone  disease 
he  had  never  known  to  arise  from  any  other  cause 
than  syi:)hilis. 

Dr.  Peabody  confirmed  the  opinion  given  by  Dr. 
Otis  with  reference  to  the  specimen  presented,  and 
believed  that  its  a23pearance  was  not  ditferent  from 
that  presented  in  bones  which  had  been  the  sub- 
ject of  ordinary  ostitis.  The  thickening  which  it 
exhibited  could  be  easily  explained  by  the  existence 
of  inflammatory  processes  independent  of  specific 
disease. 

Inquii-y  was  made  of  Dr.  Otis  as  to  whether  Vir- 
chow did  or  did  not  consider  the  diy  caries  as  spe- 
cific in  its  nature,  to  which  he  replied  that  Virchow 
made  the  statement  that  he  (Virchow)  believed  this 
afiection  peculiar  to  syphilis,  basing  this  belief,  not 
on  any  specific  element  found  in  this  lesion,  but  on 
the  fact  that  the  chief  characteristic  of  the  di-y 
caries  was  the  entire  absence  of  suppuration.  Dr. 
Otis  does  not  think  the  lesion  in  question  can  be 
correctly  termed  a  caries.  It  is  not  suppuration  or 
death  of  bone.  The  loss  of  bony  substance  which 
occurs  is  plainly  due  to  absorption — i.e.,  fatty  de- 
generation from  pressure — resulting  from  the  pres- 
ence of  gummy  material  deposited,  or  rather  im- 
prisoned in  the  cancellous  structure  of  the  bone  ; 
and  further,  that  gummy  material  does  not  difl'er  in 
its  appearance  or  physical  properties  from  the 
gummy  material  deposited  in  the  soft  tissues.  'N\'hen 
caries  or  death  of  bone  occurs,  more  or  less  sup- 
puration is  ine\"itable.  Analogous  to  this  is  the 
absorption  of  the  gummy  material  with  cicatricial 
depression,  and  without  suppuration,  in  the  tuber- 


50 


THE  MEDICAL  RECORD. 


calar  sypMlide.  Virchow  states  that  the  chief  char- 
acteristic of  the  80-calleJ  dry  caries  of  syphilis  is 
tlie  entire  ttbsenoe  of  the  suppurative  proce^'^s.  In  clos- 
ing, Dr.  Otis  remarked  that  Kindfieisch,  in  his 
"Pathological  Histology,"  states  distinctly  that 
there  is  nothing  texturally  different  in  the  osseous 
inflammations,  caries,  and  necrosis  of  syphilitic 
origin,  fiom  that  resulting  through  non-specific 
causes. 

(To  be  Continued.) 


NEW  YORK  NEUROLOGICAL  SOCIETY. 

Staied  Meeting,  January  3,  1882. 
Dr.  T.  a.  McBbide,  Pbesident,  i.v  the  CnAni. 
The  paper  of  the  evening,  entitled 

THE   EFFICACY  OF  POTASSIUM    IODIDE  IN  NON-.SYPHITjITIC 
ORGANIC   DISEASES   OF   THE   NERVOUS   SYSTEM, 

was  read  by  Dr.  E.  C.  Seguin. 

The  speaker  said  that  he  intended  his  paper 
should  be  clinical  and  suggestive  rather  than  an 
exhaustive  and  didactic  one. 

There  is  apparently  a  belief  in  the  specific  power 
of  potassium  iodide  upon  disease.  Some  teachers 
wei'e  in  the  habit  of  saying :  Give  iodide,  and  we 
will  see  whether  the  disease  is  syphilis  or  not.  A 
good  many  physicians  think  that  because  a  patient 
is  helped  by  potassium  iodide  he  is  therefore  syphi- 
litic, and  has  not  perhaps  given  a  truthful  histoi-y  of 
his  case.  The  speaker  did  not  believe  in  this  speci- 
fic action  of  drugs,  though  it  was  a  veiy  comfortable 
theory  to  hold.  He  thought  that  drugs  acted  upon 
the  organism,  not  upon  the  disease. 

Dr.  Segain  wished  to  make  the  arguments  for  his 
position  as  much  clinical  as  possible.  He  would 
present  nine  cases  illustrating  the  efficacy  of  potas- 
sium iodide,  these  cases  being  divided  for  conveni- 
ence into  three  groups. 

The  first  group  comprised  those  of  organic  disease 
of  the  brain,  in  which  symptoms  were  relieved  by 
the  iodide.  The  patients  finally  died,  however,  and 
post-mortems  were  made. 

The  second  group  comprised  cases  of  which  two 
were  cured  and  one  relieved. 

The  third  group  compri-sed  cases  of  basilar  menin- 
giti.s,  with  optic  neuritis,  in  children.  These  cases 
recovered  rai)idly  under  the  iodide. 

Not  so  much  importance  was  attached  to  this  last 
group. 

First  Group — Case  I. — Tumor  of  crus  cerebri. — 
Patient  was  a  boy  aged  nine ;  had  always  been 
healthy.  In  April,  1874,  had  measles  ;  in  May  tliere 
appeared  awkwardness  in  right  side  of  body.  This 
gradually  increased  till  finally  paresis  of  right  arm 
appeared.  By  August  he  was  worse ;  right  arm 
paralyzed.  Then  sharjj  jjains  in  various  parts  of 
head  began  to  trouble  him  ;  and  with  this  were 
nausea,  vomiting,  and  twitohings  of  par.^ly7.ed  side  ; 
also  double  vision,  and  later  strabismus.  Pulse 
habitually  slow;  no  convulsions  or  loss  of  con- 
sciousness. When  examined  by  Dr.  Seguin,  the 
patient  was  conscious  ;  right  side  hemiplegic  ;  palsy 
of  left  sixth  cranial  nerve  ;  slight  rigidity  of  fingers 
of  riglit  hand  ;  some  ataxia  of  right  upper  extremity ; 
staggering  gait ;  optic  neuritis. 

Ordered  blisters  behind  the  ears,  and  potassium 
iodide.  Ho  then  had  severe  symptoms  again  :  head- 
ache, vomiting,  pains  in  calves  of  leg.s.  Those  were 
relieved  l)y  the  iodide. 

Tlie  patient  was  seen  at  rare  intervals  by  Dr.  J. 
O.  Shaw  until  the  spring  of  1880,  when  he  died. 


Autopsy  showed  pressure  on  the  left  cms  cerebri 
and  left  side  of  the  pons  by  a  sarcomatous  tumor. 

C.ise  II. —  Cerebellar  tumor,  with  liydrocejihalns. — 
The  patient,  a  boy,  had  suflered  several  months  from 
severe  headaches,  staggering  gait,  and  vomiting  ;  ex-- 
ophthalmus.  He  had  no  paralysis  or  imijairment  of 
intelligence,  or  epileptiform  seizures. 

He  improved  under  iodide  of  potassium.  Shortly 
after  there  was  a  great  enlargement  of  the  head, 
with  separation  of  lambdoid  and  sagittal  sutures. 

With  the  appearance  of  this  enlargement  and 
bulging,  improvement  took  jjlace ;  the  exophthal- 
mus  disajjpeared.  An  examination  of  the  child  was 
made  at  this  time.  The  face  was  pale ;  vision  ap- 
parently good,  but  choked  disc  was  present.  All 
the  cranial  sutures  wide  open.  No  exophthalnius. 
In  the  right  occipital  region,  in  the  vicinity  of  the 
lambdoid  suture,  was  a  soft  tumor,  whicli  pulsated 
simultaneously  with  the  heart.  Feeble  gait,  but  no 
paralysis.  Ordered  iodide  of  potas.sium.  This  was 
given  in  very  large  doses  (90  to  150  grains  per  day), 
with  relief  of  headache  and  many  of  the  symptoms. 
The  patient  died  the  next  spring.  Autopsy  revealed 
cerebellar  tumor  of  fibro-sarcomatous  character. 
This  pressed  on  the  ven;e  Galeni,  causing  hydro- 
cephalus. The  case  was  under  the  care  of  Dr.  Mal- 
com  McLean,  of  Harlem. 

Case  III. — Tumor  of  cerebellum. — The  patient,  a 
boy  of  fourteeri,  had  been  healthy.  In  June,  1876, 
he  fell  heavily  on  a  stone  walk.  Four  months  later, 
began  to  have  attacks  of  vomiting,  without  nausea. 
At  length,  after  vomiting  he  went  into  general  convul- 
sions. These  symptoms  continued.  He  gradually  be- 
came paralyzed  in  all  his  limbs,  though  more  on  the 
left  side.  There  was  atrophy  of  optic  nerves  and  loss  of 
vision.  Spontaneous  improvement  now  occurred. 
He  regained  use  of  limbs,  and  except  for  his  eyes, 
was  almost  well.  Mind  bright.  No  further  symptoms 
for  four  years.  In  May,  1880,  he  began  to  have  at- 
tacks of  pain  in  the  occipital  region,  and  vomiting. 
One  day  he  was  found  unconscious.  He  was  occa^ 
sionally  dizzy.     Still  able  to  be  up  and  dressed. 

Examination  at  this  time  showed  left  conjugate 
deviation  of  the  eyes  ;  tongue  straight ;  left  leg  and 
hand  stronger  than  right ;  no  patella  reflex  ;  no  dis- 
tinct ataxia,  and  the  gait  was  not  that  of  the  type 
called  cerebellar  ataxia.  Ordered  bromide  and 
iodide  of  potassium.  One  month  later  he  had  im- 
proved wonderfully.  He  then  grew  somewhat  worse 
again.  The  iodide  was  increased  and  bromide 
omitted,  with  the  best  results.  He  afterward  grew 
worse  again. 

On  October  12th  he  was  seized  with  vomiting  and 
convulsions.  Death  soon  followed.  Autopsy  re- 
vealed a  tumor  involving  a  large  part  of  the  anterior 
portion  of  the  right  hemisphere  of  the  cerebellum, 
which  was  the  same  side  as  the  paresis.  It  forcibly 
compressed  the  underlying  portions  of  the  mesen- 
cephalon. Almost  the  whole  of  the  right  hemisphere 
of  the  cerebellum  was  disorganized.  An  acute  men- 
ingitis of  the  convexity  had  been  the  immediate 
cause  of  death.  The  tumor  was  a  sarcoma,  contain- 
ing masses  of  amyloid  degeneration,  some  having  a 
branch-shaped  appearance,  and  beingprobably  amy- 
loid blood -ves.sels.  The  bo+'s  family  was  an  unu- 
sually healthy  one.     The  teeth  were  normal. 

Second  Ciropp  —  Case  I.  —  Left  hemipar(FSlJiesia 
cured  bii  pntasxium  iodide. — The  patient,  a  surgeon 
in  the  United  States  Army,  had  always  enjoyed  good 
health.  In  1874  he  had  a  sudden  attack  of  hemi- 
numbness,  which  lasted  for  a  long  time.  It  was  felt 
in  ulnar  side  of  left  hand,  outer  side  of  left  leg,  and 


THE   MEDICAL  RECORD. 


51 


occasionally  iu  left  cheek.  No  true  anasthesia, 
ataxia,  or  chorea.  The  heart  was  large  and  beat 
heavily,  but  had  no  organic  lesion.  Patient  liad 
several  angina-like  attacks.  There  was  well-marked 
dementia.  Patient's  habits  have  alw.iys  been  good ; 
positively  and  repeatedly  denied  syphilis. 

Ordered  iodide  of  potassium.  The  parnesthesia 
disappeared  in  a  few  weeks.  Subsequently  patient 
developed  dementia  paralytica. 

Case  II. — Par<il>/sis  of  third  cranial  nerves — Pare- 
sis and  ataxia  of  limbs. — The  patient,  a  man  aged 
twenty-nine,  had  always  been  healthy,  except  that 
of  late  he  had  suffered  from  excessive  use  of  beer 
and  tobacco,  and  had  had  a  catarrh  of  the  bladder. 
July  2,  1878,  while  camping  in  the  woods,  he  awoke 
with  ii  paralysis  of  the  left  third  cranial  nerve. 
July  30th  he  felt  a  sensation  of  numbness,  and 
weakness  in  the  legs.  Was  ordered  ei-got,  diy  cujis, 
rest  in  bed.  About  Aiigust  1st  the  right  third 
cranial  nerve  became  paretic.  All  the  symptoms 
indicated  involvement  of  crura  cerebri.  Ordered 
iodide  of  potassium  in  large  doses.  Within  a  month 
patient  is  much  imi^roved,  both  the  thii-d  nerves 
are  better. 

Takes  I  j.  pot.  iodid.,  t.  i.  d.  September  2d, 
right  eye  normal ;  left,  nearly  well.  Iodide  con- 
tinued. December  llth,  no  change.  In  spring  and 
summer  of  1879  the  condition  of  left  third  nerve 
varied,  and  the  amount  of  iodide  given  was  varied 
accordingly. 

November,  1879.  —  New  .symptoms  developed. 
Slight  numbness  and  anaesthesia  in  left  trigeminus  ; 
legs  are  weak ;  there  is  slight  numbness  also  in 
thighs  ;  left  facial  muscles  appear  weak ;  tongue 
projects  straight. 

Ordered  increase  of  iodide. 

October,  1880. — The  patient  had  been  almost  cured 
except  for  his  weak  left  thiid  nei-ve.  He  resumed 
the  use  of  beer  and  tobacco,  however,  and,  as  a  re- 
snlt,  a  number  of  symptoms  came  on  :  an  ataxic 
walk,  absence  of  patellar  reflex  ;  marked  ansesthesia 
and  ataxia  of  hands  ;  left  third  nerve  stiU  paretic. 
No  headache  at  any  time.  Treatment  was  continued, 
but  there  was  no  improvement.  In  the  first  part  of 
the  disease,  however,  the  iodide  relieved  the  symp- 
toms in  a  most  notable  manner. 

Case  III. — Rif/ht  hemi-epilepsi/  with  aphasia  cured 
hy  potassium  iodide. — The  patient,  a  young  man, 
when  first  seen  was  suffering  from  repeated  epileji- 
tiform  attacks.  He  was  a  well-developed  person, 
who  had  always  been  well ;  never  had  had  svjjhilis. 
In  August  last  he  had  an  attack  of  what  he  called 
sunstroke,  but  it  was  probably  his  first  epileptiform 
seizure.  He  got  a  little  better,  then  the  attacks  re- 
curred. They  were  stronger  on  the  right  side. 
Patient  was  put  on  potassium  bromide.  He  con- 
tinued to  have  attacks.  Had  innumerable  slight 
attacks  eveiy  day,  affecting  right  side  of  face  and 
arm,  not  always  with  loss  of  consciousness.  Some- 
times there  were  facial  spasms  alone.  Grs.  125  to 
150  of  potas.  brom.  given  daily  by  former  physician. 

October  2d. — Pi^tient  is  better  ;  no  spasms  for 
forty-eight  hours.  Is  completely  aphasic.  Ordered 
potassium  iodide  along  with  the  bromide.  This 
mixture  was  continued,  the  bromide  being  gradually 
decreased,  and  iodide  increased  until  finally  only  tbe 
former  was  given.  Improvement  was  steady,  and 
finally  complete  recoveiT  was  established. 

Third  Group — Case  I. — Da.'iilar  menin/jilis. — Pa- 
tient was  a  girl,  aged  six  years.  One  brother  had 
phthisis  ;  another  child  of  same  parents  died  of 
brain  fever.     For  three  weeks  the  patient  had  been 


suffering  from  headache  and  vomiting.  When  seen 
there  was  marked  internal  straliismus,  also  optic 
neuritis.  Tlie  history  of  the  patient,  with  other 
symptoms,  led  to  the  conclusion  that  there  wan  an 
incipient  basilar  meningitis,  probably  non  tuliercu- 
lar.  Ordered  potassiiim  iodide  and  blisters  at  the 
back  of  the  neck.  Improvement  at  once  began  and 
resulted  in  recovery. 

('.ASE  II. — I}(isilar  meningitis. — The  patient  was  a 
girl,  aged  foTirteen  years,  previously  healthy.  The 
first  symptoms  appeared  four  weeks  before  exami- 
nation, and  consisted  of  dulness,  irritability,  .slight 
headache,  once  vomiting,  internal  strabismus  of  one 
eye.  Examination  showed  double  neuro-retinitis. 
Diagnosis,  non-tubercular  basilar  meningitis.  Un- 
der iodide  of  potassium  there  was  rajjid  improve- 
ment, and.  so  far  as  kno'nii,  recovery. 

Case  III. — Uasilar  meninf/itis. — Patient  was  a 
girl,  aged  five  years.  Had  chicken-pox  in  January. 
Janiiary  19th  left  internal  strabismus  appeared. 
Other  symptoms  followed.  Examination  of  eyes 
showed  double  neuro-retinitis.  The  samediagno.sis 
was  made  and  treatment  ordered  as  in  previous  case, 
with  equally  good  results. 

In  commenting  on  the  preceding  cases  Dr.  Seguin 
said  that  they  were  only  a  few  of  a  large  number  in 
which  he  had  seen  the  same  results  follow  the  i:se 
of  the  iodide.  He  was  aware  of  the  possibility  of 
deception  as  regards  their  having  been  syphilis. 
Still  he  had  taken  every  precaution  to  a!=sure  him- 
self upon  this  point  in  the  cases  cited  as  well  as  in 
others.  The  speaker  also  referred  to  the  large  doses 
of  the  drug  which  could  be  given  with  opi^arent  im- 
punity— from  30  to  150  grains  three  times  a  day. 

Db.  Wji.  a.  Hammond,  in  opening  the  discus- 
sion, said  that  for  several  years  he  had  adopted  the 
plan  described  by  Dr.  Seguin,  and  his  experience 
amply  sustained  that  gentleman's.  He  related 
some  recent  cases  illustrating  this.  One  was  that 
of  a  patient  who  had  been  treated  for  syphilis.  He 
was  doubly  hemi-paretic  ;  all  his  extremities  were 
very  weak.  He  could  not  walk.  He  had  double 
vision,  intense  pains  in  the  head,  and  difliculties  of 
speech — aphasia.  He  was  put  on  iodide  of  potas- 
sium with  the  best  restilts,  becoming  entirely  well  ex- 
cept for  the  double  vision.  He  had  always  strenu- 
ously denied  having  syphilis,  and  there  were  no 
evidences  of  it. 

In  another  case,  seen  three  years  ago,  the  patient 
when  first  observed  was  suffering  from  intense  pains 
in  his  head,  and  was  deaf  and  completely  blind.  There 
was  no  history  of  syphilis.  Iodide  of  potassinm 
was  recommended,  but  no  benefit  followed  until  the 
patient  had  reached  a  dose  of  240  drops  of  the  satu- 
rated solution.  The  pains  then  disappeared,  and 
hearing  and  eyesight  returned.  The  patient  became 
entirely  well. 

In  some  cases  the  speaker  had  given  as  much  as 
350  drops  of  the  saturated  solution  at  a  dose  with- 
out any  inconvenience  to  the  patient.  He  attributed 
this  to  the  fact  that  he  made  his  patients  take  a 
great  deal  of  water  at  the  same  time ;  sometimes 
even  a  pint.     In  this  way  iodism  was  prevented. 

Dr.  E.W.  Amidon  related  a  case  which  illustrated 
the  efficacy  of  iodide  of  potassium. 

As  regards  the  manner  in  which  the  iodide  acted 
i»  such  cases  as  has  been  cited,  the  sjieaker  thought 
that  it  affected,  not  the  neojjlasm,  but  the  circula- 
tion around  it.  This  is  veiy  much  impeded  in  these 
cases.  We  know  that  the  potassium  salts  are  cardiac 
sedatives,  and  tend  to  dimisnish  arterial  tension.  If 
we  weaken  the  heart,  which  is  acting  a  little  more 


52 


THE  MEDICAL  RECORD. 


strongly  than  nsual,  it  will  give  the  veins  a  chance 
to  empty  themselves  and  relieve  the  distended  capil- 
laries. This  seemed  to  be  the  most  reasonable  way 
of  explaining  the  action  of  the  potassium  salts.  The 
speaker  doubted  whether  the  iodine  had  much  to  do 
with  this  action.  On  this  jjoint  more  definite  knowl- 
edge was  needed. 

Dh.  Weber  said  that  his  experience  with  the 
iodide  of  potassium  had  been  large.  He  had  seen 
no  curative  effects  from  it  except  in  syphilis,  certain 
forms  of  articular  rheumatism,  and  bronchial  dis- 
eases. So  far  as  non-specific  di.seases  of  the  brain 
or  spinal  cord  are  concerned,  he  thought  last  year 
that  he  had  met  with  a  case  which  the  iodide  cured. 
But  he  found  afterward  that  the  patient  had  proba- 
bly had  syjjhilis.  The  patient,  a  man  fifty-two  years 
of  age,  had  all  the  symjitoms  of  general  pai-alysis, 
and  was  to  be  transferred  to  the  Bloomingdale  Asy- 
lum. Dr.  Weber  was  called  in,  however,  and  though 
convinced  of  the  diagnosis,  thought  he  would  first 
try  the  iodide  upon  him.  It  was  given  in  drachm 
doses,  and,  to  the  sj^eaker's  astonishment,  there  was 
great  amelioration  of  tlie  symptoms.  He  found  af- 
terward that  the  wife  had  syphilis. 

Regarding  the  modias  operandi  of  the  remedy,  the 
speaker  expressed  his  belief  that  its  diuretic  powers 
had  a  great  deal  to  do  with  its  efficacy.  In  certain 
forms  of  dropsy,  nothing  will  produce  relief  so  rajs- 
idly  as  the  iodide,  which  in  these  cases  markedly  in- 
creases the  amount  of  urine  passed. 

With  regard  to  the  dose,  there  were  some  persons 
who  had  iodiosyncrasies  against  it,  and  in  these  a 
dose  of  two  or  three  grains  could  not  be  borne. 
When  it  is  borne,  it  is  quickly  eliminated  by  the 
kidneys,  and  it  probably  thus  relieved  the  tedema 
around  tumors. 

The  sjieaker  thought  it  not  easy  to  tell  always 
whether  there  had  been  syphilis  or  not.  Even  the 
most  honest  persons  may  deceive  themselves  and 
their  physician. 

Dr.  Wilmam  .T.  IMorton  wished  to  corioborate 
most  emphatically  Dr.  Seguin  and  Dr.  Hammond  in 
regard  to  the  use  of  the  iodide  of  potassium  in  such 
conditions  as  had  been  described.  He  had  never 
found  any  trouble  giving  very  large  doses. 

Dr.  Seouin,  in  closing  the  discussion,  said  that  ke 
was  entirely  aware  of  the  possibility  of  being  de- 
ceived regarding  the  previous  history  of  a  patient. 
He  had,  however,  every  reason  to  believe  that  there 
was  no  mistake  in  the  histories  of  the  cases  he  had 
cited,  nor  in  others  in  which  he  had  successfully 
used  the  iodide.  He  agreed  with  Dr.  Weber  that 
the  diuretic  action  of  the  drug  migkt  be  connected 
with  its  therai)eutical  efficacy. 


EtErnANTlASIS   OP  THE  CljITOltlS — CuTORtDECTOMY. 

— ^Verrier  operated  upon  a  woman,  twenty-eight 
years  of  age,  whose  trouble  was  of  three  years'  stand- 
ing. At  first  the  tumor  presented  a  slight  degree  of 
erection  with  a  sonsaHtm  of  voluptuousness.  It  was 
voluminous,  traversed  by  two  or  three  sulci  of  ro>sy 
color,  and  occujjied  almost  the  whole  of  the  vulvar 
orifice,  into  which  it  was  impossible  to  introduce  the 
finger  without  previous  separation  of  the  labia.  The 
jiedicle  was  continuous  with  the  clitoris.  Tlie  dor- 
fn\  aspect  i>reaented  ([uite  an  elevation.  The  ex- 
<-ised  tumor,  without  its  sanguineous  contents,  meas- 
ured six  centimetres  in  longtli,  tliree  in  broadtli,  and 
nine  in  circumference  ;  its  weiglit  was  ten  grammes. 
— Atui.  dc  dipux. 


RESPECTING  NEGLECTED  PESSARIES. 

To  THE  Editor  of  Thf,  Medical  Record. 

Sm  :  One  who  sees  much  of  gynecological  practici> 
will  be  inclined  to  question  the  fitness  of  the  firi-t 
word  in  your  closing  sentence  of  the  report  of  Dr. 
Wendt's  case  of  chronic  perimetritis  (ride  pp.  7Ls 
and  719  of  Medical  Eecokd  for  December  24th  i. 
There  is  nothing  in  the  history  of  the  case  as  pub- 
lished to  show  tliat  there  had  "probably"  been  neg- 
ligence on  the  part  of  the  physician  who  placed 
the  pessary  in  si/n.  Those  who  are  accustomed  to 
use  special  care  in  impressing  upon  their  patients 
the  importance  of  occasional  examinations  of  those 
who  wear  a  pessary  know  how  often  such  advice  is 
disregarded.  I  once  removed  a  pessary  which  Dr. 
Graily  Hewitt  had  inserted  nearly  fifteen  years  be- 
fore, and  which  had  caused  ulceration  of  the  vaginal 
tissues  and  derangement  of  the  other  pelvic  organs. 
But  I  have  no  reason  to  believe  that  Dr.  Hewitt  is 
responsible  for  such  results.  I  should  doiibt  the 
statement  of  any  patient  who  might  tell  me  that  her 
physician  had  given  her  no  caution  respecting  pos- 
sible danger,  unless  I  luiew  enough  of  the  character 
of  the  man  to  waiTant  such  a  belief.  Patients  an- 
proverbially  careless  and  forgetful,  and  doctors  aiv 
not  aJl  ignorant  and  heedless,  and  in  a  matter  liki' 
this,  in  which  there  is  a  question  of  resi?onsibility. 
I  believe  that  the  latter  should  be  entitled  to  tlic 
benefit  of  the  doubt. 

Very  truly  yours, 

F.  A.  Castle. 

New  York,  Dccembei  29,  1881. 


ANTAGONISM  OF  OPIUIM  AND  VERATRUM 
VIRIDE. 

Tu  THE  Editor  op  the  Medical  Record. 

Sib  :  In  the  most  excellent  and  valuable  paper,  by 
Dr.  F.  A.  Castle,  entitled,  "  Adjuvants,  Comgents, 
etc.,"  published  in  the  Record  of  December  10th,  I 
notice  the  following  statement :  "  Opium  and  veratria 
appear  to  have  a  degree  of  antagonism  when  used  in 
toxic  doses,  but  I  am  aware  of  no  published  obser- 
vations upon  their  effects  when  used  therapeutically." 
Dr.  Castle  will  find  in  Wood's  "Materia  Medica  and 
Therapeutics"  this  statement :  "  In  administering  ve- 
ratrum  viride  it  should  be  always  borne  in  mind  that 
it  will  do  no  good  in  acute  disease  unless  given  in 
increasing  doses  until  its  physiological  eft'ect  is  pro- 
duced. In  almost  all  cases  vomiting  is  to  be  avoided. 
To  do  this,  small  quantities  of  the  drug  should  be 
given  at  short  intervals,  and  corresponding  doses  of 
laudanum  (5  to  10  gtts.)  should  be  exhibited  fifteen 
minutes  after  each  dose.  An  hour  is  the  best  inter- 
val between  the  doses."  Gross  (see  "  System  of  Sur- 
gery," vol.  i.,  page  93)  and  Tilt  (see  "  Uterine  Thera- 
peutics") both  advise  that  these  drugs  be  given  in 
combination.  I  use  veratrum  more  frequently  than 
any  of  the  antipyretic  agents,  esjiecially  in  tran- 
matic  fever,  and  invariably  combine  a  small  dose  of 
sulph.  morphia  with  it,  say  ^  grain  to  a  dose — thus 
perfectly  preventing  the  vomiting  and  diarrhoea, 
and  the  i>nlse  and  temperature  is  reduced  without 
the  severity  of  the  constitutional  symptoms  usually 


THE   MEDICAL  RECORD. 


53 


present  when  the  drug  is  pushed  to  its  full  physiolo- 
gical effect.  I  have  had  this  fact  beautifully  exem- 
plified this  week  in  three  instances  :  one,  a  woman, 
aged  iifty-five,  from  whose  scalp  I  removed  a  large 
cancerous  tumor ;  a  second,  a  negro,  with  three  dan- 
gerous stabs  in  the  back;  and  the  third,  a  mau 
whose  legs  I  amputated  for  gangi-ene,  due  to  fiost- 
bite.  In  each  of  the  cases  this  combination  con- 
trolled the  fever  admirably.  I  think  that  veratrum 
is  safer  than  aconite,  and  even  than  gelsemium 
sempervirens.  I  am  investigating  this  subject  to 
the  best  of  my  humble  ability,  and  hope  to  say  more 
anon. 

Respectfully, 

Thojias  r.  HocsTON,  M.D. 

CLjVrkesvillk,  Ga.,  Peccmber  14,  ]SS1. 


DENTAL  SURGEONS  IN  THE  AR^MY  AN^D 
NAVY. 

To  THE  Editor  of  the  Mrdical  Record. 

Sot:  Kefen-ing  to  your  editorial  on  "Dental  Sur- 
geons in  the  Army  and  Xavy,"  you  say  truly,  "there  are 
a  number  of  jiractical  difficulties  in  the  way  of  creat- 
ing and  furnishing  these  services."  Our  shii:)s  are 
ah-eady  overcrowded  with  officials,  and  a  dentist 
would  be  too  expensive  a  luxuiy  to  be  sup})lied  to 
every  vessel  in  commission,  though  one  might  be 
attached,  with  advantage,  to  each  flagship  and  shore- 
station. 

Practically,  however,  the  work  of  the  dentist  could 
be  done  by  the  ajiothecary  of  every  vessel,  hosjiital, 
and  station,  if  this  important  official  i^ossessed  a 
snfficient  knowledge  of  dentistry  for  the  purpose.  A 
graduate  of  jjliarmacy,  qiialifying  himself  for  the  po- 
sition of  a  naval  ajjothecary,  would  willingly  take 
one  or  more  courses  in  dentistry,  if  by  so  doing  he 
could  obtain  the  rank  and  pay  of  a  midshipman  or 
ensign.  The  dentist  employed  at  the  Naval  Academy 
had  no  rank  by  law,  and  there  is  no  such  rank  or 
grade  as  assistant  surgeon.  This  is  a  tUk !  The 
rank  or  grade  of  an  assistant  surgeon  in  the  navy  is 
that  of  master  or  ensign.  This  I'ank,  however,  is 
merely  relative  and  has  no  actual  value,  as  a  staff- 
officer  of  the  navy  must  not  be  addressed  by  his  mil- 
itary rank,  nor  can  he  use  it  in  his  official  signature. 

Navicula. 


FLOEIDA  AS  A  HEALTH  EESOET. 

To  THE    EDITOn    OF  THE   MEDICAL  RECORD. 

SrR:  While  perusing  Dr.  Agnew's  letter  upon  "Flo- 
rida as  a  Health  Resort,"  I  recall  a  fact  which  was 
strongly  impressed  upon  my  mind  two  years  ago, 
while  spending  the  winter  in  Florida,  that  is,  that 
I    nearly  all  Northern  invalids  vi.siting  Florida  remain 
i    somewhere  along  the  St.  John's  River.      It  is  true 
I    that  the  St.  John's  is  a  charming  river,  with  its  pla- 
I    cid  surface  and  wild  borders.     The  orange  groves 
i    are  elegant  and  the  air  refreshing.     Any  weary  mor- 
I    tal  must  enjoy  the  freedom  of  this  great  river.     The 
I    weird  sceneiy  of  fits  tributary)  the    Ocklawaha  is 
I    the   most   enchanting   I   ever  witnessed.     But  the 
I    Doctor  truly  says  of  the  St.  John's  that  its  banks  are 
I    seldom   twenty   feet   above   tide.     Swamps   are  on 
evei-y   hand.     Now  swamp  and  heat  may  produce 
I    malaria,    and  such  is  the    fact   in   Florida.     I   en- 
I    countered  such  malaria  on  the  east  as  well  as  the 


Gulf  coast.  Both  coasts  are,  to  a  large  extent, 
water-logged  swamps,  steaming  wi.sh  fogs  and 
dripping  with  dews.  As  far  as  possible,  such  con- 
ditions should  be  avoided  by  most  invalids.  But 
can  they  be  avoided  in  Florida?  To  a  large  extent, 
yes.  Florida  is  not  all  so  flat  and  so  near  the  level 
of  the  sea.  Half-way  from  Jacksonville  on  the  east, 
to  Cedar  Key  on  the  west,  is  the  backbone  of  the 
peninsulai"portion  of  the  State,  about  two  hundred 
and  fifty  feet  above  the  ocean.  Here  we  find  the 
land  quite  rolling,  the  streams  in  more  active  mo- 
tion, the  drainage  better,  the  water  purer,  and  the 
air  drier.  Here  inland,  and  on  comi^aratively  high 
and  dry  land,  away  from  coast  winds,  with  many  ad- 
vantages and  few  disadvantages,  I  would  advise  the 
invalid  %dsitor  to  Florida  to  go.  The  most  accessi- 
lile  town  on  this  high  ground  is  Gainesville,  Alachua 
County.  It  can  be  reached  by  rail  from  Fernan- 
dina,  Jacksonville,  Pilatka,  or  Cedar  Key.  While 
no  one  must  expect  full  city  life,  he  will  find  gentle- 
manly citizens,  excellent  hotels,  good  doctors, 
churches,  livery  stables,  guides,  etc.  To  those  who 
enjoy  the  rod  or  gun,  Gainesville  will  be  a  delight 
six  days  in  every  week. 

Respectfullv, 

W.'B.  Bradner,  M.D. 

Warwick.  Orasge  Co.,  K",  T.,  January  9,  lSt3. 


THE    QLTSTION    OF    EEFLEX   DISTUEB- 
ANCES  FEOM  GENITAL  lEEITATION. 

To  THE  Editor  of  The  Medical  Record. 

Dear  Sir  :  In  The  Medicai  Record  for  November 
19,  1881,  there  appears  a  report  upon  a  paper  read 
by  Dr.  L.  O.  Gray,  of  Brooklyn,  before  the  New  York 
Neurological  Society,  upon  the  subject,  "  The  Ques- 
tion of  Reflex  Disturbances  from  Genital  Irritation." 
The  report  is  quite  extensive,  the  discussion  follow- 
ing the  reading  of  the  essay  was  very  interesting,  and 
you  have  thought  the  matter  of  sufficient  imi:)ortance 
for  editorial  comment. 

When  I  read  the  report  and  discussion — which  I  did 
with  much  pleasure — I  thought  the  omission  of  any 
reference  to  my  own,  and,  I  think,  original  obsei-va- 
tions  on  this  subject,  was  due  to  the  necessarily  im- 
perfect character  of  a  report  of  this  nature  But  as 
Dr.  Gray's  paper  has  just  been  published  in  the 
January  (1882)  number  of  the  Annals  of  Anatomy 
and  Surgery,  with  only  a  passing  allusion  to  one  of 
my  ojiinions,  and  without  any  reference  to  my  pa- 
pers, I  feel  that  I  may  tresjiass  on  your  time  and 
space  and  venture  to  call  the  attention  of  your 
readers  to  the  fact  that  the  most  imjiortant  conclu- 
sions reached  by  Dr.  Gray,  and  that  many  of  the 
jioints  referred  to  by  him  and  discussed  subse- 
quently by  the  eminent  gentlemen  present,  have 
been  covered  by  me  in  an  editorial  on  "Indiscrimi- 
nate Circumcision  "  in  the  May  (1881)  number  of 
the  Annah  of  Anatomy  and  Surr/ery,  and  subse- 
quently in  remarks  on  the  subject  of  "Genital  Ir- 
ritation" in  the  July  (1881)  number  of  the  same 
journal.  And  further,  that  my  expressed  doubts 
regarding  the  existence  of  reflex  paralysis  from 
genital  irritation  in  childhood,  supplemented  by  the 
same  opinion  from  my  friend  Dr.  E.  C.  Seguin,  has 
been  confirmed  by  the  very  eminent  authorities  ^\•ith 
whom  Dr.  Gray  has  been  in  correspondence. 
Very  truly  yours, 

Newton  M.  Shaffer. 


54 


THE   MEDICAL  RECORD. 


THE    PHENOMENON    OF    PARTIAL    MOR- 
PHIA-NARCOSIS. 

To  TUE  Editor  ok  The  Mj-.dical  Record. 

De.\k  Sm;  In  your  valuable  journal  of  December 
31st,  I  flnd  a  short  article  by  Dr.  Henry  E.  Jones,  of 
Portland,  Oregon,  entitled  "  A  Phenomenon  of  Par- 
tial Morphia-Narcosis."  This  is  "a  sensation- of 
numbness  of  foot  or  hand,  sometimes  of  one  arm, 
and  occasionally  of  one  side  of  the  body." 

I  take  the  liberty  of  addressing  you  upon  this 
subject,  from  the  fact  that  Dr  Jones  has  failed  to 
find  any  written  reference  to  this  not  uncommon 
symptom.  In  my  work  "  Drugs  that  Enslave,"  etc., 
I  state  at  p.  H :  "  Sensation  is  variously  altered. 
Sometimes  there  is  a  condition  of  hypersesthesia, 
the  lea.st  touch  being  intensely  painful ;  the  clothing 
causing  decided  irritation,  occasionally  a  whole  limb 
or  part  of  a  limb,  or  portions  of  the  trunk  or  face 
will  feel  'icumb  or  dead.'  Sometimes  there  are  a 
series  of  pricking  or  tickling  sensations  that  are 
7ery  aggravating,  as  they  and  the  numbness  are 
bften  looked  upon  by  patients  as  precursors  of  pa-_ 
'ralysis,"  etc.  This  fear  of  paralysis  by  some  patients, 
and  simulation  of  it  by  others,  is  that  to  wliich  the 
doctor  calls  especial  attention.  In  this  place,  I  re- 
ferred only  to  habitual  users  of  morphia,  but  the 
^ame  symptoms  have  been  frequently  noted  in  those 
with  whom  the  drug  is  only  occasionally  used.  They 
occur  in  most  marked  intensity  in  those  instances 
where  a  vein  has  been  punctured  and  the  drug  has 
entered  suddenly  into  the  circulation.  In  these 
cases,  however,  other  symptoms,  as  dyspmta,  ring- 
ing in  the  ears,  urticaria,  palpitation,  syncojje,  and 
the  like,  are  usually  present.  For  a  fuU  considera- 
tion of  these  phenomena,  I  would  refer  the  doctor 
to  my  book,  just  mentioned,  the  subject  matter 
spoken  of  being  taken  bodily  from  my  first  work, 
"  Morphia  Hvpodermically  ;  "  a  large  number  of  ty- 
pical cases  are  there  mentioned. 

Unusual  rapidity  of  absorption  or  individual  idio- 
ayncrasy,  or  both,  would  undoubtedly  lead  to  the 
sama  symptoms,  less,  however,  in  degree  of  inten- 
sity, when  the  drug  was  taken  by  the  mouth,  as 
when  administered  hypodermieally. 

Very  respectfuUv  vours, 

■  H.  H.  Kane,  M.D. 


ARMY  NEWS. 

Official  List  of  Changes  of  Stations  and  Duties  of  Offi- 
cers of  the  Medical  Department,  United  Slates  Army, 
from  Jantuxn/  1,  1882,  to  Januari/  7,  1882. 
Trematne,  W.  S.,  Captain  and  Assistant- Surgeon, 
now  awaiting  orders  in  New  York  City,  to  report  in 
person  to  the  Commanding  General  Department  of 
the  East,  for  assignment  to  duty.     S.  O.  2.,  A.  G.  O., 
January  4,  1882. 

PowBLTj,  J.  L.,  First  Lieutenant  and  Assistant-Sur- 
geon. The  seven  days'  leave  of  absence  granted  liim 
in  Orders  186,  Port  Stockton,  Tex.,  is  extended  fifteen 
dftvs.  S.  O.  159,  Department  of  Texas,  December  27, 
1881. 

Carteb,  W.  P.,  First  Lieutenant  and  Assistant- 
Surgeon.  The  seven  days'  leave  granted  him  by 
Orders  195  C.  S.,  Fort  Concho,  Tex.,  extended  one 
month,  providing  he  furnish  an  acceptable  substitute 
during  his  absence,  without  expense  to  the  United 
States.  S.  O.  IGO,  Department  of  Texas,  December 
29,  1881. 


GioBGAS,  WniiiiAM  C,  First  Lieutenant  and  Assist- 
ant-Surgeon. The  leave  of  absence  granted  him  by 
Par.  5,  S.  O.  150,  Headquarters  Department  of 
Texas,  December  .3,  1881,  is  extended  one  month. 
S.  O.  1,  Military  Division  of  the  Missouri,  January 
4,  1882. 

Maddox,  Thomas  J.  C,  First  Lieutenant  and  As- 
sistant-Surgeon, now  awaiting  orders  in  Washing- 
ton, D.  C,  to  report  in  person  to  the  Commanding 
General  Department  of  Texas  for  assignment  to 
duty.     S.  O.  2,  A.  G.  O.,  C.  S. 


U.  S.  iLARINE  HOSPITAL  SERVICR 

Official  List  of  Changes  of  Stations  and  Duties  of  Med- 
ical Officers  of  the    U.   S.  Marine  Hospital  Service, 

October  1,  1881,  to  December  31,  1881. 

Hebeesmith,  Ernest,  Surgeon.  Relieved  from  duty 
at  San  Francisco,  Oal.,  and  placed  on  waiting  orders, 
November  7,  1881.  Relieved  from  waiting  orders, 
November  26,  1881. 

V.\NSANT,  John,  Surgeon.  Granted  fourteen  days 
leave  of  absence,  October  18,  1881.  To  proceed  to 
San  Francisco,  Cal.,  and  assume  charge  of  the  Ser- 
vice at  that  port,  November  8,  1881. 

MiLiiER,  T.  W.,  Surgeon.  Granted  leave  of  ab- 
sence for  seven  days,  October  6,  1881. 

PmsviANCE,  George,  Surgeon.  To  proceed  to 
Boston,  Mass.,  and  assume  charge  of  the  Service  at 
that  port,  November  8,  1881. 

Austin,  H.  W.,  Surgeon.  To  proceed  to  Galves- 
ton, Indianola,  Corpus  Chj-isti,  and  Brownsville, 
Texas,  as  Inspector,  October  17,  1881. 

FisHEB,  J.  C.,  Passed  Assistant-Surgeon.  To  pro- 
ceed to  Yorktown,  Va.,  as  Inspector,  October  14, 
1881.  Detailed  as  member  of  Board  for  the  Exami- 
nation of  Keepers  and  Crews  of  the  Life-Saving  Ser- 
vice, Third  District,  November  18,  1881. 

Cjoldsborodgh,  C.  B.,  Passed  Assistant- Surgeon. 
Detailed  as  member  of  Board  for  the  Examination  of 
Keepers  and  Crews  of  the  Life-Saving  Service,  Fifth 
and  Sixth  Districts,  November  2,  1881. 

O'Connor,  F.  J.,  Assistant-Surgeon.  Granted  leave 
of  absence  for  fifteen  davs,  on  account  of  sickness, 
December  23,  1881. 

GuiTEEAS,  John,  Assistant-Surgeon.  Granted  leave 
of  ab.sence  for  ten  days,  December  5,  1881. 

Benson,  J.  A.,  Assistant-Surgeon.  Granted  leave 
of  absence  for  twentv-one  davs,  December  7  and  21, 
1881. 

Banks,  C.  E.,  Assistant-Sm-geon.  To  assume  tem- 
porary charge  of  the  Service  at  San  Francisco,  CaJ., 
until  the  arrival  of  Surgeon  Vansant,  November  7, 
1881. 

CAKmcHAEL,  D.  A.,  Assistant-Surgeon.  To  pro- 
ceed to  Baltimore,  Md.,  for  temporary  duty,  Novem- 
ber 2,  1881.  To  rejoin  his  station  (New  York)  and 
thence  proceed  to  Pittsburg,  Pa.,  and  assume  cliarge 
of  the  Service  at  that  port,  November  18,  1881. 

Bennett,  B.  H.,  Assistant-Surgeon.  To  proceed 
to  Boston,  Mass.,  for  temporarv  dutv,  October  21, 
1881. 

Peckham,  C.  T.,  Assistant-Surgeon.  To  report  for 
tempor.xry  duty  to  Surgeon-  in-Charge,  Boston,  Mass., 
Octoljor  21,  1881.  To  proceed  to  Vineyard  Haven, 
Mass.,  for  temporary  duty,  November  4,  1881.  To 
rejoin  his  station  (Boston)  and  thence  jjroceed  to 
New  York,  reporting  for  dutv  to  Surgeon-in-Charge, 
November  9,  1881. 

AsLES,  R.  p.  ^I.,  Assistant-Surgeon.  To  proceed 
to  St.  Louis,  Mo.,  for  temporary  duty,  October  21, 


THE  MEDICAL  RECORD. 


55 


1881.  To  proceeil  to  Evansville,  Ind.,  for  temporarY 
duty,  December  24,  1881.  "^ 

Pevan,  S.  C,  Assistant  Surgeon.  To  proceed  to 
San  Francisco,  Oal.,  for  temporar)-  dnty,  October  21 
J881. 

Ukquhabt,  F.  M.,  Assistant  Surgeon.  To  report 
tot  temporarv  duty  to  Surgeon-in-charere,  \ew  York 
IJ.ir,,  October  21,^1881. 

.Ai»OiNT.«ENTS.— The  following  candidates  having 
^asseil  the  examination  required  by  the  Regi-dations, 
were  ^pppioted  Assistant  Burgeons  by  the  Secretary 
e(  the  Treasury,  October  20,  1881 :  Philo  H.  Ben- 
nett, M.D.,  pf  New  York;  Cyrus  T.  Peckliam,  M.D.. 
of  Massachusetts;  Robert  P.  M.  Ames,  M.D.,  of 
Pennsylvania ;  Spencer  C.  Devan,  M.D.,  of  Missouri : 
and  Francis  M.  Urquhart,  M.D.,  of  New  York. 


CoNrAGious  Diseases  —  Weekly  Statement.  — 
Comparative  statement  of  cases  of  contagious  diseases 
reported  to  the  Sanitary  Bureau,  Health  Department, 
for  the  two  weeks  ending  January  7,  1882. 


Week  EnllDg 

1 

£ 

I." 

if 

S 

.9 

1 

. 

S 
1 

^ 

e 

sa 

^ 

1 

^ 

to 

o 

m 

X 

Der.  :!1,  1881. 

1 

6 

385 

9 

184 

153 

28 

0 

Jan.  7,  1882. 

1    ^ 

9 

371 

6 

177 

148 

39 

0 

The  Recent  Death  of  Dr.  John  W.  Draper  has  re- 
moved a  man  whom  the  medical  professiou  has  some 
riglit  to  claim  as  one  of  them.  Dr.  Draper  was  a 
physiologi.st,  physicist,  philosopher,  and  historian. 
He  had  one  of  those  rare  minds  which  combine  the 
;power  of  patient  investigation  with  brilliant  general- 
jization.  His  physiological,  as  well  as  his  philosoph- 
ical works,  have  long  been  widely  read,  and  will  long 
continue  to  be  both  popidar  and  authoritative. 

TirE  House  CoinirrTEE  on  Public  Health  is  con- 
stituted as  follows :  Messrs.  Van  Aernam,  Upde- 
^•aflf  of  Ohio,  Bowman,  Cullom,  Hubbs,  Rosecranz, 
3oleriuk,  Aiken,  King.  This  committee  is  last  but 
|5ne  on  the  List— so  poorly  does  our  National  Legis- 
j.ature  esteem  the  subject. 

The  Adjourned  Annual  :Meeting  op  the  Medico- 
iii; i.AL  SociETi-  was  held  on  January  4th.  Two  new 
i-u.tees  were  elected:  Dr.  William  A.Hammond 
md  Meyer  S.  Isaacs.  A  sharp  contest  took  place 
jjver  the  election  of  the  president.  Mr.  Clark  Bell 
Ivas,  however,  elected  by  a  cousideralile  majority. 
Phe  society  then  adjourned  to  a  supper  at  the  Gil- 
'•ey  House. 

j  The  delivery  of  the  valedictory  and  inaugural  ad- 
Presses  was  postpoued,  on  account  of  tiie  supper, 
jmtil  the  nest  monthly  meeting.  Before  the  society 
■l',,iii-ned.  a  protest  was  filed  by  one  of  the  mem- 
laiming  that  the  election  of  officers  was  illegal. 

-  I  vLL-Pos  IN  THE  Untted  States. — Reports  re- 
.eived  by  the  National  Board  of  Health  to  December 
j7th  show  that  small-pox  now  prevails  to  a  gi-eater 
r  less  extent  in  sixteen  States  and  two  Tenritories, 
3  follows  :  In  Boston,  Holvoke.  and  New  Bedford, 
lass.;  New  York  City.  N.  Y.;  Hudson  County,  N.  J.; 


Philadelphia,  Pittsburg,  Alleghany,  and  Midway, 
Pa.;  Wilmington,  Del.;  Baltimore,  Md.;  Richmond, 
Lynchburg,  and  Winchester,  Va.;  New  Orleans,  La. 
(one  case  reported);  Little  Rock,  Ark.;  Cincinnati, 
O. ;  Madison,  Ind.  ;  Chicago  and  Elgin,  111. ;  in 
.\ntrim,  Berrien,  Grand  Rapids,  Leenawa,  Travers, 
and  Van  Buren  Counties,  Mich. ;  St.  Louis,  Mo.; 
San  Francisco,  CaL;  in  Oregon  and  in  the  Territo- 
ries of  Washington  and  Montana.  The  number  of 
deaths  from  small-pox  reported  during  the  week  was 
105. 

Dr.  Robert  Barry  died  on  January  6th,  at  his 
residence  in  this  city.  He  was  in  his  fifty -eighth 
year.  Dr.  Barry  was  a  gi-aduate  of  Williams  College, 
and  of  the  College  of  Physicians  and  Surgeons  of 
this  city.  He  was  an  oflGcer  of  the  Academv  of  Medi- 
cine, Chairman  of  the  Committee  on  Ethics  in  the 
County  Medical  Society,  President  of  the  Physi- 
cians' Mutual  Aid  Association,  President  of  the  East 
River  Medical  Association,  a  manager  of  the  Society 
for  the  Relief  of  Widows  and  Orphans  of  Medical 
Men,  and  a  member  of  the  State  and  National  Medi- 
cal Associations. 

Shortened  Duration  op  Human  Life  in  England. 
—It  appears  that  not  only  are  the  heads  of  English- 
men growing  smaller,  but  their  lives  are  growing 
shorter.  This,  at  least,  is  the  testimony  of  Dr.  A. 
Ravagliati,  who  discusses  the  subject  in  the  British 
Medical  Journal.  From  a  study  of  statistics,  he  finds 
that,  laying  aside  deaths  from  zymotic  diseases,  the 
mortality  is  now  gi-eater  than  it  "was  thirty  vearsago. 
The  apparent  lengthening  of  life  is  to  be  accounted 
for  by  the  diminution  of  zymotic  diseases. 

Charity  Hospptal,  New  Y'oRii.— At  the  annual 
meeting  of  the  Medical  Board  of  Charity  Hospital, 
held  at  the  Academy  of  Medicine  on  the  3d  instant,' 
the  following  officers  were  elected  : 

President,  Dr.  yVm  T.White;  Vice-President,  Dt. 
Beverly  Robinson  ;  Secretary,  Dr.  Edward  S.  Peck. 

Training  People  to  Meet  Medical  or  Surgical 
Emergencies.— The  State  Charities  Aid  Association 
prpnoses  to  estabii.ii  a  kind  of  ambulance  school  ' 
for  the  instruction  of  police  and  firemen,  general 
workmen,  and  railroad  employes,  and  the  employes 
of  all  public  institutions  and  others  who  may  w'ish 
it,  how  to  meet  emergencies.  The  plan  is  modelled 
after  that  of  a  London  society,  which  has  been  able  to 
drill  many  thousands,  so  that  they  are  now  able  to 
supply  the  place  of  the  physician" or  surgeon  until 
that  important  functionary  can  be  summoned  and 
arrive.  Lectures  will  be  given  weekly.  After  the 
lectures  examinations  will  take  place,  and  certificates 
will  be  given  to  such  as  show  themselves  possessed 
of  the  knowledge  that  will  fit  them  for  this  laudable 
work.  In  addition  to  these  lectures  it  is  also  pur- 
posed to  give  lectures  touching  important  matters 
relative  to  maternal  duties  and  home  hygiene  to 
women. 

A  National  Mussrai  or  HYGrENE.— At  the  recent 
meeting  of  the  American  Public  Health  Association, 
the  executive  committee  presented  a  report  recom- 
mending the  establishment,  at  Washington  of  a 
National  Museum  of  Hygiene.  Dr.  Oihon.  U.S.N., 
stated  that  the  Surgeon-General  of  the  Navy  had 
already  established  such  a  museum,  and  that  he  was 
authorized  to  ofi'er  it  to  the  fi-ee  use  of  this  associ- 
ation. A  resolution  accepting  the  ofi'er  and  appoint- 
ing a  committee  to  confer  with  and  convey  the 
thanks  of  ■  the  association  to  the  Surgeon-Genei'al 
was  unanimously  adopted. 


56 


THE  MEDICAL  EECORD. 


Nationaii  VrrAii  Statistics. — At  the  meeting  of 
the  Public  Health  Association  in  Savannah,  last  No- 
vember, Mr.  Ei-astus  Brooks,  of  New  York,  offered 
a  resolution  to  the  effect  that  the  United  States 
Congress  be  requested  to  take  steps  to  secure  co- 
operation between  the  Federal  and  the  various  Sta,te 
governments  to  establish  a  uniform  system  of  regis- 
tration of  births,  deaths,  and  marriages  of  the  peo- 
ple of  this  country.     Adopted. 

Misuse  of  Advertisements. — Some  time  since  we 
noticed  that  what  was  an  advertisement,  in  The 
Medicaij  Record  had  been  quoted  in  a  neigliboring 
journal  as  an  article  from  one  of  our  contributors. 
We  have  since  learned  that  the  mistake  was  due 
to  an  oversight  on  the  part  of  the  editor  of  the 
JV.  E.  Monthly  Journal,  in  which  the  quotation  ap- 
peared, and  that  the  advertisers  were  in  no  degree 
directly  or  indirectly  resijonsible  for  the  appearance 
of  the  article  in  the  shape  referred  to.  This  state- 
ment is  due  to  a  firm  which,  in  common  with  others 
of  our  patrons,  does  not  solicit  editorial  notices. 

The  Death  of  Pkofessob  Nikolaxts  Pirosopf 
is  announced.  He  was,  says  the  Dritish  Medical 
Journal,  Professor  of  Surgery  to  the  Medico-Ohirur- 
gical  Academy  of  St.  Petersburg,  and  a  member  of 
the  consulting  staff  of  several  hospitals  in  that  city. 
In  ISiO  he  brought  out  a  valuable  treatise  on  the 
division  of  the  tendo  AchiUis  in  orthopaedic  surgery. 
He  also  wrote  on  cliolera,  on  the  surgery  of  the  ar- 
terial trunks,  anl  of  the  fasciie;  on  the  medical  as- 
pects of  the  Caucasus,  and  on  topographical  anat- 
omy. His  work  on  this  last  subject  forms  a  fine 
atlas  of  anatomy  as  illustrated  by  frozen  sections. 

It  is,  however,  with  military  surgery  that  his 
name  will  ever  be  most  closely  associated.  He  is 
the  medical  historian  of  the  Crimean  and  Circassian 
camiiaigns.  He  also  wrote  a  report  on  the  military 
hospitals  in  Germany  and  Alsace-Lorraine  during 
the  war  of  1870. 

Professor  Pirogoff^s  name  is  made  familiar  to 
American  and  English  medical  men  through  its  as- 
sociation with  his  peculiar  method  of  amputating 
the  foot.  .  '  , 

Last  June  he  celebrated  the  fiftieth  anniversaiT  of 
his  official  life. 

LiND.s.w  &  Blakiston. — The  firm  of  Lindsay  & 
Blaki.ston,  in  Pliiladelphia,  which  has  continued  for 
nearly  forty  years  i)ast,  ceased  to  exist  on  the  1st  inst. 
From  tlie  first,  special  attention  was  given  to  medical 
publications,  and  their  stock  was  probably  the  lar- 
gest and  most  varied  of  any  in  the  country,  after 
that  of  Messrs.  William  Wood  &  Co.  Since  18G2  they 
have  confined  themselves  solely  to  medical  litera- 
ture, and  were  the  agents  of  the  Messrs.  Chvirchill 
in  America.  Mr.  Lindsay  is  still  a  hale  old  gentle- 
man, and  carries  with  him,  in  his  retirement  from 
active  business  cares,  the  universal  respect  and  good- 
will which  are  his  due  from  a  long  and  honorable 
mercantile  career.  Mr.  Blakiston  has  associated 
with  himself  his  son,  Kenneth  M.,  and  Frank  W. 
Robinson.  They  will  continue  the  business  of  the 
late  firm  under  the  name  of  P.  Blakiston,  Son  it  Co. 

The  Te.st  of  RE.sp0Nsn3n.iTT,  as  laid  down  by 
Judge  Cox  in  the  Gniteau  case,  is  as  follows:  "The 
legal  test  of  responsibility,  where  insanity  is  set  up 
as  a  defence  for  alleged  crime,  is  whether  the  ac- 
cu.sed,  at  tlie  time  of  committing  the  act  charged, 
knew  the  difference  between  right  and  wrong  in 
respect  of  such  act.  Hence,  in  tlie  present  case,  it 
the  jury  rind  that  the  accused  committed  the  act 


charged  in  the  indictment,  and  at  the  time  of  the 
commission  of  his  crime  knew  what  he  was  doing, 
and  that  what  he  was  doing  was  contrary  to  the  law 
of  the  land,  he  is  responsible,  unless,  in  consequence 
of  insane  mental  delusions,  or  other  form  of  mental 
disorder,  he  was  laboring  under  such  defect  of  rea- 
son as  to  be  incapable  of  understanding  the  obliga- 
tion of  the  law  of  the  land,  and  the  duty  and  neces- 
sity of  obedience  to  it,  and  of  understanding  that  his 
act  was  wrong,  because  it  was  in  violation  of  the  law." 

HospitaIj  Saturdat  and  Sunday. — The  collections 
thus  far  have  amounted  to  .?30,902.42. 

Thirty  Cysticerci  in  the  Brain  of  a  Girl. — 
Ronchut  relates  an  interesting  ease  in  which  at  the 
autopsy  of  a  girl,  fourteen  years  of  age,  thirty  cysti- 
cerci were  found  in  the  brain  of  the  deceased. 

InHAI/ATION     of     HyDEASTIX,    with    GliYCEEIKE     OP 

Borax  and  JIoephia,  in  L.4.RYNGEAii  Phthisis.— In 
laryngeal  phthisis,  says  Dr.  Bird  (Australian  i\[edi- 
cal  JouriHiI),  an  inhalation,  with  Siegle's  spray,  of 
filtered  solution  of  hydrastiu,  with  glycerine  of  borax 
and  morphia,  gives  gieat  temporal^  relief. 

A  Phthisical  Cavity  in  the  Litng  Converted  into 
an  AnEFRISM  of  the  PfLMONABY  Artery. — .\t  a 
meeting  of  the  Medical  Society  of  Victoria,  a  speci- 
men illustrating  the  conversion  of  a  phthisical  cav- 
ity into  an  aneurism  of  the  pulmonary  artery  was 
presented  ;  it  consisted  of  the  right  lung  removed 
from  a  case  of  long-standing  fibroid  phthisis.  Near 
the  base  was  a  firm-walled  old  cavity,  the  size  of  a 
■walnut,  into  which  opened  a  branch  of  the  pulmo- 
nary artery  of  considerable  size  ;  the  cavity  was 
lined  by  a  thick  layer  of  firm  decolorized  clot,  and 
communicated  freely  with  a  bronchial  tube. — Aus- 
tralian Medical  Journal. 

CBEitATioN.— A  society  for  the  promotion  of  cre- 
mation has  been  formed  at  Padua.  A  numerously 
attended  meeting  was  held  under  the  presidency  of 
Dr.  Giovanni  I5erselli.  The  institution  will  be 
known  as  the  "Ferdinando  Colletti  Cremation  So- 
ciety of  Padua." 

FlltvES  in  the  Human  Liver. — During  the  last 
five  years,  Dr.  Allen  has  found  flukes  in  tlie  ducts  of 
the  hiftnan  liver  on  three  occasions.  In  one  ease, 
seven  were  found  ;  in  each  of  the  others,  one  only. 
The  species  was  the  ordinary  distomum  hepaticum. 
Abscess  of  the  liver  was  present  in  each  instance. — 
Australiiin  Medical  Journal. 

DoLiARiNA. — This  is  a  crystalline  substance,  ex- 
tracted from  the  ficus  dolaria.  In  Brazil  it  is  re- 
garded as  a  sjiecitic  against  American  chlorosis,  a 
disease  due  to  the  ancylostoma  duodenale.  This 
creature  was  constantly  found  in  the  f:eces  of  the  la- 
borers at  St.  Gotthard  aftected  with  an.imiia.  Dr. 
Buzzolo  employed  all  sorts  of  vermifuges  in  these 
cases  without  effect,  and  finally  availed  himself  of 
doliarina,  in  the  shape  of  a  powder,  into  the  compo- 
sition of  which  iron  and  several  aromatic  vegetable 
compounds  entered.  This  was  administered  in  doses 
of  a  teaspoonful  three  times  a  day.  Relapse  was 
prevented  by  taking  a  small  teaspoonful  once  a  day 
for  a  month"  Dr.  Buzzoli  tried  the  remedy  in  two 
cases.  In  one,  the  first  spoonfid  provoked  an  abun- 
dant diarrhoea,  and  in  the  evacuation,  six  of  the 
entozoa  were  found  ;  the  third  spoonful  caused  the 
expulsion  of  eleven  more.  In  the  second  case,  the 
patient  was  soon  seized  with  diarrhrea,  and  passed 
sixteen  of  the  parasites. —  Gas.  des  Hop.  and  Gazz. 
Med.  rial.,  July,  1881. 


Vol.    X  XL-No.   3.1 
Jan.  21,  1882.     1 


THE  MEDICAL  RECORD. 


57 


©licjlual  Coimmiuicationc. 


THE  TREATIMENT  OF  DISEASES  OF  THE 
IMEDDLE  EAR  AND  CONTIGUOUS  PAETS 
BY  illLDEK  :\IEASrEES  THAN  THOSE 
COJDIONLY  IX  VO(iUE.* 

Br  SAMUEL  SEXTON,  M.D., 

Mi:  Pretiklent  and  FMowa  vf  the  Neir  York  Acad- 
emi/  of  Medicine :  A  large  number  of  cases  of  acute 
purulent  inflammation  of  the  middle  ear  recover 
notwithstanding  the  neglect  or  the  excessive  treat- 
ment to  which  they  are  often  subjected.  Some- 
times, however,  the  severity  of  the  disease,  or  its 
injudicious  management,  give  rise  to  grave  symp- 
toms and  complications  affecting  the  mastoid  and 
other  contiguous  parts  ;  we  have  then  to  contend 
with  a  condition  of  things  which  is  highly  inimical 
to  the  well-being  of  the  patient.  In  presenting  a 
cursory  and  much  condensed  resume  of  the  causes 
and  symptoms  which  must  necessarily  precede  any 
views  as  to  the  treatment  of  these  affections,  I 
shall  avoid  ma,ny  details  that  would  be  of  special 
interest  only  to  the  otologist.  By  thus  confining 
the  discussion  to  the  consideration  of  complications 
that  most  frequently  j)resent  themselves  to  the  phy- 
sician in  general  practice,  I  shall  hope  to  obtain 
more  time  for  the  question  of  treatment — especially 
such  methods  of  treatment  as  seem  likely  to  cure 
the  patient,  without  resorting  to  the  more  extreme 
operative  methods  that  some  authorities  have  hith- 
erto recommended. 

The  causes  of  suppurative  disease  of  the  ear  may 
be  conveniently  aiTanged  under  three  heads,  namely  : 
first,  those  arising  from  nervous  sympathy  ;  second, 
from  an  extension  of  catarrhal  inflammation  from 
the  naso-pharynx  through  the  Eustachian  tube  ;  and 
third,  from  mechanical  or  direct  influences.  Be- 
longing to  the  first  class  are  the  reflex  influences  on 
the  ear  from  other  organs  of  the  body  and  from 
taking  cold  ;  thus,  every  one  is  familiar  with  the 
phenomena  of  aural  sympathy  from  irritation  of 
the  dental  nerves,  or  of  those  supplying  the  naso- 
pharynx. The  ear  may  also  be  affected  from  dis- 
eased action  in  organs  even  more  remote  than  the 
mouth  or  the  naso-pharynx  ;  I  have  thus  seen  many 
cases  where  otalgia  could  readily  be  traced  to  pain- 
ful conditions  in  the  uterus  and  ovaries.  Tlie  ear 
is  also  sometimes  subject  to  attacks  of  an  acute 
natiu-e  from  the  effects  of  wetting  the  hair  of  the 
head  and  allowing  it  to  slowly  dry,  from  clipping 
the  hair  too  closely,  and  very  frequently  from  ex- 
posure of  the  head  and  neck  to  draughts  of  cold  or 
cooling  ail-. 

In  the  second  group  of  etiological  factors,  the 
extension  of  catarrhal  inflammation  from  the  naso- 
pharynx seems  to  be  directly  along  the  mucous 
membrane  which  lines  the  Eustachian  tube  ;  thus, 
a  cold  in  the  head  may  first  affect  the  naso-pharynx 
and  then  travel  along  the  Eustachian  tube  to  the 
drum  of  the  ear. 

To  the  third  group  belong  the  direct  effects  of  the 
entrance  of  irritating  fluids,  either  through  the  ex- 
ternal auditoi-y  canal  ov  the  Eustachian  tube,  trau- 
matic injuries,  and  in  rare  instances  the  entrance  of 
!     draughts  of  cold  air  into  the  external  auditoi-y  canal. 
•  Read  before  the  New  York  Academy  of  >tediciue,  January  .", 


The  middle  ear  is  thus  obnoxious  to  the  entrance 
of  cold  water  in  bathing,  or  from  the  use  of  the  nasal 
douche. 

Very  ofte«  more  than  one  of  the  causes  enumer- 
ated exert  an  influence  on  the  jiatient  at  the  same 
time,  a  strikingly  illustrative  instance  of  which 
occurs  to  me  in  tliis  connection.  The  case  was  that 
of  a  lady,  who  was  said  by  her  physician  to  have 
been  the  subject  of  some  chronic  uterine  disorder  ; 
she  was  twenty-four  years  of  age,  and  the  left  wia 
dom  tooth  was  erupting  with  difficulty — in  fact  it 
had  been  the  cause  of  a  great  amount  of  local 
irritation  for  a  year  before  she  was  brought  to  me 
for  treatment.  While  this  uterine  troiible  and  the 
irritation  in  the  mouth  were  Jjoth  going  on,  she  was 
obliged  to  make  the  journey  from  Euroi^e  to  New 
York,  and  during  the  passage  she  contracted  a  cold 
in  the  head,  resulting  in  an  acute  purulent  inflam- 
mation of  the  left  middle  ear.  When  I  first  saw 
this  patient  she  described  the  pains  as  shooting 
from  the  teeth  to  the  ears.  The  remote  causes 
■which  were  active  in  this  case  very  greatly  pro- 
tracted the  recovei-y.  In  cases  similar  to  the  above, 
improvement  has  often  immediately  followed  the 
removal  of  the  remote  causes.  The  observance  of 
these  pains  shooting  from  the  teeth  to  the  ears 
should  not  lead  to  the  mistake  of  diagnosing  catar- 
rhal inflammation  of  the  Eustachian  tubes. 

As  regards  the  influence  of  age  and  sex  on  the 
progress  of  acute  aural  catarrh,  my  experience  has 
been  that  among  adults  the  more  grave  cases  occur 
with  greater  frequency  in  males,  and  that,  jnobably, 
of  all  of  the  grave  adult  cases,  both  acute  and  chron- 
ic, about  one-half  were  consecutive  to  acute  attacks, 
•while  in  the  other  moiety  there  has  been  a  history  of 
chronic  purulent  inflammation  of  the  ear.  It  is  a 
matter  of  observiitiou  that  exacerbations  occurring  in 
chronic  cases  are  as  dangerous  as  original  attacks. 
In  childhood,  I  am  under  the  impression  that  fe- 
males are  more  liable  to  the  severer  forms  of  auial 
disease  than  males. 

In  reference  to  the  liability  of  acute  aural  catarrh 
to  take  on  a  severe  form  of  inflammation,  it  has 
been  premised  that  in  many  instances  the  attacks 
are  mild  at  the  onset ;  the  secretions  of  the  middle 
ear  are  slight  in  quantity,  and  may  escape  through  the 
Eustachian  tube,  or,  where  this  is  notpossible,  an  oirt- 
let  is  afforded  through  a  rupture  in  the  drum-head, 
which  heals  up  again  very  rapidly  under  favorable  cir- 
cumstances, and  the  patient  is  soon  restored  to  health. 
If  such  a  case,  however,  is  treated  by  violent  meas- 
ures, such  as  leeching  and  untimely  incisions  of 
any  of  the  tissues  about  the  ear,  or  by  vigorous  in- 
flations of  the  tympanum,  it  may  not  jirove  so 
simple  an  affair,  but  may  rapidly  take  on  a  severe 
form  of  inflammation,  and  adjacent  structures  may 
rapidly  become  involved.  I  would  not  be  under- 
stood as  dogmatically  asserting  that  all  cases  treated 
by  these  measures  take  such  a  course,  but  I  am  fully 
convinced  that  in  a  large  number  of  instances  the 
case  would  do  better  without  them,  and  that  in 
many  instances  they  do  much  harm.  An  untoward 
course  is  also  to  be  expected  in  a  certain  number  of 
cases  from  the  beginning  of  the  attack. 

Before  commencing  an  account  of  the  symptoms 
of  the  extension  of  inflammation  of  the  middle  ear 
to  contiguous  parts,  it  would  be  well  to  make  some 
division  of  the  subject  for  convenience  in  descrip- 
tion ;  I  shall,  therefore,  arrange  the  subject  as  fol- 
lows :  1,  catarrhal  inflammation,  caries  and  necrosis, 
of  the  air-cells  of  the  mastoid  ;  2,  periostitis  of  the 
external  auditory  canal ;  3,  periostitis  externa. 


5S 


THE  MEDICAL  RECORD. 


Meningitis,  py:T!mia,  and  other  results  of  middle- 
ear  disease,  for  want  of  time,  cannot  be  considered. 

The  symptoms  of  an  invasion  of  the  pnenmatic 
cells  of"  the  mastoid,  along  with  or  cobsecutive  to 
acute  catarrhal  inflammation  of  the  middle  ear,  are 
not  always  distinguishable  where  hyper;emia  of  the 
mucous  lining  only  exists  ;  but  when  the  disease  at 
this  stage  has  not  been  arrested  by  the  treatment, 
which  is  applicable  to  this  region  as  well  as  to  the 
middle  ear,  swelling  of  the  mucous  membrane  takes 
place.  In  the  middle  ear  the  swollen  mucous  mem- 
brane now  nearly  always  closes  the  tympanic  orifice 
of  the  Eustachian  tube,  and  thus  cuts  off  the  escape 
of  secretions  in  that  direction  ;  it  also  reinforces 
the  drumhead,  giving  it  increa.sed  j^ower  of  re- 
ristanoe.  The  retained  secretions  now  accumu- 
late in  the  drum,  and  pi'obably  are  in  some  measui'e 
the  cause  of  an  extension  of  the  disease  to  the 
mucous  lining  of  the  air-cells.  The  intense  pain 
experienced  in  the  ear  is  only  to  a  slight  extent  in- 
dicative of  mastoid  inflammation  at  this  stage;  but 
when  little  relief  is  experienced  on  the  liberation  of 
the  accumulated  fluids,  either  by  spontaneous  rap- 
ture or  by  the  incision  of  the  drum-head,  we  may 
surmise  that  inflammatory  action  has  taken  a  wider 
range  ;  and  should  there  now  be  an  excessive  dis- 
chirj;e  from  the  ear,  it  miy  be  regarded  as  pathog- 
nomonic of  mastoid  disease. 

Inflammation  of  the  middle  ear  very  often  extends 
to  the  perio.steum  of  the  external  auditory  canal. 
The  invasion  of  this  region  is  characterized  by  a 
decrease  in  the  size  of  the  inner  end  of  the  tube, 
which  is  the  portion  principally  affected.  The 
parts  have  a  humid  look  from  an  increase  of  the  se- 
cretion of  the  sebaceous  glands,  and  there  is  usually 
an  exfoliation  of  the  epidermis.  This  region,  being 
richly  supplied  with  sensitive  nerves,  is  now  very 
painful,  and  difficulty  is  experienced  in  mastication 
from  tlie  pressure  of  the  condyloid  process  of  the 
inferior  maxillary  upon  the  sensitive  surface  of  the 
glenoid  fossa  of  the  temporal  bone. 

Periostitis  externa  is  very  liable  to  occur  when  the 
external  auditory  canal  is  affected,  the  osseous  por- 
tion of  the  latter,  and  the  external  surface  of  tlie  tem- 
poral bone  having  a  common  periostic  membrane. 
It  is  probably  most  frequent  over  the  mastoid,  but 
the  entire  region  about  the  ear  is  also  very  often 
aff"i3cted,  especially  the  parts  in  front  of  the  tragus. 
The  suhcutineous  connective  tissue  overlving  the 
periosteum  of  the  temporal  bone  seems  to  be  exceed- 
ingly subject  to  inflammation  and  suppuration  ;  this 
is  doubtless  owing  to  the  abundance  of  fat-bearing 
connective  tissue  in  these  regions  The  rajjid  for- 
mation of  abscesses  about  the  ears  of  children  is 
familiar  to  every  physician,  their  enormous  size 
sometimes  presenting  a  most  alarming  appearance, 
which  fortunately  is  not  always  significant  of  dan- 
ger. In  verv  young  children  even  .slight  attacks  of 
catarrhal  inflammation  of  the  mid<lle  ear  may  give 
rise  to  extensive  inflammation  of  the  connective  tis- 
sue, and  the  subsequent  suppuration  may  re.sult  in 
the  formation  of  large  abscesses,  which  sometimes 
eventually  extend  almost  entirelv  around  the  auricle, 
often  burrowing  very  extensively  beneath  the  skin. 
In  periostitis  externa  the  inPammation  rather  in- 
frequently extends  down  along  the  sterno-cleido- 
mastoid  muscle,  when  other  abscesses  mav  form  on 
the  siile  of  the  neck.  The  latter  is,  I  believe,  an 
unusual  course  in  childhood 

The  auricle  seldom  becomes  very  much  swollen  in 
these  cases,  presumably  on  account  of  the  absence 
of  subcutaneous  cellular  tissue  ;  the  lobule,  and  the 


parts  about  the  attachment  of  the  auricle,  however, 
are  sometimes  considerably  inflamed.  When  pus 
forms  between  the  periosteum  and  the  cortical  sub- 
stance of  the  bone,  superficial  necrosis  may  ensue. 
Such  a  sequence,  however,  is  not  always  a  result. 
Perforation  of  the  cortex  almost  always  proceeds 
from  caries  and  necrosis  of  the  mastoid  cells. 

Treatment  may  be  unsuccessful  in  aiTesting  the 
middle-ear  inflammation,  or  the  case  may  not  come 
under  observation  until  the  mastoid  cells  have 
passed  the  stage  of  hyijera^mia,  and  the  mucous  mem- 
brane having  become  first  infiltrated,  the  contents 
of  the  cells  soon  assume  a  gelatinous  character.  It 
is  believed  by  Schwartze  that  in  these  cases  the 
products  of  inflammation  are  sometimes  prevented 
from  finding  an  outlet  through  the  mastoid  antnim 
into  the  tympanic  cavity,  and  thus  give  rise  to  con- 
ditions requiring  operative  procedures. 

When  the  mastoid  cells  become  denuded  from 
the  inflammatory  process,  caries  results,  the  pro- 
ducts of  the  morbid  action  finding  an  outlet  most 
frequently  into  the  posterior  wall  of  the  external 
auditory  canal.  As  a  result  of  the  necrosis,  which 
now  frequently  occurs,  sequestra  of  various  sizes 
become  detached,  and  may  be  detected,  by  the 
probe,  in  the  diseased  cavity  of  the  mastoid.  If  a 
free  outlet  for  the  secretions  is  notaff'orded  by  the 
communication  with  the  tympanum  or  the  external 
auditory  canal,  a  fistulous  opening  through  the  mas- 
toid process  is  formed.  Sometimes  a  large  seques- 
trum presents  at  the  outlet  of  these  drainage-tracts. 
When  they  are  thus  thrown  oft',  improvement  of  the 
ca.se  is  usually  rapid.  The  carious  cavity  often  gives 
rise  to  excessive  purulent  secretion,  when  small 
fragments  of  bone  are  carried  out  of  the  ear  without 
being  observed.  According  to  Schwartze,  minute 
sequestra  m*ay  disappear  veiy  slowly  by  absorption 
through  the  granulations. 

Injury  of  the  facial  nerve,  where  it  passes  through 
the  aquseductus  Fallopii,  may  be  caused  by  necrosis 
or  by  the  pressure  of  a  sequestrum  in  transit,  in 
which  event  a  facial  paralysis  would  occur.  Slip:ht 
paresis  only  may  result  from  such  an  injury  to  the 
nerve,  but  the  possibility  of  its  occurrence  should 
always  be  kept  in  mind  when  treating  these  cases, 
for  the  palsy,  when  not  great,  is  liable  to  escape 
notice. 

The  result  of  caries  and  necrosis  of  the  mastoid 
air-cells  in  children  would  seem  to  be  their  entire 
obliteration  in  some  instances.  I  have  thus  seen 
children  where  a  large  cicatrix  behind  the  auricle, 
lying  deeply  in  the  concavity  left  in  the  bone,  was 
the  result  of  such  destructive  inflammation. 

Di.sease  of  the  pneumatic  cells  of  the  mastoid  may 
exist  when  the  apj^earance  of  the  dnim-head  gives 
but  little  evidence  of  any  middle-ear  disease  ;  I 
have  observed  several  instances  of  this  kind.  In 
one  of  them  an  acute  and  painful  attack  came  on. 
accompanied  by  Bell's  palsy.  The  mastoid  inflam- 
mation did  not  abate  for  several  weeks,  and  the  palsy 
lasted  much  longer.  There  were  no  marked  acoustic 
phenomena  to  indicate  disturbance  of  the  conduc- 
tive mechanism  in  this  case,  nor  was  the  drumhead 
more  than  slightly  hyperamiic  for  a  few  days.  In 
another  case,  where  the  mastoid  disease  had  existed 
for  years,  the  perforation  in  the  drumhead  closed 
up,  and  good  hearing  returned  ;  the  purulent  secre- 
tions from  the  mastoid,  in  the  meantime,  finding  an 
outlet  through  the  outer  table. 

Caries  of  the  mastoid  cells  may  exist  for  a  long 
time  without  recognition.  A  case  of  this  kind  came 
under  my  charge  quite  recently  ;  the  patient  was  a 


THE   MEDICAL  RECORD. 


59 


woman,  nineteen  years  of  age,  who  had  been,  prob- 
ablv,  the  subject  of  chronic  j^unilent  intiammation 
since  chiklhood,  although  she  had  no  recollection 
of  ever  having  had  auv  i)ains  in  the  ear,  or  any  dis- 
chai-ge  therefrom,  iintil  a  short  time  before  I  lirst 
saw  her  ;  she  stated,  however,  that  the  ear  had  had 
a  bad  odor  at  times  ever  since  she  was  a  child.  Af- 
ter the  removal  of  a  mass  of  polypi,  a  large  seques- 
trum was  found  at  the  bottom  of  the  external  audi- 
tory canal,  which,  on  examination,  proved  to  consist 
of  the  mastoid  antrum,  some  of  the  pneumatic  cells, 
and  a  portion  of  the  roof  of  the  tympanum.  Soon 
after  these  morbid  products  were  taken  from  the 
ear  the  patient  made  a  rapid  recovery.  Facial  paral- 
ysis, however,  remained,  owing  to  an  irreparable 
injury  to  the  facial  nerve. 

When  caries  of  the  mastoid  perforates  some  por- 
tion of  the  external  auditory  canal,  there  is  at  first 
a  characteristic  bulging  of  the  integument  into  the 
canal,  which  decreases  its  calibre  ;  this  pur[jlish  pro- 
jection may  have  only  a  minute  opening  at  the  be- 
ginning, and  is  sometimes  mistaken  for  a  tumor  or 
polypus.  When  attempts  are  made  to  remove  it 
with  a  snare,  or  to  liberate  secretions,  it  is  found 
that  it  can  neither  be  readily  removed,  nor  can  any 
relief  usually  be  obtained  by  incisions.  Later  on, 
however,  the  opening  usually  becomes  larger,  and 
is  soon  the  seat  of  abundant  fungoid  or  polypous 
growths. 

I  shall  not  attempt  to  discuss  here  the  catises  of 
the  extension  of  aural  disease  to  the  brain,  or  the 
occurrence  of  pyremic  infection  or  thrombi,  my  chief 
object  being  to  oflfer  a  plan  of  treatment  that  in  my 
own  experience  has  been  more  satisfactory  than  any 
other. 

The  differential  diagnosis  of  the  invasions  of  in- 
flammation of  the  middle  ear  to  contiguous  parts, 
and  the  diagnostic  value  of  jjain  as  a  symptom,  will, 
when  taken  into  account,  do  much  toward  a  more 
rational  treatment  of  aural  disease,  and  I  shall, 
therefore,  beg  to  give  the  results  of  my  own  obser- 
vations on  these  points  before  entering  into  the  sub- 
ject of  treatment. 

The  diagnosis  of  simple  hypera'mia  of  the  mucous 
lining  of  the  mastoid  air-cells  is  difficult,  the  symp- 
toms not  always  differing  from  those  of  middle-ear 
catarrh  ;  but  when  the  mucous-periosteal  lining  is 
attacked,  an  increase  of  pain  would  be  experienced 
by  the  patient,  the  attack  might  be  ushered  in  by 
chills,  the  temperature  and  pulse  in   severe  cases 
would  be  characteristic  of  acute  inflammation,  and 
I    the  pains  would  be  non- paroxysmal. 
I        The  degree  of  pain  in  the  mastoid  is  spoken  of  by 
!    some  authorities  as  being  indicative  of  the  gravity 
of  the  case  ;  but  this,  fortunately,  is  not  always  con- 
firmed by  experience,  for  the  most  intense  neuralgic 
pains  may  exist   in   any  of   the  parts   liable    to    be 
affected,    independently   of   mastoid    inflammation. 
]    We  have  seen  how  exceedingly  painful  some  regions 
I    of  the  ear  are  when  inflamed,  and  every  physician 
I    knows  how  difficult  it  is   to   locate  this   symptom. 
Were  pains  alone,  therefore,  always  regarded  as  symp- 
tomatic of  inflammation  in  either  the  mastoid  or  the 
I   brain,  we  should  often  be  misled,  for  grave  cases  are 
i   not  always  so  announced.     It  is  important,  there- 
I   fore,    to   differentiate    between    sympathetic    aural 
I  pains  and   the   pains   that   attend   inflammation  in 
'   these  cases.     Pains  of  a  severe  character,  felt  to  be 
1  in  the  mastoid  or   in    the  whole  temporal  region, 
I  may  often  be  traced  to  irritation   of  the  nerves  in 
j  the  middle  ear.     A  patient  under  treatment  at  the 
present  time  was  for  many  weeks  affiicted  '-■v  severe 


pains  of  this  character,  but  when  the  middle-ear 

disease  rather  suddenly  yielded  to  treatment,  with 
closure  of  a  perforation  in  the  drum-head,  the  neu- 
ralgic pains  almost  instantly  ceased,  as  if  by  magic. 
A  similar  resvilt  has  been  obtained  by  the  treatment 
or  removal  of  a  diseased  tooth.  I  have  no  doubt 
but  that  the  intense  neuralgias  in  the  temporal  re- 
gion, depending  on  sympathetic  causes,  ai'e  capable 
of  producing  inflammation  in  these  parts,  and  this 
may  serve  to  explain  why  the  subcutaneous  cellular 
tissue  about  the  ear  is  frequently  the  seat  of  supjju- 
rative  inflammation,  even  when  there  is  no  evidence 
of  the  previous  existence  of  periostitis.  It  is  to  be 
feared  that,  when  .such  phenomena  exist  during  the 
progress  of  middle-ear  djsease,  it  is  too  much  the 
habit  to  consider  that  extension  of  the  inflammation 
to  the  brain  itself  is  threatened.  The  brain  may  be 
affected,  or  pyemia  or  thrombi  may  be  developed 
from  aural  disease,  without  any  severe  local  affection 
in  which  pain  is  a  prominent  symptom. 

The  absence  of  acoustic  phenomena  usually  ex- 
l^erienced  in  middle-ear  disease  would  have  some 
weight  in  the  location  of  inflammation  of  contiguous 
parts.  Inasmuch  as  acute,  purulent  inflammation  of 
the  middle  ear  is  well  known  to  be  liable  to  extend 
to  contiguous  parts,  it  is  well  to  endeavor  at  the 
outset  to  prevent,  if  possible,  the  occurrence  of  the 
more  grave  complications  which  may  thus  imperil 
the  patient.  I  have  ventured,  at  the  beginning,  to 
predict  that  in  many  instances  the  disease  would 
take  a  more  favorable  course  from  milder  treat- 
ment than  that  commonly  in  vogue  ;  but,  untoitu- 
nately,  few  cases  that  come  under  our  observation 
have  been  allowed  to  pursue  their  regular  course 
without  some  attempts  having  been  made  for  their 
relief;  thus,  it  is  commonly  believed  that  syringing 
the  ear  can  do  no  harm  under  any  circumstances, 
and  poulticing  is  also  sometimes  resorted  to  from  a 
like  conviction.  Syi'inging,  indeed,  is  a  procedure 
that,  if  left  to  the  uninstructed  nurse,  very  oJten 
consists  in  merely  douching  the  external  parts  of 
the  organ  ;  but,  when  done  energetically  by  one  who 
succeeds  in  violently  introducing  a  stream  ol  water 
into  the  external  auditory  canal,  much  damage  is 
liable  to  be  accomplished,  eitlier  by  direct  injury  to 
the  drum-head,  or,  if  water  should  enter  the  tympa- 
num through  a  perforation,  the  iiTitation  already 
existing  may  be  increased.  Should  leeches  now  be 
applied,  the  possible  relief  from  the  dejiletion  may 
be  more  than  counterbalanced  by  the  irritution  of 
their  sharjj  bite  and  the  bungling  attempts  made  in 
stopping  the  bleeding  after  they  drop  oG;  the  large 
coagula  entangled  in  pellets  of  cotton-wool  used  to 
arrest  hemorrhage  are  also  liable  to  irritate  the 
parts,  especially  in  children.  Blistering  and  paint- 
ing with  the  tincture  of  iodine  over  the  mastoid,  or 
in  front  of  the  ear,  as  is  the  practice  of  some,  are 
also  not  without  their  evil  effects  ;  and  the  instilla- 
tion of  astringent  solutions  are  often  even  yet  more 
injurious  when  successfully  introduced.  Should  in- 
flation of  the  tympanum,  either  by  the  air-bag  or  by 
the  Valsalvan  method,  he  now  accompli.shed,  the 
forcible  entrance  of  air  may  be  not  only  painful,  but 
also  harmful.  The  two  procedures  last  mentioned, 
often  employed  to  improve  the  hearing  in  chronic 
cases,  are  of  doubtful  value  in  acute  inflammation  of 
the  middle  ear,  for  we  are  not  warranted  in  further 
distending  that  cavity  by  forcing  in  njore  air  and 
mucus.  At  a  later  stage  of  the  attack  we  may,  of 
course,  avail  of  these  pneumatic  methods,  in  occa- 
sionally driving  the  accumulations  of  the  tympanum 
out  through  the  perforated  drum-head.     The  proce- 


60 


THE  MEDICAL  RECORD. 


dares  enumeratefl  above  may  transform  a  sirnple 
acate  catarrhal  inflammation  of  tlie  middle  ear  into 
one  of  more  or  less  severity,  or  at  least  very  much 
protract  the  disease. 

In  starting  out  some  years  ago  to  endeavor  to 
manage  these  cases  by  milder  methods  of  treatment 
than  seemed  to  generally  prevail,  I  must  confess 
that  my  greatest  encouragement  came  from  a  most 
unexpected  source,  namely,  the  neglect  of  some  pa- 
tients to  carry  out  the  plan  of  treatment  I  had 
thought  best  to  recommend.  In  some  instances  it 
was  the  neglect  to  apply  leeches  to  the  ear  ;  in 
others  the  inability  to  efficaciously  syringe  the  ear 
or  instil  into  it  the  astringent  solutions  ordered. 
The  instance,  however,  tliat  influenced  me  more 
than  any  other,  was  the  refusal  of  a  patient,  suffering 
from  a  large  and  painful  swelling  over  the  mastoid, 
to  have  Wilde's  operation  of  cutting  down  to  the 
bone  performed  ;  the  patient,  dreading  the  pain  of 
the  proposed  incision,  absented  himself  for  a  week, 
during  which  time  he  continued  to  take  the  calcium 
sulphide  which  had  been  prescribed.  I  fully  ex- 
pected that  he  would  return  with  an  abscess  in  an 
advanced  state  of  maturation,  but,  much  to  my  sur- 
prise, his  condition  had  very  much  improved,  and 
the  pain  and  swelling  over  the  mastoid  had  almost 
disappeared. 

The  desire  to  rebuke  this  person  for  the  irrever- 
ence thiis  manifested  toward  the  accepted  doctrines 
of  the  aural  profession  gave  way,  on  reflection,  to  the 
thought  that  perhaps  he  was  rather  to  be  congratu- 
lated in  having  escaped  the  j)ainful  experience  of 
routine  treatment. 

These  and  other  seemingly  good  and  sufficient 
reasons  led  to  the  conviction  that  certain  well- 
established  practices  in  the  management  of  aural 
diseases  could  with  advantage  be  much  modified ; 
and  experience  has,  in  the  meantime,  brought  for- 
ward general  or  constitutional  remedies  which  ap- 
pear in  great  measure  to  supersede  the  more  radical 
and  severe  local  means  to  which  reference  has  been 
made.  \ 

It  will  be  disputed  by  none  that  absolute  rest  is 
indicated  in  the  early  stage  of  acute  middle-ear  dis- 
ease, but  I  would  supplement  this  with  the  injunction 
to  maintain  rest  of  the  ear  itself ;  in  other  words,  the 
inflamed  organ  should  be  but  little  disturbed  by  local 
applications.  If  the  patient  is  seen  before  a  dis- 
charge from  the  ear  has  begun,  the  drum-head 
should  be  carefully  inspected  through  a  specidum  by 
the  aid  of  light  reflected  from  a  head-mirror  ;  if  it 
should  bo  found  to  be  inflamed,  but  not  greatly 
bulged  out  by  the  pressure  of  secretions,  it  should 
not  be  subjected  to  any  local  treatment  whatever ; 
but  if  thickened,  and  therefore  more  resisting,  as  it 
may  be  from  serous  infiltration  of  the  mucous  coat, 
or  from  j)revioias  inflammation,  and  violently  dis- 
tended, the  question  of  jiaracentesis  will  present  it- 
self. iSIy  own  practice  in  the  management  of  cases 
presenting  this  problem  has  been  to  give  the  patient 
the  benefit  of  the  doubt,  when  any  exists,  and  the 
result  of  this  course  has  been  that,  on  the  whole, 
I  have  not  regretted  the  postponement  of  the  oper- 
ation. It  is  well  known  that  the  drum-head  very 
often  gives  way  when  not  strengthened  in  the  man- 
ner above  described,  without  any  one  being  conscious 
of  the  fact  before  a  serous  discharge  appears. 

The  jiorformance  of  paracentesis  is  not  always  an 
easy  operation,  oven  in  iidnlts  ;  in  weak  or  siiscep- 
tible  persons,  and  especially  in  children,  an  anses- 
thotic  is,  as  a  rule,  rofjuircd.  I  am  not  in  the  habit, 
moreover,  of  2iorforating  the  membrane  without  ob- 


taining a  good  view  of  its  condition,  for  when  swell- 
ing of  the  inner  end  of  the  external  auditory  canal 
prevents  an  inspection  being  made,  we  are  warranted 
in  concluding  that  the  pain  and  other  urgent  symp- 
toms may  depend  on  the  inflammation  of  the  peri- 
osteal coat  of  the  canal. 

When  the  contents  of  the  tympanum  have  es- 
caped, either  from  bursting  or  incision  of  the  drum- 
head, the  .syringe  should  not,  as  a  rule,  be  employed, 
but  the  discharge  may  be  gently  wiped  away  by 
means  of  absorbent  cotton-wool  wound  into  a 
brush  on  the  end  of  a  vulcanite  probe  :  the  meatus 
should  not  be  kept  greatly  obstructed  by  pellets  of 
cotton-wool,  as  they  prevent  drainage  and  the  proper 
ventilation  of  the  parts  ;  they  are  admissible,  how- 
ever, when  the  patient  leaves  the  house. 

In  the  meantime,  attention  to  remote  influences 
is  demanded,  for  local  treatment  will  be  unavailing 
so  long  as  these  causes  remain  active.  Should  it  be 
found  that  either  dental  caries,  or  the  difficult  erup- 
tion of  teeth,  give  rise  to  reflex  irritation  in  the  ear, 
these  causative  factors  should  be,  if  possible,  elimi- 
nated by  treatment ;  if  naso-pharyngeal  catarrh  be 
also  present,  it  must  receive  attention.  In  many 
cases  it  will  be  found  that  disorders  in  regions  even 
more  remote  than  these,  as  of  the  uterus  and  its 
appendages,  exert  a  decided  influence  on  the  ear, 
and  when  this  is  the  case  the  condition  of  such  or- 
gans should  not  be  overlooked.  When,  later  on, 
muco-purulent  secretions  are  retained  in  the  ex- 
ternal auditory  canal,  because  of  their  viscidity, 
they  may  not  be  easily  removed  by  the  wiping 
process,  and  gentle  syringing  with  water,  as  hot 
as  can  be  easily  borne,  is  then  required  ;  unless 
such  collections  are  removed,  their  decomposition, 
especially  in  warm  weather,  is  to  be  apprehended. 
If  heating  agents  seem  indicated  for  the  relief  of 
pain,  or  to  counteract  vascular  tension,  I  prefer 
either  hot  vapor  or  hot  air  to  meet  these  indications. 
In  these  acute  cases,  where  discharge  is  slight,  the 
boracic  acid  with  calendula  is  sometimes  most  effi- 
cacious ;  it  is  applied  in  the  dry  state,  a  small  quan- 
tity being  introduced  and  allowed  to  remain  in  con- 
tact with  the  di-um-head  until  carried  out  by  the 
discharge,  when,  if  it  does  not  prove  irritating — 
which  is  seldom  the  case — it  may  again  be  applied 
as  before.  When  excessive  discharge  exists,  the 
remedy  is  still  of  service,  but  the  result  is,  of  course, 
not  so  satisfactory.  In  my  own  experience  in  the 
use  of  this  preparation,  its  healing  efl"ect  has  been 
very  well  shown  in  nearly  all  of  the  cases  where  it 
was  employed. 

These  measures  are,  in  many  instances,  sufficieti '. 
to  cure  the  case  in  a  week's  time,  or  even  in  a  few 
days,  when  no  important  complications  exist. 

In  by  far  the  greater  number  of  cases,  however, 
the  conditions  are  not  favorable  to  so  quick  a  re- 
covery as  might  be  inferred  from  the  above,  and 
constitutional  treatment  will  be  required.  Where 
there  are  any  reasons  for  ajiprehending  that  tlu' 
case  may  be  other  than  Tinusually  light,  general 
treatment  may  be  commenced  at  the  onset.  I  shall 
not  allude  here  to  those  hygienic  and  rational  motli- 
ods  which  every  experienced  practitioner  has  learnnl 
the  value  of  in  the  management  of  any  case  whei c 
inflammation  is  a  symptom,  but  there  are  some 
remedies,  which  have  not  been  as  yet  generally 
adopted  in  the  treatment  of  aural  inflammation, 
that  have  proved  in  my  hands  to  be  of  gieat  value  : 
one  of  the  most  important  of  these  is  tlio  calx  sul- 
l>hurata  or  sulphuretted  lime.  When  I  first  em- 
ployed this  drug — some  six  years  ago — its  use  was 


THE  MEDICAL  RECORD. 


61 


confined  mainly  to  furunculous  and  diffuse  inflam- 
mations of  the  external  auditory  canal,  and  tbe  re- 
sults then  obtained  were  so  gratifying  that  I  ven- 
tured to  present  tliem  to  the  profession  in  a  paper 
published  in  the  American  Journal  of  Oioloyit  for 
Januai-y,  1879.  The  virtues  then  claimed  for  this 
remedy,  in  a  rather  restricted  field  of  employment, 
have  been  not  only  confirmed  during  the  three  years 
that  have  now  elapsed,  but  subsequent  experience, 
in  both  private  and  infirmai-y  practice,  has  also 
demonstrated  its  value  in  most  of  the  acute  inflam- 
mations of  the  middle  ear  and  contiguous  parts. 
In  this  somewhat  extensive  experience,  I  have  found 
this  remedy  to  exert  a  more  favorable  influence 
over  acute  aural  inflammations  than  hitherto  ob- 
tained by  any  other  treatment.  This  drug  seems  to 
possess,  according  to  Kinger,  "  the  projjerty  of  pre- 
venting and  arresting  suppiu-ation."  Thus,  in  the 
inflammation  threatening  to  end  in  supjuiration.  it 
reduces  the  inflammation  and  averts  the  formation 
of  i^us.  It  then  hastens  maturation  considerably, 
whilst  at  the  same  time  it  diminishes  and  circum- 
scribes the  inflammation.  The  therapeutical  action 
of  this  medicine  cannot  be  fully  explained,  but  in 
speaking  of  it  as  producing  diti'erent  and  apparently 
opposite  effects,  as  the  di.s}>ersion  of  inflammation 
in  one  case  and  the  expulsion  of  pus  in  another, 
Einger  likens  it  to  poultices  and  hot  fomentations, 
which  both  subdue  inflammation  and  prevent  sup- 
puration, and  in  other  cases  considerably  hasten  the 
maturation  of  abscesses.  My  experience  fully  con- 
firms all  that  is  thus  claimed  for  this  drug,  and  I 
might  add  that,  whenever  its  favorable  eflects  are 
obtained,  there  is  a  marked  abatement  of  pain — an 
important  result  where  this  symptom  usually  plays 
so  great  a  part. 

As  regards  the  special  indications  for  the  em- 
ployment of  thrs  remedy,  and  the  dosage,  I  would 
say  that  whenever  there  is  acute  inflammation,  with 
or  without  supi^uration,  I  would  recommend  its  em- 
ployment.'?  Its  continuance  miist  depend  on  the 
efiect  produced,  the  length  of  time  depending  on 
conditions' that  dift'er  in  difl'erent  cases;  this,  of 
course,  is  easily  regulated  by  the  physician  when 
the  indications  for  its  use  are  fully  understood.  I 
give  it  in  one-half  grain  doses,  repeated  every  three 
or  four  hours,  and  I  have  seldom  found  that  the 
above  dose  needed  to  be  increased.  A  smaller  dose 
is  sometimes  preferable,  especially  in  children.  I 
prefer  to  use  this  drug  in  the  form  of  gelatine-coated 
pills,  unless  it  is  desirable  to  not  administer  a  pill, 
or  when  smaller  doses  are  indicated  ;  for  these  pur- 
poses the  triturations  of  "hepar  sulphur."  of  the 
homoeopaths  are  satisfactory. 

So  certain  am  I  of  the  action  of  this  drug  in  in- 
flammation, that  I  have  not  found  it  necessary  for 
several  years  past  to  resort  to  leeching  in  any  case, 
however  severe,  and  I  am  scarcely  ever  obliged  to 
use  the  knife  for  the  relief  of  inflamed  tissues  any- 
where about  the  ear.  "When  large  collections  of  jius 
have  already  formed  in  the  subcutaneous  tissue,  it  is 
of  course  nearly  always  neeessaiy  to  lance  them 
promptly  ;  but  when  the  periosteum  of  the  mastoid 
process,  or  of  other  regions  near  the  ear,  becomes 
inflamed,  and  pus  threatens  to  form  beneath  it,  I  re- 
gard the  usual  operation  of  cutting  down  to  the 
bone  for  the  relief  of  this  condition,  before  giving 
I  the  drug  a  fair  trial,  as  not  only  unnecessary  for  the 
cure,  but  also  as  a  cruel  infliction  on  the  patient,  and 
likely  in  many  instances  to  very  much  aggravate 
the  case.  I  have  usually  found  that  the  early  ad- 
ministration of  the  calcium  sulphide    or  the  hejiar 


sulphur,  in  these  cases  very  promptly  relieves  the 
symptoms,  which  are  usually  thoxight  to  I'equire  the 
use  of  the  knife. 

Sometimes  the  pains  accompanying  the  acute 
aural  aflections  under  discussion  are  so  severe  that 
the  patient's  strength  rapidly  yields  to  their  de- 
pressing influence  ;  even  when  inflammation  setms 
to  yield  to  the  calcium  sulphide,  tliere  may  still  re- 
main very  severe  pains  in  and  about  the  ear  ;  these 
pains  are  not  always  constant  ;  they  are  worse  at 
night,  and  seem  best  liorne  when  the  patient  is  sit- 
ting up  or  walking  about ;  there  are  intervals  of 
immunity,  diuing  which  the  patient  experiences 
occasional  "  darts  "  of  pain  in  the  ear,  or  behind  the 
mastoid  in  the  region  supplied  by  the  occipitalis 
minor  nei-ve.  In  the  treatment  of  this  symptom  I 
do  not  think  the  best  course  always  is  to  benumb 
the  whole  system  for  the  relief  of  the  local  pain. 
Paradoxical  as  it  may  seem,  large  doses  of  morphia 
or  quinine,  both  of  which  drugs  I  have  seen  given 
freely  in  these  cases,  seem  at  times  to  increase  the 
discomfort.  Should  any  remote  influence  keeji  up 
the  pain  in  the  ear  through  sympathy  of  the  nerves, 
or  should  the  patient  be  siibject  to  facial  neuralgia, 
these  factors  must  be  weighed,  and  any  particular 
cause,  if  possible,  should  be  removed.  For  these 
pains  there  are  several  remedies  that  I  always  try 
before  resorting  to  the  profound  narcotics,  which, 
when  employed  extensively,  are  known  to  interfere 
with  nutrition  ;  I  allude  to  aconite,  Pulsatilla,  and  gel- 
seminum.  These  maybe  employed  in  varying  quan- 
tities, from  a  drop  of  the  tincture  down  to  a  minute 
portion  of  that  dose,  given  every  few  minutes  or  every 
few  hoiirs,  according  to  the  age  of  the  patient  and 
the  urgency  of  the  .symptoms.  The  pulsatilJa  seems 
best  indicated  in  the  acute  aural  attacks  of  children, 
while  of  the  other  two  remedies  it  may  be  said  that, 
while  their  action  seems  to  be  somewhat  similar,  yet 
in  some  cases  it  will  be  advantageous  to  try  both  of 
them,  giving  one  a  fair  trial  before  resorting  to  the 
other. 

"WTien  the  periosteum  of  the  inner  extremity  of 
the  external  auditory  canal  becomes  inflamed  from 
an  exten.sion  of  the  disease  of  the  middle  ear,  a 
more  prolonged  treatment  by  the  calcium  sulphide 
must  be  persisted  in,  and,  inasmuch  as  this  region 
contains  but  little  connective  tissue,  I  would  not 
advise  cutting  down  apon  the  integument,  for  pus  is 
scarcely  ever  found  ;  besides,  the  operation  is  ex- 
tremely painful. 

When  inflammation  extends  from  the  middle  ear 
to  the  pneiimatic  cells  of  the  mastoid,  the  effect  of 
the  sulphide  of  calcium  is  most  beneficial,  and, 
when  properly  administered,  the  gelatinous  collec- 
tions spoken  of  by  some  authorities  as  very  often 
indicating  the  use  of  the  trephine  have  not,  in  my 
experience,  given  rise  to  serious  consequences.  In  a 
very  considerable  experience  in  the  treatment  of 
several  aural  disease  with  this  drug,  I  have  never 
had  to  employ  the  trephine,  nor  have  I  ever  seen 
any  results  that  gave  rise  to  a  feeling  of  regret  that 
this  radical  procedure  had  been  avoided. 

I  may  hero  suggest  that  pirostitis  externa,  when 
attended  with  much  pain,  sometimes  subjects  tbe 
patient  to  unnecessarily  severe  treatment — to  oper- 
ations which  neither  always  relieve  the  pains  or 
prevent  brain-trouble  when  actually  impending. 
The  existence  of  pain  is  certainly  not  a  sufficient  in- 
dication per  .«e  for  resorting  to  the  operation  of  tre- 
phining the  mastoid  process,  for  it  is  by  no  means 
pathognomonic  of  danger  to  the  brain.  Could  we 
determine  when  inflammatory  products  in  the  mas- 


62 


THE  MEDICAL  RECORD. 


toid  were  liable  to  become  dangerous  to  life  when 
not  liberated,  we  could  readily  enough  secure  their 
escape  by  establishing  an  outlet  through  the  cortical 
substance  of  the  bone  by  means  of  the  trephine. 
The  results  of  this  ojieration  are  sometimes  by  no 
means  as  harmless  as  its  easy  performance  would 
indicate,  for  fatal  results  are  not  at  all  uncommon, 
and  we  may  in  any  case  convert  a  simiile  catarrhal 
inflammation  of  the  pneumatic  cells  into  a  most 
troublesome  ostitis.  Inasmuch  as  the  danger  of  ce- 
rebral complications  does  not  necessarily  arise  from 
the  pressure  of  pent-iip  secretions,  but  rather  from 
transmission  by  contiguity,  trephining  cannot  always, 
even  when  pus  is  liberated,  be  relied  on  to  prevent 
their  occurrence,  however  early  it  may  be  performed. 
In  acute  otitis  media  the  mastoid  region  maybe  gi-eat- 
ly  swollen  externally  ;  there  may  be  much  pain,  and 
yet  an  extension  of  the  middle-ear  inflammation  to 
the  dura  mater  may  take  place,  while  the  mastoid 
cells  remain  comparatively  free  of  any  complica- 
tion ;  under  such  circumstances,  if  pain  and  swelling 
of  the  peri-mastoid  tissues  were  to  be  taken  as  indi- 
cating the  necessity  for  trephining  the  mastoid,  we 
should  then  have,  were  the  operation  performed,  a 
serious  wound  of  this  lioue  added  to  the  other  grave 
conditious  that  attend  inflammation  of  the  meninges 
of  the  brain.  I  cannot  but  believe,  viewing  the 
matter  in  this  light,  that  the  operation  has  been 
needlessly  performed  in  a  gi-eat  many  instances.  It 
is  stated  by  most  authorities  that  this  operation  is 
usually  followed  by  the  relief  of  the  urgent  and 
threatening  symptoms,  together  with  the  pain.  It 
is  difficult  to  understand  how  this  can  be,  especially 
ia  caseH  where  cerebral  disease  arises  from  direct 
transmission  from  the  middle  ear  and  the  commu- 
nicating mastoid  antrum,  or  from  previous  absorp- 
tion from  the  mastoid  itself;  and  when  neuralgic 
pains  have  their  origin  in  other  parts,  relief  from 
this  operation  is  likewise  improbable. 

It  may  be  expected,  perhaps,  that  I  should  state 
under  what  circumstances  I  would  regard  this  oper- 
ation as  necessary.  Without  desiring  to  be  under- 
stood as  considering  it  always  an  inadmissible 
procedvire,  I  may  say,  that  since  adopting  these  mea- 
sures, no  necessity  for  considering  its  advantages 
has  arisen  in  my  own  practice. 

Wheu  inflammation  of  the  mastoid  cells  has 
passed  to  the  stage  of  caries  and  necrosis,  the  spon- 
taneous escape  of  the  products  of  inflammation  may 
be  expected  to  take  place  either  through  the  tym- 
panum, the  posterior  wall  of  the  external  ariditory 
canal,  or  the  cortical  substance  of  the  mastoid  pro- 
cess. As  previously  stated,  necrosis  of  the  mastoid 
cells  is  a  sequence  of  disease  of  the  mucous  ;)erios- 
teal  lining  of  the  cells,  and  seldom,  if  ever,  arises 
from  periostitis  externa.  It  is  important  in  caries 
of  the  mastoid  cells  to  maintain  an  uninterrupted 
flow  of  the  secretions  ;  the  outlet,  if  into  the  tympa- 
num or  tlie  external  auditory  canal,  should  be  kept 
free  of  granulations  and  polypous  gi-owth.s.  .\ny 
loose  sequestra  that  ))resent  near  the  orifice  of  either 
the  cortex  of  tlie  mastoid,  or  in  the  external  audi- 
tory canal,  should  be  removed  and  the  canal  should 
be  kept  clean.  Hollow  cotton-wool  dilating  tents, 
which  do  not  interfere  with  the  drainage  of  the  parts, 
are  available  when  the  canal  is  narrowed.  I  have 
found,  in  cases  where  an  outlet  existed  in  both  direc- 
tions, closure  of  the  sinus  leading  outwardly  through 
the  cortex  of  the  mastoid  could  very  often  be  advan- 
tageously brought  about  by  the  use  of  compresses, 
while  the  discharge  through  the  external  auditory 
canal  is  kept  free.     WHien  all  separated  sequestra 


have  been  removed,  the  sinus  being  dilated,  or  en- 
larged by  incisions  if  necessary,  and  fragments  of 
bone  extracted  with  forceps,  the  recovery  of  these 
cases  is  sometimes  very  rapid.  When  the  subject 
of  caries  and  necrosis  is  run  down  or  has  same 
dyscrasia,  the  general  treatment  becomes  of  the 
utmost  importance ;  in  these  cases  the  calcium 
suli^hide  proves  of  service,  especially  in  the  caries 
of  scrofulous  subjects.  The  trephine  or  gouge 
have  their  uses  in  some  of  these  cases  where  it  is 
necessary  to  enlarge  the  sinus  in  order  to  gain  ac- 
cess to  pathological  cavities  for  the  liberation  of 
sequestra. 

Before  sequestra  have  been  fully  sejjarated,  the 
removal  of  carious  bone  cannot  always  be  accom- 
plished without  doing  violence  to  healthy  structures, 
especially  when  we  are  unable  to  distinguish  Ije- 
tween  dead  and  living  stnictures  ;  healthy  bone  may 
in  this  manner  be  removed,  and,  by  tlms  setting  up 
ostitis,  an  extension  of  the  disease  may  be  brought 
about.  When  the  posterior  bony  wall  and  perios- 
teum of  the  external  auditory  canal  have  been  per- 
forated in  caries,  sequesti-a  presenting  in  this  locality 
can  very  readily  be  removed  Viy  gentle  manipula- 
tion ;  sometimes,  however,  the  integument  requires 
dilatation.  It  is  usually  necessary  to  tirst  bring 
away  the  abundant  granular  tissue  which  nearly  al- 
ways obstructs  the  canal,  as  well  as  fills  any  cavities 
in  the  mastoid.  The  point  of  perforation  in  the 
young  is  often  very  near  the  outlet,  where  the  sur- 
geon can  easily  see  what  he  is  doing.  Where  no 
loose  sequestra  are  found,  the  case  had  best  be  left 
to  the  eflbrts  of  nature  so  far  as  its  surgical  aspect 
is  concerned,  as  minute  portions  of  necrotic  tissue 
rapidly  pass  out  when  the  channel  is  clear,  while  a 
certain  quantity  is  absorbed.  In  some  instances  I 
have  reason  to  believe  that  sequestra  become  en- 
cysted ;  of  this,  however,  I  can  offer  no  absolute 
proof. 


SOTklE  POINTS  IN  THE  STUDY  OF  INSAN- 
ITY, DEVELOPED  BY  THE  GUITEAU 
TRIAL. 

Br  HOR.\TIO  R.  BIGELOW,  M.D., 

WASHINGTON,   ».    C. 

There  is  something  stupendo\is  in  the  iconoclasm 
of  modern  materialism.  Equally  stupendous  are 
the  scientific  vagaries  of  an  agnosticism,  that  is 
sceptic  of  all  else  but  Ego,  and  is  nihilistic  in  its 
utilitarianism.  The  agnostic  sees  in  himself,  in  the 
finite  personality  of  the  individual,  a  limitless  possi- 
bility for  the  solution  of  all  things.  For  him  there 
is  no  pale  beyond  which  man  may  not  tread.  Facts 
do  not  exist — they  are  empty  fashionings  of  imagi- 
nation, to  be  ove  itumed  at  any  time  by  judicious 
scepticism.  He  refuses  to  accept  anything  beyond 
the  boundary  of  his  fallible  reason.  Yet,  with  a 
charming  insouciance,  he  seeks  to  reconcile  most  in- 
harmonious factors  of  life,  and,  in  the  effort,  raises 
mysteries  and  stumbling-l>!ocks,  which  he  himself 
cannot  explain,  and  which  fairly  shame  the  most  as- 
tounding dogmas  of  the  theologians.  Of  imma- 
terial force  we  can  form  no  conception  that  is  not 
objective.  Of  the  primary  causes,  producing  abnor- 
mal outcome  of  this  immaterial  force,  we  have  only 
hy])othetical  and  untrustworthy  knowledge.  To  re- 
concile a  material,  tangible,  substantial  brain  with 
an  immaterial  psyche,  or  mind,  is  the  herculean 
tasks  which  modern  experts  in  insanity   have  as- 


THE   MEDICAL  RECOED. 


63 


sumed.  That  tlie  question  of  individual  responsi- 
liility  is  still  in  a  most  chaotic  condition  is  apparent 
from  the  testimony  adduced  in  the  Guiteau  trial. 
The  cherished  theories  of  only  half  a  decade  of  vears 
iilto  are  ruthlessly  overturned,  and  no  substantial  or 
Lifting  ones  erected  in  their  places.  A  man  of  straw 
is  set  up  to  explain  phenomena  which,  in  the  pres- 
ent state  of  science,  are  beyond  the  realm  of  legiti- 
mate inquiry.  We  know  absolutely  nothing  of  the 
ill  'ei'changing  chemico-molecular  action  of  the  brain. 
\  ither  have  we  ever  approached  a  just  apprehen- 
^1  ill  of  the  various  mental  states  which  such  reac- 
ti  m  is  supposed  to  occasion.  All  metaphysical  in- 
ti  ispections  of  subjective  states  of  consciousness  are 
im've  hypotheses  that  vary  with  the  individual  idio- 
- -iicrasy.  Xo  one  can  think  honestly  who  is  conscious 

;  thinking.  Post-mortem  examinations  give  us  no 
I' ithological  changes  in  the  brain  in  many  patients 
<1  ing  insane.  There  are  no  tests  known  to  science, 
I'lemical,  microscopical,  or  spectroscopic,  that  may 
determine,  in  a  large  jiercentage  of  sTich  cases,  just 
^vIult  cerebral  changes  have  taken  place.  Material- 
ism holds  that  brain  and  mind  are  coeval,  coexist- 
ing factors  of  life — that  with  the  death  of  one  there 
is  annihilation  of  the  other — and  yet  it  fails  to  satisfy 
us  of  the  peculiar  natiire  of  the  brain  lesion  which 
gives  rise  to  the  distorted  fancies  of  many  maniacs. 
AVhy  believe  the  one  and  deny  the  other?  Confess- 
ing our  lamentable  and  litter  ignorance  of  brain 
action,  it  is  wise  to  hold  to  the  old  creed  that  the 
brain  is  simply  the  material  organ  attuned  by  im- 
material forces.  Thus  believing,  we  find  an  easy 
s.iliitiMii  of  many  questions  which  materialism  befogs 
it ^. 'If  and  its  listeners  in  trying  to  unravel.  If  the 
oiLran  and  its  outcome  are  both  material,  we  are  sur- 
rounded by  greater  mysteries  and  larger  diflSculties 
than  ever  before.  We  have  been  told  very  recently 
that  there  is  no  such  thing  as  inherited  insanity,  that 
moral  insanity  is  only  another  name  for  depravity, 
and  that  specific  brain  lesion  always  accompanies 
the  insane  diathesis. 

A  few  years  ago  some  of  the  ablest  wi'iters  on  the 
special  subject  of  insanity,  both  at  home  and  abroad, 
defended  with  much  ability  the  existence  of  moral 
insanity,  and  it  found  its  approjiriate  place  in  the 
nomenclature  of  the  neuroses.  At  that  time  most 
experts  claimed  for  it  a  recognized  existence,  and 
even  now  there  are  many  practitioners  who  can  ac- 
count for  certain  phenomena  upon  no  other  assump- 
tion. Apart  from  any  transmitted  taint  of  heredity, 
we  are  the  product  of  association,  and  of  the  condi- 
tions of  society  in  which  we  are  jjlaced.  Depravity 
or  crime,  viewed  in  the  light  of  culture,  Christianity, 
and  education,  bears  quite  a  different  aspect  when 
seen  by  eyes  that  have  never  known  these  elevating 
and  refining  outcomes  of  civilization. 

The  depravity  of  the  ignorant  boor,  born  in  the 
slums  and  amid  the  dregs  of  society,  whose  associates 
from  the  cradle  to  manhood  have  been  vile  and  crimi- 
nal, whose  parents  were  ignorant  of  virtue,  and  whose 
knowledge  of  the  higher  aims  of  life  amounts  to 
nothing,  is  the  result  of  birth  and  association.  But 
when  a  gentleman  of  position,  whose  successive 
gradations  from  infancy  to  manhood  have  been 
watched  by  zealous,  loving,  and  honorable  eyes, 
whose  relations  have  been  refined  and  elevating, 
who  has  been  taught  to  discriminate  between  good 
and  evil,  and  whose  business  successes,  founded 
upon  honest  dealinc,  have  proved  to  him  that  "hon- 
esty is  the  best  policy" — when  such  a  one,  withnut 
warning  or  intimation,  suddenly  breaks  out  into  vio- 
lent and  uncontrollable  \ice,  it  is  insanity,  and  not 


depravity.  Yet  such  admission  does  not  carry  with 
it  any  immunity  of  law  for  the  commission  of  a 
criminal  act.  It  is  not  at  all  inijuobable  or  im]i08- 
sible  that  there  may  be  moral  oViloquy  with  intellec- 
tual .soundness.  The  moral  and  the  intellectual  de- 
pend upon  different  processes.  Of  the  intellectual 
we  are  slowly  learning  from  physiology,  but  much  of 
the  actual  conditions  engendering  perception,  con- 
ception, and  will  we  can  never  know.  Of  the  birth, 
growth,  and  life  of  morality  we  know  absolutely 
nothing.  A  man  may  have  a  high  sense  of  honor 
in  regard  to  certain  decrees  of  the  moral  code,  and 
be  recreant  to  all  the  others,  and  this  without  any 
degeneration  of  intellect.  Becauseof  our  inability  to 
locate  the  pathological  change,  shall  we  refuse  to 
recognize  certain  phenomena  as  characteristic  of  in- 
sanity which  we  admit  in  those  cases  wherein  the 
abnormal  process  has  been  made  out  ?  It  is  because 
the  intellectual  faculties  are  not  radically  disturbed 
that  moral  lunatics  are  responsible  in  the  eyes  of 
the  law.  If  the  intent  of  the  law  is  preventive  of 
crime  and  preservative  of  morality,  then  are  all  men, 
sane  or  insane,  equally  responsible.  Cases  are  of 
record  in  which  the  intellect  has  been  deranged  in 
one  single  division  only  out  of  its  manifold  manifes- 
tations ;  and  it  is  not  rare  to  find  one  deranged  as  to 
intellect,  yet  sane  in  matters  of  morality.  The  con- 
verse is  equally  true.  The  entire  moral  outcome 
may  be  faulty,  and  the  intellectual  differentiation  be- 
tween right  and  -wrong  f(ntltlesi<.  Morbid  impulses, 
which  are  the  underlying  jjrinciples  of  these  con- 
ditions of  mental  erythism,  are  very  frequently  of 
this  nature.  It  is  perfectly  j^ossible  for  one  of  neu- 
rotic temperament,  with  predisposition  to  mental 
instability,  to  realize  the  enormity  of  a  vicious  ac- 
tion, and  yet  to  feel  incapable  of  resisting  the  im- 
pulse that  drives  him  on.  Until  science  shall  en- 
lighten us  further,  I  cannot  see  how  we  can  escape 
the  separative  and  distinctive  terminology  of  igno- 
rance, depravity,  and  moral  insanity.  As.^uming  that 
there  are  factors  at  work  in  the  production  of  insan- 
ity which  pathology  has  failed  to  locate,  and  whose 
action  is  not  demonstrable,  the  argument  is  purely 
tentative  which  defines  mental  disease  as  an  evidence 
j  of  cerebral  lesion.  This  is  a  mere  material  hypothe- 
I  sis,  which  has  not  even  the  balance  of  proof  in  its 
[  favor.  It  is  founded  upon  two  finite  jiremises  :  1st. 
With  brain  developed  we  have  an  outcome — mind. 
1  2d.  With  an  undeveloped  brain,  and  at  death,  mind 
■  ceases  to  exist.  The  fallacy  is  apparent.  A  force 
once  originated  is  never  lost.  An  immaterial  agency, 
of  which  we  can  form  only  speculative  deductions, 
can  manifest  itself  only  imperfectly  through  a  badly 
arranged  medium,  and  cannot  work  at  all  if  the 
medium  does  not  exist.  Consciousness  has  no  Jjhys- 
ical  counterpart  in  cerebral  action.  We  cannot  de- 
fine or  locate  its  creative  seat,  and  we  are  in  perfect 
ignorance  of  any  molecular  action  originating  it. 
Evolution  signally  fails  to  span  the  abyss  between 
amorphous  matter  and  a  potential  molecule — be- 
tween an  inert  atom  and  sentience.  Sentience  could 
hardly  evolve  itself,  unless  it  be  granted  that  sen- 
tient molecules  have  always  been,  and  were  the  pri- 
mary factors  of  conscious  creations.  The  vital  cre- 
ative act  from  amorphous  protojilasm  to  sentience 
is  beyond  the  logic  of  the  evolutionist.  Does  po- 
tentiality exist  in  the  cerebral  molecule?  If  so, 
what  are  its  special  characteristics,  its  chemical  re- 
actions, and  its  microscopic  appearance?  How  does 
the  potential  molecule  of  the  brain  differ  from  the 
inert  molecule  in  other  parts  of  the  body?  Is  con- 
sciousness the  result  of  molecular  reaction  ?     If  so, 


64 


THE  MEDICAL  RECORD. 


■what  is  the  nature  of  the  reaction  ?  What  appear- 
ance does  the  molecule  assume  in  cases  of  disease  ? 
To  assert  that  all  cases  of  insanity  tiepend  upon 
brain  lesion  is  a  mere  empty  bandying  of  terms, 
when  the  lesion  cannot  be  found,  is  demonstrated. 

A   EEMAEKABLE   GUNSHOT    WOUND    OF 

THE  ABDO?*IEN,  WITH  RECOVERY. 

Br  J.  A.  KAFTEE,  M.D., 

WHITING,    KANSAS. 

On  the  evening  of  October  12, 1881, 1  was  summoned 

to  see  I.  S ,  a  boy  about  fifteen  years  of  age,  who 

had  been  shot  in  the  abdomen  with  a  shot-gun.  At 
the  time  it  was  discharged,  the  muzzle  of  the  gun 
was  about  a  foot  from  the  boy's  body.  When  I 
reached  him  he  was  almost  in  a  state  of  collajj-se. 
The  shock  to  his  nervous  system  was,  of  course,  in- 
tense. There  had  been  at  first  excessive  hemorrhage, 
but  it  had  ceased  before  my  arrival.  He  had  fallen 
to  the  ground  and  vomited  immediately  after  being 
wounded.  On  examining  the  wound,  I  found  that 
the  charge  had  entered  the  abdomen  two  and  one- 
half  inches  to  the  left  and  two  inches  below  the 
umbilicus,  making  a  terrible-looking  opening,  nine 
and  one-half  inches  in  circumference,  tearing  away 
the  abdominal  muscles  to  that  extent,  and  leaving 
his  intestines  exposed  and  powder-burnt,  and  the 
intestinal  liquid  was  plainly  to  be  seen  oozing  from 
them  at  several  points. 

On  turning  him  over,  I  found  that  the  charge  had 
passed  through  him,  shattering  the  ilium,  and  com- 
ing out  at  a  slightly  lower  level  than  it  had  entered, 
and  a  trifle  nearer  the  lateral  aspect  of  the  body. 
The  posterior  wound  was  the  smaller  ;  its  lips  were 
protruding  and  lacerated,  due  to  the  lodgement  of 
gun-wadding,  joieces  of  coat,  vest,  pantaloons,  and 
shirt,  which  had  been  driven  throiigh  him.  I  re- 
moved all  these,  together  with  several  pieces  of 
bone.  When  I  again  examined  the  anterior  wonnd, 
I  found  that  considerable  fecal  gas  and  fluid  had 
escaped  from  it.  I  called  the  attention  of  several 
gentlemen  who  were  present  to  this  oecnn-ence, 
and  they  were  all  certain  that  the  escaped  fluid  had 
the  characteristic  odor  of  f;eces,  a  fact  of  which  I 
am  also  positive.  Carefully  cleaning  away  all 
foreign  particles,  and  covering  the  wound  with  anti- 
septic dressings,  I  brought  the  patient  fully  under 
the  influence  of  opium,  by  giving  laudanum  in 
divided  doses,  combined  with  whiskey.  After  in- 
forming the  parents  that  the  intestines  were  lacer- 
ated and  recovery  improbable,  I  directed  them  to 
summon  the  coroner  that  he  might  take  such  steps 
in  the  case  as  he  deemed  expedient,  as  the  shooting 
had  been  done  by  an  elder  brother.  The  next  morn- 
ing I  met  the  coroner.  Dr.  Scott  (a  most  excellent 
surgeon),  in  consultation.  He  considered  the  case 
hopeless,  for,  altliough  the  boy  had  rallied  consider- 
ably from  the  shock,  his  bowels  were  at  this  time 
very  tender,  marked  tympanitis  being  present.  The 
left  testicle  was  also  swollen  and  tender. 

The  treatment  ordered  was  nuti-itious  diet,  all 
the  milk  and  brandy  the  patient's  stomacli  would 
bear,  and  opium  enough  to  check  all  peristaltic  ac- 
tion, and  keep  him  perfectly  quiet ;  and,  as  his  liy- 
gionic  surroundings  were  bad  in  the  extreme,  his 
father's  house  being  situated  in  the  timber,  on  the 
bank  of  Straight  C/reek — a  stream  notoriously  mala- 
rial— I  directed  him  to  be  given  quinine  and  salicylic 
acid,  three-grain  doses  once  in  two  hours,  and  his 
wounds  to  bo  dressed  as  often  with  antiseptic  cot- 


ton and  carbolized  oil.  At  my  next  visit,  October 
14th,  I  found  the  tenderness  and  tympanic  reso- 
nance had  partly  disappeared.  The  boy  was  nnable, 
however,  to  pass  his  urine  ;  I  was  comjielled  to 
draw  it  with  a  catheter,  as  I  also  did  for  several 
days  thereafter,  till  I  deemed  it  prudent  to  in- 
corporate sp.  nit.  ether  with  the  laudanum,  when 
this  trouble  entirely  disappeared.  At  subsequent 
visits,  October  15th,"  IGth,  17th,  there  was  no  mate- 
rial change  in  my  patient's  condition.  The  abdom- 
inal tenderness  had  entirely  disappeared.  On  the 
18th  of  October  I  noticed  that  pus  was  beginning  to 
form,  and  at  this  time  the  general  appearance  of 
both  wounds  was  most  unpromising. 

There  was  nothing  to  note  on  the  19th  and  20th, 
except  that  the  boy  was  growing  weaker,  and  pus 
was  forming  in  more  abundance.  The  discharge 
from  the  posterior  wound  was  not  great,  and  was 
sanious  in  character.  ThatHhe  wound  was  not  dis- 
charging as  much  as  was  generated  was  plain.  This 
was  due  to  the  obstruction  by  the  intestines  of  the 
shot-tract. 

The  boy's  temperature  began  to  rise,  reaching 
102^°  F.,  pulse  corresponding  to  temperature.  The 
discharge  from  the  posterior  wound  became  more 
profuse  as  time  passed,  but  j^ressure  on  the  abdo- 
men in  the  vicinity  of  the  anterior  opening  would 
cause  extremely  ichoroits  pus  to  well  forth  in  great 
abundance.  Something  had  to  be  done  to  drain 
away  the  fast  accumulating  discharge,  or  my  pa- 
tient's life  would  pay  the  forfeit.  I  resolved  to 
make  an  efl'ort  to  drain  the  wound.  I  introduced  a 
gum  elastic  catheter  into  the  posterior  wound,  and, 
after  considerable  difficulty,  .succeeded  in  getting  a 
communication  between  the  jjosterior  and  anterior 
wounds.  I  then  attached  to  the  catheter  a  i)erfo- 
rated  rubber  tube,  and  carefully  drew  it  through  the 
body.  The  pus  at  once  began  to  discharge  freely,' 
and' for  the  first  half-hour  after  the  insertion  of  the 
tube  fully  a  tablespoonful  of  matter  escaped.  After 
this  time  his  temi^erature  became  lower.  The  wound 
drained  very  nicely,  discharging  a  large  quantity  of 
pus. 

Up  to  this  time  no  action  from  the  bowels  had 
taken  place.  I  ordered  an  injection,  but  with  nega- 
tive results.  It  was  repeated  on  the  following  day, 
when  a  large  quantity  of  ficces  was  expelled.  I  at 
once,  and  in  the  presence  of  several  intelligent  gen- 
tlemen, examined  the  discharge,  and  found,  as  I  ex- 
pected, a  number  of  shot,  which  were  preserved  by 
one  of  the  gentlemen  present  and  myself.  They  are 
ordinary  bird-shot  Xo.  3. 

I  do  not  wish  to  detail  the  subseciueut  progres- 
sion of  this  remarkable  case.  Suffice  it  to  say  its 
history  was  one  of  improvement.  The  treatment 
given  was  followed,  with  what  alterations  I  deemed 
prudent.  The  opium  was  discontinued  after  the 
first  ten  or  twelve  days.  Stimulants  were  used 
freely ;  milk  and  nutritious  diet  crowded.  Pieces 
of  bone  became  detached  and  removed  from  time 
to  time.  As  long  as  much  discharge  continued,  the 
drainage  was  used  as  a  sort  of  safety-vnlve.  The 
boy  has  now  so  fur  recovered  as  to  be  about  the 
house  ;  the  wound  has  nearly  healed.  His  h-ft  leg  is 
yet  weaker  than  tlie  right,  but  he  walks  without  difli- 
culty,  and  I  anticipate  a  complete  recovery. 


De.\ths  prom  Fj.EfTnicrrY. — Several  deaths  from 
electricity  have  now  been  reported.  They  were 
caused  by  accidental  collision  with  the  conducting 
wires  supplying  electric  lights. 


THE  MEDICAL  RECORD. 


65 


DEATH  FROM  GELSEJUUIM,  PRESCRIBED 
BY  AN  E^HPIRIC. 

By  a.  L.  hall,  M.D., 

FAIRHATEK.  N.  Y. 

To  the  history  of  the  following  case  is  attached  a 
double  siguiticanoe,  illustrating,  as  it  does,  the  letlial 
eflfects  of  a  drug  the  action  of  which,  until  the  recent 
investigations  of  Bartholow,  was  imi:)erfectly  under- 
stood— also  as  teaching  most  forcibly  the  necessity 
of  a  strict  enforcement  of  all  requirements  pertain- 
ing to  the  practice  of  medicine. 

On  Thursday,  December  22,  1881,  at  7  a.m.,  was 

called  to  see  Mrs.  C ,  a  strong,  robust  lady,  aged 

35  years.  The  messenger  bade  me  come  quickly,  as 
she  was  dying.  Arriving  as  speedily  as  possible,  I 
foijnd  my  services  of  no  avail,  she  having  breathed 
her  last  as  I  entered  the  room.  On  examination,  I 
noted  the  following  :  General  appearance  life-like  ; 
skin  moist ;  body  warm,  with  slight  coldness  of  the 
extremities  ;  drooping  of  eyelids  ;  relaxation  of  the 
lower  jaw  ;  the  mouth  presenting  an  oval  appear- 
ance. On  raising  the  eyelids,  the  pupils  were  found 
widely  dilated,  as  much  as  the  most  liberal  applica- 
tion of  atropia  is  capable  of  producing.  (The  reader 
of  this  may  incline  to  criticise  the  above  as  being 
simply  death  changes  common  to  and  occurring  in 
all  cases  of  death,  of  whatever  cause  ;  but  from  such 
an  opinion  I  dissent,  as  the  cadaveric  expression 
rapidly  supervened,  and  as  the  above  conditions 
make  the  complement  to  a  class  of  symptoms  ob- 
tained from  the  friends.) 

Deceased  had  acute  bronchitis,  for  which,  the  first 
week,  no  treatment  was  adopted.  Gradually  becom- 
ing worse,  the  services  of  a  quack,  on  the  Tuesday 
evening  preceding,  were  called  into  requisition,  his 
last  visit  being  about  twelve  hours  before  death.  At 
this  time  he  stated  to  the  friends  that  "  her  bron- 
chial tubes  were  badly  inflamed,"  and  he  should 
have  to  prescribe  "  more  powerful  medicines,"  the 
administration  of  which  at  first  produced  a  soothing 
eflfect.  Later  in  the  night,  the  patient  complained 
of  a  "  strange  feeling  ;"  had  double  vision  ;  respira- 
tions were  labored,  and  general  muscular  weakness 
was  noted.  Notwithstanding  she  grew  rapidly  worse, 
the  medicine  was  continued  every  third  hour,  and 
at  about  6  a.m.,  against  her  wishes,  the  last  powder 
was  given.  Soon  after,  her  husband  found  her  in 
what  he  termed  a  "  fit  without  spasms,"  incapable  of 
movement  or  speech,  and  the  respirations  labored  and 
shallow.  At  this  point  medical  assistance  was  again 
sought ;  the  prescriber  of  "  more  powerful  medicine  " 
preferring  to  lie  in  bed  rather  than  respond  to  early 
calls,  I  was  summoned,  as  before  related. 

Classically  arranging  the  foregoing  symptoms,  we 
have  :  drooping  of  the  e'^  elids,  double  vision,  widely 
dilated  pupils,  respirations  labored  and  shallow,  re- 
laxation of  the  lower  jaw,  oval  appearance  of  the 
mouth,  loss  of  speech,  great  muscular  weakness,  and 
free  perspiration.  To  which  add  a  feeble  and  weak- 
ened heart's  action,  and  aU  the  characteristic  sym- 
toms  of  gelsemium-poisoning  are  present. 

Procuring  one  of  the  powders,  and  subjecting  it 
to  a  qualitative  analysis,  it  readily  responded  to  the 
tests  for  gelsemium.  From  gross  appearances.  I 
estimated  tlie  quantity  in  each  powder  at  two 
grains  of  geheminm  and  eight  grains  of  cinchonidia 
sulphas,  the  former  article  as  prepared  by  Parke, 
Davis  k  Co.,  of  Detroit.  Upon  their  laViels  of  the 
above  article  is  written:  "Dose — One-fourth  of  a 
grain ,  to  be  gradually  increased."   But  this  empiric^ 


imbued  with  the  usual  spirit  of  liberality  common 
to  his  class,  has,  for  the  benefit  of  suffering  human- 
ity, in  this  and  three  other  cases,  generously  jire- 
scribed,  as  the  initial  dose,  two  grains,  to  be  repeated 
every  three  hours,  with  results  which,  but  for  the 
timely  good  sense  of  his  patients,  would  have  been 
as  disastrous  as  in  the  present  instance.  In  all  of 
these,  decided  and  alarming  symptoms  followed  the 
administration,  such  as  diplopia,  ptosis,  dilated  pu- 
]>ils,  muscular  weakness,  and  labored  respirations. 
The  amount  taken  was  ascertained  to  be  respectively 
two,  tliree,  and  four  grains,  in  the  above  cases,  and 
about  eight  grains  in  the  one  whose  history  is  given. 
The  friends  of  his  victim,  fully  believing  that 
death  resulted  fi-om  the  administration  of  the  medi- 
cine, are  deterred  from  jirosecution  through  fear  of 
the  body  having  to  lie  exhumed,  in  order  to  obtain 
]iositive  evidence  sufficient  to  convict  him.  In  con- 
clusion, I  would  express  a  hope  of  rej5orting,  at  no 
distant  day,  that  active  measures  have  been  under- 
taken for  the  punishment  and  repression  of  the  dis- 
penser of  "more  poa-erful  medicine,"  also  the  result 
of  such  action. 


A  CASE  OF  PROFOl"XD  UE.E1IIC  POISON- 
ING IN  AN  INFANT,  DFE  TO  AN  ELON- 
GATED .\ND  CONTRACTED  PREPUCE. 

By  CHAELES  A..  HAKT,  M.D., 

SCRGEOS-IX-CHIEF   SICHI.E.NEERG  HOSPITAL,  PLAINFIELD,  N.  J. 

O.  H.  F ,  born  in  Plainfleld,  December  14,  1881, 

of  average  size  but  poorly  nourished,  weighing  only 
four  pounds.  All  the  natural  functions  were  jjrop- 
erly  performed,  except  he  was  a  little  slow  in  uri- 
nating ;  an  examination  showed  a  long  prepuce  with 
an  exceedingly  small  orifice.  Circumcision  was  de- 
termined upon,  but  deferred  until  the  mother  had 
rallied  from  her  confinement. 

Eveiything  progressed  favorably  until  December 
22d,  eight  days  after  birth,  when  I  was  hastily  sum- 
moned to  see  the  child.  Being  some  distance  away 
I  did  not  reach  the  case  until  midnight,  when  the 
following  conditions  were  found:  pupils  widely  di- 
'ated,  skin  suflused ;  pulse  small  and  thready  :  pro- 
found stupor.  The  mother  stated  that  the  child  had 
been  in  the  above  condition  all  day,  refusing  to  nurse 
or  be  roused.  The  urine  had  not  been  voided  since 
the  night  before.  Palpation  of  the  abdomen  re- 
vealed the  bladder  distended  above  the  umbilicus. 
The  act  of  percussion  caused  the  child  to  void  fully 
six  ounces  of  urine.  Circumcision  was  immediately 
jierformed.  Dense  glandulo-preputial  adhe.'ions 
were  found  and  broken  up.  The  prejiutial  orifice 
was  a  mere  pinhole.  In  a  few  hours  the  child  be- 
gan to  nurse  and  evince  more  vitality.  The  bladder 
was  paralyzed  from  over-distention,  and  did  not  re- 
gain contractile  power  for  two  days,  it  being  f  mp- 
tied  by  pressure  over  the  pubes.  All  symptoms  of 
ursomic  disturbance  completely  disappeared  in  about 
two  days  ;  since  then  everything  has  been  satisfac- 
tory. 

The  above  case  is  the  second  of  the  same  type 
which  has  come  under  my  notice.  The  first  was 
aboiit  four  years  ago,  in  a  eVild  three  years  of  age  : 
full  ursemic  .symptoms  existed,  and  convulsions  had 
been  occarrins  for  several  hours.  DeMth  took  place 
in  less  than  thirty  minutes  from  the  time  I  entered 
the  house.  He  had  a  long,  tight  fcreskin,  and  his 
mother  stated  that  he  had  always  been  troubled  in 
making  his  water.     He  had  been  medicated  for  va- 


66 


THE  MEDICAL  RECORD. 


rioua  maladies,  some'of  them,  evidently,  of  a  ner- 
vous character. 

The  explanation  of  the  symptoms  in  the  first  case 
is  entirely  meclianical.  The  urine  backed  up  from 
the  bladder,  compressed  the  kidneys,  and  without 
relief  would  iindoubtedly  have  resulted  in  death. 

I  am  convinced  that  like  conditions  occur  more 
frequently  than  is  suspected  by  the  profession,  and 
many  cases  of  infantile  convulsions  and  nervous 
maladies  will  be  found  to  depend  upon  preputial 
abnormalities.  For  years  I  have  given  this  suliject 
close  study  and  observation,  and  am  surprised  at 
the  number  and  diversity  of  nervous  troubles  aris- 
ing from  this  source.  A  practical  point  in  the  care 
of  cases  of  udandulo-preputial  adhesions  •  is.  after 
their  destruction,  the  observance  of  particular  care 
in  the  daily  retraction  of  the  foreskin  and  rigid 
cleanliness.  A  neglect  of  this  for  a  few  days,  some- 
times a  few  hours,  will  result  in  the  reformation  of 
iidliesions  and  return  of  reflex  symptoms. 


Hc^jorts  of  tjos^jitals. 


COOK    COTIXTY    HOSPITAL,    CniCAGO. 

CURIOUS   SrrUATION    OF   ANBUKISM   OF   THORACIC   AORTA 
— AX   rNTERESTmS   AUSCULTATORY   SIGN. 

I  lU-iiovtcil  by  Dn.  G.  F.  Bk-Idlet.) 

AiiBERT  F-  — ,  aged  thirty-six,  a  laboi-er,  was  ad- 
mitted March  1,  1880.  He  had  a  strong  constitu- 
tion, and  with  the  exception  of  typhoid  fever  when 
a  youth,  had  always  enjoyed  excellent  health.  His 
history  records  that  gonorrhoea,  one  year  ago,  lias 
been  his  only  venereal  trouble.  During  the  past 
few  years  has  led  a  roving  life  in  the  Western  wilds  ; 
has  undergone  many  hardships.  He  noticed  no 
signs  of  failing  health  until  four  months  ago,  when 
he  began  complaining  of  hoarseness,  substernal 
and  laryngeal  soreness,  and  a  dry,  harsh  cough. 
Two  months  ago  liad  a  second  and  more  severe  at- 
tack of  these  symptoms,  accompanied  by  fever  and 
dysjHKS*.  The  dyspun^i  has  become  more  annoying 
during  the  past  month.  Pain  in  sternal  region  still 
continues,  and  lately  he  has  been  complaining  of 
deep  pain  in  the  left  infra-axillary  region.  His  face 
is  rather  pale  ;  skin  moist ;  pulse,  112  and  feeble  ; 
temperature,  101°  ;  respiration,  30 ;  is  most  comfort- 
able when  lying  on  back  and  left  side.  Left  side 
of  chest  more  prominent  than  right ;  motion  re- 
stricted on  left  and  exaggerated  on  right  side.  When 
the  ear  is  placed  near  his  mouth  while  he  makes  a 
slow  expiration,  a  distinct  puff  is  heard  with  each 
systole.  Vocal  fremitus  on  right  side  normal :  on 
left,  absent ;  percussion  over  upper  half  of  left  .side 
tympanitic.  Area  of  pnccordial  dulness  absent. 
Heart-sounds  normal,  but  feeble.  No  bruit  audible, 
(lomplains  of  tlatiiliMice,  and  at  times  vomiting. 

During  the  month  and  a  half  following  admission 
but  little  change  was  noticeable,  except  that  the 
lower  third  of  the  left  side  of  thorax  became'flat  'on 
percussion. 

April  2:j,  1880,  while  in  the  sitting  posture,  liic- 
moptysia  to  tlie  extent  of  six  ounces  of  blood  oc- 
curred and  he  died  immediately. 

l',iM-uiiirte:m,  twenty-four  hours  after  death.  The 
flame  of  a  liglited  taper  held  at  a  point  of  left  side 
of  the  thorax  at  which  an  incision  was  made,  was 


blown  away  from  the  body,  showing  that  air  or  gas 
was  present  in  the  chest.  The  chest-cavity  con- 
tained about  one  pint  of  brownish  fluid.  No  evi- 
dences of  pleuritis ;  left  lung  from  base  to  apex  very 
hai'd,  and  dark  red,  almost  black,  not  containing 
a  bubble  of  air,  and  resembling  the  tissue  of  the 
spleen.  JMicroscopic  examination  showed  that  the 
au'-cells  were  completely  tilled  with  blood  ;  no  signs 
of  pneumonia ",  no  blood  in  interlobular  tissue.  In 
the  anterior  surface  of  left  main  bronchus,  about  one 
and  one-half  inch  from  bifurcation  of  the  trachea, 
could  be  seen  an  opening  about  one-quarter  inch  in 
diameter,  leading  into  a  sacculated  aneurism  of  the 
inferior  surface  of  the  transverse  portion  of  the 
aorta.  The  outside  diameters  of  the  aneurismal 
tumor  were  antero-posteriorly  one  and  one-half 
inch  ;  laterally,  two  inches.  The  tumor  contained 
about  three  drachms  of  blood  and  numerous  1am- 
iniE  of  fibrinous  material.  Heart  structure  normal. 
The  case  is  interesting  not  only  for  the  curious  situ- 
ation of  the  aneurism,  but  also  for  the  pneumotho- 
rax occuri'ing  without  a  i-u2>ture  of  the  lung. 

During  my  service  in  the  hospital  I  was  fortunate 
enough  to  observe  six  cases  of  thoracic  aneurism, 
in  all  of  which  there  could  be  heard  a  distinct  p^iff 
whenever  the  patient  made  a  prolonged  expiration, 
and  the  ear  of  the  listener  was  placed  in  close  prox- 
imity to  patient's  mouth. 


BELLEVUE  HOSPIT.AL,  N.  Y. 

rTHE^SALICYLIC   TREATMENT   AND   HEART   AFFECTIONS. 

At  a  recent  clinic  at  Bellevue  Hospital,  Professor 
Flint,  Sr.,  presented  a  young  man  who  was  suffer- 
ing from  rheumatic  pericarditis.  He  was  admitted 
to  the  hospital  because  of  an  attack  of  rheumatism, 
which  came  on  three  days  previously,  and  was 
limited  to  the  ankle  and  knee-joints.  It  was  his  first 
attack ;  there  was  no  evidence  of  disease  of  the 
heart.  The  treatment  consisted  in  the  administra- 
tion of  the  salicylic  mixture,  each  dose  of  which 
contained  twenty-two  and  one-half  grains  of  salicylic 
acid,  every  three  hours  ;  one-half  drachm  of  bicar- 
bonate of  soda  every  three  hours,  and  lead  and 
opium  wash  applie.l  to  the  knee.  Two  days  after 
the  patient's  admission  the  swelling  and  pain  in  the 
joints  were  much  diminished,  and  on  the  third  day 
had  almost  entirely  disappeared.  Professor  Flint 
thought  it  was  fair  to  conclude  that  the  treatment 
had  prevented  the  further  progress  of  the  rheumatic 
affection  of  the  joints.  The  day  following  his  ad- 
mission a  double  pericardial  friction  murmur  was 
heard,  which  was  followed  by  an  effusion  into  the 
pericardial  sac,  and  five  days  later,  the  iloublo  mur- 
mur having  disappeared,  a  systolic  endocardial  mur- 
mur was  heard  over  tlie  a])ex.  Professor  Flint  took 
occasion  to  remark  in  this  connection  the  import- 
ance of  giving  a  sufficient  amount  of  the  alkalies  to 
render  and  keep  the  urine  alkaline,  and  thus  dimin- 
ish the  liability  to  the  heart  complication.  Tlie  .sali- 
cylic acid  or  the  salicylate  of  soda  treatment  of  the 
joint  was  proper,  but  it  did  not  prevent  the  heart 
from  becoming  affetrted.  He  had  observed  that  rheu- 
matic pericarditis  and  endocarditis  were  more  com- 
mon since  the  introduction  of  the  salicylic  acid 
method  of  treating  rheumatism  than  before,  when 
the  alkaline  method  was  relied  upon  almost  entirely, 
and  it  was  due  to  the  fact  that  the  j)hysieian  neg- 
lected to .  render  the  urine  alkaline  by  giving 
alkalies. 


THE  MEDICAL  RECORD. 


67 


QUEBRACHO   IN   ASTHMA. 

Pfofessor  Flint  also  presented  a  lad,  thirteen  years 
of  age,  who  was  suifering  from  asthma,  emphysema, 
and  bronchitis.     His  father  had  had  asthma.     The 
patient  l>egan  to  sillier  from  attacks  of  dyspnoea 
when  six  years  of  age,  and,  although  asthmatic  at- 
tacks often  began  early  in  life,  they  seldom  began  so 
early  as  the  sixth  year.     Xone  of  a  number  of  bro- 
thers and  sisters  had  the  disease.    The  attacks  came 
on  once  a  month,  sometimes  not  oftener  than  once  in 
three  months,  and  during  his  residence  in  Kansas,    | 
where  he  went  from  New  York  City  to  spend  two 
years,  he  was  free  from  his  trouble  a  number  of 
months  ;  but  after  his  return  to  New  York  City  he 
had  an  attack  nearly  every  week.     Professor  Flint  I 
remarked  in  this  connection  that  the  climate  of  Kan-   1 
sas,  and  more  particularly  that  of  Colorado,  had  been   | 
spoken  of  very  highly  by  some  as  being  favorable  to 
the  affections  from  which  the  patient  was  sufl'ering. 

The  treatment,  during  the  attacks  of  dyspncpa, 
consisted  in  the  administration  of  the  fluid  extract 
of  quebracho,  fifteen  minims  every  hour. 

THE   TREAT^LE^•T   OP   HTDltOCELE,    .■ 

On  December  15,  18S1,  at  the  same  hospital.  Dr. 
Weir  presented  four  cases  of  hydrocele,  performing 
four  different  operations  for  their  radical  cure,  viz., 
in  the  first  case  injecting  the  tincture  of  iodine  into 
the  sac  containing  the  fluid,  in  the  second  injecting 
pure  carbolic  acid,  in  the  third  injecting  a  ten  i:)er 
cent,  solution  of  carbolic  acid,  and  in  tlie  fourth 
case  performing  Volkmann's  ojieration.  In  the  latter 
case  there  was  found  to  be  considerable  inflamma- 
tion and  thickening  in  the  sac,  and  it  was  not  ex- 
pected that  the  patient  would  I'ecover  so  soon  as  if 
it  were  a  simple  case.  One  week  later  the  jjatient 
on  whom  the  pure  carbolic  acid  injection  was  made 
was  again  presented  at  the  clinic,  and  the  inflamma- 
tion and  enlargement  had  almost  entirely  subsided. 
The  advantage  of  this  method  over  that  by  the  in- 
jection of  the  tincture  of  iodine  was  that  there 
resulted  less  serous  exudation  prior  to  adhesion  of 
the  two  opposing  surfaces  of  the  tunica  vaginalis. 

[iodide    OF^POTASSIUMJiN   SHALL   DOSES. j 

Although  it  is  the  fashion  at  present  to  prescribe 
large  doses  of  iodide  of  potassium  in  syi^hilis,  with 
the  view  of  obtaining  rapid  and  permanent  results,   ] 
there  are  a  number  of  hospital  physicians  and  sur- 
geons who  still  believe  in  the  efficacy  of  small  doses 
of  this  drug  in  that  and  other  diseases  in  which  it   1 
is  employed.   Professor  A.  Clark,  for  instance,  rarely,   j 
if  ever,  administers  the  salt  in  doses  exceeding  ten 
grains  three  times  daily,  while  other  physicians"are 
content  with  half  that  amount. 

-A  fact  worthy  of  consideration  in  this  connection 
is  that  the  smaller  doses  have  a  marked  eifect  upon 
those  patients  who,  by  the  previous  use  of  tonics, 
are  in  a  good  receptive  condition  for  any  of  the 
powerful  eliminatives.  ]\Iore.  in  fact,  apjiears  to  Ije 
due  to  the  good  condition  of  the  patient  at  the  time 
than  the  size  of  the  dose  administered.  If  there  is 
a  good,  solid  constitutional  foundation  to  woi-k  upon, 
the  utmost  reliance  can  be  jjlaced  upon  small  doses 
of  any  medicine.  This  seems  to  be  pre-eminently 
the  case  with  iodide  of  potassium. 


The  New  Saint. — In  honor  of  Saint  Joseph  Labre, 
the  pilgrim  of  Boulogne-sur-Mer,  who  was  recently 
canonized  at  Home,  the  Catholic  University  of  Lille 
has  founded  a  chair  in  the  Faculty  of  Medicine,  and 
endowed  it  with  100,000  fi-ancs. 


progress  of  iUetiicol  Ocicucr. 


AcETONUHiA  IN  Febrile  DISEASES. — A  preliminarj 
communication  by  Dr.  Rudolf  von  Jaksch  (Prager 
medicinische  Wochensclirift,  October  5,  1881)  em- 
bodies the  following  conclusions  regarding  acetonn- 
ria  in  fevers  :  1st.  A  red  color  is  produced  in  the 
urine  by  the  addition  of  chloride  of  iron,  not  only  in 
iliabetic  coma,  but  during  the  course  of  diabetes 
without  coma,  and  with  great  regularity  in  the  erup- 
tive stage  of  some  acute  exanthemata.  The  sub- 
stance to  which  the  red  coloration  is  due  may  always 
be  extracted  from  the  urine  by  means  of  ether.  2d. 
The  occurrence  of  Liebeu's  iodoform  reaction  in 
urine  is  not  directly  dependent  upon  the  presence 
of  the  substance  producing  the  chloride  of  iron  re- 
action, but  is  observed  m  all  diabetic  urine.  3d. 
An  equally  intense  iodoform  reaction  regularly  oc- 
curs in  the  distillates  of  febrile  urine.  Its  intensity 
plainly  depends  on  the  height  of  the  fever.  4th. 
The  iodoform  reaction  is  due  to  the  fever  alone, 
and  is  entirely  indei^endent  of  the  nature  of  the 
disease. 

Notes  on  Carbolic  Aiid  Poisoning  Occurring 
During  the  Eiiployment  op  Listerian  Dressings. 
— In  cases  treated  by  Lister's  method,  Falkson  was 
always  able  to  demonstrate  the  presence  of  a  large 
amount  of  carbolic  acid  in  the  urine,  as  much  as  one- 
third  to  one-half  per  cent.  ;  these  figures  includin  - 
not  only  the  amount  of  carbolic  acid  found  as  such, 
but  also  its  derivatives,  hydrochinon,  brenzcatechin, 
etc.  The  greatest  absorption  occurs  under  the  use 
of  irrigations,  the  least  from  dressings  of  carViolized 
gauze,  while  compresses  simply  moistened  with 
carbolic  acid  introduce  considerable  amounts  of  the 
latter  into  the  system.  Absorption  takes  jjlace  with 
great  rapidity  h'om  the  peritoneum ;  less  rapidly 
from  the  following  paits,  in  the  order  named  :  pleura, 
synovial  membrane,  and  bones. 

Sonnenburg's  test  for  the  presence  of  an  abnor- 
mal amount  of  carbolic  acid  in  the  urine  is  unreli- 
able (this  test  consists  in  the  demonstration  of  the 
absence  of  free  sulphuric  acid,  as  shown  by  adding 
a  solution  of  chloride  of  barium  to  urine  previously 
acidulated  with  acetic  acid ;  in  the  healthy  urine  this 
gives  a  precipitate  of  sulphate  of  barium,  the  pre- 
cipitate not  occurring,  however,  when  the  urine 
contains  carbolic  acid,  which  combines  with  the  sul- 
phuric acid  to  form  sulpho-carbolic  acid)  because 
normal  urine  sometimes  contains  sufficient  phenol 
to  mask  the  reaction.  It  is  preferable  to  ascertain 
separately  the  amounts  of  contained  sulphuric  and 
carbolic  acids  by  the  respective  methods  of  Bau- 
mann  and  Brieger.  Falkson  carried  out  this  plan 
in  twenty-six  patients  treated  by  Lister's  method, 
and  found  that  the  percentage  of  carbolic  acid  in 
the  urine  stood  in  direct  ratio  with  the  intensity 
of  coloration  and  increased  specific  gravity  of  the 
latter,  and  in  inverse  ratio  to  the  quantity  of  urine 
jjassed.  The  latter  is  usually  diminished.  Falkson 
recommends,  therefore,  a  liberal  administration  of 
water,  both  as  antidote  and  proi>hylactic  against 
carbolic  acid  poisoning.  Hildebrandt  relates  a  case 
of  poisoning  with  this  dnig,  where  recovery  was 
procured  V)y  emptying  the  stomach  of  the  patient 
in  a  novel  manner.  A  ten-year  old  boy  swallowed 
by  mistake  a  considerable  quantity  of  a  ten  per 
cent,  solution  of  carbolic  acid,  and,  after  a  few 
moments,    .sank   to   the   floor   unconscious.     When 


68 


THE  MEDICAL  RECOED. 


the  patient  was  seen,  ten  minutes  later,  he  was 
comatose,  the  cornea  being  wholly  insensitive.  An 
oesophageal  tube  was  quickly  obtained  and  intro- 
duced as  far  as  the  stomach,  but  the  funnel  could 
not  be  attached  by  reason  of  the  elastic  tubing  being 
missing.  Falkson  then  filled  his  mouth  with  water 
and  propelled  this  into  the  patient's  stomach  through 
the  tube,  repeating  this  procedure  several  times ; 
he  then  sucked  at  the  tube  until  fluid  rose  from  the 
stomach,  when  the  free  end  of  the  tube  was  allowed 
to  hang  from  the  patient's  mouth,  and  tiie  contents 
of  the  stomach  were  evacuated  by  syphonage.  This 
manoeuvre  was  x-epeated,  until  finally  the  missing 
tube  was  obtained  and  the  stomach  then  thoroughly 
washed  out.  Five  or  six  Pravaz'  syringefuls  of  ether 
were  also  injected  snbcutaneously  during  a  period 
of  an  hour  and  a  half,  after  which  time  the  cornea, 
and  a  half  hour  afterward  the  skin,  became  sensi- 
tive. Recovery  was  uninterrupted. — Med.  Ckirurg. 
Rundschau,  Sejitember,  1881. 

P'  Amyloid  Deoenkration  of  the  Kidney  ■o'ithout 
Albuminuria. — In  a  communication  made  to  the 
Medical  Society  of  the  Hospitals  at  Paris,  June  10, 
1881,  M.  Straus  combats  the  statement  of  Bartels, 
to  the  effect  that  amyloid  kidney  is  invariably  at- 
tended by  albuminuria.  The  opinion  of  M.  Straus 
is  based  upon  a  case  of  phthisis  and  tuberculous 
pleuritis  of  long  duration.  Careful  urinary  analysis, 
made  at  every  stage  of  the  disease,  failed  to  reveal 
albuminuria.  The  autopsy  showed  extensive  amy- 
loid degeneration  of  the  spleen,  intestine,  and  kid- 
neys. The  degeneration  was  confined  in  the  last- 
mentioned  organ  to  the  pyramidal  substance,  not 
having  involved  the  Malpighian  tufts  or  the  convo- 
luted tubes,  to  which  fact  M.  Straus  refers  the  ab- 
sence of  albumen  in  the  urine. — Le,  Progris  Medi- 
cal, June  18,  1881. 

EXTBAORDrNARY  CaSE  OF  GENERAL  NeUBOPABALYTIC 

Hyterhydrosis. — Dr.  Orsi  describes  the  following 
case  :  A  lady,  forty  yeai-s  of  age,  of  nervous  tem- 
perament, who  had  always  enjoyed  good  health,  was 
seized  with  a  cough  in  October,  1877,  and  suffered 
from  it  for  four  months.  When  the  coilgh  had 
ceased,  a  profuse  persijiratiou  set  in,  lasting  for 
three  months,  that  is  to  .say,  until  the  beginning 
of  summer.  At  this  time  the  perspiratory  func- 
tion again  became  normal,  and  the  patient  having 
regained  her  somewhat  weakened  strength,  appeared 
to  liave  perfectly  recovered.  But,  in  November, 
1878,  the  hyperhydrosis  again  returned,  to  remain 
until  the  middle  of  May,  1S79.  It  was  more  pro- 
fuse than  in  tlie  first  instance,  and  left  the  pa- 
tient in  a  state  of  great  prostration  and  profound 
antemia,  sutTering  from  obstinate  anorexia,  ceph- 
alalgia, confused  ideas  and  turbulent  dreams;  in 
fact,  it  was  feared  that  she  might  become  insane. 
With  the  return  of  cold  weather,  in  November,  1879, 
the  strange  ]>honomenon  appeared  for  the  third 
time,  witli  increased  gravity  of  symptoms.  At  about 
8  P.M.  the  patient  wonld  experience  a  flush  all  over 
the  body,  but  especially  in  the  head.  The  skin 
would  become  reddened  and  tumetted,  and  perspira- 
tion would  ooze  out  in  large  di-ops,  and  flow  in  little 
streams  from  the  person  of  the  patient.  The  (luan- 
tity  of  the  cutaneous  transpiration  was  such  that  a 
mist  would  gather  around  her,  and  tlie  vapor  con- 
dense on  the  walls  and  coiling  of  the  room,  as  in  the 
dampest  suliterranean  vault.  The  total  loss  by  per- 
spiration was  estimated  at  from  two  to  ten  pounds. 
Wlien  the  sweating  was  at  its  height,  the  patient  was 
seized  with  grave  dyspnoea,  and  an  almost  killing 


sensation  of  weight  in  the  pit  of  the  stomach.  Some- 
times she  experienced  pain  in  the  knees,  or  enter- 
algia,  accompanied  by  the  vomiting  of  an  acrid, 
bitter  fluid.  Thirst  was  not  to  be  quenched  by  any 
liquid.  The  eyes  were  brilliant;  the  pupils  were 
equally  diminished,  not  dilating  at  the  end  of  the 
seizure  ;  temperature,  37.8'  to  37.9°  C. ;  urine  .scanty, 
and  without  albumen  or  sugar.  At  3  a.m.  the  hy- 
perhydrosis would  diminish,  to  cease  altogether  at 
6  A.M.  The  patient  would  then  fall  into  a  deep 
sleep,  at  times  interrupted  by  attacks  of  convulsive 
cough,  or  of  orthopnoea  of  short  duration. 

Another  fact  worthy  of  mention  is  that,  when  the 
eoi^ious  sweating  ceased,  a  dift'use  eruption  ap- 
peared, sometimes  upon  the  trunk,  sometimes  upon 
the  extremities,  very  much  resembling  that  of  scar- 
latina. It  lasted  from  twenty-four  to  foi-ty-eight 
hours,  disappearing  with  the  usual  phenomena  of 
desquamation.  If  the  attack  had  been  of  long  dura- 
tion and  the  loss  considerable,  the  patient  was  pros- 
trated ;  if  of  short  duration,  with  a  slight  loss,  she 
would  sufier  from  cephalalgia,  confusion  of  ideas,  and 
melancholy.  She  lost  flesh  gi-adually,  but  progres- 
sively, due  to  want  of  appetite  and  dyspepsia.  The 
menstrual  flow,  and  every  excitement  of  the  passions 
exercised  a  baneful  influence  over  her  trouble. 
Nothing  abnormal  was  discovered  in  the  viscera. 
An  amemic  bniit  was  heard.  The  most  varied  treat- 
ment proved  unavailing. 

The  author  denies  the  existence  of  chronic  miliary 
fever,  because  there  was  no  fever  of  irregular  type ; 
no  acrid  perspiration  ;  characteristic  urine  ;  rapid 
change  from  paUor  to  cutaneous  redness  ;  delirium 
or  hemorrhage.  The  almost  constant  abdominal 
symptoms  were  also  wanting.  He  also  rejects 
masked  malaria,  because  of  the  absence  of  enlarged 
spleen,  etc.,  and  formulates  a  diagnosis  of  a  para- 
lytic neurosis  of  the  vaso- motor  centres. —  Gaz.  Med. 
di  Roma. 

Electric  Illushnation  Applied  to  Physiological 
Demonstr.\tions. — Dr.  Laborde,  editor-in-chief  of 
La  Trihtine  Mi'dicale,  explains  in  the  number  of  that 
journal  published  on  October  2,  1881,  his  instru- 
ments of  projection,  by  means  of  which  he  is  able, 
with  electric  illumination,  to  demonstrate,  for  classes 
of  students,  not  only  the  graphic  traces  made  by 
organs,  but  the  organs  themselves  during  their  func- 
tional activity.  The  latter  result  is  obtained  by  the 
adaptation  of  the  solar  microscope  to  the  projection 
apparatus.  M.  Laborde  has  succeeded  by  this  com- 
bination in  demonstrating  the  turtle's  and  embryonic 
chick's  heart  in  the  active  performance  of  their  func- 
tions, as  well  as  the  capillary  circulation  in  the  web 
of  a  frog's  foot  and  in  its  mesentery. 

■"'  Inoculation  in  Cases  of  Contagious  Peripneu- 
monitis. — In  a  paper  read  before  the  Paris  Academy 
of  Medicine  (Le  Cotirrier  Mrdival,  October  1,  1881), 
M.  Leblanc  combats  tlie  theory  advanced  by  M. 
Bouley  relative  to  the  efficacy  of  preventive  inocu- 
lations in  cases  of  contagious  peripneunionitis 
fepizootic).  His  conclusions  are  as  follows :  Ist. 
Contagious  peripneumonitis  of  cattle  may  be  de- 
veloped spontaneously  uiuler  the  influence  of  causes 
which  have  been  recognized  since  the  last  century. 
2d.  Inoculation  with  serum  from  the  lungs  of  an 
animal  sufl'eving  from  the  di.sease  does  not  ])rovok<' 
an  analogous  malady  in  healthy  cattle,  nor  does  it 
produce  the  pathological  appearances  due  to  con- 
tagious peripneumonitis.  3d.  The  results  of  inocu- 
lation are  so  varied,  both  as  to  symptoms  and  to 
their   sequelro,    that   they   cannot   be   regarded   as 


THE  MEDICAL  RECORD. 


69 


unalagous  to  the  effects  obtained  by  inoculation 
with  the  virus  of  other  contagious  diseases.  4th. 
Inoculation  does  not,  in  many  o;xses,  confer  immu- 
nity. 5th.  The  protection  which  is  afforded  in 
some  cases  by  inoculation  is  only  of  six  months' 
duration,  as  reinoculation  demonstrates.  (Jth.  Sani- 
tary and  hygienic  measui'es  furnish  equally  satisfac- 
tory results,  and  are  less  expensive. 

Conditions  Necess.4rt  to  the  Efficacy  of  .\xi- 
5i.\L  V.\ccixE  Virus. — M.  Burg  states  in  a  note  read 
Iiefore  the  Paris  Academy  of  Medicine  {Le  Conrrhn- 
M'llkrd,  October  1,  18S1),  that  animal  vaccine  virus, 
in  order  to  produce  results  eciually  satisfactory  as 
those  (M)tained  by  arm-to-arm  vaccination,  must  be 
taken  from  the  animal  on  the  sixth  day.  Moreover, 
tiie  animal  must  have  a  limited  number  of  vesicles  ; 
dtherwise  the  virus  loses  some  of  its  efticacy  by  at- 
tenuation. M.  Burg  advocates  vaccination  with 
humanized  virus,  as  being  cheaper,  more  easily  ac- 
ci^nplislied,  and  more  satisfactory  than  inoculation 
with  animal  viras. 

Effusions  of  Bdood  at  the  Fold  of  the  Eluow. 
— An  account  of  this  condition  is  not  found  in  the 
current  text-books.  Dr.  Charvot  (Reme  de  Chirunjie, 
September,  ISSl)  relates  sis  cases  of  this  kind,  and 
observes  that  this  disease  may  give  rise  to  eiTors  of 
diagnosis.  He  concludes  his  account  of  the  cases 
with  the  following  statements  : 

1.  Injuries  which  affect  the  elbow  dii'ectly,  such 
as  contusion,  dislocation  ;  or  indirectly,  such  as  a 
sprain  or  diastasis,  frequently  give  rise  to  consider- 
able effusion  of  blood  throiighout  the  whole  of  the 
upper  limb,  and  especially  at  the  fold  of  the  elbow. 
2.  These  extravasations  of  blood  appear  to  arise 
from  rapture  of  the  vessels  aroimd  the  joint.  3.  The 
effusion  of  blood  is  not  always  completely  absorbed, 
and  is  transformed  into  fibrinous  clots,  occupying 
the  antero-internal  aspect  of  the  fold  of  the  elbow  in 
front  of  the  articulation,  and  in  the  substance  of  the 
brachialis  anticus.  4.  The  resulting  tumor  is  as 
large  as  an  egg,  unequal,  of  cartilaginous  or  even 
osseous  hardness.  At  first  it  is  independent  of  the 
bone,  but  subsequently  it  may  become  attached  to 
the  humerus.  .">.  Thus,  the  effusions  of  blood  which 
partly  till  up  the  coronoid  cavity  may  interfere  with 
the  movements  of  the  articulation,  and  considerably 
limit  flexion.  6.  They  generally  remain  stationary 
for  a  long  time,  and  are  but  little  influenced  by 
ordinary  treatment.  7.  Finally,  they  may  give  rise 
to  errors  of  diagnosis,  and  may  be  mistaken  for  ex- 
ostoses of  the  humerus,  or  tearing  away  of  the  coro- 
noid apophysis,  etc. 

USELESSNESS  OF  ANTISEPTICS  IN  OcULAB  SuKOEKT. — 

In  a  report  of  his  seventh  hundred  case  of  cataract 
extractions.  Dr.  H.  Knapp  (Archires  of  Opldhahnol- 
ogi/,  September,  1881)  makes  the  following  remarks  : 

"The  di'essings  consisted  of  the  ordinary  charpie- 
flannel  bandage.  The  flannel,  in  summer,  was  re- 
placed by  gauze,  and  when  the  wound  was  firmly 
united,  left  off  altogether.  The  eye  was  covered 
with  a  small  pad  of  absorbent  cotton  kept  in  posi- 
tion by  a  strip  or  two  of  court-]ilaster. 

"I  will  not  omit  to  mention  that  neither  spray  nor 
antiseptic  dressings,  nor  disinfection  of  the  instru- 
ments and  the  eye  and  its  surroundings,  have  been 
resorted  to.  .\11  that  was  done  preparatoiy  to  the 
operation  was  careful  washing  of  the  instruments, 
the  hands  of  the  operator,  and  the  eyes  of  the  yia- 
tients,  with  ordinaiy  water.  I  freely  confess  that 
the  advocates  of  antisepsis  in  eye- surgery  have  thus 
far  failed  to  convince  me  of  the  utility  of  their  varied 


procedures,  and  I  do  not  think  it  incumbent  upon 
me  to  waste  time  by  what  I  consider  to  be  super- 
fluous complications  of  treatment.  For  two  years 
and  a  half  have  I  had  no  case  of  suppuration  after 
any  operation  on  the  eyeball,  but  three  occurred 
lately.  I  think  the  statistics  of  those  W"ho  use  anti- 
septic means  are  no  better." 

The  Pblmabt  Union  of  Wounds. — Professor  Ver- 
ueuil  jjublishes  in  the  October  number  of  the  Retue 
de  Chirurgie  his  views  on  the  conditions  which 
should  indicate  or  eontraindicate  our  attempts  to 
obtain  healing  by  first  intention.  The  following 
conclusions  embrace  his  views  on  this  subject : 

1.  The  attempt  to  obtain  primary  union  is  some- 
times essential  and  imperative,  at  others  only  sup- 
plementary to  the  main  object  of  the  operation,  and 
again  it  may  lie  entirely  optional.  2.  Wliile  the 
chances  and  risks  of  failure  remain  the  same  under 
these  varying  conditions,  the  possible  advantages  to 
be  obtained  vary  gi'eatly.  3.  These  risks  must  be 
incurred,  although  we  should  do  all  in  our  power  to 
lessen  their  power  in  cases  where  sjjeedy  union  is 
the  main  object  in  view,  as  in  all  plastic  o]ierations. 
4.  But  before  aiming  at  jirimaiy  union  in  cases 
where  it  is  only  optional,  the  surgeon  should  be  sat- 
isfied that  the  ))atient  is  not  the  subject  of  some 
constitutional  ailment,  which  would  eontraindicate 
an  immediate  2Jerformance  of  the  ojjeration.  5.  The 
existing  taint  should  be  treated  by  appropriate  mea- 
sures ;  biit  if  delay  be  inadmissible,  or  if  the  consti- 
tutional malady  is  not  amenable  to  treatment,  then 
the  surgeon  should  not  incur  the  risk  of  an  attempt 
to  obtain  ^irimary  union,  but  should  employ  some 
other  method  of  wound-treatment  which,  while 
offering  the  prospect  of  a  less  ra})id  cTu-e,  secures'a 
gi'eater  safety  to  the  i:iatient. 

giCoNGENiTAL  ExosTO.SES. — Dr.  Schor,  of  Odessa, 
publishes  (Si.  Petershurger  medicinische  Wocheii- 
scJirift,  October  1,  1881)  a  detailed  history  of  three 
cases  of  congenital  exostoses  in  the  same  family. 
The  large  number  of  the  tumors,  the  continued 
health  of  the  individuals  in  whose  bones  they  de- 
veloped, the  symmetrical  arrangement,  i\nd  the  ap- 
parent hereditary  character  of  the  exostoses,  inclined 
Dr.  Schor  to  the  belief  that  they  owed  their  origin 
to  rachitis. 

Gangrenous  Inflamm.\tion  of  the  Side  of  the 
Neck  Due  to  Exposure  to  a  Dkaught  ofCold  Atr. — 
Dr.  Moraleda  y  Estelian  sends  an  account  of  an  inter- 
esting case  in  a  letter  from  Nambroca  (Toledo). 
The  jiatient  was  a  woman  forty  years  of  age,  and  of 
lymphatic  temperament,  who  had  been  subjected  to 
various  depressing  influences.  As  a  i-esult  undoubt- 
edly of  exposure  to  a  cold  current  of  air,  a  violent 
inflammation  was  set  up  on  the  right  side  of  the 
neck.  The  inflammatory  process  was  of  such  a  na- 
ture as  to  cause  fears  of  asphyxia,  but  this  danger 
was  averted  by  antiphlogistic  measures.  The  next 
day  the  attendant  physician  was  sui'prised  to  find 
that  all  the  superficial  tissues  had  been  converted 
into  a  gangi'enous  eschar,  a  comjjlication  which  was 
serious  on  account  of  the  invasive  character  it  pre- 
sented. The  mortified  tissues  were  removed  from 
the  wound,  and  the  latter  W'as  treated  with  nitrate 
of  silver  to  favor  the  elimination  of  the  necrosed 
parts,  and  stimulate  the  tissues  to  repair.  Regen- 
eration soon  took  place,  and  the  extensive  solution 
of  continuity,  occupying  the  whole  right  lateral  as- 
pect of  the  neck,  became  cicatrized. — Rev.  de  Med. 
y  Cir.  Pract. 


70 


THE  MEDICAL  EECORD. 


The  Medical  REroRD: 


7.  lllEckln  lomnal  of  fttciiicine  onb  Suvgtrg 


GEORGE  F.  SHRADY,  A.M.,  M.D.,  Editor. 


PUBLISHED    BY 
irin.  WOOD  &  CO.,  no.  27  Great  Jones  St.,  N.  \'. 


New  York,  January  21,  1882. 

EECENT  EESOLUTION   BY  THE   EOYAL 
COLLEGE  OF  PHYSICIANS. 

The  Eoyal  College  of  Phy.sicians  of  England  has  re- 
cently adopted  the  following  resolution  : 

"  While  the  college  has  no  desire  to  fetter  the 
opinion  of  its  members  in  reference  to  any  theories 
they  may  see  fit  to  adopt  in  connection  with  the 
practice  of  medicine,  it  nevertheless  considers  it  de- 
sirable to  exj^ress  its  opinion  that  the  assumption  or 
acceptance,  by  members  of  the  profession,  of  desig- 
nations implying  the  adoption  of  special  modes  of 
treatment,  is  opposed  to  those  principles  of  the 
freedom  and  dignity  of  the  profession  which  should 
govern  the  relations  of  its  members  to  each  other 
and  to  the  piiblic.  The  college  therefore  expects 
that  all  its  fellows,  members,  and  licentiates  will  up- 
hold these  princijjles  by  discountenancing  those 
who  trade  upon  such  designations." 

If  this  resolution  means  anything,  it  means  that  a 
man  may  believe  in  homwopathy  and  practise  it  to 
his  heart's  content,  Init  he  may  not  call  himself  a  ho- 
moeopath ;  ho  may  believe  that  there  is  nothing  like 
cold  water,  and  he  may  dose  his  patients  with  it  in- 
ternally, externally,  and  eternally,  but  he  must  not 
call  himself  a  hydropath  ;  he  may  believe  electricity 
to  be  the  most  potent  healing  agent  in  existence,  and 
may  confine  his  practice  to  its  administration,  but 
he  must  not  call  himself  an  electropath ;  he  may 
believe  that  all  diseases  are  more  quickly  cured  by 
venesection,  but  he  must  not  call  himself  a  phlel)oto- 
mist.  In  other  woi-ds,  a  man  may  think  as  he 
pleases,  practise  as  he  pleases,  but  he  must  not  as- 
sume a  party  designation. 

What  could  have  induced  the  Royal  College  to 
adopt  a  resolution  so  contrary  to  all  its  precedents 
for  the  last  thirty  years,  it  is  not  easy  to  say.  Is  this 
concession  to  liberty  of  opinion  and  practice  due  to 
the  influence  of  lUngor,  who.se  writings  contain  not 
a  little  clandestine  honiceopathy  ?    Is  it  due  to  the 


influence  of  PhiUips,  who  for  fifteen  or  twenty  years 
was  a  professed  homoeopath,  and  whose  writings 
clearly  indicate  his  special  training  in  homceopathic 
therapeutics  ?  These  questions  we  cannot  answer. 
At  a  distance  of  three  thousand  miles  it  would  be 
difficult — in  fact,  impossible — to  accurately  judge  of 
the  influences  and  motives  that  induced  the  Koyal 
College  to  unanimously  adopt  the  foregoing  resolu- 
tion, which,  on  debate,  was  supported  by  Dr.  Priest- 
ley, Dr.  Wilks,  Dr.  Beale,  Dr.  Wilson  Fox,  Sir  W. 
Gull,  Sir  W.  Jenner,  and  other  noted  medical  men 
of  the  British  metropolis.  Verily  "  tempora  mutan- 
tvr"  etc. 

This  resolution,  guaranteeing  liberty  of  opinion 
and  practice,  may  be  taken  as  a  direct  invitation  to 
homoeojiaths  and  other  dissenters  and  sectarians  to 
abandon  their  special  designations,  and  to  place 
themselves  in  relationship  with  the  college.  It  re- 
mains to  be  seen  whether  these  gentlemen  will  ac- 
cept this  in^-itation — whether  they  will  dare  to  accept 
it :  whether  they  will  dare  to  appear  before  the  pub- 
lic simply  as  physicians  relying  for  .success  on  their 
individual  merit  and  practical  application  of  what 
they  claim  to  be  superior  methods  of  treatment. 
The  Koyal  College  of  Physicians  of  England  has  of- 
fered tlie  invitation  and  the  challenge  ;  it  is  yet  to 
be  seen  whether  the  sectarians  of  Great  Britain  wUl 
accept  them. 


DEATH   IN    THE   DENTISTS   CHAIR. 

In  Chicago  a  death  is  reported  from  chloroform  in 
the  dentist's  chair.  The  deceased  was  forty-five 
years  of  age,  and  was  in  an  apparently  healthy  con- 
dition. The  aniesthetic  was  administered  by  a  so- 
called  "  expert."  Breathing  ceased  suddenly  and 
death  was  almost  immediate.  The  cause  of  death  was 
evidently  chloroform.  The  verdict  of  the  jury  was 
"  bad  enough — don't  do  so  again."  No  blame  seems 
to  be  attached  to  any  one,  and  every  ordinary  means 
seems  to  have  been  taken  to  prevent  accident,  ■with 
the  single  exception  that  chloroform  was  adminis- 
tered instead  of  nitrous  oxide  gas  or  sulphuric  ether. 
Obviously  it  is  rather  late  to  talk  of  jiossible  idiosyn- 
crasies after  the  patient  is  dead,  but  we  constantly 
hear  of  them  in  such  cases,  and  stupid  and  defiant 
men  still  continue  to  take  the  risk  of  administering 
chloroform  for  dental  operations,  despite  the  verdict 
of  the  profession  to  the  contrary. 


THE   N-ECESSrriES   OF   REVACCDIATION. 

In  view  of  the  spread  of  small-pox  in  difl'erent 
parts  of  the  country,  the  necessity  for  extensive  and 
wholesale  vaccination  need  hardly  be  enforced.  The 
profession  understand  their  duty  in  the  matter,  and 
are  prepared  to  perform  it.  From  difterent  centres 
we  hear  that  extraordinary  efi'orts  are  being  made 
to  protect  communities  from  the  ravages  of  the 
disease.    Despite  the  eflbrts  of  the  anti-vaccination- 


THE  MEDICAL  KECUKD. 


71 


ists.the  doctrines  of  .Tenner  have  the  widest  possible 
following,  and  there  'is  everr  reason  to  believe  that 
in  every  section  the  peojile  are  in  hearty  accord  with 
the  efforts  of  the  health  authorities.  The  medical 
men  throughout  the  country  can  do  much  to  aid  the 
adoption  of  the  necessaiy  protective  measure.  It 
would  appear  to  be  a  duty  on  the  part  of  every  prac- 
titioner to  advise  the  families  under  his  charge  to 
revaccinate  and  thus  run  no  risk.  With  the  use  of 
bovine  virus,  now  almost  universal,  much  of  the 
prejudice  against  vaccination  is  overcome  in  the 
minds  of  the  jjeojjle,  and  the  physician  has  little,  if 
any  necessity  for  argument  or  jiersuasion.  Although 
it  is  impossible  to  say  when  the  j^rotective  power  of 
the  virus  ceases,  it  is  generally  the  rule  to  revacci- 
nate after  pulierty,  and  at  intervals  of  from  seven  to 
ten  years  thereafter.  Especially  would  this  seem  to 
be  necessary  in  cases  of  epidemics,  or  when  the  oc- 
cupation of  the  individual  should  predispose  him  to 
contagion.  In  all  cases  of  doubt  the  benefit  of  such 
a  doubt  should  be  given  in  favor  of  revaccination. 
When  the  physician  is  not  thoroughly  satisfied  that 
his  patient  is  protected,  he  should  revaccinate  him 
without  delay,  and  repeat  the  operation  if  he  is  not 
assui-ed  by  trials  on  others  that  the  virus  is  trust- 
worthy. 

The  manner  of  introducing  the  \'irus  is  so  simple 
as  hardly  to  need  reference.  Indeed,  we  would  not 
allude  to  it  here,  except  in  a  general  way  to  answer 
many  questions  from  diiierent  correspondents.  The 
rule  in  this,  as  in  other  cities,  is  merely  to  abrade  the 
surface  with  a  lancet  by  cross-scoring,  and  gently 
and  thoroughly  rub  in  the  vims  from  the  squared 
end  of  an  armed  quill.  The  dried  virus  on  the  latter 
is  dissolved  by  contact  with  the  exudation  from  the 
abrasion,  and  is  thus  brought  in  the  pui'est  possible 
form  in  direct  contact  with  the  absorbents.  When 
the  vaccinated  part  is  thoroughly  drv"  it  is  allowed 
to  take  care  of  itself  without  any  protective  applica- 
tion being  made  to  it.  The  point  of  the  lancet  is 
cleaned  by  dijjping  it  in  alcohol  and  setting  lire  to 
the  latter.  The  quills  can  be  preserved  in  a  dry 
and  cool  place  for  a  fortnight  at  a  time,  or  even 
longer.  To  this  end  they  are  either  kept  in  a 
small  pasteboard  box,  enveloped  in  rubber-paper, 
or  in  bottles  the  corks  of  which  are  similarly  pro- 
tected. 


lEEDIClNE   .\T   FOOCHOW. 

Is  the  tenth  annual  report  of  the  Foochow  Medi- 
cal Missionary  Hospital,  Dr.  HeniT  T.  Whitney,  the 
superintendent,  gives  some  interesting  facts  regard- 
ing the  diseases  most  frequently  met  with  by  him 
among  the  Chinese.  - ' 

The  hospital  in  question  has  giown  very  rajDidly 
since  its  establishment  by  the  late  Dr.  Osgood,  in 
1872.  At  that  time  a  total  of  6,606  cases  were  treated 
during  the  year,  all  but  al)out  00  of  these  being  out- 


patients. Nine  years  later,  inJlSSO,  the  nnmber  was 
8,651,  of  which] 737[were  hospital  in-patients. 

The  disease'most  frequently'niet  with  is  rheuma- 
tism. This  is  of  the  muscular  form,  the  joints  being 
rarely  found  affected.  Syi:)hilis  comes  next  in  fre- 
quency, yet  it  is  not  so  common  as  among  Chris- 
tians. Dr.  Whitney  also  states  that  it  commonly 
develops  in  a  benign,  or  rather,  non-malignant  form. 

Leprosy  of  course  is  met  with  quite  often.  It 
is  a  disease  which  cannot  be  stamped  out  until 
the  Government  takes  most  vigorous  action  in  the 
matter.  The  common  people  are  full  of  the  gross- 
est superstitions  regarding  it.  When  a  man  is 
known  to  have  the  disease,  he  is  put  through  a  series 
of  ceremonial  performances,  including  the  eating  of 
an  entire  chicken.  He  can  then,  it  is  thought,  go 
anywhere  without  communicating  the  disease.  When 
a  leper  dies,  the  villagers  omit  lires  for  thi'ee  days, 
lest  the  parasite  come  down  in  the  flames  and  cause 
the  disease  to  develop  ;  for  the  Chinaman  believes 
in  the  parasitic  origin  of  leprosy,  and  in  this  respect 
is  rpiite  abreast  with  the  most  advanced  pathology. 

Vaccination,  we  are  told,  is  Ijeing  practised  quite 
extensively,  and  is  gradually  superseding  inocula- 
tion. 

Nervous  diseases  are  not  uncommon.  Epilepsy  is 
readily  controlled  by  the  bromides.  The  insane  are 
numerous,  but  are  rarely  seen,  being  kejit  in  private 
dwellings,  never  in  public  institutions.  Dementia 
is  the  form  most  frequently  met  with  by  Dr.  Whitney. 

Probal)ly  the  best  place  in  the  world  to  study  skin- 
diseases  is  in  China.  Every  known  form  is  found, 
except  a  very  few  peculiar  to  India.  Eczema,  scabies, 
and  the  variousjiorms^of  tinea  are  most  frequent. 

The  Chinese  are  very  subject  to  digestive  diseases, 
and  nine -tenths  of  the  people  have  "pi-tung,"  or 
dyspepsia,  some  time  during  their  lives.  Bolting 
the  food  and  improj^er  and  insufficient  diet  are  the 
causes.  Lumbricoid  worms  abound  in  the  Chine.se 
digestive  tract,  and  santonin  is  a  remedy  very  fre- 
quently required. 

Bronchitis,  asthma  and  phthisis  are  common- 
There  is  a  curious  form  of  hemoptysis,  which  has 
before  been  alluded  to  briefly  in  the  Kecokd.  It 
often  occurs  periodically,  either  every  six,  twelve,  or 
eighteen  months.  It  rarely  endangers  life  or  signifies 
any  phthisical  condition.  The  patient  coughs  up 
from  several  to  many  ounces  of  bright  red  blood. 
The  system  suffers  for  several  days,  but  soon  recovers 
itself.  Dr.  Whitney  inclines  to  adopt  the  explana- 
tion of  Dr.  P.  Manson,  of  Amoy,  that  the  trouble  is 
due  to  the  presence  of  flukes. 

Eye  diseases  are  extremely  common,  owing  to  ex- 
posure to  a  powerful  sunlight,  of  a  shaved,  uncov- 
ered head,  and  living  in  foul  and  smoky  air. 

In  the  oi^ium  asylum  connected  with  the  hospi- 
tal, 284  patients  were  treated  in  1880.  The  plan 
found  to  work  best  is  to  take  away  all  the  opium  at 
once.     From  one  to  five  days  is  the  longest  jjeriod 


72 


THE  MEDICAL  RECORD. 


of  suffering.  In  a  week  or  two  the  habit  is  broken, 
and  the  patients  become  anxious  to  leave.  Br. 
Whitney  thinks  that  from  three-iifths  to  four-fifths 
are  cured  by  this  two  weeks'  treatment.  Eestoratives, 
nerve-tonics,  and  nerve-sedatives,  are,  of  course, 
given.  A  number  of  statistics  regarding  the  habit 
have  been  compiled.  From  three-tenths  to  eight- 
tenths  of  the  male  population  are  given  over  to  it.  In 
125  cases  reported,  70  began  the  habit  for  pleasure, 
45  on  account  of  disease,  and  10  yielded  to  the  jires- 
sure  of  temptation. 


THE   .4MEKICAN    AMBtlLANCE   SYSTEM    ABKOAD. 

It  is  with  feelings  of  no  little  satisfaction  that  we 
learn  of  the  prosi^ective  adoption  of  the  Ameiican 
ambulance  system  in  London  and  Paris.  Dr.  Ben- 
jamin Howard,  formerly  of  this  city,  has  succeeded 
in  impressing  the  London  Hospital  Committee  of 
the  great  benefits  derivable  therefrom,  and  the  time 
appears  to  be  near  at  hand  when  a  scheme  of  hosjii- 
tal  and  accident  service  for  the  larger  hospitals  of 
the  former  city  will  be  an  accomplished  fact.  Dr. 
Howard  has  caused  to  be  built  under  his  personal 
supervision  a  vehicle  for  the  purpose  named,  which 
answers  to  the  most  thorough  tests  to  wliich  it  has 
been  subjected  by  the  committee,  and  the  proper 
steps  have  been  taken  to  inaugurate  an  ambulance 
system  similar  to  that  which  exists  here.  The  car- 
riage, according  to  accounts  in  the  English  papers,  is 
quite  unlike  and  "  apparently  superior  to  any  in  use 
in  America."  When  the  system  is  duly  adopted  it  is 
fair  to  presumejthat  our^English  cousins  will  won- 
der how  they  could  ever  have  done  without  it.  In 
this  respect  it  wiU  be  repeating^the'experience  in 
this  city. 

A  similar  movement  has  been  inaugiu-ated  in 
Paris  by  Dr.  Henri  Nachtel,  who  will  be  remembered 
as  the  projector'of  the  night  medical  service  in  this 
city.  Dr.  Nachtel  has,  as  the  result  of  a  study  of 
the  American  system,  presented  its  advantages  to  the 
municipal  authorities  there,  and  has  succeeded  in  in- 
teresting them  in  a  plan  which  ere  long  promises  to 
be  practically  tested  in  connection  with  the  accident 
service  of  the  Parisian  hospitals.  Let  us  hope  that 
otherjgentlemen  of  equal  energy  and  influence  in 
other  large  cities'^will  imitate  their  la^idable  exam- 
ples, and  that  their  labors  in  their  respective  fields 
will  be  attended  with  con-espondingly  good  results. 


another   :\rEDICAIi   INSTITTTTIGN   of   LEARNrXO. 

The  capacity  of  certain  organisms  to  adapt  them- 
selves to  their  environment  furnishes  a  subject  full 
of  suggestiveness  to  the  philosophic  mind.  The 
American  potato,  burrowing  in  all  the  soils  of  Eu- 
rope ;  the  polar  bear  sitting  in  unruftled  peace  under 
a  Croton-water  douche  at  the  Park  menagerie  ;  the 
Englishman  niling  India  witli  only  one  lobe  remain- 
ing to  his  liver,  all  exemplify  this  frequent  and  in- 
teresting characteristic  of  living  beings. 


But  while  this  fact  has  been  long  recognized  as 
true  of  bodies  organic,  we  venture  to  assert,  as  some- 
thing new,  that  it  is  equally  so  of  bodies  corporate. 

That  there  is  a  cai)acity  in  certain  kinds  of  corpo- 
rations to  respond  to  almost  any  surroundings,  may 
be  learned  from  a  study  of  the  growth  of  American 
medical  colleges. 

The  fact  that  certain  kinds  of  corporations  can 
resjiond  to  any  suiToundings  would  perhaps  occur 
to  eveiy  one  who  has  watched  the  growth  of  the 
American  medical  colleges.  Their  history  is,  of  it- 
self, a  lesson  in  political  science,  social  economy, 
and  human  nature. 

Tlie  American  medical  college  is  an  institution 
which  has  now,  in  its  geogi'aphical  progress,  touched 
nearly  every  point  on  our  coast-line,  including  the 
great  lakes.  It  crrnaments  the  banks  of  our  larger 
rivers,  perfumes  the  air  of  the  prairies,  gladdens 
the  anti-phthisical  climate  of  the  Kooky  Mountains, 
and  has  now  at  last  begun  to  invigorate  the  gyneco- 
logical politics  of  Utah. 

The  developmental  powers  of  the  American  medi- 
cal college  are  alike  surprising  and  unrestrainable. 
It  springs  up  in  response  to  the  minutest  want.  We 
have  colleges  solely  for  the  benefit  of  the  professors  ; 
colleges  (presumably)  for  the  benefit  of  the  students  ; 
colleges  which  just  hit  the  needs  of  the  general 
l^ractitioner,  which  teach  the  local  peiuliarities  of 
disease,  and  the  personal  peculiarities  of  the  locality. 
There  are  institutions  which  inculcate  Christian 
principles  along  with  medical  practice  ;  institutions 
which  teach  allopathy,  homoeopathy,  co-education, 
eclecticism,  iatrojjhysics,  and  all  the  new  Californian 
specifics.  In  tine,  short  of  every  doctor  having  his 
own  college,  the  condition  of  medical  education  in 
this,  our  beloved  and  incomparable  land,  could  hardly 
be  improved. 

The  last  "  real  want "  was  supplied  a  few  months 
ago  by  the  organization  of  a  medical  college  at  Weber 
Station,  U.  P.  K.R.,  Utah  Ten-itoiy.  "The  absolute 
necessity  of  such  an  institution  in  Utah  has  long  been 
felt,"  and  Pi-ofessor  X.  has  at  last  had  the  self-sacri- 
fice to  sujiply  it.  He  has  sent  us  his  prospectus, 
with  the  request  that  we  give  the  new  school  a 
"  good  send-off."  We  are  pleased  to  be  able  to  do 
so. 

The^chool  is  conveniently  situated — for  those 
ti-avelling  that  way.  The  locality  is  not  too  healthy. 
Board  is  cheap  :  by  hunting  the  bison  Sundays,  a 
sufficient  supply  of  meat  for  the  working  days  can  be 
obtained.  The  clinical  advantages  are  exceptional. 
Gunshot-  and  scalp-wounds  abound.  The  gynecolo- 
gical professor  lias,  in  one  family,  the  care  of  one  hun- 
dred wives,  and  thus  controls  his  own  clinic.  The  re- 
quirements of  graduation  are  three  years  of  medical 
study,  "  including  two  full  courses  of  lectiires  and 
twenty-one  years  of  age."  This  is,  perhaps,  the 
only  college  in  Ameiica  where  the  moral  character 
is  not  mentioned  or  inquired  into.     One  professor 


THE  MEDICAL  RECORD. 


73 


does  all  the  teaching,  which  obviates  facility  quar- 
rels, and  promotes  simplicity  and  harmony  in 
modes  of  instruction.  Co-education  of  the  seses 
prevails,  and  might  indeed  be  said  to  be  in  the  ma- 
jority, since  in  the  class  of  1880  there  are  three  la- 
dies and  two  gentlemen.  We  are  unable  to  say 
whether  these  latter  are  red  men  or  only  Mormons, 
or  neither.  In  fact,  there  seems  to  be  everything 
in  this  new  institution  to  make  the  bosom  of  the 
native  Utahite  swell  with  emotion.  We  pronounce, 
as  requested,  its  benedictive  "send  off."  It  is  de- 
monstrated now  that  anybody  can  start  an  American 
medical  college  anywhere. 


THE  OOSTROVERST  CONCERNING  HTPNOTISJI. 

We  publish  to-day  a  letter  from  Dr.  Beard,  which 
will  close,  we  trust,  a  controversy  already  much  too 
prolonged. 

On  the  testimony  of  Dr.  Hammond,  Dr.  Beard,  and 
others  acquainted  with  the  matter,  as  well  as  from 
other  sources,  we  have  very  convincing  i^roof  that 
the  "trained  subject"  exhibited  in  England  is  not  a 
fraud,  so  far  as  hypnotic  phenomena  are  concerned. 
This,  if  true,  turns  the  case  rather  against  Dr. 
Brown,  and  largely  diminishes  the  pertinence  of  his 
not  too  concise  communications  to  The  Record  and 
the  Bi-itixh  ^[edical  Journal.  It  seems,  indeed,  quite 
improbable,  on  the  face  of  it,  that  the  "  subject "  in 
question  would  or  could  have  deceived  so  many  per- 
sons in  this  city  last  winter,  where  his  performances 
were  closely  studied.  Nor  will  Dr.  Brown  convince 
the  unprejudiced  that  he  had  the  astuteness  to 
discover  in  half  an  hour  deceptions  which  were  not 
detected  by  others  more  expert  in  several  months. 
The  facts  seem  to  be  that  the  "  subject,"  frightened 
or  angry  at  the  somewhat  aggressive  methods  of  his 
investigators,  failed  to  go  into  the  hypnotic  condi- 
tion perfectly.  In  consei^iience,  it  is  not,  perhaps, 
surprising  that  Dr.  Brown  received  a  vote  of  thanks 
for  having  "brilliantly  demonstrated  a  trickery." 
But,  in  the  light  of  what  appear  to  be  the  actual  facts, 
he  carried  away  hollow  honors,  having  failed  alike 
to  discover  the  truth  and  to  treat  a  foreign  guest 
with  justice  and  courtesy. 

"Ck)RivED"  Ether  Cans. — Dr.  William  P.  Mason, 
of  the  Troy  Rensselaer  Polytechnic  Institute,  writes  : 
"  The  following  experiment  may  not  be  without  in- 
terest in  view  of  the  considerable  iirejudice  existing 
ing  against  '  corked '  ether  cans.  Fresh  cans  of 
'  Squib b's '  ether  (half-  and  quarter-pound)  were 
opened  and  the  amount  of  absolute  ether  imme- 
diately determined.  They  were  then  carefully 
corked  with  soft  corks  and  set  aside.  The  ether 
was  redetermined  at  the  end  of  three,  and  again  at 
the  end  of  seven  weeks,  with  results  identical  with 
those  of  the  lirst  determination.  Cans  where  the 
corks  had  been  merely  dropped  in  place,  showed 
marked  deterioration  in  quality  of  contents  at  the 
end  of  the  first  week.  It  thus  appears  that  where 
proper  care  is  taken  in  corking,  the  strength  of  the 
ether  may  be  relied  upon." 


Ucuimi0  anti  Uoticcs  of  Cooks. 


The  International  Encyclopedia  op  Suroebt  :  A 
Systematic  Treatise  on  the  Theory  and  Practice  of 
Surgery  by  Authors  of  Various  Nations.      Edited 
by  John  Ashhirst,  Jr.,  M.D.,  Professor  of  Clinical 
Sirrgery  in  the  University  of  Pennsylvania.    Illus- 
trated   with   chromolithographs    and   woodcuts. 
In  six  volumes.    Vol.  I.    Koyal  8vo,  pp.  702.    New 
York :  Wm.  Wood  ct  Co. 
The  first  volume  of  this  important  work  appears 
at  a  time  when  the  opportunity  is  offered  for  filbng 
an  acknowledged  gap  in  the  literature  of  surgery. 
Its  design,  although  not  entirely  original,  aims  to 
be  more  comprehensive  in  its  scope,  more  thorough 
in  its  detail,  and  more  truly  representative   in  its 
range,  than  anything   of   the   kind   heretofore   at- 
tempted. 

The  object  of  the  work  is  tersely  stated  in  the  pre- 
face ;  to  furnish  "in  a  comjirehensive  and  yet  not 
unduly  extended  form  a  systematic  and  practical  trea- 
tise upon  all  those  subjects  which  are  properly 
considered  to  pertain  to  the  science  and  art  of  sur- 
geiy,  the  various  topics  discussed  in  the  several  vol- 
umes having  been  entrusted  to  distinguished  writers 
of  various  countries,  who  are  believed  to  be  specially 
qualified  to  give  authoritative  instruction,  each  upon 
the  particular  subject  which  he  has  undertaken." 
The  full  realization  of  such  a  project,  except  as  fore- 
shadowed in  the  present  volume,  is,  for  the  present 
at  least,  in  prospective.  But  the  assurances  of  un- 
qualified fulfilment  of  the  promises  of  the  editor 
and  publishers,  given  in  the  work  before  us,  are  of 
the  most  pronounced  and  definite  character. 

The  general  plan  has  been  devised  and  matured  by 
a  most  thorough  and  accomplished  surgical  scholar, 
and  his  selection  of  authors  and  adaptation  of  sub- 
jects have  been  with  the  sole  view  to  the  fitness  of 
men  and  things. 

As  a  natural  introduction  to  what  is  to  follow, 
the  first  volume  lays  the  general  foundation  for  the 
study  of  special  subjects  in  .surgery.  Hence,  .such 
topics  as  are  looked  upon  as  belonging  to  the 
department  of  general  surgery,  including  inflam- 
mation, erysipelas  and  pvicmia,  hydrophobia  and 
glanders,  scrofuLa  and  tubercle,  rachitis  and  scurvy, 
are  discussed  in  full  detail.  In  this  volume  are  also 
contained  articles  on  the  reciprocal  efl'ects  of  consti- 
tutional conditions  and  injuries,  upon  the  general 
principles  of  surgical  diagnosis,  upon  operative  sur- 
gei-y  in  general,  upon  plastic  and  minor  surgery, 
upon  the  use  of  anaesthetics,  upon  shock,  traumatic 
delirium  and  delirium  tremens,  and,  lastly,  uijon 
amputations. 

It  is  not  diiBcult  to  appreciate,  in  view  of  the 
number  and  variety  of  the  subjects  discussed,  that 
the  field  occupied  is  a  large  and  important  one, 
and,  when  properly  worked,  lays  the  broadest  jjos- 
sible  foundation  for  the  consideration  of  all  the 
special  depai-tments  of  study  in  the  science  and  art 
of  surgery. 

The  manner  in  which  this  necessary  groxindwork 
is  laid  is  eminently  sati.sfactory  to  the  student,  for 
this  volume  is  emphatically  one  which,  to  be  properly 
appreciated  in  its  scope  and  utility,  must  be  thor- 
oughly and  patiently  studied.  Each  chapter  is  the 
thoughtful  work  of  a  master,  and  must,  in  turn, 
command  the  careful  attention  of  the  student. 
Although  some  of  the  details  may  api^ear  uninter- 


74 


THE  MEDICAL  RECORD. 


esting  to  the  superficial  reader,  they  cannot  be  ig- 
nored by  any  one  who  determinedly  and  conscien- 
tiously reads  the  work.  The  elaboration  of  the  articles 
is  a  necessity  which  must  be  admitted  in  view  of  the 
general  character  of  the  work,  and  saves  numerous 
and  useless  repetitions,  which  would  otherwise  have 
to  be  made  in  applying  general  principles  to  special 
practices.  The  first  volume,  then,  is  one  treating 
on  general  principles,  which  the  reader  will  be 
ready  to  adapt  for  liimself  as  he  studies  the  other 
volumes.  Indeed,  to  the  advanced  stiident  and  prac- 
tical surgeon,  the  ajjplication  of  these  principles  be- 
comes quite  natural  and  easy,  while  it  lifts  him,  as 
it  were,  on  the  higher  planes  of  thought  and  en- 
larges his  field  of  vision  aecordLUgly.  This  is,  per- 
haps, saying  a  great  deal  for  the  character  of  a  vol- 
ume which,  from  the  necessities  of  the  plan,  must  be 
considered  the  least  inviting,  at  least  for  the  casual 
reader,  of  the  whole  series.  The  volume  may  be 
considered  as  standing  alone  as  regards  the  masterly 
and  comprehensive  manner  in  which  the  diflerent 
subjects  are  treated,  and  so  far  as  it  goes,  is  com- 
plete in  itself. 

The  arrangement  of  subjects  is  at  once  natural  and 
.systematic.  As  may  be  anticipated,  the  fii'st  article 
is  on  the  pathology  of  inflammation.  Starting  from 
the  hi  ilth  line,  the  distinguished  author  and  re- 
nowned pxthologist.  Professor  Strieker,  of  Vienna, 
carries  his  reader  through  all  the  local  and  general 
disturbances  of  nutrition  which  finally  eventuate  in 
a  well-developed  and  classic  phlegmon.  The  tissue- 
changes  are  described  with  characteristic  clearness 
and  minuteness,  and  aU  the  dependent  circumstances 
and  conditions  are  fully  and  comprehensively  pre- 
sented. The  whole  subject  is  gone  over  in  a  man- 
ner that  leaves  nothing  to  be  desired. 

Following  the  discussion  of  the  strict  pathology 
of  inflammation,  as  interpreted  by  the  methods  of 
the  histologist,  is  the  consideration  of  inflammation 
fi'om  the  clinical  standpoint  of  observation  of  the 
practical  surgeon.  This  article  is  by  our  distin- 
guished townsman,  Prof.  Wm.  H.  Van  Bureu,  M.D., 
LL.D.  The  whole  subject  is  most  thoroughly  treated 
by  this  author  :  every  possible  question  is  answered 
concerning  the  phenomena,  causes,  progi-ess,  lesions, 
diagnosis,  and  treatment  of  inflammation,  and  the 
reader  is  left  to  wonder  how  so  much  can  be  said  on 
such  au  apparently  dry  subject  in  such  a  charmingly 
inviting  manner. 

Tlie  article  on  erysipelas,  which  is  the  third  in 
order,  is  written  by  Prof.  StiUe,  of  Philadelphia, 
than  whom,  for  the  work,  no  one  with  better  qual- 
ifications could  have  been  selected.  The  causes, 
symptoms,  diagnosis,  and  treatment  of  this  affec- 
tion are  duly  considered,  the  author  looking  upon 
it  mainly  as  the  development  of  a  cachectic  condi- 
tion and  requiring  tonic  treatment. 

Pvicmia  and  allied  conditions  is  treated  of  in  a 
terse  and  straightforward  manner  by  Prof.  Delafield, 
of  tliis  city.  The  theory  of  pns-al)sorption  is  dis- 
cussed, also  the  cliemical  and  germ  theory,  and  the 
relation  of  mechanical  and  infectious  emboli  to  the 
lesions  of  the  affection.  The  author  believes  in  the 
preventive  treatment  as  a  prime  necessity,  and  has 
little,  if  any,  confidence  in  absolutely  curative  mea- 
sures. This,  it  strikes  us,  is  an  extreme  view,  hardly 
warrantable  in  many  cases  of  blood])oisoning  as  they 
occur  in  surgical  practice. 

Hydrophobia,  glanders,  and  malignant  pustule 
are  topics  which  are  presented  by  William  S. 
Forbes,  If.D.,  Senior  Surgeon  to  the  E]uscopal 
Ho.-ipital,  Philadelpliia.     This  author  has  very  sys- 


tematically grouped  the  facts  bearing  on  these  dis- 
eases, analyzed  their  significance,  and  arrived  at  the 
usual  conclusion  as  to  their  incTuability.  The  ar- 
ticle is  well  written,  and  gives  accurate  pictui'es  of 
the  diseases  named. 

Scrofula  and  tubercle,  by  Henry  Trentham  Butlin, 
of  St.  Bartholomew's  Hospital,  is,  in  its  treatment, 
at  once  clinical  and  pathological,  and  gives  the 
reader  a  most  satisfactoiT  and  comprehensive  view 
of  the  present  state  of  our  knowledge  on  these  sub- 
jects. 

Rachitis,  by  Prof.  J.  Lewis  Smith,  of  this  city,  is 
treated  in  much  the  same  manner,  and  embodies  the 
results  of  his  large  exjierience  in  the  study  and  treat- 
ment of  children  with  the  disease.  His  view's  endorse 
those  of  other  equally  experienced  observei's  in  the 
same  field. 

Philip  S.  Wales,  Surgeon-General  V.  S.  Navy, 
contributes  the  article  on  scurvy,  and  gives  an  in- 
teresting and  exhaustive  account  of  its  history, 
etiology,  morbid  anatomy,  symptoms,  diagnosis,  and 
treatment.  Studying  it  princijially  from  the  point 
of  view  of  the  navy  surgeon,  he  lays  becoming  and 
particular  stress  ujion  the  preventive  measures  to  luj 
adopted,  and  emjjhasizes  the  triumi^hant  results  of 
the  present  well-known  methods  of  treatment. 

An  exceedingly  instructive  and  interesting  article, 
on  the  reciprocal  effects  of  constitutional  conditions 
and  injuries,  is  written  by  Professor  Verneuil,  of 
Paris.  In  this  contribution  are  answered  in  a  straight- 
forward and  satisfactory  manner  many  of  the  ques- 
tions which  perplex  the  surgeon  in  deciding  to 
operate  in  the  face  of  contraindications.  The  wlioli- 
subject  is  gi-asped  with  the  hand  of  a  master,  and 
leaves  nothing  to  be  desired,  either  in  comprehen- 
siveness of  scope  or  thoroughness  of  detail. 

Professor  D.  Hayes  Agnew,  M.D.,  of  Philadelphia, 
in  his  chapter  on  the  principles  of  surgical  diag- 
nosis, although  going  over  well-trodden  ground, 
infuses  an  interest  in  his  subject  by  the  numerous 
and  telling  applications  of  these  principles  to  jirac-  ^ 
tice.  This  article  is,  perhaps,  the  first  one  which 
will  arrest  the  attention  of  the  casual  reader  in 
search  of  practical  points,  and  he  will  read  it.  in 
spite  of  himself,  from  beginning  to  end. 

The  causes,  symptoms,  pathology,  and  treatment 
of  shock  is  the  portion  allotted  to  Dr.  C.  W.  Man- 
sell-Moullin,  of  London,  who  presents  the  subject 
from  theoretical  and  practical  standjjoints.  His 
remarks  on  the  pathology  of  shock  are  particularly 
interesting  in  connection  with  the  experiments  of 
Goltz,  Tappeiner,  ^luller,  and  Lewisson. 

Dr.  William  Hunt,  Surgeon  to  the  Pennsylvania 
Hospital,  Philadelphia,  takes  up  the  discussion  of 
the  subjects  of  traumatic  deliriiim  and  delirium 
tremens  in  a  mannei'  that  assures  the  reader  of 
his  powers  of  observation,  and  his  abilities  for 
generalization.  The  causes  of  traumatic  delirium 
are  exhaustively  considered,  and  give  particular  in- 
terest to  the  study  of  this  ofttimes  formidable 
condition.  His  remarks  on  the  treatment  of  this 
and  delirium  tremens  are  practical  and  pithy. 

The  chapter  on  aniesthesia  is  by  Professor  Henry 
M.  Lyman,  of  t'hicago.  If  it  has  any  fault,  it  is 
that  of  detailed  exhaustivenoss  concerning  ana'sthe- 
tic  substances  seldom,  if  ever,  used  :  otherwise  the 
general  principles  and  ])ractice  of  anicsthesia  ai'e 
interestingly  and  lu-ofitably  set  forth.  In  fact,  it 
api>ears  more  as  a  treatise  in  itself  than  au  ency- 
clopii'dical  contribution. 

Dr.  John  H.  Brinton,  of  Philadelphia,  in  his  dis- 
cussion of  the  conditions  demanding  surgical  o])er8- 


THE  MEDICAL  RECORD. 


tions,  will  secTire  a  wide  reading.  Not  only  will  tbis 
be  so  on  account  of  the  intrinsic  interest  in  the  sub- 
ject, but  by  the  thoroughly  appreehitive  way  in 
which  it  is  treated.  It  woiilil  he  well  if  every  sur- 
geon in  the  land  could  study  the  chapter  and  take 
its  practical  lessons  to  heart. 

But  the  general  practitioner  will  naturally  become 
most  interested  in  the  communication  on  minor  sur- 
gery, by  Dr.  Charles  T.  Hunter.  This  section  is  very 
profusely  illustrated  with  rei^resentations  of  the  ap- 
plication of  bandages  and  other  apparatus,  and  the 
descriptions  are  admirably  clear. 

It  would  seem  that  the  article  on  plastic  surgery, 
by  Professor  Christopher  Jolmston,  of  Baltimore, 
was  written  more  for  the  sake  of  bringing  out  well- 
recognized  principles  than  of  applying  any  such  to 
special  cases.  So  far,  it  has  fulfilled  its  oliject  ad- 
mirably, although,  in  the  discussion  of  the  general 
subject,  that  of  skin-grafting  appears  to  have  Jindue 
prominence. 

The  last  subject  of  this  volume  is  that  of  amputa- 
tions, exhaustively  written  up  by  the  editor.  Profes- 
sor John  Ashhurst,  .Tr.,  of  Philadelphia.  The  history 
of  these  operations  is  given  from  the  earliest  i>eriods 
to  the  present,  and  all  the  special  methods  n'ow  in 
vogue  are  carefully  described.  From  every  aspect 
the  article  is  a  classical  one,  and  will  be  appreciated 
as  such  by  every  one  who  cares  to  study  operative 
surgeiy. 

In  concluding  this  somewhat  lengthy  review,  we 
repeat,  that  if  the  work  as  a  whole  is  carried  out  as 
it  has  been  commenced,  there  will  be  nothing  to 
comp.are  with  the  " Encyclojiiedia  of  Surgery''  in 
any  language.  The  volume  is  elegantly  ])rinted,  and 
contains  excellent  woodcuts  and  elegant  chi'omo- 
lithographs. 


Treatment  of  Hemorrhakes  Produced  by  Epi- 
thelioma OF  THE  "Woim. — At  a  conference  held 
at  the  Institute  of  Operative  Therapeutics,  at  the 
Hosi^ital  de  la  Princesa,  according  to  the  Si;flo  .^[e- 
dico,  the  following  remarks  v.ere  made  in  regard  to 
the  treatment  of  hemorrhages  due  to  uterine  epi- 
thelioma : 

1.  Art  can  aflford  great  relief  to  patients  suft'er- 
ing  from  uterine  epithelioma,  though  the  disease  is 
incurable.  2.  Ergot  is  of  no  value  in  these  cases, 
because  the  di'y  and  scirrhiform  uterus  is  infiltrated 
with  epithelial  cells  which  cause  the  atrophy  and 
destruction  of  the  contractile  fibro-cellular  elements, 
over  which,  in  the  normal  state,  ergot  exercises  its 
action,  contracting  the  ves.sels  and  diminishing  their 
calibre.  3.  Chlorides  of  7.inc,  in  the  semi-fluid 
form,  not  in  solution,  should  be  used ;  plugs  of  cot- 
ton are  to  be  rolled,  smeared  with  the  chloride,  and 
applied  to  the  affected  surface,  taking  care  to  pre- 
vent dripping,  -t.  Hemon'hage  is  checked  in  this 
manner ;  other  procedures  are  totally  or  almost 
useless.  5.  Such  bleedings  may  terminate  life,  if 
not  attended  to.  G.  Chronic  liemorrhages,  or  those 
which  are  repeated  at  greater  or  less  intervals,  es- 
tablish a  certain  tolerance  of  the  organism,  and  if 
the  patient  does  succumb  to  them,  it  is  not  imme- 
diately, though  they  do  not  receive  treatment.  7. 
The  natural  and  inexplicable  tendency  which  hem- 
orrhages have  of  recurring  and  ceasing  spontane- 
ously has  endowed  many  drugs  with  haemostatic 
virtues,  although  they  may  Vie  useless  if  taken  by 
the  mouth,  and  of  but  little  value  topically  ap])lied. 
8.  The  more  hemorrhages  are  prevented,  the 
longer  will  the  fatal  issue  be  deferred. 


Heports  of  Societies. 


NEW  YOrjv  AC.\DE]\IY  OF  MEDICINE. 

Stated  Meelin<j,  Jrinuary  5,  1882. 

FoRDTCE  Barker,  M.D.,  LL.D.,  PKEsroENT,  rN  the 
Chaie. 

Dk.  Samuel  Sexton  read  a  paper,  entitled 

THE    treatment    OF    DISEASES    OF    THE     MIDDLE     EAR 
AND   CONTIGUOUS   PARTS   liY   .MILDER   MEASURES   THAN 

THOSE  cosiMONLY  IN  VOGUE  (see  jjage  57.) 

The  President  invited  Dr.  C.  H.  Burnett,  of 
Philadelphia,  to  open  the  discussion,  who  said  that 
he  could  indorse  what  had  been  stated  by  the  author 
of  the  paper,  so  far  as  his  personal  experience  ex- 
tended :  some  points,  however,  had  been  alluded  to 
ujion  which  he  had  not  had  any  experience.  He  had 
seen  the  neuralgic  cases  referred  to  as  liable  to 
be  mistaken  for  inflammatoiy  ones,  and  he  had  also 
seen  artificial  aural  disease  which  had  been  mis- 
taken for  the  original  afiection.  Such  cases  were 
important,  because  of  the  damage  done  by  surgical 
and  medical  interference.  As  already  stated  by  the 
author  of  the  paper,  there  is  a  very  great  variety  of 
mastoid  affections,  and  of  some  of  those  cases  he 
had  been  obliged  to  study  the  natural  history,  and 
had  leai-ned  a  great  deal  thereby.  A  short  time 
after  he  began  to  practice,  he  was  asked  to  see  a 
physician  who  had  middle-ear  disease,  and,  as  he 
(Dr.  Burnett)  thought,  mastoid  disease.  None  of 
the  five  gentlemen  present  at  the  consultation  were 
willing  to  operate  for  the  latter.  The  patient  was 
over  fifty  years  of  age,  and  was  recovering  from 
a  seveiy  attack  of  pneumonia.  The  drum-head  was 
bulging,  he  complained  of  deafness  in  one  ear,  with 
some  pain,  and  he  (Dr.  Burnett)  thought  it  should  be 
incised.  A  few  hours  afterward  rupture  occurred,  a 
large  quantity  of  gelatinous  matter  escaped,  and  tem- 
porary relief  followed ;  but  ultimately  more  pro- 
nounced symptoms  developed,  and  he  advised  an 
operation  for  mastoid  disease.  Within  two  weeks 
the  patient  passed  through  all  the  stages  of  that 
disease,  but  no  operation  was  performed.  The 
membrana  tympani  was  kept  ojjen  by  incisions. 
So  long  as  that  was  done  eveiy  day  or  two,  the  pain 
was  relieved,  and  finally  there  was  a  discharge  of 
purulent  matter  from  the  cortical  portion  of  the 
mastoid  cells.  Perhaps  this  was  a  case  which  should 
have  been  operated  upon,  but  recovery  took  place 
by  natural  processes,  and  the  jiatient  had  had  no 
subsequent  trouble  with  his  ear. 

Another  case  was  one  which  he  saw  in  the  Presby- 
terian Hospital,  Philadelphia.  The  patient,  twenty- 
four  years  of  age,  was  found  insensible,  and  with  a 
large  wound  behind  and  extending  across  and  into 
the  ear.  The  wound  in  the  mastoid  region  was  very 
large.  The  posterior  auditory  canal  was  opened,  and 
there  was  facial  paralysis.  Unconsciousness  contin- 
ued for  two  weeks,  after  which  the  patient  had  in- 
tense headache  upon  the  oi>posite  side,  with  enlarged 
pujiil.  Finally  a  mastoid  sequestrtim  was  removed, 
and  the  wound  healed.  The  memVirana  tymjiani 
was  not  perforated.  Hearing  was  restored  to  nearly 
normal,  but  the  facial  paralysis  remainedunchanged. 
From  a  careful  examination  of  the  sequestrum,  it 
was  believed  that  a  portion  of  the  facial  canal  was 
removed. 


76 


THE  MEDICAL  KECORD. 


With  reference  to  the  sulphide  of  calcium,  he  had 
used  it  in  one  case  of  furuncle  of  the  ear,  occurring 
in  a  strong  man,  thirty  years  of  age.  The  difficTilty 
rapidly  subsided,  and  the  patient  recovered  without 
further  trouble,  which  was  worthy  of  notice,  in  view 
of  the  fact  that  the  disease  has  a  well-known  tendency 
to  recur.  He  asked  whether  the  use  of  the  sulphide 
of  calcium  should  be  limited  to  strong,  robust  pa- 
tients, or  could  it  be  administered  with  safety  to  the 
cachectic,  etc.? 

Di{.  RoosA  said  that  the  essayist  had  been  very 
frank  in  the  statements  made  in  his  paper,  and  he 
would,  therefore,  he  equaUy  frank  in  the  few  remarks 
which  he  wished  to  make  in  reply. 

With  regard  to  that  portion  of  the  jiaper  W'hich 
treated  of  the  etiology  of  aui'al  disease,  he  would  have 
but  little  to  say ;  for  we  are  tolerably  familiar  with 
the  accepted  etiology,  and  there  would  be  no  differ- 
ences of  opinion  with  the  author  of  the  paper,  except, 
perhaps,  that  he  laid  more  stress  upon  what  he 
called  reflex  nervous  influence  than  most  of  the 
writers  upon  this  subject  had  done.  Concerning  that 
portion  of  the  paper  in  which  its  author  spoke  of 
necrosis,  removal  of  granulations,  etc.,  he  had  noth- 
ing to  say,  except  in  way  of  commendation,  which 
we  all  would  give  it  as  recommending  sound  surgical 
practice.  But  with  regard  to  the  use  of  the  sulphide 
of  calcium,  pulsatilla,  etc.,  and  abstinence  from  sui'- 
gical  interference,  he  was  so  positively  at  variance 
with  the  gentleman,  that  he  was  embarrassed  in  an- 
nouncing his  opinions.  "  It  was  an  honored  gentle- 
man, now  jjresent,  and  formerly  President  of  this 
Academy,  who  taught  me  the  surgical  principle  that 
free  vent  should  be  given  to  concealed  pus,  and  that 
the  swollen  and  inflamed  muscular  or  connective 
tissue,  or  periosteum  beneath  which  it  is,  should  be 
incised.  I  have  criticised,  as  a  pupil  may,  his  teach- 
insjs,  but  I  have  found  in  my  own  practice,  quite  dif- 
ferent from  tjie  experience  of  the  author  of  the 
paper,  that  these  principles  are  correct  to  this  day. 

"  I  cannot  verify  the  experience  of  Dr.  Sexton  or 
Dr.  Burnett  as  to  the  value  of  the  sulphide  of  cal- 
cium in  the  treatment  of  aural  disease.  I  have  tried 
the  drug  in  furunculus  and  in  diffuse  inflammation 
of  the  external  auditory  canal,  and  I  have  not  known 
it  to  produce  any  effect  whatever.  I  have  never 
dared  to  try  it  in  acute  inflammation  of  the  tym- 
panic cavity.  This  question  becomes  one  so  largely 
of  personal  experience,  that  it  is  difficult  to  speak 
intelligently  upon  it — for  one  man  sees  what  another 
fails  to  see,  and  one  man  fails  to  see  what  another 
sees ;  but  I  will  endeavor  to  formulate,  in  a  brief 
way,  the  priuciples  which  I  still  adhere  to,  which  I 
have  announced  in  as  public  a  way  as  it  is  possible 
to  announce  them,  and  which  I  do  not  believe  have 
been,  as  yet,  overthrown. 

"  Given  a  red  mernbrana  tympani ;  given,  at  the 
same  time,  serious  pain  referred  to  the  ear— and  by 
serious,  I  mean  that  which  will  keep  the  patient 
from  sleeping,  cause  him  to  cry  out  or  groan  with 
suffering — given  these  conditions,  and  if  tliey  be  not 
speedily  relieved  by  the  use  of  the  warm  douche,  I 
believe,  and  it  accords  with  my  experience,  taken 
with  whatever  of  salt  you  please,  tliat  there  is  no 
reraedv  to  l)e  compared  in  any  manner,  as  to  value, 
with  leeches,  and  I  think  the  notion  that  tlie  leech- 
wounds,  or  the  attempts  to  stop  the  hemorrhage, 
causes  such  serious  symptoms,  tends  to  deter  us 
from  using  them,  and  will  not  be  verified  by  most 
ob.servers. 

"  I  believe,  also,  that  if  the  dnira-head  be  bulging, 
and   at  the  same  time  there  be  very  considerable 


pain,  it  is  much  better,  although  many  people  get 
well  without  it — many  people  go  to  battle  and  do 
not  get  killed — that  a  man  will  get  sleep  quicker 
and  get  well  sooner  if  that  drum-head  is  incised  w  ith 
a  needle.  As  regards  my  notions  of  mastoid  disease, 
I  have  clearly  formulated  them  in  accessible  print. 
They  do  not  agree  with  those  of  the  author  of  the 
paper,  so  far  as  I  understand  them.  I  admit  that 
there  is  a  kind  of  mastoid  inflammation  which  should 
not  be  incised.  The  President  of  the  Academy  once 
quieted  my  fears  about  a  case  of  phlegmon  of  the 
mastoid  jn-ocess,  and  by  his  advice  I  was  indiiced  to 
wait  a  little  while,  and  the  patient  recovered,  with 
evacuation  of  pus  from  the  auditory  canal.  That 
class  of  cases  is  easily  distingiiished  from  those  of 
peritonitis,  external  or  internal. 

"  I  will  not  go  over  the  principles  to  which  I  still 
adhere,  and  which  are  formulated  in  what  some  of 
you  have  read  upon  that  subject.  I  wish  also  to  say 
that  I  am  very  far  from  believing  that  every  ease  of 
aural  disea.se  is  to  be  attacked  with  leeches  or  the 
knife  ;  but  I  simply  believe,  as  I  have  stated,  that 
there  are  many  cases  in  which  the  knife  and  leeclies, 
as  antiphlogistic  measures,  are  absolutely  necessary. 
And  I  have  also  heard  it  stated,  on  good  authority, 
that  cases  have  passed  out  of  the  hands  of  those  who 
have  treated  them  with  the  sulphide  of  calcium,  and 
have  come  to  the  knife  after  all. 

"  Again,  I  find  a  great  similarity  in  the  teachings 
of  the  Homoeopathic  Otological  Society  and  what  we 
have  heard  from  the  reader  of  the  paper  this  even- 
ing. There  is  no  reflection  in  that  assertion.  But 
these  are  the  principles  of  homoeopathy.  They  may 
be  correct  and  we  may  be  wrong.  The  principles  of 
treatment  enunciated  by  the  author  of  the  paper 
represent  the  kind  adopted  by  my  friends  in  that 
society,  for  I  have  several  personal  friends  among 
its  members. 

"  I  cannot  as  yet  see  that  the  principles  of  sur- 
gery have  been  turned  upside  down,  as  it  would 
seem  to  me  they  had  been  if  we  could  assert,  as  the 
gentleman  does,  that  he  now  sees  no  cases  of  acute 
aural  disease  which  require  leeches  or  the  knife." 

Dr.  O.  D.  Pomeroy  said  that  he  felt  embarrassed 
in  attempting  to  speak,  as  Dr.  Eoosa  had  pretty  ef- 
fectually taken  the  wind  out  of  his  .sails,  by  saying 
about  what  he  himself  would  have  said. 

To  speak  in  detail,  the  reader  of  the  paper  had 
astonished  him  by  mentioning  leeching  as  a  violent 
measure,  and  one  likely  to  do  harm.  With  all  the 
fairness  possible,  he  woukl  state  the  pros  afid  cons 
upon  the  question.  In  the  first  place,  leeching  need 
not  be  a  violent  measure.  The  average  American 
practitioner  does  not  apply  six  to  ten  leeches,  as  many 
Continental  .surgeons  do,  about  the  ear,  and  exsangui- 
nate the  patient.  One  leech  is  often  sufficient  to  se- 
cure all  the  local  deidetion  that  is  necessary.  Again, 
with  reference  to  the  pain  and  irritation  produced 
by  the  leech-bite,  if  there  was  any  ajiparatus  in  the 
world  which  made  a  clean,  painless  cut,  it  was  the 
mouth  of  a  leech  True,  the  bungling  efforts  of 
some  people,  in  making  subsequent  applications  to 
arrest  the  bleeding,  might  ciinse  n  return  of  the  pain 
which  had  been  previously  arrested  by  the  leech  ; 
but  that  could  not  be  used  as  an  argument  against 
the  measure.  In  what  eases  can  leeclies  do  harm,  if 
blood  suflicient  to  weaken  the  patient  is  not  extracted  ? 
If  there  is  a  decided  acute  hyperuunia  of  the  tym- 
panic cavity,  without  any  relaxation  of  tissue,  a 
leech  cannot  possibly  do  harm.  Again,  you  may  have 
hypera^mia  of  the  tympanic  cavity  associated  with 
a  relaxed  condition  of  the  tissues,  and,  under  such 


THE  MEDICAL  RECORD. 


77 


circumstances,  the  application  of  a  leech  may  aggra- 
vate the  pain,  but  in  these  instances  opium  settles 
the  question  at  once. 

He  hail  had  otitis  too  many  times  himself,  and  ex- 
perienced too  often  the  grateful  relief  from  pain 
afforded  by  the  application  of  a  leech,  to  believe  at  all 
in  their  violence  or  liability  to  do  harm  when  prop- 
erly used._  With  reference 'to  the  use  of  the  svriiige, 
a  very  eminent  -svi-iter  on  aural  surgery  had  spoken 
of  "  the  sloppy  thraldom  of  the  syringe,"  but  he 
confessed  to  being  under  that  thraldom,  sloppy  or 
otherwise.  He  admitted  that  if  water  was  thrown  into 
I  the  tympanic  caWty  it  might  produce  iniiammation, 
I  and  any  violent  syringing  might  do  harm  ;  but  pro jier 
Isyringing  of  the  ear  was  not  injurious,  especiallv  if 
k  small  quantity  of  salt  was  added  to  the  water.  The 
taildest  cleansing  with  cotton  might  inflict  more 
Bamage  than  proper  syringing  in  removing  dis- 
j^arges,  etc.,  from  the  ear.  In  acute  inflammation 
ffi  the  tympanic  ca%-ity,  when  there  is  excess  of 
pressure  and  gi-eat  hypera-mia,  attempts  at  inflation 
■wll  cause  pain,  aggi-avate  the  sufl'erings  of  the  pa- 
titot,  and  should  not  be  made.  But  often  in  acute 
inlammation  the  dense  membrane  may  be  a  good  deal 
sunken,  and  that  condition  of  itself  riiay  give  rise  to 
pah.  In  such  cases  inflation  may  be  practised  with 
beiefil;.  Occasionally  he  had  seen  pain  caused  by 
exOssive  inflation  of  the  tympanum,  even  when 
properly  done. 

I>.  Pomeroy  was  glad  to  be  able  to  coincide  with 
the  Mthor  of  the  paper  upon  one  point,  and  that 
was  ^ith  reference  to  Wild's  incision.  He  had  not 
madeit  for  nearly  a  year,  and  yet  he  had  seen  mas- 
toids swollen,  reddened,  pit  Tipon  pressure,  but 
had  hid  no  trouble  in  relieving  them  by  leeching. 
With  rference  to  paracentesis,  the  point  raised  bv  Dr. 
Roosa  \as  absolutely  impregnable.  There  should  lie 
no  quesjon  of  the  propriety  of  opening  the  membrane 
under  cicumstances  .such  as  Dr.  Roosa  had  indicated. 
It  could'ie  done  without  difficulty,  and  he  thought  it 
unnecesaiy  to  use  anesthetics,  except  in  children. 

The  aiihor  of  the  paper,  however,  astonished  him 
beyond  ttiasure,  by  stating  that  he  had  not  used 
leeches  fo.  years,  and  it  .seemed  impossible  to  him 
that,  of  tb  large  number  of  cases  of  acute  inflam- 
mation wit.  which  he  (Dr.  Sexton)  must  have  met, 
some  of  tern  had  not  required  leeching.  Dr. 
Sexton  had  .-joken  of  his  acute  cases  as  relapsing  fre- 
quently, audit  was  possible,  he  thought,  that,  had 
proper  leecbig  been  resorted  to,  such  recurrence 
would  not  hae  been  observed.  It  was  his  custom 
to  leech  the  pUent  so  long  as  he  had  a  pecidiar  dull, 
aching  pain,  c  a  feeling  of  heaviness  in  tlie  ear. 
He  had  never  (fed  the  sulphide  of  calcium,  but  did 
not  believe  thaiit  could  bring  about  such  remark- 
able results  as  ibad  been  said  to  accomplish.  His 
assistant,  howev,,  had  used  the  drug  extensivelv, 
and  the  report  ha  been  that  it  was  of  no  use  what- 
ever in  the  treatiint  of  aural  atfections. 

Db.  Dx^-id  Weiter  thought  that  all  aural  sur- 
geons who  had  mi,T  cases  of  chronic  suppurative 
inflammation  of  th  middle  ear  to  treat,  were  verv 
likely  to  obtain,  so  V  as  possible,  the  entire  history 
of  these  cases,  and  h  believed  his  experience  coin- 
cided with  that  of  ot,i.s,  namelv,  that  chronic  sup- 
purative inflammatio.  of  the  middle  ear,  which  is 
so  diflicult  to  manage,Thich  we  do  not  alwavs  suc- 
ceed in  curing  even  v.■^^  the  most  protracted  and 
faithful  treatment,  oria,ates,  in  the  vast  majoritv  of 
cases,  in  an  acute  inflaruatiou  which  has  received 
no  treatment.  He  belie  j  that  there  was  a  unani- 
mity of  opinion  upon  thtj^oint. 


Again,  aural  surgeons  had  many  cases  of  acute  in- 
flammation of  the  middle  ear  to  t;reat,  and  he  failed 
to  recall  a  single  case,  at  that  moment,  treated  from 
the  very  first  according  to  methods  recommended  in 
standard  books,  that  resulted  in  chronic  suppurative 
inflammation  of  the  middle  ear.  He  believed  that 
the  general  experience  of  aural  surgeons  would  bear 
him  out  in  that  statement. 

He  knew  nothing  concerning  the  treatment  of 
these  cases  by  the  use  of  Pulsatilla,  sulphide  of  cal- 
cium, etc.,  and  felt  that  he  should  insist  upon  seeing 
one  or  two  cases  treated  in  that  way  before  abstain- 
ing from  the  use  of  warm-water  douche,  leeches,  and 
opium,  if  necessary,  to  relieve  pain.  He  knew  that 
acute  cases,  without  treatment,  fi-equently  resulted 
in  a  chonic  inflammation  almost  impossible  to  cure. 
Dr.  Sextox,  in  reply  to  Dr.  Burnett,  concerning 
the  influence  of  age,  habits,  etc.,  upon  the  use  of 
the  sulphide  of  calcium,  said  that  it  did  make  a  dif- 
ference as  to  whether  the  patient  was  old  or  young, 
so  far  as  the  dose  was  concerned  ;  but  he  had  not  seen 
many  cases,  as  yet,  in  which  he  thought  the  drug 
was  contraindicated,  and  both  old  and  young  might 
take  the  remedy  with  safety  when  it  was  properly 
given.  It  was  thought  to  be  particularly  eflicacious 
in  scrofulous  subjects.  With  regard  to  the  remarks 
made  by  Dr.  Roosa,  he  was  not  disappointed  at  the 
gentleman's  suiprise  at  what  he  (Dr.  Sexton)  had  read. 
He  expected  there  would  be  some  .surprise  at  these 
measures ;  but  he  could  say  that  no  one  was  .surprised 
more  than  himself  when  lie  made  up  his  mind  that 
we  were  prone  to  operate  too  much  about  the  ear.  He 
still  believed  that  such  work  is  overdone  ;  that  we 
have  gone  too  far ;  and  that  it  is  well  that  we  should 
take  a  step  in  the  other  direction.  He  did  not 
say  that  he  never  used  the  knife,  and  that  leeching 
should  never  be  employed  ;  but  simjjly  said  that 
he  had  found  it  unnecessary  to  resort  to  these 
measures  since  he  had  adopted  the  plan  of  treat- 
ment already  outlined.  He  thought  that  he  had  not 
allowed  his  patients  to  suffer  from  pain  more  than 
other  surgeons,  and  as  to  the  success  of  the  treat- 
ment, the  patients  and  the  practitioner  must  judge. 
He  was  sm-prised  at  the  suggestion  concerning 
homoeopathy  made  by  Dr.  Roosa,  and  did  not  ex- 
actly understand  what  was  meant  by  the  statement. 
As  he  understood  honuieopathy,  he  "failed  to  see  any 
connection  between  it  and  his  method  of  treating 
aural  disease.  Certainly,  calcium  sulphide,  aconite, 
gelsemium,  etc.,  were  not  remedies  used  by  the 
homa-opathists  only  nor  specially.  They  had" been 
used  by  regulars  for  years,  and  also  in" very  small 
doses,  and  he  was  amazed  that  such  a  statement 
should  have  been  made  before  a  body  of  intelligent 
gentlemen.  As  to  the  use  of  calcium  sulphide,  and 
subsequent  treatment  liy  other  practitioners,  he 
thotight  it  an  improper  subject  for  discussion. 
The  academy  then  adjourned. 


Another  Case  of  Recovery  after  Prolonged 
IMMER.SION.— Dr.  E.  C.  Carter,  U.  S.  Army,  writes  : 
"  The  account  given  by  Mr.  Pope,  in  the  Lancet  for 
October  1,  1881,  of  a  man  who  recovered  after  immer- 
sion in  water  for  twelve  or  fifteen  minutes,  finds  its  j^a- 
rallel  in  a  case  which  occurred  ofif  the  coast  of  Long 
Island,  in  August,  1881.  The  patient  fell  overboard 
in  an  epileptic  fit,  and  was  brought  to  the  surface 
about  fifteen  minutes  afterward.  He  was  resuscitated. 
Ausculation  showed  that  very  little  water  had  been 
drawn  into  his  lungs,  owing,  no  doubt,  to  the  epi- 
leptic condition. 


78 


THE  MEDICAL  RECORD. 


NEW  YORK  PATHOLOGICAL  SOCIETY. 

Staled  Meeting,  December  li,  18S1. 

Dr.  T.  E.  Satterthwaite,  President,  in  the  Chaiij. 

floating  cartilages  in  the  knee-joint. 

Dr.  a.  p.  Gerster  presented  two  specimens  of 
floating  cartilage  of  the  knee-joint,  removed  from 
two  difierent  patients,  and  exhiliiting  two  varieties  of 
fl3ating  bodies  which  are  found  in  this  joint.  The 
first  variety  of  these  bodies  is  caused  by  trauma- 
tism. A  particle  of  the  joint  surface  is  chipped  off, 
and  lies  loose  within  the  cavity.  The  other  variety 
is  one  in  which  the  floating  body  is  pi-oduced  by  es- 
sential disease  of  the  synovial  membrane  ;  it  is  a 
villous  growth  of  the  synovial  membrane,  parts  of 
which  gradually  calcify,  are  detached,  and  become 
floating  bodies.  It  is  obvious  that,  having  removed 
a  floating  body  of  traumatic  origin  and  short  dura- 
tion, we  shall  be  able  to  foretell  a  good  cure  and 
complete  restitution  of  the  functional  ability  of 
the  joint.  The  prognosis  of  the  villous  variety  of 
floating  bodies  is  not  so  good  by  far  ;  their  removal 
is  more  difficult,  involving  a  good  deal  of  irritation 
of  the  synovial  membrane,  and  even  their  complete 
removal  does  not  insure  against  a  recurrence  of  the 
disease.  Yet  we  can  say  that  the  irrigation  of  the 
joint  with  a  strong  solution  of  carbolic  acid  during 
the  operation  may  so  influence  the  synovial  mem- 
brane as  to  check  the  chronic  state  of  inflammation 
that  causes  the  proliferation  of  the  membrane,  and 
thus  effect  a  radical  improvement.  The  first  of 
the  specimens  presented  was  of  traumatic  origin. 
On  one  surface  it  was  smooth  and  cartilaginous  ; 
on  the  other  it  was  rough,  and  presented  a  surface 
which  apparently  corresponded  with  the  point  of 
attachment.  He  was  unable  to  say  from  which  part 
of  the  joint  it  came.  It  was  removed  from  a  young 
man  who  fell  from  an  elevation,  and  ever  since  the 
receipt  of  the  injury  he  had  noticed  a  foreign  body 
in  the  knee-joint.  Occasionally  it  became  impacted 
between  the  joint  surfaces,  causing  intense  pain  and 
acute  inflammation,  with  extensive  effusion  into  the 
joint.  The  patient  came  under  Dr.  Gerster's  care 
in  the  German  Hospital,  in  September  last,  where 
he  operated  for  its  removal.  The  operation  was  per- 
foi'med  under  complete  antiseptic  precautions.  The 
joint  was  shaved,  washed  with  ether  and  a  carbolic 
acid  solution.  The  floating  body  was  then  fixed  by 
the  fingers  of  an  assistant  on  the  inner  aspect  of  the 
joint,  where  a  semilunar  incision  was  made  through 
the  .skin,  fascia,  subcutaneous  tissue,  down  to  the 
capsule.  The  capsule  was  then  incised  close  to  the 
base  of  the  semilunar  flap,  and  the  body  readily  re- 
moved. Quite  a  large  (piantity  of  sanguinolent 
synovia  escaped  from  the  joint.  The  synovial  mem- 
brane was  .sutured  with  carbolized  catgut,  and  the 
external  incision  was  also  closed  with  sutures.  The 
wound  was  converted  practically  into  a  subcutane- 
ous wound,  because  the  incision  through  the  skin 
and  that  through  the  capsule  did  not  exactly  corre- 
spond. Primary  nuioti  followed,  the  man  got  up 
two  weeks  afterward,  and  subsequently  regained  full 
use  of  his  joint. 

In  the  second  case  the  patient  was  a  girl,  fourteen 
years  of  ago.  The  villous  growth  originated  from 
that  mass  of  connective  and  fatty  tissue  which  is 
found  below  the  i)atella  and  beneath  the  ligamen- 
tum  patellii'  propriuni  There  was  no  history  of 
traumatism.      Api>ftrontly,    the    synovitis   was   not 


caused  by  the  presence  of  the  floating  body,  but  the 
latter  was  the  consequence  of  an  essential  lesion  of 
the  synovial  membrane.     The  patient  was  laid  up 
nearly  every  ten  or  fourteen  days,  on  account  of  the 
sudden  development  of  pain  and  copious  effusion 
into  the  joint.     Several  gentlemen  by  whom  she  was 
seen,  at  the  instance  of  her  family  physician,  re- 
garded an  operation  for  its  removal  as  exceedingly 
dangerous,  and  advised  against  it.     Dr.  Gerster  saw 
the  patient  early  in  December,  1881,  with  her  family 
physician.  Dr.  Scharlau,  and,  upon  examining  the 
joint,  found  upon  the  inner  aspect,  at  a  point  corre- 
sponding to  the  inner  margin  of  the  jjatella,  several 
floating  bodies,  tolerably  movable,  but  not  entirely 
detached.     He  assumed  that  these  bodies  were  at- 
tached upon  the  inner  side  of  the  patella,  and  pro- 
posed to  remove  them.     It  was  apjjarent  that  the 
joint  was  suffering  more  and  more  in  consequence 
of  these  bodies,  and  although  the  operation  is  a  no- 
toriously dangerous  one,  it  was  finally  decided  t) 
have  it  performed,  and  it  was  accordingly  done  cq 
December   5th.     An   incision  was   made   upon   tie 
inner  side  of  the  joint,  midway  between  the  mir- 
gin  of  the  patella  and  the  inner  condyle,  and  ore 
was  taken  to  ligate  every  vessel  before  jiroceedng 
further,  so  that  when  the  capsule  of  the  joint  vas 
reached  the  wound  was  perfectly  dry.     A  small  in- 
cision was  then  made,  about  one  centimetre  in  leigth, 
into  the  capsule,  and  one  of  these  bodies  was  etsily 
exposed  and  seized,  and  to  his  astonishment  he  fnind 
that  it  was  connected  with  a  large,  clustering  nass, 
which  he  was  unable  to  remove  on  account  if  the 
small  size  of  the  first  incision.     He  therefce  en- 
larged the  incision  to  the  extent  of  an  inch  and  a 
half,  and  turned  the  false  growth  out  of  th^  joint, 
the  base   of  which  was  half  an  inch  in  lenp^h  and 
half  an  inch  in  width,  and   the  distance  fom  the 
base  of  the  growth  to  the  tijJ  was  about  ae  inch. 
It  had  a  deep  orange  color,  and  was  covert!  with  a 
pannus  of  vessels.     It  was  gradually  sepn'ated  by 
scissors.     The   hemorrhage   was  very  sliht.     The 
joint  was  washed  out  with  a  five  per  cen-  carbolic 
acid  solution,  and  the  joint  wound  was  let  partially 
open.     Two    drainage-tubes   were   intifluced,  be- 
tween which  the  synovial  membrane  wa;  sewed  up, 
and  finally  the  external  incision  was  drpv'n  together 
with  six  or  eight  sutures.     A  Lister  ressing  was 
applied,  and  also  a  dorsal  plaster-of-Pris  splint,  in 
order  to  secure  perfect  rest  to  the  j'nt.     On  the 
third   day  the  first  dressing  was  chiiged.     There 
•were  no  inflammatory  changes  abot  the  wound, 
and  the  Lister  dressing  was  again  enewed.     The 
elevation   of  temperature  was  very  light.     On  the 
fourth  or  fifth  day  the  patient  had  A  intense  colic, 
which  was  believed  to  be  due  to  be  constipation 
succeeding  the  use  of  morphia,  a?t  entirely  disap- 
peared after  the  patient  had  a  freie'^'acuation  from 
the  bowels,  produced  by  repea^l  enemata.     The 
pulse  also,  which  had  steadily  b'Q  high— 120— di- 
minished in  frequency  very  ren^i'kil'l.y  to  80,  after 
the  first  copious  evacuation  fro;  the  bowels.     The 
dressings  were  changed  on  the  't'l  day.    The  drain- 
age-tubes were   removed  and'lf'ftnscd,  shortened, 
and  so  applied  as  to  merely  kP  tlie  incision  in  the 
skin  open,  and  the  dressings  ^re  reapplied.    These 
dressings  were  left  on  three  ».^-''  more,  and  day  be- 
fore yesterday  ho  removed  t?  drainage-tubes  olto- 
gether.     At  the  present  tie  the  joint  presents  a 
perfectly  normal  apijearam-     There  was  no  in-ita- 
tion  of 'the  synovial  uien'We,  and  the  secretion 
from  the  joint  was  actrntS  "one-     I>r-  Gerster  in- 
tended to  resume  pa8sive"o*ion  as  soon  as  possi- 


THE  MEDICAL  RECORD. 


79 


ble,  and  hoped  to  restore  the  joint  to  its  complete 

usefulness. 

In  this  connection  he  mentioned  a  third  case  of 
floating  bodv,  which  was  interesting  on  account  of 
the  cure  effected  by  the  patient  himself.  A  young 
man,  a  laborer,  had  a  floating  body  in  the  knee-joint, 
which  was  the  result  of  traumatism  Dr.  Gerster 
advised  its  removal,  and  dii-eeted  the  patient  to  en- 
ter the  German  Hospital.  The  man  on  his  way  to 
the  hospital  met  with  a  friend,  who  advised  him  to 
use  great  force  of  extension  whenever  the  piece  be- 
came impacted  in  the  joint,  and  told  him  that  in 
that  way  he  could  break  it  up  and  cure  himself. 
While  walking  to  the  hospital  the  floating  body  be- 
came impacted  in  the  joint,  and  the  patient  followed 
I  the  advice  of  his  friend,  and  actually  crushed  it,  so 
\  that  when  he  reached  the  hospital  the  house  surgeon 
\was  unable  to  detect  any  body  whatever.  On  the 
following  morning  Dr.  Gerster  went  to  the  hosiDital 
10  arrange  for  the  operation,  and  found  that  the 
•ody  was  gone.  After  the  acute  synovitis  which  was 
it  up  by  this  heroic  method  had  subsided,  the  pa- 
tient was  cured,  and  was  dismissed  from  the  hospital 
■without  operation.  Dr.  Gerster  had  seen  him  within 
tlfelast  two  hours,  and  he  was  unable  to  tind  the  float- 
ing body,  and  believed  that  the  patient  had  succeeded 
in  ^rushing  the  cartilaginous  mass  successfully. 

Il  view  of  the  dangers  attending  this  class  of  op- 
eraftons,  he  had  the  patient  and  the  room  in  which 
the  operation  was  to  be  performed  specially  pre- 
pare!. The  room  was  thoroughly  cleansed,  the  car- 
pets ^'ere  removed,  the  floors  were  scraped,  the 
walls  were  newly  covered  with  whitewash  prepared 
with  aflve  per  cent,  solution  of  carbolic  acid.  All 
the  wo)d-work  was  brushed,  and  new  beds  were  fur- 
ni8hed,and  all  jjersons  coming  in  contact  with  the 
patient,  the  instruments,  or  the  dressings,  or  any- 
thing inthe  room,  had  to  be  disinfected  in  the  doc- 
tor's preence,  and  during  the  operation  the  usual 
antiseptit  precautions  were  observed. 

Db.  Ko'.ert  Newman  referred  to  a  case  in  which  a 
plan  of  tDvtment,  similar  to  that  adopted  in  Dr. 
Gerster's  tiird  case,  was  followed.  The  patient  was 
a  lad  who  fll  upon  a  railroad  track  and  struck  his 
knee  upon  he  rail,  and  from  that  moment  he  was 
unable  to  «ilk.  The  knee  subsequently  became 
stifl',  and  wa6  constantly  painful.  Dr.  Newman  ex- 
amined the  jint  carefully,  as  also  did  Dr.  Frank  H. 
Hamilton  anc  Dr.  Saniuel  Ward,  both  of  whom 
concurred  in  hs  diagcnosis  that  a  portion  of  the  joint 
had  been  chipy^d  off  and  was  floating  in  the  cavity. 
The  treatment  rhich  he  adopted  was  to  break  Tip 
the  adhesions  cCupletely,  displaced  the  floating  car- 
tilage, brought  iijnto  a  position  where  it  could  not 
do  any  harm,  baUaged  the  knee,  applied  a  dorsal 
splint,  and  kept  t^  patient  perfectly  quiet.  He  re- 
mained in  bed  neaiy  four  weeks.  Aftei-jthat  he  had 
no  further  trouble  rith  the  joint.  Tlie  injury  was 
received  six  years  vgo,  and  the  patient  after  his 
recovery  remained  wu.  Dr.  Newman  also  referred 
to  the  cases  which  came  under  his  observation 
eighteen  years  ago,  iivhich  he  operated  almost  in 
the  same  manner  as  ad  Dr.  Gerster  in  his  second 
case.  The  incision  waspade,  and  with  a  little  spoon 
the  foreign  body  was  i)oked  out,  and  the  patient 
made  a  good  recovery.  le  believed,  however,  that 
floating  cartilages  in  the-jiee-joint  were  always  the 
result  of  traumatism. 

REMOVAL   OP   THE  >beaT   TOE-NAIL. 

Dr.  Bobert  Newman  then  resented  a  great  toe-nail 
recently  removed   by  operriion.     It   was  partially 


dead,  and  had  produced  in'itation  suflficientto  cause  a 
very  large  sore.  Against  his  \isual  method  of  treat- 
ment, he  removed  it,  and  since  that  time  the  irrita- 
tion had  entirely  ceased.  On  inspecting  the  speci- 
men, he  discovered  evidence  that  a  new  nail  was 
rapidly  growing,  which  caused  him  to  regret  that  he 
did  not  adhere  to  his  usual  treatment. 

FrBRO-5rrSO-S.UiCOMA   OP   THE   LARYNX. 

Dr.  L.  Elsberg  presented  a  specimen  with  the 

following  history  :  Dr.  M ,  a  German  physician, 

seventy-four  years  of  age,  consulted  him  July  29, 
1881.  In  early  life  he  had  sung  a  gi'eat  deal,  but 
fully  thirty  years  ago  his  voice  bad  become  veiled, 
and  he  felt  mucus  accumulate  in  his  larynx.  About 
fourteen  months  ago  he  had  an  attack  of  strangling, 
ascribed  by  him  to  "a  severe  cold"  and  drinking 
veiy  cold  beer  ;  since  then  his  voice  was  reduced  to 
a  mere  whisper.  For  six  months  he  had  felt  some 
pressure  on  his  larynx  during  deglutition,  which  had 
lately  become  iminful.  He  breathed  comfortably 
only  in  certain  positions,  had  paroxysms  of  cough, 
and  in  sleeping  could  lie  on  the  right  side  only. 
He  had  a  sudden  attack  of  dyspncea  two  weeks  before 
in  Fulton  Street,  Brooklyn,  caused  by  turning  his 
head  suddenly  ;  he  thinks  this  attack  lasted  fifteen 
minutes  and  nearly  killed  him.  For  an  hour  his 
breathing  was  very  stertorous,  and  he  expectorated 
bloody  muctis  for  a  much  longer  time.  He  was  very 
much  exhausted  for  several  days,  but  gradually  re- 
covered. He  thinks  he  breathes  normally  at  pres- 
ent, but  Dr.  Elsberg  noticed  that  he  got  easily  out 
of  breath  during  the  examination.  The  laryngoscope 
showed  a  very  large  tumor  attached  to  the  right  side 
of  his  larynx,  projecting  above  the  vocal  bands.  An 
operation  was  advised  for  its  removal  witliont  delay. 
This  being  objected  to,  a  prophylactic  tracheotomy 
was  proposed,  on  account  of  the  large  size  of  the 
tumor.     .A.11  operative  interference  was  refused. 

During  the  month  of  .August,  with  the  excejjtion 
of  occasional  more  or  less  severe  attacks  of  dyspno?a, 
the  patient  felt  well  and  managed  to  attend  to  his 
professional  engagements.  Dr.  Elsberg  was  very 
soHcitous  about  his  case,  and  sent  him  the  message 
to  prepare  for  the  necessity  of  sudden  tracheotomy. 
He  never  saw  him  alive  again.  On  the  morning  of 
October  27th  he  left  his  house,  in  Eighth  Street, 
to  visit  some  patients.  Toward  noon  he  entered  the 
room  of  a  patient  in  One  Hundred  and  Twenty- 
seventh  Street,  about  six  miles  distant  from  his  own 
residence.  .Vfter  removing  his  hat  and  gloves,  he 
showed  signs  of  suffocation  ;  his  gesticulations  were 
misunderstood,  and  though  a  physician  had  been 
called,  he  died. 

Two  days  later  the  autopsy  was  performed  by  Dr. 
M.  Waterman,  Deputy  Coroner,  to  whose  kindness 
Dr.  Elsberg  was  much  indebted.  The  lai-ynx  having 
been  opened  posteriorly,  the  tumor,  of  the  size  of  an 
elongated  small  walnut,  was  seen  occupying  the  whole 
right  side,  its  middle  portion  at  the  level  of  the  right 
vocal  band.  The  tumor  was  slightly  pear-shaped  ; 
its  broadest  part  eoiTCsponding  exactly  to  the  me- 
dian line  of  the  larynx,  the  narrow  portion  horizon- 
tally tending  toward  the  posterior  wall.  On  closing 
the  larynx,  it  was  seen  that  the  tumor  completely 
filled  its  lumen.  The  broadest  and  highest  portion 
pressed  against  the  left  ventricle,  which  was  slightly 
widened.  The  tumor  was  lobate  ;  the  largest  lobes 
corresponded  to  the  broadest  extremity  of  the  tu- 
mor, the  smallest  ones  were  posteriorly.  The  an- 
terior surface  of  the  tumor  was  flattened  and  deeply 
fissured.     Lengthwise,  viz.,  in  the  direction  of  the 


80 


THE  MEDICAL  EECORD. 


vocal  band,  it  was  divided  by  a  very  deep  fissure 
into  two  almost  equal  portions,  which  wei'e  connected 
by  a  flat  pedicle,  which  was  the  vocal  band  itself, 
projected  into  the  tumor  and  attached  in  the  depth 
of  the  fissure.  The  largest  lobe,  i.e.,  that  nearest  to 
the  median  line,  was  embedded  in  the  right  ventricle, 
which,  from  the  pressure  against  it,  was  consider- 
ably widened,  more  so  than  the  left,  and  toward  the 
middle  line  to  such  a  degree  that  the  ventricular 
band  had  completely  disappeared.  The  tumor  was 
of  medium  consistence,  and  of  pale  pink  color,  with 
numerous  ramifying  blood-vessels. 

He  had  not  yet  finished  its  histological  study,  but 
could  say  that,  under  the  microscope,  it  proved  to 
be  covered  by  stratified  epithelium,  underneath 
which  there  were  bundles  of  fibrous  connective  tis- 
sue, enclosing  large  meshes  of  a  myxomatous  basis- 
substance.  The  main  mass  of  the  tumor  consisted 
— at  least  at  tlie  jjlace  fi-om  which  thin  sections 
had  been  removed  for  examination — of  a  delicate  re- 
ticulum, the  meshes  of  which  had  a  shining,  nearly 
homogeneous  basis-substance.  Some  portions,  es- 
pecially comparatively  near  tlie  surface,  were  com- 
posed exclusively  of  a  very  little  connective  tissue, 
and  the  relatively  large  globular  bodies,  kno'mi  to 
be  characteristic  of  Virchow's  "  large,  round-celled 
sarcoma."  The  tumor,  therefore,  was  a  specimen  of 
fibro-myxoma  which  had  lately  become  sarcomatous. 

"The  tumor  must,  of  late,  have  grown  rapidly, 
but  there  can  hardly  be  a  doubt  that  it  could  have 
been  safely  removed  when  I  saw  it,  or  even  later. 
The  life  of  the  patient,  who,  despite  his  years,  was  in 
vigorous  good  health,  could  certainly  liave  been 
prolonged  either  by  the  removal  of  the  tumor  or  by 
simple  tracheotomy.  In  the  present  state  of  our 
knowledge,  and  of  our  achievements  in  laryngology, 
such  a  death  as  the  above  ought  not  to  take  place, 
and  it  probably  would  not  have  occurred  if  tlie  pa- 
tient had  not  liimself  been  a  medical  practitioner, 
strongly  prejudiced  against  operative  interference  in 
his  case." 

NASAIi   DIPHTHERIA — BKONOHO-PNECJIONIA. 

Dr.  J.  Lewis  Shith  presented  one  lung,  the  lar- 
ynx, and  the  trachea,  removed  from  the  body  of  a 
child  two  years  and  eight  months  old,  which  died 
with  the  common  histoiy  of  diphtheria.  In  the 
latter  part  of  October  the  child  had  a  pharyngitis, 
but  no  pseudo-membrane  had  been  observed.  After 
the  pharyngitis  had  continued  for  ten  or  twelve  days 
the  mucous  membrane  of  the  nose  became  inflamed, 
there  was  more  or  less  obstruction  to  breathing 
through  the  nostrils,  and  the  patient  had  persistent 
febrile  movement,  with  corresponding  acceleration 
of  pulse,  sometimes  reaching  as  high  as  140  or  150. 
No  rash  was  obsei-ved,  so  that  the  diagnosis  of  scar- 
let fever  was  excluded,  and,  from  the  severity  and 
persistence  of  the  coryza,  the  diagnosis  was  made  of 
nasal  diphtheria.  In  a  few  days  the  physical  signs 
of  bronclio-pnenmonia  occurred,  and  the  cough 
began  to  be  croupy  and  the  Iireathing  noisy.  In- 
halations of  lime-water,  with  one-fortieth  part  of 
liquor  potassie,  were  administered,  after  wliich  the 
obstruction  to  the  res))iration  diminished  somewhat. 
The  evidence  of  pneumonic  consolidation  continued, 
and  the  patient  died  about  a  week  after  the  com- 
mencement of  tlie  laryngeal  ol)struction.  The  child 
apparently  died  from  general  exliaustion  as  much  as 
from  the  dysjjnma.  At  the  autopsy  there  was  found 
a  tliin  fihn  of  membrane  extending  along  the  larynx 
and  over  tlio  tracheal  surface.  It  was  intimately 
blended  with  the  laryngeal  mucous  membrane,  but 


it  lay  upon  the  tracheal  surface  without  penetrating 
it.  The  point  of  special  interest  in  the  case  was  a 
therapeutical  one.  At  the  New  York  Foundling 
Asylum  some  experiments  had  been  instituted  with 
a  view  to  determining  what  is  the  best 

SOLVENT   FOB   PSECTDO-MEIIBRAJTES, 

and,  at  the  same  time,  such  as  could  be  safely  used 
by  inhalation.  As  the  result  of  the  experiments  the 
two  which  had  been  found  to  be  the  safest  and  most 
efticient  solvents  were  the  liquor  potasste  and  liquor 
sodiE,  in  the  strength  of  two  or  two  and  one-half  per 
cent,  of  water.  That  is,  liquor  potassfc,  or  liquor 
soda-,  one  part  to  forty  or  fifty  of  water.  These  rem- 
edies could  also  be  used  in  combination  with  lime- 
water,  and  they  could  be  employed  at  the  same  time 
both  in  the  boiler  and  cup  of  the  steam-atomizer. 
Dr.  Smith  also  stated  that,  as  the  result  of  observa- 
tions and  experiments  made  in  the  same  institutior, 
lactic  acid,  with  the  acidulated  liquid  pepsin,  hai 
not  been  found  to  be  so  good  a  solvent  as  even  tie 
officinal  lime-water. 

De.  L.  Elsberg  remarked,  with  reference  to  sav- 
ents,  that  they  ojierated  much  difierently  on  (he 
inside  than  upon  the  outside.  He  had  found  Iro- 
mine  to  be  much  more  efficient  than  either  lime- 
water  or  lactic  acid,  or  liquor  potassre,  or  liquor 
sodse. 

Db.  Smith  asked  if  bromine,  used  as  an  inhalition 
of  sufficient  strength  to  dissolve  membrane,  vould 
not  be  too  great  an  irritant. 

Dr.  Elsbekg  said  that,  used  properly,  it  dd  not 
produce  irritation.  He  uses  one  grain  of  Iromine 
with  one  drachm  of  iodide  of  potassium,  in  one 
ounce  of  water,  which  could  be  poured  intf  a  cone, 
and  the  patient  inhale  the  fumes.  And  he  bid  found 
that  it  dissolved  the  membrane  outside  beter,  and, 
apparently,  inside  better  than  either  limewater  or 
potassa  or  soda. 

The  society  then  went  into  executive  s&sion. 


The  Goveenob  of  New  York  tpon  tie  Uuca  In- 
sane AsYLUiri. — The  Governor,  in  his  recnt  message, 
has  the  following  regarding  the  Utica  Insane  Asy- 
lum : 

"  Complaint  is  made,  on  behalf  of  tie  State  Board 
of  Chai'ities,  against  the  managers  of  the  State 
Asylum  for  the  Insane  at  Utica,  fo  neglecting  to 
report,  as  required  by  law,  a  detailfl  and  classified 
statement  of  expenditures.  Comjiance  with  this 
statutory  provision  is  essential  to  a  intelligent  com- 
parison of  the  management  of  theseveral  like  insti- 
tutions, and  should  be  rigidly  anforced.  It  is 
certainly  not  creditable  to  the  oncers  of  the  Utica 
Asylum  that  this  plain  duty  hfs  been  so  long  dis- 
regarded." 

It  is  said  in  reply  to  this  that'tter  insane  asylums 
have  failed  to  report. 

The  Governor  gives  the  folowing  table,  showing 
the  increa.se  in  our  insane  : 

"  The  constantly  increasin  number  of  insane  per- 
sons is  exhibited  by  the  foPwing  statement  of  the 
number  of  inmates  of  the-ai'ious  State  and  local 
asylums,  poor-houses,  andprivate  asylums  for  the 
past  five  vears  : 

"October  1,  1881,  10,0,"  ;  October  1,  1880,  9,537  ; 
October  1,  1879,  9,015  October  1,  1878,  8,781; 
October],  1877,  7,921. 

"  The  new  asvluni  fotlie  insane,  located  at  Bing- 
hamton,  has  been  broS'i*  into  tise  during  the  past 
year,  and  already  contins  a  considerable  number  of 
patients." 


THE  MEDICAL  RECORD. 


81 


Corrcsponlirucg. 


THE  MOR.\L  CHAEACTER  OF  TEA^X•E 
SUBJECTS. 

To  THE  Editor  of  The  Medical  Record. 

Sir:  It  is  a  rule  of  my  life,  from  which  I  rarely 
depart,  to  hold  no  public  discussion  ou  scientitic  sub- 
jects with  non-experts.  The  esceUeut  and  amiable 
Englishmen,  authors  of  the  recent  letters  in  regard 
to  my  experiments  in  Europe,  must  therefore  look 
to  other  sources  for  answers  to  their  very  amaising 
inquiries. 

I  feel  it,  however,  to  be  my  duty  to  say  a  few 
words  against  the  extraordinary,  though  uninten- 
tional, attack  made  upon  Dr.  Charcot  by  Dr.  Buek- 
nUl.  The  exact  language  of  Dr.  Bucknill  is :  "  I 
should  be  indeed  surprised  if  the  accomplished 
physician  (Dr.  Charcot)  who  was  investigating  them 
had  been  willing  to  eliminate  the  moral  character 
of  each  patient,  as  no  factor  in  the  case."  If  there 
is  any  truth  in  this  charge,  then  Dr.  Charcot  is  both 
a  non-expert  and  a  fraud  ;  for  he  has  both  publicly 
and  privately  contended  for  the  genuiness  of  his 
trance  experiments,  on  the  same  ground  that  Dr. 
Hammond  and  I  do,  namely :  his  otm  private  studi/ 
of  Ihfi  phenomena  by  numerous  and  repeated  tests,  in 
which  all  the  sources  of  error  have  been  eliminated. 

Such  was  his  position  when,  three  years  ago,  he 
showed  me  his  cases,  allowed  me  to  experiment  with 
one  of  them,  and  discussed  this  very  question  ;  such 
has  been  his  position  in  his  public  lectures ;  and 
such  is  the  position  in  Kicher's  work  on  "  Hystero- 
Epilepsy  "  (pp.  579  et  seq.),  which  these  trance  re- 
searches make  an  important  feature.  Such,  also, 
was  his  position  but  a  few  weeks  since,  when  he 
exhibited  his  oases  to  one  of  our  American  physi- 
cians ;  and  such  is  the  position  which  in  future  all 
who  aim  to  know  anything  of  this  subject  will  take, 
and  without  argument.  Thephi/sician  who,  at  this  late 
hour,  after  all  the  rerolutionarij  advance  that  has  been. 
made  in  the  study  of  hitman  beings,  inquires  into  the 
moral  character  of  those  mi  vhom  he  experiments, 
however  wise  and  mature  he  may  be  on  other  themes, 
is  on  this  theme  but  a  child — as  much  behind  the  age 
as  he  who  shoidd  use  inoculation  iyistead  of  vaccina- 
tion, and  he  should  ivait  to  grow  before  he  expresses  in 
public  any  opin  ion  on  either  side. 

It  is  ■well  known,  and  has  been  publicly  stated, 
that  the  individuals  on  whom  Dr.  Charcot  experi- 
ments would  scarcely  be  accej^table  candidates  for 
teachers  in  Sunday-schools ;  but,  whether  these 
special  charges  be  true  or  not,  it  is  to  the  glory  of 
Charcot — for  which  he  will  be  remembered  long 
after  his  other  labors  and  the  names  of  his  non- 
expert opposers  are  forgotten — that  he  has  taken 
these  emotional  and  wi'etched  women,  these  waste 
products  thro\^■n  off  in  the  evolution  of  the  race, 
and  has  so  experimented  with  them  as  to  produce 
residts  as  clear,  as  true,  and  as  pure  as  the  chemist 
can  obtain  with  the  inanimate  elements  in  the  lab- 
oratory. 

Serious  mistakes  of  inference  Dr.  Charcot  has 
certainly  made,  and  is  making  now  ;  and  for  these 
no  one  has  criticised  him  more  earnestly  or  in  a 
more  public  manner  than  I  have ;  but  none  the  less 
do  I  respect  him  as  a  man  of  genius  and  a  man  of 
honor,  who  does  not  deceive,  but  tells  the  exact 
truth  when   he   says  that   the   genuineness  of  the 


trance  phenomena,  as  studied  by  him,  is  established 
by  his  private  cj^iei^iments. 

If  he  does  depend  on  the  character  and  history  of  his 
subjects,  and  should  so  declare  and  confess,  then  his 
e.rperiments  are  not  worth  cchibiting  to  scientific  men, 
or  publishing  to  the  scientific  world. 

The  worst  cases  of  sham  trance  I  have  ever  seen 
have  been  in  men  and  women  whose  moral  character 
and  position  have  been  in  other  respects  unim- 
peached.  If  we  do  not  know  whether  the  phenom- 
ena are  genuine  before  we  inquire  as  to  the  character 
of  the  subject,  we  shall  not  laiow  after,  whatever 
the  result  of  the  inquiiy  may  be. 

I  would  take  this  occasion,  in  reply  to  inquiries 
that  have  been  privately  made  by  those  who  are  tak- 
ing pains  to  inform  themselves  in  regard  to  this 
side  of  the  nervous  system,  that  of  the  general  hon- 
esty of  my  trained  subject,  I  know  and  care  nothing ; 
of  his  honesty  in  relation  to  the  trance  e.ipei-iinents,  how- 
ever, I  have  better  proof  than  I  have  of  the  honesty  of 
any  one  who  'n^itnessed  the  experiments  in  Eairope  or 
America :  that,  on  the  average,  he  did  quite  as  well 
there  as  here  ;  sometimes  succeeding,  sometimes  fail- 
ing, sometimes  succeeding  in  part  only,  as  is  often  the 
case  with  genuine  subjects  ;  that  he  never  did  bet- 
ter than  in  some  of  his  experiments  on  the  day  that 
has  given  rise  to  the  discussion ;  that,  with  perhaiis 
thi-ee  or  four  exceptions,  he  was  the  best  subject  I 
have  ever  seen — among  the  nearest  approaches  being 
the  thoroughly  trained  subjects  of  Charcot,  which, 
however,  are  trained  jihysiologically,  mainly  by  the 
method  of  Braid,  in  which  exjiectation  is  only 
one  factor,  while  mine  are  trained  psychologically, 
wholly  through  the  emotion  of  expectation  ;  that 
the  exi^eriments  were  received — on  tlie  part  of  those 
who  are  making  themselves  experts  in  this  diiec- 
tion — with  the  highest  conceivable  interest,  sur- 
passing that  which  has  been  accorded  to  any  sub- 
ject that  I  have  had  the  pleasure  of  bringing  to  the 
attention  of  physicians  in  Europe,  either  in  this 
year  or  in  previous  years.  While  some  of  the  phe- 
nomena wei-e  old,  others  were  in  detail  compara- 
tively new  discoveries,  and,  as  such,  were  appre- 
ciated. After  those  who  are  studying  these  topics 
had  opportunity  for  private  examination  of  the  case, 
a  portion  of  a  day  was  devoted  entirely  to  non-ex- 
perts, who  were  invited  for  the  same  reason  that 
they  wore  invited  here,  and  in  the  exisectation  that 
some  of  them  might  be  insjiired  to  begin  the  inves- 
tigation of  this  side  of  the  human  system  for  them- 
selves, as  indeed  has  been  the  case  in  America  and 
Europe. 

I  would  here  defend  England  against  herself,  or 
rather  against  some  of  her  representatives.  With 
one  or  two  exceptions,  the  distinguished  and  able 
medical  gentlemen  who  witnessed  the  exjieriments 
on  the  non-experts'  day,  were  gentlemanly,  consid- 
erate, and  attentive  :  the  arguments,  queries,  doubts, 
suspicions,  and  difficulties  that  were  raised  among 
them  were  precisely  those  that  have  been  gone  over 
and  over  again  by  scores  of  American  physicians  in 
my  office,  and  in  public  experiments  in  America. 
Non-expertness,  indeed — like  sniall-pos- — has  the 
same  symptoms  in  all  countries.  We  cannot  expect 
children  to  reason  like  adults  ;  and  we  cannot  hojie 
that  non-experts  will  see  with  expert  eyes,  biit  miist 
give  them,  little  by  little,  the  alphabet  of  science, 
and  not  become  impatient  if,  like  children,  they  ask 
questions  that  are  elementary  and  imperfect,  and 
our  answers  are  not  understood.  "We  are  not  to  ask 
them   to   apologize,  but   simply  wait   for   them   to 


82 


THE  MEDICAL  RECORD. 


mature ;  an  infant  class  in  psychology  is  not  to 
be  judged  by  the  standard  of  disciijliiied  pbiloso- 
phers.  Merely  seeing  trance  experiments  gives 
one  no  more  knowledge  of  trance  than  seeing  the 
cajjtain  of  a  ship  talcing  ubservations  makes  one  a 
navigator.  Dr.  Buckuill's  conclusions,  from  wit- 
nessing Dr.  Elliotson's  experiments,  that  some  of 
them  were  genuine,  is  as  worthless  as  his  conclusion 
that  some  of  them  were  simulated.  Even  one  who 
knows  something  of  the  subject — even  the  very  high- 
est expert,  may  not  be  able  to  tell  from  seeing  these 
experiments  whether  they  are  or  are  not  genuine. 

The  trained  subject  used  in  London  is  now  in  this 
city,  and  any  one  interested  can  have  the  opportunity 
of  convincing  himself  by  private  exijeriment  of  his 
honesty. 

I  have  been  many  times  interested  and  aided  by 
witnessing  experiments  and  operations  in  depart- 
ments in  which  I  was  an  utter  non-expert,  since  I 
have  been  stimulated  thereby  to  a  study  of  the  sub- 
ject. It  is  not  an  insult,  but  a  compliment  to  a 
man  to  call  him  a  non-expert ;  for  the  term  implies 
that  there  may  be  some  subject  on  which  he  is  an 
expert. 

in  England  as  in  America,  and  everywhere,  the 
difficulty  in  these  and  allied  matters  is  not  so  much 
moral  as  intellectual  ;  our  critics  are  oftentimes  as 
sincere  as  ourselves,  and  quite  as  earnest,  doing 
their  best  duty  according  to  the  light  that  God 
gives  them ;  gallant,  generous,  and  noble  natures 
oftentimes,  whose  friendship  is  a  ijos.session,  but 
wiio — from  long  living  in  an  atmosphere  that  is  a 
non-conductor  for  new  ideas — become  antidotes  to 
science  rather  than  its  adjuvants ;  they  prefer  to  be 
islands,  standing  still  in  the  midst  of  the'  stream, 
than  ships  moving  with  it ;  though  they  would  tread 
softly  on  a  worm,  they  would  banish  genius  from  the 
universe. 

It  was  not  viciousness,  but  simply  Anglo-Saxon 
non-expertness — a  special  and  scientific  term  for 
what  Mr.  Matthew  Arnold  calls  "'  Philistinism  " — • 
which,  stimulated  by  conscience  and  armed  with 
power,  persecuted  Jenner,  and  now,  with  yearly  in- 
creasing strength  in  Europe,  opposes  vaccination; 
forced  Ferrier  into  the  police  court,  and,  uuder  sanc- 
tion of  a  most  cruel  law,  which  even  medical  men 
and  medical  journals  allowed  themselves  to  approve, 
tlrives  from  Great  Britain  its  best  men  of  science  as 
lihe  Huguenots  were  driven  from  France  ;  declined  a 
paper  from  Mr.  Braid  on  some  of  the  most  impor- 
tant scientific  researches  of  the  century,  and  tlien, 
forty  years  later,  must  send  to  Germany  for  Pro- 
fessor Preyer  to  explain  what  Mr.  Braid  had  vainly 
sought  opportunity  to  explain ;  whereupon  hours 
are  spent  in  praising  that  same  Mr.  Braid,  without 
clearly  knowing  either  what  he  did  or  did  not  do 
for  science  ;  wliich,  in  our  own  country,  refused  per- 
mission to  Dr.  .1.  K.  Mitchell  to  read  an  essay  so 
classicil  that- -despite  its  errors— the  experts  of  the 
future  must  quote  it  ;  ordered  Dr.  Clymer  and  his 
friends  to  stop  investigating  science,  or  stop  pracitis- 
ing  meilicine  ;  and  resolutely  .snubbed  Dr.  Austin 
Flint  when  he  wished  to  present  to  the  American 
Medical  Association  tlie  strongest  and  most  original 
contribution  he  has  ever  made,  which  Professor 
Sohiflf  confirmed  and  the  French  Academy  gladly 
received. 

The  advantage  of  having  some  knowledge  of  the 
subject  of  whicli  wo  write  and  speak,  even  in  mat- 
ters of  science,  is  so  great,  that  one  is  amazed  to 
hear  a  non  export  speak  on  this  subject  at  all,  save 
with   mudlod  lips  auil   bated  breath  ;  but  it  is  the 


very  nature  of  non-expertness  not  to  know  that  it 
does  not  know,  and  in  dealing  with  experts  to  mis- 
take calmness  for  weakness,  and  silence  for  consent 
to  delusions. 

In  closing,  I  would  congratulate  experts,  partial 
experts,  and  experts  in  making,  of  both  Europe  and 
America,  on  the  auspiciousness  of  the  time  in 
which  they  enter  upon  and  continue  their  studies. 
As  a  result  of  the  eflbrts  of  many  pioneers,  the 
study  of  these  phenomena  of  the  nervotis  system 
has  at  last  been  made  both  fruitful  and  safe.  Be- 
fore I  reached  England  this  y'ear,  some  of  the  most 
important  and  incredible  of  my  experiments  in  this 
department  of  science  had  been  contirmed  by  a 
number  of  well-known  English  psychologixts  and, 
in  the  handsomest  way  possible,  acknowledgments 
of  priority  had  been  publicly  given  in  their  lead- 
ing scientific  journals.  The  details,  as  giithered 
from  Nature,  will  soon  be  republished  in  Ameiica. 
The  excellent  paper  and  experiments  of  Dr.  Mills, 
before  the  Medical  Society  of  Philadelphia,  and  the 
intelligent  di.scussion  thereof,  as  rei)orted  in  the 
Medical  Times  of  November  19th,  would  have  been 
impossible  five  years  ago,  and  would  have  been  im- 
possible to-day,  except  in  America  and  Germany. 

Observe  the  normal  evolution  of  our  ideas  on  this 
theme  :  the  long  and  dreary  stage  of  cold  indifierence 
has  passed  already  ;  the  short,  hot  stage  of  op})Osi- 
tion  is  rapidly  passing;  the  third  and  la.st  stage, 
through  which  all  scientific  truth  must  pass — the 
stage  of  contests  of  priority — is  near  at  hand.  For 
the  discussion  of  this  the  highest  expertness  of 
both  hemispheres  is  invited,  and,  as  I  predict,  will 
soon  be  enlisted. 

Geobge  M.  Beakd. 
New  Yobk,  1881. 


CONCERNING  A  CASE  OF  DERMOID  CYST 
OF  THE  OVARY. 

To  THE  Editor  of  The  Medical  Rhcord. 
Dear  Sir  :  In  your  recent  issue  I  notice  a  report 
of  a  "Case  of  Ovarian  Pregnancy — Autopsy,"  by  Dr. 
S.  Mitchell,  Jr.,  of  Hornellsville,  N.  Y.,  "in  which 
the  trouble  was  not  diagnosed  before  death."  From 
the  history  of  the  case,  and  particularly  from  the  re- 
sults of  the  autopsy,  it  seems  to  me  tliat  the  diag- 
nosis was  not  even  made  after  death,  and  that  the 
true  nature  of  the  case  was  most  strangely  misunder- 
stood by  the  physicians  present  on  that  occasion. 
There  was  nothing  whatever  ia  the  history,  as  re- 
ported, whicli  coukl  justify  the  susjiicion  that  the  ab- 
dominal enlargement  was  due  to  pregnancy  but  the 
cessation  of  the  menses  for  five  nionths,  which,  no 
doubt,  was  merely  incidental.  But  the  njipearances 
found  at  the  autopsy  should  have  sufficed  (o  convince 
everyone  present  that  it  was  not  an  extra-uterine 
pregnancy,  but  a  simple  dermoid  cyst  of  the  ovary, 
for  whicli  condition  the  contents  of  the  sue — the 
"large  incisor  tooth,  a  small  )uece  of  bone,  and  a 
piece  of  hairy  scalp,  all  attached  to  the  inner  sur- 
face of  the  sac,"  also  the  "  loose,  flouting  hairs, 
some  of  whiidi  were  ten  inches  in  length."  which 
were  found  in  tho  jius  contained  in  the  sac — were 
absolutely  characteristic.  That  the  tooih,  jiiece  of 
bone,  aiul  piece  of  hairy  scalp  were  "  all  attached  to 
the  inner  surface  of  the  sac  by  means  of  a  triangu- 
lar fleshy  mass,  resembling  a  rudimentary  placenta," 
proves  nothing  to  the  contrary,  since  the  mere  re- 


THE  MEDICAL  RECORD. 


83 


semblance  in  outline  to  a  placenta  does  not  neces- 
sarily denote  a  resemblance  in  stnicttire. 

Inasmuch  as  cases  of  undoubted  ovarian  pregnancy 
are  so  rare  that  Sijiegelberg,  wliile  reporting  an 
unquestionable  case  (see  ArcJiir.  fiir  Gi/nii/colix/if', 
vol.  xiii ,  1S7S),  found  himself  compelled,  after 
careful  sifting,  to  reduce  the  cases  published  as  such 
to  ten,  including  his  own.  I  think  it  worth  while  to 
occupy  your  valuable  sjiace  for  the  purpose  of 
miking  this  coiTection.  From  the  evidence,  I  can 
but  consider  the  case  one  of  sui^purating  dermoid 
tumor  of  the  ovary,  of  which  there  are  many  on 
record.  Yours  truly, 

Paul  F.  Mi-nde. 

New  York. 


Contagious  Diseases  —  Weekly  Statement.  — 
Oomparative  statement  of  cases  of  contagious  diseases 
reported  to  the  Sanitary  Bureau,  Health  Department, 
for  the  two  weeks  endiiig  Janiaary  14,  1862. 


Week  EcdiBj; 

JS 

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1 
S, 
s 

1 

1 

a. 

i 

£ 
1 

H 

H 

w 

o 

S 

a 

m 

>l 

Jan.  7,  1883. 

0 

9 

871 

6 

177 

148 

39 

0 

Jan.  14,  1882. 

0 

10 

278 

3 

202 

138 

31 

0 

U.  S.  Marine  Hospital  Service  and  Small-Pox. 
— In  view  of  the  prevalence  of  small-pox  at  various 
points  in  the  West,  Surgeon- General  Hamilton,  of 
the  Marine  Hospital  Service,  has  issued  orders  to 
his  subordinates  at  Cincinnati,  Louisville,  Cairo,  and 
St  Louis,  to  vaccinate,  without  charge,  all  steamboat 
men  on  the  Ohio  and  Mississippi  Riveis  who  may 
apply  for  vaccination,  without  regard  to  the  usual 
requirement  of  a  certain  length  of  service. 

Dr.  T.  W.  Mills,  L.E.C.P.,  London,  has  been  ap- 
pointed assistant  to  the  Chair  of  Physiology,  McGill 
Medical  College,  Montreal. 

Ergottne  in  Erysipelas. — Mr.  Kenneth  W.  Milli- 
can  used  ergotine,  locally,  in  an  outbreak  of  facial 
erysipelas  ia  his  practice  with  the  best  results. 
The  relief  to  heat  and  pain,  the  reduction  of  swell- 
ing, and  the  rapid  subsidence  of  the  disease,  were 
most  remarkable. — British  Med.  Jour. 

Banquet  to  Mb.  Spencer  Wells. — The  surgeons 
of  Paris  recently  gave  a  banquet  in  honor  of  Mi'. 

WeUs. 

Successful  Gasteotoiiy. — Mr.  Marshall,  of  Lon- 
don, recently  performed  gastrotomy  for  a  case  of 
malignant  disease  of  the  oesoi^hagus.  The  patient 
is  doing  well. 

Gastroscopy. — Dr.  Mikulicz  recently  demonstrated 
the  oesophagus  and  stomach  before  the  Vienna  Med- 
ical Society  with  his  gastroscope.  This  instrument 
has  been  perfected  by  the  addition  of  a  tube  through 
which  the  stomach  may  be  distended  with  air,  and 
thus  examined  more  completely. 

PrLOCARPINE   as   A    StDIULANT   TO    THE    MOVEMENT 

OF    THE    Stomach    and   Intestine. — M.   Morat   has 
shown  that  a  dose  of  two  milligrammes  of  pilocarjjine 


stimulates  powerfully  the  normal  movements  of  the 
stomach  and  intestine  in  a  dog.  Atropine  antago- 
nizes this  action. 

A  Society  for  the  Defence  of  Scientific  Ee- 
SEAKCH  has  been  organized  in  London.  It  is  to  fight 
the  anti-vivisectiouists. 

Caktwright  Lectures. — The  second  course  of  the 
Cartwright  Lectures  of  the  Alumni  Association  of  the 
College  of  Physicians  and  Surgeons  will  be  given  by 
Professor  John  C.  Dalton,  at  Association  Hall,  cor- 
ner of  Twenty-third  Street  and  Fourth  Avenue,  on 
Tuesday  evenings,  January  24th,  31st,  and  Febru- 
ary 7th.  Subject  of  the  course  :  "  The  Experimental 
Method  in  Medical  Science." 

Lecture  1  :  Galvani  and  Galvanism,  in  the  Study 
of  the  Nervous  System.  Lecture  2  :  Butibn  and  Bon- 
net, in  the  Eighteenth  Century.  Lecture  .3  :  Nervous 
Degenerations,  and  the  Theory  of  Sir  Charles  Bell. 

Dr.  Matthew  D.  Mann,  of  Hartford,  has  been 
called  to  deliver  a  course  of  lectures  on  Obstetrics 
and  Diseases  of  Women  and  Children  in  the  Buffalo 
Medical  College  in  the  place  of  Dr.  White,  decea.sed. 
Dr.  Mann  will  be  absent  from  Hartford  about  eight 
weeks. 

The  Record  of  Contagious  Diseases  reported  to 
the  Board  of  Health  in  the  year  1881  is  as  follows : 

Nt>.  of  Cases. 

Typhusfever 5(is 

Typhoid  fever %!) 

Cerehro-spinal  meningitis 555 

Scarlet  fever 7, .318 

Diphtheria 5.065 

Measles 5.'.i:jl) 

Sn.all-pox I,t01 

The  Comjiittee  op  the  Garfield  Memorial  Hos- 
pital have  received  a  bill  of  exchange  for  S400  from 
the  Khedive  of  Egypt  through  Consul-General  Wolf, 
who  writes  that  be  expects  to  supplement  tliis  with 
further  subscriptions  to  the  amount  of  §1,000.  Min- 
ister Morton,  at  Paris;  the  American  Exchange,  at 
London  ;  and  the  American  Consuls  at  Amsterdam 
and  elsewhere,  are  also  receiving  subscriptions  for 
this  object. 

ViscuM  Album  as  a  Substitute  for  Digitalis. — 
Dr.  E.  Park,  in  the  Practitiimer,  commends  the  use 
of  mistletoe  as  a  very  efficient  substitute  for  digita- 
lis in  diseases  of  the  heart.  He  gives  half  a  drachm 
of  the  tincture  every  four  hours. 

Vegetable  P.\thology.  —  Over  a  year  ago  Sir 
.James  Paget  called  attention  to  the  interest  and 
profit  that  might  be  obtained  in  a  study  of  vegetable 
pathology.  A  contribution  to  this  subject  has  been 
made  by  Mr.  W  K.  Higley  in  a  series  of  articles  in 
the  Amei-icayi  yaturalisl  for  November  and  Decem- 
ber, 1881. 

The  Infant  Asylum  of  this  city  has  been  found  in 
such  an  unsanitary  conrlition  that  it  has  been  or- 
dered (jlosed  by  the  Health  Board. 

Bellevue  Ncese  Training  School.  — At  the  ninth 
annual  commencement  of  this  school,  held  January 
17th,  twenty  seven  young  women  graduated.  Pro- 
fessor Flint  delivered  the  annual  address. 

New  ITse  for  Must.^bd. — The  matron  of  a  Chil- 
dren's Home,  in  Montreal,  Canada,  has  been  in  the 
haliit  of  using  mustard  poultices  for  the  puiii.'-limpnt 
of  those  under  her  charfie.  The  counter-irritating 
effects  are  somewhat  similar  to,  but  more  lasting 
than,  those  from  the  time  honored  syi-fenis  of  spank- 
ing. After  the  poultice  treatment  the  child  does  not 
enjoy  a  seat  for  a  week. 


84 


THE  MEDICAL  RECOKD. 


TBCPiiETS.— Dr.  J.  E.  Moith,  of  Fishkill,  N.  Y.,  re- 
ports a  case  of  triplets  in  his  practice.  The  first 
child  presented  by  the  head,  and  was  delivered  with 
the  forceps,  the  second  presented  by  the  foot,  and 
the  third  was  also  a  head  presentation.  The  first 
was  a  girl,  and  the  remaining  two  were  boys.  They 
weighed  respectively  seven  pounds  two  ounces,  six 
pounds  sis  ounces,"  and  si.\.  pounds  four  ounces. 
Tlie  mother  is  a  colored  woman,  aged  thirty-four 
years,  suffering  from  phthisis.  With  the  late  addi- 
tion to  her  family,  she  has  now  nine  children  alive 
and  well.  There  is  no  suspicion  of  impairment  of 
health  in  the  father. 

Neurologi  axd  Psychiatry. —With  February  next, 
begins  in  this  city  a  new  quarterly  journal  devoted 
to  the  above  subjects,  and  edited  by  T.  A.  McBride, 
M.D.,  assisted  bv  Drs.  L.  C.  Gray  and  E.  C.  Spitzka. 

The  Medical,  News. — Our  excellent  contemporary, 
the  Medical  iVeif.<  and  Liliraiy,  of  PhUadeliJhia,  has 
been  changed  into  a  weekly. 

Pbevestion  of  Lead-Poisoning.— Dr.  A.  Hunting- 
ton, of  this  city,  ^-rites  :  "While  perusing  the  arti- 
cle in  the  REroRo  of  the  7th,  relative  to  the  use  of 
'  Ergot  in  Lead-Poisoning,'  and  noting  the  statement 
of  Dr.  Stiles  as  to  the  great  frequency  of  this  form 
of  poisoning  among  silver-workers  in  Nevada,  my 
mind  reverted  to  the  prophylaxis  against  lead  which 
the  late  Professor  Draper  used  to  teach  us  in  his 
chemical  lectures,  viz.,  that  a  weak  lemonade  of  sul- 
phuric acid,  partaken  of  at  reasonable  intervals  by 
workers  in  lead,  would  go  far  toward  neutralizing 
the  poisonous  effects  of  absorption,  by  combining 
with  the  lead  in  the  system,  and  producing  the  inert 
sulphate. 

"If  this  is  a  fact,  could  not  the  lead-workers  be 
brought  to  feel  that  more  of  this  sort  of  lemonade 
and  less  whiskey  would  inure  to  their  good  ?  " 

The  Trial  of  Dr.  Lamson  for  the  murder  of 
his  brother-in-law,  and  against  whom  a  verdict  has 
been  brought  by  the  coroner's  jury,  has  been  excit- 
ing much  interest  in  medical  and  social  circles  in 
London.  Dr.  Lamson  was  in  attendance  upon  his 
brother-in-law  at  the  time  of  liis  death.  The  sus- 
picious points  are  that  the  patient  died  a  few  hours 
after  Dr.  Lamson  had  given  him  some  ijowdered 
sugar  in  a  gelatine  pill-case — aconite  has  been  de- 
tected as  the  leading  cause  of  death ;  the  prisoner 
purchased  aconite  ; shortly  before— and  the  boy's 
death  gives  the  prisoner's  wife  some  S15,000  or  .'520,- 
000.  Added  to  this,  it  is  shown  that  the  prisoner 
was  impecunious  at  the  time.  His  answer,  or  that 
of  his  witnesses,  has  yet  to  be  heard.  Dr.  Lamson 
graduated  in  medicine  at  Paris  in  1870.  There  is 
written  after  his  name  iu  the  "  Medical  Directory," 
L.E.C.P.,  Edin.,  and  L.M.,  1878;  L.R.C.S.,  1878. 
He  is  a  member  of  the  British  Medial  Association. 
He  was  senior  assistant  surgeon  in  the  French  Am- 
bulance Corps  in  1870-71,  where  he  received,  bronze 
and  iron  crosses ;  surgeon  in  the  Servian  army  in 
187G-77,  where  he  received  a  gold  cross  and  medal, 
and  was  surgeon-major  in  the  Russian  service.  He 
has  always  been  highly  esteemed  socially  and  pro- 
fessionally. 

Nhw  York  Pathologicaij  Soctety. — At  the  anni- 
versary meeting  held  January  11,  1882,  the  follow- 
ing officers  were  elected  for  the  ensuing  year :  Presi- 
dent, Dr.  E.  C.  Seguin ;  Vicc-Presidoil,  Dr.  George 
L.  Peabody  ;  Seci-elari/,  Dr.  Wesley  M.  Carpenter; 
Treasurer,  Dr.  John  H.  Hinton ;  Editor,  Dr.  John 
C.  Peters;  Members  of  the  Committee  oii,  Publication, 


Drs.  Beverly  Robinson  and  Edmund  C.  Wendt; 
Committee  on  Admissions  and  Ethics,  Drs.  Virgil  P. 
Gibney,  F.  R.  S.  Dralie,  John  H.  Hinton,  John  H. 
Ripley,  and  John  C.  Peters. 

A  Marble  Bust  of  Dr.  Protheroe  Smith,  the 
founder  of  the  Hospital  for  Women,  Soho  Square, 
London,  the  first  of  its  specialty,  was  recently  pre- 
sented to  the  institution  by  friends  and  patients, 
and  was  unveiled  recently  by  Sir  Rutherford  Alcock, 
K.C.B.,  the  chairman  of  the  committee,  on  beibg 
placed  in  position  in  the  hall  of  the  liospital.  The 
work  has  been  well  executed  by  Mr.  Belt. 

New  York  Ophthalmological  Society. — At  the 
Eighteenth  Annual  Meeting  of  the  New  York  Oph- 
thalmological  Society,  the  following  officers  were 
elected  for  the  ensuing  year  :  Prcsidi-nl,  Dr.  Thomas 
R.  Pooley;  Vice-President,  Dr.  George  R.  Cutter; 
Sea-etarii  and  Treasurer,  Dr.  W.  Oliver  Moore  ;  Com- 
mittee on  Admissions,  Drs.  Arthur  Matthewson, 
Charles  S.  BuU,  and  Edward  T.  Ely. 

The  News  Has  Reached  Spain. — Our  Spanish 
friends,  to  judge  from  articles  in  our  Spanish  con- 
temporaries, seem  to  have  at  last  awakened  to  a 
sense  of  the  importance  of  salicylic  acid  in  rheuma- 
tism. 

STRANGUIiATION   OF   THE   PeNIS   BY  A  ScREW-NlJT. 

In  the  Revista  Medica  de  Chile,  Dr.  San  Cristobal 
details  the  operative  procedures  employed  in  a  case 
of  strangulation  of  the  penis.  The  patient  was  a 
boy,  eight  or  nine  years  of  age,  and  in  good  health. 
Two  days  before  admission,  a  laborer,  during  a  fit 
of  drunkenness,  had  thrust  the  child's  penis  in  a 
a  screw-nut,  which  remained  at  the  root  of  the  mem- 
ber, resisting  all  attempts  at  removal.  The  organ 
became  tedematous,  turgid,  livid,  and  its  diameter 
increased  to  about  an  inch  and  a  half.  The  boy  had 
not  voided  urine  for  thii-ty  hours,  and  the  bladder 
formed  a  tumor  extending  to  the  umbUieal  region. 

A  longitudinal  incision  was  practised  along  the 
dorsal  aspect  of  the  penis  from  the  strangulating 
body  to  the  free  border  of  the  prepuce,  involving  the 
skin  and  ceUnlar  tissue,  and  exposing  the  corpora 
spongiosa.  Two  incisions  of  equal  length  and  depth 
were  then  can-ied  along  the  sides  of  the  member. 
Considerable  laloody  serum  escaped,  and  pressure 
further  facilitated  "disingurgitation.  Nevertheless, 
traction  still  proved  futile  in  removing  the  constrict- 
ing body. 

Taking  up  the  free  border  of  the  prepuce,  corres- 
ponding to  the  dorsal  flap,  the  operator  dissected 
the  slip  down  to  the  level  of  the  screw-nut,  with  the 
right  hand  exercising  gentle  forward  traction  upon 
the  latter ;  with  the  index  and  the  middle  finger  of  the 
left  he  di-ew  the  skin  of  the  pubis  and  root  of  the  penis 
backward  and  upward.  By  degiees,  and  without  the 
employment  of  great  force,  the  skin  of  the  fiap  was 
drawn  entirely  through  the  central  opening.  This 
being  done,  tlie  great  mobility  of  the  subpreputial 
tissue  facilitated  the  i)assage  of  a  large  part  of  the 
jirepuce  behind  the  constricting  body,  which  was 
now  readily  removed,  after  little  traction.  Urine 
was  voided' in  large  quantity,  and  the  bladder  com- 
pletely emi)tied. 

The  flaps  were  then  placed  in  position  and  dressed 
with  lint  moistened  with  carbolized  glycerine.  Diet, 
rest,  and  laxatives  were  prescribed.  Next  day  the 
general  health  was  satisfactoi7,  the  wounds  presented 
a  favorable  aspect,  and  the  urethra  was  uncontracted. 
The  flaps  were  then  sutured  together,  and  ten  days 
after  cicatrization  was  complete. 


Vol.   XXI.-No.  4.1 
Jan.  88,  1883.    ) 


THE  MEDICAL  RECORD. 


85 


©rtgtnol  Cecture©. 


THE  EXPERDIENTAL  IMETHOD   IX   5IED- 
ICAL  SCIENCE.' 

By  JOHN  C.  DALTON,  M.D., 
Lectttre  I. 

GALVAXI   AND   GALVANISM   IN   THE    STUBY   OF   THE   NEK- 
VOUS   SYSTEM. 

Mr.  President  and  Gentlemen  of  tlf  Alumni:  In  dis- 
charging the  agreeable  duty  which  yon  have  kindly 
imposed  upon  me,  of  giving  the  Cartwright  Lec- 
tnves  for  this  year,  I  propose  to  ofTer  a  few  histori- 
cal sketches,  which  shall  illnstrate  the  manner  in 
which  certain  parts  of  onr  scientific  knowledge  in 
medicine  have  been  attained.  The  connection  be- 
tween scientific  and  practical  medicine  is  further- 
more so  close  that  permanent  improvement  in  the 
one  is  inseparably  dependent  on  that  of  the  other ; 
but  this  connection  becomes  much  more  apparent 
when  we  trace  the  history  of  any  particular  depart- 
ment for  a  considerable  period  of  time.  By  this 
means  we  can  see  how  much  of  the  doctrine  accepted 
by  our  predecessors  has  survived  the  ordeal  of  a 
century ;  and  what  were  the  methods  of  investiga- 
tion which  produced  in  their  hands  the  permanent 
results  which  we  enjoy  to-day.  However  much  we 
may  pride  ourselves  on  the  advances  made  during 
oui-  own  time,  we  may  be  sure  that  by  far  the  greater 
part  of  our  actual  knowledge  is  a  legacy  from  the 
past.  It  has  been  winnowed  in  successive  genera- 
tions from  the  eiTors  and  imperfections  which  always 
accompany  its  first  acquisition ;  and  it  is  probable 
that  many  of  our  own  discoveries  will  requii-e  a 
similar  depleting  treatment  in  the  future.  But  we 
may  learn  to  rely  with  confidence  on  such  methods 
of  study  as  have  heretofore  proved  valuable;  and 
we  may,  perhaps,  sav#  ourselves  the  trouble  of  ex- 
ploring certain  paths,  when  we  see  that  others  have 
followed  them  before  and  have  found  that  they  lead 
nowhere. 

If  we  can  say  that  any  one  department  in  physi- 
ology, pathology,  and  therapeutics,  is  now  distin- 
guished by  a  .special  activity  of  investigation  and 
growth,  it  is  probably  that  of  the  nervous  system.  A 
very  large  part  of  this  advance  has  been  made  by  the 
application  of  eleotiic  stimulus  in  determining  the 
motor  or  sensitive  properties  of  different  nerves, 
their  influence  on  the  heart  and  blood-vessels,  the 
localization  of  special  centres  in  the  brain  and  sj^inal 
cord,  or  the  diagnosis  of  morbid  alterations  in  the 
cerebro-spinal  axis  ;  and  the  use  of  electricity  in  re- 
storing the  power  of  movement  or  sensation  when 
impaired  by  disease  is  now  acknowledged  to  be,  in 
many  eases,  a  most  serviceable  means  of  cure.  This 
has  aU  come,  directly  or  indirectly,  from  the  experi- 
ments of  Galvani,  nearly  a  hundred  years  ago,  on 
the  nerves  and  muscles  of  the  decapitated  frog. 

In  1789,  Gilvani  was  Professor  of  Anatomy  in  the 
University  of  Bologna.  In  addition  to  the  regular 
duties  of  his  professorial  chair,  he  had  made  a  num- 
ber of  valuable  investigations  in  comijai-ative  anat- 
omy, such  as  those  on  the  structure  of  the  kidneys 
and  urinary  ducts   of  birds,   and  on  the  organ  of 

'  Being  the  Second  Conrse  of  the  Cartwright  Lectures  of  the  Atiimni 
Association  of  the  Ckillege  of  Physicians  and  Surgeons,  New  York. 
Lectnre  I.  was  delivered  in  New  Y'ork.  January  '*M.  18S2. 


hearing  in  the  same  class.  Like  most  of  the  scien- 
tific men  of  his  day,  he  was  also  greatly  interested 
in  the  phenomena  of  electricity,  which  was  then  fast 
developing  into  an  important  department  of  physics. 
The  condition  of  electrical  science  at  that  time  was 
as  follows:  the  machine  for  producing  frictional 
electricity  by  a  rotating  glass  cylinder  and  cushion 
had  been  brought  to  practical  completion  and  was 
in  common  use,  with  its  prime  conductor  and  insu- 
lating supports.  The  two  opposite  kinds  of  elec- 
trical excitement,  known  as  vitreous  and  resinous, 
or  positive  and  negative,  were  fully  recognized,  as 
well  as  the  distinction  between  conductors  and  non- 
conductors: and  even  some  of  the  phenomena  of 
induced  electricity  were  known,  though  explained 
in  a  manner  somewhat  diffei'ent  from  that  which  is 
now  in  vogue.  Besides  the  electrical  machine,  ex- 
perimenters were  already  in  possession  of  the  Leyden 
jar,  by  which  a  large  quantity  of  electricity  may  be 
stored  in  a  given  space ;  the  electrojihorus,  by 
which  a  moderate  charge  of  electricity  may  be 
obtained  at  will  from  a  permanent  source  ;  several 
varieties  of  electrometers  or  electroscojies,  for  de- 
tecting the  existence  and  amount  of  slight  electric 
disturbances;  and  Volta's  "condenser,"  in  which 
small  quantities  of  electricity  from  a  feeble  source 
might  be  accumulated  and  made  apparent  by  the 
electrometer.  Finally,  Franklin  had  shown,  by  bis 
daring  experiment  with  the  kite  in  the  tliunder- 
storm,  that  the  lightning  of  the  clouds  was  identical 
in  its  nature  with  the  spark  from  an  electrical 
machine  :  and  this  had  largely  directed  the  atten- 
tion of  investigators  to  the  study  of  atmospheric 
electricity  as  compared  with  that  produced  by  arti- 
ficial means. 

Considering  the  long  list  of  results  which  have 
followed  from  Galvani's  early  observations,  the  man- 
ner in  which  they  were  first  made  is  a  topic  of  much 
interest.-'  He  was  in  his  laboratory,  engaged  on  ex- 
periments with  the  electrical  machine,  and  had, 
lying  upon  the  table  near  by,  a  freshly  dissected 
frog,  prepared  for  some  other  purpose  in  such  a  way 
that  the  denuded  hind  legs  were  connected  with  the 
spinal  column  by  the  crural  nerves.  One  of  his  as- 
sistants, accidentally  touching  the  nerves  of  the  ani- 
mal with  the  blade  of  a  scalpel,  saw  the  legs  convulsed, 
and,  on  watching  more  closely,  it  was  seen  that  the 
contraction  occurred  only  at  the  moment  of  drawing 
a  spark  from  the  conductor  of  the  machine.  Once 
Galvani's  attention  was  attracted  to  so  remarkable  a 
phenomenon,  his  mind  turned  instantly  to  the  in- 
vestigation of  its  conditions.  He  abandoned  all 
other  occupations,  and  seemed  absorbed  in  the  at- 
tempt to  detect  its  causes  and  to  learn  their  mode 
of  operation.  He  detei-mined,  in  the  first  jilace,  that 
the  discharge  of  the  conductor  and  the  contact  of 
the  scalpel  with  the  frog's  nerves  were  both  neces- 
sary— for  the  muscular  contraction  would  not  take 
place  with  either  of  them  alone.  But,  even  when 
both  conditions  were  present,  sometimes  the  muscles 
contracted  and  sometimes  they  did  not.  Puzzled  by 
this  variation,  but  still  confident  that  it  must  have  a 
reasonable  cause,  he  at  last  foimd  that  it  depended 
on  the  way  the  scalpel  was  held  in  the  fingers.  If 
grasped  by  the  end  of  its  non-conducting  ivory 
handle,  there  were  no  convulsions  in  the  legs  when 
the  spark  was  taken  from  the  machine  ;  but  if  held 
in  such  a  way  that  the  fingers  touched  the  steel 
blade,  or  the  rivets  which  held  it  in  place,  the  mus- 

2  Aloysii  Galvani  de  Virihiis  ElectriciUtis  in  Motn  Muscnlari  Com- 
mentariuB.  De  Bononicnsi  Scientiariim  et  Artium  Institute  atque 
Academia  Commentarii.     Tomus  septimup.  p.  363.     1T91. 


86 


THE  MEDICAL  RECORD. 


cles  were  always  thrown  into  action.  The  human 
body,  therefore,  served  as  a  conductor,  and  Galvani 
replaced  it  with  success  by  an  iron  wire,  which  he 
attached  by  one  extremity  to  the  spinal  column, 
above  the  origin  of  the  nerves,  by  a  brass  or  cojjper 
hook,  leaving  the  other  end  in  communication  with 
the  ground.  Then  he  could  dispense  witli  the  scal- 
pel altogether.  He  varied  the  contrivance  in  many 
ways,  turning  sometimes  the  attached  and  sometimes 
the  free  end  of  the  conductor  toward  the  electrical 
machine,  iacreasing  or  diminishing  its  length,  and 
at  last  adding  a  seconcT  conductor  attached  to  the 
muscles  of  the  leg.  He  took  especial  pains  to  ex- 
clude the  possibility  of  any  direct  transfer  of  elec- 
tricity from  his  machine  to  the  dissected  frog,  and 
yet  conrinced  himself  by  the  aid  of  Volta's  elec- 
trometer that  in  some  way  or  other  an  electric  dis- 
charge passed  through  the  frog,  and  was  the  exciting 
cause  of  its  convulsions. 

These  experiments  were  all  performed  with  artifi- 
cial electricity  obtained  from  the  electrical  machine. 
Galvani  then  "passed  to  his  .second  series  of  observa- 
tions, to  see  whether  a  similar  effect  would  be  pro- 
duced by  atmospheric  electricity.  On  the  approach 
of  a  thunder-storm,  he  arranged  one  of  the  conduct- 
ing-wires  so  that  its  upper  extremity  was  in  the  open 
air,  near  the  roof  of  his  house,  and  its  lower  extrem- 
ity connected  with  the  frog's  spinal  column,  whOe 
the  other  wire,  attached  to  the  muscles  of  the  leg, 
communicated  below  with  the  water  in  a  well ;  and 
he  then  waited,  like  Franklin,  for  the  discharge  of  a 
thunder-cloud.  The  result  followed  as  before,  and 
■  every  peal  was  accompanied  by  a  convulsive  motion 
in  the  dissected  frog.  He  especially  noticed  that 
the  convulsions  were  simultaneous,  not  with  the 
sound  of  the  thunder,  but  with  the  electric  dis- 
charge ;  for,  as  he  says,  "the  muscular  contractions 
and  movements  of  the  animal,  like  the  visible  splen- 
dor of  tlie  lightning-flash,  always  preceded  the  thun- 
der-clap, and,  as  it  were,  gave  notice  that  it  was 
coming."  J 

So  far,  Galvani  had  not  really  touched  upon  his 
final  discovery.  The  phenomena  of  muscular  con- 
traction in  these  two  sets  of  experiments  were  due, 
as  we  now  know,  to  the  action  of  induced  electricity. 
When  he  charged  the  prime  conductor  of  his  elec- 
trical machine,  or  when  the  thunder  cloud  was  pass- 
ing over  his  house,  an  imperceptible,  but  real,  dis- 
turbance of  the  electric  equilibrium  took  place,  by 
induction  in  the  wires  attached  to  his  dissected 
frog ;  and,  when  the  original  electrical  tension  ex- 
pended itself  in  a  discharge,  there  was  a  similar 
reaction  in  his  conducting-wires,  a  reaction  which 
necessarily  passed  through  the  nerves  and  muscles 
of  the  frog,  and  threw  it  into  convulsions.  Galvani 
did  not  understand  this,  but  he  was  engrossed  with 
the  idea  of  pursuing  the  new  fact  which  he  had  un- 
expsctedly  witnessed,  and  of  following  its  investiga- 
tion by  whatever  path  might  be  open  to  him.  So  it 
happened  that  he  was  led,  in  his  third  set  of  experi- 
ments, to  a  result  of  far  greater  importance ;  and 
notwithstanding  that  the  two  former  series  bad 
nothing  to  do  with  this  result,  so  far  as  the  nature 
of  their  phenomena  were  concerned,  they  were  still 
the  necessary  and  perfectly  natural  preliminaries  to 
its  discovery. 

Galvani  knew  that  the  violent  disturbances  of 
thunder  and  lightning  were  not  the  only  ones  which 
take  place  in  the  atmosphere,  but  that  there  were 
also  other  changes  of  electrical  condition  going  on 
more  ([uietly  in  ordinary  weather.  "  After  having 
tested,"  he  says,  "  the  action  of  atmospheric  elec- 


tricity in  thunder  storms,  I  was  exceedingly  desirous 
of  investigating  it  in  its  daily  condition  of  quietude 
and  sereaity."  For  this  purpose  he  hung  his  freshly 
dissected  frogs,  by  copper  books  attached  to  the 
spinal  column,  from  the  iron  railing  of  a  balustrade 
about  his  house,  and  left  them  there  exposed  to  the 
sky.  He  thought  that  perhaps  the  impercejitible 
exchange  of  electricity  between  the  clouds  and  the 
atmosphere  might  be  betrayed  by  some  movement 
in  the  frogs'  limbs,  and  he  watched  patiently  with 
that  object  for  several  days.  But  there  was  not  the 
least  indication  of  muscular  excitement.  At  last, 
seeing  that  nothing  further  would  come  of  the  ex- 
periment in  that  way,  he  shifted  the  position  of  the 
limbs,  and  pressed  them,  still  hanging  by  their 
hooks,  against  the  iron  framework  of  the  balus- 
trade, and  instantly  a  convulsion  took  place.  He 
had  made  a  galvanic  circuit.  The  copper  hook  and 
the  iron  railing  were  the  two  metals  of  the  battery, 
and,  by  bringing  the  muscles  in  contact  with  the 
railing,  he  had  completed  the  communication,  and 
had  seen,  for  the  first  time,  a  muscular  contraction 
excited  by  the  galvanic  current. 

But  of  course  his  knowledge  of  the  real  cause  of 
the  contraction  was  still  very  incomijlete,  and  no 
one  could  be  more  conscious  of  this  than  himself. 
He  knew  how  many  sources  of  error  there  may  be 
in  drawing  a  conclusion  from  visible  facts,  until 
they  have  been  examined  from  every  direction.  His 
most  natural  inference,  if  he  had  remained  satisfied 
with  this  experiment,  would  have  been  that  the 
electrical  cause  of  the  contractions  came  from  tl:e 
atmosphere.  "  I  was  veiw  much  inclined,"  he  says, 
"to  attribute  these  contractions  to  atmospheric 
electricity  which  had  accumulated  in  the  frog,  and 
was  then  suddenly  discharged  by  the  contact  of  the 
hooks  and  railings,  never  having  seen  contractions 
produced  in  this  way  except  in  the  open  air,  ns  I  had 
not  yet  tried  them  in  niiy  allier  place — we  may  be  eg 
easily  misled  into  thinking  that  we  have  really  seen 
whatever  we  hope  or  expect  to  see."  But  he  soon 
found  that  he  could  obtain  the  same  results  in  his 
closed  laboratoi-y  as  well  as  in  the  open  air,  at  any 
time  of  the  day,*  in  any  weather,  and  under  a  gieat 
variety  of  conditions,  provided  only  that  communica- 
tion was  male  between  the  nerves  and  muscles  by  me- 
tallic conductors,  with  no  intervening  non-conduct- 
ing material.  The  best  arrangement  was  that  in 
which  the  nerves  were  suspended  by  copper  hooks 
or  armed  with  tin-foil,  while  the  denuded  feet  of 
the  frog  rested  on  a  silver  plate,  and  the  two  were 
then  connected  by  a  metallic  arc.  The  human  body, 
being  also  a  conductor,  might  be  interposed  between 
the  ends  of  the  arc  without  lessening  the  result. 
Galvani's  description  of  this  part  of  the  discovery  is 
an  interesting  episode,  as  it  coiToborates  his  proof 
of  the  electric  nature  of  the  force  in  operation.  He 
found  that  if  he  held  the  frog  suspended  by  its 
copper  hook  in  one  hand,  and  touched  the  silver 
plate  with  a  metallic  rod  in  the  other,  the  frog  was 
convulsed.  Then  he  called  in  the  assistance  of  a 
colleague.  "  I  was  staying,"  he  says,  "  at  the  coun- 
try-house of  the  most  noble  and  excellent  Signer 
James  Zambeccari,  where  Signor  Rialpo,  of  Spnin, 
formerly  a  member  of  the  Society  of  Jesus,  and  a 
very  learned  man,  was  visiting  at  the  same  time.  He 
had  already  kin<lly  aided  me  in  former  experiments, 
and  I  begged  him  to  do  so  again  in  this  instance. 
He  accordingly  took  my  place  in  holding  the  frog, 
while,  partly  fbr  convenience  and  partly  to  vaiT  the 
conditions  of  the  experiment,  I  myself  touched  the 
silver  plate  with  my  metallic  rod.     But,  contrary  to 


THE  MEDICAL  RECORD. 


87 


expectation,  no  movement  was  produced."  Then  the 
two  observers  joined  hands,  and,  on  repeating  the 
metallic  contact,  found  "to  their  delight"  that  oom- 
mumcation  took  place  through  the  human  electric 
chain,  and  was  maaifested  by  muscular  contraction 
in  the  frog's  leg.  From  all  these  results  the  con- 
clusion became  irresistible  that  the  convulsions 
previously  observed  in  the  frogs  attached  to  the 
iron  railings  were  due  to  the  contact  of  their  metallic 
supports. 

It  is  perfectly  evident  that  this  third  set  of  ex- 
periments contained  the  substance  of  a  new  discov- 
ery, and  Galvani  fully  recognized  the  fact.  In  the 
two  former  series  there  were  external  sources  of 
electricity,  either  in  the  electrical  machine  or  in  the 
thunder-clouds  of  the  atmosphere.  But  here  all 
such  conditions  were  excluded.  There  was  nothing 
to  explain  the  phenomena  but  the  frog's  nerves  and 
muscles,  and  the  metallic  conductors  between  them. 
In  all  Galvani's  experiments  his  mind  was  forcibly 
impressed  by  this  fact,  and  he  was  naturally  led  to 
suspect  that  the  electricity  which  caused  the  con- 
vulsions might  be  derived  from  the  animal  body 
itself. 

He  made  many  attempts  to  determine  which  of 
the  two  kinds  of  electricity  was  produced  in  the 
nerves  and  which  in  the  muscles,  thinking  that  one 
of  these  tissiies  would  naturally  be  positive  and  the 
other  negative.  But  he  finally  considered  the  elec- 
tricity to  be  distributed  on  the  exterior  and  in  the 
interior  of  the  muscle,  very  much  as  it  is  on  the  outer 
and  inner  surfaces  of  a  Leyden  jar.  The  ner^-e,  with 
its  ramifications,  leading  from  the  interior  of  the 
muscles,  he  regarded  as  analogous  to  the  chain  and 
knob  of  the  Leyden  jar,  and  when  it  was  connected 
by  a  metallic  arc  with  the  exterior  of  the  muscle, 
the  animal  electric  battery  was  discharged,  and  a 
convulsion  ensued  from  the  stimulus  of  the  shock. 

In  this  way  Galvani  accounted  for  the  phenomena 
witnessed  in  his  experiments.  He  was  far  fiom  be- 
lieving that  he  fully  understood  all  their  relations  ; 
but  he  was  convinced  of  their  importance,  and  had 
no  doubt  that  their  obscurities  woidd  disappear  on 
further  investigation.  He  especially  noticed  the  ad- 
vantage of  uniting  in  the  armature  of  the  limbs,  or 
in  the  connecting  arc,  dift'erent  metallic  substances. 
"  There  is  an  additional  peculiarity,"  he  says,  "  which 
deserves  attention,  and  which  I  have  very  often  ob- 
served in  regard  to  the  coimecting  arcs,  namely, 
that  they  are  vastly  more  efficient  when  composed 
of  different  metallic  substances  than  when  consist- 
ing of  one  and  the  same  metal."  Biit  he  does  not 
tindertake  to  explain  this  peculiarity,  although  he 
found  that,  of  various  metallic  combinations,  some 
were  more  effective  than  others. 

He  was  perfectly  clear  as  to  the  prime  importance 
of  what  he  had  actually  discovered,  and  the  secondary 
value  of  what  was  only  inferential,  and  this  distinction 
is  expressly  stated  in  his  opening  chapter.  "From  all 
these  |)articulars,"  he  says,  "investigated  and  estab- 
lished by  a  long  series  of  experiments,  we  have  not 
only  shown  that  these  contractions  are  due  to  elec- 
tricity, but  have  furthermore  been  able  to  indicate 
certain  conditions  and  laws  by  which  they  are  regu- 
lated  We  have  also  appended  to  the  nar- 
rative a  number  of  corollaries,  together  with  some 
additional  conjectures  and  hypotheses,  mainly  in  the 
hope  of  opening  a  way  for  further  experiments,  by 
which  we  may  at  least  be  enabled  to  approximate 
the  truth,  even  if  we  cannot  expect  to  reach  it  alto- 
gether." 

There   are   some   curious    surmises  in   Galvani's 


book  as  to  the  possible  future  value  of  his  discov- 
eries in  the  treatment  and  cure  of  nervous  disease. 
He  recognizes  the  diflieulty  of  their  application  to 
pathology,  on  his  own  hypothesis  of  an  animal  elec- 
tricity as  the  cause  of  muscular  contraction.  But 
they  are  interesting  in  connection  with  the  imperfect 
state  of  pathological  knowledge  in  his  day  as  com- 
pared with  the  present,  and  some  of  his  remarks 
soiind  almost  prophetic.  "  In  regard,"  he  says,  "  to 
the  cure  of  paralysis,  I  see  that  it  is  a  matter  of 
great  uncertainty  ;  for  it  is  not  easy  to  say  whether 
the  disease  be  caused  by  a  degeneration  of  strncttire 
in  the  nei-ves  and  brain,  or  whether  it  be  due  to  an 
obstruction  of  the  supposed  electrical  circuits  by  the 
deposit  of  some  non-conducting  material."  "But 
perhaps,"  he  adds,  "the  whole  thing  will  some  day 
or  other  be  cleared  up  by  further  practice  and  ex- 
perience." 

Galvani  did  not  have  to  wait  long  to  see  a  vejy 
important  advance  made  in  the  path  which  he  had 
opened.  One  of  his  contemporaries  was  Volta,  who 
had  already  been  for  fifteen  years  Professor  of  Phy- 
sics in  the  University  of  Pavia.  and  who  was  admir- 
ably fitted,  both  by  his  cajjacity  and  his  attainments, 
for  treating  a  new  subject  with  success.  Volta  was 
greatly  attracted  by  the  novelty  and  character  of 
Galvani's  experiments.  He  repeated  them,  wi*h 
many  extensions  and  variations ;  and  he  not  only 
verified  their  results,  but  was  enabled  to  tlirow  a 
new  light  on  the  immediate  cause  of  their  phenom- 
ena. His  first  investigations  were  communicated  in 
the  form  of  two  letters  to  the  Pvoyal  Society  of  Lcn- 
don  in  1793,  under  the  title,  "  An  Account  of  Some 
Discoveries  made  by  M.  Galvani,  with  Experiments 
and  ObseiTations  on  Them."-'  In  this  communica- 
tion he  refers  to  Galvani's  treatise,  published  two 
years  before,  as  containing  "  one  of  the  most  splen- 
did and  striking  discoveries,  as  well  as  the  germ  of 
others  in  addition." 

Volta  naturally  approached  the  subject  rather 
from  its  physical  than  its  physiological  side,  and  he 
had  a  certain  mathematical  habit  of  mind  that  led 
him  to  apjireciate  the  value  of  quantities  in  such  an 
investigation.  He  began  by  determining,  in  an  ap- 
jDroximate  way,  the  amount  of  electrical  stimulus 
capable  of  producing  conviilsions  in  the  muscles  of 
the  frog.  I?y  using  successively  smaller  and  smaller 
charges  from  a  Leyden  jar,  he  found  that  the  entire 
and  living  frog  might  be  convulsed  by  electric  dis- 
charges which  would  give  biit  very  faint  sparks,  and 
which  would  affect  only  the  most  delicate  of  the 
electrometers  then  in  use.  But  a  recently  killed 
frog,  prepared  after  the  method  of  Galvani,  was 
more  sensitive  still.  In  this  condition  it  could  be 
made  to  contract  by  an  electric  discharge  fifty  or 
sixty  times  more  feeble,  and  quite  impercej^tilde 
with  any  electrometer,  unless  by  aid  of  the  con- 
denser. In  this  way  he  exhibited  Galvani's  frog  as  a 
new  kind  of  electrometer  or  electroscope  of  extra- 
ordinary sensibility ;  and  he  named  it  accordingly 
the  "animal  electrometer."  This  showed  conclu- 
sively that  in  all  the  experiments  withindiiced  elec- 
tricity, the  dissected  frog  might  be  convulsed  by  an 
electric  discharge  too  feeble  to  be  detected  by  other 
means. 

Volta  then  began  to  investigate  the  source  of  elec- 
tricity in  Galvani's  third  set  of  experiments,  namely, 
those  with  the  dissected  frog  and  Ihe  metallic  nrc. 
Galvani,  it  will  be  remembered,  attributed  this  elec- 


=  Philosophical  Transactions  of  the  Hoyal  Society  of  London  for  the 
Year  17H.3,  i-agc  10, 


THE  MEDICAL  RECORD. 


tricity  to  the  different  condition  of  the  animal  tis- 
sues, and  always  made  his  connection  between  the 
nerve  on  the  one  hand  and  the  muscle  on  the  other, 
as  he  would  between  the  two  surfaces  of  a  Leyden 
jar.  With  the  connection  made  in  this  way  the  ef- 
fect is  really  more  striking,  because  the  whole  of  the 
galvanic  current  passes  through  the  isolated  nerve, 
and  thus  produces  a  corresi^onding  excitement. 
But  Volta  found  that  the  two  separate  elements,  of 
nerve  and  muscle  respectively,  were  not  essential  to 
the  result.  If  one  metallic  armature  were  placed  on 
the  muscle  and  another  also  on  the  muscle  near  by, 
or  if  they  were  placed  on  corresponding  muscular 
parts  of  the  two  legs,  a  contraction  ensued  on  con- 
necting them  by  the  metallic  arc.  The  same  thing 
happened  with  the  nerve.  If  an  armature  of  silver 
were  placed  on  one  part  of  the  crural  nerve  above  its 
junction  with  the  muscles,  and  one  of  tinfoil  at 
another  part  of  the  same  nerve  still  higher  up,  and 
connection  made  between  them,  the  leg  was  con- 
vulsed, notwithstanding  that  the  whole  of  the  mus- 
cles, as  well  as  a  portion  of  the  nerve,  were  outside 
the  electric  circuit.  This  did  not  correspond  with 
the  idea  of  an  animal  electric  apparatus  consisting 
of  the  nerve  and  muscle  combined.  It  was  neces- 
sary to  look  elsewhere  for  the  source  of  the  elec- 
tricity under  these  conditions,  and  Volta  found  it  in 
the  contact  of  dissimilar  metals.  This  contact  de- 
veloped but  a  minxite  quantity  of  electricity,  too 
small  to  be  recognized  by  any  other  means  at  the 
command  of  the  experimenter ;  but  the  dissected 
frog  was  an  electroscope  of  such  sensibility  that  it 
responded  to  the  test  and  betrayed  the  electric  dis- 
charge by  a  convulsion. 

Volta  was  in  very  much  the  same  position  for  this 
part  of  the  discovery  as  Galvani  had  been  in  regard 
to  his  own  earlier  observations.  He  was  compelled 
to  recognize  its  reality  and  importance,  without  be- 
ing able  to  give  its  explanation.  "  I  confess,"  he 
says,  "it  is  not  easy  to  understand  how  or  why  the 
application  of  dissimilar  armatures,  that  is,  of  dif- 
ferent metals,  to  two  similar  parts  of  the  animal,  or 
even  to  neighboring  parts  of  the  same  muscle,  should 
disturb  the  equilibrium  of  the  electric  fluid,  and 
drive  it  from  its  condition  of  repose  into  one  of  ac- 
tive and  continued  di.splacement.  But  whatever  may 
be  the  cause  of  the  jahenomeuon,  and  whether  in- 
telligible or  not,  it  is  nevertheless  a  fact,  abundantly 
e.-itablished  by  the  experiments  already  detailed,  and 
further  corroborated  by  those  which  follow." 

For  several  years  Volta  continued  the  study  of 
this  subject,  and  at  last  found  a  way  of  greatly  in- 
creasing the  intensity  of  the  phenomena.  This  was 
by  multiplying  the  ntimber  of  pairs  of  his  dissimilar 
metals,  so  as  to  form  the  Voltaic  pile.  His  results 
were  given,  in  1800,  in  a  letter  to  the  Royal  Society,'' 
containing  a  description  of  his  new  contrivance. 
Each  member  of  the  pile  consisted  of  a  plate  of  zinc 
in  contact  with  a  plate  of  silver.  This  was  covered 
by  a  layer  of  moistened  paper  or  membrane.  Then 
followed  a  second  pair  of  zinc  and  silver  plates,  and 
80  on  alternately  ;  the  two  metals  always  recurring 
in  the  same  order,  and  each  pair  being  sejiarated 
from  those  above  and  below  by  moist  membranes. 
With  this  arrangement  the  intensity  of  the  action, 
on  connecting  the  extremities  cf  the  pile,  was  suffi- 
cient to  cause  shocks  and  muscular  contractions  in 
the  hands  and  arms,  and  to  affect  the  senses  of 
sight,  he.iring,  tasto,  and  touch.  Its  operation  was 
compared  to  that  of  the  torpedo  and  electrical  eel, 

*  rhlloRophicftl  Trntisactiuus  o(  the  Royal  Societv  of  London    for 
the  year  1600,  pngc  403. 


and  it  received  the  came  of  the  "  artificial  electrical 

organ." 

The  iJeculiarity  of  this  discovery  was  that  it  intro- 
duced into  electrical  science  two  new  features.  Be- 
fore that  time  electricity  had  been  obtained  only  by 
the  combined  use  of  different  substances,  one  of 
which  must  be  a  conductor,  the  other  a  non-con- 
ductor, as  in  the  frictional  machine,  the  Leyden  jar, 
and  the  electrophorus ;  and  when  an  electrified 
body  was  touched  by  a  conductor  the  whole  of  its 
charge  was  exj^ended,  and  it  could  be  electrified 
again  only  by  receiving  a  new  charge  from  an  ex- 
traneous source.  But  in  the  electric  pile  Volta 
found,  to  his  surprise,  a  source  of  electricity  in  sub- 
stances all  of  which  were  conductors ;  and  further- 
more, a  source  which  seemed  inexhaustible,  because, 
however  often  the  two  ends  of  the  pile  were  touched, 
the  same  shock  was  repeated  with  the  same  inten- 
sity. The  inherent  force  of  the  pile  seemed  to  urge 
the  electric  fluid  incessantly  forward,  returning  upon 
itself  in  a  continiious  flow,  so  long  as  the  circuit  of 
conductors  remained  complete. 

Volta  attributed  this  action  entirely  to  the  contact 
of  dissimilar  metals.  This  view  is  plainly  expressed 
in  the  title  of  his  letter  to  the  Royal  Society,  and  is 
repeatedly  insisted  on  in  the  course  of  the  communi- 
cation. The  fluids  or  moistened  membranes  inter- 
posed between  the  metallic  j^airs  he  regarded  only 
as  conductors  ;  and  when  a  saline  solution  was  found 
to  be  more  efficient  than  water  alone,  he  thought  it 
was  because  the  salt  increased  the  conducting  power 
of  the  water.  In  reality,  the  source  of  power  in  the 
voltaic  pile  is  the  chemical  action  between  the  fluid 
and  the  metals,  one  of  which  is  more  oxidizable  than 
the  other  ;  and  for  every  unit  of  electric  force  sent 
through  the  circuit,  a  definite  quantity  of  material 
undergoes  chemical  transformation.  The  contact 
of  dissimilar  metals  is  not  essential  to  the  result, 
for  a  current  may  be  produced  withoiTt  it,  if  we  use 
two  different  liquids,  of  which  one  is  more  decom- 
posable than  the  other.' 

Neither  the  first  nor  the  second  explanation  of  the 
phenomena  observed  was  therefore  entirely  right, 
as  we  understand  it.  Volta  imagined  the  metals  in 
his  pile  to  act  by  contact  alone,  while  they  are  really 
consumed  by  oxidation.  In  Galvani's  experiment, 
the  connecting  arc,  where  the  two  metals  join,  is,  as 
Galvani  supposed,  a  conductor  and  nothing  more; 
but  its  dift'erent  extremities,  when  applied  to  the 
animal  tissues,  form  with  ther 
of  a  single  cell,  and  thus  prodv 
excites  their  contraction. 

siological  purposes,  in  a  different  way.  We  placi 
the  two  metallic  plates  in  a  cup  of  acidulated  fluid, 
and  make  the  retui-ning  current  pass  through  the 
muscles  and  nerve.  But  the  effect  is  the  same,  for 
the  active  force  of  the  current  is  equal  in  both  di- 
rections. 

The  results  obtained  by  these  two  investigators 
were  distinct  from  each  other,  but  of  almost  equal 
importance.  Galvani  discovered  the  electric  action 
on  nerves  and  muscles  which  bears  his  name.  Volta 
gave  to  physical  science  a  new  a|)paratus,  by  which 
current  electricity  is  transmitted,  in  a  continuous 
circuit.  Each  investigator  was  partially  at  fault  in 
the  theoretical  explanation  of  his  own  discovery. 
But  the  value  of  the  di.scovery  has  remained,  and 
has  even  largely  increased  in  the  course  of  a  century, 
notwithstanding  the  difference  in  its  interjiretation. 
It  also  appears,  from   the  history  of  the  circum- 

)  the  Study  ol  Chemical  PhUosophy,  |>age 


es,  when  applied  to  the       '■ 
them  a  galvanic  battery        | 
rodnce  the  current  which 
We  now  use  it.  for  phy-         ' 


THE  MEDICAL  RECORD. 


89 


stances,  that]  the  aecond  of  these  discoveries  was  a 
consequence  of  the  first ;  and  nothing  can  show 
more  clearly  the  unbroken  connection  of  events, 
in  the  progress  of  science,  which  may  sometimes  ex- 
tend to  the  most  unexpected  ramifications.  It  is 
plain  that  we  should  not  be  to-day  in  possession  of 
the  electric  light,  were  it  not  for  Volta's  discovei-y  of 
current  electricity ;  and  Volta  produced  his  electric 
pile  in  trying  to  investigate  the  contraction  of  Gal- 
vani's  frogs. 

During  the  early  part  of  the  present  century  ex- 
perimenters were  busily  occupied  with  galvanic  elec- 
tricity. They  studied  its  action  in  a  great  variety 
of  ways,  and  thus  became  acquainted  with  its  mode 
of  operation,  and  able  to  appreciate  its  phenomena. 
They  found  that  when  it  was  transmitted  through 
.  any  portion  of  a  muscular  nerve  it  produced  contrac- 
tion at  the  instant  of  closing  the  circuit ;  that  after- 
ward, while  flowing  through  the  nerve  in  a  uniform 
current,  it  was  without  efl'ect ;  and  that  contraction 
again  oecui-red  when  the  current  was  discontinued. 
Even  during  the  passage  of  the  current,  any  sudden 
variation  in  its  intensity,  either  of  increase  or  dimi- 
nution, would  produce  the  same  efl'ect.  It  was  the 
change  in  the  electrical  state  of  the  parts,  rather 
than  their  actual  condition,  which  operated  as  a 
stimulus,  and  provoked  the  contractions.  The  di- 
rection of  the  current,  the  length  of  nerve  included 
within  the  circuit,  and  the  frequency  of  making  and 
breaking  the  connection,  all  had  a  certain  influence 
in  the  result.  Experimenters  found  themselves  pro- 
vided with  a  new  agent,  by  which  they  could  inves- 
tigate nervous  action  at  their  leisure,  in  animals  de- 
prived of  life,  with  the  nerves  and  muscles  exposed 
to  view,  and  with  far  more  delicacy  and  certainty 
than  ever  before  ;  and  the  familiarity  thus  acquired 
with  the  operation  of  the  galvanic  stimulus  prepared 
them  for  its  more  eSeetive  use  in  future  investiga- 
tions. 

The  next  event  of  suifioient  consequence  to  form 
an  epoch  in  the  history  of  nervous  physiology  was 
the  discovery,  in  1822,  of  the  distinction  of  motor  and 
sensitive  properties  in  the  two  roots  of  the  spinal 
nerves.  Eleven  yeai's  before.  Sir  Charles  Bell  *  had 
made  some  experiments  on  the  spinal  nerve  i-oots  of 
a  recently  killed  rabbit,  in  which  it  appeared  that 
mechanical  irritation  of  the  anterior  roots  caused 
convulsion  in  the  corresponding  muscles,  while  a 
similar  irritation  of  the  posterior  roots  had  no  such 
effect.  This,  however,  was  not  suppo.sed  to  show 
an  anatomical  separation  between  the  two  powers  of 
motion  and  sensibility,  but  between  those  of  volition 
and  consciousness  on  the  one  hand,  and  involuntary 
nervous  action  on  the  other.  The  ideas  of  the  au- 
thor on  this  subject  were  not  accepted  by  his  col- 
leagues. In  fact,  they  were  not  really  published, 
but  only  printed  in  pamphlet  form  for  jsrivate  dis- 
tribution. They  hardly  attracted  the  notice  of  the 
profession,  and  had  no  influence  on  the  medical  doc- 
trines of  the  day. 

Subsequently,  in  1821,  Bell  published  '  the  re- 
markable observation  that  if  the  seventh  cranial 
nerve,  distributed  to  the  face,  were  divided  in  a 
living  animal,  the  movements  of  facial  expression 
were  abolished,  while  the  faculty  of  sensation  could 
be  destroyed  by  cutting  the  corresponding  branches 
of  the  fifth  pair.  Thus,  the  two  main  properties  of 
nervous  endowment,  generally  associated  with  each 


'  Idea  of  a  New  Anatomy  of  tlie  Brain  :  Submitted  for;the  ObseiTa- 
tion  of  his  Friends.     By  Charles  Bell.  F.R.S.E. 

7  p>,:i.^ciophical  Transactions  of  the  Royal  Society,  page  .398.  Lon- 
don, 1S21. 


other,  occupied  in  this  instance  distinct  situations, 
since  the  seventh  was  shown  to  be  a  nerve  of  motion 
only,  the  sensibility  of  the  face  being  supi)!ied  from 
another  source.  This  fact  was  connected,  in  the  re- 
searches of  Sir  Charles  Bell,  with  theoretical  con- 
siderations of  a  different  bearing  ;  but  it  had  evi- 
dently great  importance  of  its  own,  and  was  received 
on  all  sides  with  much  interest.  It  especially  at- 
tracted the  attention  of  Magendie,  then  at  the  height 
of  his  activity  in  phy.siological  investigation.  Ma- 
gendie repeated  Bell's  ex25erimeuts  on  the  seventh 
cranial  nerve,  and  verified  their  results  as  to  its 
exclusively  motor  properties.  But  he  was  also  in- 
tent on  exploring  various  other  parts  of  the  nervous 
system,  and  in  1822  he  j^erformed  and  published 
his  experiments  on  the  spinal  nerve  roots.''  His 
description  is  a  model  of  directness  and  simplicitv, 
free  from  any  unwarranted  inference  or  assumjstion. 
"  I  had  long  been  wishing,"  he  says,  "to  try  tJie  ex- 
l^eriment  of  dividing  the  posterior  roots  of  the  spinal 
nerves,  but  had  never  succeeded  in  doing  so,  owing 
to  the  difficulty  of  opening  the  vertebral  canal  -with- 
out wounding  the  spinal  cord  and  inflicting  severe 
or  fatal  injury  upon  the  animal.  But  a  month  ago 
I  received  at  the  laboratory  a  litter  of  jjups  only  six 
weeks  old,  and  it  seemed  a  good  opportunity  for 
another  attemjjt  at  the  operation.  This  time,  in 
fact,  I  succeeded,  by  the  aid  of  a  very  sharp  scalpel, 
in  laying  bare  almost  at  a  single  stroke  the  poste- 
rior half  of  the  spinal  cord  with  its  membranes.  I 
then  had  no  difliculty,  after  opening  the  dura  mater, 
in  bringing  into  view  the  posterior  roots  of  the  lum- 
bar and  sacral  nerves  ;  and  by  lifting  these  roots  on 
the  blades  of  a  pair  of  fine  scissors,  I  was  able  to 
divide  them  on  one  side  withoTit  inJTu-y  to  the  spinal 
coi-d.  Not  knowing  what  would  be  the  effect  of  this 
operation,  I  closed  the  wound  by  a  suture  in  the  in- 
tegument and  kept  watch  of  the  animal.  At  first  it 
looked  as  if  the  limb  on  that  side  were  entirely 
paralyzed.  It  was  insensible  to  punctures  and  to 
pressure,  and  also  appeared  motionless  ;  but  soon 
afterward  I  was  surprised  by  seeing  it  move  very 
distinctly,  although  it  was  completely  and  perma- 
nently insensible.  After  tiyinga  second  and  a  third 
experiment  with  exactly  the  same  result,  I  began  to 
think  it  probable  that  the  posterior  roots  of  the 
spinal  nerves  might  have  a  function  distinct  from 
that  of  the  anterior  roots,  and  more  especially  devoted 
to  .sensibility. 

"  I  next  thought  of  dividing  the  anterior  roots, 
leaving  the  posterior  roots  entire  ;  but  that  was  a 
thing  more  easily  said  than  done.  There  ajipeared 
to  be  no  way  of  getting  at  the  anterior  surface  of 
the  cords  without  involving  the  posterior  root.s,  and 
at  first  it  seemed  a  hopeless  undertaking.  After 
considering  the  matter  for  a  day  or  two,  I  tried  to 
reach  the  anterior  roots  with  a  sort  of  narrow-bladed 
cataract-knife,  by  jjassing  it  in  front  of  the  posterior 
roots,  and  then  turning  its  cutting  edge  forward 
against  the  bodies  of  the  vertebra;.  This  plan  failed, 
owing  to  the  impossibility  of  avoiding  hemorrhage 
from  the  large  veins  in  the  vertebral  canal ;  but,  while 
making  the  attempt,  I  found  that,  by  drawing  aside 
the  dura  mater,  I  could  catch  a  glimpse  of  the  ante- 
rior roots  just  where  they  are  about  to  pass  through 
the  investing  sheath.  This  was  enough,  and  in  a  few 
seconds  I  had  divided  as  many  of  them  as  I  wished, 
on  one  side  only.  It  may  be  imagined  with  what 
curiosity  I  awaited  the  result.  It  finally  came  in  a 
perfectly  unequivocal  form,  for  the  limb,  though  re- 


90 


THE  MEDICAL  RECORD. 


taining  its  sensibility,  was  completely  relaxed  and 
motionless.  Finally,  not  to  leave  anytbing  undone, 
I  di\"ided  both  the  anterior  and  posterior  roots, 
causing  entire  loss  of  sensibUity  and  motion." 

Magendie  began  his  experiments,  therefore,  by 
dividing  the  nerve-roots,  and  thus  abolishing  their 
functions.  In  pursuing  the  subject,  he  tried  the 
etfect  of  their  irritation,  employing  for  this  purpose 
both  mechanical  agents  and  the  stimulus  of  galvan- 
ism. The  result  of  these  experiments  coiTesjJonded 
in  general  with  those  obtained  by  the  method  of 
d  vision  ;  that  is,  galvanization  of  the  anterior  roots 
o  lused  muscular  contraction,  and  that  of  the  poste- 
rior roots  sensation.  There  wore  also  certain  other 
phenomena  which  did  not  altogether  coincide  with 
the  doctrine  of  a  complete  separation  between  the 
two  functions,  and  which  were  not  fully  understood 
until  some  years  later.  But  Magendie  took  cogni- 
zance of  everv  experimental  fact,  whether  he  under- 
stood it  or  not ;  aad  his  own  subsequent  researches 
on  "  recurreuD  seasibility  "  explained  many  of  the 
irregularities  which  he  at  first  encountered. 

The  distinction  of  properties  between  the  spinal 
nerve  roots  was  of  greater  importance,  because  it 
indicated  a  general  plan  of  arrangement  for  the  ner- 
vous system  throughout  the  body.  It  immediately 
became  a  matter  of  criticism  and  verification  for  the 
leading  physiologists  of  Europe,  and  the  result  was 
a  complete  acceptance  of  Blagendie's  discovery.  In 
Germany,  Johann  Mtiller,  then  Professor  of  Anatomy 
and  Physiology  in  the  University  of  Bonn,  endeavored 
to  avoid  the  difficulties  of  so  serious  an  operation  on 
warm-blooded  animals  by  experimenting  on  frogs. 
He  examined  the  spinal  nerve  roots  in  these  animals, 
both  by  the  method  of  section,  by  mechanical  irrita- 
tion, and  by  galvanism  ' 

"These  experiments,"  he  says,  "have  been  re- 
warded with  the  most  brilliant  success.  They  are 
so  easy  of  ajiplication,  so  sure,  and  so  decisive,  that 
any  investigator  may  now  readily  satisfy  himself  of 
one  of  the  most  important  truths  in  physiology. 
Tlie  phenonena  are  so  regular  and  satisfactory  that, 
for  simplicity  and  certainty  of  results,  tliey  fully 
compare  with  any  crucial  experiment  in  the  physi- 
cal sciences.  Galvanization  of  the  separated  ante- 
rior roots  at  once  causes  active  convulsions  ;  that  of 
the  posterior  roots  never  gives  rise  to  any  sign  of 
spasmodic  action." 

In  this  way  the  distinct  endowment  of  the  two 
kinds  of  nerve-fibres  was  experimentally  established. 
Once  placed  on  this  footing,  the  pursuit  of  nervous 
physiology  was  greatly  increased  in  efficiency  and  ex- 
tent. Bv  applying  the  galvanic  stimulus  to  a  spinal 
nerve,  above  or  below  the  point  of  section,  its  mode 
of  action  was  determined  by  the  excital)ility  of  its 
motor  or  sensitive  fibres.  The  same  method  was 
employed  for  the  crania!  nerves,  both  externally  and 
at  their  roots,  and  every  branch  of  inosculation  was 
scrutinized  by  the  same  means.  It  is  hardly  possible 
to  overestimate  the  change  thus  introdnoed  into  the 
study  of  the  nervous  system  and  the  increased  facil- 
ities which  it  supplied  for  further  investigation. 

Wo  now  come  to  Marsliall  Hall's  discovery  of  the 
reflex  action  of  the  spinal  coi'd.  Up  to  this  time  the 
motor  and  sensitive  properties  of  the  nervous  system 
had  been  understood  by  jihysiologists  as  almost 
wholly  subserWent  to  voluntary  motion  and  con- 
scious sensil)ility.  These  functions  resided  in  the 
brain,  as  the  organ  of  intelligence  and  the  soiirce  of 
all  spontaneous  action.     From  it  the  motor  nerves 


transmitted  to  the  muscles  the  commands  of  the 
will,  while  the  sensitive  nerves  brought  to  it  from 
without  the  impressions  made  on  the  integument. 
The  spinal  cord  was  part  of  this  apparatus  of  trans- 
mission. Like  the  sjjinal  nen'e-roots,  under  the  in- 
fluence of  galvanism,  its  posterior  columns  were 
found  to  be  sensitive  and  its  anterior  columns  ex- 
citable ;  and  its  complete  division  at  any  one  point 
abolished  voluntary  movement  and  sensation  in  the 
parts  belov;.  It  was  the  channel  through  which  the 
spinal  nerves  held  their  connection  with  the  brain. 

But  Hall  observed  that,  notwithstanding  the  loss 
of  sensation  and  volition  after  removal  of  the  brain, 
the  animal  might  still  be  capable  of  motion  in  the 
limbs,  provided  the  spinal  cord  remained.  Althoiigh 
phenomena  of  this  kind  had  already  been  noticed  in 
several  instances,  they  had  not  been  demonstrated  ~ 
with  sulKcient  distinctness  to  fix  the  attention  of 
physiologists.  Hall's  observations  were  first  an- 
nounced in  a  communication  to  the  London  Zoolog- 
ical Society  in  1832.  They  were  further  embodied  in 
his  "Lectures  on  the  Nervous  System  and  its  Dis- 
eases" in  1836,  and  still  more  formally  presented  in 
his  " Memoirs  on  the  Xer\ous  System "  in  1837. 
Their  simjjlest  demonstration  was  given  by  him  in  the 
following  way  :  in  a  living  and  uninjured  frog  the 
signs  of  sensation  and  volition  are  manifested  when- 
ever the  skin  is  irritated  at  any  point,  since  the  ani- 
mal feels  the  impression  and  responds  to  it  by  a  vol- 
untary motion.  When  the  head  is  cut  oiT,  or  the  spinal 
cord  is  divided  at  its  upper  jiart,  the  limbs  are  para- 
lyzed and  sensation  is  abolished.  But  if,  whOe  the 
animal  is  in  this  condition,  one  of  the  feet  be 
pinched,  the  limb  is  drawn  upward  ;  and  the  move- 
ment may  be  repeated  as  often  as  the  irritation  is 
applied.  Such  a  movement  is  veiy  different  from 
that  caused  by  galvanizing  a  motor  nerve,  since  the 
stimulus  in  this  instance  is  applied  to  the  skin,  and 
the  muscles  react  in  consequence.  Both  skin  and 
muscles  must  retain  their  connection  with  the  spinal 
cord,  since  if  this  connection  be  cut  off,  no  move- 
ment takes  place  on  pinching  the  foot.  Finally,  the 
nerves  remaining  uninjured,  if  the  spinal  cord  be 
broken  up,  all  reaction  ceases,  and  irritatiim  of  the 
skin  has  no  further  effect.  But  does  not  such  a  vio- 
lence destroy  the  physiological  pro2:)erty  of  the  mus- 
cles, and  in  that  way  prevent  their  contraction  ? 
This  doubt  is  removed  by  applying  a  galvanic  cur- 
rent to  the  muscles  themselves,  when  they  are  at 
once  convulsed,  showing  that  their  contractile  power 
is  unimpaired.'" 

Thus,  it  is  the  spinal  cord  which  acts,  indepen- 
dently of  the  brain,  as  a  medium  of  communication 
betw-een  the  integument  and  the  muscles.  The 
stimulus  conveyed  inward,  through  the  sensitive 
nerves  to  the  cord,  is  thence  reflected  outward 
through  the  motor  nerves  to  the  muscles.  From 
this  circumstance  it  received  its  name  of  "  reflex 
action  ; "  and  since  it  was  first  studied  and  demon- 
strated in  the  spinal  cord,  it  was  generally  known  as 
the  "  reflex  action  of  the  s])inal  cord." 

But  the  same  form  of  activity  was  afterward  found 
to  bo  vei-y  widely  extended  in  the  nervous  system. 
Tlie  medulla  oblongata  has  its  own  centres  of  reflex 
action,  either  directly  or  indirectly  essential  to  the 
continuance  of  life.  Wherever  there  is  a  ganglionic 
mass  of  nervous  matter,  with  motor  and  sensitive 
fibres  originating  from  it,  there  is  a  similar  focus  of 
nervous  power,  often  quite  disconnected  with  con- 
sciousness and  volition.      In  a  state  of  aKsolute  in- 


Urtndbuoh  dcr  IMiyRiologicdwH  .Mt? 


iiuiitt  I.,  |),  t 


THE   MEDICAL  RECORD. 


91 


sensibility,  in  man  or  animals,  a  touch  upon  the 
cornea  will  cause  closure  of  the  eyelids,  irritation 
of  the  amis  will  increase  the  contraction  of  the 
sphincter,  and  the  contact  of  a  solid  body  with  the 
fauces  will  excite  the  movement  of  deglutition  ;  and 
in  all  these  instances  tiie  reaction  disappears  when 
its  special  nervous  centre  is  destroyed.  Similar 
facts  were  soon  observed  in  man  in  cases  of  paraly- 
sis, as  where  movements  are  produced  in  paraplegic 
limbs  without  the  knowledge  of  the  patient ;  and 
nearly  all  the  phenomena  of  convulsive  aflections 
were  seen  to  have  their  origin  in  some  unusual  im- 
tation  of  a  nervous  centre,  or  in  the  morbid  exag- 
geration of  its  excitability.  From  that  time  forward 
the  reflex  action  of  the  nervous  system  entered  more 
or  less  into  the  whole  study  of  its  normal  and  dis- 
eased conditions. 

The  next  topic  of  special  interest  in  this  connec- 
tion is  the  influence  of  the  nervous  system  on  the  or- 
gans of  circulation.  The  earlier  approach  to  definite 
knowledge  on  this  .subject  was  a  very  slow  one.  It 
consisted  mainly  in  establishing  the  fact  of  con- 
tractility in  the  arteries,  and  was  accomplished  by 
experimental  inquiries  extending  over  a  long  time — 
from  those  of  Hunter,  on  the  arteries  of  animals,  in 
1703,  to  those  of  K'illiker,"  in  1849,  on  the  constric- 
tion caused  by  galvanism  in  the  popliteal  and  tibial 
arteries  of  an  amputated  human  limb.  A  new  epoch 
in  the  physiology  of  the  circulation  was  reached  in 
1S.51,  when  Claude  Bernard  '"'  published  the  discov- 
ery that  division  of  the  sympathetic  nerve  in  the 
neck  is  followed  by  enlargement  of  the  blood-vessels 
on  the  corresponding  side  of  the  head.  This  effect 
was  so  striking  and  so  constant,  that  when  once  an- 
nounced there  was  no  difficulty  in  its  verification 
and  no  doubt  as  to  its  reality.  Almost  immediately 
after  the  section  of  the  nerve,  an  increased  vascu- 
larity becomes  visible  in  the  conjunctiva,  the  mucous 
membrane  of  the  nostril,  liii.  tongue,  and  cheek,  and 
in  all  parts  of  the  skin  on  the  afl'ected  side.  It  is 
most  distinctly  seen  in  the  ear  of  the  white  rabbit, 
because  the  organ  presents  a  thin  expansion  of 
semi-transparent  tissue,  convenient  for  observation, 
and  because  the  two  ears  placed  side  by  side  afford 
a  ready  criterion  of  any  change  in  vascularity.  (In 
the  first  report  of  these  experiments,  the  attention 
of  the  observer  was  principally  directed  to  the  local 
increase  of  temperature  which  also  follows  division  of 
the  sympathetic  ;  but  this  was  afterward  seen  to  de- 
pend on  the  gi'eater  activity  of  the  circulation,  which 
was  then  recoarnized  as  the  primary  and  character- 
istic result  of  the  operation.) 

This  fact,  of  enlargement  of  the  blood-vessels  ft-om 
division  of  the  sympathetic  ner%'e,  at  once  excited  a 
lively  interest  among  physiologists.  Hardly  a  year 
had  elapsed  when  a  second  observation,  equally  im- 
portant witli  the  first,  was  made  almost  simulta- 
neously bv  Brown-Sequard  in  Philadelphia,"  Ber- 
nard in  Paris, i'  and  Waller  in  London,  "  namely, 
that  the  condition  of  the  circulation  on  that  side  of 
the  head  where  the  sympathetic  has  been  divided 
mav  be  regulated  at  will  by  experimental  means. 
Suppose  that  increased  vascularity  has  been  pro- 
duced bv  division  of  the  sympathetic  in  the  neck  : 
if  the  stimulus  of  galvanism  be  now  applied  to  the 

••  Zeitschrift  fur  Wissenschaftliche  Zoologie.  Band  I.,  p.  2  iJ.  Leip- 
zifr,  1849. 

'^  Comptes  Rendua  de  la  Soci6t«  de  Biologic,  tome  iii.,  p.  I(j3.  Pane, 
ann6e  1851. 

'3  Philadelphia  Medical  Examiner,  vol.  viii,,  p.  4Si).   1852. 

'<  Comptes  Reudus  de  la  Soci6t6  de  Biologic,  tome  iv.,  p.  168.  Paris, 
18.i2. 


divided  nerve,  above  its  point  of  section,  all  the  pre- 
vious results  of  the  operation  disappear.  The 
blood-vessels  contract,  the  volume  of  the  circulation 
diminishes,  the  local  temperature  is  reduced,  and 
the  parts  resume  their  normal  color,  or  even  become 
more  pallid  than  before.  "When  the  galvanization 
is  suspended,  the  former  conditions  return,  with  all 
the  accompanying  jjhenomeiia  of  vascularity,  tem- 
perature and  redness,  and  the  circulation  in  the  part 
may  be  in  this  way  alternately  increased  and  dimin- 
ished for  many  successive  repetitions  of  the  experi- 
ment. 

It  thus  appears  that  the  muscular  coat  of  the 
arteries,  supplied  with  nerve-fibres  from  the  sym- 
pathetic, is  influenced  by  them  in  nearly  the  same 
way  as  the  voluntary  muscles  are'  controlled  by  the 
cerebro-sijinal  nerves.  Division  of  the  sympathetic 
paralyzes  the  involuntary  muscular  fibies,  relaxes 
the  arterial  walls,  and  allows  a  larger  quantity  of 
blood  to  pass  through  the  vessels  of  the  part.  Gal- 
vanization of  the  nerve,  on  the  other  hand,  stimulates 
the  muscular  fibres  to  contraction,  narrows  the 
calibre  of  the  vessels,  and  so  reduces  the  volume  of 
the  circulating  blood.  The  knowledge  of  these  facts 
introduced  into  the  nomenclature  of  the  nervous  sys- 
tem a  new  title.  There  were  evidently  nerve-fibres 
which  acted  ujjou  the  blood-vessels  to  call  into  opera- 
tion their  contractile  power;  and  the  nerves  possess- 
ing such  a  function,  then  known  for  the  first  time, 
naturally  received  the  name  of  the  "vaso-motor 
nerves." 

But,  in  following  out  this  subject,  another  observa- 
tion was  soon  met  with  of  very  unexpected  charac- 
ter, namely,  that  certain  nerves,  on  being  stimulated, 
instead  of  producing  contraction  of  the  blood-vessels, 
caused  their  relaxation  and  thus  increased  the  activity 
of  the  circulation.  This  was  first  shown  by  Bernard 
in  the  case  of  the  submaxillary  gland.  This  organ 
is  supplied  with  sympathetic  fibres  from  the  superior 
cervical  ganglion  and  the  carotid  plexus,  and  with 
cerebro-spinal  fibres  fi-om  the  lingual  nerve  and  the 
chorda  tympani.  Galvanization  of  its  sympathetic 
filaments  produces,  as  in  other  similar  instances, 
contraction  of  the  blood-vessels  and  a  diminished 
blood-supply.  But  if  the  stimulus  be  aj^plied  to  the 
lingual  nerve  above  the  situation  of  the  gland,  or  to 
the  chorda  tympani  which  unites  with  it,  the  result 
is  exactly  the  contrary.  The  blood-vessels  enlarge 
and  the  circulation  is  more  active  so  long  as  the 
galvanization  continues,  and  this  efl'ect  is  equally 
marked  if  the  nerve  be  divided  and  galvanized  be- 
tween its  point  of  section  and  the  gland. 

A  similar  influence  was  found  to  reside  in  other 
parts  of  the  nervous  system  and  the  nerves  pos- 
sessing the  power  of  thus  causing  vascular  enlarge- 
ment were  called  "  dilator  nerves."  No  sooner  was 
this  fact  established  in  a  general  way,  than  it  served 
to  explain  a  singular  phenomenon  which  had  been 
noticed  many  years  before,  Vmt  which  had  thus  far 
been  regarded  as  exceptional — namely,  the  influence 
of  the  pneumogastric  nerve  on  the  action  of  the 
heart.  As  a  general  rule,  if  the  nerve  going  to  a. 
muscular  organ  be  divided,  the  muscle  is  paralyzed, 
and  if  the  nerve  be  stimulated,  there  is  a  muscular 
contraction.  As  the  heart  receives  filaments  from 
the  pneumogastric  nerve,  we  should  naturally  ex- 
pect that  its  action  would  be  diminished  liy  section 
of  this  nerve,  and  increased  by  its  stimulation.  But 
the  effect  is  really  the  reverse.  If  the  i^oles  of  a 
galvanic  apparatus  be  applied  to  the  pneumogastric 
nerve  in  the  neck,  the  cardiac  pulsations  are  reduced 
in  frequency,  and  when  the  strength  of  the  current 


92 


THE  MEDICAL  RECORD. 


is  increased  to  a  certain  degree,  they  stop  altogether. 
The  heart  lies  quiescent,  in  a  state  of  relaxation,  its 
movements  remaining  in  abeyance  while  the  galvan- 
ization is  going  on,  and  when  it  is  suspended  they 
recommence  with  undiminished  energy.  The  inilu- 
ence  exerted  in  this  case  is  not  reflex,  but  direct  in 
its  operation ;  for,  if  the  nerve  be  divided  and  gal- 
vanized above  its  point  of  section,  there  is  no  result ; 
but  if  the  stimulus  be  apijlied  below  the  section,  its 
retarding  action  on  the  heart  is  at  once  manifest. 
Furthermore,  the  power  of  this  nerve  to  restrain  the 
cardiac  movements,  like  the  motor  influence  of  a 
spinal  nerve,  is  limited  in  duration.  You  cannot 
permanently  arrest  the  heart,  and  so  kill  the  animal, 
by  continued  galvanization  of  the  pneumogastric. 
When  the  galvanization  of  the  nerve  has  been  kept 
up  tor  a  certain  time,  the  heart  begins  to  beat  again. 
Its  pulsations  recur  at  first  slowly,  afterward  more 
frequently,  and  at  last  they  are  restored  in  full  regu- 
larity, notwithstanding  the  continuance  of  the  gal- 
vanic current.  The  nerve  has  lost  its  power  by  ex- 
haustion, and  cannot  again  manifest  its  controlling 
force  unless  allowed  to  recover  by  repose.  But  the 
heart  is  still  sensitive  to  the  same  influence,  and  if 
the  electrodes  be  shifted  to  the  pneumogastric  of 
the  opposite  side,  it  stops  as  quickly  as  before. 

It  must  be  admitted,  therefore,  that  the  influence 
of  the  pneumogastric,  whatever  it  may  be,  which 
controls  the  heart's  movement,  is  transmitted  from 
within  outward  to  the  peripheral  extremities  of  the 
nerve,  and  that  it  acts  in  a  positive  manner,  though 
producing  a  negative  result.  It  is  the  most  striking 
illusti-ation  of  a  kind  of  action  in  the  nervous  sys- 
tem unlike  any  of  those  formerly  known,  but  not 
the  less  real  for  being  difiicult  to  understand.  This 
is  the  so-called  "  action  of  arrest,"  an  influence 
which  passes  through  a  nerve  from  its  origin  to  a 
muscle,  and  by  which  the  muscular  contraction  is 
suspended.  As  often  happens  in  such  cases,  when 
the  existence  of  this  mode  of  action  was  once  real- 
ized, it  appeared  that  there  were  other  instances  of 
the  same  thing  which  had  been  overlooked.  All 
the  sphincter  muscles,  though  habitually  in  a  state 
of  involuntary  contraction,  are  suddenly  relaxed  at 
certain  periods  by  an  influence  coming  from  within. 
The  blood-vessels  generally  receive  both  kinds  of 
nervous  imjjression,  and  by  the  varying  preponder- 
ance of  one  or  the  other  they  are  alternately  made 
to  contract  or  dilate,  with  all  the  accompanying 
changes  of  local  circulation.  In  this  way  it  became 
possible  to  explain  the  mechanism  of  temporary 
physiological  congestions,  as  in  secreting  glands,  or 
in  the  alimentary  canal  during  digestion  ;  and  those 
of  longer  continuance  with  increased  nutrition,  like 
the  growth  of  the  uterus  and  mainmai-y  glands  dur- 
ing pregnancy,  as  well  as  morbid  disturbances  of 
the  circulation  in  disease. 

Quite  a  different  line  of  investigation  was  inaugu- 
rated by  Helmholtz,  in  1851,  for  determining  the 
rapidity  with  which  ner\-ous  action  is  transmitted 
througli  tlio  motor  nerves.  "  The  idea  of  measuring, 
■with  any  approach  to  numerical  jirecision,  tlie  move- 
ment of  the  intangible  nerve-force  throngh  its  fibres, 
would  seem  at  lirst  almost  beyond  the  scope  of 
reality,  and  yet  it  was  accomplished  with  satisfac- 
tory success,  and  by  perfectly  genuine  exjjerimental 
methods.  It  would  have  been  impossible,  were  it 
not  for  improvements  in  the  galvanic  apparatus  and 
the  registering  machines,  which  have  played  so  im- 
portant a  part  in  tlie  more  recent  investigation  of 

'"  Uoinntcs  Hcndus  do  I'Acnd^inie  dCH  .Scioiicc.h,  tonio  xxxiii  ,  p  'Jr,? 
Paria,  ItSl. 


animal  physics.  The  knowledge  and  use  of  induced 
electric  currents  we  owe  to  Faraday,  and  their  dis- 
covery in  1831,  with  all  the  related  phenomena  of 
electro-magnetism,  magneto-electricity,  and  the  pro- 
duction of  instantaneous  and  rapidly  alternating  op- 
posite currents,  practically  revolutionized  the  use 
of  electricity  for  medical  purposes.  It  also  supplied 
especial  facilities  for  experiments  on  the  rate  of 
transmission  of  the  nei-ve-force. 

The  conditions  necessary  for  such  an  experiment 
were  two-fold.  First,  an  instantaneous  induced  cur- 
rent, for  causing  a  single  muscular  spasm ;  and 
secondly,  an  automatic  registering  ajjparatus,  which 
should  mark  the  exact  time,  both  of  the  electric 
stimulus  and  of  the  muscular  action.  By  this  means 
a  definite  result  was  obtained.  With  the  electrodes 
applied  to  the  mu.scles  of  a  frog's  leg,  an  interval, 
amounting  to  the  one-htmdredth  jiart  of  a  second, 
appeared  between  the  closure  of  the  circuit  and  the 
contraction  of  the  muscle.  The  muscular  contrac- 
tion, therefore,  was  not  an  instantaneous  efl'ect,  but 
required  a  certain  time  to  get  under  way  after  the 
application  of  the  stimulus.  This  interval  was  not 
perceptibly  altered  on  applying  the  electrodes  to  the 
ners'e  at  or  near  its  entrance  into  the  muscle.  But 
if  they  were  applied  higher  u])  on  the  nervous  tinink, 
the  delay  became  longer ;  and  it  was  increased,  in 
subsequent  trials,  exactly  in  proportion  to  the  dis- 
tance between  the  muscle  and  the  point  of  nerve- 
stimulation.  It  represented,  accordingly,  the  time 
required  for  the  nerve-force  to  traverse  a  given 
length  of  nerve-fibre,  and,  by  repeating  the  test 
under  various  conditions,  its  I'ate  of  movement  was 
fairly  determined. 

These  experiments,  first  performed  on  the  nerves 
and  muscles  of  the  separated  fiog's  leg,  were  after- 
ward extended  to  those  of  the  living  man,  the  elec- 
tric stimulus  being  apjdied  to  the  skin  over  the 
situation  of  a  nerve  at  different  j5oints,  and  the  con- 
traction indicated  by  the  swelling  of  the  i^arts  over 
the  muscle.  In  all  the  investigations  thus  far,  the 
nerve  was  excited  by  the  ai'tificial  stimulus  of  electric- 
ity. Subsequently,  Burckhardt"  simplified  the  ex- 
periment and  increased  the  value  of  its  results,  by  em- 
ploying, instead  of  electricity,  the  natural  stimulus 
of  volition.  The  subject  being  placed  in  connection 
with  a  proper  registeiing  apparatus,  the  signal  for 
voluntary  effort  was  given  by  the  sound  of  a  bell, 
and  the  movement  was  performed  in  different  in- 
stances by  different  muscles.  XTnder  these  condi- 
tions, the  time  necessary,  both  for  volition  and  for 
the  mechanism  of  muscular  contraction,  would  be 
the  same  in  all  cases  ;  but  that  required  for  travers- 
ing the  motor  nerve  would  vary  according  to  the 
muscle  employed.  A  voluntary  impulse,  starting 
from  the  brain,  would  arrive  at  tlie  deltoid  muscle 
after  travelling  a  certain  distance,  Imt  it  would  fol- 
low a  longer  route  to  reach  the  adductor  of  the 
thumb.  The  disti-ibution  of  the  crural  nerve  to  the 
quadricejjs  extensor  muscle  is  comparatively  remote 
from  its  origin,  and  that  of  the  sciatic  nerve  to  the 
dorsal  muscles  of  the  foot  more  distant  still.  The 
difference  in  the  time  of  muscular  contraction  ob- 
served in  these  cases  corresponded  Y-ith  the  differ- 
ent lengths  of  nerve  conveying  the  stimulus,  and  it 
gave  for  the  ])assage  of  the  voluntary  impulse  in 
man  through  the  motor  nerves  an  average  rate  of 
twenty-seven  metres  per  second. 

A  similar  contrivance  for  measuring  the  trans- 
mission of  tactile  impressions  through  the  sensitive 

T  N'orveiikriuikht'iton,  p.  12.  Leip- 


THE  MEDICAL  RECORD. 


93 


nerves  gave  their  rate  of  movement  as  forty-seven 
metres  per  second,  showing  a  greater  i-apidity  of 
transmission  for  sensitive  impressions  than  for  motor 
impulses;  and  by  comparing  the  result  of  fiu-ther 
experiments  with  the  known  quantities  obtained  in 
this  way,  a  close  estimate  was  reached  of  the  time 
needed  for  the  operation  of  the  diflerent  senses,  and 
even  for  the  cerebral  acts  of  perception  and  will. 

When  these  observations  were  made  on  diflerent 
persons,  there  was  always  a  certain  amount  of  vari- 
ation in  the  result,  the  nervous  action  being  in  some 
cases  more  rapid,  in  others  comi^aratively  slow. 
This  brought  within  the  range  of  definite  physiologi- 
cal experiment  a  fact  first  noticed  in  astronomical 
observatories,  namely,  that  two  observers,  both  watch- 
ing for  the  same  event,  seldom  see  and  record  it  at  the 
same  time.  There  is  a  difference  in  the  quickness 
with  which  they  receive  its  impression  on  the  senses, 
and  in  each  case  there  is  a  certain  amount  of  delay, 
so  that  in  neither  the  one  nor  the  other  is  the  phe- 
nomenon perceived  at  the  time  of  its  actual  occur- 
rence. In  astronomical  oijerations  where  extreme 
acc.ui"acy  is  required,  as  in  transit  observations  for 
the  determination  of  longitude,  this  personal  imper- 
fection of  the  observer  needs  to  be  corrected  from  a 
previous  examination  of  his  habitual  error.  In  the 
rejjort  of  the  United  States  Geograjihical  Surveys 
for  1877,  it  is  stated  by  Dr.  Kampf  that  the  personal 
error  from  this  source  varies  somewhat  in  tbe  same 
individual  from  day  to  day,  so  that  its  amovmt  shoiild 
be  ascertained,  and  the  proper  correction  made  for 
each  person,  whenever  a  longitude  observation  is  to 
be  taken. 

Tiiere  is  still  another  point  of  interest  in  connec- 
tion with  the  modern  study  of  the  nervous  system, 
namely,  the  localization  of  function  in  different  re- 
gions of  the  brain. 

The  most  striking  part  of  this  subject  relates  to 
the  special  centres  for  motion  and  sensation  in  the 
cerebral  convolutions.  There  are  few  discoveries 
which  have  seemed  more  at  variance  with  our  for- 
mer convictions  than  that  of  the  existence  of  these 
centres.  Both  the  substance  and  the  surface  of  the 
cerebrum  had  often  been  subjected  to  exijerimental 
examination,  both  in  the  living  and  the  recently 
killed  animal,  without  showing  any  signs  of  muscu- 
lar reaction,  and  it  was  the  universal  belief  among 
physiologists  that  none  of  its  parts  were  directly 
subservient  to  any  form  of  motion  or  sensibility. 
So  industrious  and  skilful  an  observer  as  Longet  "* 
declared  in  1869  that  he  had  "irritated  by  mechan- 
ical means  the  white  substance  of  the  hemispheres 
in  dogs,  cats,  rabbits,  and  birds,  and  had  stimulated 
it  by  the  application  of  potassa,  nitric  acid,  or  the 
actual  cautery,  as  well  as  by  the  passage  of  electric 
currents  in  various  directions,  withoait  ever  bringing 
into  play  tiie  involuntary  muscular  contractility  or 
convulsive  movements,  and  similar  applications  to 
the  gray  substance  of  the  convolutions  were  equally 
without  effect." 

Those  failures  made  it  seem  hopeless  to  antici- 
pate any  further  result  from  direct  exploration  of 
the  cerebral  substance.  The  brain  was  generally  re- 
garded as  so  exclusively  the  organ  of  intelligence, 
that  it  could  not  be  expected  to  respond  to  the  irri- 
tation of  physical  agencies.  In  the  extremely  con- 
densed and  valuable  work  of  Ecker  on  the  convolu- 
tions of  the  brain,  the  author  says  in  his  jireface 
that  "the  accurate  observation  of  patients  by  their 
physicians,  in  connection  with  careful  autopsies,  is 

^*'  Traitfi  dc  Physiologie,  tome  iii.,  p.  146.  3me  Mition,  Paris,  1869. 


the  only  means  by  which  we  can  ever  hope  to  learn 
the  physiological  significance  of  particular  cerebral 
convolutions." 

This  preface  was  dated  March,  1869,  and  in  1870 
Fritsch  and  Hitzig  "  discovered,  by  experiments  with 
galvanism  on  the  dog's  brain,  that  there  are  certain 
pai'ts  of  the  cerebral  convolutions  where  this  stim- 
ulus always  produces  definite  and  unmistakable 
movements  on  the  opposite  side  of  the  body.  The 
contraction  of  certain  groufis  of  muscles,  and  conse- 
quently particular  movements  in  the  trunk  or  limbs, 
are  connected  with  the  stimulation  of  particular 
points  of  the  brain,  and  when  such  a  point  is  once 
found,  the  corresponding  movement  may  be  reiJio- 
duced  at  will  by  repeating  the  application  of  11  o 
stimulus.  There  is  plainly,  in  some  way  or  other,  a 
communication  through  definite  nervous  routes 
from  the  sjiecial  centre  of  motion  on  the  surface  of 
the  hemisphere  to  the  motor  tract  in  the  medulla 
and  spinal  cord,  and  thence  to  the  muscle  which 
performs  the  contraction.  In  all  the  animals  used 
for  experiment  these  centres  are  grouped  in  certain 
regions,  while  other  portions  of  the  cerebral  surface 
show  no  similar  indications;  and,  by  comj^aring 
their  position  in  different  species,  aided  by  ob- 
servations in  human  i^athology,  it  appears  that  in 
man  the  motor  centres  for  the  body  and  limbs  of 
the  opposite  side  are  mainly  located  in  the  anterior 
and  posterior  central  convolutions  immediately  bor- 
dering on  the  fissure  of  Eolando. 

Thus,  the  earlier  failures  and  the  more  recent  suc- 
cess in  the  discovery  of  the  motor  centres  are  both 
explained.  It  is  true  that  a  large  part  of  the  cerebral 
surface  is  unexcitable  by  artificial  means.  You  may 
apply  the  galvanic  electrodes  to  twenty  different 
points  of  the  convolutions  without  the  least  sign  of 
a  miiscular  conti-action,  but  on  the  twenty-first  trial 
you  may  strike  one  of  these  centres,  and  then  the 
muscular  spasm  immediately  follows.  We  are  now 
so  well  acquainted  with  theii-  probable  location  in 
any  particular  brain,  that  we  need  not  lose  a  great 
deal  of  time  in  finding  one  of  them ;  but,  before  the 
geography  of  their  distribution  was  known,  it  is 
not  surprising  that  experimenters  should  have  over- 
looked their  existence. 

The  account  given  of  their  discoveries  by  Fritsch 
and  Hitzig  was  exceedingly  well  expressed,  and 
bore  internal  evidence  of  its  faithfulness  of  descrip- 
tion. All  the  details  of  exjierimental  procedure 
were  fully  explained,  and  the  results  were  stated  in 
such  a  way  that  other  observers  could  easUy  follow 
in  the  same  direction  and  test  their  reality.  Some 
doubt  has  been  entertained  in  various  quarters  as  to 
the  interpretation  of  the  phenomena,  and  particu- 
larly how  far  the  muscular  contractions  might  be 
due  to  a  diffusion  of  the  galvanic  current  beyond  the 
limits  of  its  immediate  locality.  But  this  doubt 
was  removed  after  repeating  the  experiments  by  a 
variety  of  methods,  and  the  distance  of  the  motor 
centres  was  corroborated  by  subsequent  discoveries 
in  the  minute  anatomy  of  the  part.s,  and  by  observa- 
tions on  the  local  alteration  of  structure  in  cases  of 
hemiplegia.  The  subject  is  still  so  new,  and  in  so 
active  a  condition  of  development,  that  it  can  hardly 
be  presented  in  the  form  of  a  comjalete  or  well  de- 
fined physiological  doctrine.  But  it  is  evidently  a 
matter  of  gi'eat  importance,  and  is  probably  receiv- 
ing at  this  time  a  larger  share  of  attention  than  any 
other  single  topic  relating  to  the  nervous  system. 

Its  latest  extension  is  connected  with  the  centres 


94 


THE  MEDICAL  RECORD. 


of  sensation  in  the  cerebral  hemispheres.  As  some 
parts  of  the  convoluted  surface  of  the  brain  are 
plainly  subservient  to  mviscuiar  action,  it  is  natural 
to  infer  that  the  remaining  unexcitable  portions  may 
have  a  similar  connection  with  the  power  of  sensi- 
bility ;  and  it  is  asserted  by  some,  with  more  or  less 
confidence,  that  the  senses  of  touch,  taste,  smell, 
sight,  and  hearing  are  sejiarately  located  in  as  many 
different  regions  of  the  cerebral  cortex.  The  experi- 
mental evidence  of  these  localizations  is  far  from 
being  altogether  satisfactory  ;  but  in  one  instance  at 
least  it  is  very  striking,  and  indicates  beyond  doubt 
a  close  relation  of  visual  sensibility  with  the  "  angu- 
lar convolution "'  on  the  posterior  and  lateral  part  of 
the  cerebral  hemisphere.  If  this  convolution  be  ex- 
tirpated, the  operation  is  followed  by  blindness  of 
the  opposite  eye,  without  any  other  perceptible  dis- 
turbance of  either  motion  or  sensibility.  As  other 
parts  of  the  brain-surt'ace,  of  equal  or  greater  extent, 
may  be  removed  without  causing  impairment  of 
vision,  it  is  difficult  to  avoid  the  conclusion  that 
this  region  has  a  special  connection  with  the  sense 
of  sight.  The  exact  nature  of  the  connection  will 
doubtless  be  better  understood  from  further  inves- 
tigation. 

The  complete  history  of  physiological  science  for 
the  last  hundred  years,  in  regard  to  the  nervous  sys- 
tem, can  hardly  be  given  in  the  space  of  a  single 
lecture.  But  its  most  important  advances  are  so 
connected  with  each  other,  that  they  have  a  relation 
very  much  like  that  of  cause  and  effect.  When  a 
new  subject  of  inquiry  is  first  opened,  the  progress 
for  some  time  is  a  slow  one.  There  are  difliculties 
in  the  way  which  must  be  overcome  by  repeated  ex- 
periments, by  gradual  improvement  in  the  appa- 
ratus, and  by  better  methods  of  procedure.  The 
causes  of  the  phenomena  are  imperfectly  under- 
stood, and  their  relation  with  other  observed  facts 
is  not  immediately  apparent.  But  when  the  knowl- 
edge acquired  has  reached  a  certain  point,  its  ad- 
vance becomes  more  rapid.  Every  addition  enlarges 
the  circle  of  its  operations,  and  enables  it  to  execute 
them  with  gi-eater  facility.  And  the  resiilts  attained 
by  this  means  are  not  always  those  most  directly 
anticipated.  One  discovery  often  leads  to  another, 
by  bringing  Into  view  incidental  facts,  which,  in  turn, 
become  the  sources  of  new  information,  and  in  that 
way  it  creates  opportunities  for  future  progress 
which  are  sometimes  realized  in  their  fullest  extent 
only  after  an  interval  of  several  generations. 

There  is  no  more  interesting  department  of  physi- 
ological study  at  the  present  day  than  that  of  the 
vaso-motor  norvons  system.  Since  it  was  first  prac- 
tically inaugurated  by  Bernard,  thirty  years  ago,  it 
has  been  cultivated  by  many  observers,  and  has  re- 
ceived a  wide  extension  in  many  directions.  It 
touches  on  mo.st  important  points  of  pathology,  as 
well  as  the  functions  of  liealtli.  The  connection 
between  secretion  and  blood-sujiply,  tlic  mechanism 
of  congestions,  the  dependence  of  external  disturb- 
ances of  the  circulation  on  disease  of  internal  parts, 
the  red  cheeks  of  pneumonia,  the  hectic  of  pulmo- 
nary phthisis,  and  the  existence  of  nervous  centres 
in  the  corebro  spinal  system  where  these  changes 
are  controlled  by  reflex  action,  are  all  made  capable 
of  investigation  by  knowledge  which  has  been  de- 
rived from  this  source.  But  how  could  their  study 
have  been  even  attempted  unless  we  were  already 
in  possession  of  the  simpler  facts  of  reflex  action  of 
the  spinal  cord,  and  the  different  behavior  of  motor 
and  sensitive  nerve  filiros?  All  tlie  variations  in  the 
effrtct.   produced   by  electric   stimulus   of  different 


kinds  and  intensity,  the  comparative  influence  of 
direct  and  inverse  currents,  the  exhaustion  of  nerves 
by  continued  stimulation,  and  their  recovery  by  re- 
pose, together  with  many  other  similar  conditions, 
were  indispensable  stages  in  the  progi'ess  of  discov- 
ery, and  were  the  fruit  of  many  intermediate  inves- 
tigations. But  each  series  depended,  for  the  pos- 
sibility of  its  existence,  on  another  which  had  gone 
before  ;  and  they  all  had  their  origin,  in  a  continu- 
ous line  of  descent,  from  the  experiments  of  1789, 
in  Galvani's  laboratory  at  Bologna. 


©rigtnal  Communications. 


SOIVIE     CASES     OF    GOITRE    RECENTLY 
TREATED   BY   EXCISION. 

By  JOHN  A.   WYETH,   M.D., 


BFBGEON   TO   : 


SINAI   HOSPIT.\L, 


Case  I.* — Esther  Schwarz,  aged  twenty-two,  Aus- 
trian by  nativity,  admitted  to  Mount  Sinai  Hos- 
pital December  27,  1881,  suffering  with  caries  of 
the  dorsal  spine,  and  a  tumor  of  the  left  lobe  and 
isthmus  of  the  thyroid  gland.  The  spinal  curvature 
was  marked,  the  patient  aniemic,  and  in  a  generally 
wretched  condition.  Periodically  she  was  attacked 
with  chills,  followed  by  exhaustive  sweating.  The 
plaster  jacket  was  applied  for  the  patient's  disease, 
and,  by  constitutional  treatment,  her  condition  was 
much  improved.  ^Yhen,  in  July,  1881,  my  colleague, 
Dr.  A.  G.  Gerster,  asjurated  the  cystic  portion  of 
the  tumor,  and  injected  the  cavities  with  tincture  of 
iodine  (fifty  per  cent,  solution),  about  three  ounces  of 
reddish  fluid  were  removed,  which,  examined  micros- 
copically, was  found  to  contain  red  corpuscles,  leuco- 
cytes, and  compound  granular  corpu.scles.  The 
tumor  became  inflamed  and  (edematous,  which  ul- 
timately subsided,  leaving  it  in  the  same  condition 
as  before.  In  September,  1881,  I  proposed  to  re- 
move this  goitre  by  excision,  and,  the  patient  having 
readily  consented,  I  performed  the  operation  on  Sep- 
tember 7th. 

The  tumor  was  first  exj^osed  on  its  anterior  and 
lateral  aspects,  and  the  superior  and  inferior  thyroid 
arteries  were  tied,  and  a  ligature  en  masse  was  thrown 
around  the  isthmus  where  it  joined  the  right  lobe. 
The  balance  of  the  dis.section  was  made  by  working 
between  self-holding  Kcissar/orceps,  which  I  had 
constructed  by  a  modification  of  "  Heger's  pincettes." 
The  hemorrhage  was  astonishingly  insignificant. 
The  carotid  and  jugular  were  exposed,  and  the  tu- 
mor cut  from  the  trachea.  The  wound  was  washed 
out  with  five  per  cent,  carbolic,  sewed  up,  and  a 
drainage-tuV>e  buried  in  it,  which  only  came  out  on 
the  lower  angle.  In  all,  aboiat  twelve  ligatures  were 
affixed.  The  jjatient  recovered  witiiout  an  untoward 
symptom,  the  wound  healed  in  ten  days,  excepting 
where  the  drainage-tube  came  out,  and  the  patient 
was  discliarged,  cured,  two  months  later. 

Some  slight  dyspepsia  and  aphonia  followed  the 
operation,  but  the.se  symptoms,  which  were  due  to 
the  extent  of  the  dissection,  disappeared  at  the  end 
of  a  few  weeks. 

The  following  cases  have  been  reported  within  the 
last  year.  The  operations  were  performed  in 
Europe  : 

•  I  mil  iiuk-btud  to  Dr.  R.  M.  Cramer,  of  the  Uouso  start,  for  thU 
history.— W. 


THE  MEDICAL  RECORD. 


95 


Case  II. — Operator,  Baumgartner,  Baden-Baden. 

R.  B ,  female,  aged  twenty-two.  Tumor  ex- 
tended from  right  ear  to  manubrium,  and  on  the  left 
side  to  as  high  as  the  thyroid  cartilage.  Duration, 
six  years.  Had  been  treated  by  fi-equent  local  ap- 
plications of  iodine.  Marked  dyspmea,  especially 
at  night.  Operation  lasted  four  hours.  About  fifty 
ligitures  applied  (silk,  boiled  in  carbolic  acid). 
Healed  per  primam  int.,  excepting  lower  angle,  where 
drainage-tube  was  inserted  ;  bits  of  silk  discharged 
here  for  three  months.  No  fever  after  fourteenth 
day.  Tumor  weighed  394  grammes,  and  was  adeno- 
CTstoma. — Centralhlati  fur  Chirurgie,  No.  43,  pp.  680 
et  seq.,  1881. 

Case  III. — Operator,  Baumgartner.  S ,  fe- 
male, aged  thirty- two.  Tumor  on  right  side.  Du- 
ration, nine  years.  Had  been  treated  by  iodine 
injections.  Operation,  two  hours.  No  fever  after 
six  days.  Union  by  granulation.  Healed  in  nine 
weeks.  Weight,  135  grammes.  Follicular  hyperpla- 
sia of  right  lobe. — Ibid. 

Case  JX. — Baumgartner.     J.  M ,  aged  thirty, 

nAle.  Duration,  six  years.  Dyspncea  severe.  Tumor 
extended  behind  manubrium.  Vessels  enlarged. 
Operation,  one  and  one-half  hour.  Nine  ligatures. 
Cicatrization  complete  on  twentieth  day.  Weight, 
IGO  grammes.     Follioular  hyperplasia. — Ibid. 

Case  V.  —  Baumgartner.      B ,    female,    aged 

twenty-two.  Duration,  six  years.  Iodine  locally. 
Operation,  one  and  three-fourths  hour.  Ten  liga- 
tures. Tumor  weighed  210  gi-ammes.  Cicatrization 
complete  on  twenty-first  day. — Ibid. 

Case  VI. — Baumgartner.  Female,  aged  forty- 
four.  Duration,  since  childhood.  Operation,  three- 
fourths  of  an  houi-.  Seven  ligatures.  Healed  per 
primam.  From  seventh  day  high  fever,  swelling  of 
neck,  and  pain.  Nineteenth  day  abscess  opened. 
Cicatrization  on  the  twenty-eighth  day.  Weight, 
47.5  grammes. — Ibid. 

Case  VII. — Female,  aged  forty-five.  Tumor  very 
large.  Severe  dyspnoea.  Operation,  one  and  three- 
fourths  hour.  Nine  carbolized  sUk  ligatures. 
Healed  by  fifth  week.   Weight,  701  grammes.— /Aiof. 

Case  VIII. — Baumgartner.    C.  F -,  male,  aged 

thirteen.  Duration  of  tumor,  two  years ;  right 
side,  and  movable.  Had  been  operated  once,  which 
was  followed  by  marked  dyspnoea.  Operation,  three- 
fourths  of  an  hour.  Three  ligatures.  Weight,  80 
grammes. — Ibid. 

Case  IX. — Baumgartner.  Miss  M ,  aged  fifty- 
six.  Duration,  twelve  years.  Severe  dyspmea.  Tumor 
extended  beneath  sternum.  Operation,  one  and  one- 
fourth  hour.  Nine  ligatui-es.  Weight,  280  grammes. 
Both  lobes  remained. 

Case  X. — V.  Mosetig-Moorhof.  Female,  aged 
twenty-four.  Tumor  on  left  side  only.  Marked 
dyspncea.  Punctured,  with  escape  of  colloid  mate- 
rial ;  washed  out  with  carbolic.  Followed  by  sharp 
fever,  which  subsided,  leaving  the  tumor  in  same 
condition  as  before  Operation  not  bloody.  Sec- 
ondary venous  hemorrhage  on  seventh  day.  Ee- 
covery. — Centralblatt  far  Chirurgie,  No.  46,  p.  735, 
1881.' 

C.\SE  XI.  —Operator  same.  Female,  aged  forty-one. 
Tumor  bilateral.  Dyspncea  and  difficult  deglu- 
tition. Eighteen  ligatures.  Sudden  death  forty- 
two  hours  after  operation.  Cause  of  death,  pulmo- 
nary and  cerebral  embolism.  Mosetig-Moorhof 
thinks  that  tHrombi  from  inferior  thyroid  vein 
entered  the  pulmonic  circulation,  and  thence  to  the 
brain. — Ibid. 

Case  XII. — Operator,  same.    Patient,  female,  aged 


nineteen.  Tumor  bUateral.  Eemoved  in  two  opera- 
tions, on  account  of  shock  in  first  operation.  Little 
hemorrhage.  Section  of  recurrent  laryngeal  neces- 
sary. Eight  side  pneumonia  followed  operation. 
Soon  after  the  patient  liad  aphonia.  Three  months 
later  voice  returned  as  strong  as  ever.^ — Ibid. 

Case  XIII. —Operator,  Eichelot.  Patient,  female, 
aged  twenty-five.  Duration,  fourteen  years.  Punc- 
ture, iodine  injections,  drainage,  all  to  no  i)uri)ose. 
Intense  dyspnoea  and  dysphagia.  Eecovery  with 
aphonia.  It  was  surmised  that  both  recurrent  nerves 
had  been  divided.  Later  the  voice  was  completely 
restored.— (?o^(?«e  des  Hi'pitaux,  No.  133,  1881. 

Case  XIV. — Ojierator,  jNIonod.  Patient,  female. 
History  not  given.     Eecovery  complete. — Ibid. 

Case  XV.  —  Operator,  W.  Whitehead.  Patient, 
female,  aged  fifty-one.  Duration,  thirty  years.  Last 
five  years  had  grown  rapidly  and  caused  severe 
dyspnoea.  Tumor  removed  with  but  little  loss  of 
blood.  Was  located  on  right  side.  Eecovered  with 
aphonia  (due  to  section  of  right  recurrent  laryn- 
geal ?).  —  Medical  Eecobd,  p.  755,  December  31, 
1881 

Summari/. — Of  the  fifteen  cases  here  given,  only 
one  proved  fatal,  and  that  from  an  accident  which 
is  possible  to  every  major  surgical  operation.  So 
far  as  the  experience  of  six  surgeons  may  go,  the 
rate  of  mortality  is  not  very  high  in  an  operation 
which  has  met  with  such  great  disfavor,  and  which, 
to  put  it  mildly,  has  been  almost  universally  dis- 
coiiraged  by  surgical  writers. 

While  the  operation  is  one  of  danger,  I  think  its 
dangers  have  been  gi'eatly  exaggerated.  I  hold  it 
an  unfortunate  conservatism  .which  is  content  to  sit 
quietly  by  and  see  a  patient  choke  with  a  goitre,  or 
die  .slowly  from  the  annoyance,  discomfort,  and  ex- 
havistion  "which  it  may  and  often  does  prodiace. 

It  would  be  none  the  less  unfortunate  if,  encour- 
aged by  these  and  other  published  cases,  every  doc- 
tor become  convinced  that  he  could  safely  excise 
every^^goitre.  Alas  for  honesty  '  it  is  not  al-N\  ays  safe 
to  base  conclusions  as  to  the  safety  or  propriety  of 
an  operation  on  deductions  from  piiblished  cases. 
Such  deductions  do  not  usually  lead  to  the  full  and 
true  death-rate.  Far  from  putting  our  burning  can- 
dles under  a  measure,  we  are  too  apt  to  resers-e  this 
dark  and  quiet  shelter  for  oui-  candles  which  have 
been  snufl'ed  out. 


Is  Carbonate  of  Ammonia  a  Sttmulant?  —  Dr. 
Rutherford's  experience,  as  given  at  a  meeting  of 
the  Third  Congressional  District  Indiana  Medical 
Society,  leads  him  to  believe  that  carbonate  of 
ammonia  does  not  possess  a  stimulant  action  suf- 
ficient to  justify  what  has  been  claimed  for  it  by 
authorities.  Hence,  where  he  once  relied  upon  it 
and  alcohol  for  stimulation  in  the  crisis  of  pneumo- 
nia, he  now  resorts  to  a  combination  of  the  carbonate 
with  tincture  of  nux  vomica  and  tincture  of  digitalis, 
for  the  reason  that  nux  vomica  stimulates  the  respi- 
ratory centres,  supports  the  absorbent  powers  of 
the  stomach  wlien  they  flag,  and  in  this  way  serves 
to  prevent  nausea  and  the  accumulation  of  fluids 
which  otherwise  occur,  while  the  digitalis  adds 
strength  to  the  circulatory  system.  X'arbonate  of 
ammonia  he  uses  for  two  reasons  :  first,  because  it 
possesses,  in  a  small  degree,  stimulant  properties  ; 
second,  to  be  able  to  say,  provided  counsel  should 
be  called,  that  he  is  giving  carbonate  of  ammonia.— 
Medical  and  Surgical  Reporter. 


96 


THE  MEDICAL  RECORD. 


The  Medical  Record: 


51  iDteklg  ionrnol  of  fttclitcine  anb  Stirgtrn. 


GEORGE  F.  SHRADY,  A.M.,  M.D.,  Editor. 


PUBLISHED   BY 
WM.  WOOD  &■  CO.,  No.  27  Great  Jones  St.,  N.  Y. 

New  York,  January  28,  1882. 

THE  AMEEICAN  RED  CROSS  SOdETY. 

A  FEW  months  since,  we  noticed  the  organization  in 
this  country  of  a  branch  of  the  Red  Cross  Society  of 
Geneva,  and  stated  that  active  measures  were  being 
taken  to  secure  its  formal  recognition  by  this  Gov- 
ernment. Bills  for  such  a  purpose  are  now  before 
both  Houses  of  Congress,  and  there  does  not  appear 
to  be  any  doubt  as  to  their  speedy  passage.  In  the 
early  part  of  last  year,  Mrs.  Clara  Barton,  an  Amer- 
ican lady  who  served  on  the  field  during  the  Franco- 
Prussian  "War  of  1870-71,  under  the  auspices  of  the 
Red  Cross  Society  of  Geneva,  was  appointed  by  the 
central  commission  of  that  body  to  advocate  the  for- 
mation of  an  American  branch  for  work  nnder  that 
treaty.  The  project  was  duly  presented  to  Secre- 
tary Blaine,  and  was  heartily  indorsed  by  the  late 
President  Garfield,  but,  in  consequence  of  the  na- 
tional calamity  which  resulted  in  the  death  of  the 
latter,  no  active  movement  in  bringing  the  matter 
forward  was  made  until  within  the  last  few  days.  It 
is  now  understood  that  President  Arthur  has  given 
the  measure  his  support,  and  that  the  present  Secre- 
tary of  State  has  added  his  indorsement  thereto. 

It  is  hardly  necessary  at  this  time  to  refer  to  the 
usefulness  and  broad  humanitarianism  of  the  parent 
society.  As  is  well  known,  the  Society  of  the  Red 
Cross  was  formed  in  18G3  by  the  International  Con- 
vention at  Gsneva,  Switzerland.  At  first  the  repre- 
sentation was  limited  to  Baden,  Belgium,  Denmark, 
Holland,  Spain,  Portugal,  France,  Prussia,  Saxony, 
Wurtemburg,  and  Switzerland.  Since  tliat  period 
the  society  has  extended  its  auxiliaries  into  nearly 
every  country  in  Europe,  and,  in  fact,  the  United 
States  is  the  only  great  power  which  as  yet  lias  not 
formally  ad<7l)ted  the  articles  of  the  convention. 

This  parent  society  was  originally  organized  for 
the  purpose  of  establisliing  soldiers'  relief  societies 
in  various  countries,  under  a  common  badge,  for 
protecting,  in  time   of  war,  hospitals,   ambulances. 


hospital  stores,  and  supplies  for  the  wounded,  and 
for  maintaining  a  strict  neutrality  on  the  part  of 
belligerent  powers  toward  all  members  of  the  society 
while  in  sers'ice.  The  treaty  gave  to  the  movement 
a  thoroughly  international  character.  Indeed,  the 
purposes  and  designs  of  this  organization  are  past 
the  necessity  for  advocacy  on  the  part  of  any  human- 
itarian, and  are  beyond  the  chances  of  question  as 
regards  its  extended  utility  and  beneficent  results. 
If  there  had  been  any  doubts  on  this  score,  they 
were  especially  dispelled  by  the  labors  of  the  Red 
Cross  Society  during  the  Franco-Prussian  War. 
As  soon  as  the  war  was  declared,  the  Berlin 
Red  Cross  organizition,  numbering  nearly  two 
thousand  members,  offered  its  services,  and  distrib- 
uted squads  all  along  the  frontier.  Every  facility 
was  offered  for  transportation,  free  communication 
of  supplies  was  established,  and  prompt  and  effi- 
cient aid  made  available  at  all  times.  The  opAa- 
tions  were  candied  on  with  the  most  perfect  system, 
smd  on  a  sirfficiently  extensive  scale  to  insure  a  most 
satisfactory  working  of  details,  and  a  corresponding 
benefit  to  the  sick  and  wounded. 

At  first  it  wUl  appear  strange  indeed  that  the 
United  States,  foremost  in  all  endeavors  to  minister 
to  the  needs  of  suffering  humanity,  and  keenly  alive 
to  the  necessities  of  organized  effort  in  that  direc- 
tion, should  not  long  ago  have  entered  into  this  in- 
ternational agreement.  The  only  probable  reason 
for  the  contrary  is,  that  the  real  necessities  for  the 
same  in  possible  and  frequent  wars  has  not  been  ap- 
parent. But  Miss  Barton,  with  a  view  of  adapting 
the  purposes  of  the  organization  to  the  real  need  of 
the  nation,  has  proposed  that,  ia  addition  to  the 
care  of  the  sick  and  wounded  on  the  battle-field,  its 
benefits  shall  be  extended  toward  such  as  suffer 
from  pestilence,  famine,  or  other  wide-spread  cala- 
mities. Concerning  this  point,  Miss  Barton,  in  her 
memorial,  makes  the  following  practical  sugges- 
tions : 

"  It  may  be  further  a  part  of  the  work  of  these 
societies  in  America  to  afford  ready  succor  and  as- 
sistance to  sufferers  in  time  of  national  or  wide- 
spread calamities,  such  as  plagues,  cholera,  yellow 
fever,  and  the  like,  devastating  fires  and  floods.  The 
readiness  of  societies,  like  those  of  the  Red  Cross, 
to  extend  help  at  the  instant  of  need,  renders  the 
aid  far  more  valuable  and  efficient  than  that  gathered 
together  hastily  and  irresponsibly  in  the  bewilder- 
ment and  shock  which  always  accompany  such  ca- 
lamities. The  trained  niu-ses  and  attendants  subject 
to  the  relief  societies  in  such  cases,  would  accompany 
the  supplies  sent  and  remain  in  action  as  long  as 
needed.  Organized  in  every  State,  the  relief  socie- 
ties of  the  Red  Cross  would  be  ready  with  money, 
n\usos,  and  supplies  to  go  on  call  tg  the  immediate 
relief  of  all  who  wore  overwhelmed  by  any  sudden 
calamity.  It  is  true  that  the  (tovernment  is  always 
ready  in  these  times  of  public  need  to  furnish  trans- 


THE  MEDICAL  RECOED. 


97 


portation,  and  often  much  more.  During  the  late 
yellow  fever  epidemic  in  the  Sonth,  and  more  re- 
cently at  the  time  of  the  floods  in  Dakota,  it  ordered 
rations,  clothing,  and  tents  to  be  distributed  under 
the  direction  of  army  officers.  But  in  such  eases 
one  of  the  gi-eatest  difficulties  is  that  there  is  no 
organized  method  of  administering  the  relief  which 
the  Government  or  benevolent  citizens  are  willing  to 
bestow,  or  trained  and  acclimated  nurses  ready  to 
give  intelligent  care  to  the  sick ;  or,  if  there  is  organ- 
ization, it  is  hastily  formed  in  the  time  of  need,  and 
is  therefore  comparatively  inefficient  and  wastefiil. 
Although  the  people  of  the  United  States  may  hope 
to  be  seldom  visited  by  the  calamities  of  war,  yet 
the  misfortunes  of  other  nations  constantly  appeal  to 
their  sympathies.  And  in  this  country  the  South  is 
periodically  visited  by  the  scourge  of  yellow  fever ; 
the  valleys  of  the  Mississippi  are  subject  to  destruc- 
tive inundations  ;  the  i^lains  of  the  West  are  devas- 
tated by  drought  and  insects  ;  and  cities  and  coimtry 
ai-e  swept  by  consuming  fires.  In  all  such  cases,  to 
gather  and  dispense  the  profuse  liberality  of  the 
people,  ■without  waste  of  time  or  material,  requires 
the  wisdom  that  comes  of  experience  and  permanent 
organization.  To  secure  such  permanent  organiza- 
tion, the  American  Association  of  the  Eed  Cross  has 
been  founded." 

As  adapted  to  the  real  and  pressing  necessities  of 
this  nation  in  times  of  sudden  and  wide-spread 
calamity,  the  plan  is  admirable.  There  does  not 
appear  to  be  any  argument  against  its  speedy  and 
unqualified  adoption.  In  fact  the  passage  of  the 
bill  is  almost  a  foregone  conchision. 


THE   IODOFORM   ERA   IN   SUBGERT. 

ly  an  address,  delivered  not  long  ago,  by  Professor 
Podrazky,  before  the  Vienna  Society  of  Military  Sur- 
geons, a  new  epoch  in  the  treatment  of  surgical  dis- 
eases is  announced.  The  epoch-maker  in  this  case 
is  iodoform,  and  its  introduction  is  held  to  be  as 
great  an  advance  as  Listerism  ever  was. 

The  use  of  iodoform  in  the  treatment  of  wounds 
undoubtedly  deserves  the  careful  attention  of  sur- 
geons. The  uses  of  this  drug  in  dermatology,  syphi- 
lis, and  gynecology,  are  well  known,  and  its  vahie 
here  is  a  thing  quite  apart  from  the  recent  ap- 
plication of  it  to  surgery.  It  is  hardly  two  years 
ago  since  Mosetig  called  attention  to  the  value  of 
iodoform  in  the  treatment  of  unhealthy  wounds  with 
fungous  granulations,  of  tuberculous  and  scrofu- 
lous ulcers,  cold  abscesses,  etc.  In  the  first  part 
of  1881  he  announced  remarkable  results  from  its 
use  in  amputations,  resections,  as  ■well  as  in  various 
other  surgical  conditions.  The  new  treatment  was 
adopted  by  Billroth  in  his  clinic,  and  it  soon  spread 
to  other  hospitals.  It  has  already  been  introduced 
into  New  York,  and  is  employed  in  several  hospitals 
here. 


The  method  of  using  the  iodoform  dressing  is 
quite  simple.  The  wound  used  to  be  quite  filled 
with  the  pulverized  drug.  At  present,  however,  in- 
stead of  this,  iodoform-gauze  is  employed.  This  is 
covered  with  cotton-batting,  and  the  whole  enclosed 
and  made  air-tight  with  gutta-percha  pajier.  la 
cases  where  there  are  fistula^,  crayons  made  of  iodo- 
form and  gelatine  (one  part  to  two),  or  of  iodoform 
and  tragacanth,  are  inserted. 

•^•The  advantages  claimed  for  this  method  of  treat- 
ment are  :  that  it  is  absolutely  aseptic  ;  there  is  no 
formation  of  pus,  as  a  rule,  but  only  of  a  serous 
secretion,  such  as  is  found  under  the  Lister  dress- 
ing ;  that  it  is  simple,  cheap,  and  convenient ;  the 
bandages  can  be  left  on  eight,  fourteen,  or  even 
twenty  days,  without  harm  ;  it  is,  thinks  Podrazky, 
the  ideal  antiseptic  dressing  for  armies ;  that  no 
drainage  is  needed  ;  that  the  iodoform  has  an  ano- 
dyne efiect ;  that  it  secures,  in  fact,  all  the  advanta- 
ges of  perfect  asepsis  without  the  inconvenience, 
expense,  or  liability  to  failure,  which  belong  to  Lis- 
terism proper. 

One  inquires,  naturally,  what  are  the  evidences  to 
substantiate  such  claims.  These  cannot  be  given 
with  any  completeness.  In  a  recent  article  in  the 
Archiv/t'ir  klinische  Chirnrgie,  Dr.  Mikulicz  gives  the 
results  of  the  treatment  in  the  Vienna  General  Hos- 
pital, under  Billroth.  These  results  are  very  favora- 
ble. Three  sets  of  cases  are  given  :  one  in  which 
fresh  woimds  from  injiary  or  operation  were  treated  ; 
a  second,  including  septic,  or  gangrenous  or  diph- 
theritic wounds ;  a  third,  including  scrofulous  ulcers, 
caries,  and  necrosis  of  bones.  (The  treatment  is  not 
applicable  where  first  intention  is  desired.)  The 
total  number  of  cases  reported  is  thirty-two,  which 
represents  only  jiart  of  those  thus  treated. 

There  have  been  other  contributions  to  this  sub- 
ject, bTxt  the  tenor  of  them  has  been  to  confirm  the 
statements  first  made  by  Mosetig. 

The  physiological  action  of  iodoform  has  been  in- 
vestigated by  Binz  and  Hcigyes,  its  toxicology  by 
Oberlander,  its  antiseptic  powers  by  Mikulicz  and 
Panerth.  Iodoform,  when  applied  to  fresh  tissues, 
is  very  quickly  absorbed,  being  probably  dissolved 
in  the  fat  of  the  tissues  and  blood.  It  reappears  in 
the  urine  and  saliva  often  within  from  three  to  six 
hours.  Iodoform  is  said  to  be  in  part  decomposed 
when  applied  to  fresh  wounds.  It  contains  96.7 
per  cent,  of  its  weight  in  iodine,  and  this  is  set  free. 
In  its  nascent  condition  the  iodine  is  powerfully 
antiseptic ;  yet  iodoform  is  not  antiseptic  except 
when  it  is  constantly  supplied  directly  to  a  tissue. 
It  is  then  very  active  indeed  ;  but  wounds  must  be 
kept  well  supplied  with  it.  These  are  the  conclu- 
sions drawn  from  Mikulicz's  and  Panerth's  experi- 
ments. 

That  there  is  some  danger  connected  with  this 
mode  of  treatment  cannot  be  doubted.  Iodoform  in 
large  amounts  (gr.  xxx.-xl.  per  day)  jnoduces  toxic 


98 


THE  MEDICAL 'RECORD. 


symptoms :  headache,  muscular  twitchings,  malaise, 
vomiting,  intoxication,  and  delirium.  Persons  who 
have  been  thus  poisoned  generally  recover  in  a  week 
or  two.  Since  its  use  in  the  Vienna  Hosijital,  several 
slight  cases  of  poisoning  have  appealed,  and  one 
fatal  case.  This  last  was  that  of  a  weak  child  with  a 
cold  abscess,  in  which  forty  grammes  (I  s.)  of  iodo- 
form were  placed.  Podrazky  has,  however,  used  fifty 
grammes  upon  a  wound  after  operation,  with  no 
toxic  symptoms.  The  use  of  iodoform-gauze  lessens 
the  amount  of  the  drug  needed,  and  it  seems  prob- 
able that,  with  any  reasonable  care,  the  danger  of 
getting  toxic  effects  will  be  very  slight. 

There  are  some  individuals,  chiefly  women,  who 
have  an  idiosyncrasy  against  iodoform.  This,  it  is 
suggested,  may  be  due  in  part  to  its  disagreeable 
smell.  The  odor  of  the  drug  cannot  be  disguised 
without  effecting  some  chemical  chaage.  Pei-uvian 
balsam  is  probably  most  efficient,  but  this  addition 
is  a  stimulating  and  irritating  one.  The  essential 
oils  have  very  little  effect.  A  mixture  of  equal  parts 
of  iodoform  and  tonca  bean  is  perhaps  as  good  as 
anything.  The  Germans  speak  slightingly  of  the 
odor  as  a  thing  of  small  importance,  and,  on  the 
whole,  not  particularly  disjjleasing  to  Teutonic  nos- 
trils. The  American  patient  does  not  adapt  himself 
to  bad  smells  so  easily.  Nevertheless,  if  iodoform  is 
at  aU  what  is  claimed  for  it,  we  can  easily  forgive  its 
offence  to  the  special  senses.  It  should  be  given  a 
thorough  and  careful  trial. 


EXTBACTUM   OAKNIS   AND    UEDJE   AS   MEDICINAL  AGENTS. 

Mr.  G.  F.  Mastekman  has  by  several  analyses  shown 
that  the  ordinary  Liebig's  extract  has  veiy  much  the 
composition  of  urine,  except  that  it  contains  less 
urea  and  uric  acid.  Beef-tea,  as  ordinarily  made, 
does  not  contain,  including  alkaline  salts,  more  than 
from  1.5  to  2.25  per  cent,  of  solid  matters.  These  solids 
are  chiefly  urea,  creatine,  creatinine,  isoline,  and  de- 
composed hiematin — exactly  the  animal  constituents 
of  urine,  except  that  there  is  but  a  trace  of  urea.  Dr. 
Richard  Neale,  in  the  Practitioner,  comments  upon 
the  above  facts,  and  says  that  the  real  value  of  beef- 
tea  as  a  nutriment  is  still  not  appreciated,  especially 
among  the  laity.  Even  some  physicians  are  apt  to 
(dass  it  as  of  almost  equal  value  to  milk.  Dr.  Francis 
Sibson  has  shown  how  detrimental  beef-tea  may  be 
to  persons  who  are  suffering  from  Bright's  disease, 
whore  the  kidneys  are  already  taxed  to  their  utmost 
to  throw  off  metamorphosed  matters.  The  addition 
of  the  nitrogenous  metabolites  of  the  cow  cannot  but 
be  dangerous.  Frequently,  says  Dr.  Neale,  beef-tea 
is  recommended  by  practical  phvsiciaus  in  diar- 
rhoja,  dysentery,  and  during  diarrhoea  of  typhoid 
fever.  This  ho  considers  a  very  dangerous  practice, 
and  looks  upon  beef-tea  in  such  cases  as  little  better 
than  a  poison.  Dr.  Lauder  Brunton  is  also  quoted  as 
raising  the  question  whether  beef-tea  is  not  actually 
injurious. 


After  thus  emphasizing  the  fact  of  the  non- nutri- 
tive, but  stimulating  properties  of  beef-tea,  Dr.  Neale 
states  that  similar  properties  have  long  been  known 
as  pertaining  to  urine.  In  South  America,  urine  is 
a  common  vehicle  for  medicine,  and  the  urine  of 
little  boys  is  spoken  highly  of  as  a  stimulant  in  ma- 
lignant small-pox.  Among  the  Chinese  and  Malays 
of  Batavia,  urine  is  verj-  freely  used.  One  of  the 
worst  cases  of  epistasis  ceased  after  a  pint  of  fresh 
urine  was  drunk,  although  it  had  for  thirtyaix  hours 
or  more  resisted  every  form  of  European  medicine. 
This  was  by  no  means  an  unusual  result  of  the  use 
of  urine,  as  Dr.  Neale  was  informed  by  the  natives. 
As  a  stimulant  and  general  pick-up,  he  had  fre- 
quently seen  a  glass  of  a  child's  or  young  girl's 
urine  tossed  off  with  gi-eat  gusto  and  apparent  bene- 
fit. In  some  parts  of  England  the  use  of  urine  as  a 
medicinal  agent  is  not  unknown.  In  18.52  Bauer  rec- 
ommended the  external  use  of  urate  of  ammonia  in 
lepra,  morphcea,  and  other  obstinate  skin  diseases. 
In  1862  Dr.  Hastings  made  a  report  on  the  value  of 
the  excreta  of  reptiles  in  the  treatment  of  phthisis. 


RECENT   STUDIES   IN   THE  PATHOLOGY   OF    LEPROSY. 

The  pathology  of  leprosy  has  received  considerable 
attention  of  late.  Much  efforftlias  been  made  to 
prove  that  a  minute  organism  is^  <*ie  bottom  of  all 
the  trouble.  The  3[aryland  Medical  Journal  gives 
a  very  good  resume  of  the  history  of  these  latter 
attempts. 

Bacilli  were  first  observed  in  leprous  tissues  by 
Hansen,  in  1867.  Klebs  and  Neisser  coiToborated 
Hansen's  discovery.  Neisser  made  some  very  ex- 
tensive observations,  and  announced  that  in  twenty- 
one  cases  examined  he  found  organisms  uniformly 
present.  They  were  rod-shaped,  and  were  from  one- 
half  to  three-fourths  the  length  of  a  red  l)lood  cor- 
puscle. He  cultivated  them,  and  also  inoculated 
dogs  with  tissue  containing  them.  The  disease  was 
not  communicated,  but  organisms  were  found  at 
the  site  of  the  inoculation  some  months  later.  In 
France,  Hillairet  and  Gaucher  have  observed  the 
organisms  and  claim  to  have  cultivated  them. 

Quite  recently  M.  Cornil  has  been  studying  the 
matter,  and  has  presented  his  results  to  the  Acad- 
emy of  Medicine,  of  Paris.  He  found  bacteria  in 
the  leprous  tubercles  of  the  skin  and  in  the  mucous 
membranes.  Here  they  were  very  small,  being  about 
iij,7  millimetres  in  diameter.  But  he  found  much 
larger  organisms  in  softer  tissues,  like  the  liver  and 
the  testicles.  It  seems  that  those  bacteria  have  a 
most  universal  distribution.  Besides  the  places  enu- 
merated, they  exist  in  the  fibrous  tissues,  the  cornea, 
neurilemma,  adipose  tissue,  and  lymi)hatic  glands. 
In  this  counti-y.  Dr.  Bermaim,  of  Baltimore,  has  an- 
nounced the  discovery,  in  leprous  tissues,  of  bacteria 
similar  to  those  found  by  other  observers. 

In  the  December  number  of  the  Archives  of  Medi- 
cine there  is  a  clinical  contribution  to  the  subject  of 


THE  MEDICAL  RECORD. 


99 


leprosy,  by  Dr.  H.  D.  Bnms,  of  New  Orleans,  and  an 
article  upon  the  pathological  anatomy  of  the  disease, 
by  Dr.  H.  D.  Schmidt.  This  latter  observer  gives 
an  exhaustive  account  of  his  histological  studies,  in 
three  cases  ;  but  he  makes  no  mention  of  bacilli  or 
bacteria.  He  describes  the  characteristic  histolog- 
ical element  of  leprosy,  as  represented  by  certain 
small  proliferating  cells,  of  a  round,  oval  uni-  or  bi- 
polar or  otherwise  irregular  form. 

The  origin  of  these  ceUs  has  heretofore  been 
generally  ascribed  to  the  connective  tissues  of  the 
afifected  organs.  Dr.  Schmidt  .shows  that  they  may 
also  originate  from  the  glandular  epitheKal,  the 
endotheli.\l,  or  even  the  fat-cells.  They  are  gener- 
ally foimd  in  groups  or  nests.  The  whole  process, 
therefore,  according  to  Dr.  Schmidt,  cannot  be  re- 
garded as  a  mere  hyperplasia  of  the  connective  tis- 
sues. Its  products  represent  rather  a  neoplastic 
growth,  resembbng,  in  its  general  characteristics,  the 
tubercle  of  tuberculosis,  and  like  that  undergoing 
ultimately  a  retrograde  metamorphosis.  The  neo- 
plastic element  of  leprosy  remains  for  a  long  time 
limited  to  the  skin,  and  life  is  not  endangered  until 
it  reaches  the  internal  organs.  Dr.  Schmidt  found 
some  changes  in  the  nerve-centres,  e.g.,  in  the  central 
canal  of  the  cord,  and  in  the  lateral  columns.  There 
was,  however,  nothing  to  indicate  that  these  changes 
were  primary,  or  that  the  disease,  as  has  been  al- 
leged, is  of  nervous  origin. 

The  view  that  it  dejiends  upon  the  presence  of 
specific  organisms,  has  at  present  very  slender 
grounds  for  supjjort.  If  leprosy  were  thus  origi- 
nated, it  would  probably  be  contagious,  but  it  has 
not  been  inoculated  in  lower  animals  as  yet;  nor 
have  the  bacilla  found  in  the  tissues  been  cultivated 
with  any  results.  The  idea  that  so  chronic  and  in- 
sidious a  disease  is  dependent  upon  minute  living 
germs  is,  on  the  face,  improbable. 


The  Qdestiox  op  Mokax  Ixsasity. — In  a  reported 
interview.  Dr.  G.  M.  Beard  discourses  as  follows 
regarding  moral  insanity:  "In  a  certain  sense,  all 
insanity  is  moral  insanity.  It  is  impossible  for 
anybody  to  be  insane  without  being,  sooner  or  later, 
aiiected  in  his  moral  nature.  I  have  never  seen, 
read  nor  heard  of  a  case  of  any  kind  of  insanity 
where  the  moral  nature  was  not  affected.  Indeed, 
this  is  usually  the  very  first  thing  that  is  noticed — 
taking  the  form  of  ill-manners.  Manners  are  minor 
morals,  and  change  of  manners  from  gentle  to  severe 
and  rude  is  one  of  the  constant  symptoms  of  most 
cases,  and  that  which  is  first  noticed  by  friends. 
The  man  is  moody,  capricious,  impolite,  silent, 
tricky,  cunning,  passionate,  excessively  hilarious, 
extravagant,  inconstant — all  this  is  immorality,  and 
if  the  insanity  continues  it  may  develop  into  theft, 
murder,  suicide.  I  do  not  myself  use  the  term 
'  moral  insanity '  on  accoimt  of  its  vagueness — it  is 
liable  to  convey  a  wrong  impression.  For  the  same 
reason  I  do  not  use  the  term  '  mental  insanity  ' — all 
insanity  is  both  mental  and  moral.  The  intellect  is 
affected  often  when  there  are  no  delusions." 


Ecolctug  anij  Uoticcs  of  iSoolis. 


The  Science  and  Art  of  Midwtfert.  By  William 
Thompson  Lusk,  A.M.,  M.D.  With  numerous 
Illustrations.  New  York  :  D.  Api^leton  <fe  Co. 
1S82. 

It  is  now  two  hundred  years  since  the  labors  of 
Mauriceau  placed  the  ancient  art  of  midwifery  upon 
a  scientific  ba.sis.  It  is  a  century  since  Baudilocque 
taught  the  mechanism  of  labor ;  explained  the  use 
of  the  forceps  ;  defined  the  symptoms  of  pregnancy, 
and  made  obstetrics  the  most  exact  of  the  medical 
sciences.  Since  that  time  there  have  been  no  epochs 
in,  or  revolutionary  contributions  to,  obstetrical  sci- 
ence. Its  progress  has  been  rather  in  the  minuter 
details  of  ante-  and  post-partum  treatment,  in  the 
introduction  of  ecbolies  and  ansesthetics,  and  in  the 
application  of  modem  pathology  and  surgery  to  va- 
rious conditions.  In  place  of  growing,  obstetrics 
has  given  place  to  gynecology,  and  thus,  in  a  meas- 
ure, satisfied  the  uneasy  aspirations  of  the  scientific 
mind  to  find  something  new  in  parturient  phe- 
nomena. 

The  result  of  the  application  of  modern  scientific 
methods  to  obstetrics  has  been  to  surround  child- 
birth and  all  the  conditions  relating  to  it  with  a 
great  many  artificialities.  The  examination  of  the 
urine,  auscultation  of  the  abdomen,  anesthetics,  er- 
got, dilators,  forceps,  CredC-'s  method,  antisepsis, 
supporting  and  stitching  the  perineum,  are  all  liable 
to  accompany  the  process  of  child-bearing  in  these 
days.  This  tendency  has  one  element  of  danger  in 
it.  The  physician  may  be  led  to  trust  to  his  scien- 
tific methods  more  than  to  his  good  sense.  It  is  a 
sentiment  as  old  as  Confucius,  that  "learning  with- 
out thought  is  perilous."  It  well  applies  to  the 
modem  scientific  obstetrician. 

Professor  Lusk's  book  presents  the  art  of  mid- 
wifery with  all  that  modem  science  or  earlier  learn- 
ing has  contributed  to  it.  It  has  all  the  merits  and 
dangers  of  a  treatise  in  which  science  and  art  have 
got  rather  the  better  of  natui-e  in  the  mind  of  the 
writer. 

The  work  naturally  leans  largely  on  German  au- 
thorities. It  bears  the  evidence  of  much  conscien- 
tious labor  and  research.  It  is  freer  from  refer- 
ences to  the  author's  personal  experiences  than  is 
usually  the  case,  which  shows  a  good  taste  too 
rarely  seen  now-a-days.  It  does  not  injure  the  book, 
since  that  bears  plenty  of  indirect  evidence  of  a 
wide  practical  experience.  The, style  is  clear,  but 
has  no  other  positive  literary  merits. 

We  cannot  go  into  any  complete  analysis  of 
the  work.  There  is  the  usual  anatomical  intro- 
duction. There  are  two  chapters  on  the  physiology 
of  the  ovum,  which  are  exceedingly  good,  and 
supply  a  deficiency  that  exists  in  many  similar 
text-books.  The  author  devotes  a  somewhat  dispro- 
portionately large  space  to  pelvic  and  sexual  abnor- 
malities. They  are  chapters,  however,  which  show 
original  work.  Under  the  head  of  Diseases  of 
Childbed,  the  author  gives  up  most  of  his  space  to 
the  subject  of  puerperal  fever.  He  evidently  has 
spent  a  great  deal  of  time  in  studying  the  literature 
of  its  pathology.  The  result  is  an  acceptance  of  the 
bacterial  theory  of  the  origin  of  the  disease.  In 
spite  of  the  many  authorities  quoted,  we  cannot  con- 
sider Dr.  Lusk's  opinion  of  much  weight.  His  dis- 
cussion of  the  question  shows  that  he  is  not  himself 


100 


THE  MEDICAL  RECORD. 


a  practical  pathologist ;  and  his  unquestioned  ac- 
ceptance of  the  doctrines  and  discoveries  of  the 
eminent  but  imaginative  Klebs,  certainly  shows  an 
immaturity  of  pathological  attainments.  The  re- 
maining diseases  of  childbed  are  treated  of  very 
briefly. 

The  book  is  well  printed  and  superbly  illustrated. 
It  is,  on  the  whole,  the  most  creditable  contribu- 
tion to  obstetrics  which  America  has  vet  made. 


tlrports  of  Societies. 


NEW  TOEK  ACADEMY  OF  MEDICINE. 

Stated  Meeting,  January  19,  1882. 

FoRDTCE  Barker,  M.D.,  LL.D.,  President,  in  the 
Chair. 

Dr.  Joseph  Wiener,  through  the  Library  Commit- 
tee, presented  a 

CRAYON  PORTRAIT  OP  WILLIAM  DETMOLD,  M.D. 

Eemarks  were  made  by  Drs.  WiUard  Parker, 
Lewis  A.  Sayre,  and  the  President. 

The  paper  of  the  evening  was  then  read  by  Dr. 
Samhbl  W.  Gross,  of  Philadelphia,  and  entitled 

THE  INFLUENCE  OP  OPERATIONS  UPON  THE  PROLONGA- 
TION OP  LIFE  AND  PERMANENT  RECOVERY  IN  CARCI- 
NOMA OP  THE  BREAST. 

He  began  by  saying  that  "the  conviction  is  stead- 
ily gaining  ground  that  carcinoma  of  the  breast  is 
curable,  and  that  it  is  primarily  a  local  affection,  and 
not  an  exjjression  of  constitutional  taint,  dyscrasia, 
or  diathesis." 

In  favor  of  these  views  were  Virchow,  Billroth, 
Fischer,  Esmarch,  Nussbaum,  Volkmann,  Kocher, 
Hutchinson,  Gull,  and  others  in  Europe ;  and  Parker, 
Gross,  Peters,  and  others,  in  this  country. 

In  connection  with  this  subject  three  important 
questions  arise  : 

1.  Does  the  knife  prevent  local  dissemination  of 
the  disease  ? 

2.  Does  the  knife  prevent  lymphatic  involvement  ? 
and 

3.  Does  the  knife  prevent  the  development  of 
metastatic  tumors? 

Fimt.  — Does  surgical  intervention  prevent  invasion 
of  adjacent  tissues?  This  question  must  be  answered 
in  the  affirmative  in  a  certain  proportion  of  cases. 
The  conclusion  of. the  reader  was  that  extirpation 
precludes  extension  to  the  skin  and  surrounding 
parts  in  ten  per  cent,  of  all  cases. 

Second. — Does  surgical  interference  with  the  knife 
prevent  involvement  of  lymphatic  glands  ?  It  cer- 
tainly does. 

Third. — In  attempting  to  answer  this  question — 
Does  the  knife  prevent  the  development  of  metas- 
tatic tumors — it  must  be  borne  in  mind  that  such 
tumors  are  not  always  developed. 

After  analyzing  several  collections  of  cases.  Dr. 
Gross  reached  the  conclusion  that  operation  pre- 
vented implication  of  internal  organs  in  .32.30  out 
of  every  one  hundred  casee. 

Again,  life  may  be  prolonged  and  permanent  cure 
may  be  effected  by  surgical  intervention.  Extirpa- 
tion adds  one  year  to  life.  Special  attention  was 
directed  to  Volkraann's  statement  that  the  result 
might  be  regarded  as  final  if  the  patient  survives 


over  three  years  after  the  last  operation.  The  author 
of  the  paper  then  presented  an  analysis  of  524  cases, 
in  which  1  in  9.19  fulfilled  these  requirements.  Sub- 
jecting the  524  cases  to  Paget's  severe  test — that 
the  patient  should  live  more  than  ten  years  from 
the  beginning  of  the  disease,  or  that  the  disea.'^e 
should  be  stationary — he  found  that  1  in  5.7  fulfiUed 
these  requirements.  The  aveiage  duration  after 
operation  in  all  these  cases,  was  from  seven  to  ten 
months.  An  analysis  of  the  57  cases  cured  was  then 
given,  and  the  conclusion  reached  that  recurrent 
tumors  should  be  freely  extu'pated  as  soon  as  they 
appear. 

The  absence  of  glandular  implication  does  not 
afford  absolute  guaranty  that  secondary  deposits  are 
not  in  the  viscera. 

Dr.  Gross  makes  it  a  rule  to  amputate  the  entire 
mamma,  search  for  any  outlying  nodules,  dissect 
away  the  fascia  overlying  the  pectoral  muscle,  open 
the  axilla,  and  remove  any  glands  which  have  escaped 
obsM'vation  previous  to  interference.  Heretofore, 
one  cure  out  of  every  nine  and  one-fifth  cases  has 
been  the  most  expected  from  early  radical  measures ; 
but  there  was  reason  to  believe  that  the  ratio  of  cure 
woiild  be  increased.  Partial  operations  should  be 
discarded,  for  they  are  more  fatal  than  removal  of 
the  entire  breast,  and  they  hold  out  but  little  pros- 
pect of  permanent  recovery.  He  believed  that  in 
the  future  the  mortality  from  radical  procedures 
would  not  reach  ten  per  cent. 

The  conclusions  reached  by  the  author  of  the 
paper  were  substantially  as  follows  : 

1.  That  surgical  intervention  in  carcinoma  of  the 
breost  tends  to  retard  the  progi'ess  of  the  disease  by 
preventing  local  dissemination,  implication  of  asso- 
ciated lymphatic  glands,  and  the  development  of 
visceral  tumors, 

2.  That  local  reproductions  do  not  militate  against 
permanent  recoveiy,  provided  they  are  thoroughly 
and  early  excised,  as  soon  as  they  a^ipear  ;  and  that 
lymphatic  involvement  does  not  forbid  opei'ation, 
since,  in  fact,  glands  were  removed  in  more  than 
one-third  of  the  examples  of  final  cure. 

3.  That  the  subject.?  are  almost  without  exception 
saved  from  local  and  general  reproduction,  if  tfiree 
years  have  elapsed  after  the  last  operation. 

4.  That  the  risk  from  operations  is  outweighed  by 
benefits  which  accrue  from  them,  since  they  not 
only  add  twelve  months  to  the  life  of  the  patient, 
liut  also  cure  one-half  as  many  patients  as  they 
destroy. 

5.  That  all  carcinomas  of  the  breast — if  there  is 
no  evidence  of  metastatic  tumors,  and  if  thorough 
removal  is  practicable — should  be  dealt  with  as  early 
as  possible,  by  ami>utating  the  entire  mamma,  in- 
tegument and  aU,  dissecting  away  all  the  sulijacent 
fascia,  opening  the  axilla,  with  the  view  to  explora- 
tion and  removal  of  all  the  glands  not  palpable  prior 
to  interference. 

The  paper  being  before  the  Academy,  the  Presi- 
dent invit«d  Dr.  Georoe  A.  Peters  to  open  the  di* 
cussion.  He  said  that,  tliirty  years  ago,  he  wa» 
taught  not  to  meddle  with  carcinoma  of  the  breafilV 
for  it  was  sure  to  recur,  and  if  an  operation  was  peiK 
formed,  it  would  hasten  rather  than  postpone  a  fatal 
termination  of  the  case.  He,  however,  failed  to  feel 
the  force  of  tlie  teaching,  and  determined  to  pursue 
another  cours«,  and  the  result  of  his  experi(>nce  liad 
boen  very  much  in  accord  witli  the  conchisions 
reached  by  Dr.  Gross.  He  agreed  tlioronglily  with 
the  deductions  which  the  author  of  the  ]>aper  bad 
made.      He  recalled  three  eases  of  pormnnont  re- 


THE  MEDICAL  RECORD. 


101 


cover}'.  In  one  the  patient  was  forty-five  or  fifty 
years  old,  from  whom  he  removed  a  cancerous  breast 
sixteen  or  seventeen  years  ago,  and  she  is  yet  living, 
and  haH  Vieen  free  from  the  recurrence  of  the  dis- 
ease. In  two  other  cases  the  patients  had  remained 
in  good  health,  now  ten  years  since  the  operations. 

He  had  a  case  \inder  observation,  in  which  the  pa- 
tient was  fifty  years  of  age,  had  ceased  to  menstru- 
ate, and  for  whom  he  removed  a  cancerous  breast 
two  years  ago.  The  entire  gland,  the  glands  in  the 
axilla,  and  the  fascia  of  the  pectoral  muscle,  were  re- 
moved. The  disease  recurred  in  the  cicatrix  one 
year  afterward.  The  recurrent  tumor  was  removed 
as  soon  as  it  was  discovered.  One  year  subsequent 
to  the  second  he  performed  a  third  operation,  and 
removed  ttro  nodules  in  the  skin.  The  wound  healed 
kindly  and  completely,  and  he  hoped  to  be  able  to 
add  her  case  to  his  number  of  permanent  recoveries. 

He  believed  it  to  be  well  to  always  remove  the,en- 
tire  breast  and  open  the  axilla,  if  there  was  any^rea- 
son  to  suspect  contamination  there. 

With  regard  to  the  manner  of  performing  the 
operation,  the  incision  should  be  made  carefully, 
but  freely  down  to  the  gland,  being  sui-e  that  all^the 
affected  tissue  is  included  in  the  mass  removed ; 
and  also  be  careful  not  to  bruise  the  neighboring 
tissues,  lest  lymphatic  channels  were  opened  and  ad- 
ditional opportunity  for  the  extension  of  the  disease 
was  thus  ottered. 

Dii.  WEm  was  surprised  at  the  comparatively  high 
rate  of  mortality  reported  by  Dr.  Gross  after  am- 
putation of  the  breast — seventeen  per  cent. — which 
was  very  much  greater  than  occurred  generally  with 
surgeons  in  New  York.  He  had  amputated  the 
breast  between  sixty  and  seventy  times,  with  only 
one  death,  which  was  due  to  erysipelas.  Since  the 
advent  of  Listerism  the  rate  of  mortality  from  the 
operation  should  not  be  high. 

As  to  the  absolute  curability  of  the  disease,  he  had 
not  obtained  so  good  results  as  Dr.  Gross  had  re- 
ported, namely,  one  in  nine  cases.  He  believed 
that  the  greatest  hojie  was  in  the  direction  of  pro- 
longation of  life  and  postponing  recuiTence.  A 
ease  as  a  remarkable  illustration  was  cited.  In  1S56 
Dr.  Wood  removed  the  right  breast  of  a  patient ; 
Dr.  Post  the  left  breast  of  the  same  patient  in  1^67. 
A  nodule  of  the  disease  recui'red  in  the  cicatrix  of 
the  right  side  in  1873,  which  was  removed  by  Dr. 
Weir,  examined  by  Dr.  Delafleld,  and  pronounced 
to  be  cancerous.  The  disease  recun-ed  in  187.5,  was 
removed  in  1877  and  1880,  and  then  recurred  with 
such  extensive  adhesions  to  the  sternum  that  further 
operation  was  inadmissible,  and  the  patient  died 
about  one  month  ago. 

He  also  cited  a  case  in  which  the  breast  was  re- 
moved in  18G9,  and  the  disease  reappeared  in  1881. 
These  cases  do  not  invalidate  the  rule  given  by 
Volkmann  and  quoted  by  Dr.  Gross,  but  at  the  same 
time  they  made  him  less  hopeful,  and  also  feel  that 
he  could  not,  with  safety,  pronounce  against  danger. 

With  regard  to  the  method  of  operation  recom- 
mended by  the  author  of  the  paper,  he  had  had  too 
short  an  experience  with  it  to  enable  him  to  give  a 
decided  opinion  concerning  its  real  merits  or  de- 
merits. 

Db.  T.  E.  Sattekthwaite,  upon  invitation,  occu- 
pied the  attention  of  the  Academy  chiefly  with  some 
statistics  that  he  had  derived  from  the  study  of  car- 
cinoma in  New  York.  Before  presenting  these  facts, 
he  stated  that  he  ijersonally  felt  that  the  piofession 
owed  a  great  debt  to  Dr.  Gross  for  the  careiui  and 
laborious  study  he  had  given  to  breast-tumors,  and 


for  the  vigorous  eflbrt  he  had  made  to  show  that  a 
certain  definite  cUnical  picture  was  associated  with 
equally  definite  microscopic  appearances. 

The  attainment  of  this  resuJt  should  be  of  great 
importance  to  the  surgeon,  as  he  is  now  able  to  rec- 
ognize the  sjiecial  variety  of  disease,  and  make  it 
tally  with  the  advanced  standard  of  pathological 
terminology,  while  he  has  at  the  same  time  an  ad- 
ditional satisfaction  in  being  able  to  give  a  ceitain 
mathematical  precision  to  his  prognosis.  Indeed, . 
the  sui-geon  will  now  rarely  maJie  a  mistake,  if  he 
notes  the  time  of  life  at  which  the  disease  com- 
menced its  duration,  rate  of  growth,  external  appear- 
ances, feel,  conditions  of  the  nipple  and  of  the  ad- 
jacent glands.  Dr.  Sattertliwaite  observed  that  in 
his  experience  we  had  only  three  varieties  of  carci- 
noma to  deal  with  in  the  breast — scirrhus  in  its 
various  forms,  colloid  and  encej^haloid.  Of  the 
former  he  would  not  sjaeak,  because  its  characters 
were  so  well  known  that  a  descrijijtion  would  be  super- 
fluous. It  was  well  enough,  however,  to  allude  to 
encephaloid,  because  it  was  Irequently  mistaken  for 
sarcoma.  The  former,  occurring  in  about  three  per 
cent,  of  his  cases,  was  surpassed  in  this  regard  by  sar- 
coma, which  occurred  in  tour  i^er  cent.  Lncephaloid 
is  a  disease  that  belongs  to  a  more  advanced  peiiod 
of  hie  than  scin-hus,  the  age  of  fifty  to  fifty-one  rep- 
resenting the  date  of  its  average  ajipearance.  It 
is  apt  to  be  a  rapidly  forming,  often  bulky  tumor, 
which  is  associated  with  much  pain,  and  may  or  may 
not  imphcate  the  nipple  and  neighboring  glands. 
The  surface  of  the  tumor  is  usually  soft,  often  semi- 
fluctuating,  is  apt  to  break  down  early  and  give  the 
appearances  that  attend  active  inflammation.  Its 
surface  also  is  apt  to  be  lobulated,  and  the  growth 
will,  if  sufficiently  advanced,  adhere  to  the  under- 
lying tissues.  Though  this  form  of  gi-owth  is  vei-y 
natui'ally  associated  in  one's  mind  with  a  rapid  and 
excessively  malignant  course,  it  was  but  proper  to 
say  that  in  two  cases — the  only  ones  of  encej^haloid 
of  which  he  had  extensive  notes — one,  a  Bermuda 
lady,  survived  the  inception  of  the  disease  five  years, 
and  the  other  eight  and  nine.  The  latter  is  now  a 
private  uorse  in  St.  Luke's  Hosijital  and  is  appar- 
ently in  perfect  health,  having  had  no  signs  ol  re- 
currence since  the  first  and  only  operation.  The 
gi-owth  was  removed  foiu-  months  after  it  was  first 
detected. 

Sarcomas  are  met  with  at  an  earlier  period  of  life 
than  encephaloid,  attain  a  great  bulk  in  a  short 
time,  but  are  thought  to  have  a  more  chronic  course 
on  the  whole,  as  they  recur  after  considerable  inter- 
vals. In  them  the  nipples  are  occasionally  retracted 
and  there  is  implication  of  adjacent  glands,  while 
often  the  skin  becomes  involved,  and  later  breaks 
down,  allowing  the  new  growth  to  j^rotrude,  form- 
ing, as  in  encephaloid,  a  " fungus  htematodes."  Such 
tumors  are  not,  however,  adherent  to  underlying 
parts.  The  surface  is  slightly  lobulated,  but  smooth. 
On  cutting  open  such  a  tumor  with  an  ordiaary  knife, 
it  will  be  seen  to  have  a  capsule,  while  encephaloid 
does  not.  The  microscopic  appearances  are  those 
of  round-  or  spindle-eeUed  sarcoma.  In  addition, 
cysts  are  quite  common,  but  both  in  sarcoma  and  in 
encephaloid  there  may  be  discharge  from  the  nipjfle. 

In  colloid  carcinoma  we  have  a  variety  that  occurs 
in  about  two  per  cent,  of  aU  breast-neoplasms.  It 
appears  on  an  average  at  an  earlier  period  than  scir- 
rhus, and  is  essentially  chronic  in  its  development. 
The  surgeon  is  quite  apt  to  mistake  this  variety  for 
scirrhus,  because  the  physical  characters  before 
operation  simulate  those  of  the  former  disease  very 


102 


THE  MEDICAL  RECORD. 


closely.  After  removal,  however,  when  it  has  been 
opened  by  the  knife,  the  peculiar  gelatinoicl  material 
exufles  or  can  be  expressed,  and  then  the  diagnosis 
of  colloid  is  easily  made.  Of  two  cases  in  Dr.  Sat- 
terthwaite's  experience,  where  pretty  full  histories 
have  been  obtained,  the  patients  were  well  at  last 
accounts — one  at  the  end  of  two,  and  the  other  at 
the  end  of  six  years  after  the  origin  of  the  disease. 
As  to  its  danger  of  being  confounded  with  myxoma. 
Dr.  Satterthwaite  was  not  prepared  to  say  anything, 
as  he  had  never  met  with  this  former  tumor  in  the 
breast.  Colloid  was  the  most  chronic  of  all  these 
varieties. 

These  statistics,  and  others  he  was  able  to  furnish, 
had  been  collected  from  records  of  eighty-six  cases 
that  had  come  into  his  possession,  mainly  through 
his  connection  with  the  St.  Luke's  and  Presbyterian 
Hospitals  as  pathologist,  and  also  through  the  New 
York  Pathological  Society.  All  of  the  cases  had  been 
restudied  during  the  summer  of  the  past  year,  and 
in  all  thirty-six  cases  were  sufficiently  complete  to 
furnish  material  for  statistical  work.  He  enumer- 
ated some  of  the  chief  points  that  he  had  elicited. 
Carcinoma  (all  varieties)  never  appeared  before 
twenty-eight  or  later  than  seventy.  In  ninety-seven 
per  cent,  it  attacked  the  female  breast,  and  in  three 
per  cent,  the  male.  Usually  it  was  the  right  breast. 
The  most  frequently  assigned  cause  was  some  form 
of  traumatism,  including  under  that  term  such  acci- 
dents as  a  blow,  the  chafing  of  corsets,  friction  of 
the  breasts  against  a  washing-board,  mammary  ab- 
scess, injury  by  child  during  lactation.  Heredity  was 
a  factor  that  was  assigned  in  a  much  smaller  number 
of  cases,  say  in  one-sixth.  In  about  seventy-three  per 
cent,  the  previous  health  was  said  to  have  been  good. 
Becurrences  took  place,  on  the  average,  about  the 
tenth  month  after  the  operation  ;  but,  if  the  patient 
had  no  recurrence  during  three  years,  a  cure  might 
be  predicted.  This  conclusion  was  singularly  pre- 
cise in  its  agreement  with  the  statements  of  Dr. 
Gross.  The  last  recurrence  occun-ed  exactly  at  the 
thirty-sixth  month. 

As  to  the  matter  of  cure,  he  was  glad  that  he  was 
able  to  say  of  metropolitan  practice  that  it  just 
about  reached  tlie  liigli  standard  of  excellence  set  by 
Dr.  Gross.  Taking  thirty-one  cases  in  which  this  mat- 
ter could  be  ijroperly  studied,  and  accejiting  the  fact 
that  no  recurrence  had  taken  place  for  three  years 
after  operation,  a  cure  might  be  claimed.  Dr.  Sat- 
terthwaite was  able  to  say  that  three  cases  were 
definitely  cured.  This  was  a  percentage  of  9.68 
per  cent.  In  these  cases  the  period  of  immunity 
lasted  from  six  to  ten  years.  On  the  other  hand,  a 
chock  was  given  to  the  disease  in  two  cases,  the 
duration  of  life  after  the  origin,  the  dise^ise  being  re- 
spectively about  live  and  twenty-four  years.  He  was 
also  able  to  say  that  the  dangers  of  the  operations 
in  this  vicinity  were  trivial  as  compared  with  the 
statistics  of  Dr.  Gross.  The  actual  mortality,  car- 
rying the  computation  to  the  eighth  day  after  the 
operation,  was  h^ss  than  tliree  per  cent. 

In  conclusion,  he  had  a  word  to  say  upon  the  com- 
parative advantage  of  early  and  lato  oi)erations. 
This  was  a  topic,  he  was  free  to  confess,  lie  ap- 
proached with  liositation,  because  the  statistics, 
both  on  tliis  and  on  another  occasion  when  ho  had 
studied  them,  gave  little  encouragement  to  the  sur- 
geon who  advocates  early  operation.  And  yet  he 
felt  impressed  with  the  idea  that  early  operations, 
and  in  ret^nrrence,  frequent  operations  offer  tlie  best 
chances  of  securing  immunity  or  retardation.  To 
be   brief,  there   was  a  disturbing  element   in   the 


computation,  and  it  was  the  fact  that  benign  tu- 
mors became  unavoidably  confused  with  the  ma- 
lignant. That  he  believed  to  be  the  case  in  the 
examples  of  cure  or  retardation  already  alluded  to. 
Thus,  in  the  cases  of  cure  while  two  wore  operated 
on  early — one  at  the  end  of  four  months  and  the 
other  at  the  end  of  six — the  third  went  five  years 
without  operation  ;  and  in  the  retarded  cases,  one  was 
not  treated  surgically  until  two,  and  the  otlier  until 
eighteen  years  had  passed  after  trouble  was  first  no- 
ticed in  the  breast.  Could  it  not  be,  and  was  it  not 
probable,  from  the  history,  that  these  instances  of 
late  operation  were  in  cases  where  the  growths  were 
at  first  benign  ? 

Perhaps,  at  a  later  period  in  the  study  of  tumors, 
when  the  number  of  carefully  recorded  cases  is 
much  larger,  such  as  these  might  be  thrown  out  of 
the  calculation,  and  we  should  be  able  to  decide  this 
very  important  question. 

The  President  remarked  that,  at  the  time  Dr. 
Willard  Parker  made  his  communication  upon  this 
subject  to  the  Library  and  Journal  Association,  he 
was  called  upon  to  make  some  remarks,  and  then 
threw  out  the  suggestion  that  age  had  a  decided  in- 
fluence upon  the  probable  recurrence  of  the  disease 
after  the  original  tumor  was  removed  with  the  knife 
— the  liability  to  recurrence  diminishing  as  age  in- 
creased. That  point  he  had  not  seen  mentioned  by 
any  %vi'iter,  and  ho  would  be  glad  to  have  the  ex- 
perience of  surgeons  with  reference  to  it. 

Dr.  Lewis  A.  Satre  said  he  was  early  taught  to 
leave  cancer  of  the  breast  undisturbed  by  suigical 
interference,  but  during  the  last  twenty  or  thiity 
years  he  had  pursued  another  line  of  practice.  Since 
the  teaching  of  Atlee,  in  1846  or  1847,  that  arsenic 
should  be  employed  in  these  cases,  he  had  uni- 
formly used  it  after  removal  of  the  breast,  and 
whether  or  not  it  had  anything  to  do  toward  pro- 
longing life  he  was  not  positive,  but  at  all  events 
some  of  his  patients  had  lived  twenty  years  after  the 
operation,  and  witliout  return  of  the  disease.  His  ex- 
perience accorded  with  the  general  iirinciples  incul- 
cated by  the  paper. 

Dr.  Frank  H.  Hamilton  thought  that  the  central 
jjoint  of  the  discussion  was  whether  cancer  is  pri- 
marily a  local  or  constitutional  disease.  If  it  is  local, 
it  should  ))e  cut  out,  and  the  earlier  the  better  before 
it  invaded  the  entire  system.  Opinions  seemed  to  be 
more  and  more  confirmed  in  the  direction  of  primary 
localization  of  the  disease.  Upon  that  point  he  had 
entertained  a  doubt,  but  it  had  always  been  exceed- 
ingly small.  So  far  as  cancer  of  the  breast  was  con- 
cerned, he  had  observed  that  it  occnn-ed  most  fre- 
quently at  that  period  of  life  when  the  organ  was 
undergoing  tlie  change  incident  to  cessation  of  func- 
tion. Certainly  there  was  no  evidence  in  that  fact 
of  constitutional  fault,  for  it  was  a  purely  local 
decadence  which  was  taking  ])lace.  The  same  thing 
had  been  obser\od  with  reference  to  the  uterus,  and 
such  facts  pointed  toward  a  local  origin.  He  also 
believed  that  an  argument  might  be  drawn  from  the 
consanguinity  of  the  aflection.  Epithelioma  was 
regarded  as  primarily  a  local  disease  in  the  majority  / 
of  cases,  but  there  is  a  time  when  it  may  become  a 
constitutional  disease.  He  also  believed,  with  Dr 
Satterthwaite,  that  milder  forms  of  tliese  disenscs 
might  pass  into  the  malignant.  Now,  if  the  disense 
is  local,  the  earlier  it  is  removed  the  better.  A  little 
later  its  atmosjihere  must  be  removed,  and  a  liitK' 
later  still  its  jirolongation  into  lymphatics.  ]?y  so 
doing,  the  disease  was  retarded  in  its  progress,  if 
not  arrested 


THE  MEDICAL  RECORD. 


303 


Dr.  a.  C.  Post  bad  always  been  in  favor  of  the 
earlv  removal  of  cancer  of  the  breast,  and  also  in 
favor  of  following  the  disease  with  operation  so  long 
as  it  recurred  in  situations  where  the  relations  of 
the  surrounding  parts  admitted  of  surgical  interfer- 
ence with  the  knife. 

A  remarkaVile  case  was  cited  in  illustration  of  the 
benetit  which  might  follow  repeatedly  attacking  the 
disease  with  the  knife.  A  surgeon  in  Virginia,  dead 
for  many  years,  removed  the  original  disease,  re- 
moved the  secondary  growth  the  next  year,  and 
then  followed  it  year  after  year  and  during  ten 
years,  performing  nine  operations  in  succession ; 
and  after  the  last  one  the  patient  remained  under 
observation  for  ten  years,  and  continued  well.  The 
ultimate  result  he  was  unable  to  give. 

The  operation  should  be  performed  at  an  early 
period,  while  the  disease  is  of  limited  extent.  After 
the  disease  has  involved  lymphatic  glands  in  the 
axilla,  he  thought  it  proper  to  perform  it  if  the  ad- 
hesions were  not  so  extensive  that  the  disease  could 
not  be  removed.  He  believed  that  a  partial  opera- 
tion is  fi-aught  with  mischief.  There  might  be  ex- 
ceptional cases  where  temporary  relief  might  be 
alibrded  by  removal  of  only  a  portion  of  the  diseased 
mass.  But,  as  a  rule,  it  was  better  not  to  interfere 
unless  all  the  adjacent  tissues  were  removed.  "With 
regard  to  the  suggestion  made  by  the  President, 
that  cancerous  disease  was  of  slow  progress  and  in- 
frequent recurrence  the  later  in  life  it  appeared,  he 
had  been  of  that  opinion  for  a  long  time,  and  had 
seen  it  in  print  many  years  ago.  When  cancer  was 
removed  after  seventy  years  of  age,  there  was  pros- 
pect of  long  freedom  from  retTim  of  the  disease. 

Dr.  WrLLARD  Parker's  conviction  was  that,  in  se- 
lected cases,  an  oi^eration  for  the  removal  of  the  breast 
and  affected  tissues  should  be  performed.  Some 
cases  should  be  let  alone.  Out  of  four  hundred  and 
fifty  cases,  which  had  been  under  his  own  observation, 
some  had  done  very  well  when  there  seemed  to  be  no 
chance  whatever  for  benefiting  the  patients  by  opera- 
tion. His  own  observation  had  led  him  to  the  con- 
clusion that  the  disease  is  not  hereditary.  He  also 
believed  that  it  is  not  a  primaiy  disease,  but  always 
has  a  starting-jjoint  in  some  abnormality.  It  may 
begin  in  a  sore  upon  the  cheek,  or  lip,  or  some 
benign  growth,  but  never  has  its  origin  in  a  physio- 
logical basis.  A  benign  growth  may  be  carried  for 
years,  and  then  suddenly  change  in  character,  be- 
come painful,  its  blood-vessels  enlarge,  and  soon 
present  all  the  usual  appearances  of  malignant  dis- 
ease. He  believed  that  the  great  exciting  cause  of 
cancer  was  traumatism,  but  what  is  it  that  antedates 
the  action  of  the  exciting  cause?  The  gi'eat  ques- 
tion was :  How  shall  the  disease  be  prevented  ?  If 
the  system  can  be  revolutionized  and  brought  back 
to  a  physiological  condition,  we  might  hope  for 
good  results.  It  was  in  that  direction  that  attention 
should  be  turned.  A  mere  operation  is  surgeon's 
play ;  to  save  the  patient  makes  the  man  godly. 
Dr.  Parker  referred  to  cases  in  which  he  had  opera- 
ted with  vei-y  favorable  restilts.  and  among  them 
one  especially  interesting,  because  the  breast  (enor- 
mously enlarged  and  sloughingl  was  removed,  many 
years  ago,  simply  to  rid  the  patient  of  the  foul  mass 
and  afford  temporary  relief ;  but  the  woman  made 
a  good  recovery  and  still  lives  ;  the  disease  has  not 
recurred  and  she  is  in  good  health  (see  Medical 
Record,  vol.  viii.,  p.  431). 

Dr.  Charles  A.  Leale  presented  a  photograph  of 
a  patient  from  whom  he  removed  a  breast  completely 
together  with  the  axillary  glands.    The  tumor  was  ul- 


cerated when  the  operation  was  performed.  The 
wound,  seven  by  thirteen  inches,  healed  by  first  inten- 
tion except  in  the  hollow  of  the  axillary  .«pace,  where  a 
granulating  surface  was  finally  covered  after  several 
api)Hcations  of  nitric  acid.  The  operation  was  per- 
formed in  February,  1S80.  The  cicatrix  remained  red. 
The  jjatient  was  put  upon  the  use  of  arsenic,  and 
the  drug,  in  the  form  of  Fowler's  solution,  was  car- 
ried to  the  extent  of  produciug  very  marked  general 
symptoms,  and  the  color  of  the  cicatrix  soon  began 
to  change  and  became  nearly  normal.  Only  a  very 
moderate  amount  of  hemorrhage  occurred  when  the 
breast,  with  the  axillary  glands,  were  removed,  al- 
though the  axillary  artery  was  raised  upon  the  fin- 
ger for  the  purpose  of  reaching  deeij-seated  diseased 
glands.  There  had  been  no  evidence  of  recurrence 
of  the  disease.  The  patient  still  took  arsenic  in 
small  doses.  The  case  illustrated  the  benefit  by 
prolonging  life  which  an  operation  could  afford,  and 
also,  as  it  seemed  to  Dr.  Leale,  the  favorable  effects 
produced  by  the  use  of  arsenic  in  these  cases. 

Dr.  ArsTDj  Flint  referred  to  a  case  which  came 
under  his  observation  thirty  years  ago.  The  patient 
wa^  forty-five  or  fifty  years  of  age,  and  had  an  aft'ec- 
tion  of  the  breast  that  jiresented  all  the  gross  ap- 
pearances of  scirrhus.  Dr.  Frank  H.  Hamilton  ad- 
vised an  operation  and  performed  it.  The  disease 
did  not  return.  The  woman  lived  more  than  twenty 
years  after  the  breast  was  removed,  and  died  of  a 
disease  other  than  cancer. 

Another  patient  came  to  see  him  ten  years  ago. 
She  evidently  had  scirrhus  of  the  breast,  which  was 
removed  and  shown  by  the  microscope  to  be  cancer. 
Within  two  years  the  disease  returned  twice  in  the 
neighborhood  of  the  breast,  and  in  both  instances  it 
was  removed  by  operation.  Since  the  last  operation 
she  had  enjoyed  excellent  health,  and  was  still  living. 

The  President  referred  to  the  change  of  opinion 
which  had  taken  place  within  thirty  years.  Surgeons 
have  now  reached  the  conclusion  that  there  is  a  pos- 
sibility, in  a  good  percentage  of  cases,  of  arresting 
the  disease  by  operation — certainly  of  retarding 
its  progi'ess — and  prolonging  life,  whereas  the  al- 
most uniform  teaching  used  to  be  to  avoid  operating 
for  the  removal  of  a  cancerous  breast.  There  are, 
however,  many  at  the  present  time,  probably,  who 
believe  that  the  cases  are  numerous  in  which  an 
operation  should  not  be  performed.  The  President 
then  referred  to  one  case  in  which  he  removed  a 
cancerous  breast  in  1860.  The  disease,  after  micro- 
scojiical  examination,  was  decided  to  be  cancerous. 
The  specimen  was  presented  to  the  New  York  Path- 
ological Society  by  Dr.  Foster  Swift,  and  in  the  jour- 
nal in  which  the  report  of  the  case  appeared,  credit 
for  the  operation  was  given  to  Dr.  Parker  instead  of 
Dr.  Barker,  which  was  a  fair  illustraticn  of  the  un- 
certainty of  surgical  glory.  It  was  in  that  case  that 
acupressure  was  used  for  the  first  time  in  this  city, 
and  with  veiy  satisfactory  results,  only  a  small 
amount  of  suppuration  ensuing  (see  Medical  Rec- 
ord, vol.  viii.,  p.  435).  The  patient,  at  the  time  of  the 
operation  forty -three  years  of  age,  still  lives,  and  is 
in  the  enjoyment  of  good  health. 

With  reference  to  arsenic  in  the  treatment  of  can- 
cer, he  believed  that  it  can  be  used  internally  with 
positive  advantage. 

Dr.  Gros.s,  in  closing  the  discussion,  said  that  the 
17.87  per  cent,  of  mortality  from  the  immediate 
effects  of  interference,  was  accounted  for,  to  a  cer- 
tain extent,  by  the  mode  in  which  the  axillary  wound 
was  treated.  Instead  of  veins  being  ligated,  the 
wound  was  stuffed  with  material  which  caused  the 


104 


THE  MEDICAL  RECORD. 


secretions  to  be  pent  up,  and  pysemia  and  septicae- 
mia and  other  bad  accidents  followed.  The  opera- 
tions which  were  followed  by  such  a  rate  of  mortal- 
ity were  not  performed  in  English  and  American 
hospitals,  V)ut  for  the  most  part  in  Germany,  where 
the  mortality  had  been  notoriously  high. 

He  had  removed  the  breast  in  seventy-two  cases  : 
seventeen  by  the  thorough  operation,  fifty -five  by  the 
common  operation,  and  he  hiui  lost  only  two  jjatients, 
or  less  than  1.5  per  cent.  At  most  the  mortality  should 
not  reach  five  per  cent.  He  thought  that  surgeons 
should  expect  better  results  than  preventing  the 
extension  of  the  disease  in  10.87  per  cent,  of  all 
cases  of  cancer  of  the  breast ;  that  was  the  limit 
obtained  by  all  kinds  of  operations.  But  he  had  pre- 
sented the  more  thorough  procedure,  believing  that 
if  it  was  more  uniformly  practised,  better  results 
than  those  ah-eady  given  coidd  be  obtained. 

Recurrence  of  carcinoma  after  the  ordinary  opera- 
tion was  the  rule,  and  generally  in  the  line  of  the 
cicatrix.  It  was  his  point,  and  he  regarded  it  as  the 
most  important.  Why  do  we  leave  anything  in  which 
the  disease  may  recur?  To  rid  a  field  of  l^rge 
weeds  and  leave  the  little  ones  standing  did  not 
cleanse  it ;  the  farmer  must  remove  the  small  weeds 
as  well  as' the  large,  if  he  would  not  have  his  crops 
destroyed.  The  thorough  operation  was  not  espe- 
cially serious.  He  had  lost  only  one  patient  out  of 
the  seventeen  upon  whom  he  had  pei'formed  it,  and 
in  that  case  the  patient  was  a  bad  subject,  enor- 
mously fat,  and  she  died  on  the  third  day,  from 
causes  unknown.  The  disease  recurs  in  the  skin — if 
not  in  tlie  skin,  in  the  subcutaneous  connective  tis- 
sue and  fat.  Hence,  why  leave  these  tissues  be- 
hind ?  His  method  of  procedure  is  as  follows : 
first  palpate  the  entire  mammary  region,  feel  for 
lobules  outside  of  the  gland  in  the  axilla,  above  and 
below  the  clavicle,  and  then,  instead  of  maldng  an 
elliptical  incision  embracing  the  nipple  and  a  small 
portion  of  skin,  remove  the  breast  by  a  circular  in- 
cision, remove  the  pectoral  fascia,  then  secure  blood- 
vessels, then  prolong  the  incision  into  the  axilla, 
which  is  to  be  explored  with  the  finger  thoroughly, 
and  all  glands  in  the  least  affected  removed  ;  ligate 
with  catgut  each  vein  which  goes  into  the  axillary 
veins  and  all  the  arteries,  make  a  clean  and  com- 
plete dissection  of  the  axiUa,  and  then,  after  all 
hemon-hage  has  been  stanched  with  hot  water,  a 
drainage-tube  is  inserted,  and  the  lips  of  the  wound 
approximated  as  closely  as  possible  by  stitches 
introduced  one  and  one-half  or  two  inches  from 
edges,  and  the  remaining  space  left  to  heal  by  gi-an- 
ulation.  In  some  cases  it  will  be  possible  to  ap- 
proximate the  edges  of  the  woiand  accurately. 

He  believed  that  carcinoma  is  primarily  a  local 
disease,  and  the  sooner  such  an  operation  for  its 
radical  removal  was  performed,  the  better. 

On  motion  by  Dr.  Flint,  the  thanks  of  the  Acad- 
emy were  tendered  to  Dr.  Gross  for  his  able,  inter- 
esting, and  instructive  paper. 

The  Academy  then  adjourned. 


Vaccination  in  Scotland. — Scotland  is  greatly  in 
favor  of  vaccination.  Dr.  Kobertson's  report  of  the 
vaccination  of  children  born  in  Scotland  in  1879 
states  that  only  one  individual  refused  to  have  his 
children  vaccinated.  Small-pox  has  not  caused 
much  trouble  since  187i,  in  which  year  there  were 
1,246  deaths.  In  1^*80  there  were  only  10  fatal  cases. 
— British  Medical  Journal. 


NEW  YORK  PATHOLOGICAL  SOCIETY. 

Stated  Meeting,  December  28,  1881. 

Db.  T.  E.  Satterthwaite,  President,  in  the  Chair. 

Dr.  William  H.  Porter,  on  behalf  of  a  candidate, 
presented  a  specimen  of 

SIULTIPLE    FRACTURE    OF   THE    REBS CROUPOUS    PNEU- 
MONIA— DiTERMENINGEAL   HEMORRHAGE. 

The  President,  on  behalf  of  a  candidate,  presented 
a  specimen  of 

DIPHTEffiRinC   LABINGITIS. 

De.  William  H.  Porter  presented  a  specimen  of 

EETICUI.ATED  ROUND-CELL  SARCOMA  OF  THE  ORBIT, 
WITH  SEGONDART  GROWTHS  INTERNALLY  CONTAINING 
MELANOTIC  DEPOSITS, 

removed  from  the  body  of  a  gray  mare,  twelve  years 
of  age.  About  one  year  before  death,  there  was  no- 
ticed, for  the  first  time,  a  small  tumor  over  the  left 
eyeball,  and  evidently  gi'owing  from  the  wall  of  the- 
orbit.  During  the  first  few  months  after  it  was  dis- 
covered, the  tumor  grew  veiy  slowly.  In  May,  1881, 
an  incision  was  made  into  the  growth,  to  ascertain 
whether  it  was  solid  or  contained  fluid.  Nothing 
but  blood  oozed  from  the  opening,  and  the  tumor 
appeared  to  be  solid.  During  the  next  four  weeks 
the  growth  gradually  increased  in  size.  Late  in 
Jime  it  was  again  cut  into,  and  a  small  portion  re- 
moved for  microscopical  examination,  which  showed 
that  the  tumor  was  sarcomatous,  of  the  large  round- 
cell  variety,  and  not  a  melanotic,  so  frequently  met 
with  in  the  eye  and  in  various  parts  of  the  body  of 
white  and  gray  horses.  At  this  time  sarcoma  was 
diagnosticated  and  an  operation  advised,  with  the 
prospect  of  local  or  internal  recurrence. 

During  the  next  two  months  the  animal  continued 
in  fair  condition  and  worked  every  day,  the  growth 
enlarging  slowly. 

In  the  early  part  of  October,  she  suffered  from 
the  disease  known  as  '•  pink  eye,"  being  laid  up 
about  ten  days.  By  this  time  the  tumor  had  at- 
tained considerable  size,  was  growing  rapidly,  push- 
ing the  eyeball  from  the  socket,  and  evidently  giving 
the  animal  considerable  pain.  She  was,  however, 
again  put  to  work,  accomplishing  the  same  with  or- 
dinary ease.  Still  it  was  noticed  that  she  was 
gradually  failing,  both  in  flesh  and  strength,  prob- 
ably from  the  pain  and  annoyance  of  the  gi-owth  in 
the  orbit,  as  well  as  from  the  general  disease,  t. 

October  2.3,  1881. — The  mare  being  unfit  for  duty, 
an  operation  was  decided  upon.  The  tximor,  which 
was  quite  firmly  attached  to  the  orbital  wall,  and  com- 
pletely filled  the  orbit,  so  that  the  whole  contents 
of  the  orbital  cavity  were  involved,  was  removed  by 
Dr.  E.  Berry  Kamsdell.  The  animal  suffered  severely 
from  shock,  but  rallied  completely  at  the  end  of  a 
few  hours.  The  edges  of  the  wound  were  brought 
togetlier  by  a  few  sutures,  and  cold  dressings  applied. 
It  healed  kindly,  with  scarcely  any  suiipuratioii,  and 
the  animal  was  so  much  )mpro\ed,  that  two  weehs 
after  the  operation  she  was  again  at  work.  At  first 
she  seemed  to  gain  both  in  strength  and  flesh. 

Two  weeks  after  she  was  put  to  work,  it  was  no- 
ticed that  the  breathing  was  hurried  and  iiiii>cded. 
This  interference  with  respiration  gradually  in- 
creased until  December  10,  1881,  when  the  animal 
was  no  longer  able  to  work,  and  was  placed  in  the 
hospital. 

Two  days  later,  a  careful  physical'examiuation  re- 


THE  MEDICAL  RECORD. 


105 


vealed  fluid  in  the  left  pleural  cavity.  A  few  days 
later  a  small  quantity  of  fluid  was  detected  upon  1 
the  opposite  side.  Four  days  before  death,  the  left 
chest-cavity  was  aspirated,  and  one  gallon  of  clear, 
serous  fluid  drawn  oft'.  After  the  removal  of  the 
fluid,  marked  and  extensive  consolidation  of  the  left 
lung  was  diagnosticated,  and  thought  to  be  due  to 
secondary  deposits,  as  none  of  the  i-ational  signs  of 
pneumonia  were  present.  Some  pulmonary  consoli- 
dation was  also  detected  on  the  right  side.  The 
left  pleural  cavity  rapidly  refilled  with  fluid,  and  the 
animal  died  four  days  later,  December  21,  1S81. 

yecrojjsi/,  a  few  hours  after  death.—  The  operation 
wound  was  perfectly  healed,  and  there  was  no  evi- 
dence of  return  of  the  disease  at  that  jjoint. 

Thoracic  carily. — The  right  pleural  cavity  con- 
tained about  eight  gallons  of  clear,  serous  fluid,  the 
left  equally  as  much.  The  diaphragm  was  a  thick- 
ened mass  of  new  gi'owths ;  the  costal  pleura  was 
covered  with  round  tumors,  varying  in  size  from 
that  of  a  pea  to  that  of  a  hen's  egg.  The  right  lung 
was  also  thickly  studded  with  pinkish  white  masses, 
varying  much  in  size.  Most  of  the  growths,  espe- 
cially the  smaller  cues,  were  of  a  soft  consistency ; 
some  of  the  larger  ones  seemed  to  have  also  some 
fibrous  elements.  Kew  growths  were  distribiited 
through  the  left  lung,  over  the  left  costal  i:)leura,  and 
in  the  diaphragm,  but  were  really  more  abundant 
than  uijon  the  right  side.  Some  of  the  abdominal 
organs  seemed  to  be  involved,  but,  owing  to  the  in- 
completeness of  the  necropsy,  nothing  positive  was 
determined  ujion  that  point. 

E-iamination  of  tlie  tumors  macroscopicall;) . — They 
were  whitish  in  color,  marbled  with  a  pale  pink.  In 
some  of  them,  dark,  almost  black,  sj^ots  were  met 
with,  as  if  they  were  deejjly  pigmented.  The  smaller 
masses  were  very  soft  when  isolated,  and  easily 
broke  down  under  the  slightest  pressure.  When  only 
a  single  mass  existed  at  a  given  point,  it  seemed  to 
be  encapsulated  by  a  thin  layer  of  distinct  tissue. 

Microscopic  examination. — Scrapings  of  the  juice 
from  the  cut  surface  showed  only  large  round  con- 
nective-tissue cells  and  blood-corpuscles.  Sections 
from  the  tumors  show  at  points  a  distinct  reticu- 
lated stmcture,  closely  packed  with  these  large 
round  cells ;  at  other  points  only  large  round  cells 
imbedded  in  a  homogeneous  matrix  could  be  seen — 
the  growth  resembled  somewhat  a  medullary  car- 
cinoma—  they,  however,  were  very  vascular,  and 
contained  numerous  extravasations  of  blood.  The 
black  points  recognized  with  the  naked  eye  apjjeared 
under  the  microscope  like  the  deposits  in  the  mela- 
notic sarcoma  found  in  the  human  body.  It  was 
without  doubt  blood-pigment,  and  not  masses  of 
carbon  parotitis,  commonly  met  with  in  lung-tis- 
sue. In  sections  made  from  the  tumors  in  the  lung- 
substance,  numerous  yellow  elastic  fibres  were  seen 
running  in  various  directions ;  also,  in  many  in- 
stances, the  true  pulmonai-y  tissue  was  present. 
This  condition  would  lead  one  to  suppose  that  the 
new  material  had  been  deposited  in  and  around  the 
vesicular  tissue,  and  not  at  its  expense.  In  some 
of  the  larger  masses,  considerable  fibrillated  connec- 
tive tissue  had  been  developed,  forming  numerous 
bands,  running  in  various  du-ections.  The  micro- 
scopic appearance  of  the  primary  tumor  and  the 
secondary  deposits  was  almost  identical. 

The  sj^ecimen  was  interesting  as  an  illustration 
of  a  third  form  of  sarcoma  in  the  lower  animals, 
also  as  a  specimen  in  comparative  pathology.  In  a 
surgical  point  of  view,  the  case  showed  what  relief 
can  be  given  to  animals  as  well  as  man,  and  the 


health  was  apparently  improved.  The  improvement 
of  the  animal  after  the  operation  would,  in  future, 
be  a  warning  to  surgeons  to  operate  early  and  thus 
relieve  the  suflering,  and  perhaps  prolong  life. 

Dr.  J.  0.  Peters  remarked  that  " pink-e\e "  in 
horses  was  analogous  to  scarlatina  in  man  ;  at  least 
the  two  diseases  had  several  symptoms  in  common, 
the  most  prominent  of  which  were  swelling  of  the 
glands  of  the  neck,  swelling  of  the  legs,  and  dis- 
turbances of  the  kidneys.  He  thought  it  to  be  un- 
doubtedly contagious  among  horses,  but  had  never 
heard  of  its  being  transmitted  from  animals  to  man. 
The  French  had  regarded  it  as  a  form  of  scarlet 
fever  occumng  in  horses. 

rSCAKCERATED    FE5I0KAL    EPEPLOCELE — KEMOVAL    OF 
THE   MASS — KECOVEKY. 

Dr.  Wxeth  presented  a  specimen,  with  the  follow- 
ing history:  The  patient  was  a  German  by  birth, 
forty-two  years  of  age,  and  a  laborer.  His  family 
history  was  unimportant,  except  that  his  father  had 
a  hernia.  Twenty  years  ago  he  had  gonon-htta  and 
an  accompanying  swelling  in  the  right  groin,  and 
occasionallv  '-cramps"  at  this  point.  The  tumor 
diminished  to  a  small  lump,  half  as  large  as  an  egg. 
At  varying  intervals,  up  to  1881,  the  swelling  had  in- 
creased and  diminished,  giving  him  always  more  or 
less  inconvenience.  Two  weeks  before  admission, 
while  doing  heavy  work  as  a  railroad  hand,  the  tu- 
mor suddenly  increased  in  size,  and  gave  him  great 
pain.  During  the  following  night  he  vomited  pro- 
fusely. The  next  day,  he  says,  the  tumor  was  par- 
tially reduced  by  a  doctor.  On  admission,  patient 
in  good  general'condition  ;  hard,  non-elastic  swell- 
ing, as  large  as  a  hen's  egg,  in  right  "Scarpa's 
space,"  which  was  irreducible.  Diagnosis  :  incar- 
cerated femoral  epiplocele,  and  operation  advised, 
since  his  condition  would  not  admit  of  his  wearing 
a  truss,  and  it  was  impossible  for  him  to  work  with- 
out it.  June  12th  he  cut  down  on  the  mass,  followed 
it  into  the  outer  opening  of  the  femoral  canal,  which 
it  completely  plugged,  removed  the  sac,  and  having 
tied  the  neck  of  the  epiplocele  securely,  it  was  cut 
awav.  The  patient  recovered,  and  was  discharged 
as  cured  on  the  24th  of  July,  forty-two  days  after  the 
operation. 

At  the  time  of  this  report,  over  six  months  after 
the  operation,  the  patient  is  able  to  work  as  a  labor- 
er by  wearing  a  truss.  Upon  the  removal  of  the 
truss,  a  slight  hernia;  which  is  readily  reducible,  pro- 
trades  at  the  femoral  canal. 

Dr.  "Wyeth  also  presented  a  specimen  of 

CYSTO-ADEKOMA   OP   THE   TUIKCID 

removed  bv  operation.     (See  p.  94.) 

Dr.  Beverly  Kobinson  presented  three  speci- 
mens, with  histories,  furnished  by  Dr.  William  C. 
Campbell,  house  physician  at  St.  Luke's  Hospital. 

The  first  was  a  specimen  of 

ATROPHY   OF   THE  LUNG, 

removed  from    the   body  of  A.   B ,  thirty-five 

years  of  age,  a  native  of  Germany,  and  a  juano- 
tuner,  who  gave  a  family  history  of  pulmonary. 
})hthisis,  and  a  personal  histoiy  of  having  sufl'ered 
from  that  disease  during  the  last  three  years. 

At  the  autopsy,  both  lungs  were  found  firmly 
bound  to  the  chest-walls  by  old  adhesions.  The 
right  vi'as  markedly  emphysematous  ;  was  the  seat  of 
hvpostatic  congestion  in  the  lower,  and  of  fibrous 
phthisis  in  the  upper  half,  and  the  upper  portion  of 
the  middle  lobe  was  tuberculous.     The  lung  was  en- 


J  06 


THE  MEDICAL  RECORD. 


larged,  so  as  to  extend  over  upon  the  left  side  con- 
siderably. Its  weight  was  two  pounds  and  fourteen 
ounces.  There  were  evidences  of  clironic  bronchitis. 
The  left  lung  was  compressed  upward  and  backward 
ag.iinst  the  vertebral  column,  and  was  about  the 
size  of  a  closed  liand.  The  first  bifurcation  of  the 
bronchus  extended  to  the  limits  of  the  lung,  and  the 
pulmonary  tissue  about  it  was  in  a  state  of  cheesy 
degeneration.  The  air-cells  were  completely  oblit- 
erated.   Weight,  twelve  and  one-half  ounces. 

The  liver  was  enlarged  and  fatty.  The  Icidneys 
were  large  and  white.  Tlie  pericardium  contained 
half  an  ounce  of  clear  serum  ;  there  were  a  few  lon- 
gitudinal adhesions  upon  the  left  side  of  the  heart ; 
the  ventricles  were  distended  with  currant-jelly  clots, 
and  the  valves  were  normal.  The  interest  in  the 
specimen  centred  in  the  condition  of  the  left  lung, 
probably  due  to  the  contraction  of  a  hypertrophied 
pleural  membrane,  the  result  of  a  previous  pleurisy. 

The  second  specimen  was  a  heart,  removed  from 
the  body  of  O.  S ,  thirty-four  years  of  age,  mar- 
ried, who  was  admitted  December  3,  1881.  It  il- 
lustrated extensive  ____^^___^_^^__^^ 

CALCAKEOCS   DEGENERATION    OF   THE   AORTIc[aND 

MITKAL   V.ILVES. 

The  patient  gave  the  history  of  rheumatism  occur- 
ring at  vai'ious  times  since  he  was  ten  years  old. 
Twelve  years  ago  he  first  began  to  have  palpitation. 
There  were  no  cerebral  symptoms.  The  attacks 
wei'e  of  short  duration,  and  occurred  at  long  inter- 
vals. The  patient  did  not  suiJer  very  much  until 
last  October,  when  he  had  severe  attacks  of  dyspnoea 
and  cougliing,  and  at  the  same  time  the  swelling  of 
the  ankles,  which  had  been  slight  during  the  sum- 
mer, became  very  marked.  On  admission,  it  was 
found  that  the  area  of  pra!Cordial  dulness  was  in- 
creased ;  the  apex  was  beating  in  the  left  sixth  inter- 
costal space  ;  and  there  was  undoubted  evidence  of 
aortic  and  mitral  regurgitation.  Subcrepitant  rfdes 
■were  heard  posteriorly  at  the  bases  of  both  lungs. 
The  urine  contained  hyaline  and  epithelial  casts, 
albumen  thirty  per  cent.,  had  an  acid  reaction,  and 
a  specific  gravity  of  1020.  The  patient  died  coma- 
tose, December  li)th,  the  heart  coutinuing  to  beat 
for  thu-ty  seconds  after  breathing  had  ceased. 

The  third  was  a  specimen  of  marked 

MriRAL   STENOSIS. 

The  heart  was  removed  from  the  body  of  J.  D , 

thirty- eight  years  of  age,  a  widow,  teacher,  who  was 
admitted  November  19,  1881.  For  the  last  seven 
years  the  patient  was  a  confirmed  invalid,  .sufl'ering 
from  dyspnnea  which  gradually  increased  in  severity. 
There  was  no  oedema.  She  gradually  lost  flesh  and 
strength,  but  was  able  to  attend  to  her  duties  until 
within  a  month  of  her  admission  to  the  hospital, 
when  she  was  prostrated  with  symptoms  of  pelvic 
abscess.  When  admitted  she  was  extremely  ante- 
mic,  weak,  vomited  occasionally,  and  complained  of 
great  distress  in  the  region  of  the  stomach  after 
eating.  She  was  restless  and  suffered  from  insom- 
nia, and  lier  bowels  were  constipato<l.  Tliere  was  no 
oedema  nor  cerebral  symptoms.  The  urine  had  a 
specific  gravity  of  1031) ;  reaction  acid,  microscopi- 
cal examination  negative,  contained  abundance  of 
urates.  A  presystolic  murnmr  was  hoard  with  its 
greatest  intensity  about  the  middUiof  the  sj)ace  be- 
tween tlio  left  nipple  and  tlio  centre  of  the  sternum. 
There  was  no  i)urring  thrill.  TIhmc  was  marked 
dvspncea.  The  pulse  was  irregular,  although  strong. 
The  diagnosis  of  mitral  stenosis  and  regurgitation 


was  made.  The  dyspnoea  increased,  the  jiatient  be- 
came delirious,  sank  into  a  comatose  condition,  and 
died  November  30th  at  three  a.m. 

The  autopsy  was  made  December  1,  1881,  by  Dr. 
E.  C.  Wendt.  The  upper  half  of  the  body  was 
somewhat  emaciated  ;  the  lower  half  was  well  noui'- 
i.shed.  Slight  cudema  of  the  lower  extremities. 
Rigor  mortis  absent.  Twenty  ounces  of  flocculent 
fluid  was  found  in  the  abdominal  cavity.  There 
were  twenty-four  ounces  of  fluid  in  the  right,  four 
ounces  in  the  left  pleural  cavity,  and  four  ounces  in 
the  pericardium.  [There  was  no  evidence  of  fluid 
in  either  of  these  cavities  at  the  last  examination, 
twelve  hours  before  death.] 

The  right  lung  contained  several  recent  hemor- 
rhagic infarctions  in  the  lower  part  of  the  upper 
lobe,  and  there  was  a  single  small  one  in  the  poste- 
rior pai-t  of  the  left  lung. 

The  heart  weighed  thirteen  ounces.  The  cavities 
of  its  right  side  were  dilated.  There  was  marked 
stenosis  of  the  mitral  orifice,  not  admitting  a  single 
finger  ;  the  curtains  of  the  valve  were  contracted  and 
cicati-icial.  There  was  no  hypertrophy  of  the  left  ven- 
tricle, and  only  very  slight  dilatation.  The  aortic 
valves  were  normal.  The  liver  presented  the  nut- 
meg appearance,  and  was  enlarged.  The  kidneys 
were  congested.  The  stomach  presented  evidence 
of  gastritis.  The  spleen  was  small.  The  vtei-vs  was 
bound  down  by  adhesions,  and  an  abscess  was  found 
in  the  left  ovary. 

Dr.  Robinson  remarked  that  he  had  often  heard 
of  and  had  read  of  the  existence  of  mitral  steno- 
sis and  of  its  being  diagnosticated  before  death,  but 
he  had  not  been  able  to  find  a  case  in  which  such  a 
diagnosis  was  made  and  afterward  confirmed  by  au- 
topsy, until  he  obtained  the  specimen  presented. 

The  Pbesident  remarked,  with  reference  to  the 
question  of  the  complete  destruction  of  lung-tissue, 
that  it  was  a  very  common  saying  that  patients  had 
only  one  lung  left,  but  he  had  never,  except  in  one 
instance,  seen  so  complete  absence  of  the  aerating 
structure  of  the  lung  as  was  manifest  in  the  speci- 
men presented.  In  the  specimen  referred  to,  an 
account  of  which  had  already  been  published  by 
Dr.  Alonzo  Clark  (see  Medical  Recced,  vol.  x.,  p.  1), 
the  nodule  was  still  smaller  than  that  in  the  speci- 
men presented  by  Dr.  Robinson,  and  death  occurred 
as  a  result  of  hemorrhage  from  the  other  lung.  He 
believed  it  to  be  rare  to  find  such  complete  obliter- 
ation of  the  lunjr  as  seemed  to  be  present  in  the 
specimen  Dr.  Robinson  had  exhibited. 

Dr.  William  H.  Porter  said  that  in  the  speci- 
men which  he  presented  at  the  last  stated  meeting 
of  the  society,  there  was  no  lung-tissue  remaining, 
it  was  simply  a  fibrous  mass  (carnification  of  the 
lung  the  result  of  pleurisy  witli  effusion  and  empy- 
emaV  It  was  the  left  lung  that  was  affected ;  the 
right  lung,  in  his  case,  did  not  project  beyond  the 
median  line. 

The  society  then  went  into  executive  session. 


<v  the  Cervix. — 
month,  with  opi-    I 


Preonanct,  with  Epithelioma  of 
A  case  of  pregnancy  at  the  sixth 
thelioma  of  the  cervix,  was  rei)orted  to  the  I^ondon 
Obstetrical  Society  by  Dr.  Edis.  The  Porro-Freund 
operation  was  inadmissible,  because  the  vaginal  wall 
was  implicated.  The  cpu'stion  of  what  ought  to  be 
done  was  disc\issed.  The  couclnsion  of  most  was 
that  the  woman  should  be  allowed  to  go  on  to  full 
term,  then  the  Cojsarian  operation  might  be  per- 
formed. 


THE   MEDICAL  RECORD. 


107 


■    OBSTETRIC   SECTION  OF  NEW  YORK      ] 
ACADEMY  OF   IVIEDICrNE. 

Stated  Meeting,  October  27,  1881. 

Dr.  Henky  E.  Cr.vmpton,  CHAiRM.4i>r. 

THROUGH   AND   THROUGH   DRAINAGE  IN  CHRONIC   PELVIC 
ABSCESS. 

Dr.  Ch-veles  a.  Leale  gave  a  histoyy  of  the  fol- 
lowing imiqiie  surgical  operation  for  the  relief  of 
pelvic  cellulitis  of  over  thirteen  vears'  duration, 
when  the  pelvic  abscess  had  discharged  through  a 
rent  into  the  rectum  one  iach  above  the  internal 
sphincter  ani  muscle. 

Mrs.   S ,   thirty-three  years  of  age,  otherwise 

perfectly  healthy,  at  the  age  of  nineteen  years  had  an 
abortion  at  six  weeks,   followed  by  metritis,- pelvic 
cellulitis,  and  painful  adhesions,  giving  her  distress 
at  each  subsequent  menstruation.     During  the  sum- 
mer of  1881  she  came  under  the  care  of  Dr.  J.  H. 
Fruitnight,  who,  after  getting  her  in  as  good  a  condi- 
tion as  possible,  requested  Dr.  Leale  to  see  her  with 
him  on  October  21st,  to  decide  in  regard  to  the  pro- 
priety of  performing  an  operation  for  a  permanent 
cure  of  the  large  pelvic  abscess.     On  that  day  they 
found  that  very  large  quantities  of  pus  discharged 
from  the  pelvic  abscess  through  an  opening  into  the 
rectum  about  one  inch  above  the  internal  sphincter 
ani  muscle,  and  October  2.5th  was  named  as  the  day 
for  operating.     Present,  Dr.  Leale,  Dr.  J.  H.  Fniit- 
night.  Dr.  A.  M.  Jacobus,  Dr.   Harwood,  and  Dr. 
Wm.  Fruitnight.     A  grand  square   piano,  covered 
with  a  thin  mattress  and  blanket,  gave  an  excellent 
operating-table.      The  jiatient  was  readily  brought 
under  the  influence  of  sulphuric  ether  by  Dr.  ^Vil- 
liam  Fruitnight,  and  after  being  placed  in  the  posi- 
tion  for   lithotomy,   a   thorough   investigation  was 
made  to  complete  the  diagnosis.     While  doing  this 
with  a  Nott's  speculum  iu  the  rectum,  large  quan- 
tities of  exceedingly  offensive  fecal  pus  were  seen 
flowing  from  the  pelvic  abscess  through  the  large 
fistulous  opening  into  the  gut.     By  vaginal  and  ex- 
ternal manipulation  a  mass  was  found,  the  size  of  a 
fetal  head  at  nine  months,  filling  the  pelvic  cavity. 
"When  pressure  on  this  was  made,  pus  flowed  from 
the  rectal  opening.     The  pus  in  the  abscess  con- 
tained particles  of  fecal  matter,  showing  that  faeces 
passed  into  the  suppurating  pelvic  cavity,  demon- 
strating  an   additional  source   of   imtation.       The 
offensive   smell  was  beyond   description,  and   had 
been  the  most  loathsome  part  of  the  trouble  for  the 
sufiferer  to  bear.    On  introducing  the  finger  through 
the  anus  the  sinus  was  easily  felt,  and.  as  an  exten- 
sive suppurating  cavity  existed,  it  was  decided  to 
make  the  throvrih  and  through  dr/thiage,  as  being  the 
best  to  accomplish  the  most  effectual  result.  Accord- 
ingly Dr.  Leale  made  an  incision  in  the  right  gi'oin, 
below  Poupart's  ligament,  the  same  as  he  does  for 
ingriinal  hernia,  and  extended  the  opening  through 
the  abscess-cavity  of  the  pelvis  into  the  rectum,  at 
the  point  of  the  fistulous  opening,  without  entering 
the  peritoneal  cavity  ;  through  this  opening  he  drew 
a  drainage-tube,  Xo.  12,  English  measurement.    Pus 
flowed  freely  through  this  tube,  but  it  was  thought 
advisable  to  have  a  second   di-ainage  through    the 
vagina,  thereby  having  one  drainage  from  the  gi'oin 
to   the   rectum  and  out  by  the  anus,  and  another 
through   the  groin   to  the   abscess-cavity,    through 
Douglas'  cul-de-sac,  and   out  by  the  vagina.      The 
old  pelvic  abscess  could  now  easily  be  washed  out 


by  streams  of  weak  disinfectants,  and  applications 
made  to  the  pyogenic  membrane.  On  the  seventh 
day  after  the  operation,  October  31st,  the  patient, 
was  in  a  very  comfortable  condition.  There  had 
been  no  peritonitis,  and  the  wounds  were  s-uppura- 
ting  well  ;  two  or  three  times  a  day  the  pus  was 
washed  out,  and  all  ai)i)eared  in  a  prosperous  con- 
dition to  accomplish  the  desired  result,  riz..  a  com- 
plete cure  after  trouble  of  over  thirteen  years'  dura- 
tion. As  usual  in  these  cases,  the  patient  had  taken 
morphia  for  a  long  time. 

Dr.  C.  A.  Leale  stated  that  he  had  seen  a  similar 
case  to  that  noticed  by  Dr.  J.  Lewis  Smith,  where 
the  ulceration  of  the  bowels  and  subsequent  per- 
foration caused  what  is  known  as  a  cold  abscess,  and 
lasted  for  years,  which  he  finally  cured  by  an  oper- 
ation through  the  abdominal  walls  at  the  csecum. 
He  considered  that  these  idiopathic  instances  of  in- 
flammation of  the  ciEcum  and  its  surrounding  areolar 
tissue  occasionally  lead  to  perforative  ulceration,  and 
was  generally  followed  by  circumscribed  peritonitis 
and  an  abscess.  This  abscess  tended  either  to  dis- 
charge spontaneously  into  the  intestine,  in  -s^hich 
case  temporary  recovery  usually  followed,  or  to  rup- 
ture into  the  ca\'ity  of  the  peritoneum,  when  usually 
death  soon  ensued  from  shock  or  exhaustion. 

Dr.  Leale  gave  the  following  histories  of  two  cases 
operated  on  liy  him  : 

ABSCESS   ESIPTYtNG   INTO   THE   CiECUM. 

A.  W.  G ,   aged   fourteen   years,  had   always 

been   a  delicate  boy  since  the   age  of  two   years, 
when,    from   improper    diet,  he   contracted  gastro- 
enteritis, and,   as   a   sequel,   bloody   dysentery  fol- 
lowed for  several  months.     His  mother  was   stru- 
mous, and  his  father,  at  the  time  of  operation,  was 
I   an    inmate    of    the    Lunatic    A.sy]um,    Blackwell's 
I   Island.     The  father  had  never  had  syphilis,  but  was 
rickety,  and  had  a  large,  irregular  cranium.     The 
child  had  always  been  feeble,  and  since  his  attack 
of  intestinal  trouble  at  two  years  of  age,  he  had  ten- 
:   derness,  on  pressure,  in  the  right  ileo  ca-cal  legitn, 
I   with  occasional  tumefaction  and  fever.     The  mother 
:  noticed  that  his  trouble  was  always  relieved  when  he 
passed  pus  iu  the  evacuations  from  the  bowels.  The 
j   original  abscess  had  opened  into   the  intestines  at 
I   the  csecum,  so  far  as  could  be  judged,  and  -while 
this  abscess  continued  to  discharge  the  boy  kept 
well.     "When  the  pus  accumulated,  unpleasant  symp- 
toms followed  until  nature  aftbrded  an  exit  by  the 
!   perforation  of  the  bowel.     Thus  he  continued  in  a 
delicate  condition  until  the  operation,  June  9,  1872. 
Ten   days   prior  to  that,  while  at  a  picnic,  and 
taking  unusually  violent  exercise,  he  was  suddenly 
seized  with  intense  pain  in  the  right  iliac  region. 
He  had  profound  collapse,  and  was  earned  home, 
after  which  a  hardness  and  tumefaction  at  this  point 
increased,  but  there  was  no  discharge  of  pus  from 
I   the  bowels.     When  Dr.  Leale  first  saw  him,  deep- 
seated,  circumscribed  fluctuation  was  detected.    He 
had  hectic  fever  and  great  pain   on  pressuie.     Dr. 
Leale  made  an  opening  with  a  scalpel  one-third  the 
,   distance  from  the  anterior  superior  spinous  process, 
on  a  line  to  the  umbilicus  and  through  to  the  deep 
fascia ;    then    he    explored    with    a   needle    passed 
through   the  peritoneum,  and  on  finding  fecal  pus 
I   by  suction  with  a  hypodermic  syringe,  made  an  in- 
!   cision  cue  inch  long,  evacuating  very  thick,  cheesy 
pus,  having  an  intensely  offensive  smell.    The  wound 
discharged    freely,  and  was  kept  cleansed  with  liq. 
sodse  chlor.  dil.  for  seven  days,  after  which  it  healed, 
.  never  again  to  refill,  and  two  years  after  the  opera- 


108 


THE  MEDICAL  RECORD. 


tion  the  boy  was  in  the  enjoyment  of  good  health. 
His  right  leg,  because  of  partial  disuse  for  so  many 
years,  was  half  an  inch  shorter  than  its  fellow,  and 
its  symmetrical  development  permanently  prevented. 
Dr.  Leale  also  gave  the  history  of  the  following 
case  of 

PEKFORATION   OF   THE   APPENDIX   VERMIFOBMIS. 

G.  S ,  aged  twenty-three  years,  had  a  circum- 
scribed hardnes.s,  commencing  in  the  right  iliac 
fossa,  and  gradually  extending  in  all  directions  fi-om 
the  position  of  the  cajcum,  until  it  reached  a  circum- 
ference of  over  twelve  inches.  He  was  kept  as  quiet 
as  possible,  anodynes  given  to  allay  pain,  and  hot 
fomentations  were  applied  directly  over  the  seat  of 
the  induration,  until  fliictuation  could  be  detected. 
Dr.  Leale  first  explored  with  the  usual-sized  explor- 
ing-needle,  followed  by  the  director.  Subsequently, 
on  enlarging  the  oj^ening  to  the  extent  of  one  inch, 
at  least  ten  ounces  of  exceedingly  offensive  fecal  pus 
came  out. 

In  the  d.ischarge  six  or  eight  small  masses  of  fieces 
were  extruded,  which  were  of  the  shape  and  size  of 
those  usually  found  in  the  ajjpendix,  showing  that 
they  must  have  been  moulded  as  they  jjassed 
through  this  small  opening  from  the  intestines.  The 
patient  being  exceedingly  thin,  the  boundaries  of  the 
abscess  could  be  easily  felt  externally  with  the  fin- 
gers, by  gliding  the  end  of  a  silver  catheter  ai'ound 
the  cavity. 

The  cavity  was  kept  thoroughly  cleansed,  and  all 
done  to  increase  the  appetite  and  strength  of  the 
patient.  In  two  weeks  convalescence  was  complete, 
excepting  a  weakness  of  the  abdominal  walls,  which 
remained  for  months.  To  prevent  a  rupture  he  wore 
an  abdominal  supporter  for  a  year,  after  which  time 
there  was  no  further  trouble. 


SUtted  Meeling,  December  22,  1881. 
Db.  Henry  E.  Cbampton,  Chairman. 
Dr.  Joel  Foster  reported  a  case  of 

PELVIC    CELLULITIS,    WITH   ABSCESS, 

of  four  or  five  montlis'  standing,  and  spontaneous 
rupture  into  the  vagina.  The  patient  was  sixty-one 
years  of  age,  and  had  not  suffered  from  any  symp- 
toms, except  slight  pain,  and  the  gradual  growth  of 
a  tumor  beginning  in  the  lower  part  of  the  abdomen, 
upon  the  right  side,  and  finally  reaching  consider- 
ably above  the  umbilicus.  Tlie  abscess  discharged 
about  one  quart  of  offensive  material.  The  walls  of 
the  abdomen  at  the  last  examination  were  pliable  ; 
no  tumor  could  be  felt,  but  the  cervix  was  liard  and 
enlarged,  and  suggested  to  him  the  possibility  of 
cancer.  The  opening  through  which  the  abscess 
evacuated  itself  was  situated  about  half  an  inch  to 
the  right  of  the  cervix. 

Dr.  H.  T.  Hanks  believed  that  Dr.  Foster's  case 
was  one  of  suppurative  pelvic  cellulitis,  and  that  the 
induration  remaining  would  probably,  at  least  to  a 
large  oitent,  disappear.  At  all  events,  the  hard  en- 
largement of  the  cervix  doubtless  was  benign  in  char- 
acter. 

STENOSIS,  WITH  IMPERFECT  DEVELOPMENT  AND  M.ALl'OSI- 
TION   OF   THE   CERVIX   irrURI. 

Db.  a.  C.  Post  narrated  a  case  as  follows  :  The  pa- 
tient was  twenty-two  years  of  age,  unmarried,  and 
had  suffered  severely  from  dysmenorrhoca  ever  since 


the  beginning  of  menstmation.  The  cervix  uteri 
seemed  to  be  imperfectly  developed  ;  it  inclined 
backward  rather  than  forward ;  the  orifice  of  the  ex- 
ternal OS  admitted  only  the  smallest  size  Peaslee's 
sound,  and  he  was  unable  to  introduce  any  instru- 
ment, either  flexible  or  solid,  and  bent  at  differ- 
ent angles  and  turned  in  all  directions,  more  than 
one  inch.  That  there  was  a  cavity  beyond  that 
depth,  rudimentary  at  least,  he  did  not  doubt.  He 
instituted  gradual  dilatation  as  the  esjjecial  plan  of 
treatment,  and  suiaplemented  it  with  vaginal  injec- 
tions of  hot  water.  The  result  had  been  that  he 
was  able  to  pass  the  largest  size  of  Peaslee's  sounds 
easily,  and  to  nearly  the  normal  depth.  The  patient 
still  has  jjain  at  the  menstrual  jieriod,  diminished  in 
severity,  however,  and  her  general  health  has  im- 
proved very  much.  The  position  of  the  cervix  had 
changed  during  the  treatment,  so  that  the  instru- 
ment finally  passed  in  the  normal  direction.G 

EXTREME  UTERINE  FLEXION — DILATATION — CONCEPTION. 

Dr.  a.  S.  Hi'NTEU  reported  a  case  as  follows ;  A 
sterile  woman  had  corporeal  flexion  of  the  uterus  to 
an  extreme  degree,  the  organ  being  rolled  up  so  as 
to  be  nearly  round.  She  had  suffered  intensely  from 
dysmenorrhea,  had  had  such  severe  straining  and 
bearing-down  2iains,  and  for  so  long  a  time,  that  the 
uterus  was  upon  the  floor  of  the  jjerineum.  The 
treatment  consisted  in  the  use  of  hot-water  vaginal 
injections,  maintaining  the  pelvis  in  an  elevated 
position  for  half  an  hour  after  each  one,  and,  after 
the  congestion  and  tenderness  had  subsided,  intro- 
ducing a  laminaria-tent,  previously  wet,  shaped  to 
corresjjond  to  the  curve  of  the  cervical  canal,  and 
dried.  The  patient  was  kept  in  bed  while  the  tent 
was  in,  and  the  dilatation  occurred  without  accident. 
Afterward  he  used  a  bivalve  dilator,  candying  on 
the  dilatation  gently,  and  finally  succeeded  in  re- 
ducing the  curve  in  the  uterus  considerably.  The 
woman  conceived,  and  subsequently  passed  through 
a  normal  labor.  Her  jjregnancy  was  quite  painful, 
the  pain  being  due,  as  Dr.  Hunter  suggested,  to 
traction  upon  the  shortened  anterior  wall  of  the 
uterus.  To  relieve  or  diminish  the  uterine  irrita- 
tion, he  administered,  foui-  times  daily,  ten  drops  of 
the  mother-tinctui'e  of 

CAULOPHYLLUM   THALACTOIDES, 

and  with  very  marked  benefit.  He  had  used  this 
drug  in  several  cases  in  which  a  uterine  sedative 
seemed  to  be  indicated,  and  with  good  results  in 
each,  instance.  There  was  some  difficulty  in  obtain- 
ing a  reliable  tincture  of  the  drug. 

Dr.  Griswold  narrated  a  case  as  follows :  Three 
months  ago  he  was  called  to  see  a  primiparous 
woman,  who  had  been  in  labor  one  week,  during 
which  time  there  had  been  constant  flowing  of  am- 
niotic flnid,  stained  with  meconium.  By  ordinary 
digital  examination  he  was  imable  to  find  the  os 
uteri.  The  patient  was  then  placed  in  the  (Sims 
position,  when  he  thought  he  detected  sometliing 
high  above  the  pubis  that  appeared  as  if  it  might 
be  the  os.  On  the  next  day  the  woman  was  anaes- 
thetized (ether),  the  w\\\a,  dilated,  and  the  os  found 
high  above  the  pubis ;  the  cervix  was  small,  but 
very  dilatable.  The  finger  was  introduced,  dilatation 
carried  on,  and  soon  it  engaged  in  the  internal  os. 
Then,  by  means  of  external  pressure,  with  the  fin- 
gei'S  in  the  cervix,  he  was  able  to  rotate  the  uterus 
into  place,  and  found  that  the  feet  were  i>resenting, 
with  the  face  forward.  The  child  was  macerated  so 
that  the  oi)idermis  readily  slipped  off,  but  he  sue- 


THE   MEDICAL  RECORD. 


109 


ceeded  in  turning  it  without  difficulty,  and  nearly 
completed  the  deliveiy,  when  further  progress  was 
entirely  arrested,  although  he  endeavored  for  some 
time  to  terminate  the  labor  without  resorting  to  the 
use  of  instruments.  Not  succeeding,  he  applied 
the  forceps,  and  while  making  almost  no  traction, 
something  suddenly  gave  way,  and  the  delivery 
was  at  once  effected.  On  inspection,  it  was  found 
that  complete  rupture  of  the  jjerineum  had  oc- 
cuired.  The  wound  was  closed  immediately,  and 
the  woman  recovered  without  a  single  bad  symptom, 
although  there  was  a  case  of  sepsis  in  the  same 
house.  All  that  he  attemjited  to  do  in  tlie  primary 
operation  was  to  close  the  rent  in  the  rectum,  leav- 
ing the  perineum  to  be  operated  ujjon  subsequently. 
One  point  in  the  after-treatment  consisted  in  Ipq^ing 
the  bou-els  opeyi  from  the  beginning,  and  that  was  ac- 
complished by  the  conjoined  use  of  enemata  and 
teaspoonful  doses,  a  half-tumblerfnl  of  water,  of 
the  compound  licorice  powder  (German  Pharma- 
copoeia). Examination  also  revealed  as  the  original 
source  of  the  difficult  labor,  a  large  subperitoneal 
fibroid  attached  to  the  side  of  the  uterus,  and 
partly  engaged  in  the  broad  ligament. 
I!.    Pulv.  glycyiTh.  rad.  and  pulv.  sennte.   .aS   ?  ss. 

Siilphuris  sublim.  and  pulv  f(_eniculi.. .  .Sa    3  ij. 

Sacchar.  purif §  iss. 

M.  S. — Teaspoonful  a  half-cupful  of  water  at  bed- 
time. 

Dr.  a.  S.  HrxTER  said  that  the  last  seven  or  eight 
times  he  had  operated  for  lacerated  jierineum  he  had 
not  tied  the  limbs  together  nor  drawn  the  urine,  and 
he  had  allowed  the  bowels  to  move.  In  none  of  the 
cases  had  he  had  any  reason  to  regret  adopting  that 
plan  of  after-treatment.  He  believed  that  the  knees 
might  be  separated  to  the  extent  of  eighteen  or 
twenty  inches  without  putting  any  strain  ujjon  the 
perineum.  If  the  laceration  was  closed  immediately 
after  delivery,  it  was  desirable  to  atiord  opportunity 
for  all  the  secretions  to  flow  away  ;  but  if  the  limbs 
were  kept  close  together,  the  position  favored  the 
retention  and  percolation  of  the  lochia  and  other 
discharge  between  the  torn  surfaces.  He  believed 
that  primary  union  was  favored  by  allowing  the 
limbs  to  be  separated.  If  the  surfaces  were  properly 
united,  the  urine  would  not  get  between  them  and 
prevent  primary  union,  and  certainly  union  by  first 
intention  would  not  take  place  unless  the  surfaces 
of  the  wound  were  brought  into  complete  coapta- 
tion. 

Db.  H.  T.  Hanks  believed,  with  reference  to  keep- 
ing the  knees  together,  that  there  would  probably 
be  no  trouble  in  allowing  them  to  remain  free,  pro- 
vided that,  when  the  limbs  were  flexed  or  .separated, 
the  flexion  or  separation  was  equal  upon  both  sides  ; 
but  there  was  such  a  possibility  that  the  woman 
might  draw  up  one  limb  sufficiently  to  certainly 
separate  the  parts,  he  thought  it  not  well  to  take 
the  risk  and  leave  the  limbs  unfastened.  The  dis- 
charge of  the  secretions  could  be  favored,  as  well  as 
the  irksomeness  of  the  restrained  positiim  be  re- 
lieved, by  placing  a  sponge  between  the  knees. 

With  reference  to  drawing  the  urine,  it  had  been 
his  custom  to  use  the  catheter  himself  during  the 
fir.st  twenty-four  hours,  after  which  the  patient  was 
permitted  to  pass  her  water  without  assistance. 

With  reference  to  the  bowels,  he  favored  keep- 
ing them  open  from  the  beginning.  Dr.  Hanks  also 
advised  the  immediate  operation  when  it  was  pos- 
sible to  perform  it.  He  had  performed  it  in  thu-- 
teen  cases,  and  in  only  two  had  the  secondary  opera- 


tion been  required,  and  in  every  instance  where  he 
kept  the  bowels  open  the  results  were  all  that  could 
be  desired. 

Dr.  Hunter  recalled  two  eases  in  which  the 
bowels  were  kept  confined  for  a  week  or  more,  and 
then  opened  with  ca.stor-oi!  followed  by  enemata, 
and  careful  breaking  up  of  the  fecal  masses  as  they 
came  down  into  the  rectum.  The  results  were  ex- 
cellent. 

Dr.  Hanks  did  not  doubt  that  good  results  could 
be  obtained  when  the  evacuation  of  the  bowels  was 
carefully  and  personally  superintended,  as  it  had 
been  by  Dr.  Hunter ;  but  he  believed  that  the 
chances  of  securing  such  attention  were  not  good  in 
very  many  cases,  and  that  satisfactory  retults  would 
be  obtained,  under  ordinary  circumstances,  more 
frequently  by  keeping  the  bowels  open  than  by  se- 
curing constipation. 

Dr.  Foster  said  that  in  quite  a  large  obstetric 
practice,  during  the  last  thirty  years,  he  had  not  had 
a  case  of  rupture  of  the  perineum  which  reqiiired 
an  operation.  His  plan  of  management  had  been  to 
keep  the  limbs  together  for  several  days,  draw  the 
urine  regularly,  and  move  the  bowels  with  enemata, 
rather  than  cathartics,  when  desired.  He  did  not 
disai)prove  of  the  operation,  however,  in  appropri- 
ate cases.  He  thought  it  possible  to  determine  by 
digital  examination  whether  or  not  rupture  had  oc- 
curred. 

De.  Griswold  said  that  he  did  not  draw  the  urine 
after  the  first  day.  He  thought  it  impossible  to  de- 
tect the  rupture  in  most  cases  by  the  finger  alone. 

Tlie  section  then  adjourned. 


NATIONAL  ASSOCIATION  FOR  THE 
PROTECTION  OF  THE  INSANE  AND 
PREVENTION  OF  INSANITY. 

Annual  Meeting,  held  in  Mmiicipril  Hall,  Xeir  Yarl: 
City,  January  20,  1882. 

Dr.  H.  B.  Wilbub,  President,  is  the  Chair. 

The  President  opened  the  meeting  ■«ith  a  brief 
statement  of  what  the  association liad  accomplished, 
and  what  it  proposed  for  the  future  Public  senti- 
ment had  been  much  awakened  by  the  work  of  the 
society,  many  a.sylum  superintendents  had  joined 
it,  and  a  more  ijrogi'essive  spirit  was  showing  itself 
among  all  of  them. 

Four  i^apers  were  read  by  Dr.  Nathan  Allen,  of 
Lowell,  Mass.,  Dr.  E.  0.  Seguin,  Dr.  J.  U.  Shaw,  and 
Dr.  C.  L.  Dana. 

The  first  paper,  by  Dr.  Axlex,  was  entitled 

"  INSANITT    IN    its     RELATION     TO    THE    JIEDIC.^L   PRO- 
FESSION." 

The  study  of  insanity  was  one,  the  sjieaker  said, 
that  had  been  greatly  neglected  by  the  medical  joro- 
fession.  There  were  as  yet  only  three  or  four  medi- 
cal colleges  in  the  United  States  in  which  there  was 
a  sijecial  professorshij5  of  mental  diseases,  or  even  a 
course  of  lectures  devoted  to  the  subject.  Indeed, 
so  little  attention  was  paid  to  this  important  depart- 
ment of  medical  science,  that  scarcely  ever  was  a  text- 
book ou  insanity  comjirised  among  the  standard 
works  for  study. 

The  American  Medical  Association,  when  it  was 
first  organized  in  1847,  created  a  dejiartment  of  Psy- 
chological Medicine.  It  so  happened,  however,  that 
the  supeinntendents  of  our  insane  hospitals  had,  just 


110 


THE  MEDICAL  RECORD. 


prior  to  its  organization,  formed  a  small  association 
of  their  o^vn,  and  they  were  not  inclined  to  join  the 
larger  body,  or  to  "work  with  it  in  the  discussion 
of  their  specialty.  The  resnlt  was  that  this  sec- 
tion of  the  association  did  not  start  under  favoi-able 
auspices,  nor  find  the  ready  workers  that  were  re- 
quired to  render  its  proceedings  of  large  professional 
interest.  The  speaker  next  reviewed  the  history  of 
the  American  Association  of  Superintendents  of 
Lunatic  Asylums,  now  thirty-five  years  old.  Its  dis- 
cussions were,  he  admitted,  occasionally  imjjortant, 
and  a  quarterly  journal  was  issued  in  its  interest. 
The  latter  had,  however,  a  very  limiteil  circulation, 
and  its  perusal  was  confined  almost  wholly  to  spe- 
cialists. It  liad  done  little  to  enlighten  the  great  body 
of  t!ie  profession  on  the  pathology  or  treatment  of 
insanity,  its  princijial  object  having  apparently  been 
to  build  up  a  class  of  experts  in  insanity,  and  to  place 
in  their  hands  the  treatment  of  the  disease  and  the 
management  of  tlie  lunatic  asylums  of  the  country. 
Dr.  Allen  referred  to  the  methods  of  committal  and 
management  in  vogue  in  Great  Britain,  and  com- 
pared them  with  American  methods.  Under  British 
law,  every  physician  signing  a  certificate  of  committal 
was  required  to  write  down  the  distinct  evidences 
upon  which  his  opinion  had  been  formed,  and  to 
state  explicitly  such  facts  as  he  had  obtained  from 
others  as  to  the  mental  alienation  of  the  patient, 
while  in  this  country,  if  a  husband  and  wife  got  at 
variance  with  each  other,  or  an  indiridual  was  ad- 
dicted to  the  opium  habit  or  had  a  large  property  of 
which  his  heirsat-law  wished  to  obtain  the  control, 
men  could  be  found  to  sign  the  necessary  papers  and 
the  person  was  committed  to  a  lunatic  hospital.  Dr. 
Allen  spoke  in  conclusion  of  the  trial  of  Guiteau  as 
a  striking  illustration  of  the  lack  of  exactness  and 
coherence  in  our  methods  of  dealing  with  the  prob- 
lems of  insanity. 

The  paper  by  Dr.  C.  L.  D.vna  was  entitled 

"the  asylum   super [xtendents   on    the    needs   of 
the  insane." 

It  was  based  upon  the  study  of  the  aunual  reports 
of  all  the  different  asylums  in  the  country. 

A  large  number  of  statistics  were  given.  The  num- 
ber of  insane  in  1880,  of  which  any  census  could 
be  obtained,  was  estimated  at  over  08,000,  giving  a 
ratio  to  the  population  of  about  1  to  777  ;  tliat  of 
1860  was  1  to  1,310.  The  ratio  varied  indifferent 
parts  of  the  countrv,  being  for  Kew  England  about 
1  to  580  ;  for  the  Middle  States,  1  to  GOO  ;  for  the 
West,  1  to  850 ;  and  for  the  South,  1  to  1,100. 
The  proportionate  rate  of  increase  was  most  rapid 
in  the  West,  after  that  in  the  South.  The  less 
amount  of  insanity  in  tlie  Soutli  was  due  in  part  to 
climate,  in  part  to  the  presence  of  the  colored  race, 
which  is  less  susceptible  to  the  disease.  It  was  sug- 
gested that  the  proportionate  increase  in  insanity  in 
America  would  not  rise  above  1  to  450  or  1  to  500, 
since  in  the  past  twenty  years  that  ratio  liad  not 
raftterially  changed  in  the  New  England  States. 
Legislators  must  expect,  however,  an  increase  of 
insanity  up  to  1  in  4.50  to  1  in  800,  according  to  the 
section  of  the  country.  They  should  provide  asy- 
bnis  for  three-fourths  of  these,  as  was  done  in  Eng- 
land. 

The'^annual  cost  of  caring  for  the  insane  was 
estimated  at  over  S12,000,00(C 

There  were  88  asylura.s,  with  about  300  medical 
men  connected  thei-ewith. 

A  long  list  of  the  needs  of  asylums  and  of  the  in- 
sane, as  given  by  the  superintendents,  was  recited. 


The  conservatism  and  absence  of  scientific  spirit  in 
the  superintendents,  as  shown  by  their  reports,  was 
criticised. 

Dr.  E.  C.  Seguin  read  a  paper  entitled 

"  THE    FUNCTION  OF  A  CONSULTING   STAFF   TO  A  LUNATIC 
HOSPITAl." 

The  results  of  the  speaker's  experience  as  consult- 
ing physician  to  the  Poughkeepsie  Insane  Asylum 
were  given.  It  seemed  that  the  consulting  board 
had  been  in  a  measure  a  failure.  It  had  found  the 
medical  officers  unable  to  give  histories  of  many  of 
the  cases.  The  recorded  histories  were,  in  large  part, 
valueless.  Careful  and  scientific  examinations  of 
the  patients  were  not  made.  The  consulting  physi- 
cians consequently  had  few  data  to  give  them  on 
which  to  base  an  opinion.  Neither  was  their  advice 
sought  upon  jjoints  where  it  should  be. 

The  speaker  made  the  point  tliat  consulting  boards 
should  not  be  boards  of  inspection  for  seveial 
reasons  :  thu.s,  a  medical  inspection  of  asylums  to  be 
useful  should  be  made  at  unexpected  times,  even  at 
inconvenient  hours,  and  the  inspector  should  go 
about  the  asylum  alone,  free  to  look  into  every  cor- 
ner and  ask  questions  of  everybody.  Almost  inevi- 
tably, he  said,  the  members  of  a  medical  consulting 
board  feel  a  professional  sympathy  with  resident 
medical  ofticer.s,  and  also  feel  a  pride  in  the  good 
reputation  of  the  asylum.  These  are  faults  insepa- 
rable from  local  association  and  neighborly  bias.  A 
lunacy  commissioner  or  State  inspector,  with  no 
special  reason  for  favoring  any  one  asylum,  would  be 
much  more  likely  to  make  searching  visits  and  to 
pen  truthful,  unsparing  reports.  While  Dr.  Seguin 
would  reserve  for  a  consulting  medical  staff  the  right 
to  point  out  any  existing  evil  and  to  make  any  sug- 
gestions for  the  welfare  of  patients,  he  was  adverse 
to  its  acting  as  an  inspecting  board.  The  functions 
of  a  consulting  medical  staff  to  a  lunatic  asylum 
should  be  as  nearly  as  possible  like  the  duties  of  a 
consulting  physician  in  general  medical  practice. 

In  a  subsequent  discussion,  Dr.  Putnam-Jacobi 
confirmed  Dr.  Seguin's  views. 

Dr.  J.  C.  Shaw's  paper,  entitled 

"  TWO   years'    EXPERIENCE   WITH   NON-RESTRAINT   IN  AN 
ASYLUM   CONTADJIXO    EIGHT   HUNDRED   PATIENTS," 

was  interesting  on  account  of  its  showing,  by  further 
experience,  that  non-restraint  could  be  successfuDy 
employed  in  this  countiy,  even  under  adverse  cir- 
cumstance.s.  The  speaker  related  several  instances 
in  wliicli,  by  perseverance  and  ingenuity,  some  most 
intractable  cases  had  been  made  manageable.  Trans- 
ference to  another  ,ward  was  often  a  successful 
measure. 

In  the  discussion  at  the  close  of  the  reading  of 
the  papers,  Drs.  Putnam-Jacobi,  Beard,  Morton, 
Parrisli,  and  others  took  part. 

A  resolution  was  jjassed  authorizing  the  council 
to  secure  all  legislative  help  possible  to  promote 
the  interests  of  the  insane  and  a  knowledge  of  in- 
sanity. 

The  council,  by  vote,  ajjpointed  a  committee  to 
confer  with  the  National  Board  of  Health,  and  en- 
deavor to  secure  its  help  in  collecting  all  possillc 
statistics  and  other  information  regarding  the  con- 
dition of  the  insane  of  the  United  States.  Dis. 
Seguin,  Dana,  and  Pan-ish  were  appointed  on  this 
committee. 


Mr.    H.    N.    Moseley,    M.A.,    F.R.S.,    has    been 
elected  professor  of  physiology  at  Oxford. 


THE  MEDICAL  RECORD. 


Ill 


Corrcsponticuce. 


STATE   EXAIVIINATIONS  AND   LEGAL 
QUALIFICATIONS. 

To  THE  Editor  of  The  Medic.il  Record. 

Dear  Sib  :  In  my  note  of  November  5th  (which  was 
intended  by  me  to  be  private,  but  was  not  so  un- 
derstood by  Ton,  see  Record  of  December  17th),  I 
did  not  intend  to  find  fault  with  sowi.se  and  virtuous 
a  body  as  the  Legislature  of  Pennsylvania  in  its  eiibrts 
to  protect  the  peoijle  against  incompetent  practi- 
tioners. The  fact  that  it  legislates  in  the  electric 
eifulgence  of  its  own  record  is  sufficient  to  place 
any  net  it  may  pass  out  of  the  reach  of  criticism ; 
and  again,  if  I  had  linown  fas  was  my  duty)  that 
Section  -t  of  the  Pennsylvania  Act  is  an  almost  exact 
reproduction  of  one  of  the  sections  of  the  New  York 
Medical  Act  of  1880,  I  could  not  have  certified  my 
own  insanity  by  questioning  either  its  constitution- 
ality or  its  propriety.  When  the  Empire  iindergirds 
the  Keystone,  the  Mississippi  Valley  may  open  its 
mouth  to  wonder,  but  not  to  speak — as  the  i)hoto- 
grapher  said  when  he  had  focvissed  the  corpse  :  "  You 
may  wink,  but  you  must  not  speak." 

The  question  is  as  to  whether  a  law  ignoring  med- 
ical schools  of  other  States  by  giving  to  home  col- 
leges the  unrestricted  and  irresponsible  right  to  sub- 
ject all  comers  to  an  examination,  and,  in  effect,  to 
confer  all  degrees  by  making  a  diploma  of  no  signi- 
ficance until  indorsed  by  order  of  the  faculty  of  a 
college  doing  business  in  the  State,  is  in  harmony 
with  our  institutions.  "  The  object  of  medical  legis- 
lation in  any  given  State  is  to  provide  that  none  but 
competent  men  shall  practise  there  "  (very  good) ; 
and  to  "  provide  "  that  no  competent  man  shall  be 
subjected  to  unnecessary  expense  or  annoyance,  or 
exposed  to  the  danger  of  being  totally  discredited 
by  corporate  organizations  having  a  selfish,  rather 
than  (or  as  well  as)  a  profes.sional  interest  to  .sub- 
serve. It  almost  seems  as  if  to  put  the  question  of 
competence  in  the  hands  of  medical  faculties  who 
have  mercenai-y  interests  to  be  nurtured  by  discred- 
iting competing  schools  and  their  graduates,  is  to 
"  discriminate  against  citizens"  and  institutions  of 
other  States. 

It  is  undoubtedly  right  that  the  "  local  authori- 
ties "  should  be  satisfied  as  to  a  man's  qualifications 
before  they  permit  him  to  engage  in  the  practice  of 
medicine  ;  but  if  self-interest  or  corporate  rapacity 
may  be  thrown  into  the  scale  when  the  question  of 
competence  is  to  be  weighed,  how  much  value  may 
the  local  authorities  attach  to  the  indorsement  of 
the  native  institution  over  that  which  may  inhere 
in  the  certifieate  of  the  foreign  faculty.  To  pre- 
judge incompetence  is  not  much  better,  perhaps, 
than  to  assume  competence  when  certified  by  hon- 
orable "  foreigners,"  if  there  may  be  any  such. 

If  Pennsylvania  and  New  Y'ork  legislators  are  con- 
sumed by  a  patriotic  desire  to  protect  their  people 
against  unqualified  practitioners,  why  not  take 
the  whole  question  out  of  the  hands  of  the  college 
faculties,  who  have  several  reasons  for  graduating  a 
candidate  aside  from  his  qualifications,  and  put  it 
in  the  hands  of  men  who  have  no  money  interest  in 
pushing  anybody  through,  who  have  no  prosi^ective 
profits  to  blur  their  sight,  who  know  nothing  of  the 
candidate  until  he  presents  himself  for  examination, 
and  who  only  care  that  the  profession  should  be 
learned  and  honorable,  and  that  the  people  should  be 


protected.  I  know  of  an  institution  wliich,  for  fif- 
teen years,  has  annually  put  its  candidates  for  gradu- 
ation into  the  hands  of  a  board  of  eminent  men 
from  more  than  one  State,  who  had  no  other  con- 
nection with  the  college  and  no  uni^rofessional  in- 
terest in  it,  wlio  were  jjresent  at  the  examinations 
and  balloted  on  each  candidate,  and  no  degree  was 
conferred  over  their  heads.  It  was  not  a  meie  for- 
mal affair,  for  there  was  a  loss  of  from  five  to  twelve 
Ijer  cent,  of  the  applicants.  I  am  unable  to  say  how- 
common  a  similar  method  may  be  among  the' great 
institutions  of  the  East,  but  inquiry  has  convinced 
me  that  the  percentage  of  loss  is  not  so  gi-eat  in  some 
other  institutions. 

No  doubt  men  can  be  found,  in  almost  any  State, 
outside  the  college  faculties,  competent  to  sit  in 
judgment  on  the  pretensions  of  an  unfledged  doctor 
without  thrusting  him,  in  his  defenceless  infancy,  in- 
to a  nest  whose  maternal  instincts  are  concentrated 
and  spent  on  the  native  brood.  Let  the  State  take 
the  whole  matter  in  its  own  hands  and  settle,  by  a 
competent  and  disinterested  board  of  examiners, 
who  shall  be  allowed  to  practi.se  medicine  within  its 
bounds — the  citizen  may  as  well  be  maltreated  by  a 
foreigner  as  by  a  native,  the  loss  to  the  Slate  is  the 
same  in  either  case.  When  Penn.sylvania  or  New 
Y'ork,  or  any  other  State  for  that  matter,  br  ngs  into 
existence  such  a  board  of  examiners,  responsible  to 
the  people,  responsiWe  to  the  profession,  re.sjjon- 
sible  to  their  own  unblinded  consciences,  no  doubt 
Ohio  colleges  will  smilingly  forward  their  quota  of 
candidates  with  a  comfortable  confidence  that  they 
will  not  discredit  their  teachers,  and  that  they  will 
fare  as  well  as  they  deserve,  if  not  as  well  as  the 
more  eastern  product.  Such  a  board  woidd  sit  in 
Judgment  on  the  work  of  medical  teacheis,  native 
as  well  as  "foreign,"  and  the  legislatine  would  thtn 
have  a  means  of  determining  "  whether  the  colleges 
within  the  State  graduate  competent  men  "  or  not,  in 
order  that  it  might  intelligently  "  revoke  their  char- 
ters "  if  necessary. 

The  law  seems  to  be  set  on  two  boneless  legs  :  1st, 
that  the  home  institutions  do  not  and  cannot  gradu- 
ate incompetent  men;  2d,  that  "foreign"  institu- 
tions do  not  and  cannot  gradr.ate  any  other  kind.  Of 
course  the  colleges -mrfi/ put  a  liberal  construction  on 
the  law,  but  institutional  pride  and  aniliition,  as  •neU 
as  money  interests,  plead  in  the  opposite  direction. 

Y'ou  say  "  it  is  simply  a  question  of  iirotection  to 
the  people  against  the  influx  of  so-called  giaduates 
which,  until  of  late,  flourished  in  Pennsylvania,  and 
against  institutions  nearly  as  had,  which  ire  believe 
are  still  in  operation  in  Ohio."  I  submit  that  you 
must  have  a  tubstantial  foundation  for  this  belief, 
which,  expre.ssed  in  this  dubious  and  indefinite  way, 
casts  a  share  of  discredit  on  all  Ohio  colleges ;  and 
if  you  have  any  basis,  you  wrong  the  profession  of 
the  State  and  of  the  nation  by  not  making  your 
charges  squarely  and  above  board.  The  profession 
of  Ohio  is  anxious  to  conserve  its  honorable  respect- 
ability, and  you  will  confer  a  favor  if  you  will  be 
much  more  explicit  than  you  are  when  you  say  "we 
believe,"  etc.  The  Eecord  is  national,  perhaps  more 
than  that,  and  these  are  little  tidbits  which  may 
be  eagerly  devoured  on  ths  seaboard,  but  will  not 
be  relished  at  all  a  few  hundred  miles  inland,  and 
will  only  bring  American  medicine  into  undeserved 
contempt  with  foreigners. 

I'ours  very  respectfully, 

T.  Clarke  Melne. 

MASSnxoN,  C,  December  S3,  18S1. 

[Our  correspondent  has  evidently  been  a  good 


112 


THE  MEDICAL  RECORD. 


student  of  The  Record  in  the  past,  as  his  principal 
plea  seems  to  be  in  favor  of  an  independent  examining 
board  for  all  comers — a  plan,  it  will  be  remembered, 
that  has  frequently  been  advocated  in  the  editorial 
columns  of  this  journal.  The  remarks  concerning 
the  existence  of  diploma-selling  colleges  in  Ohio 
were  based  on  statements  contained  in  the  medical 
journals  of  that  State.  We  would  be  glad  to  learn 
that  they  are  unfounded. — Ed.] 


ARMY  NEWS. 


Official  List  of  Changes  of  Stations  and  Duties  of  Offi- 
cers of  the  Medical  Department,  United  States  Army, 
from  January  1.5,  1882,  to  January  21,  1882. 

Gardner,  Wm.  H.,  Capt.  and  Asst.  Surgeon.  Now 
at  St.  Augustine,  Fla.,  to  proceed  to  San  Antonio, 
Texas,  and  report  in  person  to  the  Commanding 
General,  Department  of  Texas,  for  assignment  to 
duty.     S.  O.  14,  A.  G.  O.,  January  19,  1882. 

La  Garde,  L.  A.,  1st  Lieut,  and  Asst.  Surgeon. 
Granted  leave  of  absence  for  one  month,  to  take 
effect  on  arrival  of  Asst.  Surgeon  Collins,  at  Can- 
tonment on  the  North  Fork  of  the  Canadian  River, 
Indian  Territory.  S.  O.  12,  Department  of  the 
Missouri,  January  16,  1882. 

Birmingham,  H.  P.,  1st  Lieut,  and  Asst.  Surgeon, 
who  returned  to  Fort  Leavenworth,  Kansas,  on  12th 
instant,  from  leave  of  absence,  to  proceed  to  Fort 
Gibson,  Indian  Territory,  and  report  to  the  com- 
manding officer  for  duty,  relieving  Asst.  Surgeon 
Collins.    S.  O.  12,  C.  S.,  Department  of  the  Missouri. 


iHetical  Stents   antr  tleros. 


Co>rrAGious  Diseases  —  Weekly  Statement.  — 
Comparative  statement  of  cases  of  contagions  diseases 
reported  to  the  Sanitaiy  Bureau,  Healtli  Department, 
for  the  two  weeks  ending  January  21,  1882. 


Week  Ending 

i 

s 

1 

1 

•Is 

i 

1.- 

II 

la 

s 

1 
5 

i 

i 

a 

1 

1 

Jan.  14,  1882. 

0 

10 

378 

3 

203 

128 

31 

0 

Jan.  21,  1882. 

0 

17 

303 

8 

210 

137 

40 

0 

Mortality  in  this  City  Last  Year. — The  number 
of  deaths  in  this  city  last  year  was  38.324,  of  which 
7,102  occurred  in  hospitals  and  other  institutions. 

SiTDCtiTANEOiTS  NERVE-STitETcnrNG.  — Billroth  treats 
sciatica  by  subcutaneous  ncrvo-stretcln'iig.  The  pa- 
tient is  placed  flat  upon  his  back,  the  leg  is  extended, 
and  then  tlie  tliigh  flexed  strongly  upon  the  trunk. 
This  puts  the  sciatic  nerve  upon  the  stretch. 

New  York  and  PniLADELiniiA  Clinical  liEfTURES 
(adapted  from  the  Ik»re.r  'I'rih-.-.ne  "  Primer"). — Wlio 
do  I  see  ?  You  see  a  lecturer  describing  a  case  to 
his  class.  Do  you  see  the  case  or  the  class?  Of 
course  you  do  not,  they  are  both  in  the  lecturer's 
mind. — St.  Louis  Cliniait  Record. 

A  Very  Simple  Back-Rest  is  described  by  Jlr.  T. 
R.  Fendriek  in  the  Ilrilish  Medical  Journal.  It  con- 
sists of  an  ordinarv  roller- towel  which  is  over  the 


patient's  head  and  adjusted  to  the  back.  The  other 
end  is  then  fastened  to  a  bed-post.  In  this  way  the 
patient  is  comfortably  sujiported,  while  the  upper 
part  of  the  towel  will  hold  a  luncheon  tray  very 
nicely. 

The  Condition  of  Mrs.  Lincoln.— In  a  report  of 
Mrs.  Lincoln's  physical  condition,  which  has  been 
signed  by  Drs.  M.  Clymer,  Sayre,  Knapp,  and  Pan- 
coast,  it  is  stated  that  "  she  is  .suffering  from  chronic 
myelitis  the  result  of  a  fall,  from  dropsy,  which  is 
caused  by  Bright's  disease  of  the  kidneys,  and  from 
two  cataracts  on  her  eyes.  She  is  truly  in  a  deplor- 
able condition." 

Carbonic  Acid  as  a  Poisonous  Product  op  Diges- 
tion.— According  to  Dr.  I.  Munk,  of  Berlin,  a  horse 
of  average  weight  excretes  over  three  drachms  of 
carbonic  acid,  or  its  near  allies,  in  twenty-four  hours. 
This  acid  is  developed  as  one  of  the  final  products 
of  digestive  change  in  the  intestinal  canal.  He  sug- 
gests that  it  may,  at  times,  be  the  cause  of  death  of 
horses  in  cases  of  colic. 

The  Percentage  of  Cure  of  Insanity  in  England 
and  Wales  last  year  was  forty.  The  mortality  rate 
was  nine  jier  cent. 

SsiALL-Pox  Declared  Epidemic  in  the  United 
States. — The  Executive  Committee  of  the  National 
Board  of  Health,  at  its  meeting,  .January  20th,  de- 
clared small-pox  to  be  epidemic  in  the  United  States. 
An  order  was  made  directing  an  inspection  of  sev- 
eral of  the  most  impoi'tant  quarantine  stations  in 
the  country  in  order  to  determine  if  the  rules  and 
regulations  of  the  Board,  approved  by  the  President, 
November  14,  1881,  are  being  jiroperly  enforced. 
An  appropriation  of  .82,000  was  made  for  the  pur- 
pose of  preventing  the  introduction  of  the  disease 
in  the  District  of  Columbia. 

The  Infant  Asylum  Closed  by  the  Health 
Board  is  situated  in  Clinton  Place,  and  is  not  the 
New  York  Infant  Asylum,  as  might  otherwise  be  in- 
fen-ed. 

Dr.  L.  C.  Gray's  Reply  to  Dr.  N.  M.  Shaffer  is 
crowded  out  of  the  present  issue. 

Dr.  Kenneth  Reid,  of  tliis  city,  died  on  Sunday 
of  acute  pericarditis. 

Bovine  Vrans. — An  unprecedented  amount  of  bo- 
vine virus  has  been  sold  by  dealers,  and  the  demand 
is  increasing. 

Diabetes  and  Malaria.  —  M.  Verneuil  recently 
presented  to  the  Academie  de  Medecine  the  reports 
of  six  cases  of  diabetes  following  malaria.  He  be- 
lieved that  malaria  frequently  causes  diabetes,  which 
may  be  in  two  forms  :  an  acute  and  temporary  one, 
and  a  chronic  form  coming  on  some  time  after  the 
malarial  attack. 

Vivisection  received  a  most  powerful  defence  in 
the  December  number  of  the  Nineteenth  Century. 
Sir  James  Paget,  Dr.  Wilkes,  and  Professor  Owen 
argue  for  liberty  in  scientific  research.  The  absurd- 
ity of  the  English  law  is  well  illustrated  by  a  state- 
ment of  Sir  James  Paget.  He  says  :  "  I  may  pay  a 
rat-catclier  to  destroy  all  the  rats  in  my  house  with 
any  poison  he  jileases,  but  I  may  not  myself,  unless 
with  a  license  from  tlie  Home  Secretary,  poison 
them  with  snake-poison." 

The  S.ati'rday  and  Sunday  Hospital  Fund  for 
the  present  vear  had  amounted,  up  to  Januarv  23d, 
to  $38,884.G().  It  is  exi>ected  that  $50,000  will  be 
raised  before  the  books  are  closed. 


Vol.   XXI.-No.  5. 
.     Feb.  4,  1882. 


THE  MEDICAL  RECORD. 


113 


(Driainal  Cccturcs. 


BUFFON  AND  BONNET  IN   THE  EIGH- 
TEENTH  CENTURY.' 

By  JOHN  C.  DALTOX,  M.D., 

JJEW    YORK. 
IlECTUKE    II. 

Mr.  President  and  Gentlemen :  I  shall  ask  your  at- 
tention in  this  evening's  lecture  to  two  remarkable 
phases  of  physiological  doctrine  which  once  held  a 
conspicuous  place  in  the  world  of  science,  namely, 
Buffon's  theory  of  Organic  Molecules,  and  Bonnet's 
theory  of  the  Inclusion  of  Germs.  Notwithstand- 
ing that  both  are  now  so  obsolete  that  perhaps  the 
majority  of  my  hearers  will  hardly  recall  their  mean- 
ing, they  were  formerly  considered  of  sufficient 
importance  to  be  test  questions  in  the  controversies 
of  the  period,  and  they  are  fair  examples  of  the 
fluctuating  estimate  to  which  such  subjects  are  lia- 
ble at  different  times. 

It  sometimes  happens  that  in  searching  the  an- 
nals of  medicine  we  lind  allusions  to  systems  and 
theories  which  have  so  far  gone  out  of  vogue  that 
we  know  them  only  by  name.     They  are  no  longer 
part  of  our  scientific  doctrines,  and  they  have  so 
little  present  value  or  significance,  that  we  seldom 
spend  the  time  even  to  weigh  their  merits  or  defects. 
And  yet  these  systems  once  had  theii-  day.     They 
were  prominent  topics  of  discussion  and  interest, 
and  they  divided  medical  opinion  between  the  views 
of  antagonistic  parties,   or  carried  with  them    the 
scientific   world  in  a  temporary  enthusiasm  of  ac- 
ceptance and  admiration.     They  were  often  origi- 
nated by  men  of  learning  and    ability,   and    owed 
much  of  their  success  to  the  superior  talent  of  their 
authors.     They  were  usually  ambitious   in    design 
and  seductive  to  the  imagination.     They  claimed  to 
open  a  wider  field  of  knowledge,  and  to  unlock  the 
secrets  of  nature  by  some  new  formula  that  should 
dispense   with   the   older   and   slower   methods   of 
plodding  investigation.     So  long  as  they  held  out 
this  prospect   they   stimulated   the   hopes   and  at- 
tracted the  interest  of  all ;  but  after  a  time  it  ap- 
peared  that  the    anticipations  which  they  excited 
were  not  fulfilled,  and  that  their  promised  results 
failed  of  realization.     Then  the  theories  themselves 
'■    began  to  lose  in  importance,  and,  once  started  on 
I    the  downward  road,  they  i-eceded  more  and  more 
■    rapidly  from  view,  until  they  finally  passed  out  of 
!    sight   and  out  of  mind.      They  vanished   into  the 
Umbo  of  departed  spirits,  and  if  they  ever  show 
j    themselves  at  the  present  day,  it  is  only  to  gi-atify  a 
I    momentary  curiosity  as  the  relics  of  thought  and 
opinion  in  former  times.     Like  unsubstantial  shad- 
j    ows,  they  flit  across  the  pages  of  a  foi-gotten  litera- 
'    ture,  and  the  glimpses  that  we  catch  of  them  here 
;    and  there  are  the  only  traces  of  their  existence  in 
j    the  history  of  the  past. 

One  of  these  phantoms,  alive  and  flourishing  a 
hundred  years  ago,  was  Buflbn's  theory  of  Organic 
Molecules. 

Buffon  was  a  remarkable  instance  of  a  man  of 
splendid  but  temporary  reputation.  His  ability 
commanded  the  attention  of  his  contemisoraries,  and 

*  Being  the  Second  Course  of  the  Cart^Tright  Lecttircs  of  the  Alumni 
Association  of  the  College  of  Phvsicians  anil  Surgeons,  New  Yoik. 
Lecture  II.  was  delivered  in  New  York,  January  31.  1882. 


enlisted  their  interest  and  cooperation  for  natural 
history  as  no  modern  writer  had  done  before.  His 
immediate  successors  were  fond  of  comparJKg  him 
with  .\ristotle  and  Pliny  ;  and,  if  we  take  their  esti- 
mate of  his  reputation,  there  liave  been  few  men, 
either  in  science  or  literature,  who  ever  acquired  so 
great  a  popular  renown.  He  was  a  member  of  the 
French  Academy,  of  the  .\cademy  of  Sciences,  of 
the  Royal  Societies  of  London  "and  Edinburgh, 
and  of  the  Academies  of  Berlin  and  Bologna.  He 
was  created  a  count  by  Louis  XV.,  and  was  for  for- 
ty years  Superintendent  of  the  Garden  of  Plants, 
which  he  more  than  doubled  in  extent,  and  where 
his  statue  was  erected  while  he  was  yet  alive.  His 
great  work  on  natural  history  was  received  as  an 
authority  from  the  date  of  its  publication  ;  most  of 
the  European  potentates  sent  him  specimens  for  his 
museum  or  complimentary  messages  ;  strangers  from 
abroad  thought  it  a  privilege  to  see  him  ;  and 
among  the  visitors  at  his  country-house  were  Thomas 
Jefferson  and  the  Prince  of  Prussia. 

Xotwithstanding  this  extraordinary  success,  Buf- 
fon's qualities  could  not  secure  a  lasting  reputation. 
He  excited  the  enthusiasm  of  his  readers  by  his  elo- 
quence and  originality,  but  he  did  not  give  them 
much  real  instruction.  This  deficiency  was  felt  even 
by  his  friends.  Vicq  d'Azyr,  who  pronounced  his 
eulogy  in  the  French  Academy,  and  who  calls  him 
"  one  of  the  lights  of  the  age,  and  an  ornament  to 
his  country,"  says  that  he  often  "compels  admira- 
tion, -without  convincing  the  judgment."  According 
to  Moreau,  he  "  supplemented,  by  the  brilliancy  of 
his  imagination,  the  imperfections  of  his  knowledge," 
and  showed  himself  "  more  remarkable  for  boldness 
of  conception  than  for  precision  of  ideas."  There 
can  be  no  doubt  that  he  did  much,  in  his  own  time, 
to  i^opularize  natural  history  among  the  educated 
and  influential  classes,  but  it  was  rather  as  an  intel- 
lectual entertainment  than  a  scientific  pursuit,  and 
his  works  are  now  nearly  destitute  of  value  for  any 
purposes  of  reference  or  exact  information. 

It  appears  that  Bitffon's  style  as  a  writer  was  one 
of  his  principal  charms  for  the  readers  of  that  day, 
and  formed  a  large  element  in  his  success.  It  had 
a  sort  of  poetic  splendor  that  would  be  thought 
quite  inadmissible  at  present  in  a  scientific  work, 
and  sometimes  will  hardly  bear  translation  without 
a  close  approach  to  puerility  :  but  at  the  period 
when  he  wrote,  and  in  his  hands,  it  magnified  his 
subject,  and  made  an  impression  upon  his  readers. 
He  often  adopts  this  lofty  tone  at  the  opening  of  a 
chapter,  and  nearly  always  employs  it  for  descrip- 
tive passages.  He  introduces  the  horse  as  "this 
in-oud  and  impetuous  animal,  the  noblest  conquest 
ever  made  by  man,  his  companion  in  the  fatigues  of 
war  and  in  the  gloiy  of  combats."  The  elephant, 
he  says,  "makes  the  earth  tremble  beneath  his  foot- 
step, uproots  trees  from  the  soil,  and  with  one  thrust 
of  his  body  will  batter  down  a  wall."  Buffon  took 
great  pains  to  cultivate  and  perfect  this  .style.  They 
say  he  would  often  repeat  certain  passages  aloud,  or 
get  his  friends  to  do  so,  with  himself  for  an  audience, 
to  enjoy  the  sound  of  his  swelling  sentences,  and 
perhaps  make  some  improvement  in  their  construc- 
tion. One  of  the  extracts  which  he  was  especially 
fond  of  hearing  in  this  way  was  his  delineation  of 
the  feelings  of  the  first  man,  when  just  awakened  to 
consciousness  and  Wtality.  The  newly  created  be- 
ing is  supposed  to  be  telling  his  own  story,  as  fol- 
lows :  - 

edition.    Paris,  ISl'J.    Tom. 


114 


THE  MEDICAL  RECORD. 


"  I  well  remember  tliat  instant  of  mingled  joy  and 
anxiety,  when  I  felt  for  the  first  time  my  extraordi- 
nary existence.  I  knew  not  what  I  was,  where  I 
was,  nor  whence  I  came.  I  opened  my  eyes.  What 
an  overflow  of  sensation !  The  daylight,  the  celes- 
tial vault,  the  green  earth,  the  crystal  tr..nsi5arency 
of  the  waters,  all  attracted  me,  excited  me,  and  gave 
me  an  inexpressible  sense  of  enjoyment." 

And  so  on,  for  seven  or  eight  consecutive  pages. 
Another  favorite  passage  was  his  picture  of  an  Ara- 
bian desert,  introduced  apropos  of  the  natiu-al  his- 
tory of  the  camel.^ 

"  Imagine,"  he  says,  "  a  region  without  verdure  or 
moisture,  a  blazing  sun,  the  sky  always  arid,  plains 
of  sand,  and  mountains  stiU  more  iiarched,  where 
the  eye  searches  in  vain  for  any  trace  of  a  living 
creature  ;  a  land  lifeless  and,  as  it  were,  stripped  by 
the  winds,  where  nothing  is  to  be  seen  but  dead 
bones,  scattered  pebbles,  and  rocks  standing  or  over- 
turned ;  a  barren  desert  where  the  traveller  never 
finds  a  shady  resting-place,  where  he  has  no  com- 
panionship, nor  anything  to  remind  him  of  life  in 
nature:  absolute  solitude,  a  thousand  times  more 
frightful  than  that  of  the  forest,  since  even  trees  are 
living  beings  for  the  man  who  is  there  alone.  In 
these  void  and  measureless  regions,  more  isolated, 
denuded  and  desolate  than  any  other,  the  empty 
space  seems  to  enclose  him  like  a  tomb.  The  light 
of  day,  more  gloomy  than  the  shades  of  night,  only 
serves  to  disclose  his  lielplessness  and  destitution. 
It  shows  him  the  horror  of  his  situation  by  enlarging 
before  his  eyes  the  boundaries  of  vacancy,  and  shuts 
him  out  from  the  habitable  world  by  stretching 
around  him  an  abyss  of  immensity  which  he  can 
never  hope  to  cross." 

The  satisfaction  which  Buftbn  felt  in  these  descrip- 
tions does  not  seem  to  have  been  diminished  in  any 
way  by  the  fact  that  he  had  never  seen  an  Arabian 
desert,  and  that  his  story  of  the  first  man  was  en- 
tirely imaginary. 

"  JBuffon's  Natural  History "  was  a  work  of  veiw 
extensive  design.  It  included  an  exj^lanation  of  the 
structure  and  physical  geography  of  the  globe,  the 
nature  of  man  and  animals,  a  general  view  of  ani- 
mals, vegetables,  and  minerals,  the  functions  of  nu- 
trition and  reproduction,  an  account  of  the  varieties 
of  the  human  race,  and  the  different  species  of  bii-ds 
and  iiuadrupeds,  with  a  description  of  sjiecimens  in 
the  Royal  Museum. 

He  had  a  theoiy  of  the  planetary  system,  which 
was  one  of  his  favorite  doctrines,  and  which  occu- 
pies the  greater  part  of  his  first  volume.  He  be- 
lieved that  the  planets  were  originally  a  part  of  the 
solar  sphere,  from  which  they  had  been  struck  off 
at  some  time  by  the  shock  of  a  comet  in  collision 
with  the  sun.''  The  materials  of  different  densities, 
propelled  under  this  impulse  with  different  veloci- 
ties, he  supposed  would  naturally  collect  into  masses 
at  corresponding  distances  from  their  starting-point, 
and  so  give  rise  to  a  series  of  planets,  moving  in 
successive  orbits.  Their  axial  rotation  was  accounted 
for  by  the  obliquity  with  which  the  comet  struck 
the  sun,  and  the  consequent  twirling  motion  im- 
parted to  its  detached  portions. 

Wild  as  this  hypotliesis  sounds  when  stated  by  it- 
self, it  was  advocated  by  its  autlior  with  much  force 
and  ingenuity.  Kven  mathematics  came  in  for  a 
share  in  its  support,  and  it  was  fortified  with  argu- 
ments from  the  doctrine  of  probabilities.  As  all  the 
planets  move  round  the  sun  from  west  to  east,  and 


nearly  in  the  same  plane,  they  must  all  have  been 
set  in  motion,  accoiding  to  Buffon,  at  the  same  time 
and  by  a  single  impulse.  Otherwise  the  chances 
would  be  as  sixty-four  to  one  that  the  six  planets 
then  known  would  not  all  move  in  the  same  direc- 
tion, and  as  7,962, 624''  to  one  that  all  their  orbils 
would  not  be  within  seven  and  one-half  degrees  of 
the  same  plane.  He  extended  the  calculation  still 
further — to  the  size,  distance,  and  density  of  the  dif- 
ferent planets,  and  to  the  relation  in  each  betwetn 
its  density  and  the  rai:)idity  of  its  orbital  motion. 
The  figures  did  not  all  come  out  exactly  right,  but  in 
the  case  of  Jupiter  and  Saturn  the  theoretical  and 
actual  proportions  were  very  nearly  alike  ;  and  the 
author  observes  with  much  satisfaction  tliat  "  we  can- 
not often  obtain,  in  matters  of  pure  conjecture,  ko 
close  an  approximation  to  reality  as  this." 

But  the  most  remarkable  production  of  Buffon's 
genius  was  his  s^s'stem  of  organic  molecules,  with  its 
associated  theories  of  nutrition  and  reproduction. 
According  to  this  view,  the  bodies  of  all  living  crea- 
tures, animal  and  vegetable,  were  composed  of  mi- 
nute particles,  differing  in  kind  and  configuration, 
but  all  possessing  the  general  character  of  vital  en- 
dowment. These  were  the  organic  molecules  ;  as 
we  call  a  compound  group  of  hydrogen  and  oxygen 
atoms  a  molecule  of  water,  or  one  of  carbon,  hydro- 
gen and  oxygen  a  starch  or  glucose  molecule,  so 
Buffon  seems  to  have  imagined  a  still  more  complex 
molecule,  having  the  properties  of  organic  life. 
These  molecules,  when  associated  in  the  form  of  an 
organized  body,  gave  to  each  part  its  specific  char- 
acter, and  thus  provided  for  the  physiological  ac- 
tivity of  the  whole.  But  they  were  themselves  in- 
destructible, and  contained  in  tlieir  own  substance 
the  essential  principle  of  vitality.  When  the  animal 
or  plant  died  and  was  decomposed,  its  organic  mole- 
cules were  at  once  ready  to  assume  new  combina- 
tions. When  one  animal  fed  upon  another,  or  an 
animal  upon  a  plant,  the  organic  molecules  of  the 
creature  used  as  food  passed  into  the  tissues  of  that 
which  devoured  it ;  and  when  an  animal,  in  decom- 
posing, enriched  the  soil  and  fed  vegetation,  its  oi- 
ganic  molecules  were  absorbed  into  the  structure 
of  tlie  growing  plant.  Thus  these  molecules  rep- 
resented the  living  elements  of  the  material  world. 
Their  quantity  was  never  either  increased  or  dimin- 
ished. Tliey  only  passed  from  one  form  of  combi- 
nation to  another,  always  transferring  their  activity 
from  the  old  organisms  to  the  new.  Consequently 
there  was  no  such  thing  as  destruction  of  life  in  na- 
ture, but  only  continual  changes  in  its  distribution. 
The  organic  molecules  were  an  exhaustless  reservoir 
of  vitality,  from  which  all  living  beings  took  their 
origin,  and  into  which  they  all  again  returned. 

But  nutrition  and  generation  require  something 
more  than  the  mere  existence  of  organic  molecules. 
For,  even  suppo.sing  the.se  vitalized  particles  to  be 
present  in  full  abundance  and  variety,  how  could 
they  be  arranged  in  proper  order  within  the  plant 
or  animal,  so  as  to  form  its  different  organs  or  ena- 
ble it  to  reproduce  its  like  V  This  want  was  sup- 
plied by  Buffon's  celebrated  idea  of  inlrrinr  moulds. 
It  is  not  easy  to  say  exactly  what  he  meant  by  this 
expression,  except  tliat  it  was  soTuething  capable  of 
arresting  the  ijiolecules  and  placing  them  in  a  cer- 
tain combination.  "  In  the  same  way,"  he  says, 
"  that  we  have  moulds  for  giving  to  the  outside  of 

6  This  WBs  in  1750,  when  Ratnru  wji;*  supposed  to  l>e  the  otit^rmort 
pinnct  of  the  Roltir  system.  If  the  niithor  had  included  in  his  calcula- 
tions Umnufi  nnd  Neptune,  lie  ini^ht  have  nindc  the  chances  in  favor 
of  hi»  throry  cis  •t.BS6,17!,l-M  to  one. 


THE  MEDICAL  RECORD. 


115 


things  any  form  we  choose,  suppose  that  nature  can 
produce  moulds  which  will  determine  not  only  the 
external  configuration,  but  also  the  internal  struc- 
ture of  bodies  formed  in  them." 

Most  readers  will  perhaps  say  that  this  definition 
of  interior  moulds  is  only  an  analogy,  and  does  not 
include  any  intelligible  idea  of  their  construction. 
Buftbn  himself  seems  partly  conscious  of  this,  and 
makes  a  rather  labored  and  metaphysical  defence  of 
the  term,  to  show  that  there  is  nothing  in  it  contra- 
dictory. However  that  may  be,  the  "  interior 
mould"  is  .something  which  belongs  to  the  entire 
body,  and  also  to  each  of  its  separate  parts.  The 
whole  body  is  a  mould  which  determines  the  posi- 
tion ami  ari'augemeut  of  its  difierent  organs.  Each 
organ  and  each  part  of  an  organ,  when  sup]plied  with 
organic  molecules  from  the  food,  selects  those  which 
are  like  its  own,  and  rejects  the  rest ;  while  it  ar- 
ranges the  incoming  nioleciiles  in  proper  order,  and 
incorporates  them  with  its  substance,  still  j^reserv- 
ing  its  original  form  and  texture.  In  this  way  the 
body  is  nourished,  and  gi'ows,  not  by  addition  to  its 
exterior,  but  by  the  intimate  penetration  and  intus- 
susception of  approjjriate  molecules  throughout  its 
mass,  and  all  by  means  of  its  "  interior  moulds." 

The  mysterious  phenomena  of  reproduction  were 
fully  explained  by  the  aid  of  organic  molecules  and 
interior  moalds.  This  explanation  was  even  the 
simplest  in  cases  which  we  usually  consider  the  most 
wonderful ;  as  where  plants,  worms,  or  polyps  re- 
produce and  multiply,  without  sexual  generation,  by 
division  or  budding.  Suppose,  in  a  polyp,  the  or- 
ganic molecules  to  be  an-anged  tlu-oughout  in  the 
form  of  minute  polyps,  just  as  a  cube  of  salt  may 
be  made  up  of  an  indefinite  number  of  smaller 
cubes ;  then  any  part  of  such  an  oi-ganism,  when 
separated  from  the  rest,  will  reproduce  an  entire 
polyp,  because  it  already  contains  the  whole  of  it 
in  miniature.  Something  similar  takes  place  in  ani- 
mals or  plants  which  multiply  by  budcling.  In  them 
the  organic  molecules  absorbed  with  the  food  are 
distributed  in  due  proportion  until  every  part  has 
received  its  full  supply.  After  that  the  surplus 
molecules  are  sent  back  from  the  different  organs, 
and  collected  in  some  particular  locality,  where  they 
form  a  composite  mass,  rejiresenting  the  materials 
of  the  whole  body.  Such  a  mass  is  a  bud,  and, 
when  separated  from  its  stock  and  placed  where  it 
can  absorb  nourishment  for  itself,  it  of  course 
grows  into  an  organism  like  its  parent,  because  it  is 
composed  of  the  same  kind  of  molecules,  arranged 
in  the  same  order  and  in  tlie  same  proportions. 

In  sexual  generation,  like  that  of  man  and  the 
higher  animals,  the  process  is  more  complicated. 
Here,  again,  every  part  of  the  body  absoi'bs  the  or- 
ganic molecules  appropriate  to  itself,  and  moulds 
them  into  the  substance  of  its  own  texture.  But 
the  excess  of  material  not  required  for  the  nourish- 
ment of  the  organs  and  returned  from  them  as  super- 
fluous, appears  in  the  form  of  a  li(^uid,  and  is  deposited 
in  a  special  reservoir.  This  liquid,  made  up  of  contri- 
butions from  every  part  of  the  body,  is  the  seminal 
fluid.  It  is  a  mingled  organic  extract  of  the  entire 
frame,  and  thus  contains  all  the  materials  necessary 
for  reproduction.  Its  jilace  of  deposit  is  in  the  tes- 
ticles and  vesicuhe  seminales. 

The  extreme  acti\-ity  of  this  seminal  fluid,  the 
concentrated  essence  of  the  animal  organism,  is 
proved  by  the  formation  of  the  spermatic  animal- 
cules. .According  to  Buflbn,  these  are  not  original 
or  essential  ingredients  of  the  seminal  fluid,  Imt  a 
product  of  its  restless  vitality,  an  incidental   form 


in  which  its  generative  power  is  exhibited."  They 
represent  the  first  assemblage  of  its  organic  mole- 
cules, as  combined  into  moving  particles  large 
enough  to  be  visible  by  the  microscope. 

But  the  female  also  produces  a  seminal  fluid,  in 
the  same  manner  and  with  the  same  general  qua'i- 
ties  as  the  male.  Both  fluids,  male  and  female, 
contain  all  the  elements  common  to  either  sex.  The 
only  difi"erence  between^^  them  is  that,  each  fluid 
being  a  special  extract  of  the  body  from  which  it 
comes,  that  of  the  male  contains  molecules  repre- 
senting the  male  organs,  that  of  the  female  those 
representing  the  female  oigans.  Buflbn  entirely  re- 
jects the  doctrine  that  vi\-iparous  females  produce 
by  means  of  eggs.  For  him,  the  ovaries  are  tes- 
ticles ;  the  Graafian  follicles  are  reservoirs  of  nutri- 
tious lymph  ;  and  the  corpora  lutea  are  glandular 
structrires,  which  produce  tlje  female  seminal  fluid 
by  a  process  of  filtration.' 

Thus  BuSbn  accounts  for  reproduction  in  a  very 
simple  manner.  Generation  is  only,  in  a  higher  de- 
gree, the  act  of  nutrition,  operating  with  the  sur- 
plus of  nutritive  material.  A  mixture  of  the  male 
and  female  seminal  fluids  contains  all  the  organic 
elements  of  both  sexes,  and  therefore  represents  the 
species.  In  the  cavity  of  the  uterus  it  finds  its  ap- 
propriate nidus  and  nourishment,  and  grows  into  a 
perfect  organism  like  that  from  which  it  came.  The 
theoiy  was  supported  by  abundance  of  proof,  for  it 
explained  to  a  charm  most  of  the  important  phe- 
nomena of  generation.  1st.  During  infancy  and 
childhood  there  is  no  power  of  reproduction,  be- 
cause all  the  organic  molecules  are  taken  up  by  the 
growing  tissues  ;  it  is  only  after  puberty,  when  the 
body  has  acquired  its  full  growth,  that  there  is  a 
surplus  of  organic  material,  to  be  filtered  through 
the  testicles  in  the  form  of  seminal  fluid.  2A.  The 
young  child  or  animal  usually  resembles  both  its 
parents,  because  its  substance  is  derived  from  both 
the  male  and  female  seminal  fluids.  3d.  Creatures 
of  small  size,  like  insects,  mice,  and  guinea-pigs, 
have  a  numerous  progeny,  because  the  demands 
of  nutrition  are  easily  satisfied,  and  there  is  a  large 
sui)erfluity  left  for  reproduction  ;  but  those  of  greater 
bulk,  such  as  man,  the  horse,  the  elejihant,  produce 
only  a  single  young  one  at  a  time,  and  at  long  inter- 
vals, since  the  nourishment  of  their  own  bodies  takes 
up  most  of  the  organic  molecules  of  the  food.  All 
these  facts  were  plainly  in  accordance  with  the  new 
system. 

Indeed,  the  only  difficulty  about  Buffon's  theory 
(if  it  is  not  a  contradiction  to  say  so)  was  that  it 
made  the  matter  too  easy.  If  the  seminal  fluid  of 
the  male  contains  all  the  organic  molecules  neces- 
sary to  make  an  embryo,  why  does  it  not  make  one  ? 
\May  should  not  the  male  be  self-producing,  and 
why  should  not  the  female,  on  the  other  hand,  have 
a  progeny  of  little  females,  from  her  own  seminal 
fluid,  without  the  necessity  of  impregnation  by  the 
male?  According  to  the  theory  of  organic  mole- 
cules, every  adult  animal  produces  a  fluid  capable 
of  generating  young.  But  in  point  of  fact,  the  fe- 
male must  also  receive  the  fluid  of  the  male  ;  and, 
without  the  concourse  of  the  other,  each  sex  remains 
barren. 

This  is  the  gr'eat  difficulty  in  Bufi"on's  way,  and  to 
do  him  justice,  he  does  not  try  to  conceal  or  evade  it, 
but  straggles  with  it  manfully  for  sixteen  octavo 
pages.     The  reader  almost  feels  a  sympathy  for  him 


'^  fEiivres  Completes,  torn. 
■  Ibid.,  p.  34.5. 


,  p.  335. 


116 


THE  MEDICAL  RECORD. 


wlien  his  system  of  reproduction,  after  running  so 
smoothly  eveiTwhere  else,  is  aiTested  by  so  bulky 
an  obstacle  as  the  fact  of  sexuality.  His  exj^lana- 
tion  is  full  of  ingenious  hypotheses ;  but  it  is  veiy 
complicated,  and  leaves  in  the  chain  of  eWdence  ^o 
many  gaps  and  contradictory  possibilities  that  it  is 
hardly  worth  while  to  remember  it.  Xevertheless, 
the  author  thinks  too  well  of  the  system  to  have  his 
faith  in  it  shaken  by  one  or  two  imperfections.  The 
main  jiart  of  it,  he  says,  he  has  "proved  by  so  many 
facts  and  arguments,  that  to  doubt  it  is  hardly  pos- 
sible." He  does  not  doubt  it  himself ;  and  he  avows 
that  he  "  entertains  no  uncertainty  whatever  as  to 
the  basis  of  the  theory,  after  careful  scrutiny  of  its 
principles  and  the  most  vigorous  estimate  of  its  con- 
sequences and  details." 

Buifou's  system  has  its  widest  extension  and  most 
splendid  success  in  the  dim  regions  of  equivocal 
and  spontaneous  generation.  His  organic  molecules 
are  the  genuine  repositories  of  life  ;  the  interior 
moulds  of  particular  organisms  being  only  the  means 
of  arranging  them  in  special  forms.  And  when,  by 
the  death  of  an  animal  and  the  decomposition  of  its 
body,  its  organic  molecules  are  released  from  the 
constraint  of  theu-  interior  moulds,  they  are  set  at 
liberty,  living  and  active  as  ever,  to  be  disseminated 
in  any  direction  where  chance  may  carry  them.  In 
this  condition  they  are  the  universal  seed  of  nature, 
without  any  character  of  specific  organization,  but 
containing  all  the  prolific  force  of  the  bodies  fi-om 
which  they  came.  After  a  time  they  are  absorl)ed 
by  some  other  mould,  animal,  or  vegetable,  into 
which  they  transport  theii'  own  indestructible  quali- 
ties of  nutrition  and  life.  But  during  the  interim, 
after  leaving  the  old  organism  and  before  their  in- 
corporation into  the  new,  they  form,  by  their  reunion, 
a  multitude  of  living  stractures  which  do  not  belong 
to  any  of  the  ordinary  or  recognized  species  in  na- 
ture. Such  are  the  moving  corpuscles  of  the  seminal 
fiuid,  the  microscopic  fungi  and  infusorial  animal- 
cules of  organic  solutions,  and,  in  their  larger  vari- 
eties, the  eels  of  starch- paste  and  vinegar,  and  even 
earth-worms,  mushrooms,  and  entozoa.  All  these 
creatures  come  by  spontaneous  generation.  They 
are  the  connecting-link  in  nature  between  the  simple 
organic  molecule,  on  the  one  hand,  and  the  com- 
plete animal  or  plant  on  the  other.  This  exuberant 
force  of  production  is  always  in  acti\'ity.  Notwith- 
standing the  death  of  any  number  of  existing  crea- 
tures, the  total  quantity  of  life  on  the  globe  cannot 
be  diminished  even  for  a  moment ;  for  it  continues 
uninterrupted  in  the  organic  molecules,  which  pass 
and  repass  from  the  animal  to  the  vegetable,  and 
from  the  vegetable  to  the  animal,  or  ])roduce  in  the 
interval  an  endless  variety  of  spontaneous  genera- 
tions. 

No  doubt,  Buifon  was  in  love  with  his  system,  and 
admired  it  for  its  own  sake.  Still,  he  had  a  fair 
share  of  what  CJondorcet  calls  the  "  sentiment  of  his 
own  superiority,"  and  ends  one  of  his  chapters  in  a 
strain  that  sounds,  at  tliis  day,  rather  exalted.  "I 
will  add  nothing  more,"  he  says,  "to  these  reflec- 
tions. To  be  accepted,  or  even  to  be  comprehended, 
they  require  a  profound  acquaintance  with  nature, 
and  complete  freedom  from  prejiulice  ;  so  that  for 
the  majority  of  my  readers,  a  longer  explanation 
would  be  insuflicicnt,  and  for  tho.se  W'ho  can  under- 
stand me  it  would  bo  superfluous." 

AVhen  Buffon's  work  upjieared,  it  attracted  at  once 
the  curiosity  and  applause  of  the  public.  The  re- 
viewers praised  it  as  "  an  honor  to  both  the  age  and 


the  nation."*  Hume  said  that  its  author  "gave  to 
things  no  human  eye  had  seen  a  probability  almost 
equivalent  to  proof;"  and  Needham  declared  that 
his  investigations  on  the  seminal  fluid  would  be  a  . 
subject  of  admiration  "for  centuries  to  come."  All 
his  readers,  however,  were  not  of  that  opinion.  There 
were  some  who  did  not  accept  the  doctrines  of  the 
book,  and  who  feared  that  its  popularity  might  have 
a  bad  eflfect.  Buftbn's  high  position,  his  magnificent 
style,  and  his  confident  tone  of  assertion,  alarmed 
his  adversaries,  and  made  them  dread  his  influence 
on  the  public  mind.  His  theory,  they  said,  was 
"filled  with  dazzling  paradoxes,  as  disastrous  to  the 
principles  of  science  as  the  mines  of  a  skilful  engi- 
neer to  the  solid  ramparts  of  a  fort."  This  difference 
led  to  a  warm  discussion.  The  Abbe  de  Lignac  wrote 
an  anonymous  treatise  against  Buftbn's  work,  under 
the  title  of  "Letters  to  an  American,"'  where  he 
criticised  the  system  of  moulds  and  molecules,  and 
said  that,  instead  of  describing  natural  objects,  it 
contained  only  "the  philosoiihical  dreams  of  M.  de 
Buftbn."  Burton's  friends,  on  the  other  hand,  de- 
noimced  the  "  American  Letters "  as  a  lampoon. 
They  accused  de  Lignac  of  having  written  it  out  of 
envy,  and  to  punish  Buftbn  for  not  showing  more 
respect  to  his  friend  ECaumur.  De.slandes  called  the 
book  an  imposture,  because  it  was  entitled  "Letters 
to  an  .\merican."  when  it  had  not  been  written,  in 
the  form  of  letters,  to  anybody ;  and  because  the 
title-page  bore  the  imprint  of  Hambourg,  though  it 
was  really  printed  at  Paris.  "  That  makes  no  differ- 
ence," replied  de  Lignac  ;  "  the  only  title-page  that 
can  be  called  an  imposture  is  one  that  promises 
something  the  book  does  not  contain ;  like  a  natural 
histoiy,  for  instance,  made  up  of  disjointed  and  ex- 
travagant systems,  without  anything  natural  about 
them." 

Buffon's  critics  were  especially  dissatisfied  with 
the  organic  molecules  of  the  seminal  fluid,  and  their 
wonderful  capacity  for  producing  an  embryo.  "If 
these  molecules,"  they  said,  "are  indifl'erently  the 
elements  of  a  plant,  a  man,  a  dog,  or  a  polyp, 
how  can  they  combine  to  make  either  ?  'W'e  might 
as  well  go  back  to  Epicurus  and  his  atoms."  One 
of  them  was  asked,  by  an  admirer  of  Butt'on,  which 
he  would  rather  be.  the  author  of  the  "  Histoire 
Naturelle,''  or  that  of  the  "  Lettres  Americaines." 
He  replied  that  he  would  rather  be  an  organic  mole- 
cule, because  then  he  would  have  more  intelligence 
than  either  of  them.  Buftbn  held  his  own  against 
these  attacks  without  making  any  direct  reply.  His 
literary  talent  alone  was  almost  enough  to  secure 
him  the  victoi-y ;  and  if  his  opponents  denied  the 
truth  of  his  theory,  they  generally  had  nothing  bet- 
ter to  oft'er  in  its  place. 

The  only  investigations  at  that  time  which  seri- 
ously threatened  Buffon's  system  were  those  of  Hal- 
ler  on  fecundation  and  development.  They  first 
a])peared  in  1753,  four  years  after  Buffon's  first  pub- 
lication. Haller  had  examined  the  ovaries  of  sheep 
lioth  before  and  after  impregnation,  and  observed 
the  condition  of  the  Ciraatian  follicles  and  corpora 
lutea.  Since  corpora  lutea,  according  to  Bnffon, 
were  glands  for  producing  a  seminal  fluid,  tlioy  must, 
of  course,  be  formed  before  impregnation,  and 
could  only  open  to  discharge  their  fluid  at  the 
time  of  conception.  Haller  declared  tliat  there 
were  no  corpora  lutea  in  the  ovaries  during  the  pe- 
riod of  heat,  nor  immediately  after  conception,  at 


.foiirnnl  di's  Siivnns.    rnris.  Octobrc,  ITJfl. 
*  LcttiTs  i\  un  Amcnquiiin,  sur  rHi*"toirc  Katurdle  Ae  SI.  do  Buifoii« 


A  HanibourK,  1751. 


THE  MEDICAL  RECORD. 


117 


which  time  there  was  nothing  to  be  seen  but  a  sim- 
ple orifice  leading  into  a  ruptured  follicle.  The 
glandular  structure  of  the  corpus  luteum  was  only 
formed  some  days  afterward,  and  therefore  could  not 
have  furnished  anything  essential  to  conception.'" 
We  now  know  the  accuracy  of  these  observations  by 
Haller,  and  can  hardly  understand  how  those  of 
Buffon  should  have  been  so  i^reposteroTisly  incor- 
rect. But  at  that  time  it  was  difficult  to  decide  be- 
tween them.  Both  were  men  of  high  scientific  po- 
sition, and  the  system  of  organic  molecules  was 
too  promising  and  seductive  to  be  surrendered  at 
the  first  attack. 

But  as  time  went  on,  it  began  to  suffer  from  its 
own  defects.  After  thirty  or  forty  years'  trial,  its 
promises  had  not  produced  anything,  its  obscurities 
had  not  been  cleared  up,  and  the  organic  molecules 
were  still  as  hypothetical  as  ever.  One  of  Bnffon's 
tenets  for  explaining  reproduction  by  division,  was 
that  the  simpler  organisms,  like  plants  and  polyps, 
were  composed  of  particles  in  the  form  of  their  O'wn 
miniature  ;  and  he  had  argued  at  great  length  that 
this  kind  of  structure,  if  we  only  thought  so,  was 
as  simple  as  any  other.  Malesherbes"  finally  con- 
cluded that  it  would  be  of  no  use  to  think  so,  be- 
cause the  thing  was  impossible.  "  To  be  convinced 
of  this,"  he  says,  "  let  any  one  try  to  draw  a  pic- 
ture of  this  pretended  polyp,  entirely  made  Tip 
of  similar  polyps  ;  or  let  him  get  a  quantity  of  little 
wooden  or  ivory  figures  in  the  form  of  polyps,  and 
then  see  whether  he  can  put  them  together  in  any 
way  so  as  to  make  an  entire  polyp  of  the  same  shajie. 
I  defy  him  to  do  so." 

Buffon's  interior  moulds  had  no  better  luck  in  the 
end.  When  it  came  down  to  genuine  matter  of  fact, 
no  amount  of  verbiage  could  make  it  plain  what  sort 
of  things  they  were,  nor  how  they  ojierated.  JMales- 
herbes  declared  that  the  very  idea  of  a  moiild  is 
that  of  something  which  acts  by  its  surfaces,  and 
that  consequently  the  hy25othesis  of  interior  moulds 
is  a  mere  metaiihysieal  subtlety,  without  any  real 
application.  "  To  make  use  of  interior  moulds, 
therefore,  for  explaining  the  process  of  nutrition 
or  development,  is  to  solve  one  difficulty  by  another ; 
it  accoirnts  for  one  thing  by  the  supposition  of  a 
second  no  more  intelligible  than  the  first.  The 
truth  is,  it  does  not  really  give  any  explanation  at 
all ;  it  only  answers,  like  the  doctor  in  Molicre  : 
Opium  facit  donnire  quia  hahet  facullateni  dormi- 
tivnm." 

Another  cause  of  decline  for  Buffon's  system, 
toward  the  end  of  the  last  century,  was  the  progi-ess 
of  opinion  in  regard  to  spontaneous  generation.  At 
that  time  there  was  much  investigation  on  this  sub- 
ject, especially  as  to  the  infusorial  animalcules. 
Needham  and  Sjiallanzani  were  the  principal  dis- 
putants in  this  field,  and  attracted  to  it,  for  some 
years,  the  attention  of  the  scientific  world :  the 
result  being,  at  last,  a  genei-al  conviction  that  Spal- 
lanzani's  experiments  had  destroyed  the  hv]5othesis 
of  spontaneous  generation,  at  least  for  the  infusoria. 
Buffou's  system,  therefore,  diminished  in  importance, 
because  this  mysterious  department  of  reproduction, 
which  it  had  explained  so  well,  no  longer  needed 
explanation.  It  thus  lost  one  of  its  strongest  claims 
to  supjjort ;  and,  without  being  actually  disproved, 
it  was  discredited  to  an  extent  which  must  have 
seriously  impaired  its  scientific  statiis. 

Finally,  it  received  its  death-blow  in  1827,  from 


'  Histoiro  iIp  rArauleniie  Kovalo  des  Science.^,  p.  134.     Anni5c  1753. 
'  ObservBtions  ear  rHistoirc  N.iturcllc  iId  BnfEoil.     Paris,  1738. 


De  Baer's  discovery  of  the  ovule  in  the  ovarian  folli- 
cle of  mammalians. '" 

De  Ciraaf  had  supjiosed,  when  he  first  described 
the  ovarian  follicles,  one  hundred  and  fifty  years 
before,  that  they  were  really  eggs,  and  this  view 
was  widely  accepted.  The  ovaries  of  mammalians, 
like  those  of  fislies  and  birds,  were  regarded  as 
clusters  of  eggs  held  together  by  intervening  tissue. 
But  it  was  not  easy  to  demonstrate  in  man  and 
quadrupeds  the  discharge  of  these  supposed  eggs 
from  the  ovary.  No  observer  had  ever  succeeded 
in  finding  one  of  them  separated  from  its  ova- 
rian connections ;  and  the  earliest  ovum  discover- 
able, in  the  uterus  or  Fallopian  tube,  was,  of  course, 
considerably  smaller  than  the  ripe  follicle  in  the 
ovary.  This  threw  a  doubt  over  the  doctrine  of  De 
Graaf,  and  left  room  for  Button's  assertion  that 
there  were  no  such  things  as  eggs  in  the  mammalian 
female;  that  her  so-called  ovaries  were  testicles,  as 
much  so  as  those  of  the  male  ;  and  that  she  pro- 
duced a  seminal  fluid  composed  of  organic  molecules 
similar  to  his. 

This  view  was  so  interwoven  with  Buffon's  whole 
.system  that  one  could  hardly  exist  without  the 
other.  And  when  the  microscopic  ovum  and  its 
mode  of  exit  from  the  ovary  were  at  last  fully 
brought  to  light,  so  that  any  one  could  see  them 
when  he  chose,  the  discussion  naturally  came  to  an 
end.  The  female  testicles  and  seminal  fluid,  with 
their  glandular  corpora  lutea,  no  longer  had  a  place 
in  court  ;  everything  connected  with  them  shared  in 
the  collapse,  and  the  entire  company  of  organic 
molecules,  reproductive  extracts,  composite  organ- 
isms, and  interior  moulds,  disappeared  together, 
like  actors  at  the  end  of  a  play. 

Another  set  of  ideas,  once  in  high  repute,  but 
now  long  obsolete,  are  those  of  Bonnet  on  the  "  In- 
clusion of  Germs." 

Bonnet  was  of  a  wealthy  and  influential  family  in 
Geneva,  where  he  passed  the  whole  of  his  life,  en- 
gaged in  the  study  of  natural  histoiw  and  kindred 
subjects.  He  became  widely  known  for  his  attain- 
ments in  this  direction,  and  was  connected  with 
nearly  all  the  learned  societies  of  Europe.  He  was 
the  friend  and  corresijondent  of  ECanniur,  Haller, 
Spallanzani,  Trembler,  and  De  Saussure.  Spallan- 
zani  communicated  to  him  in  manuscript,  for  peru- 
sal and  advice,  his  own  researches  on  the  generation 
of  infusoria,  and  wlien  the  volume  appeared,  he 
printed,  as  part  of  it.  Bonnet's  letters  in  reply. ''■ 

The  personal  character  of  Bonnet  had  traits  of 
superior  excellence,  and  secured  him  a  large  share 
of  attachment  and  esteem.  His  disinterestedness 
and  modesty,  in  regard  to  his  own  opinions,  were 
well  known  and  were  often  the  subject  of  eulogy. 
His  own  discoveries  in  entomology  were  of  acknowl- 
edged merit  :  Init  he  attributed  them  mainly  to  the 
teaching  of  Reaumur,  because  he  had  been  inspired 
by  the  example  and  encouragement  of  this  master, 
under  whom  he  felt  "  proud  to  enrol  himself  as  a 
pupil."  Spallanzani  calls  him  the  "Philosopher 
of  Geneva,"  and  the  "  sublime  author  of  the  '  Contem- 
plation of  Nature.' "  His  first  publications  appeared 
in  1715,  and  were  followed  by  others  at  various  dates 
until  1770,  after  which  they  were  collected  in  a  series 
of  eighteen  volumes." 

Bonnet  presented  the  curious  spectacle  of  a  man 


12  K.  E.  von  Baer :  De  Ovi  mammalium  et  hominis  gcnesi.    Lipsix, 
1S27. 

13  Spallanzani :  Opuscoli  di  fi^ica  animale  et  vegetabiie. 

"  Ch.   Bonnet :    OSnvies  d'Histoire   Naturellc  et  de    Philosophic 
Neuchatel,  1779. 


118 


THF   MEDICAL  RECORD. 


under  the  varying  influence  of  two  opposite  tenden- 
cies— at  one  time  an  exact  and  painstaking  obsex'ver 
of  nature,  at  another  an  irresponsible  wanderer  in 
the  vaguest  of  speculations.  His  earliest  scientific 
work  was  an  e^cperimental  investigation  on  the  repro- 
duction of  aphides,  by  which  he  first  demonstrated 
with  certainty  the  non-sexual  viviparous  propagation 
of  the  insects.'  ■  It  is  hardly  possible  to  imagine  a 
more  thorough,  direct,  and  conscientious  method 
than  that  adopted  by  Bonnet  in  these  observations. 
He  took  the  young  aphis  just  expelled  from  the 
body  of  its  parent,  placed  it  upon  a  sprig  of  fresh 
leaves,  stuck  in  a  pot  of  earth  and  covered  with  a 
bell-glass,  and  then  watched  his  solitaiy  prisoner 
for  twenty-one  days,  until  it  had  grown  to  maturity 
and  had  i^roduced,  without  fecundation,  ninety-five 
young  ones.  During  this  time  he  kept  exact  records 
of  the  insect's  moulting,  and  also  of  the  new  births, 
most  of  which  took  place  under  his  own  eye.  He 
repeated  the  trial  with  apliides  of  dill'erent  species, 
and  with  those  which  had  themselves  been  produced 
in  captivity ;  and  he  succeeded  in  raising  them  in 
this  way,  without  fecundation,  for  eight  successive 
generations.  For  these  observations  he  received  the 
honor  of  an  election  as  CoiTespondeut  of  the  French 
Academy  of  Sciences.  He  also  made  valuable  con- 
tributions to  natural  history  on  the  multiplication  of 
aquatic  worms  by  division,  on  the  gi'owth  of  plants,  on 
the  function  of  leaves,  and  on  the  habits  of  insects. 

On  the  other  hand,  he  constructed,  out  of  his  own 
meditations,  a  graduated  system  of  things  visible 
and  invisible,  which  he  called  the  "  Scale  of  Being," 
and  which  formed  the  subject  of  one  of  his  later 
works,  published  under  the  title  of  "Contemplation 
de  la  Nature."  It  embraced  the  structure  of  the  en- 
tire universe,  from  the  simple  elements  of  inor- 
ganic matter  to  the  "  celestial  hierarchies  "  of  other 
worlds.  According  to  this  system,  there  are  no 
gaps  or  sudden  variations  in  nature,  but  only  a  con- 
tinuous series  of  combinations  and  modifications  in 
ascending  grade.  Everything  is  immediately  con- 
nected with  that  which  i:)vecedes,  and  with  that 
which  is  to  follow.  At  the  beginning  of  the  volume 
there  is  inserted,  for  the  reader's  convenience,  a 
printed  table,  exhibiting  the  regular  succession  of 
natural  objects,  from  gaseous  substances  up  to  man. 
The  purely  inorganic  elements,  in  various  grades  of 
combination,  lead  to  the  composite  earths,  svilphurs 
and  metallic  bodies  ;  thence  through  the  vitriols  or 
metallic  .salts,  to  ordinary  saline  substances  in  crys- 
talline form;  and  thence  to  compound  rocks  "of 
heterogeneous  structure,  like  granite  and  sand- 
stones. Immediately  above  these  are  rocks  like 
slate,  talc,  and  asbestos,  which  exhibit  a  laminated 
or  fibrous  texture,  and  which  may  therefore  be  con- 
sidered as  "  the  connecting-link  between  inorganic 
and  organic  solid  bodies." 

This  point  is  especially  important  in  Bonnet's 
scheme,  for  it  marks  the  passage  from  dead  matter 
to  living  organisms.  It  is  not  altogether  what  its 
author  could  wish ;  but  he  makes  the  best  of  it  by 
quietly  putting  its  burden  of  proof  on  posterity. 
"  It  must  be  acknowledged,"  he  .says,  "  that  the 
transition  hero  is  not  quite  so  perfect  as  in  many 
other  cases.  It  looks  as  tliough  nature  in  this  in- 
stance had  made  a  leap.  But  tlie  gap  will  undoubt- 
edly bo  filled  up  as  our  knowledge  increases  in 
precision  and  extent." 

Once  fairly  started  among  organized  structures, 
the  scale  rises  easily  tjirough  corals,  lichens,  and 


*  CEuvroa  do  Roiinet,  torn,  i.,  p.  10. 


mushrooms,  to  plants  in  general ;  through  the  sen- 
sitive plant  to  animals,  from  insects  to  snails,  ser- 
pents, eels,  and  fish;  through  flying-fish  to  birds, 
from  birds  to  bats  and  quadrupeds,  and  so  on,  to 
monkeys,  apes,  and  man.  But  this  extended  grada- 
tion is  not  enough  for  Bonnet.  He  has  also  the 
"  Celestial  Hierarchies  "  and  the  "  Gradation  of  the 
Worlds  ;  "  some  of  which,  he  l>elieves,  are  as  su- 
perior in  physical  and  moral  organization  to  our 
earth  as  man  is  above  the  ape. 

The  frontispiece  to  Bonnet's  work  is  an  engraved 
portrait  of  himself,  taken,  as  he  tells  us,  when  he 
was  "plunged  in  dee])  meditation  on  the  restitution 
and  perfectibility  of  living  creatures."  It  renders, 
he  thinks,  his  "  reflective  expression  "  with  much 
success  ;  and  it  is  certainly  fortunate  that  the  artist 
saw  him  just  when  he  happened  to  be  meditating  on 
so  abstruse  a  svibject. 

Bonnet's  great  theory  of  reproduction,  or  the  "In- 
clusion of  Germs,"  appears  mainly  in  his  work  en- 
titled, "  Considerations  sur  les  Corps  Organises,"  with 
some  additional  am  jilifications  in  the  "  Contemplation 
de  la  Nature."  His  thoughts  were  turned  in  this  di- 
rection ]iartly  by  Trembley's  recent  discoveiy  of  the 
multiplication  of  fresh- water  polyps  by  division,  and 
partly  by  his  own  observations  on  the  reproduction 
of  aquatic  worms  and  aphides.  He  was  further 
strengthened  in  his  opinion  by  Haller's  observa- 
tions, which  appeared  in  1758,  on  the  formation  of 
the  chick  in  the  fowl's  egg. 

There  were,  about  that  time,  three  different  views 
entertained  as  to  the  nature  of  sexual  generation  : 

First. — The  spermatic  animalcules,  one  or  more  in 
number,  were  arrested  in  the  uterus  and  there  be- 
came developed  into  embryos.  According  to  this 
view,  the  male  parent  furnished  the  living  germ,  the 
female  only  providing  for  its  care  and  nourishment. 

Secoiiil. — The  seminal  fluids  of  both  sexes,  when 
mingled  to.sether,  produced  the  embryo,  de  noro,  by 
a  mutual  aiTangement  of  their  organic  particles. 
This  was  the  doctrine  of  Buff'on,  and  attributed  an 
equal  and  similar  action  to  both  parents. 

Tliird. — The  germ  pre-existed  in  the  ovai-y  and 
egg  of  the  female,  and  was  only  stimulated  to 
further  development  by  the  seminal  fluid  of  the 
male. 

Bonnet  accepted  the  third  of  these  doctrines. 
He  believed  in  the  preexistence  of  germs,  but  he 
gave  to  the  idea  a  much  wider  extent  and  signifi- 
cance. The  germ,  as  he  understood  it,  was  not  only 
a  structure  capable  of  being  developed  into  a  living 
creature,  it  actually  contained,  within  itself  and 
ready  formed,  all  the  parts  of  the  future  organism. 
These  parts  were  exceedingly  minute,  delicate,  and 
transparent;  but  they  nevertheless  existed,  though 
as  yet  imperoe])til)le  to  the  senses.  It  was  only  their 
small  size,  their  softness,  and  transparency,  which 
prevented  their  being  seen.  After  impregnation, 
they  gi-ew  larger,  more  consistent,  and  more  opaque, 
and  tlien  first  became  recognizable  as  the  organs  of 
the  embryo.  These  organs,  accordingly,  were  not 
things  of  new  formation.  They  only  showed  plainly, 
at  a  certain  period  of  development,  wliat  had  }ire- 
viously  existed  in  invisible  form.  The  author  ex- 
tended this  doctrine  without  hesitation  to  its  farthest 
limits.  For  him,  every  seed  contains  a  plant  in 
miniature.  In  an  animal  germ,  evei-y  organ  and 
tissue,  without  exception,  is  already  present  :  the 
heart,  the  ves.sels,  the  liver,  the  kidneys,  the  intes- 
tine, the  nerves,  and  the  brain,  consequently  tliore 
is  no  such  thing  as  generation,  if  by  that  we  under- 
stand the  production  of  a  new  being,  or  even  of  a 


THE   MEDICAL  RECORD. 


1]9 


new  organ.  What  appears  to  be  such  is  only  the 
development  of  something  that  was  in  existence  be- 
forehand. 

These  views  were  adopted  by  some,  and  rejected 
by  others,  the  physiological  theorizers  of  the  day 
dividing  into  two  parties,  known  as  the  g^/cyKiitwvV/.s- 
and  the  evolu/ionist.'!.  The  epigenesists  were  those 
who  believed,  like  Buffon,  that  the  embryo  was  a 
new  formation,  produced  by  the  union  of  molecules 
and  the  snccessive  organization  of  different  parts. 
The  evolutionists,'*  on  the  other  hand,  maintained 
with  Bonnet  the  pre-existence  of  germs,  and  insisted 
that  nothing  in  the  embryo  was  newly  formed,  but 
onlv  enlarged  and  solidified  by  development. 

These  notions  were  sustained  in  some  degree  by 
the  discoveries  of  Haller  in  the  incubation  of  the 
fowl's  egg.  Haller  had  studied  the  development  of 
thfi  chick,  day  by  day,  and  had  noted  the  appear- 
ance of  its  diti'erent  organs  and  envelopes.  His  mas- 
terly observations  on  the  yolk-sac,  and  its  connection 
with  the  embryo,  were  claimed  by  the  evolutionists 
tibe  decisive  as  to  the  pre-existence  of  the  germ 
aid  its  essential  i)arts.  "  The  membrane  enclosing 
the  yolk,"  says  Bonnet,  "i.s  continuous  with  the  in- 
testine of  the  chick.  The  arteries  and  veins  of  the 
yolk  are  branches  of  the  mesenteric  vessels  of  the 
fuetus.  The  blood  circulating  in  the  yolk-vessels 
revives  its  impulse  from  the  fetal  heart.  The 
yolk  is,  therefore,  essentially  a  part  of  the  chick. 
But  the  yolk  exists  in  the  egg  before  impregnation  ; 
consequently  the  chick  also  exists  in  the  egg  before 
impregnation.  .  .  .  This  proves  incontestably 
that  the  embryo  is  at  first  a  part  of  the  parent,  and 
that  its  existence  is  anterior  to  the  time  of  concep- 
tion. 

Bonnet's  assumption  of  the  pre-existence  of  the 
embryo,  as  well  as  of  the  germ,  was  not  without  a 
certain  plausibility.  The  organs  of  the  embryo, 
when  first  formed,  are,  in  fact,  not  only  small,  but 
also  colorless  and  transparent ;  so  that  they  are 
seen  with  considerable  difficulty,  and  may  even  be 
overlooked  for  some  time  after  they  are  really  pres- 
ent. Bonnet  says  this  is  the  mistake  made  by 
the  epigenesists.  "  They  estimate  the  time  when 
the  parts  of  an  animal  are  first  created  by  that 
at  which  they  fii-st  liecome  visil^le  ;  and  whatever 
cannot  be  seen  they  assume  has  no  existence." 
But  the  organs  in  an  imperfect  embryo  might  very 
easily  have  been  there,  though  not  sufficiently  dis- 
tinct to  meet  the  eye.  "  Do  you  wish,"  he  says,  "a 
short  and  ready  demonstration  of  this?  When  the 
lung  of  an  embryo  chick  is  first  ])epceptible  to  the 
senses,  it  already  measirres  ten  one-hundredths  of 
an  inch.  It  is  evident  that  it  would  have  been 
visible  when  only  half  that  size,  were  it  not  for  the 
extreme  transparency  of  its  tis.sue." 

And  so  on  of  all  the  other  parts.  Bonnet  has 
more  faith  than  the  ejDigenesists.  He  believes  that 
the  organs  of  the  embryo  were  there  before  he  could 
see  them,  and  that  they  even  existed  from  the  be- 
ginning, though  invisible  in  the  unimpregnated 
egg- 
But  if  the  germ  contains  all  the  organs  of  the 
chick,  ready  formed,  only  small  and  undeveloped,  it 
contains  ovaries  as  well  as  the  rest,  and  these  ova- 
ries contain  the  germs  of  the  next  generation.  It  is 
plain  the  series  cannot  end  here.  The  germs  of  the 
second  generation  are  chicks  in  miniature  as  much 
as  those  of  the  fii-st.     Consequently,  they  contain 

*"  It  is  unnecessary  to  say  thtit  this  term  was  nsed.  dnrinpr  the  la.st 
cent\u-y,  in  a  sense  entirely  different  from  that  which  attaches  to  it 


their  own  ovaries  and  germs,  which,  in  turn,  con- 
tain others  still ;  and  so  on  without  any  definable 
limit,  one  .set  of  germs  within  the  other  in  geomet- 
rical progression,  each  germ  containing  not  only  its 
own  embryo,  but  also  all  the  embryos  that  can  pos- 
sibly be  produced  from  it  in  unnnmbeied  genera- 
tions hereafter. 

Bonnet  does  not  shrink  from  the  magnitude  of 
this  spectacle.  He  rather  glories  in  it,  and  enjoys 
the  contemplation  of  its  unlimited  persjiective. 
"  For  my  i>ai't,"  he  says,  "  I  like  to  extend,  as  far  as 
possible,  the  limits  of  creation.  There  is  a  pleasure 
in  the  thought  of  this  magnificent  series  of  organized 
beings,  enclosed,  like  so  many  little  worlds,  one 
within  the  othei-.  I  see  them  receding  by  degrees, 
diminishing  in  regular  order,  and  losing  them.selves 
at  last  in  an  impenetrable  night.  It  gives  me  a 
sense  of  satisfaction,  when  I  look  at  an  acorn,  to  see 
in  it  the  germ  of  a  majestic  oak  that  centuries  hence 
will  shelter  the  birds  and  the  beasts  under  its 
branches ;  or,  still  more,  to  behold,  in  Emilia's 
womb,  the  germ  of  the  hero  who  thousands  of  years 
hereafter  will  found  an  empire ;  or  perhaps  of  the 
philosopher  who  shall  discover  to  mankind  the 
cause  of  gravitation,  the  mysteiy  of  reproduction,  or 
the  mechanism  of  our  existence."  '" 

This  prospect,  however,  for  the  germs  of  the  fu- 
ture, which  Bonnet  found  so  attractive,  was  not  as 
satisfactory  to  some  of  his  contemporaries.  They 
even  haggled  with  him  about  the  past.  If  the  age 
of  the  world,  as  generally  admitted,  was  six  thou- 
sand years,  and  if  each  generation  of  man  is  com- 
pleted in  thirty  years'  time,  that  would  give  two 
hundred  successive  generations  since  Adam  and 
Eve,  with  about  a  thousand  million  human  beiugs 
at  jiresent  on  the  earth.  All  these  inconceivable  num- 
bers must  have  been  contained,  under  the  form  of 
germs,  in  the  ovaries  of  Eve.  The  minuteness  of 
the  embryos  of  the  two  hundredth  generation,  when 
enclosed  in  the  body  of  our  first  parent,  was  declared 
to  be  something  incredible.  Still  more  so,  for  plants 
which  gi'ow  and  fructify  every  year.  Hartsiiker 
calculated  that  the  relation  in  size  between  the  first 
wheat-gi"aiu,  and  that  to  be  produced  at  the  end  of 
six  thousand  years,  would  be  expressed  by  the  figure 
of  unity, /o//o!ce(/  iv  thirt)/  thoiismid  zeros. 

All  this  did  not  give  Bonnet  or  his  friends  any 
discomfort.  Such  terrific  estimates  may  serve  to 
confound  the  imagination,  but  logic  always  finds  a 
sure  refuge  in  the  infinite  or  indefinite  devisabiJity 
of  matter.  Hartso-ker  and  his  followers,  according 
to  Bonnet,  put  the  senses  and  the  imagination  in 
place  of  the  understanding.  They  want  to  see  and 
touch,  so  to  speak,  what  can  only  be  comjjrehended 
by  an  effort  of  the  mind.  The  hypothesis  of  the  in 
elusion  of  germs  is  above  the  level  of  such  calcula- 
tions, and  is,  he  concludes,  a  "  .si^lendid  triumph  of 
pure  reason  over  the  senses." 

Bonnet's  theory  is  by  no  means  confined  to  the 
simple  hypothesis  of  one  germ  included  within 
another.  It  is  an  extensive  and  elaborate  .system, 
ramifying  into  all  departments  of  natural  history 
and  physiology.  The  included  germs  not  only  exist 
before  fecundation,  but  they  are  nourished  and 
grow,  in  a  way  analogous  to  that  of  adult  bodies. 
There  can  be  no  doubt  of  this,  because  the  fowl's 
eggs  certainly  increase  in  volume  before  fecundation, 
and  are  to  be  seen  in  the  ovaiy,  of  many  diti'erf  nt 
sizes  and  grades.  But  the  yolk  is  essentially  a  jjurt 
of  the  young  chick.     Therefore,  if  the  yolk  grows 

1^  Q-'nvres  de  Bonnet,  torn,  v.,  p.  ^Ofi. 


uo 


THE  MEDICAL  RECORD. 


before  fecundation,  the  embryo  does  also.  Besides, 
in  the  theory  of  inclusion,  the  contained  germs  di- 
minish progressively,  one  -within  the  other,  to  an 
inconceivable  minuteness.  The  outermo-st  germ  is, 
of  course,  the  largest,  and  is  nearly  ready  for  im- 
pregnation. But  when  it  has  lieen  fecundated,  and 
has  expanded  into  the  body  of  an  adult  female,  the 
next  included  set  of  germs  have  in  turn  come  to  be 
as  large  as  the  other  was  before  ;  and  so  on,  in  con- 
tinuous order,  the  smaller  germs  gradually  moving 
up  in  the  scale  of  magnitude,  to  be  ready  for  im- 
pregnation wlien  their  time  amves.  The  process  of 
nutrition  and  growth  must  therefore  Vie  going  on  in 
these  embryonic  organisms,  and  has  been  going  on 
in  them  ever  since  the  creation. 

But  how  is  the  nuirition  of  the  germs  provided 
for,  and  what  are  the  materials  used  in  their  gTowth  ? 
It  is  well  known,  says  Bonnet,  that  the  dill'erent 
l^arts  of  the  body  are  not  nourished  directly  by  the 
blood.  A  more  delicate  and  colorless  fluid,  called 
bimph,  separated  from  the  blood  by  appropriate  or- 
gans, serves  for  the  immediate  supjily  of  the  tissiaes. 
And  as  these  tissues  vary  in  fineness  and  consistency, 
we  can  hardly  doubt  that  the  secretory  organs  pre- 
pare for  them  different  kinds  of  lymph,  more  or  less 
attenuated  to  correspond  with  the  delicacy  of  stnic- 
ture  in  separate  parts.  Some  tissues,  as,  for  ex- 
ample, the  brain  and  nerves,  must  requii-e  a  lymph 
many  times  finer  and  more  subtle  than  that  employed 
for  the  grosser  parts. 

But  the  included  germs  are  made  up  of  tissues 
finer  stilL  If  we  admit  that  there  is  no  such  thing 
as  real  generation,  and  that  everything  has  been 
pi-eformed  from  the  beginning,  then  the  germs 
which  are  to  make  their  appearance  a  thousand 
years  hence  have  now  actually  within  them,  and 
incalculably  minute,  all  the  parts  characteristic  of 
the  species.  Imagine  the  lieart,  the  brain,  the 
nerves,  and  the  stomach  of  such  an  embryo.  Cer- 
tainly, no  lymph  could  penetrate  their  tissTics,  or  be 
of  the  least  use  for  their  nutrition.  What  fluid  is 
there  in  the  body  sufficiently  attenuated  and  ethereal 
to  insinuate  its  particles  into  a  structure  of  such 
delicacy,  and  incorporate  them  with  its  substance  ? 
There  is  only  one,  and  Bonnet  secures  it.  This 
precious  and  double-distilled  material,  which  is 
alone  capable  of  nourishing  an  unfecundated  germ, 
is  the  NEr.vous  FLriD. 

The  nervous  fluid  was  not  an  invention  of  Bon- 
net's. It  was  generally  acknowledged,  in  his  time, 
as  the  immediate  cause  of  nervous  action.  Like 
the  electric  fluid,  it  was  intangible  and  invisible, 
and  was  known  only  by  its  elf'ects.  Its  invisibility 
was  due  to  its  vaporous  or  ai'rial  constitution,  and 
this  enabled  it  to  circulate  in  the  delicate  passages 
of  the  nervovis  tissue,  which  were  themselves  invisi- 
ble, owing  to  their  minuteness.  The  nervous  fluid, 
or  "  animal  spirits,"  so  called,  after  being  elaborated 
in  the  brain,  was  disseminated  through  tlie  nervous 
channels  to  the  various  organs  of  sense  and  motion. 
Its  existence  was  proved  by  a  very  simple  fact.  If 
you  tie  a  nerve  going  to  a  muscle,  the  muscle  is 
paralyzed.  How  could  a  ligature  cut  off  tlio  ner- 
vous influence,  except  by  arresting  the  passage  of 
a  fluid?  Tliere  was,  tlierefore,  little  or  no  doubt  in 
regard  to  it. 

The  nervous  fluid,  in  Bonnet's  system,  was  not  en- 
tirely dissipated  in  the  exercise  of  sensibility  and 
muscular  acti(m.  The  unconsumcd  portion,  after 
returning  to  the  brain,  was  again  sent  out  by  similar 
channels  to  be  used  in  nutrition.  It  was  cari-ied  by 
the  maternal  nerves  to  the  ovaries,  and  there  im- 


mediately distributed  to  the  germs  "of  the  first 
order,"  or  those  nearest  maturity.'*  Elaborated  anew 
and  still  further  spiritualized  by  the  organs  of  this 
delicate  structure,  it  supplied  a  finer  nourishment 
to  the  germs  of  the  second  order ;  here  it  underwent 
a  similar  prejiaration  for  those  of  the  third  order ; 
and  so  on,  to  the  belated  and  unfortunate  germ 
which  "would  not  be  ready  for  fecundation  till  the 
end  of  the  world." 

This  staggering  array  of  infinitesimals,  in  struc- 
ture and  function,  only  serves  to  increase  the  author's 
admiration  and  strengthen  his  confidence.  "  What 
an  abyss  of  wonders,"  he  says,  "  in  the  human  brain. 
Even  a  single  fibre  of  the  brain  is  itself  an  abyss. 
AVhat  shall  we  s.ay,  then,  if  all  these  mysteries,  exist- 
ing in  the  adult  body,  are  repeated  and  concentrated 
in  so  many  organized  atoms,  enclosed  one  within 
the  other,  and  giowing  constantly  smaller  in  indefi- 
nite progression  ?  " 

The  act  of  impregnation,  in  reproduction  by  sexes, 
comes  in  for  a  very  easy  and  natural  explanation. 
The  nervous  fluid  is  the  ajjpropriate  nourishment 
for  an  unfecundated  germ.  AVhen  this  germ  be- 
comes a  fcjetus  it  will  be  supplied  with  lymph,  and 
its  organs  will  grow  like  those  of  the  adult.  But 
how  can  it  make  the  transition  from  one  state  to  the 
other,  and  how  are  the  finely  woven  tissues  of  tl)e 
germ-embryo  to  be  made  capable  of  admitting  tie 
grosser  substance  of  the  lymph?  This  is  exactly 
the  function  of  the  eeminal  fluid.  It  is  not  only  a 
source  of  nourishment  for  the  mature  gei'm,  but  it 
has  a  sijecial  stimulating  influence  on  the  embnonic 
heart.  The  pulsation  of  the  heart  in  the  germ- 
embiyo  is  very  faint,  and  only  serves  for  the  circula- 
tion of  the  nervous  fluid.  Consequently  the  un- 
fecundated germ  increases  but  slowly,  and  never 
gets  beyond  a  certain  stage  of  development.  But 
when  the  seminal  fluid  comes  in  contact  with  it  and 
penetrates  its  substance,  the  heart's  pulsation  is  in- 
creased in  force.  This  causes  an  expansion  of  the 
circulatory  channels,  an  increased  volume  of  the  cir- 
culating fluid,  and  consequently  more  rapid  nourish- 
ment ;  and  thus  the  limit  is  passed  between  the 
condition  of  the  germ-embryo,  whose  tissues  only 
admit  nervous  fluid,  and  that  of  the  growing  fcrtus, 
that  can  thrive  upon  the  lymph.  Once  begun,  the 
process  naturally  continues  until  the  body  has  at- 
tained its  full  development. 

StOl  the  theory  of  inclusion  was  not  altogether 
free  from  difficulty.  One  of  its  most  troublesome 
problems  was  that  of  intestinal  worms  and  other 
parasites.  Bonnet  wrote  a  sjiecial  treatise  on  the 
ticnia,  partly  devoted  to  ditiVreut  theories  of  its 
origin.  He  rejects,  of  course,  the  idea  of  equivocal 
or  spontaneous  generation.  But  if,  like  everything 
else,  it  comes  from  pre-existing  germs,  are  thffe 
germs  introduced  into  the  intestine  from  witht  ut. 
or  did  they  exist  beforehand  in  the  embrj'onic  human 
body  itself?  If  so,  the  gerin  of  the  first  tape-worm 
and,  in  fact,  of  all  which  have  existed  since,  must 
have  been  included  in  the  body  of  the  first  num. 
There  are  objections  to  be  met  in  either  case,  but 
the  most  singular  are  those  connected  with  the 
second. 

In  this  view,  the  tania  has  a  contemporaneous 
origin  with  man  ;  that  is,  it  already  existed  in  .\dani, 
ami  so  has  passed  into  his  posterity.  But,  accord- 
ing to  Genesis,  the  animals  wore  all  created  before 
Adam.  Therefore  tlie  tieuia  must  have  first  lived  in 
a  foreign  element ;  but  the  fact  is,  we  never  find  it 


'  CKuvrca  dc  Bonuot,  torn,  x.,  p.  10. 


THE   MEDICAL  RECORD. 


121 


except  in  the  intestines.  Besides,  how  can  we  sup- 
pose such  a  pest  to  have  been  placed  in  the  body 
of  our  innocent  progenitor,  living  in  the  earthly 
paradise  of  the  Garden  of  Eden  ?  Valisnieri,  who 
adopted  the  contemporaneous  theory,  had  an  odd 
answer  to  this  objection.  He  assumed  that  before 
Adam's  fall  the  intestinal  worms  did  not  do  him  any 
harm,  but,  on  the  contrary,  were  rather  useful,  in 
"  consuming  the  superfluous  humors  and  gently 
stimulating  the  intestinal  walls."  Bonnet  thinks 
this  explanation  a  trifle  far-fetched,  and  doubts 
whether  Adam,  in  his  state  of  innocence,  had  any 
superfluous  humoi's,  or  needed  any  tajie-worm  to 
excite  his  intestines.  He  prefers  the  idea  of  M.  Le- 
clerc,  that  the  intestinal  worms,  which  are  now  so 
troublesome,  only  existed  at  first  in  Adam  under 
the  form  of  eggs,  and  were  not  hatched  until  after 
his  disobedience." 

But  the  line  of  descent  for  tape-worms  is  not  yet 
quite  clear.  Granting  that  they  existed  in  Adam, 
either  as  eggs  or  as  worms,  how  did  they  get  into 
the  body  of  Eve,  through  which  they  must  have 
passed,  for  transmission  to  posterity  ?  The  most 
direct  roiite  from  the  intestine,  according  to  Valis- 
nieri, would  be  through  the  thoracic  duct,  which 
"mounts  upward  along  the  ribs"  to  that  one  wliich 
was  taken  for  the  body  of  Eve.  Bonnet  is  inchned 
to  adopt  a  simpler  and  less  miraculous  method  ot 
transfer,  by  supposing  that  the  eggs  of  the  tronia 
are  so  small  that  they  can  pass  through  the  blood- 
vessels, and  thus  reach  the  vesicute  seminales.  "  In 
this  way,"  he  says,  with  a  puzzling  kind  of  naivetf, 
"  we  can  explain  the  whole  thing  without  much  diih- 
culty,  and  without  having  recourse  to  divine  power." 

Howevei',  the  author  regarded  the  introduction  of 
parasitic  germs  from  without  as,  on  the  whole,  the 
more  probable  theory  of  theii-  origin,  especially  as 
the  weight  of  evidence  was  already  in  that  direction. 

The  system  of  Bonnet  has  applications  to  many 
different  points  of  general  physiology,  such  as  the 
resemblance  of  the  young  animal  to  both  j^arents, 
the  production  of  hybrids  and  monstrosities,  and  in 
particular  to  non-sexual  generation,  or  multiplica- 
tion by  budding  and  division ;  all  of  which  it  ex- 
plained -nuth  more  or  less  ingenuity  and  success.  It 
had  an  ajjparent  support  in  several  recent  and  im- 
portant observations ;  such  as  the  existence  in  cer- 
tain seeds  of  an  embryo  jilant,  the  multiplication  by 
interior  germs  of  Volvox  globator,  the  reproduction 
of  aphides  without  impregnation,  and  Haller's  re- 
searches on  the  embryo  chick.  Haller  himself  de- 
fended it  from  a  variety  of  objections,  and  adduced 
a  number  of  arguments  in  its  favor.-"  But  the  theo- 
ry itself  went  so  far  beyond  the  limits  of  possible 
demonstration  that  its 'basis  of  reality  bore  no  cal- 
culable proportion  to  its  towering  superstmcture. 
It  discounted  the  results  of  embryological  discoveiT 
at  too  exorbitant  a  rate  ;  and  it  could  not  afford  to 
have  any  of  them  turn  out  differently  from  what  was 
expected.  This  happened  in  the  case  of  the  mam- 
malian egg.  Subsequent  observations,  made  with 
better  facilities,  showed  that  the  organs  of  the  fcetus 
do  not  pre-exist  in  the  ovum  in  the  sense  imagined 
by  Bonnet.  The  impregnated  ovum  has,  it  is  true, 
a  remarkable  property,  by  which  each  separate  part 
assumes  afterward  a  definite  shape,  and  becomes  a 
distinct  organ.  But  the  actual  configuration  of 
these  organs  is  certainly  not  present  in  the  ovum, 
because  we  can  now  see  its  original  structure,  as 

■«  CEiivres  ile  Bonnet,  torn,  iil.,  p.  140. 

'»  Haller:  Elementa  PhysiologisB  Corporis  Hnmani,  torn.  viii..  Kect- 
ii.,  art.  xxix.    1766, 


well  as  the  intermediate  forms  which  are  to  be  re- 
placed by  those  of  the  future  embryo.  The  system 
of  the  inclusion  of  germs,  in  the  time  of  its  glory, 
embraced  the  whole  history  of  the  world  from  be- 
ginning to  end,  and  the  mechanism  of  growth  and 
reproduction  throughout  organic  nature,  and  en- 
listed in  its  behalf  the  discoveries  of  scientific  re- 
search as  well  as  the  results  of  logical  deduction. 
But  it  came  to  grief  when  the  study  of  embiyology 
liad  reached  a  certain  stage  in  its  development,  by 
demonstrating  the  actual  constitution  of  the  mam- 
malian egg. 


©rigmal  Communications. 


EXOSTOSES  OF  THE  POPLITE.\L  EEGIOX.* 
By  THOMAS  M.  MAEKOE,  M.D., 

NEW  YORK. 

The  subject  which  I  have  to  bring  before  the  Sur- 
gical Society  to-night,  is  not  one  which  presents  ar.y 
features  of  novelty,  and,  perhaps,  none  of  any  great 
interest  or  importance  in  itself.  I  have  ventured  to 
present  it  because  it  deals  with  cases  not  common 
enough  to  be  familiar  to  the  busy  practitioner,  and 
yet  occurring  sufficiently  often  to  fall  in  the  way  of  a 
very  moderate  .surgical  experience.  I  ask  your  at- 
tention to  the  exostoses  which  grow  from  the  pos- 
terior and  lateral  surfaces  of  the  lower  end  of  the 
femur  and  the  upper  end  of  the  tibia,  and  which, 
therefore,  may  be  said  to  belong  topographically  to 
the  i)opliteal  region.  I  have  thought  that,  by  group- 
ing these  cases  together,  I  might  help  a  little  toward 
an  easy  recognition  of  a  disease  which,  in  the  books, 
is  treated  of  only  under  those  general  considerations 
which  belong  to  many  growths,  in  whatever  part  of 
the  skeleton  they  may  be  situated.  I  shall  relate 
very  briefly  the  history  of  three  cases  of  this  form 
of  tumor,  as  preliminary  to  what  I  have  to  say  about 
the  disease  itself. 

Case   I. — Henry   F.  W ,   seventeen  years   of 

age,  was  admitted  into  the  Eoosevelt  Hospital,  De- 
cember 10,  1877,  with  a  hard  lump  on  the  inner  and 
lower  side  of  the  popliteal  space  on  the  right  side, 
which  he  said  he  had  discovered  about  four  years  i?re- 
viously,  when  it  was  extremely  small.  It  slowly  and 
steadily  increased  duringthe  pastthree  years,  but  dur- 
ing the  la.st  year,  and  particularly  during  the  last  six 
months,  it  has  been  increasing  at  a  much  more  rapid 
rate.  A  firm,  hard  tumor  was  found  projecting  from 
the  posterior  and  inner  .surface  of  the  head  of  the 
tibia,  about  two  inches  below  its  articular  extremity. 
It  seemed  to  be  nearly  the  size  of  the  closed  fist,  and 
occupied  and  filled  all  the  lower  and  inner  portion 
of  the  popliteal  space.  The  surface  was  smooth, 
but  presented  a  number  of  knobs  and  irregularities 
which  could  be  distinctly  felt  through  the  integu- 
ments. It  was  painless  on  pressure,  and  perfectly 
unyielding  to  any  amount  of  force.  It  had  already 
gained  such  a  size  as  to  interfere  with  complete 
flexion  of  the  leg,  particularly  iu  walking.  Pulsa- 
tion good  in  all  the  arteries  below.  No  oedema. 
There  could  be  but  little  ground  for  hesitation  as  to 
the  diagnosis  of  exostosis,  but  the  knobbed  and  ir- 
regular surface  suggested  a  predominance  of  carti- 
lage. 

The  operation  for  its  removal  was  performed  De- 

•  Read  before  the  New  York  Surgical  Society,  December  13,  18S1. 


123 


THE  MEDICAL  EECORD. 


cejaber  13,  1877.  A  long,  longitudinal  incision  was 
made  over  the  centre  of  the  tumor,  and  exposed  a 
free,  serous-looking,  shining  surface,  evidently  car- 
tilaginous, and  from  all  the  exposed  faces  the  tissues 
could  be  separated  with  the  greatest  facility.  In 
fact,  it  seemed  as  if  there  was  no  connection  what- 
ever with  the  surrounding  tissues  over  the  largest 
part  of  the  surface  of  the  tumor,  except  by  a  few 
tine,  glistening,  white  fibres,  which  passed  loosely 
from  one  to  the  other.  The  tumor  was  traversed  by 
a  few  healthy  muscular  fibres,  which  were  easily 
slijiped  aside  over  the  smooth  surface.  Some  few 
deeper  muscular  layers  were  divided  to  give  more 
easy  access  to  the  point  of  origin  of  the  growth. 
Tne  artery  was  found  skirting  the  base  of  the  tumor 
on  its  oiiter  side,  pushed  somewhat  from  its  normal 
course,  and  some  care  was  necessary  in  order  to 
avoid  it.  The  base  of  attachment  was  found.to  be 
comparatively  small,  the  mass  of  the  tumor  over- 
hanging it  nearly  equally  on  all  sides.  A  chain-saw 
was  passed  round  this  narrow  pedicle,  and  the  mass 
removed.  From  the  deep  situation  of  the  pedicle 
at  the  point  where  it  sprang  from  the  bone,  the 
chain-saw  coiild  not  be  worked  parallel  with  the 
surface  of  the  tibia,  and,  accordingly,  it  sawed  its  way 
o.it  obliquely,  leaving  the  pedicle  still  quite  j^romi- 
nent  from  the  bone.  With  some  considerable  diffi- 
calty,  owing  to  its  depth  from  the  surface,  this  prom- 
inence was  removed  by  chisel  and  gouge,  and  then 
it  could  be  seen  that  the  point  of  outgrowth  of  the 
tumor  from  the  bone  did  not  occupy  a  space  of 
more  than  about  a  square  inch.  The  operation 
WIS  done  under  full  Lister  precautions.  Some 
suppuration  followed,  and  rather  a  slow  healing 
by  granulation,  but  no  important  accident  hap- 
pened during  the  cure,  which  was  completed,  and 
the  patient  discharged  from  the  hospital,  February 
2,  1878. 

Case  II. — The  second  case  was  one  which  occur- 
red in  private  practice,  and  is  the  more  valuable, 
because  I  have  been  able  to  keep  watch  of  the  case 
during  the  three  years  which  have  elapsed  since  the 
tumor  was  I'emoved.  Mrs.  R — — ,  thirty-eight  yeai-s 
of  age,  of  fine  physical  development,  and  generally 
in  very  good  health,  had  first  been  conscious  of  a, 
lump  in  the  popliteal  space  at  about  the  age  of 
eigliteen,  which,  during  the  twenty  years  of  its  ex- 
istence, increased  from  the  size  of  a  hen's  egg  to 
the  dimensions  of  a  man's  fist,  and  at  the  time  of 
her  coming  under  my  care  was  still  growing.  The 
increase  was  very  slow  until  about  seven  years  ago, 
since  which  time  it  has  grown  more  rapiclly.  The 
patient  being  of  an  anxious  and  extremely  sensitive 
nature,  her  dise.iso  has  been  a  constant  source  of 
trouble  to  her  during  these  later  years,  not  so  much 
from  actual  pain  in  the  tumor  itself,  as  from  neu- 
r.i,lgic  pains  in  various  parts  of  the  limb,  aggravated, 
and,  indeed,  frequently  induced,  by  the  blows  and 
pressures  to  which,  in  spite  of  her  watchful  care, 
the  growth  was  often  accidentally  subjected.  At 
times  such  injuries  gave  rise  to  a  certain  amount  of 
inSammatory  swelling,  lasting  for  several  days.     On 

0  le  occasion  a  vein  was  supposed  to  have  been  nip- 
t  ired,  for  very  great  occhymosis  and  oedematous 
sivelling  supervened  somewhat  suddenly,  which  only 
slowly  subsided,  leaving  the  whole  limb  much  on- 
fe  ibled.  She  has  boon  able,  wlien  not  suffering  from 
tlnse  injuries,  to  walk  tolerably  well,  thongli  not 
witliout  a  limp  and  some  dragging  of  the  diseased 

1  imb,  but  of  late,  owing  to  the  increase  of  the  growth 
in  an  upward  direction,  the  fiexion  of  the  knee-joiut 
Ins  bseu  more  and  more  restricted,  and  threatens 


soon  to  be  entirely  prevented.  There  is  habittuil 
oedema  of  the  limb  below  the  knee. 

Examination  shows  a  large,  hard,  irregularly 
shaped  tumor,  springing  from  the  tibia  on  its  pos- 
terior face,  and  presenting  nearly  in  the  middle  of 
the  popliteal  space,  which  it  almost  comjjletely 
fills.  It  appears  to  be  a  good  deal  larger  than  a 
man's  closed  fist,  and  has  an  acuminated  prolonga-  _ 
tion  extending  upward,  and  encroaching  upon  the 
posterior  asjjeot  of  the  knee-joint.  This  last  seems 
to  be  the  point  of  most  active  growth.  The  whole 
tumor,  and  this  part  of  it  particularly,  gives  the  un- 
even knobbed  feel  characteristic  of  its  cartilaginous 
surface.  The  operation  was  performed  May  1,  1878. 
It  perhaps  should  be  mentioned  that  she  had  allowed 
the  operation  to  be  deferred  so  long,  because  she  had 
been  told  that  it  could  never  be  removed  without 
danger  to  both  limb  and  life,  and  she  had  been  cau- 
tioned by  several,  who  she  says  were  excellent  sur- 
geons, not  to  allow  it  to  be  interfered  with  in  any 
way. 

The  steps  of  the  operation  were  similar  to  those 
described  in  Case  No.  I.  A  longer  incision  was 
made,  and  the  surface  of  the  tumor  exposed  as  be- 
fore. The  growth  proved  to  be  nearly  twice  as  large 
as  in  the  first  case,  and  gave  us  more  trouble  in 
using  the  chain-saw.  A  large  piece,  however,  was 
taken  olf  by  the  saw,  and  this  gave  access  to  the  rest 
of  the  pedicle,  which,  with  the  remaining  mass  of 
the  tumor,  was  removed  by  gouge  and  chisel  dovm 
to  the  level  of  the  sound  bone.  The  surface  of  at- 
tachment, though  the  tumor  was  so  much  larger, 
was  about  the  same  in  extent  as  in  the  previous  case, 
covering  in  a  rounded  outline  about  one  square  inch. 

The  oj^eration  was  done  under  full  Lister,  with 
spray  and  all  other  precautions,  but,  unfortunately, 
we  were  at  this  time  experimenting  with  thymol, 
and  this  was  the  antiseptic  used.  As  hajipened  in 
so  many  other  cases  in  which  we  relied  upon  this 
remedy,  it  failed  to  protect  my  jiatient  against  the 
ordinary  inflammatory  complications  to  which  such 
wounds  are  always  liable.  Deep  suppuration  oc- 
curred, happily  not  spreading  to  the  thigh,  and 
phlebitis  and  thrombosis  of  the  jjopliteal  and  fem- 
oral veins  very  seriously  complicated  and  delayed 
the  healing  of  the  wound.  The  final  result,  how- 
ever, was  a  perfect  cicatrix,  but  not  till  after  several 
weeks  of  sutt'ering  and  tedious  delay.  The  limb  had 
been  so  long  crippled,  and  she  had  been  so  long  ac- 
customed to  favor  it,  that  it  was  not  till  many  weeks 
had  elapsed  that  she  could  fully  flex  the  knee,  or  use 
the  limb  with  any  confidence  or  comfort.  By  steady 
and  courageous  perseverance  in  passive  motion  and 
in  active  exercise,  however,  she  at  last  regained  the 
free  and  perfect  movement  of  the  joint,  and  she  has 
now  so  far  recovered  the  use  of  the  limb  that  she 
is  able  to  walk  without  the  slightest  limp,  and 
she  scarcely  recognizes  any  difference  in  the  move- 
ment, strength,  or  endurance  of  the  once  crippled 
limb.  The  phlebitis  did  not  extend  beyond  the 
femoral  vein,  but  tenderness  was  slow  in  subsiding, 
and  it  left  behind  a  tendency  to  oedema  which  only 
gradually  disappeared. 

C.\SE  III. — W.  D ,  aged  twenty-two,  came  into 

the  New  York  Hospital,  October  7,  1881.  He  had  a 
hard,  pi-ominent  growth  on  the  outer  aspect  of  tlie 
right  femur,  just  above  the  knee-joint.  He  said  the 
swelling  had  been  increasing  painlessly  for  about 
four  years.  It  was  manifestly  smaller  than  either  of 
the  two  preceding  cases,  and,  being  situated  on  the 
outer  margin  of  the  jjopliteal  space,  had  developed 
at  right  angles  to  the  surface  of  the  bone  from  which 


THE  MEDICAL  RECORD. 


Ii3 


it  grew,  and  was,  therefore,  not  strictly  in  that 
space.  The  history,  with  the  hard,  immovable, 
knobbed  feel  of  the  tumor,  left  no  doubt  as  to  the 
diagnosis,  and  the  operation  for  its  removal  was 
parformaj  on  the  12th,  five  days  after  his  admission. 
This  operation  was  more  tedious  and  difficult  than 
either  of  the  i^revious  ones,  by  reason  of  the  strong 
and  very  tense  bands  of  fascia  lata  which  here  com- 
bine with  the  tendinoTis  origins  of  the  vastus  exter- 
nus,  and  which  encircled  the  neck  of  the  tumor  with 
a  ring  of  resistant  fibrous  tissue,  which  veiy  greatly 
impeded  access  to  the  pedicle  by  which  it  was 
supported.  Besides  this,  the  pedicle  was  extremely 
short,  so  that  the  deep  surface  of  the  tumor  ap- 
proached veiy  nearly  the  surface  of  the  bone  from 
which  it  grew.  In  consequence  of  these  conditions, 
it  was  impossible  to  use  the  chain-saw,  and  even 
with  the  chisel  the  tense  bands  of  fascia  lata  inter- 
fered with  the  handle  being  sufficiently  depressed 
to  bring  the  cutting  edge  fairly  against  the  pedicle. 
After  much  difficulty,  and  the  dividing  of  some  deep 
tendinous  bands,  the  base  was  reached  and  the 
growth  separated.  The  surface  of  attachment  was 
less  than  an  inch  square,  and  was  smoothed,  as 
nearly  as  was  practicable,  to  a  level  with  the  sur- 
rounding surface.  So  much  disturbance  of  the  sur- 
rounding tissues  had  taken  place  in  the  operation, 
that  quite  a  jiocket  had  been  formed  down  toward 
the  popliteal  space,  and  across  this  a  throTigh 
drainage-tube  was  passed  by  a  coiinter-ojieniug 
made  near  the  outer  border  of  the  biceps  muscle. 
The  wound  was  dressed  lightly  with  gauze  dipped 
in  a  solution  of  carbolic  acid  (1-40).  Some  inflam- 
mation followed  the  ojieration,  and  the  cavity  of  the 
wound  suppurated.  Inflammation  seemed  at  one 
time  tlisposed  to  travel  up  the  cellular  planes  of  the 
thigh,  but  this  tendency  was  arrested  before  any  se- 
rious addition  was  made  to  the  suppurating  surface, 
and  then  gi-anulation  became  healthy  and  vigorous. 
He  was  discharged  from  the  hospital,  cured,  No- 
vember 11,  1881. 

By  far  the  best  general  account  of  these  growths 
that  I  have  been  able  to  And,  is  contained  in  a  paper 
by  Mr.  Astley  Cooper,  jjublished  in  a  volume  of 
memoh-s,  written  by  himself  and  Mr.  Travers,  on 
various  surgical  topics,  and  published  in  1818.  He 
says:  "The  mo.st  frequent  seat  of  the  periosteal 
exostosis  is  on  the  inner  side  of  the  os  femoris,  just 
above  the  internal  condyle.  I  have  also  seen  it 
seated  on  the  tibia,  immediately  under  the  insertion 
of  the  sartorius  and  gracilis  muscles."  He  gives 
several  carefully  described  cases,  and  one  in  particu- 
lar which  has  a  sort  of  historic  interest,  for  he  says, 
in  concluding  the  histoi-y  and  treatment  of  the  case 
in  Guy's  Hospital  :  "  She  was  the  first  jjerson  upon 
whom  I  performed  ajy  operation  in  that  institu- 
tion." In  this  paper,  Mr.  Cooi:>er  gives  an  account, 
with  a  drawing,  of  a  saw  invented  by  a  Mr.  Machell, 
who  must  have  been  the  Luer  of  his  day,  and  Mr. 
Cooper  invited  him  to  use  his  saw  on  one  of  his 
cases,  which  he  did,  as  is  stated,  veiy  satisfactorily. 
It  was  a  complicated  affair,  and,  to  my  eye,  not  well 
fitted  for  this  sort  of  deep-sawing. 

The  pathology  of  these  cases  is  extremely  simple, 
consisting  in  an  outgrowth  of  bone,  perfectly  nor- 
mal in  its  microscopic  and  macrosco2Jic  features  ; 
abnormal  only  in  its  excess.  The  growing  bone  is 
deposited  in  a  cartilaginous  matrix  which  thinly  en- 
crusts its  surface,  and,  so  far  as  I  know,  never  exists 
at  any  other  point.  It  is  thus  sharply  defined  from 
enchondroma,  the  ossification,  which  is  often  found 
in  long  and  old  enchondromata,  being  irregularly 


disseminated  through  the  tumor  mass,  and  never 
presenting  the  gross  api^earances  and  orderly  con- 
stniction  of  the  true  exostosis.  In  the  exostosis 
proper,  the  whole  process  is  one  of  orderly  and  per- 
fect ossification,  and  the  result  is  a  growth  which 
not  only  presents  under  the  microscope  the  normal 
elements  of  bone,  but  in  its  arrangement  into  com- 
pact and  cancellous  tissues,  follows  absolutely  the 
normal  type  of  development.  The  thin  layer  of  car- 
tilage which  is  found  on  its  surface,  is  only  in  quan- 
tity sufficient  to  act  as  the  nidus  in  wliich  the  bone- 
development  is  to  take  place,  and  even  the  most 
rapidly  growing  portions  of  the  tumor  will  be  found 
to  possess  a  bone-foimdation,  with  a  covering  of  dfc- 
tilage  only  a  little  thicker  than  that  on  the  older 
parts  of  the  growth.  Authors  state  that  these  tumors 
are  always  jjedunculated,  and  that,  once  formed,  they 
grow  by  extension  of  the  l)ody  of  the  tumor,  without 
any  increase  of  the  base  from  which  it  springs.  This 
Mr.  Stanley  very  strongly  insists  on  ;  and  it  certainly 
distinguishes  these  tumors  from  enchondromata, 
where  such  limitation  of  base  is  not  found.  Mr. 
Queckett  has  also  noticed  that  in  the  ossifying  en- 
chondroma there  are  found  many  distinct  points 
of  ossification  ;  wliereas,  in  the  true  exostosis  there  is 
but  one.  Something  quite  similar  in  perfection  of 
structure  is  found  in  the  exostoses  which  spring 
from  the  surface  of  the  shaft  of  the  long  bones  at 
the  point  where  strong  tendinous  or  aponeurotic  in- 
sertions exist.  Tliese  gi-owths,  though  similar  in 
structure,  difl'er  from  the  true  exostosis  in  many  re- 
spects. Two  of  the  chief  points  of  difference  a.e 
found  in  the  fact  that  these  tendinous  growths  are 
never  pedunculated,  and  that  they  have  at  no  time 
a  cartilaginous  matrix,  the  bone-substance  being  de- 
posited directly  in  the  fibrous  structure  which  is 
involved. 

It  has  been  contended  that  the  true  exostosis 
sometimes  is  arrested  in  its  growth  after  it  reaches 
a  certain  size,  and  remains  unchanged  for  an  indefi- 
nite period.  Of  course,  I  cannot  deny  the  possi- 
bility of  such  an  arrest,  but  from  the  steady  increase 
of  all  the  cases  I  have  seen,  and  similar  regular  in- 
crease being  noted  in  almost  every  published  case 
I  have  read,  I  cannot  help  feeling  that  cases  in 
which  arrest  takes  place  are  probably  those  of  ten- 
dinous variety  and  not  of  the  true  exostosis. 

The  surface  of  these  tumors,  smooth,  shining,  and 
cartilaginous,  is  very  loosely  attached  to  the  sur- 
rounding tissues — so  loosely,  that  the  slight  bands 
or  fibres  of  connective  tissue  are  easily  broken  up 
by  the  finger.  Where  the  tendons  and  muscles  play 
over  its  most  superficial  surface,  there  are  found 
well-developed  bursas  lined  by  a  shining  serous 
membrane,  and  iiermitting  the  freest  possible  glid- 
ing motion  of  the  parts  upon  one  another.  In  each 
of  mj  cases,  this  sujjerficial  bursa  has  been  well- 
marked,  and  in  the  last  case  reported  I  took  pains 
to  discover  its  extent  with  my  finger,  and  also  with 
a  probe  introduced  into  its  cavity.  I  found  it  to 
occupy  all  the  free  surface  of  the  growth,  except 
some  spaces  on  the  sides  where  the  new-formed 
synovial  sac  descended  only  to  varying  distances  to- 
ward the  neck.  It  was,  however,  not  a  perfectly 
free  serous  cavity,  for  at  several  points  it  was  crossed 
by  fine  threads  of  connective  tissue,  more  abundant 
at  some  points  than  at  others,  Init  at  all  points  so 
loose  and  slender,  that  if  the  cavity  had  been  in- 
jected with  fluid,  the  surfaces  would"  nowhere  have 
been  held  in  conf  act  by  them.  The  deeper  synovial 
bursie  could  not  be  so  fully  examined,  but  it"  f  eercs 
probable  that  they  are  merely  enlarge  ments  of  (1  9 


IM 


THE  MEDICAL  RECORD. 


normal  serous-lined  sheaths  belonging  to  the  ten- 
dons of  the  region.  In  the  cases  I  have  presented, 
these  deejjer  burs?e  have  not  been  interfered  with, 
being  pulled  aside  from  the  deeper  surfaces  of  the 
tumor  with  the  tendons  to  which  they  belonged.  I 
think  by  a  careful  operator  they  would  never  be 
opened. 

The  question  of  interest  which  arises  with  regard 
to  these  synovial  cavities  is  :  Do  they  communicate 
with  the  adjacent  joint?  On  this  point  I  have  been 
able  to  find  little  or  no  clinical  evidence.  Virchow, 
Corriel.  and  Ranvier,  the  writer  in  the  "Nouveau  Die- 
tyjnniire,"  and  some  of  the  English  writers,  allude  to 
tie  existence  of  these  burs?e,  and  speak  of  their  oc- 
casionally communicating  with  the  joint  as  a  source 
of  danger.  None  of  them  give  any  cases  in  which 
mischief  has  arisen  from  such  communication,  and 
none  of  them  make  any  distinction  between  original 
normal  burs.Te,  and  those  of  new  formation.  None 
of  the  anatomical  authorities  pretend  to  assert  that 
any  of  these  normal  bursre  do  always  communicate 
with  the  synovial  cavity,  nor  even  to  indicate  pre- 
cisely which  ones  do  thus  communicate.  Witli  regard 
to  the  bursse  of  new  formation,  I  believe  that  they 
never  do  communicate  with  the  joint ;  a  belief  which 
I  cannot  justify  by  any  demonstration,  but  one  which 
tlieir  mode  of  formation,  and  the  analogy  of  new- 
formed  bursas  in  other  situations,  makes  so  probable, 
that,  in  the  absence  of  any  proof  to  the  contrai-y,  I 
am  willing  to  accept  it  as  a  fact.  The  practical 
point  lies  here.  The  normal  bursse  have  firm,  weU- 
deiined  walls,  and  though  perhaps  somewhat  ex- 
tended from  increased  pressure  and  friction,  they 
are  simply  displaced  by  the  neck  of  the  tumor,  which 
they  skirti  sometimes  very  closely,  but  always  near 
the  surface  of  the  bone  from  which  the  tumor  has 
grown.  Thus  lying,  they  are  out  of  the  way  of  the 
external  incisions,  and  in  the  deeper  dissections  can 
always,  I  believe,  be  pushed  out  of  the  way  and 
avoided  by  closely  hugging  the  neck  of  the  tumor, 
and  that  part  of  the  adjacent  bone  which  may  be 
necessarily  exposed.  If  this  be  true,  then  all  dan- 
ger from  joint  involvement  disappears,  and  neither 
through  the  superficial  burs.'e,  which  must  be 
opened,  nor  from  the  deeper  ones,  which  ought 
not  to  be  opened,  have  we  anything  to  fear. 

With  regard  to  the  treatment  of  these  exostoses, 
the  first  question  which  presents  itself  is,  whether 
they  should  be  interfered  with  at  all.  If  they  are 
small,  not  rapidly  growing,  and  giving  ri.se  to  but 
trifling  inconvenience,  I  think  they  should  not  be 
meddled  with.  In  the  ordinary  case,  however,  where 
the  increasing  size  of  the  tumor  brings  constantly 
iocreasing  discomfort,  there  seems  to  be  no  good 
reason  for  postponing  its  removal. 

The  first  step  in  the  operation  is  a  free  incision  to 
expose  the  tumor.  This  incision  must  be  made  free 
to  allow  access  to  the  pedicle,  and  should,  if  possi- 
ble, bo  made  in  reference  to  drainage.  This  first 
incision  opens  the  bursa  on  the  surface  of  the  tumor, 
and  a  very  little  force  turns  aside  the  surrounding 
tissue  till  we  reach  near  the  base  of  the  pedicle. 
Here  we  encounter  the  strong  tendinous  and  apo- 
neurotic bands  which  represent  the  fibrous  struc- 
tures attached  to  the  bono  in  tlie  situation  of  the 
tumor,  and  which  are  pushed  aside  by  its  encroach- 
ment. From  the  tension  of  these  structures,  mus- 
cular as  well  as  tendinous,  they  rondor  the  deeper 
»  manipulations  difficult.  Two  things  are  to  be  borne 
in  mind  in  dealing  with  them  :  1st,  to  avoid  un- 
necessary vif)lence,  and,  '2d,  to  avoid  opening  the 
normal  bursie  which   are  hero  situated.     It  seems 


almost  impossible  to  avoid  altogether  the  bruising 
and  tearing  of  these  strong  and  unyielding  struc- 
tures, and  this  iirises  partly  from  the  dilKculty  we 
have  in  pushing  them  back  so  as  to  expose  the  base 
of  the  pedicle,  and  partly  to  the  necessity  of  bring- 
ing the  instrument  we  use  for  cutting  the  bone  to 
act  at  right  angles  to  the  l>aso  of  the  growth,  and  on 
the  same  plane  as  the  normal  surface  of  the  bone 
from  which  it  springs.  Applying,  for  example,  the 
edge  of  the  chisel  to  the  base  of  the  pedicle,  at  the 
point  where  it  springs  from  the  bone,  we  have  the 
handle  of  the  chisel  held  at  an  oblique  angle  with 
the  bone-surface,  to  which  it  ought  to  be  parallel ; 
and  every  attempt  to  depress  the  handle,  so  as  to 
bring  the  line  of  section  where  it  should  be,  acts 
with  powerful  lever-force  on  the  resisting  tendinous 
bands,  and  of  necessity  bruises  and  often  lacerates 
them.  This  violence  is  doubtless  the  explanation 
of  the  fact  that  the  wounds  left  after  these  opera- 
tions rarely  heal  by  primary  union,  and  are  ex- 
tremely liable  to  extensive  and  spreading  suppura- 
tion. Mr.  Stanley  says  :  "  Where  an  exostosis  is 
covered  by  muscle,  the  fibres  should  be  divided 
transversely,  because  the  retraction  of  these  will  fa- 
cilitate the  exposure  of  the  tumor;  also  because  sup- 
puration is  almost  sure  to  occur  at  the  bottom  of 
the  wound,  and  the  retraction  of  the  cut  edge  of  the 
muscle  will  facilitate  the  discharge  of  the  matter 
and  prevent  the  evil  of  its  burrowing  among  the 
surrounding  parts."  He  stiU  further  says:  "After 
the  removal  of  an  exostosis,  especially  when  deep- 
seated,  it  is  not  expedient  to  approximate  the  divi- 
ded edges  of  the  integument,  in  the  view  of  ob- 
taining their  adhesion ;  since,  in  the  exposure  and 
removal  of  the  tumor,  so  much  injury  is  usually  done 
to  the  surrounding  cellular  tissue,  that  suppura- 
tion tlirough  it  will  almost  necessarily  ensue."  This 
injury  to  the  deep-seated  fibrous  structures  is  un- 
questionably the  chief  danger  we  have  to  guard 
against,  and  with  the  ordinary  straight  chisel  I  do 
not  see  how  it  can  be  entirely  avoided.  In  \-iew  of 
this  mechanical  difficulty,  I  have  had  some  chisels 
made,  which  I  think  wiU,  at  least  to  a  degree,  ena- 
ble \is  to  avoid  its  worst  consequences.  These 
chisels  are  of  two  forms,  which  will  be  adapted  to 
difl'erent  cases,  their  efficiency  depending  upon  how 
much  the  tumor  ovei-laps  its  base,  and  how  near  its 
lower  surface  comes  to  the  surface  of  bone  from 
which  it  springs.  The  idea  of  theee  chisels  is  to 
change  the  line  of  their  cutting  action  from  one 
oblique  to  the  surface,  to  one  which  shall  represent 
a  tangent  to  that  surface,  without  the  necessity  of 
depressing  the  handles  so  as  to  make  injurious  pres- 
sure. Of  course,  in  using  these  chisels,  it  is  to  be 
borne  in  mind  that  we  only  require  to  cut  through 
the  outer  compact  lamina  at  each  point  of  applica- 
tion of  the  chisel,  and  that  the  neck  should  thus  bo 
cut  through  on  all  sides  before  any  attempt  is  made 
to  remove  it.  When,  however,  the  compact  lamina 
is  thus  cut  completely  round  the  base,  the  cancel- 
lous tissue  yields  readily,  and  tlie  mass  is  easily  sep- 
arated. One  other  danger,  I  think,  may  be  avoided 
by  the  u.se  of  these  chisels,  and  that  is  the  splitting 
of  the  bone  on  which  the  tumor  grows,  an  accident 
which  I  conceive  would  be  much  more  likely  to  oc- 
cur from  a  chisel  driven  obliquely  downi  into  a  bone, 
than  it  would  where  the  chisel-cut  merely  gi-azes  its 
surface.' 
The  treatment  of  the  wound  after  the  operation 


•  I  havo  Slid  iiothinR  nbout  the  use  of  the  chnin-saw.  but  my  expert 
encc  with  it  (iipponoi*  mo  to  abnntion  it  ftltogcthcr. 


L 


THE  MEDICAL  RECORD. 


125 


demands  a  word.  I  have  in  each  of  mj  cases  oper- 
ated under  full  antiseptic  precautions,  and  in  the 
two  first  cAses  the  wound  was  closed  with  drainage- 
tube  and  full  Lister  dressing.  None  of  my  wounds, 
however,  have  healed  by  primoi-y  union  ;  suppura- 
tion has  always  occurred,  and  in  one  case  iihleVtitis, 
and  in  the  other  deep  cellular  inflammation  took 
place.  These  accidents  have  hapi)ily  proved  slight, 
and  their  consequences  have  been  mere  delay  in  the 
healing  of  the  wound,  but  much  of  this  happy  issue 
I  am  disposed  to  attribute  to  careful  antiseptic  man- 
agement. Under  the  old  regime,  I  can  recall  sev- 
eral cases  where  the  inflammatoi'y  accidents  were 
much  more  serious,  and  one  in  particular  I  remem- 
ber, where  Dr.  John  Watson  removed  an  exostosis 
of  moderate  size  from  the  lower  and  outer  part  of 
the  femur  with  fatal  consequences.  Several  writers 
report  fatal  cases. 

With  regard  to  recurrence  after  removal,  the  ex- 
ostoses are  classed  amoug  the  most  benign  of  new 
growths.  Mr.  Stanley  thinks  it  very  important  to 
remove  every  portion  of  the  morbid  growth.  He 
says,  "If  but  the  smallest  portion  of  the  exterior  of 
the  exostosis,  with  its  cartilaginous  capsule,  be  left, 
reproduction  of  the  tumor  will  be,  at  tlie  least,  not 
an  improbable  oceiu-rence."  Of  this  belief,  how- 
ever, he  does  not  advance  a  single  fact  in  corrobora- 
tion, and  I  have  found  none  in  the  aiithors  I  have 
consulted.  It  has  been  noticed,  however,  that,  in 
exosto.sis  of  the  great  toe,  a  p:irtial  removal  does  not 
prevent  a  continuance  of  the  growth,  and  this  analogy 
seems  fairly  to  strengthen  Mr.  Stanley's  views.  Of 
my  own  cases,  I  have  had  an  opportunity  of  watch- 
ing but  one,  the  subject  of  Case  II.  She  has  no 
symptom  of  the  rej,iipearance  of  the  growth — now 
three  and  one-half  years  since  the  removal  of  the 
tumor. 

December  12,  ISSl. 


]\IEDICAL    INDUCTION    COILS. 
By  LUCIUS  E.  FELTON,  M.D., 


A  coMPiiETE  induction  coil  consists  of  a  coil,  a  bat- 
tery-ceU,  a  vibrator,  and  a  current-regulator.  A  coil 
is  generally  made  np  of  a  bundle  of  soft  iron  wires, 
called  a  core,  surrounded  by  one  or  more  coils  of  in- 
sulated copper  wire.  If  a  current  of  electricity  be 
sent  through  the  primary  wire,  a  part  of  it  is  stored 
up  in  the  core  as  magnetism,  and  remains  there  until 
the  battery  circuit  is  broken,  when  it  is  again  trans- 
formed into  a  current  of  electricity  in  the  surround- 
ing coils,  if  they  form  a  circuit.  This  current  has 
the  power  of  overcoming  several  hundred  times  the 
resistance  that  the  battery  cm-rent  has,  depending 
upon  its  electro-motive  force. 

Electro-motive  force  is  the  exciting  cause  which 
sets  up  tension  ;  it  is  located  at  the  point  or  points 
where  energy  takes  the  form  of  electricity — in  the 
galvanic  cell,'  at  the  surface  of  the  zinc  plate  ;  in  the 
induction  coil,  in  the  convolutions  forming  the  coil, 
each  convolution  having  its  own  electro-motive  force, 
so  that  the  electro-motive  force  of  a  coil  is  in  direct 
ratio  with  the  number  of  turns  of  wire,  without  regard 
to  its  size.  The  smaller  the  -wire  the  greater  number 
of  turns  in  a  given  length  of  coil 

The  electro-motive  force  of  the  coil  varies  as  the 
number  of  turns  of  wire  ;  the  electro-motive  force  of 
each  turn  varies  as  the  amount  of  energy  from  which 
it  is  derived,  and  that  is  the  energy  stored  up  in  the 
core  as  magnetism. 


The  amount  of  magnetism  induced  in  the  core 
depends  upon  the  quantity  of  current  flowing 
through  the  jirimary  or  battery  wire,  and  upon  the 
number  of  turns  of  this  wire.  The  battery  current 
depends  upon  the  electro-motive  force  of  the  cell, 
its  internal  resistance,  and  the  resistance  of  the  jari- 
mary  wii'e.  The  cell  which  gives  the  greatest  electro- 
motive force  is  the  bichromate;  the  elements  are 
zinc  and  carbon,  and  the  battery  fluid  a  solution  of 
bichromate  of  potash  and  sulphuric  acid. 

The  electro-motive  force  of  this  cell  is  a  trifle  over 
two  voltaics,  and  the  internal  resistance  very  much 
less  than  any  other  cell,  being  less  than  half  an 
ohm.  Hence  it  is  best  fitted  for  a  portable  battery, 
as  a  small  cell  may  be  used  without  materially  in- 
creasing the  resistance.  There  are,  however,  some 
decided  disadvantages  in  the  form  usually  employed 
— the  Grenet.  The  carbon  plates  are  attached  to  a 
brass  connection  within  the  cell ;  the  fliiid  very  soon 
finds  its  way  between  them  and  oxidizes  the  brass, 
and  breaks  the  circiiit,  and  the  current  ceases.  The 
same  trouble  occurs  where  the  rod  is  screwed  into 
the  zinc  plate,  and  also  at  the  joint  in  the  rod.  An- 
other disadvantage,  the  zinc  plate  is  carried  in  the  cell 
and  is  subject  to  the  action  of  the  fluid  when  carried. 
The  plate  beuig  seldom  cleaned  and  amalgamated, 
becomes  coated  with  chrome  alum,  and  produces  an 
unsteady  current. 

I  have  devised  a  oell  ■which  overcomes  all  of  these 
objections.  The  cell  or  jar,  a  (Fig.  1),  is  hard  rub- 
ber, all  sides  permanently  closed  when  vulcanized. 
The  negative  element  is  a  rod  of  carbon  three-fourths 
of  an  inch  in  diameter,  into  one  end  of  which  is 


\ 


« 


soldered  a  short  piece  of  metal,  e,  for  better  contact. 
Upon  this  end  is  fitted  a  hard  rubber  ferrule,  b,  se- 
cured by  rubber  cement  so  perfectly  that  no  fluid 
can  find  its  way  through.  The  end  of  the  feri-ule  is 
closed  by  a  hard  rubber  disc,  having  a  hole  for  e, 
secured  in  same  manner.  Upon  lower  end  of  fernde 
is  a  .screw  fitted  to  a  hole  in  one  end  of  cell  o,  and 
screwed  in  with  cement.  The  carbon  leaches  nearly 
to  bottom  of  cell,  while  end  with  ferrule  i^rojects 


126 


THE  MEDICAL  RECORD. 


outside,  as  shown  in  Fig.  1.  A  hard  rubber  neck  is 
ssrewed  into  another  hole  in  top,  and  closed  with 
stopper  c.  The  connections  are  thus  made  outside 
of  cell,  so  that  there  is  no  possibility  of  connection 
corroding  or  cell  leaking,  whether  upright  or  not.. 
The  cell  is  carried  full  of  iluid  ;  when  used,  the  stop- 
per is  removed,  the  zinc  introduced,  and  connection 
made  with  it.  The  zinc  can  be  kept  clean  and  amal- 
gamated without  trouble,  and  is  not  wearing,  except 
when  in  use. 

The  core  should  be  made  of  a  bundle  of  wires,  as 
they  can  be  more  thoroughly  annealed  than  a  mass 
of  iron;  the  better  annealed  the  quicker  they  de- 
mignetize  and  the  stronger  the  current  induced. 
The  insulated  wire  should  be  iiarafflued  before  it  is 
wound,  as  it  makes  the  insulation  more  perfect  and 
keeps  the  moisture  out  of  the  coil.  It  is  better  to 
connect  the  inner  end  of  the  secondary  wire  with  the 
outer  end  of  the  primary,  as  you  can  get  the  com- 
bined effect  of  primary  and  secondary  currents,  and 
do  not  get  the  inverse  induced  current  from  sec- 
ondary coil  when  contact  is  made. 

The  current  induced  in  the  primary  or  battery- 
wire  at  the  breaking  of  the  circuit  is  called  the  pri- 
mary or  the  extra  current ;  that  in  the  secondary 
coil,  the  secondary  current.  But  as  there  is  a  cur- 
rent upon  making  and  breaking  battery  current,  the 
former  is  called  the  inverse  induced  ctirrent  and  the 


latter  the  direct.  The  direct  induced  current  has 
many  times  greater  tension  than  the  inverse,  because 
the  inverse  is  induced  from  the  battery  current,  while 
tlie  direct  is  induced  from  the  magnetism  stored  up 
in  the  core. 

While  the  vibrator  performs  one  of  the  most  im- 
portant offices  in  a  medical  induction  coil,  it  has 
received  little  or  no  attention  from  electrologists  in 
their  writings.  It  is  this  which  breaks  the  battery 
current  and  allows  the  energy  which  it  has  stored 
up  in  the  core  to  form  a  current  in  the  coils.  The 
plan  of  a  vibrator  is  shown  in  Fig.  2  :  e  is  vibrator, 
having  a  soft  iron  armature  )i,  and  platinum  con- 
nection/ soldered  to  it ;  n  is  adjusting  screw,  having 
platinum  point .'/  for  contact  witli/.  Wlien  contact 
is  made  botwi'on  ud  justing  screw  and  vibrator,  a  cur- 
rent of  electricity  will  "tlow"  from  carlion  through 
adjusting  screw,  which  is  connected  with  it  and  vi- 
brator, to  inner  end  of  coil,  which  is  soldered  to  il, 
and  tlirougli  coil  /•  to  zini-.  This  current  magnetizes 
the  bundle  of  wires /aiul  soft  iron  Imr/.-  /  attracts 
armature  h,  drawing  vibrator  away  from  adjusting 
screw,  thus  breaking  the  circuit  and  domaguetizing 


the  wires  and  rods,  which  releases  the  vibrator,  the 
elasticity  of  which  causes  it  to  fly  back  in  contact  with 
adjusting  screw,  completing  tlie  circuit  again.  At 
each  intemiption  we  have  a  cuiTent  induced,  lasting, 
according  to  the  researches  of  Professor  Blaserna, 
about  -i.^iTT,  second.* 

The  chemical  effects  of  a  current  of  this  duration 
must  be  very  minute,  but  would  be  in  a  given  length 
of  time  just  in  proportion  to  the  number  of  interrup- 
tions in  that  time  ;  that  is,  one  thousand  interruptions 
per  second  would  produce  one  thousand  times  the 
chemical  results  that  one  would.     Now,  if  the  thera- 
peutic effects  are  due  rather  to  the  chemical  effects 
of  the  current  than  to  the  simple  shock,  as  I  am  led 
to  believe  by  the  results  of  the  galvanic  current  as 
compared  with  the  induced,  and  the  induced  current 
with  rapid  vibrations  compared  with  slow,  we  have 
reason  to  believe  tliat  the  more  rapid  the  interrup- 
tions the  better  the  therapeutic  lesults.     The  inter- 
riipters  on  nearly  all  of  the  induction  coils  are  too 
clumsy  to  be  called  vibrators,  but  slioaild  rather  be 
called  oscillators.     The  springs  are  large  and  long, 
supporting  on  the  free  end  a  heavy  iron  armature 
and  a  large  metal  disc  for  the  platinum.     Such  an 
inten'upter  can  neither  make  rapid  nor  regular  in- 
terruptions. A  vibrator,  to  make  rapid  interruptions, 
must  1)6  constructed  in  accordance  with  the  laws  of 
vibration.     These  laws  wiU  be  found  fully  discussed 
in  works  on  acoustics.     The  vibrator  must  be  made 
upon   precisely  the  same  plan  as    the    organ-reed 
which  gives  the  highest  pitch,  as  pitch  depends  en- 
tirely upon  the  number  of  ^^brations  in  a  given  time. 
Temper,  length  and  thickness,  as  well  as  uniformity, 
are  important  factors.     It  is  highly  important  that 
no  extra  weight  be  put  upon  the  free  end,  siach  as  a 
heavy  armature  ;  the  armature  should  be  no  thicker 
than  the  vibrator  itself.     The  size  of  the  vilirator 
depends  upon  the  motive  power  that  produces  the 
vibrations,  viz.,  the  magnetism.     From  a  long  series 
of  experiments,  I  find  that  copper,  zinc,  and  silver, 
or  copper  and  zinc,  melted  together,  gives  the  best 
temper  for  rapid  vibration.    The  tempering  must  be 
done  by  means  of  rolls,  and  requires  considerable 
skill  to  get  the  projier  temper.     I  make  the  vibrator 
one  inch  long  and  about  one-eighth  inch  wide.     On 
the  free  end  I  solder  a  piece  of  what  is  known  as 
artist'.s  tintvpe,  about  -iIjtj  of  an  inch  thick,  in  such  s 
manner  that  it  makes  an  extension  of  the  vibrator 
instead   of  thickening  it ;    this  is  only  about  one- 
eighth  inch  square  and  forms  the  soft  iron  armature. 
A  piece  of  platinum  foil,  about  same  size,  is  soldered 
on  surface  of  vibrator  near  middle  for  contact  with 
adjusting  screw  (see  Fig.  2).     The  vibrations  from 
this   interrupter  are  very  rapid,   as  shown  by  the 
pitch  and  quality  of  current.     I  am  conducting  a 
series  of  experiments  to  determine  the  number  of 
vibrations  that  can  be  produced  per  second,  the  re- 
sult of  which  will  be  given  at  some  future  time. 

It  is  of  the  utmost  importance  that  the  sti-ength  of 
the  current  can  he  accurately  regulated  by  the  oper- 
ator. Nearly  all  of  the  current-regiilators  are  based 
upon  the  following  law  :  Where  there  are  two  or 
more  circuits  surrounding  a  magnetized  core,  a  cur- 
rent will  be  induced  in  each  inversely  as  the  resist- 
ance. If  a  copper  tube  surrounds  the  core  and  a 
great  resistance  (like  a  part  of  the  body)  be  inclu<led 
in  tlie  circuit  of  one  of  these  coils,  the  current  would 
nearly  all  be  induced  in  the  copper  tube.  If  tliis 
tube  bo  arranged  so  that  it  will  slide  on  the  core, 
and  a  portion  of  the  core  be  uncovered,  a  cuiTent 

•  Gordon,  EIcc.  nnd  Map.,  vol.  i,,  p.  316. 


THE  MEDICAL  RECORD. 


127 


will  be  induced  in  the  coil  surrounding  that  part  of 
the  core  that  has  been  uncovered  by  the  tube.  The 
tubes  arc  gt>uerallT  placed  between  tlie  core  and  the 
primary  or  battery  coil,  or  between  the  primary  and 
secondary  coils.  The  last  is  objectionable,  because 
the  primary  wire  should  be  wound  as  close  to  the 
core  as  possible  so  as  to  magnetize  the  core  as 
highly  as  possible.  A  compact  coil  cannot  be  made 
with  a  tube  sliding  within  it.  I  overcome  these  ob- 
jections by  sliding  a  copper  tube  over'  the  whole 
coil.  The  current  is  regulated  to  a  nicety.  The 
tube  should  not  be  made  of  brass,  as  the  resistance 
is  too  great.  The  method  of  sliding  the  secondary 
coU  over  the  primary  is  objectionable  on  account  of 
the  connections  becoming  broken  while  the  coU  is 
being  moved,  the  result  being  to  give  the  full  force 
of  the  current  induced  in  the  primai-y  wire,  which, 
when  applied  to  nervous  patients,  particularly  if 
ujion  the  head,  is  veiy  pernicious. 

It  is  held  by  many  electrologists  of  authority  that 
a  different  quality  of  current  and  different  therapeu- 
tic results  are  produced  by  different  sized  wires. 
Based  upon  this  theoiy,  coils  are  sometimes  made 
up  of  half  a  dozen  different  sizes,  each  size  supjjosed 
to  produce  its  special  therapeutic  effect  and  applica- 
ble to  special  cases. 

But  a  coil  that  has  an  electro-motive  force  suffi- 
cient to  produce  a  tension  that  will  overcome  the  re- 
sistance of  the  body,  and  furnish  a  sufficient  quantity 
of  current  for  therapeutic  purposes,  will  do  aU  that 
a  dozen  wires  can  do.  With  the  galvanic  cun-ent, 
the  same  quantity  passing  through  a  circuit  in  a 
given  time,  will  produce  the  same  effects  without 
regard  to  the  kind  of  battery  used.  So  with  the 
electro-magnetic  battery,  the  same  qiiantity  of  cur- 
rent at  each  interruj^tion  and  the  same  number  of 
interruptions  per  second,  will  produce  the  same 
effect  without  regard  to  size  of  wii'e  or  kind  of  ma- 
chine. Now  a  coil  can  readily  be  made  of  two  wires, 
or  even  one,  that  will  furnish  a  sufficient  electro- 
motive force  to  give  the  desired  qiiantity  for  thera- 
peutic ijurjioses  and  with  a  ])ro2jer  regulator  any 
desii-ed  quantity  can  be  obtained.  Where  several 
sizes  of  wire  are  used,  it  makes  a  complicated  affair 
for  the  physician,  requires  a  larger  number  of  con- 
nections to  get  out  of  order,  and  makes  it  more  mys- 
terious for  the  inexperienced. 

With  due  deference  to  the  high  authorities  in 
both  this  country  and  England,  who  advocate  this 
theoi-y,  I  must  say  that,  based  iipon  electrical  laws, 
and  careful  experiment  with  differently  arranged 
coils,  cells,  and  vibrators,  it  is  fallacious. 

I  will  next  consider  slow  interi-uptions  of  the  in- 
duced cun'ent  as  compared  with  slow  intermptions 
of  the  galvanic  current  We  are  told  by  good  au- 
thorities that  slow  interruptions  are  preferable  to 
rapid  in  the  treatment  of  paralysis,  and  that  slow 
interruptions  of  the  galvanic  are  i)referable  to  either. 
There  must  be  some  reason  why  the  galvanic  current 
produces  contractions  in  paralyzed  muscles  when 
the  induced  fails,  but  I  have  never  seen  one  given. 
I  will  give  the  one  that  seems  to  me  the  most  jilausi- 
ble.  Sxipposing  the  interruption  to  be  one  a  second 
with  the  induced  cuiTent.  we  would  have  at  each 
interruption  a  current  lasting,  say  yiMin  of  a  second, 
and  in  another  second  another  current  of  like  dura- 
tion. But  with  the  galvanic  battery,  when  the  cir- 
cuit is  closed,  the  current  ]>asses  until  it  is  open 
again,  and  if  of  the  same  electro-motive  force  and 
resistance,  we  have  several  Imndred  times  the  quan- 
tity passing  at  each  intemiption,  as  with  the  induced  ; 
and  so  long  as  electricity  is  just  the  same  as  long  as 


it  flows  in  the  one  case  as  in  the  other,  it  is  safe  to 
assume  that  the  difference  in  therapeutic  results  is 
due  to  the  difference  in  the  quantity  that  flows  at 
each  inten-uption.  Then  it  is  reasonable  to  suppose 
that,  with  a  \-ibrator  that  will  produce  a  large  num- 
ber of  interruptions  per  second,  we  should  obtain 
results  nearer  like  those  of  the  galvanic  current ;  this 
1  have  found  to  be  the  case  as  I  have  repeatedly 
demonstrated  in  my  experiments.  In  doing  this,  I 
make  my  slow  interruptions  in  the  induced  circuit 
by  removing  the  electrode,  or  using  an  inteirupting 
handle. 


THE  ABSENCE   OF   ORGASM. 
Bx  FEEDINAND  C.  VALENTTNE,  M.D., 

GtTATEMiLA.  CENTRAL  AMERICA. 

I  DESiBE  to  occupy  a  little  space  in  the  columns  of 
The  Medical  Eecoed  by  the  recital  of  a  few  cases 
of  absence  of  orgasm  occurring  in  my  practice,  in 
the  hope  that  some  Korth  American  neiirologist  or 
gynecologist  may  give  a  sohition  to  the  question, 
which  is  of  indubitable  interest  to  the  parties  of 
whom  I  propose  to  write. 

Case  I.— Mrs.  T.  E.  O ,  aged  twenty-five  ;  North 

American  by  bu-th ;  man-ied  three  years.  Has  had 
four  miscarriages  (one  and  one-half,  two,  two  and 
one-half,  and  thre«  months).  Eesident  of  this  city 
for  two  years,  with  occasional  short  trips  to  the  hot, 
malarial  coast.  Is  now  in  the  fourth  month  of  preg- 
nancy. Her  general  appearance  is  that  of  a  refined, 
aesthetic  person  ;  height,  four  feet  eleven  and  one- 
half  inches ;  weight,  one  himdred  pounds.  Health 
good.  Her  education  is  of  the  unfortunate  school 
of  to-day,  causing  her  to  look  upon  woman's  home 
duties  with  contempt,  and  maternity  with  disgust, 
which  arouses  the  suspicion  that  the  above-cited 
miscarriages  were  not  as  accidental  as  she  claims. 
Her  home  life  is  not  happy, because  of  her  morbidly 
idealistic  disposition,  which  she  attributes  to  xm- 
gratified  sexual  appetite.  She  says  that  she  feels 
mammary  tumescence,  and  also  swelling  of  the  labife 
■sTilvif,  and  an  increase  of  the  vaginal  secretion  with 
each  sufficiently  intense  series  of  sensual  thoughts. 
During  such  times  erection  of  the  nipples  occurs, 
but  not  noticeably  of  the  clitoris,  which  is  rudimen- 
tary in  this  patient.  In  all  other  respects  her  geni- 
talia are  well  developed  and  normal,  except  a  slight 
right  lateral  flexion  of  the  utenis.  Separate  private 
conversations  with  her  and  her  husband  yield 
the  following:  he  is  not  a  sensual  man,  and  more 
inclined  to  think  of  his  biisiness  as  a  means  of  gain- 
ing a  competence  for  his  wife  ;  while  she,  although 
she  claims  to  possess  great  affection  for  him,  does 
not  deny  that  she  is  unhappy  with  him,  as  she  can- 
not rid  herself  of  the  idea  of  ha^^ng  made  a  mesalli- 
ance, and  attributes  her  lack  of  orgasm  to  this  cause. 
She  confesses  to  having  excited  him  to  sexual  ex- 
cesses, in  the  endeavor  to  bring  about  a  gratification 
of  her  passion,  but  all  efforts  have  been  fiitile. 
Tonics  of  all  kinds,  and  damiana  in  various  forms, 
have  been  used  for  about  six  months,  with  no  result 
whatever. 

Case  II. — Jesus  N ,  aged  twenty-eight ;  single  ; 

seamstress.  Native  of  Guatemala ;  of  mixed  Cau- 
casian and  Indian  blood.  Consulted  me  July,  1880, 
for  the  condition  which  I  use  her  own  words  to 
destribe  :  "I  have  been  indulging  in  sexual  inter- 
course with  my  lover  since  I  was  eighteen  years  old. 
I  began  to  menstruate  at  thirteen.     He  seduced  me, 


128 


THE  MEDICAL  RECORD. 


and  I  have  not  cohabited  with  any  other  man.  I 
have  no  desire  for  sexual  iutercouree,  and  submit  to 
it  only  to  please  him.  We  have  repe.ated  the  act 
as  often  as  eight  times  in  a  night,  and  I  have  never 
had  any  pleasure  therefrom,  nor  even  excitement  .of 
any  kind,  neither  at  the  beginning,  nor  during,  nor  at 
the  end  of  the  act.  The  act  is  not  painful  nor  dis- 
giisting  to  me."  This  person  is  small,  angular,  and 
of  poor  muscular  development,  her  form  presenting 
the  appearance  of  a  girl  of  about  thirteen  or  four- 
teen years  of  age,  but  physical  exploration  reve.ala 
no  abnormality,  except  a  rather  large  vulva.  Her 
menstruation  is  normal,  appetite  good,  and  all  other 
functions  good.  Her  intelligence  is  mediocre,  and 
her  edTication  nil.  She  cannot  read.  Nearly  a  year's 
treatment,  as  in  the  first  case,  yielded  only  negative 
results. 

Case  III. — Trinidild  B.  de  F ,  Mexican,  aged 

nineteen ;  married  seven  months.  Menstruation 
always  regular  and  normal,  both  in  quantity  and 
quality.  Not  pregnant.  She  is  of  nearly  pure  In- 
dian blood,  and  of  a  voluptuous  appearance.  No 
evident  abnormality.  She  has  erotic  desires  and 
pleasurable  sensations  during  the  sexual  act ;  but,  no 
matter  how  prolonged,  she  experiences  no  orgasm, 
unless,  when  at  the  time  her  husband  ejaculates,  she 
titillates  her  clitoris.  But  even  then  it  is  slight,  and 
leaves  her  with  her  sexual  appetite  ungratifled. 
Tonics  and  damiana  have  yielded  no  results. 

C.isE  IV. — Pedrona  L.  deE ,  aged  fifty.  Mixed 

Spanish  and  Indian.  Under  treatment  for  second- 
ary syphilis.  Began  to  menstruate  when  twelve 
years  of  age.  Was  maiTied  at  fourteen.  Never  was 
pregnant,  and  has  menstruated  regularly  until  the 
menopause,  which  came  on  at  thirty-nine.  After 
being  married  four  months  her  husband  discarded 
her,  upon  discovering  her  in  sexual  congress  with  a 
servant,  whose  embraces  she  sought  with  the  inten- 
tion of  gratifying  her  sexual  desires.  Although 
possessing  some  means,  she  virtually  became  a  pros- 
titute, and  cohabited  with  a  number  of  men.  She 
told  me  that,  at  one  time,  with  the  intention  of  grati- 
fying her  desire,  she  arranged  a  libidinous  orgy 
with  four  men,  who  cohabited  with  her  in  immedi- 
ate succession.  She  says  that  there  was  not  half  a 
minute's  interval  lietween  each  act,  and  after  the 
last  man  had  occupied  his  place  a  second  time,  she 
still  not  having  succeeded  in  bringing  on  an  orgasm, 
endeavored  to  do  so  by  the  abuse  of  a  large  candle. 
Long  continued  efforts  resulted  only  in  extensive 
excoriation  and  great  debility,  but  her  passion  in- 
creased, if  anything.  Repeated  efi'orts  of  the  .same 
kind  always  yielded  the  same  negative  results.  Va- 
ginal exploration  reveals  nothing  further  than  the 
appearances  incidental  to  old  prostitutes,  and  vari- 
ous cicatrices  from  cauterizations.  This  case  was 
not  treated  for  the  absence  of  orgasm. 

Perhaps  a  few  remarks  on  these  four  cases  will 
serve  to  bring  forth  the  matter  more  clearly.  The 
absence  of  orgasm  in  them  cannot  be  attributable 
to  the  age  when  sexual  intercourse  was  first  indulged 
in,  which  occurreil  in  the  first  case  at  twenty-two,  in 
the  second  at  eighteen,  in  the  third  at  nineteen,  and 
in  the  fourth  at  fourteen.  It  cannot  be  attributable 
to  nationality  or  race,  Case  T.  being  ])ure  Caucasian, 
Oases  II.  and  IV.  mixed  Indian  and  Caucasian,  and 
Case  III.  almost  pure  Indian,  with  a  suspicion  of 
negro.  It  is  hardly  attributal)le  to  the  husband's 
incapacity,  as  Case  IV.  has  cohabited  with  all  kinds  of 
men,  and  never  succeeded  in  bringing  on  an  orffasm. 
Case  I.  would  offer  a  doubtful  exjilanation  on 
quasi-ffisthetical  grounds,  still  a  curious  contradic- 


tion thereto  exists  in  the  pregnancies.  Would  not 
the  fact  of  this  woman  becoming  impregnated  be  a 
weight  in  the  scale  of  evidence  in  cases  of  preg- 
nancy said  to  result  from  rapes  on  conscious  women, 
and  on  those  partially  or  completely  unconscious 
from  syncope,  alcohol,  opium,  or  anajsthetics.  None 
of  the  cases  present,  to  me  at  least,  any  sexual  de- 
formity sufficient  to  account  for  the  complaint. 
Education,  social  standing,  physical  conformation 
can  have  no  influence  on  the  conjoint  consideration 
of  these  cases.  Case  I.  being  a  lady  evidently  of  the 
highest  walks  of  society,  and  of  a  superior  educa- 
tion and  intellect — slightly  distorted,  perhaps,  by 
morbid  thoughts,  manifested  in  that  frequently  en- 
countered romantic  desire  which  many  women  pos- 
sess to  elicit  sympathy  for  presumed  uuhappiness. 
Case  II.  is  ignorant,  vulgar,  of  the  lowest  walks  of 
society.  She  cannot  understand  that  any  disgrace 
attaches  to  cohabiting  with  her  lover,  but  is  proud 
of  the  claim  that  she  has  always  been  true  to  him. 
The  only  point  of  similarity  between  Cases  I.  and  II. 
rests  with  the  general  conformation,  both  being 
small,  thin  women,  of  anything  but  a  sensual  appear- 
ance. Intellectually,  Case  III.  is  between  I.  and  II. 
She  is  of  the  middle  class  of  society,  of  limited 
education,  rather  heavy  intellect,  and  capable  of 
very  little  independent  thought.  Her  physique, 
however,  differs  from  the  rest,  as  among  the  major- 
ity of  women  she  would  be  distinguished  by  her 
marked  voluptuous  appearance.  This  is  the  only 
case  which  by  any  means  at  all  can  bring  on  any- 
thing like  an  orgasm,  i.e.,  by  titillating  the  clitoris 
during  sexual  congress.  Case  r\^.,  although  of  the 
appearance  incidental  to  persons  having  led  a  dis- 
solute life,  bears  evidence  of  having  jihysical  attrac- 
tiveness. Her  intellect  and  education  ai-e  slightly 
above  the  average,  and  she  attributes  her  past  im- 
morality to  nymphomania. 

I  am'well  aware  that  I  am  presenting  nothing  new 
to  the  profession,  except,  perhaps,  that  I  dare  speak 
of  a  matter  which  some  incomprehensible  morbid 
prudishness  has  prevented  the  profession  from  dis- 
cussing. The  sad  results  of  this  condition,  as  de- 
scribed in  Case  IV.,  alone  should  be  sufficient  incen- 
tive for  our-specialists  to  take  the  matter  into  serious 
consideration,  if  this  has  not  already  been  done ; 
while,  if  it  has,  why  not  give  their  younger  coUeagiies 
the  benefit  of  their  experience  ? 


The  AnntJjVL  Meeting  of  the  Hosprr.^n  Satuhdav 
AND  SiTND.w  Association  was  held  in  St.  Luke's 
Hospital  a  short  time  ago,  and  officers  for  the  en- 
suing year  were  elected  as  follows :  Pi-esidait, 
George' MacCulloeh  Miller;  Vice-President,  Henry 
Blum  ;  Secretaty,  The  Rev.  George  S.  Baker ;  Treas- 
urer, Charles  Lanier ;  Directorx :  The  Mayor  of  New 
York,  the  Postmaster  of  New  York,  the  President  of 
the  Chamber  of  Commerce,  the  Rev.  ]\Iorgan  Dix, 
D.D.,  the  Rev.  Talbot  W.  Chambers,  D.D..  the 
Bev.  Thomas  Armitage,  B.l)..  Cornelius  Vanderbilt. 
Henry  E.  Pellew,  Robert  Waller,  George  .Tones, 
John  S.  Bussing,  and  a  re|>resentative  from  each  of 
the  twenty  hospitals  connected  with  tlie  association  ; 
K.reriitire  Committee:  George  M.  Miller,  the  Rev. 
George  S.  Baker,  George  Jones,  Willy  Wallnch, 
and  Dr.  Richard  H.  Derby;  DIalrihiitiyjn  Commit- 
tee: the  ISIayor,  the  Postmaster,  the  President  of  the 
Ciiamber  of  Commerce,  Judcre  Samuel  Blatchford, 
Jesse  Seligman,  Henry  E.  Pellew,  and  Morris  K. 
Jesup. 


THE  MEDICAL  RECORD. 


129 


J^xoQxtss  0f  iletricol  Science. 


BoKACic  Acid  as  an  Antiseptic  in  Skin  Affec- 
tions.— Dr.  George  Thin,  of  London,  emphasizes 
strongly  the  advantage  of  using  some  prejiaration  of 
boracic  acid  to  ovei'come  the  oiiensive  odor  of  the 
feet,  and  gives  instances  in  which  this  treatment  has 
been  thoroughly  successftil.  In  some  cases  he  rec- 
ommends the  wearing  of  stockings  and  cork-soles 
saturated  with  the  acid.  In  others  he  i>rescribes  an 
ointment,  or  rather  a  kind  of  glycerine  cream,  made 
as  follows  :  a  solution  of  boric  acid  is  incorporated 
with  a  fatty  basis  of  white  wax  and  almond  oil, 
which  produce  a  soft,  homogeneous  mixture,  free 
from  the  ii-ritating  crystalline  plates  of  the  crystal 
that  are  apt  to  separate  from  vaseline.  He  finds  that 
this  is  also  a  vei'y  useful  remedial  agent  for  inflamed 
feet,  as  after  long  walking  tours,  and  in  such  ecze- 
mas as  are  produced  by  the  irritation  of  dyed  under- 
clothing. 

XoTES  ON  Seven  Fatal  Cases  of  Hydrophobia. — 
Mr.  Southam  has  tabulated  his  notes  of  all  the^cases 
of  hydrophobia  seen  during  two  years'  term  of 
oiJice  in  tlie  Manchester  Koyal  Infirmary,  and  fur- 
nishes some  items  of  interest  from  a  clinical  point  of 
view.  As  the  treatment  cannot  be  based  upon  any 
definite  i^athological  condition  which  is  to  be  met,  it 
became  purely  .symptomatic,  and  resolved  itself  into 
four  princiiaal  methods  :  1st,  by  chloral  and  opium ; 
2d,  by  chloroform  and  cuiara ;  3d,  by  tracheotomy  ; 
4th,  by  the  hot-air  bath.  Of  the  four  drugs  men- 
tioned, chloral  appeared  to  secure  the  most  benefi- 
cial results,  prolonging  life,  and  temporarily  aiTesting 
the  spasms.  Its  administration  was  readily  eSected 
hypodermicaUy,  the  introduction  of  the  needle  caus- 
ing no  spasm.  With  regard  to  curara,  the  author 
found  in  two  instances  that  there  were  alarming 
symptoms  of  respiratory  weakness,  once  after  one- 
sixth  gi'ain  had  been  administered,  and  yet  the  spasms 
were  not  relieved.  Tracheotomy,  which  was  per- 
formed to  obviate  death  from  spasm  of  the  glottis, 
was  of  little  use.  In  sis  of  the  cases  death  was  due 
to  gradual  heart-failure,  and  in  only  one  to  spasm 
of  the  glottis.  In  respect  to  the  temperatiu'e,  it 
was  found  in  three  cases  to  have  risen  above  103  F., 
and  in  one  to  above  105  F.  The  urine  of  all  the 
cases  contained  albumen.  lu  three  instances  there 
was  sugar  in  the  urine,  indicating,  jjrobably,  that 
some  abnormal  condition  of  the  medulla  oblongata 
was  present. 

Direct  Transfusion  for  the  Hemokrhages  of 
Typhoid  Fevek. — At  a  recent  meeting  of  the  Clini- 
cal Society,  held  in  London  (November  25th),  Dr. 
Mahomed  related  two  instances  where  he  had  em- 
ployed dii'ect  transfusion  with  marked,  but  tempo- 
rary, benefit.  In  the  first  case,  that  of  a  man,  twenty 
years  of  age,  there  was  a  coUapse  on  the  twenty-fifth 
day  of  his  typhoid  ;  on  the  thirty-fifth,  he  had  a  se- 
vere hemorrhage,  which  recurred  twice  on  the  fol- 
lowing day.  His  jjulse  had  reached  160  F.,  and  he 
was  fast  sinking  when  the  operation  was  performed. 
He  rallied  and  even  gave  hoj^es  of  recovery,  but  six 
days  later  another  hemorrhage  occurred,  and  he 
began  again  to  fail,  dying  on  the  forty-fourth  day  of 
the  fever,  nine  days  after  the  operation. 

The  second  case  was  that  of  a  married  man, 
twenty-five  years  of  age.     He  had  a  relapse  on  the 


twenty-sixth  day.  Two  days  later  he  had  a,  hemor- 
rhage, four  days  later  three  severe  hemorrhages,  and 
he  iell  into  a  state  of  exliaustion.  Tran.sfusion  was 
performed  the  next  day,  but  the  patient  died  five 
days  later  from  some  lung  complication.  Dr.  Ma- 
homed stated  that  hemoi-rhage  occurs  in  about  seven 
per  cent,  of  all  cases,  and  that  in  them  the  fatality 
18  about  fifty  per  cent.,  and  that  in  these  instances 
one-half  die  from  the  immediate  efi'ects  of  the  loss 
of  blood. 

For  these  cases  he  advocates  transfusion,  and  rec- 
ommends Aveling's  aj^paratus. — Medical  Press  and 
Circular,  November  30,  1881. 

FHiAKiA  Sanguinis  Homdjis  and  Chtlous  TJeinj!;. 
— At  a  recent  meeting  of  the  Pathological  Society 
of  London,  Dr.  Stejjhen  Mackenzie  showed  speci- 
mens of  the  human  filaria  in  the  freshly  drawn 
blood,  and  at  the  same  time  specimens  of  the  same 
parasite  from  the  mosquito,  which  was  found  by 
Manson,  of  Amoy,  to  be  the  "  intermediate  host." 
The  patient,  who  was  present,  was  born  in  India  of 
Euroijean  iiarents.  About  a  month  before  reaching 
England  he  had  incontinence  of  urine,  which  later 
became  milky,  and  still  later  contained  blood.  The 
urine  passed  at  night  contained  more  blood  and 
more  filarise.  Sometimes  they  were  only  found  at 
night,  appearing  at  first  about  9  p.m.,  and  being 
most  numerous  at  midnight.  At  9  a.m.  some  could 
be  found.  By  inverting  the  habits  of  the  patient, 
making  him  eat  and  work  at  night  and  sleejj  in  the 
day,  the  fUariie  were  made  to  alter  theii-  habits,  and 
only  appeared  during  the  day.  These  hoematozoa 
measured  from  -^,t  to  rhr  inch  in  length,  and  TTf,—  to 
Tn'.Tv  inch  in  breadth.  It  is  said  by  Dr.  Manson 
that  the  mosquito  forces  his  proboscis  into  the 
lumen  of  the  cai^illary,  usually  making  his  vieit 
when  the  prey  are  in  greatest  numbers.  The  fi- 
larite  coil  their  tails  about  the  jiroboscis,  and  are 
withdrawn  in  great  numbers.  Dr.  Vandyke  Carter 
was  not  disposed  to  lay  very  great  stress  upon  the 
periodicity  of  the  parasite.  At  some  seasons  he 
would  be  absent,  and  at  others  would  aj^pear  in  the 
blood.  The  parent  worm,  an  animal  of  considerable 
size,  perhaps  three  inches  in  length,  was  lodged 
somewhere  in  the  lymphatic  system — often  in  the 
urinary  tract — and  at  intervals  the  young  were  dis- 
charged into  the  ehculation.  Often  might  filaria 
exist  in  the  blood,  without  producing  any  symp- 
toms whatever. — British  Medical  Journal,  October 
22,  1881. 

Opeeatiok  in  Cases  of  Diseased  Joints  in 
Phthlsical  Subjects. — Mr.  Henry  Smith,  in  a  letter 
to  the  Lmicel  (November  12,  1881),  confirms  the 
views  of  Mr.  Bryant,  who  has  already  spoken  upon 
the  above  subject.  Mr.  Bryant  does  not  think  that 
an  operation  for  the  removal  of  a  diseased  joint  in  a 
phthisical  patient  is  unwise,  where  the  local  disease 
is  of  such  a  nature  as  to  i^revent  the  recovery  from 
the  systemic  disease.  But  apparently  in  such  cases 
he  confines  his  operations  to  amputation,  while  Mr. 
Smith  does  not  hesitate  to  jjerform  excision.  The 
latter  gentleman  states  that  great  benefit  has  re- 
sulted from  excision  in  cases  which  he  has  obsei-ved. 
He  mentions,  as  an  instance,  a  tailor,  suS'ering  from 
tubercular  phthisis  and  extensive  disease  of  the 
elbow-joint,  who,  after  oj^eration,  was  greatly  bene- 
fited as  regards  the  phthisis  and  the  joint  disease. 
He  also  says  that  there  are  instances  of  lardaceous 
disease  of  the  liver,  where  this  condiiion  will  disap- 
1  pear  after  operation  upon  the  hip-joint. 


130 


THE  MEDICAL  RECORD. 


The  Medical  Recokd: 


rfl  Ulccklg  JJouvnal  of  fncbicine  anb  Suvgcrji. 


GEORGE  F.  SHRADY,  A.M.,  M.D.,  Editor. 


PUBLISHED   BY 
Wm.  WOOD  &  CO.,  No.  27  Great  Jones  St.,  N.  If. 

New  York,  Febraary  4,  1882. 

JUDGE  COX'S  CHAEGE   TO  THE    JUEY. 

The  charge  of  Judge  Cox  and  the  verdict  of  the  jury 
in  the  case  of  Guiteau  have  akeady  been  widely 
approved  and  commented  upon.  But  the  medico- 
legal bearings  of  this  final  judicial  utterance  and  of 
the  decision  which  followed  will  for  a  long  time 
merit  discussion. 

We  venture  to  say  that  few  judges,  in  a  trial  so  fuU 
of  bitterness  and  feeling,  have  given  a  charge  show- 
ing such  impartiality  and  clearness  of  statement, 
and  such  full  grasp  of  the  subject  in  most  of  its  re- 
lations. In  only  one  point  do  the  views  set  forth 
deserve  criticism. 

The  learned  judge  begins  by  stating  that  in  the 
crime  of  murder  there  are  three  elements  :  the  act, 
malice,  and  sanity.  In  the  case  of  Guiteau  the  act 
and  also  malice,  in  its  legal  sense,  were  acknowl- 
edged by  the  defence,  therefore  this  question  alone 
remained  for  the  jury:  Was  the  prisoner  insane? 
If  so,  he  was  irresponsible  and  committed  no  crime. 
Here  is  introduced  Judge  Cox's  test  of  responsibility  : 
"  You  are  to  decide,"  said  the  court,  "  whether,  at  the 
time  of  shooting  President  Garfield,  the  i)risoner, 
through  brain  disease,  did  not  know  the  natiire  of 
his  act.  If  he  did  know  what  he  was  doing  and  that 
it  was  wrong,  he  was  and  is  responsible,  whether 
he  had  brain  disease  then  or  not."  This  test  is  un- 
questionably incorrect  in  science,  and  leaves  the  way 
open  to  false  and  unjust  decisions.  The  true  test, 
as  we  have  rajjeatedly  said,  is  that  laid  down  by  all 
sound  medical  jurists,  and  affirmed  in  several  courts  : 
Was  the  person  compelled  to  do  the  act  by  disease  of 
his  brain  ?  It  is  abundantly  established,  indeed,  it 
is  known  (as  is  stated  by  Ray)  to  every  ward  attend- 
ant, that  the  insane  can  commit  acts  which  they  know 
to  be  wrong. 

This  jjarticular  point  in  the  charge,  however,  has 
only  a  general  bearing  or  importance.  No  test 
of  responsibility  would  have  modified  the  verdict, 


nor  does  it  diminish  the  value  of  the  admirable  sum- 
ming up  which  followed. 

Guiteau  was  by  the  defense  claimed  to  have  par- 
tial insanity  of  a  chronic  form.  This  subjected  him 
to  the  control  of  occasional  delusions  and  the  in- 
dulgence of  morbid  propensities.  What  the  jury 
had  to  consider,  however,  was  whether,  supposing 
him  partially  insane,  he  was  at  the  time  of  the  as- 
sassination under  the  control  of  his  disease.  The 
things  by  which  they  must  decide  this  were  the 
speech  and  conduct  of  Guiteau  as  interpreted  by  the 
experts  and  their  own  good  sense.  The  facts  re- 
garding Guiteau's  speech  and  conduct  before  and 
subsequent  to  the  trial  were  then  recited  by  the 
court.  These  facts  bore  especially  iipon  the  ques- 
tion, whether  the  prisoner  was  acting  under  an  in- 
sane delusion.  If  the  evidence  given  represented 
the  facts,  then,  said  the  Judge,  "  there  was  nothing 
in  the  prisoner's  conduct  or  speech  which  showed 
the  existence  of  a  delusion." 

This  part  of  the  Judge's  charge  went  severely 
against  the  prisoner.  It  was  evident  that  he  con- 
sidered that  the  evidence  of  Guiteau's  having  origin- 
ally had  any  inspiration  theory  was  insufficient ;  that 
the  assassin  did  not  act  under  an  insane,  b\it  a  mor- 
bid and  vicious  impulse.  Both  judge  and  jury 
subscribed  to  the  graphic  pictiu-e  with  which  the 
charge  is  closed  :  of  a  "  youth  of  more  than  average 
mental  endowments,  surrounded  by  certain  immoral 
influences  at  the  time  his  character  was  being  devel- 
oped ;  commencing  life  without  resources,  but  de- 
veloping a  vicious  sharpness  and  cunning ;  conceiv- 
ing enterprises  of  great  pith  and  moment,  that 
indicated  unusual  forecast  though  beyond  his  re- 
sources ;  consumed  all  the  time  by  unsated  egotism 
and  a  craving  for  notoriety  ;  violent  in  temper,  sel- 
fish, immoral,  dishonest ;  leading  a  life  of  hypocrisy, 
swindling,  and  fraud ;  and  finally,  as  a  culmination 
of  his  depraved  career,  working  himself  into  the 
resolution  of  startling  the  world  with  a  crime  which 
would  secure  him  a  bad  eminence." 

If  we  add,  that  as  the  organic  basis  of  his  charac- 
ter there  was  a  nervous  system  not  wholly  sound, 
yet  not  seriously  impaired,  Judge  Cox's  portraiture 
will  be  sufficiently  complete.  Such  men  deserve  to 
be  punished  when  they  violate  law. 

A    CIIKIOUS   CASE. 

A  .SUIT  likely  to  bring  out  some  interesting  physio- 
logical and  pathological,  as  well  as  legal  points, 
has  recently  come  before  the  Supremo  Court  at 
Suffolk,  Mass.  The  defendant  is  a  C'litholic  clergy- 
man, the  plaintift"  a  girl  of  about  fifteen  years  of  ago. 
It  appears  that  in  the  spring  of  187i)  the  plaintifl" 
became  subject  to  attacks  of  trance.  In  this  con- 
dition she  saw  visions  of  heaven  and  of  angels,  ami 
had  communications  from  the  same.  Her  trances 
were  brought  about  by  looking  at  a  little  image  of  a 


THE  MEDICAL  RECORD. 


131 


cherub  made  of  pasteboard.  She  had  at  flrat  two  of 
these  images,  which  she  said  were  given  her  by  her 
deceased  brother.  One  of  them  was  afterward  pre- 
sented to  a  relative. 

The  trance  conditions  naturally  excited  the  in- 
terest of  the  neighbors.  Finally  the  parish  priest 
(the  mother  was  a  Catholic)  began  to  visit  her.  He 
seems  to  have  regarded  the  attachment  of  the  child 
to  an  unconsecrated  image  as  a  kind  of  idolatry,  and 
tried  to  get  her  to  substitute  a  rosary  in  its  stead. 
The  rosary  did  not  have  the  desired  eiiect,  however. 
Finally,  while  the  child  was  in  a  trance  the  priest 
took  the  image  and  cut  off  its  head,  stuck  it  on  a 
jienknife  and  held  it  before  her.  The  girl  uttered 
a  shriek  and  went  into  convulsions.  The  priest  then 
carried  away  both  images.  After  this  the  child, 
when  in  a  trance,  was  unable  to  speak  and  describe 
her  visions.  She  apparently  suffered  in  consequence. 
The  priest  was,  therefore,  summoned  whenever  the 
trances  came  on.  He  held  uji  the  image  and  thus 
reheved  the  child.  After  a  time,  however,  he  refused 
to  come,  and  also  refused  to  give  up  the  images. 
Meanwhile  the  trances  continued,  but  they  were  no 
longer  of  the  usual  kind.  Instead  of  seeing  visions 
and  talking  concerning  them,  the  girl  woiild  pass  into 
a  profoundly  lethargic  condition.  Her  health,  which 
had  previously  been  excellent,  became  imiiaired. 

The  parents,  after  making  fruitless  attempts  to 
secure  the  images  from  the  priest,  have  at  length 
brought  suit  against  him  for  their  possession.  Be- 
fore the  suit  was  brought,  an  appeal  was  made  to 
the  archbishop  to  comi^el  the  restoration  of  the 
images.  With  this  appeal  there  was  enclosed  a  let- 
ter from  the  girl's  attendant  physician.  Dr.  R.  M. 
Hodges,  who  wrote  that  "the  loss  of  the  figures 
seemed  to  have  produced  a  deep  imi^ression  on  Mr. 
Gannon's  daughter,  and  I  am  of  the  oj)inion  that 
their  restoration  would  be  of  advantage  to  her,  as 
regards  her  condition  of  hysteria  in  which  she  is 
now  and  has  been  for  a  considerable  period  of  time." 

The  account  of  the  case  which  we  have  given  is 
obtained  from  the  Boston  Advertiser  and  seems  to  be 
entirely  trustworthy,  although  it  presents  only  the 
plaintiff's  side.  It  certainly  has  veiy  curious  and 
novel  features. 

A  NEW  SliEEP-PRODUCINQ  AGENT. 

Professor  C.  Bisz,  in  a  series  of  articles  contributed 
to  the  Berliner  klinische  Wochenschrift,  announces  the 
discoveiy  of  nerve-depressing  and  sleep-producing 
properties  in  ozone. 

The  accepted  view  regarding  this  gas  has  been 
that  it  is  very  easily  decomposed,  nascent  oxygen 
being  set  free  ;  that  it  is  extremely  irritating  on  this 
account  to  the  tissues,  acting  much  like  chlorine, 
and  that  it  cannot  be  absorbed  by  the  blood.  Binz, 
however,  shows  that,  in  projier  quantities,  it  is  not 
irritating,  can  be  inhaled  and  absorbed,  producing, 
as  he  claims,  peculiar  effects  on  the  nervous  system. 


The  gas  was  generated  by  the  sparks  of  an  elec- 
trical battery  containing  four  of  Bunsen's  elements. 
The  ozonized  air  was  conducted  by  a  tulje  through 
chloride  of  calcium.  It  was  then  carried  by  a  tube 
either  to  a  large  air-tight  glass  bell,  in  which  an  ani- 
mal was  placed,  or  to  a  mask  which  was  worn  by  the 
persons  who  inhaled  it.  Animals  were  first  tried. 
If  a  strong  and  long-continued  dose  of  the  ozone  was 
supijlied,  the  usual  symptoms  of  laryngeal  and 
tracheal  catarrh  with  strangulation  and  death  oc- 
curred. If  siipplied  in  more  diluted  quantities  for 
less  than  two  hours,  sleep  or  a  lethargic  condition 
was  produced.  Frogs,  rabbits,  and  kittens,  reacted 
best.  The  latter  would,  in  the  coui'se  of  ten  or  fif- 
teen minutes,  become  quiet  and  then  lie  down  and 
apparently  sleep.  Shaking  the  jar  would  not  arouse 
them.  When  removed  and  supjilied  with  fresh  air, 
however,  they  soon  returned  to  their  normal  condi- 
tion. Several  animals  were  killed  after  having  been 
in  this  condition,  and  no  changes  in  the  air-passages 
or  other  tissues  noted.  Precautions  were  taken  and 
experiments  made  to  show  that  there  was  no  car- 
bonic acid-poisoning  and  no  introduction  of  nitrous 
oxide  gas.  The  animals  coidd,  as  a  rule,  be  kept  in 
the  bell  jar  for  two  hours  before  any  symptoms  of 
irritation  appeared,  even  of  the  outer  parts  of  the 
air-passages. 

The  experiments  were  then  tried  upon  human 
beings.  Dr.  Hugo  Schultz  was  the  first  to  submit 
himself.  Subsequently  five  other  gentlemen  inhaled 
the  gas.  Three  of  them  were  put  to  sleep  by  it,  the 
others  were  slightly  stujiefied  or  otherwise  dejiressed. 
The  time  required  for  bringing  on  sleep  varied  be- 
tween six  and  sixteen  minutes.  The  sensations  du- 
ring this  time  were  very  agreeable.  After  removal 
of  the  gas  the  sleeper  would  awake  within  half  a 
minute,  generally  sooner.  It  was  suggested  that  in 
one  quite  susceptible  person  the  condition  was  a 
hypnotic  one,  but  inhalation  in  the  same  way  of 
pure  air  i^roduced  no  efi'ect.  After  awaking  there 
was  some  feeling  of  fatigue,  but  this  soon  passed 
away. 

Large  and  prolonged  doses  of  the  gas  produced 
sensations  of  nausea,  dizziness,  and  strangling.  But 
the  diluted  ozone  was  breathed  for  over  half  an  hour 
without  harm.  Binz  states  that  in  too  smaU  amounts 
no  efi'ect  is  gotten ;  in  too  large  ones,  irritation  is 
produced.  He  compares  its  action  in  this  respect 
to  that  of  alcohol  when  given.  Prof.  Binz  claims  no 
practical  results  from  his  discovery  as  it  stands  at 
present,  but  thinks  that  like  every  new  scientific 
truth  it  may  have  eventually  some  useful  bearing. 


THE   WORK   OF  THE   STATE   SOCIETT. 

At  the  coming  meeting  of  the  Medical  Society  of 
the  State  of  New  York,  several  interesting  subjects 
vv'ill  be  brought  up  for  discussion.  Aside  from  the 
scientific  papers,  of  which  a  goodly  number  are 
jiromised,  certain  matters  bearing  upon  legislation 


132 


THE  MEDICAL  RECORD. 


for  the  profession  will  doubtless  be  considered. 
Among  these  may  be  mentioned  with  due  promi- 
nence, on  account  of  its  importance,  the  report  of 
the  committee  to  revise  the  Code  of  Ethics.  It  is 
safe  to  say,  whatever  may  be  the  recommendations 
offered  in  the  revised  code,  that  their  significance 
has  been  thoroughly  considered,  and  all  the  pros  and 
cons  carefully  and  conscientiously  weighed.  The 
character  and  standing  of  the  committee  guarantee 
the  foundation  for  such  a  prediction.  Whether  the 
judgment  of  these  gentlemen  shall  be  confirmed  by 
that  of  the  members  of  the  society  can,  of  course, 
only  be  conjectured.  It  must  be  remembered,  how- 
ever, that  the  committee  has  a  difficult  task  to  per- 
form. It  will  be  compelled  to  compromise  between 
the  ultras  and  liberals  to  the  extent  of  pleasing  both, 
while  at  the  same  time  the  interests  of  the  profession, 
as  a  whole,  are  properly  conserved.  Certain  men  look 
upon  the  present  elaborate  code  as  so  many  articles 
of  faith,  to  question  which  would  appear  like  the 
rankest  heresy ;  while  others  consider  it  an  absolute 
failure  as  regards  its  application  to  the  present  con- 
ditions and  associations  of  medical  men,  and  desire 
its  abolishment  altogether.  It  is  quite  evident,  in 
view  of  these  facts,  that  the  majority  of  the  pro- 
fession call  for  some  happy  and  consistent  mea.n 
which  shall  eliminate  the  useless  and  impracticable 
injunctions  of  the  present  instrument,  and  at  the 
same  time  preserve  all  of  the  good  rules  which  it 
has  been  found  possible  for  conscientiously  honest 
men  to  follow. 

It  needs  no  argument  to  prove  that  any  new  code 
can  safely  dispense  with  the  moral  platitudes  which 
abound  in  the  present  one,  can  do  away  with  some 
of  the  absurd  provisions  which  tend  so  directly  to 
intei'fere  with  the  liberty  of  conscience  of  the  sub- 
ject, and  can  omit  many  of  those  injunctions  be- 
gotten in  the  apparently  righteous,  but  really  dog- 
matic, spirit  of  half  a  century  ago.  The  tendencies 
of  the  present  age  are  in  the  direction  of  the  absolute 
liberality  of  opinion  in  all  things.  We  are  arriving 
at  a  point  when  we  can  safely  leave  matters  of  con- 
science and  fair  dealing  to  the  sound  judgment  of 
intelligent  and  honorable  men ;  and  the  more  the 
necessities  of  the  situation  in  that  respect  are  con- 
sidered in  the  formation  of  any  code,  the  better  will 
it  be  for  the  profession  and  for  humanity.  Of  course 
it  is  hardly  to  be  expected  that  the  requu-ements  of 
every  case  cannot  be  perfectly  met ;  but  general 
principles  of  action  can  be  explicitly  presented,  the 
force  and  significance  of  which  every  right-minded 
man  can  directly  and  intelligently  apply.  A  lengthy 
code  is  not  needed.  In  fact,  the  shorter  it  can  be 
made  the  better.  The  letter  of  any  law  governing 
honorable  conduct  is  of  small  importance  compared 
with  the  proiJCir  appvtH-iation  of  its  spirit.  But  we 
have  every  reason  to  believe  that  all  these  points 
will  receive  tlioir  due  consideration  by  the  mem- 
bers of  the  committee. 


The  practicability  of  altering  the  present  law  re- 
lating to  the  practice  of  medicine  in  this  State,  will 
also  claim  attention.  An  effort  will  be  made  to  give 
more  force  to  the  i^ei-juiy  clause,  and  other  objection- 
able features  will  be  eliminated  which  have  so  di- 
rectly militated  against  its  proper  enforcement.  The 
recommendation  for  a  change  will  be  based  jsrinci- 
paUy  upon  the  experience  of  the  County  Society  in 
the  prosecution  of  offenders.  It  is  difficult  to  under- 
stand how  the  desired  alterations  can  be  effected  short 
of  framing  an  entirely  new  law.  We  believe  that  a 
movement  to  that  end  is  contemplated  by  the  dele- 
gates from  this  county.  Bearing  upon  the  question 
of  changing  or  modifying  the  law,  is  the  one  having 
reference  to  compulsory  State  examinations  for  li- 
cense. This  will  also  be  advocated  by  the  New  York 
County  Society,  and  will  doubtless,  for  obvious  rea- 
sons, meet  with  lively  opposition  from  some  of  the 
colleges.  In  reality,  however,  if  viewed  in  the 
proper  light,  it  is  destined  to  benefit  all  parties  con- 
cerned, to  elevate  the  standai-d  of  medical  education, 
to  challenge  the  schools  to  do  their  best  in  turning 
out  jjroper  men,  and  to  effectually  shut  the  door 
against  unqualified  practitioners  of  eveiy  kind.  But 
we  shall  have  occasion  to  say  more  on  this  subject 
at  another  time. 


EeDi£iM0  antr  tlDttrieg  of  Hooks. 


A  Study  of  the  Tumoks  of  the  Blabdek:  With 
Original  Contributions  and  Drawings.  By  Alex. 
W.  Stein,  M.D.,  Surgeon  to  Charitv  Hospital,  etc. 
8vo,  pp.  94.  New  York  :  W.  Wood  \-  Co.  1881. 
The  author  of  the  present  monograph  on  vesical 
neoplasms,  has  had  the  rare  good  fortune  of  observ- 
ing four  cases  of  the  affection  within  a  few  years. 
He  has  made  a  careful  study  of  the  literature  of  the 
subject,  collecting  all  the  more  imijortant  cases 
which  he  found  accessible.  These  records,  in  con- 
junction with  his  personal  obseiTations  on  tumors 
of  the  bladder,  have  furnished  him  with  ample 
material  for  the  preparation  of  his  monograi>h.  It 
is  certainly  tlie  most  complete  description  as  regards 
the  practical  details  of  symptomatology,  diagnosis, 
and  treatment  of  these  growths,  that  can  he  found 
in  the  English  language.  The  text  is  elucidated  by 
a  number  of  full-page  j'lates,  most  of  which  are  ad- 
mirably executed. 

Favorite  PBEscRn'TiONS  oF  Distinguished  Practi- 
tioners :  With  Notes  on  Ti-eatment.  By  B.  W. 
Palmer,  A.M.,  M.D.  New  York  :  Bermingham  & 
Co.  1881. 
MoDE.STT  is  a  virtue,  even  when  it  lives  in  the  breast 
of  the  ambitious  medical  aspirant  for  literary  fame. 
Hero  is  Dr.  Palmer,  who  collects  a  number  of  well- 
known  and  time-honored  prescriptions  in  a  diminu- 
tive duodecimo  stripling,  and  then,  fondly  contem- 
plating the  result  of  liis  mental  parturition,  informs 
us  that  the  "design  of  the  writer  will  have  been  ac- 
complished if  he  succeeds  by  his  ott'ering  in  render- 
ing more  available  for  every -day  use  and  guidance 
the  practical  treasures  of  medical  wisdom  vhioh 
have  been  gathered  from  the  earnest  labors  and  care- 


THE  MEDICAL  RECORD. 


133 


ful  observations  of  the  most  distinguished  practi- 
tioners of  the  age." 

The  student  or  practitioner  who  will  depend  on 
this  or  similar  collections  for  his  therapeutical  reeom- 
msnd.atious  should  be  earnestly  solicited  to  change 
his  profession.  Nothing  is  more  calculated  to  lower 
the  standard  of  professional  intelligence  than  to  en- 
courage the  student  or  young  practitioner  to  rely  on 
these  ready-made  formidas.  It  deadens  the  capacitv 
for  original  thought,  and  will,  in  time,  hopelessly 
cripple  all  self-reliance,  than  which  there  is  scarcely 
a  quality  more  essential  at  the  liedside.  No  ;  let 
the  beginner  study  well  the  physiological  action  of 
drugs,  and  then  he  will  be  able  to  combine  his  reme- 
dies in  such  a  way  as  to  make  his  prescriptions  ful- 
fil the  varying  indications  of  each  individual  case. 
And  then,  also,  he  will  learn  to  discard  the  thought- 
killing  aid  of  collections  like  the  one  before  us. 
The  Pkevention  of  Stkictuke  and  op  Pkostatic  Ob- 
struction. ■  ByPiEGixALD  Hakrison,  F.E.C.S.,  etc. 
London  :  J.  A:  A.  Churchill.  1881. 
The  first  portion  of  this  little  volume,  dealing  with 
the  prevention  of  stricture,  originally  ajjpeared  in 
the  Lancet  of  May  15,  1880.  The  profession  are  al- 
ready familiar  with  the  views  of  the  author  on  this 
subject.  Dr.  Harrison  believing  that  thorough  irri- 
gation of  the  urethra  by  a  suitable  catheter  will  do 
much  toward  lessening  the  frequency  of  strictures 
after  gonon-hoea. 

As  regards  the  second  poi'tion  of  the  book,  it  em- 
bodies the  description  of  the  author's  method  of 
preventing  the  occurrence  of  prostatic  obstruction, 
or,  moi-e  con-ectly  speaking,  attemjiting  to  prevent 
it.  He  strongly  urges  the  employment  of  persistent 
catheterism  on  the  first  indication  of  the  prostatic  en- 
larging. In  addition,  he  uses  olive- shaped  dilators, 
made  from  two  to  four  inches  longer  in  the  stem 
than  ordinary  urethral  bougies,  in  order  that  the 
olive  portion  may  be  fairly  passed  into  the  bladder. 
It  is  quite  obvious  that  considerable  relief,  if  not  a 
pei-fect  cure,  should  follow  the  conscientious  and 
persistent  use  of  these  instruments,  and,  indeed,  Dr. 
Harrison's  experience  has  demonstrated  that  this  is 
the  case. 

Die  Kb.^xkheitex  dee  Fracen  :  Aerzten  und  Studi- 
senden  geschildert.     Von  Dr.  HErNTucH  Fritsch, 
Professor  der  Gynrekologie  uxuX  Geburtshidfe  in 
der  Universitat  zu  Halle.     Mit  159  Abbildungen  in 
Holzschnitt.   Braunschweig  :  Wreden's  Sammluug 
Kurzer   Medizinischer   Lehrbiicher.    1881.     (The 
Diseases  op  TTojien.     By  Dr.  H.  Fritsch.     SVre- 
den's  Library  of  Medical  Works.) 
It  appears  that  the  publishers  of  this  work  have  de- 
termined to  issue  a  series  of  short  and  concise  text- 
books on  subjects  embracing  the  most  important  de- 
partments of  medicine.    This  plan  has  probably  been 
suggested  by  the  success  of  Wood's  Library  of  Stand- 
ard Authors.     Judging  from  the  excellence  of  the 
first  volume,  this  undertaking  will  be  favorably  re- 
ceived by  the  profession,  and  meet  with  a  merited 
success. 

Prof.  Fritsch,  in  the  416  pages  of  the  book  before 
us,  disposes  of  the  most  prevalent  diseases  of  women 
in  a  manner  which  leaves  nothing  to  be  desired.  His 
style  is  lucid  and  simple,  the  diction  concise,  and  all 
statements  go  directly  to  the  point ;  accordingly  he 
is  able  to  convey  much  information  in  few  words. 
Special  attention  is  paid  by  the  author  to  treatment, 
and  this  circumstance  will  doubtless  contribute  to 
make  the  present  work  a  deservedly  popular  one 
with  students  and  practitioners. 


Reports  Df  Societies. 


NEW  TOEK   SUEGIC.VL   SOCIETY. 

Stated  Meeting,  December  13,  1881. 
Db.  T.  M.  Mabkoe,  Pbesident,  in  the  Chaie. 
The  President  read  a  paper  on 
exostoses  op  the  poPLiTEAii  SPACE  (see  page  121). 

Dr.  L.  A.  Stdison  asked  the  President  if  he  traced 
any  connection  between  these  gi-owths  and  the  con- 
jugal cartilage ;  in  other  words,  did  he  make  any 
'distinction  between  them  and  the  ecchondroses  of 
Virchow  ? 

The  President  thought  there  was  no  connection 
between  them,  because  in  all  his  cases  the  giowiLs 
were  two  inches,  at  least,  below  the  head  of  the 
tibia.  He  believed  that  they  did  not  belong  to  the 
ecchondroses  of  Virchow. 

Db.  Stdison  remarked  that  the  fact  that  the  growths 
were  at  some  distance  on  the  diaphysal  side  of  the 
epiphysis  was  not  an  argument  against  their  having 
originated  in  the  conjugal  cartilage  ;  because  it  is 
well-known  that,  as  the  bone  grows  in  length,  the 
conjugal  cartilage  advances  with  the  end,  so  that 
the  portion  of  bone  which  in  early  life  immediately 
adjoins  the  epiphysis  is,  when  adult  life  is  reached, 
more  or  less  near  the  centre  of  the  shaft.  In  illus- 
tration of  this  he  mentioned  the  fact  that  it  is  not 
uncommon  to  find  multiple  gi'owths  upon  the  same 
individual  occupying  vertical  positions  on  the  dia- 
physal side  of  the  joint  and  usually  increased  in  size 
from  joint  toward  the  centre. 

In  one  reported  case,  speaking  from  memory, 
there  were  sereii  such  growths.  The  origin  in  the 
conjugal  cartilage,  of  some  of  these  growths  at  least 
— such,  for  example,  as  probably  the  small  one  upon 
the  humerus,  which  had  been  presented — was  ac- 
cepted by  all  vniters,  and  they  show  that  there  are 
two  varieties,  one  in  which  persisting  embi-yonal 
cartilage  occupies  the  tijj  of  the  jirocess,  and 
another  in  which  it  lies  at  the  base,  between  it  and 
the  shaft. 

The  clinical  evidence  points  in  the  same  direction  ; 
because,  as  a  rule,  all  these  exostoses  ordinarily  cease 
to  grow  at  about  the  period  of  consolidation  of  the 
epiphyses,  and  it  is  exceptional  to  find  them  con- 
tinuing to  gi'ow,  as  in  Dr.  Markoe's  second  case, 
until  the  age  of  thirty-eight  years.  They  are  recog- 
nized as  the  phenomena  of  adolescents,  and  have 
been  described,  among  others,  byGosselin  as  among 
the  diseases  of  youth.  The  same  writer  also  men- 
tions, in  his  lecture  upon  this  subject,  a  case  com- 
ing under  his  own  observation,  where  death  by  py- 
aemia followed  a  compound  fracture  of  one  of  these 
gi'owths. 

Db.  Weir  refeiTed  to  a  case  which  he  saw  in  his 
wards  at  St.  Luke's  Hospital,  some  thirteen  years 
since.  The  patient  was  a  boy,  sixteen  or  seventeen 
years  of  age.  The  exostosis  was  situated  at  the 
outer  surface  of  the  femur,  low  down.  It  was  ex- 
posed, shaven  ofl'at  a  level  with  the  bone,  and  inflam- 
mation and  suppuration  took  place  in  the  wound 
pocket.  Comijlete  recovery,  however,  occurred,  and 
he  had  seen  the  patient  recently,  and  there  had  been, 
as  might  be  anticipated,  no  return  of  the  disease. 
In  connection  with  such  and  other  operation  wounds 
for  necrosis,  ununited  fracture,  etc..  he  referred 
to  the  fact  that  Lister  of  late  had  sj^oken  especially 


J  34 


THE  MEDICAL  EECORD. 


of  treating  them  antiseptically  without  attempting 
to  close  the  wound  at  all.  He  also  referred  to  the 
fact  that  for  exostoses  of  the  femur,  Maunder,  many 
years  ago,  refrained  from  resorting  to  the  cutting 
operation,  and  broke  the  tumor  off  with  a  hammer 
without  making  an  incision  througli  the  skin.  In 
those  cases  the  tumor  ceased  to  grow,  and  was  no 
longer  a  source  of  irritation. 

Db.  Keses  recalled  a  case  in  which  there  were  two 
pointed  exostoses  upon  the  inner  .side  of  the  knee  at 
different  distances  below  the  knee-joint.  One  tumor 
was  as  large  as  a  puUet's  egg,  and  the  other  as  large 
as  an  Italian  chestnut.  They  were  absolutely  hard 
to  the  touch,  appeared  to  be  bone,  and  occurred  in  a 
girl  sixteen  or  seventeen  years  of  age.  They  gave 
tlie  patient  no  inconvenience,  and  no  operation  was 
performed.  He  suggested,  in  cases  in  which  there 
was  a  small  pednncnlated  base,  that,  instead  of 
cutting  down  in  the  popliteal  region  and  using  the 
curved  chisels,  presented  by  Dr.  Markoe,  it  might 
be  possible  to  cut  down  on  the  side  of  the  limb  and 
use  a  straight  chisel  for  the  removal  of  the  mass. 

The  Pee.siden't  said  that  it  was  always  desirable  to 
cut  through  the  compact  lamina  completely  around 
the  neck  of  the  tumor  before  it  was  safe  to  break  it 
otf.  Dr.  Keyes'  suggestion,  however,  might  be  prac- 
ticable in  certain  cases. 

Dr.  Weir  inquired  with  reference  to  the  mode  of 
removal  which  Dr.  Markoe  employed  in  the  cases  of 
exostoses  of  the  toes. 

The  President  replied  that  they  were  removed  by 
partial  amputation.  He  first  removed  the  nail  and 
its  matrix  entirely,  then  cai-ried  the  incision  around 
the  tip  of  the  toe,  leaving  a  good  flap,  which  could 
subsepiently  be  brought  over,  and  then  removed  the 
anterior  half  of  the  distal  phalanx. 

Dh.  Stimson  suggested,  in  cases  where  complete 
removal  of  the  growth  was  impracticable  and  danger- 
ous, that  shaving  ofT  the  cartilaginous  surface,  from 
which  the  growth  is  supposed  to  proceed,  might  be 
sufficient. 

The  President  replied  that  Dr.  Buck  in  one  case 
did  precisely  the  same  thing ;  that  is,  he  burned  off 
and  cut  off  the  cartilaginous  surface  entirely,  but  the 
growth  recurred  after  each  operation.  Dr.  Buck's 
case  was  one  of  exostosis  of  the  toe,  but  the  Presi- 
dent regai'ded  exostoses  of  the  toe  and  of  the  lower 
portion  of  the  femur  and  of  the  upper  portion  of  the 
tibia  as  identical  in  nature. 

Db.  Post  had  removed  a  number  of  exostoses 
from  the  great  toe,  and  had  lost  sight  of  the  patients 
entirely  ;  still  he  thought  that  the  tumors  had  not 
returned,  for,  probably,  the  patients  would  have 
reappeared  had  tlie  operations  not  been  successful. 

The  President  remarked  that  in  all  of  his  cases  of 
exostosis  of  the  great  toe,  operated  upon  in  the  man- 
ner described,  the  cure  had  been  permanent. 

SARCOMA   OF   THE   TIBIA. 

Dr.  \.  C.  Post  narrated  a  case  as  follows :  A 
boy,  fifteen  years  of  age,  was  brought  to  him  with 
a  very  large  tumor,  occupying  the  iipper  part 
of  the  left  leg,  about  a  hand's  breadth  below  the 
knee.  Tlie  tumor  was  evidently  sarcomatous  in 
character.  The  point  of  special  interest  consisted  in 
its  rapid  grovvtli.  The  patient  liad  previously  en- 
joyed good  healtli —although  never  very  robust  — 
until  about  two  months  ago,  when  he  noticed  a  swell- 
ing about  the  size  of  a  lien's  egg.  From  that  time 
it  hid  rapidly  increased,  was  painful,  and  tlie  integu- 
ment covering  it  was  of  a  dusky  red  color,  and  some- 
what cfidematous.     The  tumor  was  firm,  vet  vielded 


slightly  to  pressure,  and  gave  an  obscure  sense  of 
fluctuation.  The  circumference  of  the  limb  was 
forty-eight  centimetres;  the  circumference  of  tl.e 
opposite  limb,  twenty-three  centimetres.  The  pro- 
portion of  the  one  to  the  other  being  about  the  same 
as  that  of  the  tliumb  to  the  wrist.  He  amputated 
the  thigh,  and  found  that  the  morbid  growth  origi- 
nated from  the  j^eriosteum  of  the  tibia,  and  had 
grown  in  all  directions  from  the  bone.  There  were 
fine  spicuhe  of  bone,  needle  like  larolongations,  tra- 
versing the  suljstance  of  the  tumor.  Dr.  Post  asked 
if  it  was  not  rare  for  a  tumor  to  acquire  such  dimen- 
sions in  so  short  a  time.  [The  sijecimen  was  pre- 
sented to  the  Society  January  10,  1882.] 

FBACTtlBE   OF   CATHETEB   TN    THE   UBETHEA. 

Dr.  Erskdje  Mason  narrated  a  case  as  follows  :  A 
physician  came  to  his  office  on  the  5th  of  July,  1881, 
with  a  man  forty-three  years  of  age,  and  giving  the 
following  history :  The  patient  had  a  very  tight 
stricture  and  retention  of  urine.  The  jjhysician  was 
sent  for,  and  tried  to  introduce  the  smallest  Mexible 
instiiiment  he  had,  and  failed.  He  then  took  a  small 
Thompson's  metallic  catheter — about  a  No.  3  French 
— and  endeavored  to  introduce  it.  It  passed  very 
well  until,  as  he  supposed,  it  was  about  to  enter  the 
bladder,  when  it  met  with  resistance,  and,  on  at- 
tempting to  withdraw  the  instrument,  the  straight 
portion  down  to  the  curve  came  away,  leaving  the 
curved  portion  behind.  The  jiatient  was  suffer- 
ing from  no  pain,  and  complained  of  no  inconveni- 
ence. The  accident  occurred  about  four  o'clock  in 
the  afternoon.  Dr.  Mason  saw  him  about  half  past 
five,  and  sent  him  to  Bellevue  Hospital  with  a  note 
to  his  hou.se-surgeon,  asking  him  to  try  to  pa.'-s  a 
filiform  bougie  into  the  bladder,  and  to  let  liim 
know  if  he  did  not  succeed,  and  also  as  to  whether 
he  felt  any  substance  in  the  urethra.  The  small 
bougie  was  jiassed  into  the  bladder,  and  no  foreign 
body  was  detected.  Dr.  Mason  saw  the  patient  the 
next  morning,  and  found  tliat  he  had  jiassed  water 
in  a  very  small  stream,  sometimes  only  by  drops,  and 
had  succeeded  in  relieving  his  bladder.  He  was 
able  to  reach  the  bladder  with  a  fine  whalebone  bou- 
gie, without  obstruction  or  coming  in  contact  with 
a  foreign  body,  and  he  tlien  sujijiosed  that  the  end 
of  the  metallic  instrument  liad  broken  off  within  tbe 
bladder.  With  the  whalebone  bougie  as  a  guide,  lie 
proceeded  to  enter  the  bladder  by  the  median  oper- 
ation for  stone.  The  bladder  being  entered,  a 
thorough  search  was  made  with  both  the  finger  and 
forceps,  and  he  was  tiuable  to  detect  any  foreign 
substance  whatsoever.  He  then  examined  tlior- 
oughly  the  tissues  in  the  perineum,  throtigh  the 
wound,  and  also  through  the  rectum,  and  was  urpble 
to  convince  himself  that  he  found  any  foreign  body 
in  the  surrounding  parts.  He  then  divided  the 
strictures  anteriorlv,  relieved  them  completely, 
passed  a  large  sound  into  the  bladder,  and  left  the  pa- 
tient, who  subseipiently  did  perfectly  well.  Nothing 
untisual  occurred  in  the  ]>rogress  of  the  case  until 
the  morning  of  the  .31st  of  July,  when  the  house- 
surgeon,  while  attempting  to  pass  a  large  steel 
sound,  felt  that  it  clicked  against  something  in  tlie 
urethra.  On  the  following  morning  the  jiatient  prn- 
ducod  the  ]>oint  of  the  metallic  instrument,  wliich 
had  passed  through  the  wound  in  the  perineum.  It 
was  about  two  inches  in  length.  The  metallic  cath- 
eter had  separated  at  its  weakest  point,  in  the  region 
of  the  eye.  The  patient  recovered  entirely,  and  left 
the  hospital  able  to  introduce  a  No.  18  Encli.sh 
sound.     The  portion  of  catheter  broken  off  and  le- 


THE  MEDICAL  RECORD. 


135 


maining  had  evidently  made  a  false  passage  for  itself 
and  lodged  in  the  soft  tissues,  fiom  where  it  had 
gradually  worked  its  w^ay  out. 

RAPID  LITHOTRITY    IN   OLD   MEN. 

Di!.  ICeyes  narrated  the  history  of  two  cases  of  rapid 
lithotrity,  in  illustration  of  the  tolerance  of  this 
operation.  In  the  first  case,  the  patient  was  seventy- 
five  years  of  age.  Seventy-five  minutes  were  occu- 
pied in  the  operation,  and  393  grains  of  ealcuhis 
material  were  removed.  It  was  the  most  serious 
and  difficult  operation  of  this  kind  which  he  had 
ever  performed.  The  patient  was  exceedingly 
feeble  ;  had  been  for  some  time  confined  to  the  bed 
by  pain  and  feebleness,  and  was  using  anodvnes  to 
control  frequent  desire  to  urinate.  In  simply  sound- 
ing him,  the  hemorrhage  was  profuse.  The  intro- 
duction of  the  evacuating-tube  was  attended  and 
followed  by  very  profuse  bleeding,  although  no  cut- 
ting of  the  urethra  at  any  point  had  been  done. 
The  patient's  condition  was  so  feeble  that  it  became 
necessary  to  administer  brandy  by  the  rectum,  after 
operating  an  hour  and  a  quarter.  He  vomited  cofl'ee- 
ground  material,  and  having  been  so  long  under 
ether,  it  was  deemed  advisable  to  postpone  further 
procedure,  although  it  was  evident  that  a  small  por- 
tion of  the  stone  still  remained  in  the  bladder.  The 
patient  had  no  chill  or  subsequent  trouble,  e.xcept 
very  great  pain,  a  more  intense  prostration,  and  de- 
lirium, with  mild  feverislmess.  He  rallied  entirely 
from  the  influence  of  the  anaesthetic  and  from  the 
operation,  and  is  now  waiting  to  recovea-  strength 
sufficient  to  have  the  remaining  portion  of  stone  re- 
moved. In  less  than  three  weeks  the  patient  was 
out  of  his  bed  and  going  to  his  meals.  Dr.  Keyes 
felt  certain  that  any  other  operation  would  have 
killed  the  patient. 

The  second  case  was  that  of  a  man  fifty-seven  and 
a  half  years  old,  upon  whom  he  operated  in  1878. 
The  operation  lasted  forty  five  minuter,  and  136 
grains  of  calculus  material  were  removed.  The  ])a- 
tient  had  long  been  a  sufiei'er  from  his  bladder 
trouble ;  desire  to  urinate  had  been  almost  con- 
stant, and  he  had  been  obliged  to  resort  to  opium 
freely  for  the  relief  of  his  suft'eriug.  He,  however, 
made  a  good  recovery  from  the  operation,  so  miich 
so  that  he  was  able  to  retain  his  iirine  for  six  or 
eight  hours  in  succession,  was  able  to  attend  to 
his  ordinary  occupation,  and  engage  in  some  sports, 
such  as  trout-fishing  and  the  like.  Within  a  few 
months  he  had  had  what  was  aj)parently  a  mild 
attack  of  renal  colic.  Otherwise  he  retained  his 
usual  good  health  until  December  1,  1881,  when 
he  had  an  attack  of  renal  colic.  On  the  morning  of 
December  3d,  he  had  a  severe  chill,  suffered  great 
pain  in  the  loins  and  hips,  his  urine  became  scanty, 
and  he  died  comatose  on  the  8th  of  December.  At 
the  post-mortem  examination,  the  right  kidney  was 
found  entirely  degenerated,  one  half  of  the  capsule 
being  occupied  with  a  cy.st,  which  contained  an 
ounce  and  a  half  of  serum.  The  left  kidney  was 
double  the  natiiral  size,  was  intensely  congested,  its 
surface  was  covered  with  ecchymotic  spots,  and  the 
pelvis  was  distended  with  bloody  urine,  a  mulberry 
calculus  blocked  the  entrance  to  the  ureter.  The 
bladder  was  not  contracted  ;  the  walls  were  some- 
what thickened  ;  the  mucous  membrane  moderately 
congested  ;  the  prostate  was  not  hypertro)ihied.  At 
the  base  of  the  bladder  there  was  a  depression,  which 
was  probably  occupied  by  the  calculus  removed 
three  years  ago.  The  bladder  contained  no  stone. 
Dr.  Keyes  thought  it  altogether  probable   that  the 


right  kidney  was  substantially  in  the  condition  found 
at  post-mortem  at  the  time  of  the  operation.  He 
thought  that  both  cases  were  good  illu.strations  of 
the  tolerance  with  which  rapid  lithotrity  was  borne 
by  patients  advanced  in  years. 

Db.  Weib,  in  connection  with  Dr.  Keyes'  cases, 
referred  to  obstruction  of  the  ureters  as  being  a 
point  of  special  interest.  The  most  common  place 
where  siich  olistruction  occurs  from  a  calculus  is 
within  three  or  four  inches  from  the  kidney,  or  at 
the  jimction  of  the  ureter  with  the  bladder.  In  thf  fe 
cases,  so  ably  described  by  Eoberts,  of  Manchesti  r, 
he  believed  that  there  is  yet  hope  of  saving  the  li^e 
of  the  patient  by  means  of  a  .surgical  operation. 
With  a  history  of  renal  colic  upon  one  side,  with  or 
without,  in  certain  instances,  a  subsequent  attack 
of  renal  colic  upon  the  other  side,  sui>pressicu  of 
urine  or,  as  was  more  common,  scanty  discharge 
of  urine  with  greatly  lowered  specific  gravity,  and 
threatening  head  symptoms,  he  was  j^repared  to 
make  an  incision  in  the  groin,  and  either  to  extract 
the  stone  from  the  ureter  if  possible,  or  to  create  a 
fistula  above,  or  to  endeavor,  with  the  hand  in  the 
rectum,  to  force  the  calculus  into  the  bladder.  Mr. 
Annandale  had  demonstrated  that  from  the  loin  the 
ureter  could  be  exposed  for  a  considerable  length. 

Dr.  Weir  also  referred  to  a  case  of  stone  in  the 
bladder  as  follows  :  A  j)ati€iit,  seventy  years  of  age, 
had  during  the  last  six  months  suffered  from  symp- 
toms of  stone  in  the  bladder.  He  was  under  the 
care  of  Dr.  Robert  Abbe,  who  proceeded  to  per- 
form rapid  lithotrity  in  the  usual  manner.  He  was 
able  to  effect  a  number  of  seizures,  and  occasionally 
a  very  large  one,  one  and  one-half  to  two  inches,  but 
he  was  prevented  attcmi^ting  in  the  large  grasps  to 
either  crush  the  stone  by  inability  to  rotate  it,  and 
thus  satisfy  himself  that  the  vesical  walls  w  ere  safe. 
At  other  times  he  was  able  to  effect  only  a  very  small 
grasp.  After  several  attemjits  to  overcome  the  un- 
usual dilficulties  of  the  case,  which  were  also  expe- 
rienced in  several  trials  by  Dr.  Weir,  Dr.  Abbe 
effected  a  seizure  in  such  a  position  that,  while  the 
calculus  could  not  be  rotated  laterally,  it  could  be 
pushed  back  and  forward,  its  differentiation  from 
the  bladder  being  thus  effected.  The  lithotrite 
was  then  shut  and  removed,  and  when  its  jaws  weie 
examined  they  were  found  tto  contain  a  portion  of  a 
soft  French  catheter.  Upon  fur-ther  inquiry  it  was 
then  learned  from  the  patient's  sen  that  the  man 
had  had  an  attack  of  retention  of  urine  about  six 
months  previously,  when  a  soft  catheter  had  Veen 
introduced  to  relieve  the  bladder,  and  had  been  al- 
lowed to  remaio,  and  that  the  instrument  had  dis- 
appeared, the  patient  stating  that  he  had  passed  it 
in  the  water-closet.  It  had  not  passed,  however, 
but  had  entered  the  bladder  and  had  coiled  xip 
there.  The  diagnosis  being  satisfactorily  made,  the 
two  remaining  fragments  were  luckily  seized  with  a 
small  Tliompson's  lithotrite-  and  readily  extrscted, 
and  the  bladder  subsequently  evacuated  by  the  as- 
pirator tube  of  a  large  amount  of  crushed  jihosphate 
calcidus.     The  patient  subsequently  did  well. 

INTESTINAL    OBSTRl'CTION. 

Dr.  Briddon  narrated  a  case  as  follows  :  At  four 
o'clock  on  that  afternoon  he  was  summoned  to  visit 
a  patient  at  the  hospital  department  of  the  Colored 
Home,  who  was  said  to  be  suflering  from  intestinal 
obstruction.  The  man  was  about  thirty-five  years 
of  age,  and  entered  the  in.stitution  three  weeks  ago 
with  retention  of  urine,  which  was  not  relieved 
by  the  catheter,  but  by  aspiration,  and  the  bladder 


136 


THE  MEDICAL  RECORD. 


■was  punctured  three  different  times.  Ten  days  ago 
a  soft  instrument  was  introduced  and  continuous 
dilatation  practised.  -\t  the  present  time  there  was 
no  trouble  with  the  bladder.  Two  or  three  days 
ago  the  man  l>egan  to  suffer  from  constipation, 
having  had  no  evacuation  -from  the  bowels  for  four 
or  live  days,  and  yesterday  tympanitis  develoi:)ed. 
The  patient's  pulse  was  100,  the  temperature  almost 
normal,  the  abdomen  tympanitic,  and  he  had  almost 
incessant  vomiting.  When  Dr.  Briddon  saw  the 
patient  he  was  upon  his  hands  and  knees,  straining 
in  efforts  of  vomiting.  There  was  no  hernia,  and  no 
abdominal  tumor  to  be  felt  either  through  the  walls 
or  in  the  rectum.  He  gave  directions  that  the  pa- 
tient should  be  narcotized  with  ethei",  inverted,  the 
rectum  filled  with  water  through  a  funnel,  as  much 
as  could  be  injected,  that  he  should  receive  opium 
in  doses  sufficient  to  (|niet  the  pain  and  render  him 
comfortable,  and  called  a  consultation  with  a  view  to 
subsequent  surgical  interference.  He  had  no  idea 
as  to  what  the  cause  of  the  obstruction  was.  He 
asked  the  society  what  condition  would  warrant  sur- 
gical interference  in  such  cases.  His  own  impres- 
sion was  that  delays  were  more  dangerous  than  ac- 
tion. 

Dr.  Post  thought  that  in  obstinate  constipation 
of  the  bowels,  such  as  could  not  be  relieved  by  other 
means,  it  was  safer  to  perform  laparotomy  than  to 
leave  the  jsatient  to  his  fate. 

GRIFFE   DE    LA   MAIN. 

Dr.  Weir  referred  to  a  case  of  claw-shaped  hand, 
griffii  de  la  iiuiin,  due  to  division  of  the  ulnar  nerve. 
He  attempted  to  secure  the  ends  of  the  divided 
nerve  and  to  bring  them  out  for  the  purpose  of 
uniting  them,  but  failed.  The  injury  occurred  four 
months  ago.  He  was  unable  to  find  the  upper  ex- 
tremity of  the  divided  nerve.  Dr.  Weir  asked  for 
the  experience  of  the  members  with  reference  to 
the  success  of  this  operation. 

Dr.  Briddon  referred  to  a  case  which  he  had  re- 
ported to  the  society.  In  that  instance  the  divided 
extremities  of  the  nerve  were  brought  together  and 
united  by  sutvire  throiigh  the  neurilemma.  The 
operation  wne  performed  several  months  after  the 
injury.  The  parts  came  into  accurate  apposition 
without  any  tension,  but  the  result  was  negative. 

The  Pre-sideni  asked  if  there  were  any  cases  ujion 
record  of  successful  operation  after  the  elapse  of  so 
long  a  period  after  the  receijit  of  the  injury. 

Dk.  Weir  replied  that  there  were,  although  there 
were  many  failures. 

Dr.  Stimson  referred  to  a  remarkable  case  which 
had  been  reported  in  the  London  Lancet.  It  was 
one  in  wliich  tlie  sciatic  nerve  was  divided,  and  it 
was  necossai-y,  in  order  to  bring  the  divided  ends 
into  apiiosition,  to  flex  the  leg  upon  the  thigh,  and 
extend  the  thigh  upon  the  body,  and  draw  them 
back  as  far  as  possible.  Good  union  of  tlie  nerve, 
however,  was  ol)tained  with  restoration  of  power  in 
the  limb.  The  divided  extremities  of  the  nerve  in 
that  instance  were  four  inches  apart. 

Dr.  Weiu  tliought  that  late  researches  had  gone 
far  to  prove  that  tho.  liistoi-y  of  success  rei)orted  in 
many  cases  had  been  incorrect ;  the  success  at- 
tributed to  the  oi>erati()n  being  due  to  the  supjily 
given  to  the  parts  by  neighboring  nerves. 

Dr.  HriM.soN  remarked  that  tliis  was  certainly  true 
of  sensitive  nerves. 

The  society  then  proceeded  to  the  transaction  of 
miscellaneous  business. 


Corrcspoulicuce. 


THE  QUESTION  OF  PiEFLEX  DISTFEB- 
ANCES  FROM  GENITAL  IREITATION. 

To  THE  Editor  of  The  Medical  Record. 

Dear  Sir  :  I  was  somewhat  surprised  to  read  the 
grave  charge  that  Dr.  Newton  M.  Shaffer  makes 
against  me  in  the  last  issue  of  your  journal,  and 
the  feeling  was  not  lessened  when  I  turned  to  his 
articles  to  see  whether  I  had  inadvertently  done 
him  an  injustice.  Dr.  Shaffer  states  "  that  the  most 
iwportfinf  condufsions  reached  by  Dr.  Gray,  and  that 
many  of  the  points  referred  to  by  him  and  discussed 
subsequently  by  the  eminent  gentlemen  present  (at 
the  meeting  of  the  New  York  Neurological  Society), 
have  been  covered  by  me  in  an  editorial  on  '  Indis- 
criminate Circumcision '  in  the  May  (1881)  number 
of  the  Annals  nf  Anatomy  and  S'jov/ctv/,  and  .subse- 
quently in  remarks  on  the  subject  of  '  Genital  Irri- 
tation' in  the  July  (1881)  number  of  the  same 
journal.  .\jid,  further,  that  my  expressed  doubts 
regarding  the  existence  of  reflex  paralysis  from  gen- 
ital irritation  in  childhood,  supplemented  by  the 
same  opinion  from  my  friend,  Dr.  E.  C.  Seguin,  has 
been  confirmed  by  the  very  eminent  authorities  with 
whom  Dr.  Gray  has  been  in  cori-espondence." 

Please  remember,  IMr.  Editor,  that  the  italics  are 
my  own. 

The  upshot  of  all  this  is,  then,  that  my  most  im- 
portant conclusions  and  many  of  my  points  have 
been  "covered"  by  Dr.  Sliatfer,  and  that  he  had 
expressed  doubts  which  other  gentlemen  had  not 
only  had  the  temerity  to  entertain,  but  had  also 
communicated  to  me. 

It  is  to  be  regi-ettod  that  Dr.  Shafler  did  not  see 
fit  to  give  the  proof  of  his  first  assertion  in  more 
detail  than  is  contained  in  a  general  allusion  to  two 
articles  written  months  ago.  Let  me  now  make  an 
abstract  of  all  matters  in  Dr.  Shatter's  two  papers 
that  are  germane  to  this  charge,  compare  them  with 
all  similar  matters  in  my  own,  and  let  the  readers  of 
the  Record  judge  for  themselves. 

In  his  first  paper  {Annals  of  Anatomu  and  Siir(/eiy, 
May,  1881,  p.  214)  Dr.  Shaffer  says,  speaking  of  cir- 
cumcision :  "  And  yet  this  operation  has  sometimes 
been  followed  by  temporary  relief  in  cases  other 
than  genito-urinary."  He  then  cites  a  case  of  Pott's 
disease  in  a  child,  to  which  had  come  relief  after  cir- 
cumcision. This  improvement,  he  states  to  the  pa- 
rents, "  did  not  come  at  all  from  the  oi^erafion,  but 
from  the  enforced  re.st  which  it  and  the  subsequent 
treatment  necessitated."  We  are  next  told  of  a  case 
of  incipient  Pott's  disease  improved  by  a  week's  rest 
in  bed ;  and  the  statement  is  made  that  "  inci)>ient 
and  obscure  joint  and  spinal  disease"  have  been 
seen  by  Dr.  Shaffer  to  be  improved  by  the  rest  fol- 
lowing circumcision.  In  the  great  majority  of  in- 
stances, howovei-,  he  lias  seen  no  efl'oct  from  the 
operation.  He  then  informs  us  :  ".\niong  the  many 
cases  of  this  so-called  '  reflex  paralysis'  that  I  liave 
seen,  I  have  found  none  that  did  not  prove  to  be  a 
lateral  sclerosis  of  the  cord,  with  a  gi'eatcr  or  less 
modification  of  co-ordinating  power  .  .  .  some 
movements  would  be  awkwardly  executed  ...  or 
there  would  be  a  slight  ataxic  movement  of  one  or 
both  of  the  lower  extremities  in  the  ordinary  move- 
ments." I  certainly  did  fail,  Jlr.  Editor,  to  give  due 
credit  to  this  original  description  of  a  lateral  sclero- 


THE   MEDICAL  RECORD. 


137 


sis  with  ataxia,  and  I  hasten  to  make  amends  by 
calling  the  attention  of  neurologists  to  the  interest- 
ing discovery.  Three  cases  of  lateral  sclerosis — 
without  ataxia — are  then  narrated,  in  which  circuiu- 
cision  had  no  efl'ect.  In  conclusion,  circumcision  is 
advised  in  cases  of  preputial  initation,  or  for  sani- 
tary reasons ;  and  these  words  are  used :  "  Much 
good  frequently  results,  and  many  patients  have  de- 
rived permanent  relief  from  incontinence  of  ui-ine, 
priapism,  etc." 

In  Dr.  Shaflier's  second  paper,  in  the  July  num- 
ber of  the  Anjials,  the  gentleman  states  his  belief 
that  circumcision  should  not  be  done  except  •'  for 
simple  local  and  directly  traceable  genito-urinary 
troubles  ;  and  the  paper  concludes  with  :  "  A  care- 
fid  inquiry  into  the  details  of  the  previous  history 
(of  every  case  of  so-called  reflex  paralysis)  and  a 
painstaking  study  of  the  symptoms  and  condition 
develop  a  cause  for  the  '  reflex  paralysis '  wholly 
unconnected  with  the  undeveloped  genital  organs 
of  childhood."  A  case  of  Drs.  Fruitnight  and 
Taylor  is  also  spoken  of,  in  which  a  jjost-diphtheri- 
tic  paralysis  improved  after  circumcision.  Dr. 
Shafl'er  attributes  this  relief  to  the  fact  that  "  na- 
ture had  done  her  work  unaided  by  the  circumci- 
sion." 

This  is  fairly  the  gist  of  Dr.  Shalier's  two  articles. 
To  sum  up,  the  views  esjiressed  are  that  circum- 
cision causes  improvement  in  other  than  genito- 
urinary diseases,  but  that  this  improvement  is  due 
to  the  rest  following  the  operation ;  that  lateral 
sclerosis  with  ataxia  is  the  most  frequent  cause  of 
"  reflex  paralysis  ;  "  that  incontinence  of  urine  and 
131'iapism  are  frequently  relieved  by  circumcision  ; 
that  circumcision  should  be  performed  to  remove 
pneputial  irritation,  but  only  for  local  and  distinctly 
traceable  genito-urinaiy  troubles ;  that  most  cases 
of  so-called  reflex  paralysis  have  a  cause  outside  of 
the  genitals — in  the  aforesaid  sclerosis,  as  follows 
logically. 

The  views  of  Dr.  Shaffer,  concerning  the  value  of 
rest,  have  certainly  not  been  borrowed  b}'  me,  for  I 
state:  "The  patient  usually  obtains  rest,  as  has 
been  suggested  by  Dr.  Shaffer,  but  this  is  usually 
short  in  my  own  cases,  not  extending  over  twenty- 
four  or  forty-eight  hours,  and  is,  therefore,  obviously 
inadequate."  Can  Dr.  Shaffer  point  out  any  para- 
graph of  my  article  in  which  I  have  expressed  a 
belief  that  most  cases  of  reflex  paralysis  are  due  to 
lateral  sclerosis  with  ataxia  ?  I  can  scarcely  believe 
that  he  means  to  lay  claim  to  having  originated  the 
idea  that  circumcision  often  relieved  urinary  incon- 
tinence and  priapism  ;  for  Mr.  Thomas  Bryant,  of 
London,  wrote  upon  this  matter  about  the  time  when 
Dr.  Shaffer  was  graduating,  and  Drs.  Sayre  and  Otis 
have  generally  been  regarded  as  the  American  pio- 
neers in  this  branch  of  surgery.  Dr.  Shaffer  ad- 
vises circumcision  for  the  removal  of  prseputial  irri- 
tation, but  qualities  it  by  the  caution  that  it  be  done 
only  for  local  and  directly  traceable  genito-urinary 
troubles.  My  conclusions  are  ;  '■  that  operations 
for  the  removal  of  genital  irritation  may  be  beneficial 
even  in  organic  nervous  disease :  that  we  shouM. 
therefore,  remove  such  genital  irritation  if  it  exist 
in  any  case  whatsoever,  and  thus  give  our  patients 
the  benefit  of  the  doubt ;  that  operations  upon  the 
genitals,  even  when  there  be  no  genital  imtation. 
may  prove  to  be  an  useful  therapeutic  measure." 
Is  there  any  loan  of  ideas  here  from  Dr.  Newton  M. 
Shaffer?  The  gentleman  does  state  that  causes  for 
reflex  paralysis  may  be  found  usually  in  other  organs 
than  the  genitals,  but  he  has  distinctly  stated  that 


this  canse  is  always  a  lateral  sclerosis  with  ataxia. 
In  my  article  1  reach  the  conclusion,  too,  that  reflex 
paralysis,  so  called,  has  its  cause  aloof  from  the 
genitals,  but  I  have  nowhere  mentioned  the  jieculiar 
sclerotic  theory  ;  I  have  cited  various  organic  dis- 
eases which  have  produced  a  seeming  reflex  paraly- 
sis ;  and  my  postulate  is  based  not  upon  loose  gen- 
eral statements  and  a  case  or  two  of  a  new  disease, 
but  upon  a  long  review  of  the  literatiue  of  the  sub- 
ject from  the  first  paper  of  M.  Stanley,  in  1833,  upon 
an  analy.sis  of  all  the  cases  of  Dr.  Sayre  and  Dr. 
Barwell,  and  upon  statements  made  to  me  by  letter 
or  in  person  by  such  gentlemen  as  Drs.  Weir  Mit- 
chell, Da  Costa,  Jacobi,  Jewell,  Edes,  Miles,  Webber, 
Spitzka,  Seguin,  Kinnicutt,  McBride,  Hammond, 
Newton  M.  Shaffer. 

For  these  reasons  I  fail  to  perceive  that  Dr.  Shaf- 
fer had  "covered "my  most  important  conclusions 
and  many  of  my  points. 

But  none  of  us  will  fail  to  sympathize  with  Dr. 
Shafl'er  in  his  lament  that  other  gentlemen  should 
have  had  the  same  doubt  that  he  possessed  about 
the  genital  origin  of  reflex  paralysis  ;  and  the  only 
consolation  which  can  be  offered  to  the  gentleman 
is  that  this  doubt  was  beginning  to  spread  in  the 
profession,  and  was  lurking  in  the  minds  of  hun- 
dreds. It  was  mainly  from  the  desire  of  substan- 
tiating it  with  proof  that  I  took  up  my  pen. 

To  the  judgment  of  tho.se  members  of  the  pro- 
fession who  will  do  me  the  honor  of  reading  my 
paper,  I  think  I  may  safely  leave  the  settlement  of 
the  question  as  to  whether  I  have  boiTOwed  from 
Dr.  Shaffer  in  any  other  particidars. 

One  thing  more,  Mr.  Editor,  and  I  am  done.  I 
presume  that  Dr.  Shatter  must  have  read  the  whole 
of  my  article,  else  he  cculd  not  know  which  were 
my  "most  important  conclusions;"  and  yet  but 
half  of  it  has  been  published,  the  other  half  remain- 
ing for  the  February  number  of  the  Annals. 
Yours  very  truly, 

LaXDON  C.U5TEK  Gk.\Y,  M.D. 
Bbookltn. 


ARMY  NEWS. 


Official  List  of  Changes  of  Stations  and  Duties  of  Offi- 
cers of  the  Medical  Department,  United  States  Army, 
from,  January  22,  1882,  to  January  28,  1882. 

Sternbeeg,  Geo.  M.,  Major  and  Surgeon.  Granted 
leave  of  absence  for  one  month,  and  during  his  ab- 
sence Surgeon  J.  C.  Bailey  to  attend  the  sick  at 
Point  San  Jose,  Cal.,  S.  0.  9,  Middle  Division  of  the 
Pacific  and  Department  of  California,  January  16, 
1882. 

CoMEGYs,  E.  T.,  Captain  and  Asst.  Surgeon,  now 
stationed  at  Columbus  Barracks,  Ohio,  to  report  in 
person  to  the  President  of  the  Medical  Examining 
Board,  in  session  in  New  York  City,  for  examination 
for  promotion,  and  upon  completion  of  examination 
to  return  to  proi^er  station,  S.  O.  19,  A.  G.  O.,  Jan- 
uary 25,  1882. 

Banister,  .1.  M.,  First  Lieutenant  and  Asst.  Sur- 
geon, Fort  Reno,  Ind.  T.  Granted  leave  of  absence 
for  one  month,  S.  0. 18,  Department  of  the  Missouri, 
January  24,  1882. 

!Maddox,  Thomas  J.  C,  First  Lieutenant  and  Asst. 
Surgeon.  Having  reported  at  these  heail-qtiai-ters 
incompliance  with  S.  O.  2,  C.  S.,  A.  G.  O.,  will  rej^ort 
to  the  commanding  officer  Fort  Clark,  Texas,  for 
dutv,  S.  O.  6,  Department  of  Texas,  January  16, 
1882.  '  y       ' 


138 


THE  MEDICAL  RECORD. 


iHrtiral  3tcms   aiiti  nct»0. 


Contagious  Diseases  —  Weekly  Statement.  — 
CJoruparative  statement  of  cases  of  contagious  diseases 
reported  to  the  Sanitaiy  Bureau,  Healtli  Deijartment, 
for  the  two  weeks  ending  January  28,  1882. 


1 

ii 

1, 

'? 

Week  BndiBg 

ft* 

S 

& 

if 

Is 

1 

1 

i 

1 

H 

17 

303 

8 

S 
210 

a 
137 

m 
40 

Jan.  21,  1882. 

0 

0 

Jan.  28,  1882. 

0 

10 

278 

3 

202 

128 

31 

0 

The  American  Medical  Bi-Weekxy  has  been 
changed  to  a  weekly.  It  presents  an  excellent  ap- 
pearance. 

The  Sixty-second  Annuai,  Meetincj  op  the  White 
Mountain  Medic.^x  Society  was  held  at  Wells 
River,  Yt.,  January  4  and  5,  a  large  number  of  mem- 
bars  being  present.  The  New  Hampshire  State 
Medical  Society  will  print  the  most  important  of  the 
jjapers  read. 

The  officers  elected  for  the  ensuing  year  were  : 
President,  Dr.  O.  L.  Watson,  of  West*  Topsham, 
Vt.;  Vice-President,  Dr.  E.  Mitchell,  Jr. ;  Secretary, 
Dr.  C.  K.  Gibson,  of  Woodville,  N.  H.  ;  and  three 
directors  and  six  censors. 

School  Hygiene  and  Boards  of  Health. — Our 
correspondent,  Dr.  Tuckerman,  suggests  that  the 
National  Board  of  Health,  as  well  as  State  Boards 
co-operate  with  the  Commissioner  of  Education  to 
secure  a  general  improvement  in  school  hygiene. 

Sib  Robert  Christison,  Bart,  M.D.,  the  eminent 
chemist  and  medical  jurist,  died  recently  at  the  age 
of  eighty-three.  His  "  Treatise  on  Poisons  "  was  for 
a  long  time  a  standard  work. 

Consulting  Boards  to  Lunatic  Hospitals. — The 
following  petition  is  before  the  Massachusetts  Leg- 
islature : 

"  That  a  board  of  visiting  or  consulting  physicians 
attached  to  each  lunatic  hospital,  such  as  was  pro- 
vided by  a  bill  before  the  last  legislature,  would  not 
only  give  the  patients  the  benefit  of  additional  pro- 
fessional services,  but  also  tend  to  increase  the 
knowledge  of  diseases  of  the  brain  among  prac- 
titioners. 

"  Your  i^etitioners,  therefore,  solicit  the  passage  of 
such  laws  as  they  have  above  recommended,  and 
such  others  as  are  needed  for  the  protection  of  the 
rights  of  persons  really  insane,  and  of  all  charged 
with  being  so." 

A  Bean  the  Nucleus  op  a  Calculus. — In  the 
Rivhla  lie  Medlcinn  y  Civugia  Prnrticax  Dr.  Bide 
publishes  the  curious  case  of  an  individual  twenty 
years  of  age,  who  had  introduced  a  beau  into  his 
urethra,  from  whence  the  object  ])assed  into  the 
bladder,  becoming  the  nucleus  of  a  cah'ulus,  which 
was  subsequently  removed  by  lithotrity. 

Styptic  Action  op  Cat's  Hairs. — In  a  case  of  re- 
bellious epistaxis  occurring  in  an  anioniic  girl,  Dr. 
Devtereos  was  about  to  i)lug  the  nares,  when  the 
s\iggestion  was  made  to  introduce  a  few  cat's  hairs. 
This  being  done,  tlie  hemorrhage  instantly  ceased. 
Dr.  Devtereos  has  had  recourse  to  this  method  in 
other  cases,  with  good  results.  (!) 


Venereal  Atfections  in  Guatemala. — Accoi-ding 
to  the  Diario  de  Centro- America,  an  official  examina- 
tion of  the  public  women  of  Guatemala  proved  that 
over  ninety-live  per  cent,  of  these  unfortunates  were 
in  bad  health. 

Sulphide  of  Calcium  in  Strumous  Ophthalmia 
is  highly  recommended  by  Mr.  Simon  Snell  in  The 
Priiclilioner.  It  is  given  in  doses  of  one-tenth  of  a 
grain  to  one-fourth  of  a  grain,  three  times  a  day,  the 
usual  applications  of  atropine,  poppy  fomentations, 
etc.,  being  employed  at  the  same  time. 

A  Bill  to  Regulate  Pharju^cy  is  before  the 
Kentucky  Legislature.  It  is  said  argumentatively 
that  the  Kentucky  doctors  ought  to  be  regulated 
first. 

The  Church  and  Scientific  Progress. — Rev. 
Richard  Hill,  of  Stockwell,  England,  recently  de- 
livered a  sermon  justifying  vivisection. 

Lister's  Treatment  of  Fractured  PxTELLiE. — 
Mr.  Lister  and  his  colleagues  have  been  for  some 
time  treating  transverse  fractures  of  the  patella  by 
cutting  down  upon  the  bone  and  passing  silver  wires 
through  holes  bored  into  the  separate  fragments, 
the  ends  of  the  wires  being  then  twisted  together  so 
as  to  hold  the  fractured  surfaces  in  close  apposition. 
It  was  claimed  that  the  operation  was  (under  the 
spray,  of  course)  without  danger,  and  secured  the 
firmest  possible  union.  I  say  vas  claimed  ;  for,  since 
in  one  instance  the  knee-joint  suppurated,  we  have 
heai'd  less  of  the  immunity  of  the  operation. — Corr. 
Chicago  Med.  Journ.  and  Ex. 

The  Bacterial  Hallucination  sometimes  pre- 
sents amusing  phases.  Not  long  ago  a  rigid  disciple 
of  Lister  made  an  amputation  at  the  hiij.  The  dress- 
ing was  applied  over  the  same  regions  as  the  gauze 
of  a  ballet-dancer.  Whenever  the  patient  desired 
to  evacuate  his  bladder  (fortunately  it  was  a  '  he ') 
the  house-surgeon  or  dresser  was  summoned  ;  the 
spray  was  du-ected  so  as  to  shower  the  patient's  tor- 
rid zone  ;  the  dressing  was  carefully  loosened,  the 
necessary  organ  was  fished  up  out  of  the  depths  and 
directed  over  a  vessel,  and  then  the  gentle  gurgle  of 
the  escaj^ing  renal  seci'etion  mingled  sweetly  with 
the  murmured  admiration  of  the  bystanders,  the 
fizz  of  the  faithful  spray,  and  (presumably)  the 
teeth-gnashing  of  IwlHed  bacteria.  Needless  to  say 
that  the  patient  died. — Dr.  W.  T.  Belfield,  ihid. 

Vaccinia  Following  Small-Pox. — Dr.  B.  G.  Bris- 
tol, of  Webster  Grove,  INIo.,  writes  that  he  had  small- 
pox in  1817,  since  which  time  he  had  seen  and  treat- 
ed many  cases  of  that  disease.  As  an  experiment,  a 
short  time  ago  he  was  vaccinated  with  virus  from 
Dr.  Higgins's  vaccine  farm  at  Manchester,  Mo.,  and 
two  weeks  later  he  had  two  perfect  vaccine-pocks  on 
his  arm,  each  five-eighths  of  an  inch  in  diameter. 

Re.section  op  the  Precordial  Region. — In  a  let- 
ter to  the  editor  of  the  KaccngliUire  Medico,  Dr.  Fe- 
derico  details  a  case  of  precordial  resection.  Tlio 
patient  was  a  countryman,  aged  twenty-five.  The 
soft  parts  of  the  precordial  region,  traversed  by  va- 
rious fistulous  canals,  were  removed  ;  the  left  half  of 
the  sternum  below  the  manubrium,  and  the  anterior 
extremity  of  the  third,  fourth,  and  fifth  ribs,  with 
their  corresponding  cartilages,  were  resected.  Great 
care  was  necessary  to  avoid  wounding  the  pleura 
and  entering  into  its  cavity.  The  resection  com- 
pleted, the  heart,  covered  by  the  memliranes,  was 
exposed  to  view.  Tho  wound  measured  thirteen 
and  one-half  centimetres  in  its  vertical  and  sixteen 
in  its  transverse  diameter.     A  compress  moistened 


THE  MEDICAL  RECORD. 


139 


with  carbolic  acid  solution  was  laid  upon  the  pleura, 
the  resected  surfaces  were  touched  with  the  thermo- 
cautery. The  operation  occuijied  two  hours  and  a 
half;  chloroform  was  used  as  an  aniesthetic,  and  a 
modified  Lister  method  employed.  For  the  first 
few  days  the  j^atient  sutiered  from  pleurisy  on  the 
left  side.  When  granulations  had  filled  in  a  good 
part  of  the  space  skin-grafting  was  resorted  to,  using 
the  integument  of  the  right  side  of  the  thorax.  The 
patient's  further  progress  was  exceedingly  satisfac- 
tory. 

Phthisis  and  TimEEcrLosis  in  Italy. — Statistical 
data  presented  by  Prof.  Sormani  demonstrates  that 
phthisis  and  tuberculosis  are  relatively  less  frequent 
in  Italy  than  in  France,  Belgium,  Austria,  Hungary, 
and  Germany,  but  more  so  than  in  England,  Switz- 
erland, and  Spain.  In  Italy  phthisis  and  tubercu- 
losis are  more  frequent  in  the  northern  than  in  the 
southern  cities.  The  percentage  of  mortality  for 
these  diseases  in  Belgium,  England,  and  Italy  shows 
a  tendency  to  diminish. 

Tayoya  as  an  AntisyphhiItic. — The  tayuya  (Der- 
mophilla  pendentica)  is  a  native  of  Brazil,  and  is 
employed  by  the  indigenous  inhabitants  of  that 
country  as  a  remedy  in  syphilis.  It  was  introduced 
into  Europe  by  an  Italian  naturalist,  Ubicini.  The 
root  is  the  most  active  part  of  the  plant.  In  Italy 
two  tinctures  are  made  from  it :  a  strong  one,  known 
as  the  mother  tincture,  employed  in  hypodermic  in- 
jections, in  daily  doses  of  a  gramme  ;  the  other  a 
weaker  tincture,  consisting  of  a  dilution  of  the  for- 
mer with  three  parts  of  alcohol,  is  prescribed  inter- 
nally, in  daily  doses  of  from  six  to  sixty  drops. 
Analysis  has  demonstrated  the  presence  of  the  oxa- 
lates of  calcium,  magnesium,  and  of  iron,  a  resin, 
and  an  uncrystallizable  substance  supi^osed  to  be  an 
alkaloid.  The  physiological  effects  of  tayuya  in 
small  doses  resemble  those  of  aloes  ;  in  large  doses 
it  produces  diarrhrea,  diaphoresis,  and  salivation. 
Clinical  experiments  have  revealed  in  this  substance 
an  antisyphilitic  remedy  of  great  value  and  complete 
innocuousness. — Gaz.  des  Hop.  and  Gazz.  med.  de 
DahUi. 

Sulphate  of  Cadiiium  in  Corneal  Opacities. — 
Dr.  Miguel,  of  the  Belgian  army,  uses  the  following 
solution  ;  Cadmii  sulj^hatis,  .05  (gr.  J),  mucil.  aca- 
ciie,  10  gram.  (  ;  ijss.).  With  this  solution  the  spot  is 
to  be  touched  several  times  in  twenty-four  hours. — 
Paris  Medical 

MiLK-SiCKXESs. — A  comprehensive  article  upon 
this,  to  most  physicians,  rare  disease,  is  published 
by  Dr.  Joseph  Spaulding,  of  Lafayette,  Ind.,  in  the 
Western  Medicul  Reporter.  The  disease  has  been 
cilled  "trembles,"  "  tires,"  "  slows,"  "  puking  fever," 
etc.  It  seems  to  be  peculiar  to  the  great  central 
valleys  of  the  Ohio  and  Mississij^pi  Rivers.  It  may, 
however,  be  transmitted  to  persons  living  at  quite 
long  distances  from  its  place  of  origin,  by  the  butter, 
milk,  and  beef  of  affected  animals. 

In  Dr.  Spaulding's  opinion  the  cause  was  a  plant 
containing  a  fermentive  poison.  This  jjlant  is  dis- 
tasteful to  animals,  and  only  eaten  when  there  is  a 
scarcity  of  vegetable  food.  A  friend  described  it  as 
a  low  vine  nmning  underground,  and  occasionally 
sending  up'a  stem  with  leaves. 

Si/mjjtoms. — Mild  cases  :  they  are  languid,  nau- 
seated, slow  pulse,  dry,  red  tongue,  cannot  eat. 
Medium  severe  cases :  nauseated,  bad  breath,  dim- 
ness of  vision,  muscular  soreness,  a  general  lassi- 
tude, perhaps  muscular  trembling,  an  entire  distaste 
for  food,  no  fever,  pulse  slow,  surface  cool,  and  feels 


to  the  touch  waxy.  Severe  cases  :  constant  retch- 
ing to  vomit,  very  little  thrown  up ;  odor  of  breath 
and  excretions  exceedingly  disagreeable  ;  you  can 
hardly  stay  near  them  or  even  in  the  room  ;  the 
stench  is  so  pungent,  oflensive,  you  will  want  a  draft 
of  fresh  air  in  order  to  sit  by  them  a  sufficient  time 
to  make  your  examination  ;  the  bowels  are  very  cos- 
tive, so  much  so  that  you  will  let  your  iiatient  die  if 
you  fail  in  your  diagnosis  ;  jralse  weak,  surface  cold 
and  dry,  eyes  sunken,  the  salivary  glands  cease  to 
act,  the  mouth  is  dry  and  red  ;  the  fauces  are  also 
dry  ;  the  passage  of  the  air  in  resiurafion  sounds  as 
if  forced  through  diy  parchment ;  the  gastric  mucus 
becomes  less  and  less,  and  shortly  none  is  secreted. 
The  liver  at  first  secretes  bile,  but  later  no  bile  is 
secreted,  and  to  ajopearance  glandular  action  is  en- 
tirely suspended,  even  the  bronchial  mucus. 

A  veiy  noticeable  feature  is  the  peculiar  and  offen- 
sive odor.  The  treatment  recommended  is  to  stimu- 
late early  and  late,  and  to  give  cathartics  early  and 
late.  Antiseptics  are  to  be  given,  if  possible' — such 
as  creasote.  Whiskey  is  given  in  very  large  amounts, 
from  a  pint  to  a  quart  a  day.  It  acts  here  almost 
as  in  cases  of  snake-poisoning. 

The  "  Lady  FE^•EK." — Dr.  J.  B.  Garrison,  of  Men- 
tor, Ark.,  writes  as  follows  (Tf'eslem  Medical  Repor- 
ter) concerning  certain  urethral  troubles  in  the 
West :  "  The  title  '  lady  fever'  is  the  local  .synonym 
for  a  most  virulent  form  of  gonorrhoea  among  the 
colored  residents  of  this  section,  and  which,  fortu- 
nately, is  comparatively  rare  when  the  almost  uni- 
versal promiscuous  intercourse  of  the  sexes  is  taken 
into  consideration.  A  mild  form  of  clap  prevails 
among  the  negroes  quite  extensively,  which  is  gen- 
erally unnoticed  by  the  female,  or  considered  ordi- 
nary 'whites,'  and  which  the  masculine  element 
denominates  'runnin'  range'  (running  reins).  Ac- 
cording to  my  own  observation,  as  well  as  that  of 
my  medical  confreres,  the  colm-ed  clergy  are  peculi- 
arly susceptible  to  its  influence.  But,  be  he  lay 
or  clerical,  /(/.■-"  version  of  the  cause  is  invariably 
the  same  :  he  '  hurt  his  back  strainin" — liftin'  at  a 
heavy  log.'  In  a  majority  of  instances  they  aie 
sincere  as  to  their  belief  in  its  traumatic  origin,  sinf  e 
it  is  irreferable  to  a  source  of  infection.  This 
variety  yields  readily  and  rapidly  to  internal  reme- 
dies ;  copaiba  and  ol.  terebinth.,  in  moderate  doses 
for  a  few  days,  with  enforced  continence  for  a  couple 
of  weeks,  being  all  that  is  usually  requisite  for  a 
cure.  But  woe  to  the  individual  on  whom  the  cruel 
hand  of  '  lady  fever '  falls  !  The  initial  lesion  in  the 
community  is  readily  traced  to  some  flammifercus 
wayfarer  from  the  city.  In  the  male  all  the  more 
formidable  characteristics  oigonorrhua  rirulenta  pre- 
sent themselves,  with,  in  many  cases,  balano-jios- 
thitis,  orchitis,  epididymitis,  with  frequent,  painful, 
clonic  spasms  of  the  neck  of  the  bladder  ;  and  I  Lave 
seen  the  urethral  discharge  so  acrid  as  to  excoriate 
the  contiguous  integument. 

SKnniED  Milk  Proclaimed  Un^vholesome.  —  A 
milk-dealer  named  Gray,  of  this  city,  was  recently 
indicted  by  the  Board  of  Health  for  selling  skim- 
milk  at  three  cents  a  quart.  The  Board  of  Health 
based  the  prosecution  of  Gray  on  the  ground  that 
skimmed  milk  was  not  a  wholesome  article  of  human 
food,  and  that  its  sale  was  a  violation  of  law.  The 
defence,  on  the  other  hand,  contended  that  such 
milk,  unmixed  with  water  or  any  other  substance, 
was  a  wholesome  article  of  food,  and  consequently 
did  not  come  under  the  head  of  "adulteration." 
i  The  ordinance  prohibiting  its  sale  they  held  to  be 


140 


THE  MEDICAL  RECORD. 


unconstitutional.  In  support  of  their  argument  the 
defence  examined  a  number  of  experts,  who  testified 
that  milk  from  which  the  cream  had  been  removed, 
unadulterated  bv  any  other  substance,  was  not  un- 
wholesome. The  jury  brought  in  a  verdict  to  the 
effect  that  in  their  opinion  tliat  skimmed  milk  as  an 
article  of  human  food  was  impure,  injurious,  and  un- 
wholesome. This  is  certainly  a  very  extraordinary 
view. 

The  Treatment  op  Sea-Sickness. — Dr.  Milan 
Soule,  surgeon  on  the  steamship  City  of  Sidney, 
has  written  an  account  of  his  experience  with  the 
bromide  treatment  for  sea-sickness,  as  laid  down  by 
Dr.  G.  M.  Beard.  His  testimony  to  its  efficacy  is 
very  emphatic  and  convincing.     He  says  : 

"About  three  years  ago  I  began  to  use  the  bro- 
mides in  treating  sea-sickness,  following,  as  nearly 
as  possible,  the  direction  given  in  Dr.  Beards  vaht- 
/  able  monograph  on  that  subject.  I  had  then  been 
in  the  service  of  the  Pacific  Mail  Steamship  Com- 
pany nearly  four  years,  and  as  my  field  for  experi- 
ment was  large,  I  had  tried  nearly  every  drug  or 
combination  of  drugs  that  had  ever  been  proposed 
for  the  cui'e  or  alleviation  of  this  disagreeable 
malady.  Repeated  failures  and  humiliating  disap- 
pointments had  so  shaken  my  faith  in  the  power  of 
drugs  over  this  disease,  that  I  began  to  use  the  bro- 
mides with  a  good  deal  of  doubt  and  hesitation. 
Greatly  to  my  surprise  and  gi-atification,  however, 
I  found  that  I  was  able  to  entirely  prevent  or  greatly 
to  alleviate  the  disease,  and  have  not  one  single 
failure  to  record.  The  following  is  the  combination 
I  most  frequently  employed,  viz. : 

B .     Sodii  bromidi 3  iv. 

Ammonii  bromidi 3  ij. 

Aqu;e  menthfe  piperita? S  iij. 

M.  S. — A  teaspoonful  before  meals  and  at  l>ed- 
time  ;  begin  treatment  three  days  before  going  on 
board. 

"When  preparatory  treatment  had  been  neg- 
lected and  the  disease  fully  established,  I  put  a  tea- 
spoonful  of  the  above  in  a  half  tumbler  of  water, 
add  a  drop  of  ext.  ipecac,  fluid.,  and  give  a  tea- 
spoonful  every  five  minutes  ;  it  generally  relieves 
the  patient  in  less  than  an  hour.  I  have  received 
several  letters  (guinea  enclosed)  from  passengers 
aslcing  me  to  send  them  the  above  formula.  Next 
to  the  bromides,  I  have  found  hyoscyamia  the  mcst 
successful  remedy.  Atrojiia  will  frequently  afford 
relief,  but  is  not  altogether  safe,  as  I  have  noticed  a 
few  cases  of  retention  of  urine  to  follow  its  use.  I 
give  nitrite  of  amyl  a  fair  trial,  but  it  proved  a  com- 
plete failure.  I  have  notes  of  several  cases  where  the 
bromides  entirely  prevented  sea-sickness  during  \oy- 
agas  of  from  twenty  to  thirty  days,  although  these 
patients  were  always  sick  on  previous  voyages." 

A  CuRiou.s  Misu.se  of  Terms. — A  corresjjondent 
from  Appleton,  Wis.,  sends  us  the  following  amusing 
and  suggestive  note :  "  The  vast  amount  of  medical 
knowledge  unexpectedly  displayed  by  the  non-pro- 
fessional press  during  the  illness  of  the  late  Presi- 
dent is  now  to  a  groat  extent  a  matter  of  record.  As 
evidence  of  the  singular  accuracy  of  much  of  this 
knowledge,  I  offer  the  following  statements,  all  of 
which  were  taken  from  the  columns  of  leading  daily 
papers  of  several  large  cities:  'Hyparentliesis'  was 
feared,  as  also  was  'hyi)odralic  congestion.'  Amoiig 
tlie  glands  affected  during  the  course  of  the  case 
were  tlio  '  salwary  conglomerated,'  the  '  sympath- 
etic,' the  '  partoid,'  '  parotidid,'  '  paratodit,'  one  of 


which,  it  was  feared,  would  '  sulphurate,'  while  in 
the  case  of  another,  '  siipperation  '  was  the  expected 
catastrophe.  There  were  also  '  metastalic  abscesses,' 
and  others  which  were  '  metallastic '  in  character, 
and  the  '  plexus  cosiacus '  played  an  important  jiart, 
which  was  also  true  of  '  septicemid  '  and  '  septi- 
cemsemia,'  'sceptic  matter'  was  treated  by  the  use 
of  '  permanganesed  i)otash  '  and  '  permanganose  pot- 
ash,' while  the  vital  powers  were  sustained  by  the 
use  of  '  reptonized  enemetics,'  and  '  liquor  nourish- 
ment.' Finally,  Dr.  Bliss  gave  a  reporter  his  personal 
assurance  that  '  President  Garfield  had  not  been  un- 
der the  influence  of  optics  for  more  than  a  week.'" 

Bread  Pkepaked  with  Sea-Water.  — Dr.  Sena  has 
faithfully  studied  the  internal  administration  of  sea- 
water,  and  asserts  its  efficacy  in  scrofula  and  otlier 
conditions  of  malnutrition,  and  its  utility  as  a  pre- 
servative in  many  other  maladies  difficult  to  combat. 
In  order  to  avoid  the  objections  to  administering 
sea-water  as  such,  it  is  used  in  the  preparation  of 
bread.  This  bread  is  preferable  to  the  ordinary 
article,  is  less  insij^id,  and  may  be  kept  longer.  All 
the  properties  possessed  by  the  chlorides  and  iodides 
combine  to  make  it  at  once  a  hygienic  food  and  a 
therapeutical  agent.  The  statistical  data  cited  by 
the  author  show  the  results  obtained  in  the  Hospital 
de  Nuestra  Senora  de  la  Misericordia,  at  Valencia, 
one  of  the  finest  charitable  institutions  in  Spain, 
where  this  species  of  bread  has  been  adopted.  Com- 
jjaring  the  number  of  patients  cured  after  this  bread 
had  been  made  use  of,  with  the  number  cured  the 
year  before,  a  considerable  increase  is  noticed..  Dr. 
Sena  concludes  as  follows :  1.  Bread  prepared  with 
sea-water  is  exceedingly  useful  in  the  prevention  and 
cure  of  scrofula.  2.  It  jiossesses  the  same  virtues 
as  the  fluid  in  corresponding  doses.  3.  It  should  be 
used  in  all  charitable  institutions  near  the  coast. 
4.  Bakers  of  towns  so  situated  should  prepare  it  for 
use  as  a  hygienic  article  of  diet. —  Ci-on.  Med.  de  Val. 

CtTBiors  Case  op  Acute  Dermatosis. — The  patient 
was  a  demented  individual,  without  pathological 
antecedents  related  to  his  trouble.  He  was  sud- 
denly seized  with  a  general  pruritus,  which  obliged 
him  to  call  in  a  physician.  Examination  revealed  an 
eruption  composed  of  papular  circles  surrounded  by 
others  formed  by  agglomerated  and  transparent 
miliaiy  vesicles.  These  patches  were  as  large  as  a 
dollar  piece,  and  tlie  skin  between  them  was  of  a 
pronounced  cyanotic  hue.  The  eruption  involved 
the  tliorax,  neck,  and  face,  but  was  absent  altogether 
on  the  abdomen  and  lower  extremities  :  the  latter 
parts  wore  the  seat  of  pruritus  which  did  not  involve 
the  seat  of  the  eruption.  A  week  passed  without 
material  change  in  the  condition  of  the  patient,  but 
at  the  end  of  this  period  the  pruritus  of  the  extrem- 
ities ceased  entirely,  translating  itself  to  the  eruptive 
patches.  From  this  time  the  lesion  diminished  in 
intensity,  and  on  the  eleventh  day  tlie  dermatosis  and 
pruritus  had  disappeared.  The  case  was  reported 
by  Dr.  Lucio  Lopez,  of  the  Province  of  Biscay. — 
Ret;,  de  Med.  >/  Cir.  Prnct. 

Ea.st  Eiveb  Medicai.  Association. — A  reunion  of 
this  Society  was  held  at  tlie  residence  of  Dr.  James 
K.  Taylor,  234  East  T\v(-Ifth  Street,  on  Tuesday  even- 
ing the  31st  ult.  Tlie  members  of  the  Association 
and  invited  guests,  witli  their  ladies,  were  given  a 
reception  by  Mrs.  Taylor,  and,  notwithstanding  the 
inclemency  of  the  weather,  the  gathering  was  large. 
The  entertainment  was  well  appointed  in  every  re- 
spect, and  reflected  credit  upon  one  of  the  oldest 
medical  organizations  in  this  city. 


Vol.   XXI.-No.  6.1 
Feb.  11.  1888.    I 


THE  MEDICAL  KECOED. 


141 


(©rtghtnl  Cccturcs. 

NERVOUS   DEGENEEATIONS   AND   THE 
THEORY  OF  SIR  CHARLES  BELL.  ' 

By  JOHN  C.  DALTON,  M.D., 

Lecture  III. 

Mr.  President  and  Gextlejien  :  It  is  now  a  little 
over  forty  years  since  the  beginning  of  an  investiga- 
tion which  has  produced  most  important  changes  in 
the  study  of  the  nervous  system.  It  relates  to  the 
alteration  of  structure  taking  place  in  nerves  after 
they  have  been  divided  by  a  transverse  section. 

The  manner  in  which  attention  was  first  directed 
to  this  point  is  as  follows :  It  had  long  been  known 
that  when  a  nerve  was  cut  at  any  point  the  immedi- 
ate effect  was  a  suspension  of  its  functional  activity. 
If  it  were  a  motor  nerve  which  had  been  divided, 
voluntary  motion  was  abolished  in  the  parts  below  ; 
and  if  a  sensitive  nerve,  there  was  loss  of  sensibility 
in  the  region  where  it  was  distributed.  But  this 
interruption  of  the  nervous  activity  was  not  always 
permanent.  In  some  cases  the  power  of  motion  or 
sensation  would  return  in  the  affected  parts ;  and 
the  ends  of  the  nerve  were  then  found  to  be  re- 
united by  a  cicatricial  tissue,  in  which  there  were 
connecting  nerve-fibres  of  new  formation.  This  re- 
union of  a  divided  nerve,  and  the  mode  in  which  its 
structure  and  functions  were  re-established,  formed 
the  subject  of  many  laborious  investigations. 

The  observations  in  question  were  mainly  directed 
to  the  cicatrix  between  the  ends  of  the  divided  nerve. 
This  was  natui-ally  sujaposed  to  contain  the  key  of 
the  whole  secret,  and  consequently  received  most  of 
the  attention  given  to  the  subject.  But,  in  1839, 
Nasse^  extended  his  examination  to  the  nerve-fibres 
at  a  lower  level.  He  divided  the  sciatic  nerve  in 
frogs  and  rabbits,  and,  after  waiting  from  two  to 
five  months,  found  that  the  fibres  in  the  separated 
portion  of  the  nerve  had  become  altered  in  struc- 
ture. They  were  of  irregular  forui,  granular,  and 
semi-opaque ;  they  often  contained  what  seemed 
to  be  minute  fat-globules,  from  the  degeneration  of 
their  myeline ;  and  they  appeared  to  undergo,  in 
this  way,  a  gradual  atrophy.  Nasse's  observations 
were  almost  immediately  followed  by  those  of 
Gunther  and  Schon,'  which  were  to  the  same  efiect. 
They  were  made  on  the  divided  sciatic  nerve  in  rab- 
bits, from  twelve  hours  to  one  year  after  the  opera- 
tion. They  showed  that  a  nerve,  after  a  few  days' 
separation  fi-om  its  nervous  centre,  loses  its  irrita- 
bility, so  that  its  galvanization  will  no  longer  pro- 
duce contraction  in  the  muscles  below  ;  and  that 
this  loss  of  irritability  coincides  in  time  with  the 
granular  degeneration  of  its  fibres. 

All  these  researches  were  connected  with  the  ques- 
tion of  the  re-establishment  of  the  nervous  con- 
tinuity, and  they  did  not  extend  for  any  great  distance 
below"  tlie  point  of  section.  Thus  far,  whenever 
obsei'vers  use  the  term  "regeneration,"  as  apjilied 
to  divided  nerves  or  nerve-fibres,  they  mean  the 
formation  of  new  connecting  fibres  in  the  cicatricial 

'  Being  the  Second  Course  of  the  C.irtwriKht  L^otiiros  of  ehe  Alumni 
Association  of  the  College  of  Physicians  and  Surgeons.  New  York. 
La.turein   was  delivered  in  New  York,  February  7.  18Sa. 

'  Archiv  fur  Anatomie,  Physiologic  and  wissenschaftllche  Medicin. 
p.  405.     Berlin,  18S3. 

'  Ibid.,  p.  2T0.    Berlin,  ISIO. 


tissue.  It  was  supposed  that  when  this  reunion 
took  place,  the  altered  fibres  below  were  restored  to 
their  normal  condition,  the  nerve  being  enabled,  ic 
tliis  way,  to  resume  its  functions.  The  fact  of  de- 
generation was  considered  as  of  secondary  conse- 
quence, as  limited  in  extent,  and  often  of  temporary 
duration. 

But  ten  years  later  the  subject  was  taken  up 
afre.sh  by  Augustus  Waller,  and  was  treated  by  him 
in  a  manner  so  original  and  so  thorough  that  it  at 
once  assumed  a  character  of  the  first  importance. 
Waller  began  his  professional  life  in  England,  as  a 
practitioner  of  medicine  ;  but  he  had  a  strong  taste 
for  independent  research,  and,  after  being  for  a  time 
Professor  of  Physiology  in  the  medical  school  at 
Birmingham,  he  transferred  his  residence  to  the 
continent,  where  he  remained  for  most  of  his  sub- 
sequent life,  and  where  the  greater  part  of  his  scien- 
tific work  was  accomplished.  For  the  anatomical 
study  of  musciilar  and  nervous  fibres  he  empkyed 
the  tongue  of  the  living  frog.  This  gave  him  a  great 
advantage  ;  since  the  exten.sibility  and  transparency 
of  the  organ  enabled  him  to  examine  its  internal 
23arts  in  their  normal  place  and  condition,  undis- 
turbed by  the  contact  of  artificial  reagents.  He 
applied  this  method  to  the  observation  of  nerve- 
fibres,  and  the  change  which  they  undergo  after 
division  ;  and  thus  followed  their  granular  degen- 
eration in  the  living  animal  from  day  to  day,  under 
the  microscope. 

One  of  his  earliest  and  most  important  results 
was,  that  the  degeneration  in- the  fiWes  of  a  divided 
nerve  below  the  point  of  section,  extends  through 
its  whole  length,  reuching  to  its  ultimate  ramifica- 
tions. After  division  of  the  glosso-pharyngeal  neive 
in  the  upper  jiart  of  the  neck,  he  saw  its  degener- 
ated fibres  in  the  tongue,  and  even  in  the  papilla  of 
the  mucous  membrane.  He  also  established  the 
fact,  that  in  a  nerve  once  divided,  the  degeneration 
of  the  aftected  fibres  is  final ;  and  that  when  the 
nervous  functions  are  restored,  it  is  by  a  process  of 
regeneration,  that  is,  the  growth  of  new  fibres 
throughout  the  separated  portion  of  the  nerve. 

But  the  principal  merit  in  Waller's  discovery  was 
something  additional.  He  did  not  rest  content  with 
its  value  as  an  acquisition  ;  he  made  it  serve  as  an 
instrument.  He  saw  in  the  degeneration  of  divided 
nerve-fibres  a  means  of  investigation,  which  he  at 
once  put  to  further  use.  A  nerve  is  often  made  up 
of  fibres  from  different  sources.  It  receives  branches 
of  communication  from  other  nerves ;  and  in  the 
inosculating  filaments  between  two  different  tiunks 
there  maybe  fibres  going  or  coming  in  either  direc- 
tion. In  the  nervous  trunks  and  branches  these 
fibres  are  for  the  mo.st  part  hopelessly  intermingled, 
and  it  is  impossible  to  follow  them  for  any  distance 
by  ordinary  dissection.  But  by  dividing,  in  the 
liWng  animal,  a  nervous  trunk  or  branch  near  its 
origin,  Waller  could  afterward  trace  its  degenerated 
fibres,  however  erratic  their  course,  or  whatever 
their  distribution.  He  communicated  his  results  to 
the  French  Academy  of  Sciences^  under  the  title: 
"  A  New  Method  for  the  Study  of  the  Nervous  Sys- 
tem, Adapted  for  Investigating  the  Anatomical  Dis- 
tribution of  the  Nerves." 

The  first  aj^plication  of  the  new  method  was  in 
the  frog's  tongue.  This  organ  is  supplied  by  two 
nerves,  corresponding  respectively  to  the  glosso- 
pharyngeal and  the  hypoglossal.  After  dividing  one 
of  these  nerves,  and  allowing  time  for  its  subsequent 

:  des  Sciences,  tome  xxxiii.,  p.  606. 


142 


THE  MEDICAL  RECORD. 


degeneration,  Waller  could  determine  the  course 
and  destination  of  all  its  fibres.  He  followed  them 
throughout  the  frequent  anastomoses  of  the  two 
nerves,  where  the  altered  fibres  could  always  he  dis- 
tinguished from  the  normal  ones  around  them ;  and 
the  two  kinds  were  so  different  in  appearance  that, 
as  he  expressed  it,  "  there  could  be  no  doubt  what- 
ever as  to  the  origin  of  either." 

These  results  were  obtained  by  repeated  and  ac- 
curate experimental  investigation,  and  they  have 
been  fully  corroborated  by  subsequent  observers 
down  to  Vulpian  ■■  in  18G6  and  Eanvier "  in  1878. 
According  to  Vulpian,  six  weeks  after  the  division 
of  the  sciatic  nerve  in  a  dog,  no  unaltered  nerve- 
fibres  could  be  found  in  the  muscles  of  the  corre- 
sponding toot ;  and  in  similar  experiments  by  Ran- 
vier  on  the  rabbit,  the  terminal  ramifications  of  the 
nerve  in  the  muscles  of  the  leg  contained  only  nerve- 
fibres  with  disorganized  and  granular  myeline. 

The  advantages  in  Waller's  mode  of  procedure 
were  so  obvious,  and  so  readily  verified,  that  it  was 
soon  generally  adopted,  and  received  the  name  of  the 
"  Wallerian  iinethod."  It  at  once  yielded,  in  the 
hands  of  its  author,  much  interesting  information. 
After  division  of  the  pneumogastric  nerve  on  one 
side,  in  cats,  at  the  level  of  the  larynx,  granular 
degeneration  was  found  throughout  its  peripheral 
fibres,  except  in  those  joining  it  below  from  the  in- 
ferior cervical  ganglion  of  the  sympathetic,  which 
remained  normal.  Above  this  junction  the  nerve 
was  wholly  disorganized  ;  below,  it  contained  a  mix- 
ture of  fibres,  degenerated  and  normal.  It  was  thus 
made  evident  that  the  inosculating  branches  be- 
tween the  two  nerves  are  given  by  the  sympatlietic 
to  the  pneumogastric,  and  not  by  the  pneumogas- 
tric to  the  .sympathetic. 

Physiologists  had  often  been  at  variance  as  to 
the  origin  and  character  of  the  chorda  tympani — that 
remai'kable  filament  of  communication  between  the 
facial  and  lingual  nerves.  Was  it  a  branch  of  tlie 
facial  nerve  going  to  the  lingual ;  or  was  it  an  off- 
shoot from  the  lingual  returning  to  join  the  facial  ? 
This  point  was  determined  by  the  method  of  section. 
Waller  introduced  his  stilet  into  the  middle  ear, 
and  divided  the  filament  where  it  crosses  the  mem- 
brana  tympani.  Fifteen  or  twenty  days  afterward, 
nearly  all  its  fibres  were  degenerated  between  the 
point  of  section  and  the  lingual  nerve ;  that  is,  in 
the  direction  of  tlieir  peripheral  distribution.  The 
chorda  tympani  was  consequently  shown  to  be  a 
branch  of  communication//-o)«  the  facial  nerve  lo  the 
lingual. 

In  this  way  many  doubtful  questions  of  nervous 
distribution  received  their  solution.  The  granular 
degeneration  of  tlie  divided  nerve-fibres  became  an 
artificial  aid  to  the  anatomist,  of  the  same  value  as 
the  injection  of  minute  blood-vessels  with  an  opaque 
pigment.  Even  a  single  disorganized  fibre  could  be 
distinguished  among  a  crowd  of  normal  ones  ;  and 
in  a  mixture  of  the  two,  the  niimerical  proportion 
of  each  could  be  fairly  determined. 

But  Waller  did  not  remain  satisfied  with  this  suc- 
cess. He  determined  to  apply  the  same  method  to 
the  study  of  the  nerve-roots  ; '  and  in  doing  so  he 
opened  a  new  chapter  of  nervous  physiology,  and 
greatly  enlarged  the  field  of  liis  operations. 


^  Lecjons  s 

Pnris.  1878. 

'  HH  second  communicttbion  to  the  French  Acndcmy,  in  18.52.  was 
cntitle-l,  Experiinontftt  Uescarchoft  on  tho  Structure  nnd  Functions  of 
the  Ganglia.  ComptC)*  RonJua  do  rAcad6mio  dcu  Sciences,  tonio 
xxxiv.,  p.  B?4.     Paris,  186S. 


The  history  of  these  experiments  is  so  well  known 
that  they  only  need  to  be  stated  in  a  few  words. 
Waller  had  already  shown  that  if  a  spinal  neiTe 
were  divided  at  its  exit  from  the  vertebral  canal,  all 
its  peripheral  jjarts  suffer  degeneration.  Motor  and 
sensitive  fibres  are  alike  involved,  andean  be  traced, 
in  their  disorganized  condition,  to  their  ultimate 
termination  in  the  muscJes  and  the  integument.  On 
continuing  the  same  mode  of  investigation  within 
the  vertebral  canal,  if  the  anterior  root  only  were  di- 
vided, the  motor  fibres  alone  degenerated  in  the 
tiTink  and  branches  of  the  nerve,  while  its  sensitive 
fibres  remained  normal ;  if  the  posterior  root  were 
divided  outside  its  ganglion,  the  sensitive  fibres  of 
the  nerve  degenerated,  and  the  motor  filji'es  were 
unaffected  ;  and  in  both  eases  the  portion  of  the 
nerve-root  still  connected  with  the  spinal  cord  pre- 
served its  normal  structiire.  But  if  the  posterior 
root  were  divided  above  the  situation  of  its  ganglion, 
two  remarkable  consequences  followed.  First,  there 
was  no  degeneration  of  the  nerve  whatever,  outside 
the  ganglion ;  and  secondly,  that  portion  of  the 
nerve-root  separated  from  the  ganglion,  but  stUl 
united  with  the  spinal  cord,  sufiered  complete  de- 
generation. 

These  effects  were  repeatedly  observed,  under  va- 
ried conditions,  until  there  was  no  doubt  in  regard 
to  them.  In  the  frog,  when  both  roots  of  a  sciatic 
nerve  were  divided  above  the  level  of  the  ganglion, 
there  was,  of  course,  complete  loss  of  both  motion 
and  sensibility  in  the  paralyzed  limb  ;  but  while  all 
its  muscular  nerve-fibres  degenerated,  the  sensitive 
fibres  distributed  to  the  skin  exhibited  no  alteration, 
even  at  the  end  of  two  months.  Similar  experiments 
-on  warm-blooded  animals  turned  out  in  the  same 
way.  In  dogs  and  cats.  Waller  utilized  for  tliis  pur- 
pose the  exceptional  position  of  the  second  cervical 
nerve :  the  two  roots  of  which  remain  distinct  in 
these  animals  until  after  their  emergence  from  the 
intervertebr.al  foramina.  He  could  thus  operate  on 
the  nerve-roots  without  opening  tlie  vertebral  canal ; 
and  by  this  means  he  verified  Magendie's  discovery, 
that  section  of  the  anterior  root  destroys  the  jwwer 
of  motion,  and  that  of  the  posterior  root  the  power 
of  sensibility.  But  he  demonstrated,  furthermore, 
that  when  both  roots  are  severed  above  the  level  of 
the  ganglion,  all  the  motor  fibres  of  the  nerve  degen- 
erate, and  all  its  sensitive  fibres  remain  sound. 

It  is  therefore  evident  that  the  immediate  less  of 
action  in  a  divided  nerve,  and  its  structural  degen- 
eration, are  two  independent  phenomena,  having 
nothing  to  do  with  each  other.  A  motor  nerve,  when 
cut,  ceases  to  excite  voluntary  motion,  not  because 
its  fibres  are  incapacitated  by  degeneration,  but  be- 
cause their  physical  continuity  is  broken  at  one 
point;  and  a  sensitive  nerve,  un'lor  like  conditions, 
can  no  longer  communicate  with  the  sensorium  for 
the  same  reason.  The  proof  of  this  is  that  if  we 
galvanize  the  motor  nerve  below  the  point  of  section, 
it  at  once  calls  out  the  action  of  its  muscles  ;  and  a 
like  stimulus,  applied  to  the  sensitive  nerve  above 
its  point  of  section,  will  be  transmitted  to  the  brain 
and  produce  tho  effect  of  a  sensation.  This  is  the 
state  of  things  immediately  after  the  nerve  has  been 
cut. 

But  at  the  end  of  some  days  a  different  condition 
shows  itself  in  the  peripheral  part  of  the  divided 
nerve.  Its  fibres  tlien  become  unable  to  react  under 
artificial  stimulus,  and  their  galvanization  no  longer 
produces  mn.scular  contraction.  This  is  due  to  their 
progressive  degeneration,  which  requires  time  for 
its  development,  but  which  at  a  certain  stage  de- 


THE  MEDICAL  RECORD. 


143 


stroys  the  functional  aoti\-ity  of  the  nerve-fibres. 
Simple  paralysis  of  motion  and  sensation  is  conse- 
quently the  /mmed/a/e  result  of  diWsion  of  a  spinal 
nerve.  Its  degeneration,  with  loss  of  irritability,  is 
a  suhseqi-ient  result.  The  independence  of  tlie  two  is 
especially  manifest  in  Waller's  experiments  on  the 
spinal  nerve-roots.  When  both  are  divided  above 
the  level  of  the  pcanglion,  the  motor  fibres  of  the 
anterior  root  become  degenerated  throughout  their 
distribution  in  the  jjaralyzed  parts  ;  but  tlie  sensitive 
fibres,  from  the  posterior  roots,  remain  everywhere 
sound  in  the  integument  of  the  same  region. 

From  these  facts  Waller  concluded  that  the  two 
sets  of  uerve-tibres  had  ditferent  centres  of  nu- 
trition ;  that  the  motor  fibres  of  the  anterior  root 
were  dependent,  for  structural  integi'ity,  on  their 
connection  with  the  spinal  cord,  while  the  sensitive 
fibres  of  the  posterior  root  depended  on  their  con- 
nection with  the  spinal  ganglia.  He  was  fully  justi- 
fied in  claiming  that  his  results  were  unequivocal, 
and  "calculated  to  throw  a  new  light  on  the  rela- 
tions of  the  nervous  system." 

For  Waller's  communications  on  this  subject  to 
the  French  Academy  he  was  awarded,  in  1856,  the 
Montyon  Prize  of  Experimental  Physiology,  by  a 
committee  consisting  of  Flourens,  Bayer,  Serres, 
Milne-Edwards,  and  Bernard.  In  reporting  the  de- 
cision of  the  committee,  the  chairman,  Bernard,  be- 
gins with  the  following  words :  "  The  discoveries 
usually  presented  to  ns  are  of  two  different  kinds. 
In  some,  the  facts  have  been  already,  to  a  certain 
extent,  anticipated,  and  are  mainly  serviceable  in 
their  new  form  by  increasing  the  precision  of  our 
knowledge,  and  by  elucidating  subjects  previously 
obscure.  Those  of  the  other  kind,  on  the  contrary, 
are  unexpected.  The  principal  feature  in  them  is  their 
novelty  ;  and  they  enlarge  the  boundaries  of  science, 
not  merely  by  the  solution  of  pai-ticular  questions, 
but  still  more  by  tlie  ideas  and  suggestions  which 
they  originate.  It  is  to  the  last  of  these  two  cate- 
gories that  the  present  essay  belongs.'' 

It  soon  appeared  that  the  committee  were  not 
mistaken  in  their  estimate.  The  immediate  result 
of  Waller's  researches  was  the  discovery  of  the  so- 
called  '■  centres  of  nutrition"  for  nerve-fibres  of  dif- 
ferent kinds.  The  existence  of  these  centres  of 
nutrition  was  fully  demonstrated ;  although  it  was 
not  quite  plain,  and  has  not  even  yet  become  so,  in 
what  v.-ay  their  influence  is  exerted.  But  there  was 
also  the  additional  discovery  that  the  degeneration 
of  divided  nerve-fibres  may  take  place  in  two  oppo- 
site directions.  It  may  be  centrifugal,  that  is,  from 
the  point  of  section  to  the  periphery  ;  or  it  may  be 
centripetal,  that  is,  from  the  point  of  section  toward 
the  spinal  cord  and  brain.  This  fact  afterward  be- 
came the  most  prolific  source  of  further  investiga- 
tion. 

Up  to  this  point  Waller's  experiments  had  been 
confined  to  the  spinal-nerves  and  nerve-roots.  In 
his  last  communication  to  the  French  Academy,''  he 
goes  a  step  farther,  and  traces  the  course  of  similar 
degenerations  in  ihe  cord  itself.  He  divided  the 
spinal  cord,  in  a  dog,  between  the  third  and  foiuth 
lumbar  vertebrae.  After  twenty  days  the  coi-d  was 
found  to  be  reunited  at  the  line  of  section.  But 
above  the  section  the  posterior  columns  were  dis- 
organized for  the  space  of  about  two  vertebras ;  while 
in  the  inferior  segment  the  same  columns,  as  well  as 
the  posterior  nerve-roots,  were  normal.  The  an- 
terior nerve-roots,  on  the  contrary,  were  degenerated 


for  the  first  three  pairs  below  the  section  ;  and  tie 
same  alteration  continued,  diminishing  gradually  in 
amount,  for  the  fourth,  fifth,  and  six  pairs.  Thus 
there  may  be,  within  the  columns  of  the  cord,  as 
well  as  in  its  nerve-roots,  centripetal  or  centrifugal 
degenerations,  ali'ecting  exclusively  particular  ner- 
vous tracks. 

This  discovery  corresponded  with  certain  patho- 
logical observations  in  man,  made  about  the  same 
time  by  Tiirck,  and  communicated  by  him  to  the 
Academy  of  Sciences  at  Vienna.'  They  were  cases 
in  which  post-mortem  examination  revealed  an  old 
morbid  deposit  in  the  brain,  together  with  a  struc- 
tural alteration  of  the  spinal  cord  on  the  opposite 
side.  This  alteration  consisted  mainly  in  a  produc- 
tion of  abnormal  granular  cells,  occupying  the  tis- 
sues of  the  cord,  and  resembling  those  met  with 
about  the  morbid  deposit  in  the  brain.  The  most 
striking  featiire  of  the  alterations  in  question  was 
that  they  occupied  definite  longitudinal  tracts,  the 
rest  of  the  cord  being  normal.  By  examining  suc- 
cessive sections  at  difl'erent  levels,  it  became  evident 
that,  from  the  lesion  in  the  brain  to  the  lower  end 
of  the  spinal  cord,  only  certain  bundles  of  fllires 
were  affected  ;  and  these  bundles  con-esponded  in 
situation  with  those  which  could  be  demonstrated 
by  dissection  in  normal  specimens  of  the  cord,  after 
hardening  in  alcohol. 

Observing  this  correspondence,  in  certain  cases, 
between  the  degenerated  tracts  and  parts  already 
known,  the  author  was  led  to  apply  the  same  means 
of  observation  to  the  study  of  anatomical  relations 
not  so  well  understood.  The  attemiit  proved  suc- 
cessful. The  first  fact  which  it  brought  out  was 
a  distinction  between  the  anterior  and  posterior  seg- 
ments of  the  lateral  column.  No  such  distinction 
can  be  shown  by  ordinary  dissection  :  most  of  the 
nerve-fibres  in  both  segments  running  in  a  direction 
parallel  with  each  other,  and  between  origins  and 
terminations  too  distant  to  be  traced.  But  in  some 
of  the  cases  mentioned,  the  morbid  alteration  of  the 
lateral  column  was  found  only  in  its  posterior  jjart, 
the  anterior  part  remaining  sound  ;  and  this  differ- 
ence was  so  constant,  in  sections  made  at  various 
levels,  as  to  leave  no  doubt  that  there  must  be  some 
anatomical  distinction  between  the  two  segments  of 
the  column,  extending  through  the  gi'eater  i^art  of 
its  length. 

It  was  also  seen,  in  these  cases,  that  on  approach- 
ing the  upper  end  of  the  cord,  the  degenerated  tract 
shifted  its  position  forward  and  inward,  and,  at  the 
medulla  oblongata,  crossed  into  the  anterior  pyra- 
mid of  the  opposite  side.  Thence  it  extended  up- 
ward through  the  pons  varolii,  where  the  distinction 
was  extremely  evident,  the  transverse  bundles  of  the 
pons  being  free  from  alteration,  while  its  longitu- 
dinal bundles  were  deeply  aifected.  It  appeared, 
therefore,  that  the  degenerated  tracts  had  been  in- 
vaded by  a  special  alteration  confined  to  their  own 
limits,  and  extending  continuously,  from  the  seat  of 
the  brain  lesion,  throTigh  the  cms  cerebri,  the  pons, 
and  the  anterior  pyramid  of  the  same  side,  and 
thence  through  the  posterior  part  of  the  lateral 
column  on  the  opposite  side,  to  the  lower  end  of  the 
spinal  cord. 

This  showed  that  there  was  a  longitudinal  tract 
of  nerve-fibres,  reaching  for  long  distances  in  the 
cerebro-spinal  axis,  and  having,  so  to  speak,  its  own 
centre  of  nutrition  :  and  that,  when  this  centre  of 
nutrition  was  disturbed  or  disorganized  by  local  le- 

•  Sitzunes  bprichte  der  Kaiserlichcn  Akadeniie  der  Wissenschaften, 
p.  288.     Wien,  1851. 


144 


THE  MEDICAL  RECORD. 


sion,  the  subsequent  degeneration  might  extend 
throughout  the  tract  in  question,  while  others  in  its 
immediate  contiguity  remained  sound.  The  cases 
observed  by  Turck  were  accompanied  by  more  or 
less  hemiplegia  ;  and  while  the  brain-lesion,  as  well 
as  the  degeneration  of  the  jjons  and  anterior  pyra- 
mid, were,  as  usual,  on  the  opposite  side,  that  in  the 
spinal  cord  was  on  the  same  side  with  the  paralysis. 
Everything  showed  the  degenerated  portions  in  the 
spinul  cord  to  be  continuous  with  the  opposite  an- 
terior pyramids  and  their  extension  in  the  crura 
cerebri,  and  consequently  to  represent  the  motor 
tracts  of  the  cerebrospinal  axis.  But  while  Turck 
followed  the  crossing  of  these  tracts  at  the  decussa- 
tion of  the  pyramids,  he  also  shosved  that  in  certain 
cases  their  crossing  was  incomplete — that  is,  al- 
though the  bulk  of  a  degenerated  anterior  i^yramid 
crosses  at  the  level  of  the  decussation  and  reappears 
below,  in  the  lateral  column  of  the  opposite  side,  a 
remnant  of  its  fibres  continue  their  downward  course 
for  some  distance  on  the  same  side.  These  direct 
columns,  visible  more  or  less  constantly  in  the  cei'- 
vical  portion  of  the  cord,  are  still  known  by  the 
name  of  the  "columns  of  Tiirck." 

But  his  most  important  results  were  those  indicat- 
ing the  difference,  in  anatomical  connection,  between 
the  anterior  and  the  posterior  parts  of  the  lateral 
column.  These  two  parts  were  distinguishable  from 
each  other  by  the  granular  deposit  with  which  one 
was  infiltrated  while  the  other  remained  normal ; 
and  the  deposit  i-eappeared  with  such  constancy  at 
the  same  spot,  in  successive  sections,  and  crossed  so 
distinctly  at  the  decussation  of  the  jjyramids,  as  to 
show  that  it  followed  the  course  of  an  associated 
bundle  of  nerve-fibres.  As  this  bundle  represented, 
in  the  cord,  the  contimxation  of  the  anterior  pyramid 
above,  the  whole  tract,  from  end  to  end,  afterward 
received  the  name  of  the  "pyramidal  tract."  The 
first  indication  of  the  exact  locality  of  this  tract  in 
the  lateral  columns  was  derived  from  the  sections  of 
Tiirck. 

The  same  author  made  an  incidental  observation, 
afterward  seen  to  be  very  imi^ortant,  in  regard  to 
degenerations  from  local  lesion  of  the  cord  itself. 
They  were  instances  of  paraplegia  from  compression 
or  disorganization'  of  the  spinal  cord  at  one  point. 
In  these  cases  the  portion  of  the  cord  above  the 
lesion,  while  mainly  free  from  granular  degeneration, 
nevertheless  contained  single  degenerated  tracts, 
always  identical  in  situation,  extending  upward  to 
the  medulla  and  pons.  But  these  tracts  were  not 
the  same  witli  those  found  degenerated  after  a  brain- 
lesion  ;  and  the  latter  were  entirely  sound  in  the 
above-mentioned  cases  of  injury  to  the  cord.  If  one 
portion  of  the  spinal  coi-d,  therefore,  can  degenerate 
in  consequence  of  a  lesion  situated  above  it,  anotlier, 
and  an  entirely  different  portion,  may  be  affected  by 
degenerations  coming  from  below. 

80  far,  tlie  knowledge  of  degenerations  within  the 
spinal  cord  had  been  mainly  acquired  from  patho- 
logical observations  in  man.  But,  about  ten  years 
ago.  Goltz,  in  Strasburg,  undertook  a  series  of  in- 
vest 'nations  on  the  functions  of  the  hunbar  portion 
of  Ih  !  spinal  cord,  especially  with  regard  to  its  influ- 
ence on  the  sexual  and  urinary  organs.  His  experi- 
ments were  performed  on  young  dogs,  by  dividing 
the  cord  transversely  at  the  lower  end  of  the  dorsal 
region,  and  then  preserving  the  animals  long  enough 
to  study  the  pi-rmanent  effects  of  the  operation.  By 
adopting  various  imiirovenu  nts  in  the  selection  of 
animals,  the  opei-ntive  procedure,  and  the  subsequent 
treatment,  he  became  very  successful.   The  cord  was 


divided  without  serious  injury  to  the  vertebral  col- 
umn or  the  external  parts.  Dogs  of  the  proper  age 
and  organization  were  not  dangerously  affected  by 
the  operation,  sometimes  taking  food  within  the  first 
twenty-four  hours,  and  generally  regaining  their 
natural  appetite  in  a  few  days.  The  wounds  healed 
in  two  or  three  weeks,  and  some  of  the  animals  were 
preserved  several  months,  remaining  paraplegic,  but 
otherwise  in  good  condition. 

This  was  valuable  material  for  the  study  of  de- 
generations in  the  spinal  cord,  and  it  was  utilized 
for  that  purpose  by  Schieferdecker,"'  the  assistant 
of  Goltz,  who  was  already  familiar  with  the  history 
and  condition  of  the  animals  employed. 

On  examining  microscoi^ic  sections  of  the  cord  in 
these  cases,  the  granular  degeneration  of  the  pyra- 
midal tracts  was  recognized.  It  was  present  in 
every  instance,  and  had  invariably  taken  a  descend- 
ing course,  from  the  point  of  section  to  the  lower  ex- 
tremity of  the  cord.  This  portion  of  the  spinal  cord, 
therefore,  became  altered  after  section  in  the  same 
way  as  a  divided  sjiinal  nerve,  that  is,  from  the  centre 
toward  the  periphery  ;  and  the  degeneration  of  the 
pyramidal  tract,  whether  it  be  due  to  a  cerebral 
lesion,  or  to  compression  and  transverse  section  of 
the  cord  itself,  follows  the  same  direction. 

On  the  other  hand,  when  a  similar  degeneration 
takes  place  in  the  posterior  columns  of  the  cord,  it 
is  always  ascending.  We  have  now  the  experience 
of  Chai'cot  "  to  corroborate  the  earlier  assertion  of 
Tiirck,  that  such  posterior  degenerations  invariably 
extend  from  the  point  of  injury  or  disease  upward 
toward  the  brain,  and  never  in  a  downward  direction. 
By  this  means  the  ascending  and  descending  degen- 
erations of  the  spinal  cord  were  established  with  the 
same  certainty  as  the  centripetal  and  centrifugal  de- 
generations of  the  nerve-roots,  and,  like  them,  were 
shown  to  occupy  separate  tracts,  easily  distinguish- 
able ft-om  each  other. 

These  facts  gieatly  increased  the  confidence  of 
physiologists  in  the  value  of  degenerations,  as  indi- 
cating the  continuity  and  destination  of  nerve-fibres. 
It  was  evident  from  the  first  that  a  divided  nerve- 
fibre  degenerates  because  of  its  severance  from  some 
special  nerve-centre,  and,  once  cut  off' from  this  centre, 
it  becomes  affected  throughout  its  remaining  length. 
When  we  see,  in  the  spinal  nerves,  complete  degen- 
erations strictly  limited  to  the  ramifications  of  a 
single  trunk,  and  similar  alterations  in  the  spinal 
cord  equally  confined  to  particular  tracts,  we  can 
hardly  refuse  the  conviction  that  these  tracts  also 
consist  of  continuous  nerve-fibros  following  a  com- 
mon direction.  Waller's  experiments  on  the  nerve- 
roots  show  that  when  such  a  group  of  fibres  meets  a 
ganglion  or  centre  of  gray  substance  interposed  in 
its  course,  the  degeneration  does  not  pass  this  point. 
Either  the  injured  fibres  receive  a  further  accession 
of  nutritive  energy  from  the  ganglion,  or  else  they 
terminate  in  its  substance  and  are  replaced  beyond 
by  new  fibres  originating  from  its  gray  matter.  This 
gives  a  special  significance  to  the  fact  observed  by 
Charcot  '•'  in  regard  to  disease  of  the  pyramidal 
tracts.  These  tracts  are  manifestly  tlie  channels  for 
voluntary  motion  in  the  spinal  cord.  The  paralysis 
caused  by  either  their  morbid  alteration  or  their  ex- 
perimental division  shows  that  they  are  really  the 
paths  followed  by  voluntary  motor  impulses  from 


1"  Ai-chiv  fiir  piitholoRtt^chc  Aimtomic  uiul  rhysiologie,  Bond  Ixvii., 
p.  tua.  Berlin,  1S7(1. 

'  1  LoyoiiK  Rur  les  LooaliRations  (Inns  los  maladies  du  cerveaii  ct  de 
la  Mocllo  6pinifrc.  p.  347.     Pans,  ISSO. 

"  Lemons  8iir  les  Maladies  du  SyEtemc  Ncrvcux,  tome  ii..  p.  219. 
Paris,  1877. 


THE  MEDICAL  RECORD. 


145 


the  brain  to  the  anterior  nerve-roots.  But  descend- 
ing degenei-ations  of  the  pyramidal  tract,  however 
complete  in  the  spinal  cord,  do  not  usually  extend  to 
the  motor  nerves  or  nerve-roots.  This  is  easily  ex- 
plained on  the  assumption  that  the  fibres  of  the 
pvramidal  tract  terminate  in  the  gray  substance  of 
the  anterior  horn,  while  those  of  the  anterior  root 
have  an  origin  of  their  own  at  the  same  point.  The 
nerve-root  therefore  degenerates  only  when  divided 
beyond  its  emergence  from  the  anterior  horn. 

A  further  study  of  the  posterior  columns  led  to 
the  additional  discoveiy  of  two  different  kinds  of 
degeneration,  as  well  as  to  a  distinction  between 
different  parts  of  these  columns.  Hitherto  the  mor- 
bid alteration  of  nervous  tracts  had  appeared  only 
as  the  consequence  of  a  local  lesion  in  either  the 
nerves,  spinal  cord,  or  brain,  extending  upward  or 
downward  from  its  point  of  origin,  as  if  propagated 
in  certain  directions  along  the  natural  route  of  the 
nerve-fibres.  These  alterations  of  stnioture  were, 
therefoi-e,  known  as  "secondary  degenerations,"  be- 
cause resulting  from  some  primai'V  affection  in  a 
different  locality.  But  it  a]:)peared  that  certain 
tracts  in  the  spinal  cord  might  also  be  the  seat  of 
primary  degenerations,  originating  within  their 
own  substance  independently  of  lesions  elsewhere. 
As  these  alterations  often  followed  a  similar  course 
to  those  of  secondary  origin,  occupying  only  tlieir 
own  tracts  or  systems  of  fibres,  they  received  the 
name  of  "  systematic  degenerations." 

The  posterior  columns  of  the  cord  were  liable  to 
both  secondary  and  systematic  degenerations.  But 
these  two  affections  occupied  different  regions,  thus 
showing  an  anatomical  distinction  in  the  posterior 
column,  like  that  already  established  between  the 
front  and  back  parts  of  the  lateral  column. 

In  the  posterior  column  of  the  cord,  the  inner 
part,  next  the  median  line,  is  a  narrow  band,  visibly 
marked  off"  from  the  remainder  in  the  cervical  re- 
gion by  a  slight  furrow  on  the  surface.  This  is  tlie 
funicidi/;  rfracilis,  OT  the  "column  ofGoll."  At  the  me- 
dulla oblongata  it  diverges  from  the  median  line  in  an 
oblique  upward  direction,  forming,  on  the  inner  bor- 
der of  the  restiform  bodies,  the  so-called  "posterior 
pyramids."  The  columns  of  Goll  are  the  seat  of  the  as- 
cending degenerations  noticed  by  Tiirck.  When  they 
are  affected  in  this  way  their  alteration  extends  un- 
broken from  its  starting-point  often  quite  to  the  level 
of  the  medulla  oblongata,  whence  it  is  inferred  that 
they  are  composed  throughout  of  continuous  fibres. 

But  the  remainder  of  the  posterior  column  is  af- 
fected bv  degenerations  which  have  a  different  form 
and  different  results.  This  portion  is  included  be- 
tween the  column  of  Goll  and  the  posterior  nerve- 
roots,  and  forms  the  outer  part  of  the  posterior  col- 
umn. It  has  not  received  a  distinct  name,  but  is 
important,  owing  to  its  connection  with  locomotor 
ataxia.  It  is  regarded  as  made  up  of  comparatively 
short  fibres,  originating  and  terminating  in  succes- 
sion along  the  cord,  for  the  reason  that  its  secondai-y 
degenerations  are  never  propagated  to  any  consider- 
able distance,  extending  at  most  only  two  or  three 
centimetres  above  their  origin.  But  it  is  liable  to 
systematic  alterations  of  structure,  mainly  sclerosis, 
invading  a  large  portion  of  its  extent :  and  when 
such  alterations  occur  they  are  accompanied  by 
symptoms  of  locomotor  ataxia,  never  produced  by 
structural  disease  in  other  parts.  According  to  the 
observations  of  Charcot,"  the  columns  of  Goll  may  be 

"  Lemons  stir  les  Maladie.s  du  Syst^me  Nen-enx,  tome  ii..  p.  11.  P.-\ris. 
1877.  T.econB  sur  les  Localisations  dans  les  Maladies  du  Cerveau  et  de 
la  Moelle  fipiniSre,  p.  259.     Paris,  18S0. 


completely  degenerated  -without  causing  any  signs 
of  ataxia,  while  sclerosis  of  the  outer  ]5art'  of  the 
posterior  columns  is  always  accompanied  by  ataxic 
symptoms,  and  these  symptoms  are  in  j^roportion  to 
the  extent  of  the  degeneration. 

Lastly,  the  anatomical  study  of  nervous  tracts,  bv 
the  aid  of  secondaiy  degenerations,  has  been  carried 
into  the  brain  itself.  There  is  already  a  reasonable 
certainty  of  the  extension  of  the  2nramidal  tracts 
through  the  anterior  pyramids,  the  pons  Varolii,  and 
the  crura  cerebri  ;  and  the  filues  of  the  cms  cerebri 
are  manifestly  succeeded  by  the  diverging  expan.sions 
of  the  internal  capsule  and  the  corona  radiata.  These 
expansions  are,  beyond  question,  for  the  most  part, 
means  of  communication  between  the  cerebral  con- 
volutions and  the  ganglia  at  the  base  oi  the  brain, 
whOe  the  fibres  of  the  eras  cerebri  connect  the  gan- 
glia with  the  spinal  cord  below.  But,  beside  these 
interrupted  communications,  are  there  also  direct 
fibres,  running  continuously  from  the  motor-centres 
in  the  cerebral  cortex,  through  the  corona  radiata 
and  internal  capsule  into  the  pyramidal  tract?  The 
centres  of  motion  about  the  fis.sure  of  Eolando  might 
produce  their  effect,  when  galvanized,  either  through 
the  intervention  of  the  cerebral  ganglia,  or  more  di- 
rectly by  means  of  continuous  fibres.  Such  tracts 
of  direct  fibres  have  been  sometimes  imperfectly 
recognized  in  the  examination  of  hardened  speci- 
mens ;  but  they  have  never  been  clearly  demon- 
strated by  this  method,  owing  to  the  complicated 
interlacement  of  fibres  in  the  upper  part  of  the  in- 
ternal capsule.  Their  existence  is  mainly  inferred 
from  the  cour.se  of  descending  degenerations  in  this 
region.  According  to  Charcot,  destructive  lesions 
of  the  cortex,  in  the  anterior  and  posterior  central 
convolutions,  give  rise  to  degenerations  in  the  white 
substance,  which  pass  downward  through  the  inter- 
nal capsule,  crura  cerebri,  anterior  pyramid.s,  and 
lateral  columns  of  the  cord.  The.se  degenerations 
may  be  found  without  accompanying  lesion  of  the 
cereVu-al  ganglia  ;  and  they  are  not  produced  by 
morbid  alterations  in  other  parts  of  the  brain  than 
those  about  the  fissure  of  Eolando.  Similar  obser- 
vations, made  during  a  period  of  fifteen  years,  point 
with  much  significance  to  a  continuity  of  fibrous 
structure  throughout  this  tract.  If  we  remember  the 
uniform  progress  of  discovery  thus  far  made  by  these 
investigations,  first  in  the  nerves,  then  in  the  nerve- 
roots,  then  in  the  columns  of  the  spinal  cord  and  me- 
dulla oblongata,  it  does  not  seem  pre.'umptuous  to  ex- 
pect from  their  further  prosecution  a  corresponding 
success  in  the  more  difficult  exploration  of  the  brain. 

The  study  of  nervous  degenerations  has  already 
boi-ne  fruit  of  great  value.  Like  many  other  re- 
searches of  similar  character,  it  was  at  first  a  matter 
of  purely  scientific  interest,  without  any  apparent 
bearing  on  the  treatment  or  even  the  pathology  of 
disease.  But  it  has  gro-mi  in  importance  with  evei^y 
additional  ob.servation,  and  it  is  now  an  indis2iensa- 
ble  aid  in  investigating  the  morbid  affections  of  the 
nervous  system.  It  has  extended  our  anatomical 
knowledge  far  beyond  its  previous  limits.  It  has 
demonstrated  the  existence  of  nervous  connections 
which  could  hardly  have  been  detected  in  any  other 
way.  It  has  shown  the  relation  between  certain 
forms  of  paralysis  and  the  altered  structure  of  ]iar- 
ticular  nervous  tracts,  and  it  seems  likely  to  yield 
results  of  still  wider  application  before  its  capacity 
is  exhausted.  It  began  with  the  degenerating  fibres 
of  a  divided  sciatic  nerve,  and  it  has  now  reached 
the  intricate  region  of  the  white  substance  of  the 
cerebral  hemispheres. 


146 


THF   MEDICAL  RECORD. 


We  ■will  now  pass  to  the  second  topic  for  the 
evening,  namely,  Sir  Charles  Bell's  theory  of  the 
nervous  system. 

Sir  Charles  Bell's  theory  of  the  nervous  system  is 
of  so  recent  a  date,  comparatively  speaking,  tliat  its 
traces  have  not  entirely  disappeared  from  our  no- 
menclature. The  student  will  still  find,  among  the 
synonymes  in  some  anatomical  te.xt-books,  such 
names  as  the  "  Respiratory  nerve  of  the  face,"  or 
the  "  Superior  and  external  respiratory  nerves  of 
Bell."  But  the  system  of  which  these  names  formed 
a  part  has  become  so  obsolete  that  their  former  sig- 
nificance is  hardly  remembered ;  and  even  the  dis- 
tinctive features  of  the  theory  itself  has  been  for- 
gotten in  the  discussion  of  more  important  topics 
connected  with  the  nervous  system. 

Among  the  eminent  medical  men  of  the  present 
century,  perhaps  none  have  attracted  more  cordial 
admii-ation  than  Sir  Charles  Bell.  His  earnest  and 
strictly  professional  ambition,  his  restless  mental 
activity,  his  versatility  of  talent,  and  his  genial  and 
enthusiastic  disposition,  secured  him  a  rapid  success 
and  a  po.sition  of  acknowledged  superiority.  "  Anat- 
omist, surgeon,  author,  ai'tist,  and  critic,"  he  taught 
anatomy  by  lectures  and  demonstrations,  was  the 
equal  of  Cooper  and  CHne  in  practical  surgery,  pub- 
lished his  magnificent  works  on  the  Operations  of 
Surgery  and  the  Anatomy  of  Expression,  illustrated 
by  himself,  and  created  the  reputation  of  the  Mid- 
dlesex Hosisital  as  a  centre  of  medical  instruction. 
When  he  received  the  Order  of  Knighthood,  in  1831, 
at  the  same  time  with  Herschel,  Babbage,  and  Brews- 
ter, he  thought  more  of  his  companions  than  of  his 
title.  "  The  batch,"  he  said,  "  makes  it  resjiectable." 
He  always  retained  a  strong  attachment  to  his  early 
friends  and  family  relatives,  and  to  the  jjleasure  and 
sports  of  a  country  life  ;  and  if  he  experienced  some 
disappointment  in  regard  to  the  success  of  his  scien- 
tific opinions,  this  was  fully  compensated  by  his 
general  jiopularity  and  his  high  professional  repu- 
tation. 

Bell's  attention  was  especially  attracted  to  the 
nervous  system  in  1807,  a  few  years  after  his  arrival 
in  London,  and  while  occupied  as  lecturer  in  a  pri- 
vate medical  school,  established  by  himself.  In 
his  demonstrations  he  was  sti-uck  with  the  appa- 
rent complexity  of  the  nervous  apparatus,  and  tlie 
diificnlty  of  presenting  it  fairly  to  the  oomin-ehen- 
sion  of  his  audience.  His  mind  dwelt  persistently 
on  this  subject,  with  a  view  of  reaching  some  more 
intelligible  arrangement  of  what  seemed  so  confused 
and  disconnected.  His  thoughts  were  first  turned 
to  the  anatomy  of  the  brain,  which,  he  says,  at  that 
time  "  occupied  his  head  almost  entirely."  "  He 
puzzled  over  the  varied  form  and  structure  of  the 
cerebrum  and  cerebellum,  the  processes,  protuber- 
ances, and  ganglia  at  the  base  of  the  brain,  and  the 
connections  and  course  of  the  different  cranial 
nerves.  He  tried  to  reduce  these  complicated  parts 
to  something  like  order  in  his  mind,  and  to  divine 
the  secret  of  their  anatomical  relations. 

This  was  the  origin  of  his  new  system  in  cerebral 
anatomy ;  and  when  once  it  had  assumed  a  distinct 
form,  it  grow  in  importance  and  took  entire  posses- 
sion of  his  conviction  and  imagination.  He  made  it 
the  subject  of  his  lectures,  and  speaks  of  it  in  his 
correspondence  with  the  greatest  enthusiasm.  "I 
hinted  to  you."  he  says,  in  a  letter  to  his  brother  in 
Edinburgh,  "that  I  was  hiirtmir/,  or  on  the  eve  of  a 
grand  discovery."  "  I  really  think  this  new  anatomy 

■«  r,i-t,l<T»  of  sir  OhnrlM  lioll.    Solci^ti-d  Trom  liiu  corrcspo; 
bU  brother,  Ueorjro  .Joseph  Bell,  piigc  117.     London,  lS7n, 


of  the  brain  will  strike  more  than  the  discovery  of 
the  lymphatics  being  absorbents,"  "  My  object  is 
to  lecture  it,  to  make  the  town  ring  with  it,  as  it  is 
the  only  new  thing  that  has  appeared  in  anatomy 
since  the  days  of  Hunter,  and,  if  I  make  it  out,  as 
interesting  as  the  circulation  or  the  doctrine  of  ab- 
sorption." " 

Up  to  this  time  there  is  no  trace  of  any  experi- 
mental investigations  by  Bell  in  regard  to  this  sub- 
ject. His  system  was  wholly  inferential,  and  based 
on  the  visible  facts  of  anatomical  structure.  But  a 
year  or  two  later  he  felt  the  necessity  of  making 
some  experiments,  especially  as  lie  had  formed  the 
intention  of  i^rinting  his  views  in  a  pamphlet  for 
pi'ivate  distribution.  He  hoped  by  this  means  to 
elicit  the  opinion  of  the  representative  men  of  the 
profession,  and  to  see  whether  his  innovations  would 
be  likely  to  meet  with  apinoval. 

Accordingly,  in  1810"  he  records  having  made  two- 
experiments,  with  a  satisfactory  result ;  so  much  so 
that  he  believes  he  is  now  about  to  establish  his 
system  on  facts  "the  most  important  that  have  been 
discovered  in  the  history  of  the  science ; "  and  in 
1811  his  essay  was  printed,  under  the  title,  "  Idea  of 
a  New  Anatomy  of  the  Brain ;  submitted  for  the  Ob- 
servations of  his  Friends,  by  Charles  Bell,  F.E.S  E."" 

The  idea  developed  in  this  essay,  and  the  impor- 
tance attached  to  it  in  the  mind  of  its  author,  can 
be  best  understood  from  Bell's  own  account  of  its 
origin  and  growth.  In  a  letter  to  his  brother  a  year 
before,  he  details  his  plan  of  investigation  and  the 
object  to  be  accomplished.  He  had  already  reached 
the  conviction,  on  anatomical  grounds,  that  the  sev- 
eral divisions  of  the  encephalon  were  different  from 
each  other  in  function  ;  and  especially  that  a  wide 
distinction  of  this  kind  existed  between  the  cere- 
brum and  the  cerebellum.  But  how  gain  access  to 
these  deep-seated  and  vascular  jiarts,  so  as  to  ex- 
periment upon  them  ?  This  seemed  too  difficult  an 
undertaking.  It  might  be  possible,  however,  to 
expose  for  that  purpose  the  spinal  cord  and  its 
nerve-roots,  and  this  is  what  he  accordingly  did. 
"It  occurred  to  me,"  he  says,  "that,  as  there  were 
four  grand  divisions  of  the  brain,  so  were  there  four 
grand  divisions  of  the  spinal  marrow  :  first,  a  lateral 
division,  then  a  division  into  the  back  and  fore  part. 
Next  it  occurred  to  me  that  all  the  spinal  nerves  had, 
■within  the  sheath  of  the  spinal  marrow,  two  roots, 
one  from  the  back  part,  another  from  before.  When- 
ever this  occun'ed  to  me,  I  thought  that  I  had  ob- 
tained a  method  of  iiiquiry  into  the  functions  of  the 
par/n  of  the  hniin.""' 

That  is  to  say,  experiments  on  the  anterior  col- 
umns of  the  spinal  cord,  or  the  anterior  nerve-roots, 
■would  throw  light  on  the  fuiietions  of  the  cerebrum, 
with  which  they  were  anatomically  connected.  Ex- 
periments on  the  jiosterior  columns  of  the  cord,  or 
the  posterior  nerve-roots,  would  indicate  the  func- 
tion of  the  cerebellum,  to  which,  he  thought,  these 
parts  belonged. 

These  are  the  experiments  described  in  tJie  "Idea 
of  a  New  Anatomy  of  the  Brain,"  and  this  is  the 
meaning  attributed  to  them  by  its  author.  He  found 
that  irritation  a))i)lied  to  the  anterior  part  of  the 
spinal  cord  produced  contraction  in  the  voluntary 
muscles,  while  a  similar  injury  intlictcd  on  its  pos- 
terior part  did  not  do  so.  On  laying  l)are  the  roots 
of  the  spinal  nerves,  he  could  cut  across  the  poate- 

■»  Ibid.,  pp.  IIT,  118. 
>•  Ibid.,  p,  170, 

"  Reprinted  in  the  Journal  of  Anatomy  and  rhysiolo^'v,  vol,  iii„  p. 
IB-f.    Cambridjie  iind  London.  18C9. 
■«  Letters  of  Sir  Charles  Bell,  p.  170. 


THE   MEDICAL  RECORD. 


147 


rior  fasciculus  without  convulsing  the  muscles  ;  but 
touching  the  anterior  fasciculus  at  once  produced 
convulsions.  "  Such  were  my  reasons,"  he  says, 
"  for  concluding  that  the  cerebrum  and  cerebellum 
were  parts  distinct  in  function,  and  that  every  nerve 
possessing  a  double  function  obtained  that  by  having 
a  double  root."  " 

The  distinction  made  by  Bell  between  the  two  di- 
visions of  the  eueei^halon  is  this  :  The  cerebrum  is 
the  organ  of  the  mind,  of  conscious  sensation  and 
volition.  Consequently  the  anterior  roots  of  the 
spinal  nerves,  being  connected  with  the  cerebrum 
through  the  anterior  part  of  the  spinal  cord,  are  sub- 
servient to  sensation  and  volition,  and  when  arti- 
ficially irritated  cause  contraction  in  the  voluntary 
muscles.  The  cerebellum,  on  the  other  hand,  pre- 
sides over  the  secret  or  iinconscious  operations  of 
the  bodily  frame,  as  in  the  vital  action  of  the  inter- 
nal organs  ;  consequently,  irritation  of  the  posterior 
columns  of  the  cord,  or  the  posterior  nerve-roots, 
has  no  perceptible  eflect  on  the  voluntary  muscles. 
A  spinal  nei've  accordingly  possesses  two  roots, 
because  it  performs  two  sets  of  functions :  one. 
those  of  consciousness  and  volition,  derived  from  the 
cerebrum ;  tlie  other,  those  of  unconscious  vital  in- 
fluences, derived  from  the  cerebellum.  The  cranial 
nerves,  however,  have  for  the  most  part  only  a  single 
root,  and  exercise  but  one  set  of  functions,  con-e- 
sponding  to  their  place  of  origin.  Thus,  "  the 
eighth  nerve  (par  vagum)  is  fi'om  the  (back)  portion 
of  the  meduUa  oblongata,  which  belongs  to  the  cere- 
bellum ;  the  ninth  nerve  .(sublingual)  comes  from 
the  (fi-ont)  portion,  which  belongs  to  the  cerebrum. 
The  fir.st  is  a  nerve  of  the  class  called  rilal  nerves, 
controlling  secretly  the  operations  of  the  body  ;  the 
last  is  the  motor  nerve  of  the  tongue,  and  is  an  in- 
strument of  volition."  -"  This  is  the  substance  of 
the  views  contained  in  the  essay  of  ISll. 

Bell  was  much  disappointed  in  the  impression 
produced  by  this  pamphlet.  It  turned  out  an  "  un- 
propitious  experiment,"  for  it  "  excited  no  criticism, 
and  threatened  to  stitie  the  enthusiasm  of  the  au- 
thor." Bell  himself  says  regretfully  that  this  an- 
nouncement, from  which  he  expected  so  much, 
"  failed  to  draw  one  encouraging  sentence  from 
medical  men."  But  we  can  hardly  blame  them  very 
much  for  this  apathy.  The  systematic  ideas  of  the 
author,  however  attractive  to  himself,  might  not 
have  the  same  interest  for  others  ;  and  his  experi- 
mental proofs  were  certainly  insufficient  to  command 
belief  on  their  own  merits.  Indeed,  we  now  know 
that  they  do  not  really  bear  the  significance  which 
he  attached  to  them.  The  anterior  and  posterior 
nerve- roots  are  not  connected  respectively  with  the 
cerebrum  and  cerebellum,  and  we  cannot  use  them 
in  our  experiments  to  determine  the  sejiarate  func- 
tions of  the  brain.  It  was,  no  doubt,  a  suspicion 
of  this  physiological  «o«  sequitur  i\\Sit  prevented  the 
profession  at  large  from  appreciating  the  pamphlet 
as  its  author  had  hoped. 

But.  notwithstanding  this  temporary  discourage- 
ment. Bell  afterward  returned  to  the  subject  witli 
new  vigor,  and  soon  came  to  regard  his  former  work 
as  only  the  introduction  to  a  more  extended  system. 
In  his  fir.st  essay,  the  anatomy  of  the  brain  was  the 
main  subject  of  research,  the  nerves  and  their  dis- 
tributions being  only  secondary  ;  but  in  his  theci-v, 
as  afterward  developed,  the  nerves  and  their  distri- 
butions occupied  the  prominent  place.  This  matter, 
in  181i,   was   already,  he   says,   "ripening  in  his 


'^  R'-rrinte-l  in  the  Jour,  of  Anatomy  .ind  Pbysiology,  vol. 
"  Ibid.,  p.  162. 


,  p.  161. 


head ;  "  and  in  his  lectures  on  the  nerves  for  that 
year  he  promises  to  "  lay  open  a  fine  system."  Like 
his  anatomy  of  the  brain,  this  new  system  increased 
in  importance  the  more  he  thought  about  it.  Year 
by  year  he  enlarged  its  proportions,  and  seemed  to 
anticipate  from  it  greater  results  than  ever.  He 
gradually  brought  it  into  the  form  of  a  series  of 
communications  to  the  Royal  Society.  In  1819  he 
regarded  it  as  nearly  complete,  and  fully  worth  the 
labor  it  had  cost,  containing,  as  he  believed,  the  ma- 
terials of  a  grand  system,  destined  to  "  revolutionize 
all  we  know  of  this  part  of  anatomy  more  than  the 
discovery  of  the  circulation  of  the  blood."  By  the 
time  the  first  paper  was  ready  for  presentation  he 
was  abundantly  satisfied  with  it,  and  declared  that 
he  had  made  "  a  greater  discovery  than  ever  was 
made  by  any  one  man  in  anatomy." 

In  this  communication,-'  Bell  presented  the  main 
principles  of  his  new  arrangement  of  the  nervous 
sy.stem.  with  special  reference  to  the  nerves  of  the 
face.  The  paper  had  been  prepared  by  its  author 
with  much  care,  and  he  offered  it  to  the  Eoyal 
Society  as  the  result  of  several  years  of  thought  and 
investigation. 

This  time,  he  had  no  reason  to  be  disappointed, 
as  the  essay  attracted  everywhere  attention  and 
approval.  In  speaking  of  a  reception  which  he  at- 
tended soon  afterward,  "  My  paper,"  he  says,  "  has 
done  me  as  much  good  aa  if  I  had  bought  a  new  blue 
coat  and  figured  French  black  silk  waistcoat.  One 
gentleman  called  it  the  first  discovery  of  the  age." 
He  received  a  number  of  complimentary  letters  in 
regard  to  it,  which,  he  says,  were  enough  to  show 
that  he  was  "  not  a  visionary"  on  the  subject.  "It 
will  hereafter,"  he  adds,  "  put  me  beside  Harvey.""- 

This  paper  of  1821  well  deserved  the  praise  be- 
stowed upon  it,  for  it  contained  the  announcement 
of  Bell's  most  lasting  and  undisputed  discovery, 
namely,  that  the  facial  nerve,  or  jjoriio  dura  oi  the 
seventh  pair,  was  not  a  nerve  of  sensibility,  but  a 
channel  for  muscular  action  and  the  nervous  medium 
of  expression  in  the  face.  The  importance  of  this 
discovery,  both  scientific  and  practical,  was  abun- 
dantly manifest  ;  and  it  was  sustained  by  direct  and 
satisfactory  experiments  on  the  living  animal,  as 
well  as  by  observations  on  man.  It  is  evident  that 
Bell  did  not  get  at  the  whole  truth  in  regnrd  to  this 
nerve,  for  he  represented  its  action  as  limited  to  the 
involuntary  movements  of  respiration  and  expression, 
and  considered  the  voluntary  motions  of  the  face 
and  lips  as  still  provided  for  by  the  fifth  pair.  But 
it  is  very  seldom  that  all  the  details  of  so  complex 
a  subject  are  mastered  Vw  one  person  or  at  one  time, 
and  the  primary  facts  of  the  motor  character  of  the 
facial  nerve  and  its  insensibility,  as  contrasted  with 
the  extreme  sensibility  of  the  fifth  pair,  were  then 
fully  established  on  incontestable  evidence. 

Bell,  however,  was  much  more  interested  in  the 
general  i^lan  of  his  new  classification  than  in  any  of 
its  details,  which  he  valued  mainly  as  illustrations  or 
proofs  of  his  system  as  a  whole.  He  continued  to 
develop  this  system  in  a  series  of  jiapers  addressed 
to  the  Boyal  Society,  and  it  was  afterward  embod- 
ied, with  some  necessary  modifications,  in  his  "Ner- 
vous System  of  the  Human  Body,"  published  in  1830. 

Bell's  conception  of  the  arrangement  of  the  nerves 
was  this  :  All  the  nerves  of  the  cerebro-spinal  sys- 
tem were  divided  into  two  great  classes  or  groups. 
The  first  group  was  that  of  the  regnlnr,  original,  or 

=1  Philceophical  TranRactions  of  the  Hoyal  Society,  page  398.     Lon- 
don, 1821. 
22  Letters  of  Sir  Charles  Bell,  p.  2T2. 


148 


THE  MEDICAL  RECORD. 


symmelrical  nerves,  namely,  the  thirty-one  pairs  of 
spinal  nerves  and  the  flfth  pair  of  cranial  nei-ves. 
All  these  nerves  arise  by  two  roots,  on  one  of 
which  is  a  ganglion ;  they  pass  out  regularly  to  suc- 
cessive divisions  of  the  body ;  tliey  are  all  subser- 
vient to  voluntary  motion  and  common  sensibility  ;' 
they  are  distributed  to  every  part  of  the  frame,  but 
are  symmetrical  and  simple  in  their  arrangement. 
The  second  group  was  made  up  of  the  irrer/alar  or 
superadded  nerves.  These  do  not  arise  by  double 
roots,  and  have  no  ganglia  at  their  origins ;  they 
come  off  from  the  sides  of  the  medulla  oblongata 
and  upper  part  of  the  spinal  cord ;  and,  instead  of 
being  distributed  in  regular  order  to  successive 
parts  of  the  frame,  are  sent  to  remote  organs,  wliich 
they  combine  in  functional  activity.  They  therefore 
have  the  character  of  being  superadded,  for  a  spe- 
cial purpose,  to  the  original  system  of  regular  nerves. 
They  constitiite  the  great  group  of  respiratorynei-ves, 
which  are  distributed  to  a  variety  of  organs,  and, 
instead  of  going  out  on  each  side  straight  to  their 
destination,  often  pass  through  the  body  in  a  longi- 
tudinal or  oblique  direction.     They  are  : 

First. — The  facial,  portio  dura  of  the  seventh  pair, 
respiratory  nerve  of  the  face. 

Second. — The  glosso -pharyngeal  nerve,  distributed 
to  the  tongue  and  pharynx. 

Third. — The  par  vagum,  or  pneumogastric,  the 
nerve  of  the  lungs,  heart,  and  stomach. 

Fourth. — Tiie  spinal  accessory,  or  superior  respi- 
ratory nerve  of  the  trunk,  distributed  to  the  steimo- 
mastoid  and  trapezius  muscles. 

Fifth. — The  sublingual,  or  the  nerve  of  articula- 
tion. 

Sixth. — The  phrenic,  or  great  internal  respiratory 
nerve. 

Seventh. — The  long  thoracic,  or  external  respira- 
tory nerve  of  the  trunk. 

Eighth. — The  fourth  nerve,  or  patheticus,  distrib- 
uted to  the  superior  oblique  muscle  of  the  eyeball. 

These  are  the  nerves  which  produce  the  appear- 
ance of  irregularity  or  confusion  in  the  nervous 
system ;  because  they  often  cross  the  track  of  the 
symmetrical  nerves,  and  are  distributed  to  organs 
already  supplied  by  them. 

Tlris  last  fact  gives  the  key  to  the  functional  pe- 
culiarity of  the  superadded  nerves.  According  to 
Bell,  an  organ  which  performs  only  a  single  function 
has  but  one  nerve  supplied  to  it ;  and  whenever  an 
organ  I'eceives  nerves  from  two  or  more  sources,  it 
is  because  it  performs  as  many  different  functions. 
This  explains  why  certain  muscles,  like  the  sterno- 
mastoid  and  trapezius,  already  supplied  with  nerves 
from  the  regular  or  symmetrical  system,  also  re- 
ceive branches  from  the  respiratory  system.  The 
former  nerves  enable  them  to  execute  the  ordinary 
acts  of  voluntary  motion  ;  tlic  latter  bring  them  into 
occasional  involuntary  unison  witli  the  act  of  respi- 
ration. This  is  illustrated  in  a  still  more  striking 
manner  by  the  two  nerves  distributed  to  the  face ; 
namely,  the  fiftli  pair,  supplying  the  face  with  sen- 
sation and  voluntary  motion,-''  and  the  facial  nerve, 
or  seventh,  a  superadded  nerve,  which  controls  the 
involuntary  motions  of  the  face  in  breathing,'''  or,  as 
he  says.  "  when  the  muscles  of  these  parts  are  in 
associated  action  with  the  other  organs  of  respira- 
tion." 

The  respiratory  nerves,  however,  come  into  play 
not  only  in  the  motions  of  respii-ation  proper,  but  in 

«>  PhilOHophlcal  Trnnsaotlons,  1831,  pp.  410,  411,  413,  417 ;  and  1822 
p.  284. 
!"  Iblrt.,  1821,  pp.  400,  410,  414. 


all  those  connected  with  the  entrance  and  exit  of  air 
from  the  lungs;  as  in  speaking,  singing,  coughing, 
gasping,  or  sneezing.  They  are  also  the  agents  in 
all  movements  of  expression,  or  the  emotional  affec- 
tions of  the  frame.  This  is  esi^ecially  marked  in  the 
seventh  pair,  which  regulates  the  involuntary  changes 
of  expression  in  the  face.  But  it  applies  also  to  the 
manifestations  of  emotion  in  other  parts ;  as  in  the 
hurried  respiration  of  anxiety,  the  retardation  or 
quickening  of  the  heart,  and  the  sobbing  of  the  dia- 
phragm in  grief,  excitement,  or  depression.  Under 
every  strong  impulse  the  central  organs  of  respira- 
tion are  stimulated  or  disturbed,  and  thus  bring  into 
associated  action  all  theii'  subordinate  parts,  as  or- 
gans of  expression. 

Besides  this,  the  nerses  of  respiration,  wherever 
they  may  be,  have  more  vitality  than  other  nerves  ; 
for  the  movements  connected  with  this  function  con- 
tinue to  be  performed  after  all  manifestations  of 
sensibility  and  volition  have  disappeared.  Thus 
these  nerves  form  a  great  system  by  themselves,  dis- 
tinguished from  the  ordinary  or  regular  nerves  by 
their  mode  of  origin,  their  functions,  their  distribu- 
tion, and  their  vitality. 

Evidently  there  was  much  of  real  value  in  these 
observations.  They  placed  in  strong  relief  the  fact 
of  associated  respiratory  motions.  The  expansion 
and  collapse  of  the  nostrils  or  lips  accompanying 
the  action  of  the  thorax,  are  occasional  in  man, 
constant  in  some  animals,  and  always  increase  in 
proi:>ortion  to  the  intensity  of  respiration.  They 
are  truly  respiratory  motions,  as  much  so  as  those  of 
the  diajihragm.  The  sterno-mastoid  and  traiJezins 
muscles  are  also  brought  into  action  whenever 
breathing  is  impeded  or  laborious.  The  classifica- 
tion which  Bell  constructed  on  this  basis  and  illus- 
trated with  so  much  ingenuity  has  a  certain  charm 
about  it,  and  is  plainly  marked  with  the  talent  and 
originality  of  its  author.  But,  even  as  a  system,  its 
joints  do  not  all  bear  inspection,  and  it  contained 
from  the  outset  certain  defects,  which  became,  after 
a  time,  plainly  perceptible. 

Bell  showed  by  his  experiments  and  observations 
that  the  seventh  nerve  controls  the  involuntaiy  mo- 
tions of  expression  and  resjjiration  in  the  face,  and 
that  these  motions  are  abolished  by  its  division  or 
injury.  Tf  he  had  accej^ted  this  fact  at  its  own 
value,  and  had  assumed  nothing  further,  he  would 
have  been  secure  ;  but  he  believed,  in  accordance 
with  his  system,  that  these  involuntary  movements 
were  the  only  ones  under  control  of  the  seventh 
nerve,  and  that  sensibility  and  volition  were  pro- 
vided for  by  the  fifth  pair.  This  idea  influenced  his 
mind  to  such  an  extent  that  he  was  led  to  conclude, 
after  division  of  the  fifth  pair  alone,  that  the  vclun- 
tary  movements  of  the  lips  were  paralyzed,  while 
those  of  rosj^iration  continued. ''"  Magendio,  on  the 
other  hand,  who  believed  in  nothing  but  direct  ex- 
periment, soon  afterward  repeated  this  ojieration  on 
the  fiftli  pair,  and  declared  that  he  could  not  per- 
ceive any  paralysis  of  the  lips  produced  in  conse- 
quence.'-" We  now  know  that  ho  was  right,  and  that 
the  fifth  pair  does  not  animate  any  of  the  .superficial 
muscles  of  the  face.  Tliat  being  true,  according  to 
Bell's  principle  there  ought  to  be  tiro  other  nerves 
distributed  to  this  ])art — one  for  its  voluntary,  the 
other  for  its  respiratoi-y  functions.  But,  in  fact,  it 
has  only  the  seventh  pair,  which  serves  for  botli. 

Bell's  classification  of  the  respiratoiy  nerves,  with 
regard  to  their  origin,  is  by  no  means  perfect  in  its 


'»  lliiil..  1S21,  p.  4n. 

^i"  .loiinml  de  I'liysiolORio.  tome  i 


.387.     Aiini^e  1821. 


THE  MEDICAL  RECORD. 


149 


•  etails.  Xnese  nerves  were  said  to  ditler  irom  the 
others  in  having  no  ganglia  at  their  roots,  and  in 
originating  from  an  intermediate  tract  on  the  sides 
of  the  medulla  and  spinal  cord.  But  both  the  pneu- 
mogastric  and  glosso-pharyngeal  nerves  have  ganglia 
at  their  roots,  which  are  as  real,  though  not  quite  so 
conspicuous,  as  the  Gasserian  ganglion  of  the  fifth 
pair.  Again,  the  origin  of  nerve-roots,  in  a  nearly 
continuous  line  from  the  lateral  tract  of  the  me- 
dulla and  spinal  cord,  is  certainly  a  marked  fea- 
ture in  the  glosso-pharyngeal,  pneumogastrie,  and 
spinal  accessory  nerves.  On  the  other  hand,  it  can- 
not be  asserted,  with  any  plausibility,  of  the  facial, 
sublingual,  and  patheticus. 

The  last-named  nerve  was  associated  with  the  res- 
piratory system,  because  it  was  regarded  as  causing 
the  upward  rolling  of  the  eyeball  in  involuntary 
movements  and  emotional  expressions.  Everything 
connected  with  the  subject  bad,  for  Bell,  a  great  at- 
traction. His  book  on  the  Anatomy  of  Expression 
was  his  earliest  publication  in  London,  and  first 
called  attention  to  him  as  a  man  of  ability.  He  gave 
lectures  ou  the  same  topic  to  professional  artists  ; 
and  the  exercise  of  his  talent  in  painting  and  mod- 
elling was  always  for  him  a  source  of  pleasure  in 
connection  with  his  anatomical  pursuits.  This 
probably  accounts  for  the  rather  forced  amalgama- 
tion, in  his  theory,  of  the  functions  of  respii'ation 
and  expression. 

But  how  does  it  hapjien  that  Bell  omitted  from 
his  respiratory  system  the  inle.rcostnl  muscles  and 
their  nerves '?  One  would  think  they  had  some 
claim  to  be  considered  as  part  of  this  gi-eat  appara- 
tus. They  are  constantly  at  work,  and  keep  time 
with  the  diaphragm  and  lungs  more  steadily  than 
any  other  outlving  organs  of  respiration.  But  the 
intercostals  are  part  of  the  regular  symmetrical  sys- 
tem of  nerves,  originating  from  the  spinal  cord,  with 
double  roots,  and  all  the  other  features  of  their  class. 
The  author  ignores  this  diiSculty  almost  entirely, 
or  alludes  to  it  only  so  far  as  to  surmise  that  the 
branches  of  these  neiTes  which  influence  respiration 
are,  "in  all  probability,"  derived  from  the  same  lat- 
eral tract  of  the  spinal  cord.-"  But  there  is  not  the 
least  evidence  adduced  in  support  of  this  probabil- 
ity, and  the  assumption  looks  very  much  like  reas- 
oning in  a  circle. 

The  controversy  once  carried  on  as  to  the  exact 
significance  of  Sir  Charles  Bell's  doctrine  and  dis- 
coveries was  due,  in  great  measure,  to  the  singiilar 
obscurity  of  his  style  and  his  indefinite  manner  of 
statement.  These  defects  were  habitual  with  him 
as  a  writer,  and  in  many  instances  are  extremely 
marked.  There  are  few  pieces  of  harder  reading 
than  the  preface  and  introduction  to  his  "Kervous 
System  of  the  Human  Body."'^*  In  attempting  to 
account  for  this  obscurity,  the  reader  is  sometimes 
left  in  doubt  whether  Bell  really  has  any  distinct 
idea  to  communicate,  or  whether  he  voluntarily 
stops  short  of  its  complete  expression.  One  of  these 
puzzling  passages  is  the  following.  After  speaking 
of  the  par  vagum  and  the  spinal  accessory  nei^ve,  he 
says  fpage  47) :  "Directed  in  the  next  place  to  the 
portio  dura,  I  wished  to  answer  the  question,  Why 
does  the  nerve  which  supplies  certain  muscles  of  the 
face  take  an  origin  and  a  course  different  from  the 
fifth  nerve,  destined  to  the  same  parts?  Guided  /;v 
these  mnsiilerations  in  mu  e.rperiinents,  hy  inference  I 
cnncluileil  that,  on  cutting  across  this  nerve,  all  the 
motions   of  the   face    connected    with    respiration 


ceased,  and  that  it  had  the  origin  X\e  see  and  took 
its  course  with  the  respiratory  nerves,  because  it 
was  necessary  for  the  association  of  the  muscles  of 
the  nostrils,  cheek,  and  lips  with  the  other  muscles 
used  in  breathing,  speaking,  etc."  It  is  certainly 
impossible  to  determine,  from  the  phraseology  of 
this  sentence,  whether  it  contains  the  statement  of 
an  experimental  fact,  or  is  only  the  expression  of  a 
hypothetical  surmise. 

Having  enumerated,  again,  the  various  organs  of 
respiration,  he  says  (page  49)  :  "  It  appears,  then, 
that  it  is  the  distance  and  irregular  position  of  the 
eye,  nostril,  mouth,  throat,  and  larynx,  and  muscles 
of  the  neck  which  require  these  diverging  and  appar- 
ently irregular  nerves,  to  connect  them  with  the 
act  of  respiration,  and  without  which  they  would 
have  possessed  no  more  attributes  than  the  nerves 
of  the  limbs — that  is  to  say,  sensibility  and  mo- 
tion." 

There  is  nothing  in  the  context  to  indicate  from 
what  point  the  eye,  nostrils,  mouth,  throat,  and 
larynx  are  "distant,"  or  why  they  should  be  con- 
sidered as  more  "irregular"  in  position  than  the 
limbs. 

One  of  the  most  curious  instances  of  this  peculi- 
arity is  !i  passage  in  one  of  Bell's  earlier  letters, 
describing  his  new  system  of  the  anatomy  of  the 
brain,  and  1  think  it  hardly  jirobalile  that  any  one 
now  j^resent  will  be  able  to  understand  exactly  what 
he  means  by  it.  "I  consider,"  he  says,'''  "the organs 
of  the  outward  senses  as  forming  a  distinct  class  of 
nerves  from  the  other.  I  trace  them  to  correspond- 
ing parts  of  the  brain,  totally  distinct  from  the  ori- 
gins of  the  others.  I  take  five  tubercles  within  the 
brain  as  the  internal  senses.  I  tr;.ce  the  nerves  of 
the  nose,  eye,  ear,  and  tongue  to  these.  Here  I  see 
established  connections.  Then  the  great  mass  of 
the  brain  receives  processes  from  these  central  tu- 
bercles. Again,  the  greater  mass  of  the  cerebrum 
sends  down  processes,  or  crura,  which 'give  off  all 
the  common  nerves  of  voluntary  motion,  etc.  I  es- 
tablish thus  a  kind  of  circulation,  as  it  were.  In 
this  inquiry  I  describe  many  new  connections.  The 
whole  ojiens  up  in  a  new  and  .simple  light :  the 
nerves  take  a  simple  arrangement ;  the  parts  have 
ajipropriate  nerves  ;  and  the  whole  accords  with  the 
phenomena  of  the  pathology,  and  is  snpjyorted  hy  in- 
teresting rieirs." 

This  indefinite  style  of  expression  extends,  as  in 
one  of  the  passages  just  quoted,  even  to  the  descrip- 
tion of  expei-iments  and  their  results.  It  is  u.sually 
thought  essential  in  reporting  experiments,  espe- 
cially if  bearing  on  new  questions  in  physiology,  to 
state  all  the  particulars,  so  that  the  reader  may 
form  for  himself  some  estimate  of  their  value.  Bell 
habitually  neglects  this  useful  precaution.  He  gen- 
erally omits  all  mention  of  tlie  details  of  the  opera- 
tive procedure,  often  that  of  the  .species  of  animal 
employed,  and  sometimes  even  whether  it  were  liv- 
ing or  dead  at  the  time  of  the  experiment.  The 
consequence  is  that  doubts  have  been  entertained 
on  these  points,  in  regard  to  some  of  Ms  most  im- 
l^ortant  investigations. 

The  truth  is,  Bell  had  no  real  faith  in  experimen- 
tation as  a  source  of  knowledge.  He  preferred  to 
make  his  deductions,  in  the  first  place,  from  the  de- 
tails of  anatomical  stmcture  ;  employing  experi- 
ments afterward  to  "  prove  "  or  "  confirm  "  them,  or 
to  impress  his  convictions  on  the  minds  of  others. 
This  is  abundantly  evident  from   his  own  express 

2»  Lettei-s  of  Sir  Charle.^;  BeU,  p.  117. 


150 


THE  MEDICAL  RECORD. 


declaration  in  various  parts  of  his  works,  as  well  as 
from  the  method  he  pursued  in  originating  and  car- 
rying out  his  plans  of  investigation.  With  him  the 
coneeptiou  of  a  system  was  the  beginning  and  the 
end  of  the  mental  process  ;  its  experimental  evidence 
was  only  an  intermediate  episode.  For  this  reason, 
Bell  would  hardly  be  considered  at  the  present  day 
as  a  physiologist.  Indeed,  he  never  speaks  of  him- 
self as  such,  but  always  as  an  "  anatomist,"  whose 
whole  pleasure  is  in  "investigating  structure ;  "  and 
even  his  new  doctrines  and  ideas  he  expressly  desig- 
nates as  "  discoveries  in  anatomy." 

This  explains,  in  some  degree,  his  undue  estimate 
of  the  two  methods  of  inquiry.  He  had  so  high  a 
regard  for  the  results  of  anatomical  research,  that 
he°believed  them  capable  of  also  solving  questions 
in  physiology.  Already  in  1808,  three  years  before 
printing  his  "  Idea  of  a  New  Anatomy  of  the  Brain," 
he  "  is  sure,"  he  says,  "  that  he  is  correct ;  "  and  that 
was  before  he  had  made  a  single  experiment.  And 
long  afterward  he  declares  that  the  "few  experi- 
ments"  which  he  has  made  "were  directed  only  to 
the  verification  of  the  fundamental  principles  on 
which  the  system  is  established."  But  the  result  of 
this  method  has  been  exactly  the  reverse  of  what  he 
anticipated.  The  experimental  observations,  which 
he  undervalued,  form  the  only  part  of  his  system 
which  has  remained  ;  while  the  attractive  and  har- 
monious classitication,  which  he  constructed  with 
so  much  ingenuity  on  the  basis  of  anatomical  deduc- 
tion, has  now  lost  its  importance  and  almost  its 
place  in  medical  literature. 


The  value  of  the  experimental  method  in  medical 
science  cannot  be  measured  by  the  direct  results  of 
any  particular  discovery.  It  is  true  that  these  dis- 
coveries are  often  of  great  importance,  and  increase 
largely  the  fund  of  our  medical  knowledge.  They 
possess,  moreover,  a  vitality  which  distinguishes 
the  01  in  a  marked  degree  from  the  ephemeral  pro- 
ducts of  scientific  hypothesis.  When  a  hyi^othetical 
system  has  served  its  time,  it  disappears  and  is  re- 
placed by  a  di&'erent  one  ;  but  the  knowledge  de- 
rived from  experiment  remains  serviceable  long  after 
its  novelty  has  passed  away.  The  experimental  ob- 
servations of  Galon  on  the  recurrent  laryngeal  nerves 
and  on  the  functions  of  the  arteries  as  blood-vessels 
are  as  conclusive  now  as  when  he  first  made  them, 
and  retain  at  this  day  their  fuU  value.  They  have 
lasted  for  over  seventeen  centuries,  and  have  sur- 
vived during  that  time  all  the  fluctuating  medical 
systems  of  solidism  and  fluidism,  of  animism,  vital- 
ism, archeism,  and  iatro-mechanism.  The  informa- 
tion which  they  imparted  was  a  reality,  and  is  neither 
destroyed  nor  impaired  by  the  lapse  of  time. 

But  the  benefits  of  an  experimental  discovery  ex- 
tend far  beyond  its  immediate  limits.  When  a  now 
fact  has  been  estal)lished  in  anatomy  or  jjliysiology, 
it  is  impossible  to  say  what  bearing  it  will  have  on 
other  facts  not  yet  discovered  ;  and  in  the  history  of 
medicine  there  are  many  instances  of  curious  obser- 
vations which  remained  imperfect  and  apparently 
Darren  until  subsequent  discoveries  invested  them 
with  an  unexpected  importance.  It  is  evident  that 
Galen's  detection  of  the  arterial  blood-current  in  the 
second  century  was  a  necessary  preliminary  to  Har- 
vey's complete,  discovery  of  the  circulation  in  the 
seventeenth  ;  and  the  lymphatic  vessels,  discovered 
in  1(551,  wore  thought  to  bo  the  agents  of  a  slow  and 
insignificant  absorption  until  (Jolin  found,  two  hun- 
dred years  later,   that  the  daily  quantity  of  fluids 


passing  through  the  thoracic  duct  was  from  four  to 
ten  per  cent,  of  the  entire  bodily  weight.  It  is  al- 
most certain  that  a  genuine  investigation,  however 
isolated  at  fir.st,  will  produce,  some  time  or  other, 
its  legitimate  fruit.  But,  to  secure  this  object,  tl.ere 
is  one  essential  requisite,  and  that  is  that  experi- 
mental research  be  followed  and  cultivated  for  its 
own  results,  whatever  they  may  be,  without  de- 
manding immediate  returns  of  a  kind  that  can  be 
designated  beforehand,  and  with  entire  confidence 
in  the  substantial  value  of  this  method,  which  has 
always  been  and  always  will  be  the  only  source  of 
permanent  improvement  in  medical  science. 


©rrgtnal  Commumcatlons. 


NO  BACTERIA  IN  DIPHTHERIA. 
By  ROLLIN  E.  GEEGG,  M.D., 


I  DESIRE  to  call  the  attention  of  the  profession  to  a 
few  points  in  connection  with  bacteria,  which  have 
not  had  the  consideration  that  they  ought,  or,  in- 
deed, which  have  never  hitherto  received  any  con- 
sideration from  the  profession.  They  are  as  fol- 
lows : 

First. — There  is  not  the  slightest  diflerence  to  be 
found  recorded  by  the  best  observers,  between  the 
three  classified  forms  of  so-called  bacteria  in  diph- 
theria, namely,  spherical,  rod-like,  and  spiral,  and 
the  three  exactly  corresponding  forms  of  coagula- 
ting fibrin,  namely,  granular,  thread-like,  and  spi- 
ral. Spherical  bacteria,  so-called,  are  exactly  like 
the  molecular  granules  of  fibrin,  or  the  particles 
which  the  latter  always  first  organizes  into  when  it 
begins  to  coagulate.  Eod  like  bacteria  are  exactly 
like  the  threads  or  fibrils  of  fibrin,  formed  by  the 
union  of  its  granules  into  fibrils,  in  the  next  step  in 
its  coagulation  ;  and  spiral  bacteria  are  exactly  like 
the  spirals  into  which  the  fibrils  of  fibrin  always 
contract  when  the  clot  of  blood  contracts,  and  into 
which  they  contract  when  they  organize  into  false 
membranes  in  connection  with  any  inflammatoi-y  dis- 
ease, unless  said  fibrils  secure  attachments  of  their 
ends  that  hold  them  straight.  And  yet,  no  ob- 
server of  these  assumed  bacteria  appears  ever  to 
have  stopped  for  a  moment  to  consider  whether  bis 
alleged  bai-terial  forms  might  not  be  the  long  and 
well-known  forms  of  coagulating  fibrin,  which  are 
always  found  existing  in  the  .same  positions  and  un- 
der precisely  the  same  circumstances  that  bacteria 
are  said  to  lie  found  in  diphtheria. 

Second. — Wherever  blood  congests  as  a  result  of 
disease  or  other  cause,  there  the  fibrin  very  soon 
commenoes  to  coagulate,  first  into  granules,  then 
these  join  together  to  form  fibrils,  and  the  latter 
contract  into  spirals,  unless  prevented  by  the  at- 
tachment of  their  ends  as  just  stated. 

Lehmaun,  vol.  i.,  p.  312,  says,  in  speaking  of  the 
coagulation  of  fibrin  under  various  circumstances : 
"The  same  process  goes  on  wiihin  the  vessels  of 
the  /irijifj  orffiinism  as  soon  as  the  hhod  censes  In 
circulate." 

Wood,  "  Practice  of  Medicine,"  vol.  i.,  p.  28,  says 
of  the  exudation  and  organization  of  fibrin  in  con- 
nection with  inflammation  :  "As  it  first  escapes 
it  is  a  homogeneous,  formless,  transparent  fluid  ; 
but  very  soon  afterward,  if  examined  by  the  micro- 


THE  MEDICAL  RECORD. 


151 


scope,  it  is  found  to  contain  multitudes  of  Jibrils," 
&ni"  great  numbers  of  minute  granules  of  different 
sizes."    (The  italics  in  both  quotations  are  my  own.) 

Third. — Hence,  as  will  be  seen,  we  hare  the  proof 
from  Lihm.inn,  that  wherever  the  blood  stagnates, 
— as  it  always  does  under  established  congestion  or 
inflammation — there  is  where  the  fibrin  of  the  blood 
commences  at  once  to  coagulate ;  and  the  proof 
from  Wool  that  those  parts  where  all  observers  say 
their  bacteria  are  fouad  in  the  greatest  profusion 
— namely,  in  all  congested  and  inflamed  parts — are 
the  very  parts  where  the  granules  and  fibrils  of 
fibrin  are  found  in  the  greatest  profusion ;  only 
Wood  ought  to  have  referred  to  the  granules  first 
and  the  fibrils  last,  instead  of  the  reverse,  to  have 
had  his  description  conform  to  the  fact  exactly  as  it 
occurs. 

Fourth. — Therefore,  those  who  make  the  unnatu- 
ral claim  of  the  presence  of  bacteria,  or  vegetable 
organisms  in  the  same  parts  where  the  exactly  cor- 
responding forms  of  fibrin  develop  rapidly  and  in 
great  numbers,  must  show  us  the  clearest  distinc- 
tions between  these  two  sets  of  forms,  and  wherein 
they  differ,  also  something  of  the  projjortions  of 
each  in  the  part,  or  they  must  wholly  withdraw 
their  unnatural  claim,  and  allow  the  natural  fact  to 
take  its  place.  Some  allowance  must  certainly  be 
made  for  the  existence  and  presence  in  congested 
parts  of  these  forms  of  fibrin  in  every  case  of  dijjh- 
theria  (which  has  never  yet  been  done)  befoi'e  we 
can  understand  the  disease  fully  and  scientifically. 

Fifth. — Fibrin  is  always  in  excess  in  the  blood  in 
diphtheria,  and  all  the  false  membranes  of  tlie  dis- 
ease are  composed  of  fibrin.  So,  also,  are  all  the 
heart-elots,  or  thrombi  and  emboli  of  diphtheria 
composed  of  fibrin.  Then,  if  all  the  so-called  bac- 
teria of  diphtheria,  also,  are  nothing  but  coagulated 
particles  of  fibrin,  in  the  successive  steps  of  its  or- 
ganization to  form  the  false  membranes,  and  if  all 
thrombi  and  emboli  are  the  same,  we  see  what  a 
simple  solution  we  have  of  all  these  hitherto  great 
mysteries.  In  more  concise  language,  bacteria, 
heart-clots,  and  the  false  membranes  of  diphtheria 
are  all  one  and  the  same  thing,  namely,  fibrin  ;  bac- 
teria being  the  different  stages  of  fibrin  coagulating 
from  the  fluid  into  the  fibrillar  form  ;  heart-clots 
being  the  fibrils  of  fibrin  entangled  and  inter- 
laced with  each  other  into  a  mass  in  the  heart, 
something  as  they  form  in  a  clot  of  blood  outside  of 
the  body  ;  the  false  membranes  of  diphtheria  being 
fibrin  organized  into  more  or  less  dense  membi'snes, 
as  it  always  does  organize  when  extravasated  upon 
an  inflamed  surface. 

Suvth. — Fibrin  cannot  fibrillate  into  false  mem- 
branes, or  form  thrombi  without  forming  first  into 
granules,  and  these  granules  joining  into  threads  or 
rods.  Therefore,  we  certainly  must  have  the  gran- 
•nles  and  threads  of  fibrin  in  and  about  all  false 
membranes,  and  also  in  the  blood,  or  we  could  have 
■no  false  membranes  and  no  thrombi.  The  granules 
and  threads  of  fibriu  being  exactly  like  the  corre- 
sponding forms  of  the  so-called  bacteria,  and  occu- 
p.ying  the  same  positions  as  already  stated,  the 
place  where  the  latter  are  asserted  to  begin  their 
growth  or  development— that  is,  in  or  upon  con- 
gested and  inflamed  surfaces — is  taken  possession  of 
in  advance  by  the  organizing  fibrin  ;  so  there  is  no 
necessity  for  accounting  for  said  forms  in  any  other 
■way,  and  certainly  not  for  calling  them  bacteria. 

But  this  does  "not  complete  all  that  I  desire  to 
say  here  upon  this  subject  of  bacteria.  Kecently, 
when  reading  an  extract  from  a  lecture  by  Professor 


H.  C.  Wood,  of  Philadelphia,  I  fell  upon  this  para- 
graph :  "  The  membrane  from  an  affected  throat 
bears  everywhere  the  appeai-ance  of  little  balls  about 
the  size  of  blood-corpuscles,  either  singly  or  in 
gi'oups  of  four  or  more.  When  the  blood  is  exam- 
ined the  white  blood  cells  are  found  to  contain  these 
micrococci  moving  about  to  the  number  of  forty  or 
fifty  in  each  cell,  which  gradually  melt  down."  And 
this  :  "  By  careful  study  and  esijeriments,  both  in 
human  beings  and  the  lower  animals,  it  was  found 
that  this  infinitesimal  plant  fastens  upon  the  white 
coi-puscles,  and  multiplies  its  ceUs.  altering  their 
character  until,  with  the  interior  destroyed,  they 
burst,  and  the  plants,  set  loose  in  an  irregular  mass, 
separate  and  go  off  individually,  to  continue  the  de- 
structive work  on  other  corpuscles.  Thus  increased, 
they  poison  the  blood,  choke  the  vessels,  and  are 
found  in  myriad  numbers  in  the  sjDleen  and  bone 
marrow,  where  the  blood  is  manufactured." 

Now,  from  a  most  careful  study  of  the  nature  and 
demeanor  of  blood-corpuscles  under  all  circumstan- 
ces, which  study  has  continued  through  a  period 
of  twenty  years,  I  feel  confident  that  the  "  micro- 
cocci," to  the  "  number  of  forty  or  fifty,"  which  Prof. 
Wood  says  he  saw  in  each  white  blood-cell,  were 
nothing  more  nor  less  than  the  grantdes  which  natu- 
rally C0Q9litnte  every  white  blood-cell ;  and  that  the 
"little  balls  about  the  size  of  blood-corpuscles," 
which  he  describes  and  says  "  the  membrane  from 
an  affected  throat  everywhere  bears,"  were  simply 
red  blood-corpuscles  which  had  been  decolorized  by 
the  inflammatory  and  suppurative  processes,  and 
thereby  distended  from  their  natural  disc-shape  to 
the  globular  form,  and  thus  brought  to  the  appear- 
ance of  little  balls  without  color. 

Certainly,  all  white  blood-cells  are  constituted  of 
granules  to  the  number  of  forty  to  fifty  or  more  in 
each  cell,  which  any  one  may  see  pictured  in  Fig. 
12,  Plate  II.,  at  the  close  of  vol.  ii.,  "Lehmann's 
Physiological  Chemistry."  And  it  is  just  as  certain 
that  many  of  the  red  blood-corpuscles,  congested  in 
the  parts  or  vessels  under  diphtheritic  membranes, 
are  decolorized  by  the  inflammatory  process,  and  are 
thereby  made  viscous,  or  sticky,  so  that  they  readily 
adhere  together  in  groups. 

Red  blood-coi-ptiscles,  too,  when  decolorized,  and 
then  shrivelled  by  the  heat  of  inflammation,  or  by 
removal  to  the  plate  of  the  microscope,  also  present 
the  appearance  of  being  nothing  but  a  mass  of 
granules.  For  an  illustration  of  this  fact  I  would 
refer  the  reader  to  Fig.  6"),  p.  215,  "  Virchow's  Cel- 
lular Pathology,"  edition  of  1863,  by  J.  B.  Lippin- 
cott  &  Co.,  where  this  author  pictures  "  a  few 
granular  decolorized  blood-corijuscles  "  that  "  have 
become  evident,"  after  a  mass  of  "inspissated  hemor- 
rhagic pus"  had  been  "treated  with  water." 

Virchow  also  gives  a  fine  illustration  of  the  granu- 
lar structiu-e  of  white  blood-cells  in  Fig.  59,  p.  185, 
of  the  above-named  work. 

Thus,  it  may  be  seen  that  both  the  white  and 
decoloi-ized  red  blood-corpuscles  are  constituted  al- 
most wholly  of  granitles  ;  and  that  the  "  micrococci " 
seen  by  Prof.  Wood  in  the  white  blood-cells,  etc.,  ' 
were  no  doubt  the  natural  granules  constituting  said 
cells. 

Other  authors  also  speak  of  large  "bacterial 
cells,"  like  those  described  by  Prof.  Wood,  and  refer 
to  them  as  "parent-cells"  generating  and  filled  with 
micrococci,  which  finally  burst,  or  expel  their  brood, 
when  the  latter,  as  both  they  and  Wood  say,  seize 
upon  and  destroy  many  of  the  blood-corpuscles, 
and  much  besides  that  thev  come  in  contact  with. 


152 


THE  MEDICAL  RECORD. 


But  these  observers  were  all  evidently  deceived,  for 
they  were  no  doubt  simply  looking  at  and  describ- 
ing white  blood-cells  and  decolorized  red  blood- 
cells  aud  their  granules,  and  nothing  else ;  while 
the  claim  that  the  latter,  or  these  granules,  seize 
upon  or  destroy  blood-globules  or  other  structures, 
would  seem  to  be  an  imaginary  and  gratuitous  as- 
sumption. 

That  the  decolorized  blood-globules  burst,  or 
"  melt  down,"'  and  release  their  component  granules, 
is  true,  because  they  are  now  dead  cells  and  under- 
going disorganization,  that  is,  disintegrating  into 
the  granules  of  which  they  are  made,  like  all  other 
organic  structui-es  undergoing  decay  ;  but  that  they 
have  the  power  to  seize  upon  living  tissiies  or 
bodies  and  devour  them  is  wholly  imaginary, 
though,  when  stagnated  under  congestion,  until 
they  become  putrid,  they  may  then,  and  often  actu- 
ally do,  poison  other  tissues  and  structures,  and 
even  the  whole  system  to  a  serious  extent.  Leh- 
mann  says  of  globulin,  of  which,  as  all  know,  the 
blood-globules  are  in  great  part  constituted :  "  It 
decomposes  and  becomes  putrid  much  more  readily 
than  the  other  protein  compounds."  And  when 
these  granules,  aud  the  decolorized  blood-corpuscles 
as  well,  stagnate  under  congestion,  they  soon  be- 
come putrid,  and  may  do  much  harm  in  that  way, 
or  even  cause  sei^tictemia ;  but  they  do  not  and  can- 
not seize  upon  and  devour  other  structures  in  the 
sense  taught. 

And  this  brings  us  to  another  quite  important 
point,  in  a  scientific  sense  at  least,  for  a  proper  un- 
derstanding of  the  true  pathology  of  diphtheria 
in  all  its  bearings.  I  allude  to  the  fact  that  no  ob- 
server of  diphtheria,  whether  microscopic  or  other- 
wise, has  ever  hitherto  jjointed  out,  or  apparently 
even  recognized  the  distinction  that  exists  and 
should  be  made  between  the  gi-antdea  into  which  de- 
colorized and  disintegrating  blood-corpuscles  break 
up,  in  all  congested,  or  especially  suppurating 
parts,  in  diphtheria,  and  the  molecular  granules 
into  which  fibrin  first  coagulates,  in  all  such  parts. 
No  distinction,  I  repeat,  has  ever  hitherto  been 
pointed  out  between  these  two  sets  of  granules,  and 
yet  both  are  certainly  present  in  every  such  diseased 
part  in  every  case  of  diphtheria,  and  both  are  also 
present  to  a  greater  or  less  extent  in  the  general  cir- 
culation in  all  svcei-e  cases  of  the  disease.  And  they 
are  not  only  different  in  themselves,  but  very  difiier- 
ent  in  all  their  consequences,  which  also  should  and 
must  be  discussed  and  understood — the  granules  of 
fibrin  leading  directly  and  rapidly  on  to  the  organ- 
ization of  false  membranes,  and  also  to  heart-clots 
or  emboli,  while  the  granules  of  decolorized  and 
disintegrating  blood-corpuscles  lead  to  suppurations 
or  putrid  ulcerations,  and  possibly  to  septiciemia, 
but  never  to  false  membrane. 

We  therefore  find,  on  viewing  this  subject  from 
the  standpoint  of  nature's  great  simi)licity  in  all 
things,  that  all  the  pathological  or  unnatural  forms 
present  in  and  about  the  membranes  of  dijihtheria, 
in  all  c<)iigeHt(!d  and  iiitlamed  jiarts,  and  in  the 
blood,  wliich  have  been  niisciiUed  vegetable  jiara- 
sites  under  such  a  multitude  of  confusing  names, 
and  to  which  have  been  ascribed  so  much  malig- 
nancy and  disaster,  are  fully  accounted  for  on  the 
simplest  of  all  bases,  and  shown  to  be  mUiiral  ele- 
ments of  the  aninuil  body  morbidly  changed  in  ap- 
pearance and  local  d(!velopments  by  disease,  but  not 
the  cause  of  disease.  That  they  are  simply  the 
organizing  fornis  of  fll>rin  and  the  granules  of  de- 
colorized   blood-corpuscles,  supplemented   also,    to 


some  extent,  of  course,  by  the  shreds  and  grannies 
of  dissolved  natural  tissues  in  cases  of  snppuratic  n 
or  ulceration. 

What  Professor  Wood  says  of  the  "infinitesimal 
plant,"  or  micrococci,  being  "found  in  myriad  num- 
bers in  the  spleen,"  also  allows  of  the  simplest  of  all 
explanations.  He  was  unquestionably  looking  at 
white,  or,  more  strictly  speaking,  at  decolorized 
blood-corpuscles  in  the  spleen,  and  the  granules  into 
which  many  other  such  oorjjuscles  had  been  broken, 
which  are  sent  to  the  spleen  to  be  still  further 
disintcgTated,  preparatory  to  being  cast  out  of  the 
system  through  the  bowels,  as  refuse  matter.  Be- 
sides, the  blood-globules  are  not  made  in  the  spleen, 
but  by  the  mesenteric  glands,  and  disintegrated  by 
the  spleen  and  liver  at  the  close  of  their  life,  whether 
of  old  age  or  disease. 

It  will  thus  be  seen  what  a  purely  scientific  and 
yet  very  simple  solution  we  have  of  all  these  many 
points,  and  how  inseparably  connected  they  are.  All 
mystery  is  at  once  dispelled,  the  physician's  mind  is 
released  from  the  contemplation  of  something  he 
does  not  understand  and  the  dread  which  that  en- 
genders, and  his  entire  time  and  thought  can  be 
given  to  the  best  curative  means  to  be  employed  in 
the  disease,  instead  of  being  bewildered  and  dis- 
tracted, as  now,  to  find  something  that  wiU  the  most 
effectually  destroy  what  does  not  exist — at  least,  as 
a  devouring  parasite,  or  even  as  an  element  foreign 
to  animal  life — excepting  in  the  imagination. 

Mystery  and  error  must  be  made  to  give  way  to  sim- 
plicity and  truth  in  pathology. 


CuTANEOiTS  Eruptions  Caused  by  the  Use  of  Cer- 
tain Medicines  (Giorn.  It.  dei  Malatt.  Vener.  e  del 
Pelle,  June,  1881). — Anspitz,  in  his  valuable  "  Sys- 
tem der  Hautkrankheiten,"  gives  the  following  list  of 
eruptions  liable  to  follow  the  use  of  certain  reme- 
dies.    It  will  be  a  iiseful  table  for  reference  : 

Quinine. — (a)  Scarlatinous  erythema,  (6)  morbil- 
lous  papular  erythema,  (o  h;emorrhagia  and  pur- 
pura, (dj  wheals,  oedema,  priiritus. 

Cinchona,  Belladonna,  Strychnine,  and  Stramonium. 
— Manifestations  like  papula?  sudorales. 

Digitalis. — Erythema  after  a  few  days'  use. 

Aconite. — Vesicular  exanthema. 

Sanlonine. — Vesicles,  wheals. 

RJius  Venenata  and  To.xicodendron.  —  Vesicular 
eruption. 

Opium  and  Morphine. — Erythema,  papular  erup- 
tion, with  much  desquamation  and  prm-itus. 

Pilocarpin  (?) — Augmentation  of  the  perspiration. 

Phosphorus. — Purpura. 

Phospjhoric  Acid. — Bullous  eruption. 

Mercury  (internally). — Erythema,  eczema. 

Arseiiic. — Erythema  and  pap^iles,  eczema. 

Carbolic  Acid. — Erythema,  vesicles,  or  wheals. 

Salicylic  .Acid. — Purpura,  vesicles  with  laryngeal 
catarrh,  wheals. 

Chlond  Hydrate. — Erythema  (well  colored),  pru- 
ritus, desquamation,  purpiira  and  petechia?,  eczema 
with  crust  and  scab. 

Balsam  Cojyaiba,  Cubcbs,  Turpentine.  —  Vesicles, 
erythema,  eczema. 

Cod-Liver  Oil. — Acne. 

Iodide  of  Potash.  —  Papules,  vesicles  and  bullse, 
pustules  and  ecthyma,  eczema,  ecchymosis,  and 
purpura. 

Bromide  of  Potassium.  —  Papules  and  pustules, 
deep  tubercles  and  ecchymosis,  vesicles,  ulcers. — 
Virginia  Medical  Monthly. 


J 


THE  MEDICAL  RECOED. 


153 


TEIVIPOKARY  FEBRILE   RISE   AFTER 
SIMPLE   FRACTURES. 

By  j.  W.  STICKLER,  M.D., 

ORANGE,   N.  J. 

In  the  treatment  of  quite  a  large  number  of  simple 
fractures,  while  serving  as  house  surgeon  to  the  Pres- 
byterian Hospital,  X.  Y.,  I  discovered  that  iu  almost 
every  instance  there  was  an  appreciable  elevation  of 
temiserature  beginning  within  twelve  hours  after  the 
receipt  of  the  injury.  In  order  to  ascertain  definitely 
the  range  of  temperature,  I  had,  at  the  suggestion 
of  L.  A.  Stimson,  M.D.,  the  temperature  of  a  num- 
ber of  ijatients  taken  night  and  morning  for  several 
consecutive  days.  The  table  shows  the  result.  A 
few  of  the  temperature-charts  were  kindly  furnished 
me  by  my  successor,  Dr.  W.  K.  Simpson. 


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Fracture  of  femur 

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Fracture  of  leg. 

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femur  in    lower 

Practnie  of  patella. 
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Kraetnre  of  tibia. 
Fracture  of  femur 

in  lower  third. 
Fracture  of  cervix 

femorlB. 
Fracture  of  femur 

in  upper  third. 
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Dr.  Theodore  Billroth,  in  his  article  on  "  Trau- 
matic Fever  of  Open  "Wounds,"  states  that  in  some 
instances  the  temperature  begins  to  rise  immedi- 
ately after  the  injury,  but  more  commonly  on  the 


second,  third,  or  fourth  day.  The  highest  tempera- 
ture attained,  although  this  is  rare,  is  104-1(15  F. 
As  a  rule,  it  does  not  rise  above  101'-10'2  F.  This 
simple  traumatic  fever  does  not  last  more  than  seven 
days,  and  in  some  cases  it  is  entirely  aV)sent.  It 
will  be  observed  that  the  course  of  temperature  as 
liere  given  corresponds  very  closely  with  that  of 
simple  fractures.  In  every  instance  except  one  (No. 
6)  did  the  temperature  rise  within  twelve  hours  after 
the  injury.  The  highest  elevation  readied  was 
102J°  F.,  and  as  it  is  probable  that  such  a  tempera- 
ture in  these  injuries  is  rarely  exceeded,  it  may  be 
regarded  as  the  maximum  elevation  ;  hence,  a  ther- 
mometrio  difference  between  subcutaneous  and  open 
wounds,  i.e.,  a  temijerature  of  102f"  F.,  following  a 
subcutaneous  wound  from  which  air  is  exchtded,  is 
much  lower  than  the  maximum  temperature  of  an 
open  wound  whose  surface  is  exposed  to  atmos- 
pheric influences.  The  highest  average  elevation  of 
temperature  of  the  thirteen  cases  was  attained  dur- 
ing the  first  three  days,  although  this  result  does 
not  indicate  the  day  on  which  in  every  instance  the 
highest  point  was  reached,  for  in  Xos.  1  and  6  the 
maximum  elevation  was  reached  on  the  fifth  day,  in 
No.  9  on  the  fourth  day,  while  in  Nos.  2,  3,  8,  11, 
and  V2  it  was  attained  on  the  first  day,  and  in  Nos. 
4,  5,  (),  7,  and  13  on  the  second  day.  Thus,  while 
the  temperature  does  not  reach  the  maximum  of 
elevation  in  some  cases  till  the  fourth  or  fifth  day, 
it  is  the  rule  for  it  to  reach  the  highest  point  during 
the  first  forty-eight  hours.  The  duration  of  the 
febrile  rise  in  these  cases  is  also  about  the  same  as 
in  open  wounds,  for  in  ten  of  the  cases  the  normal 
temperature  was  reached  on  the  seventh  day,  and 
after  that  period  did  not  vary  from  98|°  F.  more 
than  i°  or  i"  F.  In  only  one  case  was  the  fever  ab- 
sent ;  that  was  in  the  case  of  fracture  of  the  patella, 
due  to  muscular  action.  If  this  injury  may  be  sub- 
stituted for  such  an  one  as  Billroth  refers  to  when 
speaking  of  a  slight  wound  which  causes  no  general 
rise  of  temperature,  the  analogy  between  the  febrile 
disturbance  of  the  two  lesions,  ojien  and  sub- 
cutaneous wounds,  will  be  nearly  perfect.  Hunter 
says  :  "  The  injuries  done  to  sound  parts  I  shall  di- 
vide into  two  sorts,  according  to  the  eftects  of  the 
accident.  The  first  kind  consists  of  those  in  which 
the  injured  parts  do  not  communicate  externally,  as 
concussions  of  the  whole  body  or  of  particular  parts, 
strains,  bruises,  and  simple  fractures,  which  form  a 
large  division.  The  second  consists  of  those  which 
have  an  external  communication,  comprehending 
wounds  of  all  kinds  and  compound  fractures.  The 
injuries  of  the  first  division,  in  which  the  parts  do 
not  communicate  externally,  seldom  inflame,  while 
those  of  the  second  commonly  both  inflame  and  sup- 
purate. Of  tlie  two  injuries  inflicted  in  a  wound — 
the  mechanical  disturbance  of  the  parts  and  the  ex- 
posure to  the  air  of  those  that  were  covered— the 
exposure,  if  continued,  is  the  worse.  Both  are  apt 
to  inflame,  but  the  exposure  excites  it  the  more  cer- 
tainly and  in  the  worse  form.  In  simjile  fractures  an 
early  consequence  is  a  production  of  inflammatory 
Ivmph  containing  a  large  proportion  of  albumen, 
fibrinogenous  substances,  chlorides,  phosphates, 
and  carbonates.  The  blood-vessels  are  dilated,  the 
blood-current  becomes  slower,  many  of  the  white 
and  some  of  the  red  globules  pass  throngh  the  walls 
of  the  vessels.  The  tissue-elements  are  swollen, 
while  the  nuclei  and  cells  undergo  proliferation. 
These  changes  give  rise  locall.v  to :  1st,  pain,  be- 
cause of  pressure  on  the  nerves  by  the  swollen  tis- 
sues; 2d,   redness,   because   of  increase   of  blood, 


154 


THE  MEDICAL  RECORD. 


exudation  of  haematin  and  red  blood-globules ;  3d, 
swelUng,  on  account  of  the  exudation  of  lymph,  in- 
creased cell-growth,  and  increased  flow  of  blood  to 
the  part ;  4th,  heat,  because  of  increased  flow  of 
blood  and  chemical  changes.  The  local  signs  of  in- 
flammation are  well  marked  in  proportion  as  the  • 
part  injured  is  near  the  surface  — in  fracture  of  the 
tibia  the  inflammatory  signs  being  well  marked,^ 
wliile  in  fracture  of  the  thighthey  are  more  obscure." 
If,  tlien,  it  is  the  rule  for  these  phenomena  to  follow 
a  subcutaneous  mechanical  disturbance  of  the  tis- 
sues, occasioned  by  the  fracture  of  a  bone,  it  is  not 
fair  to  assume  that  subcutaneous  wounds  seldom  in- 
flame because  air  is  excluded  from  them,  for  the 
cases  tabulated  seem  to  indicate  that  inflammation 
does  follow  these  injuries,  and  that  the  presence  of 
air  is  not  a  necessary  condition  for  the  development 
of  such  an  inflammation.  Of  course  the  process  was 
a  much  milder  one  than  would  have  been  the  case 
had  air  been  admitted  into  the  wounds,  in  which 
case  suppuration  would  have  suiservened,  provided 
the  exposure  had  been  continued  long  enough.  Li- 
flammation,  however,  may  be  just  as  comiflete  in 
type  when  organizable  lymph  is  a  product,  as  when 
pus  is  formed.  The  thermometric  range  in  these 
cases  apparently  indicated  the  duration  of  this  in- 
flammatory stage,  for  it  will  be  remembered  that 
the  temperature  remained  highest  during  the  first 
three  days— the  period  mentioned  by  pathologists 
as  the  one  in  which  tlie  inflammatory  lymph  is 
thrown  out.  The  conclusions,  then,  which  may  \)e 
deduced  from  a  consideration  of  these  cases,  so  far 
as  they  go,  are  :  1st,  that  it  is  the  rule  rather  than 
the  exception  for  the  temperature  to  rise  after  simple 
fractures  of  the  long  bones  ;  2d,  that  the  maximum 
elevation  of  temperature,  in  the  majority  of  tliese 
cases,  is  reached  during  the  first  three  days,  or  "the 
period  of  inflammation." 


A  Novel  and  Simi'le  Method  of  Eemoving  In- 
sects PROM  THE  Ear — B.  F.  Kingsley,  M.D.,  Acting- 
Assistant  Surgeon,  U.S.A.,  of  Fort  Quitman,  Texas, 
writes :  "  The  article  in  The  Kecord  of  December 
30tli,  on  '  The  Expulsion  of  Insects  from  the  External 
Auditory  Canal,'  brought  to  my  mind  a  simple  case 
that  came  under  my  notice  a  few  years  ago,  wliich 
may  be  of  some  interest.  While  en  route  from 
San  Antonio,  Texas,  to  Fort  Concho,  Texas,  in  .June, 
1877,  with  recruits,  I  was  aroused  from  my  sleep 
one  night,  about  midnight,  by  a  man  who,  much 
frightened,  said  '  ho  had  a  bug  in  his  ear.'  In  short 
order  I  had  a  light,  a  pair  of  tixation-forceps,  a  glass 
penis-syringe,  and  a  basin  of  water,  and  in  a  shiv- 
ering condition  pi-ooeeded  to  give  the  patient  relief. 
I  had  no  sooner  placed  the  candle  before  the  ear 
than  the  bug — a  small  black  one — ran  out  over  the 
cheek,  and  jumped  off  on  to  the  ground  very  quickly. 
When  told  that  the  bug  was  gone  he  would  not  be- 
lieve me,  because  I  had  done  nothing ;  he  had 
been  intent  on  my  syringe — which  evidently  ho  had 
used  before  for  quite  another  pur|)0se — and  had  not 
noticed  the  escape  of  tlio  bug.  Upon  several  occa- 
sions while  scouting,  I  have  been  successful  in  remov- 
ing insects  from  the  ear  at  night  bysimi)ly  placing 
a  light  near.  "Wo  all  know  what  a  peculiar  attrac- 
tion light  has  for  insects  at  night,  and  under  the 
circumstances  related,  it  seems  to  retain  its  attrac- 
tive power  over  an  aural  abiding-iflace,  and  the  in- 
sect rushes  toward  it  as  usual,  with  the  desired  re- 
sult." 


|)ro0re0S  of  illeUicol  Science. 


SuKGicALi  Operations  and  theib  Relations  tvtth 
Diabetes,  and  the  Origin  of  the  Latter. — At  the 
meeting  of  the  AcadCmie  de  Mfdecine,  held  Novem- 
ber 29th,  M.  Verneuil  made  a  communication  having 
practical  bearing  on  the  obscure  toiiic  of  diabetes 
mellitus  and  its  inter-relations  with  other  afl'ectiong. 
The  first  case  brought  forward  was  that  of  a  man, 
fifty  years  of  age,  of  robust  figure,  who  consulted 
him  for  epithelioma  of  the  penis.  Some  years  pre- 
viously he  had  suflfered,  while  in  Africa,  from  inter- 
mittent fever,  -but  had  apparently  recovered.  His 
urine  contained  a  large  proportion  of  sugar  daily 
(twelve  grammes).  On  the  second  day  following  the 
operation  he  had  a  well-marked  attack  of  intermit- 
tent fever,  which  yielded  to  quinine,  Irat  about  the 
fifteenth  day  sugar  reappeared  in  considerable  quan- 
tity, although  the  antidiabetic  treatment  had  pre- 
viously reduced  the  sugar  to  a  minimum. 

The  second  case  narrated  was  that  of  an  Algerian, 
who  was  operated  upon  for  epithelioma  of  the 
tongue.  His  urine  contained  sugar  and  urea.  On 
the  fifth  day  after  the  operation  he  experienced 
most  acute  pain  in  the  wound,  and  upon  a  number 
of  consecutive  days,  at  the  same  hour,  there  was 
hemorrhage  from  the  wound.  Quinia  controlled 
the  pain  and  checked  the  bleeding. 

A  third  patient  had  gangrene  of  the  heel.  He  had 
suffered  much  from  malarial  fever,  and  his  urine  was 
highly  charged  with  sugar.  M.  Verneuil,  recogniz- 
ing the  case  as  one  of  glycosuric  gangrene,  adminis- 
tered the  sulphate  of  quinine.  The  eschar  sejiarated 
and  the  wound  healed.  Judging  from  these  and 
other  instances  in  his  experience,  the  following  con- 
clusions were  formulated,  which  in  many  respects 
corroborate  older  views  expressed  by  Corneliani, 
Sydenham,  Cullen,  Pi'out,  Griesinger,  and  many 
others.  Malarial  infection  is  frequently  engendered 
by  glycosuria,  which  assumes  two  forms :  one  con- 
temporaneous wich  the  access  of  fever,  and,  like  it, 
transitory  ;  the  other  slow  in  development,  inde- 
pendent of  febrile  exacerbation,  and  of  permanent 
dui'ation.  This  latter  variety  seems  to  attack,  by 
preference,  the  malarious  of  vigorous  type  and  sub- 
jects of  arthritic  difficulties.  The  intercurrent  affec- 
tions in  the  uialario-diabetics  may  assume  the  type 
of  either  one  or  the  other  of  the  associated  diseases, 
or  of  both  combined.  When,  in  such  cases,  surgi- 
cal operations  are  performed,  a  fresh  impetus  may 
be  given  to  either  the  malaria  or  the  glycosuria, 
nveferablv  the  former. — BttlL  de  I' Acad,  de  Med.,  48, 
1881. 

LUMBO-COLOTOMT   AS   A    PbELIMINABY    MEASURE   UK 

Imperforate  Rectum. — Dr.  W.  A.  Byrd,  of  Qnincey, 
111.,  describes  an  interesting  series  of  procedures, 
which  succeeded  in  establishing  a  passage  for  fieoes 
in  the  normal  situation.  Being  called  to  see  an  in- 
fant, two  days  old,  with  imperforate  anu.-j,  he  made 
an  incision  backward  and  upward  from  the  anus,  to 
the  depth  of  two  and  one  half  inches.  No  evidence 
of  intestine  being  obtained,  and  the  trocar  and 
canula  having  previously  failed  to  discover  intes- 
tinal contents,  lumbo-colotomy  was  performed  upon 
the  left  side.  An  incision,  two  inches  in  length, 
was  made  downward  and  forward  fi-om  a  point  over 
the  cxteiTial  border  of  the  quadratus  luniborum 
muscle,  and  half  way  between  the  ilium  and  the 
ribs.      The  left  kidney  was   disclosed  in  this  way. 


THE  MEDICAL  RECORD. 


155 


but,  by  an  incision  extending  one  inch  farther 
forward,  the  descending  colon  was  reached.  An 
oblique  cut  was  then  made  in  it,  three-fourths  of  an 
inch  long,  and  the  edges  of  the  intestinal  opening 
were  stitched  to  the  skin  at  the  inner  border  of 
the  external  wound.  The  wound  was  well  cicatrized 
in  a  week,  but  the  bowel  woiild  evert  to  the  extent 
of  some  two  or  three  inches,  giving  great  pain  if 
the  part  was  not  returned  and  held  hi  silu  by  a  pad. 

Accordingly  a  further  eliort  was  made  about  a 
month  later.  The  linger  being  passed  into  the  bowel, 
through  the  wound,  it  was  found  that  the  calibre  of 
the  bowel  easily  permitted  its  passage  for  about 
three  inches,  when  it  suddenly  narrowed.  Into  this 
narrow  portion  was  pnissed  a  small  sound,  used  as  a 
searcher  in  infants,  and  the  end  of  it  was  worked 
down  in  the  narrowed  bowel  toward  the  anus. 

An  incision,  two  inches  deep,  admitting  the  index 
finger,  was  made  from  the  anus  to  the  coccyx,  with 
the  view  of  meeting  this  instrument  from'  below. 
Finding  that  only  about  one-eighth  of  an  inch  inter- 
vened between  the  instrument  and  the  finger,  the 
former  was  pushed  through  the  intermediate  space. 
To  the  point  of  the  searcher  a  short  thread  was 
then  attached,  and  this  in  turn  to  a  No.  10  Jacques' 
catheter,  which  was  drawn  into  the  passage  thus 
formed,  while  either  extremity  projected,  one  from 
the  upper  and  one  from  the  lower  wound.  But  a 
third  operation  was  required  to  secure  the  establish- 
ment of  a  more  natural  outlet  for  the  fa?ces.  Taking 
a  piece  of  soft-rubber  tubing,  about  a  foot  long  and 
as  large  round  as  the  little  finger,  half  an  inch  of 
one  extremity  was  tucked  up  into  the  tube,  making 
a  bulbous  extremity.  This  end  was  then  attached 
by  a  stout  thread  to  the  catheter  and  drawn  into  the 
bowel.  By  steady  traction  the  nan'owed  cul  de  sac 
was  drawn  down  into  the  new  anal  opening  and  fit- 
ted into  place,  so  that  there  is  now  a  continuity  of 
mucous  membrane  from  mouth  to  anus. 

It  is  now  hoped,  and  confidently  expected,  that 
the  first  artificial  opening  will  close  without  further 
operative  interference.  In  case  this  hojje  is  not  real- 
ized, a  plastic  operation  will  be  resorted  to.  The 
infant  is  now  doing  very  well. — St.  Louis  Courier  of 
Medicine,  December,  1881.  [ 

Besjjet  on  Liacer.4tiox  of  the  Cekvtx  Uteki. — In 
the  Gynecological  Section  of  the  International  Med- 
ical Congress  of  London,  Dr.  J.  Henry  Bennet  read 
a  paper  calculated  to  check  some  of  the  enthusiasm 
with  which  the  advocates  of  Emmet's  operation  have 
proclaimed  the  virtues  of  this  method  for  relieving 
uterine  disease.  Eefening  to  the  work  of  American 
and  German  gynecologists  during  the  past  few  years, 
he  credits  them,  the  former  esj^ecially,  with  doing 
good  work  in  bringing  the  matter  of  laceration  so 
prominently  before  the  pi-ofession,  but  he  dissents 
from  the  view  that  such  lacerations  are  the  fertile 
causes  of  hypertrophy,  displacement,  leucorrhcea, 
sterility,  or  are  apt  to  produce  post-purtuni  hemor- 
rhage, septicaemia,  metritis,  and  the  like. 

He  admits  that  these  moi-bid  conditions  may  fol- 
low labor  in  a  healthy  female  from  manual  or  instru- 
mental interference,  but  he  regards  such  accidents 
as  exceptional.  In  an  experience  of  forty  years  he 
has  always  succeeded  in  healing  the  laceration  and 
in  curing  the  morbid  manifestations  accompanying 
them,  by  simple  surgical  means  and  appliances,  with- 
out any  plastic  operation.  In  a  certain  class  of 
cases  the  propriety  of  such  an  operation  may  be  de- 
cisive, as  when  the  laceration  extends  to  the  blad- 
der. He  observes  also  that,  singularly  enough,  during 


the  last  twenty  years,  gynecologists,  eminent  on 
both  sides  of  the  water,  advocated  deep  incision  of 
the  cervix,  even  down  to  the  bcdv  of  the  uterus,  for 
nearly  every  uterine  ailment^in  tact,  the  san  e  class 
that  now  are  to  be  cured  by  the  opposite  course  of 
treatment,  viz.,  sewing  up  the  rents.  Such  extreme 
doctrines,  therefore,  rebut  tht  mselves.  The  explaca- 
tion  given  of  the  apparently  marvellous  cases  is  as 
follows:  those  who  perfoim  the  operations  do  not 
themselves,  in  most  instances,  follow  up  their  sub- 
sequent histories. 

■rhe  eminent  gynecologist  leaves  the  operation  to 
the  family  attendant,  thinking,  most  conscientiously, 
that  he  has  cured  the  case,  when,  in  reality,  the 
health  has  been  little,  if  at  all,  imjiroved  ;  or  the 
patient  may  belong  t-o  that  class  of  women  whose 
uterus  and  ovaries  require  attention  frcm  the  date 
of  menstmation  to  the  menopause.  Ko  treatment 
of  any  form  or  kind  will  give  them  complete  relief, 
but  they  are  always  ready  and  willing  to  submit  to 
anything  new  in  the  way  of  treatment  or  practice, 
and,  whatever  is  done,  are  apt  to  think  themselves 
improved.  The  real  therapeutic  value  of  any  treat- 
ment in  such  cases  cannot  be  appreciated  until 
years  have  passed  by.  Dr.  Bennet  states  that,  in  ut- 
tering this  protest  against  methods  that  he  regards  as 
unreascnably  surgical,  he  has  no  desire  to  obstruct 
real  progress,  but  will  still  accept  new  views  and  new 
doctrines,  provided  they  have  a  legitimate  basis  on 
facts. — British  Medical  Journal,  November  26,  1881. 

Htoeo-  and  Pto-Salpisx  :  their  Causation,  akd 
TEE  Noksial  Position  of  the  Ovakt. — At  a  recent 
meeting  of  the  London  Pathological  Society,  Mr. 
Lawson  Tait  exhibited  twelve  tijecimens,  with  the 
object  of  directing  attention  to  the  pathological 
anatomy  of  diseased  Fallopian  lubes.  The  patients 
had,  with  one  exception,  been  married  and  preg- 
nant, but  had  been  long  under  treatment  for  men- 
strual irregularities  and  distress.  As  bearing  upon 
the  etiology  of  such  aifections,  it  was  observed 
that  the  cases  (nine  in  number^  had  each  given  a 
history  of  some  previous  pelvic  inflammation,  of 
pain  on  exertion,  during  sexual  intercourse  and 
menstruation,  and  of  tender,  fluctuating,  localized 
swellings  on  the  sides  of  the  uterus.  The  treat- 
ment recommended  was  excision  of  these  uterine 
appendages.  Tapping  was  held  to  be  diiBeult,  and, 
if  practised,  useless.  Ail  of  the  operations  i^roved 
successful,  and  the  patients  (twenty  two  in  number) 
were  completely  cured.  Menstruation  was  stopped, 
but  the  marital  function  was  restored.  Ovaritis  is 
named  as  the  primary  disease,  the  inflammation  ex- 
tending progressively  along  the  tube  to  its  uterine 
extremity.  In  commenting  on  these  cases,  Mr.  A. 
Doran  alluded  to  the  falsity  of  our  prevailing  opin- 
ions as  to  the  relation  in  po.sition  between  the  ovary 
and  the  fimbria;  of  the  Fallopian  tube.  Instead  of 
overhanging  the  ovary,  the  fimbrire  lie  beneath  or 
to  the  outside  of  it,  and  therefore  the  "niorstis  dia- 
roke"  is  a  delusion.  The  ripe*  ova  have  simply  to 
droi^  into  the  tube,  and  they  may  be  fortunate 
enough  to  fall  at  once  among  the  spermatozoa. 
Pathological  anatomy  corroborates  this  view,  for, 
when  adhesions  take  place  between  the  ovary  and 
the  fimbria",  the  latter  underlie  or  are  to  the  out- 
side of  the  former. — Lancet,  December  10,  1881. 


^Medical  Department  of  the  Uniteesitt  of  the 
City  of  New  York. — Dr.  William  C.  .Tarvis  has  been 
appointed  lecturer  in  Laryngology,  vice  Professor  L. 
Elsberg,  M.D.,  resigned. 


156 


THE  MEDICAL  RECORD. 


The  Medical  Record: 


^  lUccklt)  JJournal  of  fttcbicine  anb  Suvgn-y; 


GEORGE  F.  SHRADY,  A.M.,  M.D.,  Editor. 


PUBLISHED   BY 
WM.  WOOD  &  CO.,  No.  27  Great  Jones  St.,  N.  Y. 


New  York,  February  11,  1882. 

THE  PROGRESS  OF  THERAPEUTICS. 
It  seems  to  be  in  the  nature  of  scientific  study  to 
run  for  a  time  in  certain  special  lines,  to  the  neg- 
lect of  others— first  one  branch  and  then  another 
being  pushed  far  out  in  advance  of  the  general  prog- 
ress of  the  science,  and  receiving,  for  the  time,  almost 
the  undivided  attention  of  investigators.  This  has 
been  pre-eminently  the  case  in  medicine.  Anatomy, 
physiology,  physical  diagnosis,  and  lastly  pathol- 
ogy, have  each  in  their  turn  almost  monopolized  the 
study  of  those  who  gave  direction  to  medical  thought. 
But  the  branch  which  includes  in  itself  the  object 
and  aim  of  all  the  others  has  always  been  allowed 
to  lag  far  behind.  More  has  been  known  about 
everything  else  in  medicine  than  about  the  cure  of 
disease. 

It  is  only  within  a  comparatively  recent  period 
that  any  systematic  effort  has  been  made  to  do  for 
therapeutics  what  so  many  and  such  zealous  woi-lcers 
have  been  doing  for  the  other  departments  of  medi- 
cal science.  Thero  can  be  no  doubt  that  legitimate 
medicine  owes  not  a  little  to  the  homcBopathists  for 
stimulus  given  to  investigation  into  the  so-called 
physiological  action  of  drugs  ;  and  it  is  only  to  be 
regretted  that  tlie  good  work  which  they  did  was  so 
overlaid  by  absurdities  as  to  make  disgusting  the 
task  of  separating  the  wheat  from  the  chaff.  Never- 
theless, partly  by  their  efforts  and  partly  by  the  ef- 
forts of  others,  a  beginning  was  made  toward  a 
thorough  and  criticad  study  of  the  materia  medica 
in  its  relations  to  the  human  body.  From  this  be- 
ginning there  has  been  very  notable  progress,  and 
especially  during  the  last  two  or  three  decades.  A 
great  stride  forward  was  made  when  the  attention 
of  investigators  was  directed  toward  ascertaining  the 
hidden  stops  by  whicli  the  obvious,  palpable  action 
of  a  drug  was  l>rought  about.  For  example,  it  is  the 
obvious  action  of  certain  drugs  to  produce  sleep,  and 
of  others  to  proiluoe  convulsions,  and  the  earlier  ob- 


servers were  contented  with  simply  noting  these  facts. 
But  later  investigators  went  beneath  these  superficial 
appearances,  and  by  direct  experiment  found  that  in 
the  one  case  sleej?  was  preceded  by  anaemia  of  the 
brain,  and  in  the  other  that  the  convulsions  were  ac- 
companied by  congestion  of  the  cord.  Still  further 
investigation  showed  that  these  vascular  changes 
were  produced  through  the  agency  of  the  nervous 
system,  and  that,  at  least  in  the  case  of  the  brain, 
mechanical  factors  sometimes  entered  into  the  prob- 
lem, so  that  apparent  venous  congestion  produced 
real  capillary  ansemia  by  the  compression  exerted 
upon  the  cerebral  mass. 

This  example  illustrates  the  direction  which  ther- 
apeutical research  is  now  taking,  and  in  which  the 
most  encouraging  progi'ess  is  being  made.  Medi- 
cines are  beginning  to  be  classified  according  to 
their  primary  action  rather  than  their  secondary  re- 
sults, and  the  old  loose  and  general  designations, 
such  as  stimulants,  tonics,  antispasmodics,  evacu- 
ants,  etc.,  are  giving  way  to  terms  expressing  the 
action  upon  special  centres,  such  as  cardiac,  vaso- 
motor, cerebral,  spinal,  cerebro-spinal,  excitants  and 
depressants,  etc.  We  now  ask  ourselves,  not  What 
is  good  for  the  disease  in  hand  ?  but  What  are  the 
morbid  conditions  which  find  expression  in  the  dis- 
ease ?  How  far  are  they  capable  of  being  modified 
by  drugs  ?  and  lastly.  What  medicines  will  be  best 
adapted  to  effect  these  modifications  ?  This  series 
of  questions  shows  not  only  the  dependence  of  ra- 
tional therapeutics  upon  pathology,  but  also  that 
pathology  cannot  be  brought  to  the  aid  of  therapeu- 
tics except  through  a  knowledge  of  the  initial  action 
of  drugs  upon  the  several  parts  of  the  body.  Thus, 
if  our  knowledge  of  pathology  enables  us  to  deter- 
mine that  there  is  spasm  of  the  vessels  in  a  given 
part,  and  experimentation  has  taught  us  tl)at  a  cer- 
tain medicine  will  relax  the  vessels  of  that  part,  we 
have  an  exact  indication  for  the  use  of  that  medicine 
such  as  no  amount  of  merely  clinical  experience 
could  aflbrd  us. 

Most  important  resiilts  have  been  obtained  in  de- 
termining the  effect  of  particular  drugs  upon  par- 
ticular organs.  It  is  here  that  all  the  good  that  ho- 
moioijathy  has  accomplished  has  been  done,  although 
it  is  entitled  to  credit  for  but  a  very  small  part  of 
the  progress  made. 

In  a  general  way  it  has,  of  course,  always  been 
known  that  emetics  act  upon  the  stomach,  and  ca- 
thartics upon  the  bowels ;  that  the  skin  is  stimu- 
lated by  diaphoretics,  and  the  urine  increased  by 
diuretics ;  and  the  use  of  drugs  with  the  purpose  of 
"  stirring  up  the  liver  "  is  as  old  as  medicine  itself. 
But  in  later  times  it  has  been  found  tliat  tliis  prin- 
ciple of  elective  action  has  a  much  wider  range  than 
was  supposed,  and  is  much  more  definite  and  exact 
in  its  application.  Thus,  the  action  of  ergot  upon 
unstriped  muscular  fibre  makes  it  much  more  than 
a  "  parturient,"  and  that  of  aconite  upon  the  vaso- 


THE  MEDICAL  RECORD. 


157 


motor  centres  makes  it  more  than  a  simple  diapho- 
retic or  febrifuge.  The  specific  action  of  the  sola- 
nace.'c  upon  the  third  nerve,  and  of  aconitia  iipon 
the  fifth,  of  quebracho  upon  the  respiratory  centres, 
and  of  digitalis  upon  the  cardiac,  are  instances  in 
point.  Xay,  sometimes  special  branches  of  a  nerve 
are  affected  to  the  exclusion  of  other  branches  of  the 
same  nerve,  as,  for  example,  the  twig  to  the  levator 
palpobr^,  which  is  paralyzed  by  gelsemium. 

Examples  of  this  elective  action  are  already  very 
numerous,  and  this  list  is  probably  but  just  begun. 
Indeed,  it  seems  not  unlikely  that  in  the  course  of 
time  nearly  every  organ  and  tissue  in  the  body  will 
be  found  to  have  special  relations  to  special  drugs. 

Very  valuable  work  has  been  done  in  studying  the 
antagonisms  of  medicines.  The  British  Commis- 
sion appointed  some  ten  or  twelve  years  ago,  with 
Hughes  Bennett  at  its  head,  brought  out  some 
very  important  results,  many  of  which,  however, 
had  been  anticipated  in  our  own  country,  and  that 
too  by  a  worker  belonging  to  the  gentler  sex.  The 
Cartwright  lectures  by  Professor  Bartholow,  along 
with  much  that  is  original,  give  an  admirable  sum- 
ming up  of  what  has  been  accomplished  of  late  in 
this  most  interesting  field,  while  Fothergill's  little 
treatise  on  the  same  subject  is  full  of  valuable  in- 
formation. 

Going  back  only  so  short  a  period  as  twenty  years, 
we  have  had  within  that  time  many  new  and  most 
valuable  medicines  added  to  our  list.  Among  these 
may  be  mentioned  the  bromides,  iodoform,  chloral, 
carbolic,  salicylic  and  boracic  acids  and  their  com- 
pounds ;  thymol,  amyl  nitrite,  guarana,  jaborandi, 
quebracho,  etc.  Hypodermic  medication  with  its 
multiform  uses,  and  rectal  alimentation,  have  been 
added  to  our  resources  within  this  period. 

The  use  of  small  and  frequently  repeated  doses, 
which  has  been  introduced  within  a  few  yea-rs,  seems 
to  have  much  to  recommend  it,  especially  in  the 
case  of  drugs  which  are  raj)idly  eliminated.  If  the 
action  of  a  medicine  is  needed  at  all,  it  appears  more 
reasonable  that  it  should  be  sustained  at  a  nearly 
even  intensity,  rather  than  that  the  field  should  be 
occupied  alternately  by  the  remedy  and  the  disease. 
The  subject  has  not  yet  received  the  attention  which 
it  deserves,  and  it  is  to  be  hoped  that  its  merits 
will  be  tested  on  a  sulEciently  large  scale  to  afford 
conclusive  results. 

At  the  present  moment  there  are  two  societies  in 
New  York  which  are  working  toward  a  more  per- 
fect develoi^ment  of  therapeutics.  The  one  is  the 
Therapeutical  Society,  which  takes  up  one  form  of 
treatment  after  another,  focussing  upon  it  the  at- 
tention of  the  members,  and  ultimately  fi'om  the  ex- 
jierience  of  all  endeavoring  to  arrive  at  a  just  con- 
clusion. The  other  is  the  Materia  Medica  Society, 
which  aims  to  advance  the  study  of  the  medicines 
themselves.  Both  societies  are  doing  good  work — 
the  first  mentioned,  which  is  the  older,  having  is- 


sued several  reports,  ■which  ha^e  teen  well  leceived 
both  at  home  and  abroad. 

On  the  whole,  whether  we  consider  the  many 
valuable  additions  to  our  list  of  remedies,  or  the 
more  exact  knowledge  which  has  been  obtained  of 
the  action  of  medicines,  the  outlook  for  therapeutics 
is  full  of  promise.  Stupid  legislation  may  interfere 
with  the  experimentation  upon  which  its  most  trust- 
worthy results  are  founded ;  but,  even  if  so,  a  basis 
has  been  obtained  for  clinical  observation  which  will 
enable  us  to  interpret  better  our  daily  experience  at 
the  bedside,  to  the  end  that  we  may  be  qualified  to 
discharge,  in  a  more  practical  and  intelligent  man- 
ner, our  first  duty  to  the  sick. 


THE   AMEBICAN   MEDICAL   STUDENT. 

There  are  at  present  in  the  United  States  about 
twelve  thousand  medical  students.  The  number 
has  more  than  doubled  in  the  past  ten  years.  The 
universality  of  this  class  of  students  has  also  become 
more  pronounced.  There  is  now  a  "  centre  of 
learning"  for  them  in  almost  every  State.  In 
Maine,  in  Oregon,  on  the  high  plateaus  of  Colo- 
rado, on  the  prairies  nearer  east,  and  along  the 
Gulf  there  are  institutions  which  all  furnish  excep- 
tional advantages  for  the  prosecution  of  his  work. 
It  is  evident  that  the  medical  student  has  become 
no  small  factor  in  society. 

"We  have  1,800  in  this  city,  and  there  are  not  far 
from  2,200  in  the  State.  Ohio  stands  nest  in  num- 
ber, having  l,iO0,  thanks  to  a  large  attendance 
upon  irregular  schools.  Pennsylvania  follows  with 
1,200  students,  and  Illinois  with  1,000,  nearly  one- 
third  of  the  last  number  being  homceopaths.  Mis- 
souri and  Kentucky  have  about  700 ;  Maryland, 
Michigan,  and  Tennessee,  each  500.  Massachusetts 
has  only  aLiout  400.* 

It  would  not  be  easy  to  portray  the  type  of  a 
class  so  widely  distributed  and  subject  to  so  many 
different  conditions.  The  Harvard  medical  student, 
if  we  may  credit  the  statement  of  his  instructors, 
must  be  quite  a  different  creature  from  some  of  his 
prairie  or  even  of  his  New  York  confreres.  The  per 
cent,  of  college-bred  men  in  the  Harvard  Medical 
School  is  nearly  fifty.  That  in  the  Kentucky  schools 
is  zero.  Among  Missouri's  seven  hundred  students 
two  had  received  a  classical  education.  New  Y'ork's 
per  cent,  is  about  17 ;  that  of  Illinois,  16 ;  that  of 
Pennsylvania,  8,  and  that  of  Ohio,  G,  f  these  being 
only  ajiproximate  figures.  While  the  possession  of 
a  careful  preliminary  training  does  not  always  insure 
sui^eriority  as  student  or  physician,  it  undoubtedly 
has  much  influence  upon  his  character  and  manners. 

New  Y'ork  City  gathers  in  medical  students  from 
every  qiiarter  of  the  Western  hemisphere,  and  here 


*  Report  of  the  Commissioner  of  Education  for  1879.    Wasliington, 
ISSl. 

t  V  ide  01).  cit. 


158 


THE  MEDICAL  RECORD. 


is  the  best  place,  perhaps,  to  study  the  average  spe- 
cimen and  place  a  due  value  upon  him. 

He  comes  in  from  the  counti'y  or  some  small  town, 
where  he  has  been  spending  the  summer  with  his 
preceptor.  He  has  picked  up  quite  a  number  of 
ideas  in  his  recent  work,  and  has  some  very  posi- 
tive views  upon  a  few  pathological  or  therapeutical 
points.  Having  consulted  a  boarding-house  direc- 
tory, he  takes  a  room  with  board,  in  an  establish- 
ment which  can  hardly  be  supremely  genteel  and 
charge  only  six  dollars  a  week.  The  question  of  lo- 
cality was  settled  with  our  student,  however,  by  his 
seeing  a  nice-looking  girl  practising  on  the  piano  in 
the  front  parlor,  while  he  was  discussing  terms  with 
the  landlady.  He  matriculates,  joins  a  quiz,  and  set- 
tles down  to  work ;  for  our  American  medical  student 
is  essentially  an  industrious  fellow.  He  must  graduate 
after  two  courses,  and  his  hard  studying  is  done  for 
the  most  part  during  his  two  winters  at  the  college. 
But  he  is  not  entirely  unsocial  or  non-convivial. 
He  picks  up  some  acquaintances,  and  takes  a  chum. 
There  is  a  gradual  accumulation  of  beer-bottles 
under  the  bed.  A  few  bones,  and  rather  more  pipes 
adorn  his  tables  and  walls.  Although  the  chemical 
professor  has  discoursed  upon  nicotine,  and  shown 
that 

'*  One  (or  two  at  most) 
Drops  make  a  cat 
A  ghost,'* 

a  permanent  odor  of  Tabaci  folke  attaches  itself  to 
the  room. 

As  our  student  progresses  in  acquaintances,  he 
finds  that  the  mind  really  needs  intervals  of  rest  and 
relaxation— a  point  in  mental  hygiene  which  takes 
an  especially  strong  hold  upon  him.  By  this  time 
he  knows  the  young  lady  of  the  house  very  well. 
She  has  taken  him  to  church,  and  he  has  escorted 
her  to  the  theatre.  He  horrifies  her  with  tales  of  the 
dissecting-room,  and  with  the  most  harrowing  and 
hemorrhagic  descriptions.  She  thinks  the  doctor's 
life  very  hard,  but  sympathetically  asserts  that  it 
is  a  very  noble  one ;  and  it  is  not  impossible  that 
he  sqtieezed  her  hand  one  evening  in  the  back 
parlor. 

Our  friend  awakes  on  a  certain  morning,  and  has 
an  indistinct  impression  that  he  visited  from  ten  to 
twenty  beer-saloons  the  previous  evening,  with  a 
party  of  friends.  How  "it  ended,  or  how  he  got 
home  it  is  not  easy  to  recall.  This  experience, 
though  subsequently  repeated,  is  not  a  freqiient  one. 

Our  student's  conduct  in  the  lecture-room  is,  on 
the  whole,  a  dignified  one.  There  is  occasionally  an 
interchange  of  missiles  between  hours,  some  loud 
talking,  or  even  a  scrimmage.  But  he  finds  that  to 
be  boisterous  is  a  habit  that  is  wearing  away,  and 
now  has  a  hold  only  in  the  inferior  schools. 

The  individual  who  is  kindly  sitting  for  us  does 
not  wear  fashionable  clothes.  He  shows  a  slight 
aspiration  for  gentility  in  the  matter  of  sleeve-but- 


tons, which  are  in  the  skull  and  cross-bones  style, 
with  green  glass  eyes ;  also  in  his  cane,  of  which 
the  head  is  grotesquely  carved.  With  this  he  walks 
up  Fifth  Avenue  on  Sundays.  He  has  one  or  two 
nice  acquaintances,  but,  on  the  whole,  his  appear- 
ance in  society  is  confined  to  the  unpretentious 
boarding-house  hop  or  more  quiet  social  gatherings, 
all  terminating  invariably  in  ice-cream  and  cake. 
He  still  likes  to  bring  in  stories  from  the  college 
into  his  general  conversation,  and  is  rather  proud  of 
the  sensations  which  his  descriptions  or  comments 
call  out.  When  dining  with  his  chum  and  another 
medical  friend  at  the  general  table,  the  conversation 
may  at  times  have  a  somewhat  atonic  effect  upon 
the  lay  listeners. 

As  examinations  approach,  he  works  harder, 
smokes  more,  and  drinks  just  as  mucli ;  and  when 
he  has  passed  and  received  his  degree,  he  is  just  as 
likely  as  not  to  pack  Vip  and  go  straight  home  in  a 
perfectly  normal  and  non-alcoholic  condition. 

Our  average  student  is  not  a  bad  fellow  nor  an 
extraordinary  fellow ;  he  has  no  great  fondness  for 
study,  but  he  works  with  enthusiasm  and  graduates 
creditably.  He  settles  in  the  country  or  in  some 
provincial  centre,  battles  with  fortune  and  disease 
against  hea\"y  odds,  for  several  years,  finally  estab- 
lishes himself,  and  becomes  a  useful  and  respected 
member  of  society,  passing  from  the  "average  stu- 
dent "  to  be  something  more  than  an  average  man. 

There  are  some  odd  types  hanging  about  our  col- 
leges, and  among  them  we  should  not  forget  the 
dilettante  student,  who  has  become  something  of  a 
feature  in  late  years.  He  has  plenty  of  money,  and 
spends  it  freely  on  cigarettes,  beer,  the  theatre,  and 
the  other  necessaries  of  medical  student  life.  Just 
now  he  wears  very  tight  pants,  very  .short  coats,  and 
very  pointed  shoes.  His  parents  did  not  siicceed  in 
persuading  him  to  go  through  college  ;  but  they  want 
their  boy  to  study  a  profession,  and  medicine  seemed 
to  be  in  least  discord  with  his  tastes.  The  student  in 
question  does  not  study,  but  has  considerable  dis- 
secting-room enthusiasm,  likes  clinics,  takes  a  gieat 
many  sprees,  and  finally  hires  a  tutor  to  cram  him  for 
examinations.    He  sometimes  turns  out  well  after  all. 

The  rowdy  student  has  not  entirely  disappeared. 
He  is  dirty  in  person,  coarse  by  nature,  and  made 
more  so  by  his  studies,  for  medicine  makes  its  fol- 
lowers either  better  or  worse.  He  revels  in  obscene 
stories  and  vulgar  jokes.  During  lecture  he  takes  a 
few  notes,  and  expectorates  a  great  deal  of  tobacco- 
juice.  He  never  studies,  but  he  crams  spasmodi- 
cally, borrowing  his  friend's  notes  for  the  purpose. 
As  the  end  of  tlie  term  ap]iroaches  he  becomes 
greatly  excited,  and  is  very  busy  getting  "  points "' 
for  the  examination,  with  which  he  mixes  himself 
up  till  he  is  a  curious  picture  of  bravado  and  igno- 
rance. We  are  sorry  to  say  that  he  generally  passes, 
after  which  he  proves  to  his  companions  that  he  re- 


I 


THE  MEDICAL  RECORD. 


150 


ceived  the  hardest  and  most  unreasonable  questions. 
He  then  proceeds  with  all  rapidity 'to  get  into  a 
state  of  alcoholic  coma,  from  which  he  in  time 
emerges,  and  lays  plans  for  his  i>rospective  high  and 
beneficent  career. 

Among  our  twelve  thousand  medical  students 
there  is  a  per  cent.,  which  is  not  large,  of  earnest, 
cultivated,  and  ambitious  minds.  They  may  be 
brilliant,  or  may  show  only  dogged  industry  and 
high  purpose.  It  is  from  these  that  American  medi- 
cine may  most  expect  its  progress.  They  are  those 
who  can  work  jjatiently  in  laboratory  and  library  as 
well  as  by  the  bedside,  who  are  not  content  with 
routine  or  a  narrow  knowledge  of  their  craft.  Their 
number  is  increasing,  perhaps  more  jjroportionately 
than  the  general  increase.  Knowing  that  there  are 
such  students  as  these,  it  is  comforting  to  reflect 
that  in  the  fierce  contest  for  a  foothold  among  ouv 
seventy  thousand  medical  men,  those  who  are  really 
best  will,  as  a  rule,  succeed.  We  have  to  admit 
that  in  a  minority  of  cases  audacity  and  unscrupu- 
lousness  press  hard  upon  the  honest  practitioner. 


AN'NDAL    REPOKT    OF    THE    SrKGEOX-GEXEKAL    OP    THE 
ARMY. 

The  annual  report  of  the  work  of  the  medical  staff 
of  our  army  has  always  some  items  of  interest. 
Aside  from  special  labors  at  Washington,  our  army 
surgeons  show  themselves  awake  to  their  ojipoitu- 
nities  to  a  greater-  degree,  as  a  rule,  than  civil  prac- 
titioners. 

During  the  fiscal  year  1880-81,  there  were  5,962 
cases  of  wounds,  accidents,  and  injuries  recorded 
among  23,S0i  men.  The  mortality  was  3.8  per  1,000. 
The  officers  who  died  during  the  year  were  Lieut. - 
Col.  R.  S.  Satterlee,  Lieut.-Col.  George  E.  Cooper, 
Major  Geo.  A.  Otis,  and  Capt.  John  W.  Brewer. 

There  were,  at  the  date  of  report,  162  medical 
officers  on  duty  and  16  on  leave  of  absence,  making 
a  total  of  178.  There  are  nine  vacancies  in  the 
medical  corps  in  the  grade  of  Assistant  Sm-geon. 
During  the  past  year  there  were  221  aijplicants  for 
admission  to  the  service,  of  whom  183  were  exam- 
ined in  whole  or  part,  and  29  found  qualified. 

Of  more  general  interest  are  the  facts  regarding 
the  library,  the  museum,  and  the  medical  history  of 
the  war.  There  is  a  record  of  an  addition  of  nearly 
three  hundred  new  specimens  to  the  museum,  be- 
sides the  printing  and  distribution  of  over  a  thou- 
sand photogi-aphs  of  surgical  objects.  Two  hundred 
and  ten  illustrations  have  been  prepared  for  Volume 
II.,  Part  III.  of  the  "  Medical  and  Surgical  History 
of  the  War."  The  written  portion  has  been  ad- 
vanced one  hundred  and  fifty-two  pages. 

Regarding  the  library,  the  urgent  request  of  last 
year  for  a  fire-pi'oof  building  is  now  reiterated. 
Nearly  two  thousand  five  hundred  volumes  and 
three  thousand  two  hundred  pamphlets  have  been 
added  to  the  library  during  the  past  year.     This 


makes  the  total  number  about  fifty-four  thousand 
volumes  and  sixty  thousand  two  hundred  pamphlets. 
Volume  II.  of  the  Index  Catalogue  has  been  printed 
and  distributed.  The  manuscript  of  Volume  III.  is 
now  going  to  press.  An  appropriation  for  lirintiug 
Volume  IV.  has  been  asked  for,  and  it  is  to  be  hojjed 
tliat  it  will  be  promptly  given. 


THE    HARVARD     MEDICAL      SCHOOL     AND     EDrCATIONAIi 
REFORM. 

It  is  a  pleasiire  to  obsei-ve  the  continued  prosi^erity 
of  such  American  medical  colleges  as  are  showing 
a  genuine  desire  to  elevate  the  educational  standard 
of  the  profession.  In  the  recent  report  of  the  Har- 
vard Medical  School  for  1880-81  we  are  informed  re- 
garding the  working  of  the  new  and  higher  require- 
ments adopted  by  its  authorities. 

The  whole  number  of  students  keeps  at  about  the 
same.  The  number  who  applied  for  matriculation 
examinations  was  forty,  of  whom  four  were  rejected. 
Of  the  eighty-five  applicants  for  the  degree  of  M.D., 
twenty-five  were  rejected.  As  about  one-half  the 
students  have  a  literary  or  scientific  degree,  and  all 
have  had  a  compulsoiy  three  years'  course,  this  indi- 
cates a  thorough  sifting. 

In  regard  to  the  foui'th  year  course,  the  class  last 
year  contained  ten  students.  Five  of  them  received 
hospital  aiipointments,  and  only  four  went  up  for 
the  special  degree  given  for  the  extra  year's  study. 
None  of  these  passed.  The  rejiort  states  that  it  is 
too  soon  yet  to  say  anything  regarding  the  success 
or  failure  of  the  attempt  at  a  four  years'  course.  It 
seems  probable,  however,  that  it  will  not  amount  to 
much  until  it  is  made  obligatory,  or  with  only  the 
alternative  of  a  hospital  appointment. 

The  new  college  building  is  being  erected.  It  is 
expected  to  cost  §270,000,  including  the  site.  A 
large  part  of  this  money  has  been  raised.  An  at- 
tempt is  also  making  to  endow  scholarshijjs  and 
professorships.  As  Harvard  Medical  College,  since 
1871,  ceased  to  be  a  jirivate  venture  and  became 
part  of  the  university,  there  is  not  likely  to  be  any 
gi-eat  difficulty  in  securing  money.  Ah-eady  in  the 
past  decade  the  institution  has  received  over  a  quar- 
ter of  a  million. 

The  recent  histoi-y  of  this  medical  college  is  an 
instructive  one.  It  is  admitted  that  endowments  are 
extremely,  if  not  absolutely,  essential  for  conducting 
a  college  according  to  the  highest  standards.  But 
endowments  will,  of  course,  never  be  given  to  insti- 
tutions which  are  really  only  commercial  enterj^rises. 
Medical  colleges  must  be  under  higher  patronage 
than  their  own  professors  before  they  can  get  help 
fi-om  outside. 


An  Exceptioxal  Case. — Louis  XV.  died  in  his 
sixty- fifth  year  of  confluent  small-pox.  He  had  had 
the  disease  once  before,  when  fifteen  years  old. 


160 


THE  MEDICAL  RECORD. 


Hcports  of  Soctcttc®. 


NEW  YOEK  ACADEjMY  OF  MEDICINE. 

Stated  Meeting,  Fehruarrj  2,  1882. 

FoRDTCE  Barker,  M.D.,  LL.D.,  President,  in  the 
Chair. 

santtart  science  and  the  public  health. 

TriE  evening  was  devoted  to  the  consideration  of 
the  scientific  work  necessary  to  jwevent  the  insidi- 
ous entrance  of  disease  into  dwelling-houses.  In- 
troductory to  the  paper  of  the  evening,  the  Presi- 
dent delivered  a  brief  address,  in  which  he  said  : 

•'  There  is  not  a  physician  in  this  city,  engaged 
in  active  practice,  who  is  not  frequently  called  on 
to  see  disease  of  various  degrees  of  severity  often  re- 
sulting in  death,  which  has  been  caused  by  a  poison. 
If  we  can  see  our  patients  early  enough,  we  can  suc- 
cessfully meet  such  poisons  as  arsenic,  as  corrosive 
sublimate,  as  aconite,  and  all  of  this  class,  because 
we  have  antidotes  which  will  prevent  their  effects. 
But  where  the  poison  is  introduced  into  the  system 
so  insidiously  that  the  subject  is  unconscious  of  its 
absorption  until  its  effects  are  produced,  then  it  is 
not  a  question  of  antidotes,  but  the  problem  is,  how 
shall  we  counteract  its  consequences,  and  how  shall 
we  keep  our  patients  alive  until  the  life-destroying 
agents  have  ceased  to  put  in  jeopardy  the  vital 
powers? 

"  The  special  poison  to  which  I  now  refer  is  the 
gases  resulting  from  defective  plumbing,  to  which 
all  classes,  the  rich  as  well  as  the  poor,  are  alike 
exposed. 

"  None  but  physicians  can  know  how  general  this 
poison  is,  and  how  positively  it  explains  much  of  the 
disease  they  are  called  upon  to  treat,  and  of  the 
many  deaths  which  follow. 

"When  I  assert  that  it  is  a  daily  experience  with 
me  to  see  persons  whose  general  health  is  suffering 
from  this  poison  ;  that  I  have  seen  infants,  children, 
and  adults  suffering  from  diphtheria,  or  scarlet  fever 
of  a  mild  type  complicated  with  this  disease,  and 
destroying  life ;  also  those  in  vigorous  health  stricken 
down  by  typhoid  fever,  and  that  the  cause  has  been 
demonstrated  to  be  this  poison,  I  only  state  facts 
which  are  common  in  the  experience  of  all  physi- 
cians in  this  city.  In  some  cases  this  has  been  the 
result  of  ignorance  of  tlie  very  unsanitary  conditions 
which  envirnncd  them. 

"  It  is  the  custom  of  many  in  this  city  to  take  their 
families  for  health  and  pleasure  to  various  summer  re- 
sorts, but  every  year  for  some  time  past  some  of  these 
places  have  proved  fatal  to  health,  and  often  to  life, 
by  typhoid  fever,  so  that  now  it  seems  to  be  the 
plain  duty  of  every  physician  to  warn  such  families 
as  hold  him  responsible  for  their  health,  of  the  dan- 
ger of  every  such  resort  as  does  not  give  them  the 
evidence  of  a  competent  sanitary  expert  that  their 
house  is  safe  from  all  sTich  dangers. 

"None  but  physicians  are  alive  to  the  fact  that 
many  of  those  now  living  in  beautiful  and  expensive 
honsea  in  this  city  are  like  the  inhabitants  who 
dwell  at  the  l)ase  of  l\Iount  Vesuvius,  whose  sur- 
roundings mask  and  liide  the  danger  and  desolation 
of  the  lava  and  ashes. 

"  Tlio  jiliysician  should  never  be  an  alarmist ;  he 
should  never  hoist  the  signal  of  danger  excejit  when 
he  sees  the  forcwarningsignsof  an  impending  storm. 


Unfortunately,  he  never  can  see  the  danger  from 
this  poison 'until  its  effects  are  already  beginning 
to  develop,  as  shown  by  disease.  Then,  again,  he 
labors  under  the  difficulty  of  being  unable  to  de- 
monsta'ate,  or  even  suggest,  where  the  poison  origi- 
nates. He  can  only  say  that  science  has  established 
the  fact  that  certain  symptoms  are  due  to  certain 
causes.  It  seems  to  me  that  it  is  the  duty  of  the 
profession  to  educate  itself  up  to  the  point  of  being 
able  to  demonstrate  intelligently  to  their  patients 
how  the  danger  from  these  poisons  may  originate. 
I  now  have  the  pleasure  of  introducing  Mr.  Charles 
F.  Wing.\te,  who  will  read  the  paper  of  the  evening." 
The  paper  was  entitled, 

practical  points  in  pluhibing  :  knowledge  neces- 

SAKT  for  physicians  for  the  PROTECTION   OF   THEIR 
PATIENTS. 

The  speaker,  after  making  some  general  remarks 
concerning  the  relations  of  medicine  to  sanitary  .sci- 
ence, proceeded  to  the  consideration  of  the  unsan- 
itary conditions  of  dwellings  and  their  most  frequent 
sources. 

First,  dajnpnpss,  such  as  arises  from  imperfect 
measures,  or  none  at  all,  taken  to  prevent  snow  and 
rain  from  soaking  into  the  soil,  and  finding  its  way 
directly  beneath  the  foundations  of  the  building. 
Broken  and  leaky  underground  drains  very  com- 
monly were  frequent  sources  of  soil,  saturation,  with 
not  only  moisture,  but  sewage  matter.  Made  lands, 
fillings  with  broken  rock,  which  increased  the  area 
of  dampness,  old  water-courses,  old  drains,  origi- 
nally intended  to  carry  off  rain-water  only,  and  never 
constructed  for  sewers,  etc. 

The  sources  of/oi(/<«)- were  broken  and  leaky  gas- 
mains,  cold  air- boxes  for  furnaces,  etc.  The  refri- 
gerator should  never,  as  was  so  commonly  done,  he 
connected  with  the  sewer  by  a  drainpipe.  The 
houses  should  invariably  be  separated  from  the 
sewers  by  means  of  traps. 

The  si:)eaker  then  studied  a  dwelling-house,  be- 
ginning with  the  cellar  and  going  upward,  and  pre- 
sented practical  points  concerning  plumbing  and  its 
defects. 

PROPE.SSOR  R.  Ogden  Doremus  demonstrated  with 
apparatus  certain  points  concerning  the  porosity  of 
the  material  of  which  walls  are  commonly  con- 
structed, and  the  ease  with  which  noxious  gases  can 
penetrate  them  and  find  their  way  to  the  apartments 
in  which  we  live.  He  demonstated  that  a  stream  of 
ordinary  street-gas  directed  against  one  side  of  a 
thick  block  of  stone  would  pass  through  so  that  it 
could  be  lighted  on  the  ojiposnte  side.  He  also 
showed  that  l)y  blowing  against  tlie  side  of  a  brick 
wall,  eight  inches  thick,  and  of  the  finest  brick,  the 
breath  could  be  made  to  pass  through,  and  extin- 
guish a  candle  upon  the  opposite  side. 

He  also  illustrated  the  fact  that  gases  will  pass  in 
opposition  to  pressure  equal  to  the  weight  of  a 
single  atmosphere,  thus  showing  that  the  water-trap, 
contrary  to  general  supposition,  was  no  barrier  to  the 
entrance  of  poisonous  gases  from  the  water-closet. 
For  these  gases  there  is  no  antidote.  Their  inhala- 
tion must  be  prevented.  They  could,  howevei-,  be 
destroyed  by  chlorine,  bromine,  etc.,  and  tlie  decom- 
position should  be  effected  before  they  have  oppor- 
tunity to  enter  the  rooms  in  houses.  For  examjde, 
tlie  sulpliiirette<l  hydrogen  and  other  gases  which 
could  pass  througli  the  water  in  the  goose-neck  at- 
tached to  the  basin  of  the  water-closet  could  be 
destroyed  by  throwing  into  the  water  a  mixture  of 
equal  parts  by  weight  of  manganate  of  soda  anil  sul- 


THE   MEDICAL  RECORD. 


161 


phate  of  magnesia.  The  chloride  of  zinc  was  also 
efficacious.  The  sohition  of  hypochlorite  of  soda 
(Labajraiiue's  solution)  might  be  employed. 

Dk.  Willard  Pakker  spoke  of  tlie  eflect  which 
pure  air  has  upou  typhus  fever,  of  the  appearance  of 
diphtheria  iu  this  city  after  the  water-supply  was  con- 
nected with  the  sewers,  etc.  He  believed  that  diph- 
theria begins  in  what  he  called  "  sewer  malaria."  If 
the  disease  occurs,  there  is  something  wrong  with 
the  sewerage  of  the  house  in  which  it  aj^jjears.  He 
would  cut  ofi'all  connection  between  the  water-suj)- 
ply  for  houses  and  the  sewers. 

Dr.  S.  O.  Vasder  Poel  thought  it  as  necessary 
that  physicians  should  be  able  to  point  out  sources 
of  defect  in  the  sanitary  condition  of  dwellings,  as 
it  was  important  to  be  able  to  recognize  any  disease 
which  may  make  its  appearance.  He  directed  at- 
tention to  one  point  overlooked  by  sanitarians, 
namely,  that  the  city  of  Kew  York  has  no  proper 
sod-drainage. 

Dr.  E.  G.  Janew.ay  said  that  in  certain  parte  of 
the  city  soil-drainage  was  provided  for,  but  it  was 
by  no  means  so  general  and  efficient  as  it  should 
be. 

With  reference  to  the  development  of  diseases 
in  houses  due  to  sewer-gas  proper,  it  was  difficult  to 
separate  (1)  the  effect  of  sewer-gas  from. (2)  the  ef- 
fect produced  by  particles  of  contagion  which  enter 
sewers  and  do  not  develop  other  than  diseases  like 
those  from  which  they  came  ;  whether  sewer-gas 
loilhoul  tlie  pre-entrance  nf  the  poison  produced  diph- 
theria, was  a  question.  He  had  been  impressed  by 
the  fact  that  the  portability  of  diphtheria  was  far 
greater  than  usually  admitted.  He  then  referred  to 
a  case  already  rejjorted,  iu  which  diphtheria  was 
carried  several  hundred  miles  by  a  toy  i-abbit,  and 
there  communicated  to  a  child,  who  died  of  the  dis- 
ease. [See  Medical  Eecord,  vol.  sx.,  p.  190.]  We 
must  correct  the  defective  sewers,  but  at  the  same 
time  we  must  not  overlook  the  possibility  of  conta- 
gion being  carried  in  clothing  and  articles  used 
about  the  sick.  , 

The  question  of  the  relation  of  typhoid  fever  to 
sewer  gas  also  came  forward,  and  Dr.  Janeway  cited 
several  cases  which  seemed  to  admit  of  the  possi- 
bility, perhaps  probability,  of  the  transmission,  in 
city  houses,  of  the  poison  of  typhoid  fever  from  the 
sewers  through  the  medium  of  croton  water  iifedfor 
drinkhi'j  purposes,  rather  than  by  way  of  inhalation, 
and  so  through  the  medium  of  the  respii-atory  or- 
gans. In  many  of  the  investigations  which  lie  had 
made  with  reference  to  an  outbreaii  of  typhoid  fever, 
serious  defects  in  plumbing  had  been  found,  such  as 
permitted  the  water-supply  to  be  contaminated  by 
sewage  material.  Special  reference  was  then  made 
to  an  institution  in  which  tifty  cases  of  typhoid  fever 
oceuiTed,  and  by  means  of  the  chloride  of  lithium 
test  it  was  found  that  the  water  used  from  an  old 
well,  although  five  hundred  feet  away  from  the  hos- 
pital, could  be  poisoned,  and  without  doubt  was  the 
source  of  the  contamination  which  caused  the  out- 
break, for  from  it  the  water  dx'ank  by  the  inmates  of 
the  institution  was  taken. 

Dr.  .J.  C.  Peters  referred  to  the  filthy  condition 
of  the  docks  on  account  of  the  sewers  emptying  into 
them,  and  the  prevalence  of  contagious  diseases  in 
their  immediate  locality.  From  these  docks  the 
sewer-gas  is  forced  back  into  the  houses,  where  it 
produces  its  poisonous  effects.  A  remedy  was  to 
carry  the  sewers  out  to  the  end  of  the  piers. 

On  motion  by  Dr.  John  G.  Adams,  the  Academy 
tendered  a  vote  of  thanks  to  ilr.  Wingate  and  to 


Prof.  Doremiis,  for  their  insln^ctive  and  interesting 
communications. 

first   aid  to   the   INJIIRED. 

Dr.  W.  Gill  Wylie  brought  this  subject  before 
the  Academy,  and  stated  the  objects  of  the  organi- 
zation which  had  received  already  the  indorsement 
of  the  medical  profession  in  England. 

Dr.  Austin  Flint  offered  a  resolution,  which  was 
adopted,  sanctioning  the  objects  held  in  view  by  the 
society,  and  indorsing  the  efforts  which  it  juoposed 
to  make  for  the  instruction  of  those  who  might  be 
called  upon  to  give  aid  to  the  injured  in  an  emer- 
gency. 

The  Academy  then  adjourned. 


MEDICAL   SOCIETY   OF    THE    STATE   OF 
NEW  YOKE. 

Seveniy-Si.iih  Aitnual  Meeting,  held  in  Albany,  Feb- 
ruary 7,  8,  and  9,  1882. 

Tdesdat,    FEBRUAEr    7th  —  First   Day  —  Morning 
Session. 

The  society  met,  jiursuant  to  adjournment,  in  the 
city  of  Albany,  at  10  o'clock,  a.m.,  and  was  called  to 
order  by  the  President,  Dr.  Abraham  Jacobi,  of 
New  York. 

Prayer  was  offered  by  Right  Eev.  Bishop  Doane. 

THE   president's  INAUGUEAL   ADDRESS. 

Gentlemen  of  the  JIedigal  Society  of  the  State 
OF  New  Y'ork  :  The  third  quarter  of  the  first  century 
of  the  existence  of  the  Medical  Society  of  the  State 
of  New  York  is  just  closing.  The  history  of  these 
seventytfive  years,  compri-sing  almost  the  whole  of 
the  life  of  the  Kepublic,  and  also  the  gieatest  pos- 
sible changes  in  the  development  of  medical  science, 
is  of  vast,  importance.  At  the  time  when  this  so- 
ciety was  formed,  Bichat  first  thought  of  establishing, 
on  a  sound  basis,  a  pathology  of  the  tissues ;  iu  this  the 
thii'd  quarter,  such  a  pathology,  though  open  to  fur- 
ther evolution,  reigns  supreme.  Those  times  were 
still  periods  of  systems  and  schools ;  oiu'  own  has 
succeeded  in  establishing  medicine  on  the  sound 
foundation  of  close  observation  of  the  histological  ele- 
ments and  of  experimentation.  This  society,  though 
we  cannot  boast  of  revolutionizing  medical  thought, 
has  jjarticipated  in  the  general  i^rogress.  Although 
it  be  true  that  in  modern  times  a  large  number  of 
those  who  have  given  an  unusual  sjilendor  to  the 
American  name  are  connected  with  medical  schools, 
yet  when  these  schools  were  but  few  it  was  in  the 
profession  at  large  that  the  men  of  learning,  prog- 
ress, and  reference  were  found,  and,  fortunately, 
even  to-day  this  condition  of  things  is  not  entirely 
changed,  and  the  exj^erience  of  a  former  period  in 
Europe  has,  in  part,  repeated  itself  with  us.  This 
society  owes  its  increasing  influence  and  power  mostly 
to  tliose  who  never  presided  in  the  lecture-rooms. 
For  it  is  a  fact  that  we,  the  delegates  of  the  county 
societies  mainly,  and  the  representatives  of  the  i>ro- 
fession,  have  had  to  rely  less  upon  the  co-operation 
of  the  schools  than  upon  our  own  resources.  It  is 
true  that  the  progress  of  medical  education  in  our 
countiy  has  been  due  to  the  labor  of  the  colleges, 
V)ut  this  labor  has  been  mostly  involuntary.  Less 
than  oue  knows  one  will  hardly  teach.  The  teach- 
ing of  the  formerly  acknowledged  branches  has  im- 
proved and  special  branches  of  knowledge  have  been 
added  to  the  curricidum.     All  this  is  known ;  but  it 


J  62 


THE  MEDICAL  RECORD. 


is  also  known  that  not  always  has  the  world  been 
progressed.  It  is  not  long  since  a  celebrated  col- 
lege publicly  rescinded  measures  adopted  with  the 
view  to  securing  better  preliminai-y  education  on  the 
part  of  the  matriculants.  The  consciousness  of  the 
necessity  of  advancement  has  certainly  rooted  first  in 
the  profession  at  large,  and  not  a  few  of  the  colleges 
have  consciously  or  unconsciously  obeyed  the  dic- 
tates of  public  opinion. 

STATE  I50AKD  OF  EXAJVUNATION. 

The  profession  for  many  years  has  insisted  upon  a 
change  in  the  law  which  licenses  pi-.actitioners  of 
medicine.  Perhaps  it  cannot  be  said  that  the  medi- 
cal schools  ever  opposed  the  establishing  of  a  State 
Board  of  Examination,  which  alone  would  be  author- 
ized to  convey  the  license  to  practise,  the  right  of 
the  colleges  to  confer  dijjlomas  notwithstanding. 
If  it  ever  did,  it  is  not  probable  that  any  college 
would  now  oppose  any  such  movement  which  might 
be  set  on  foot  and  result  in  the  Legislature  passing 
a  proper  law  ;  for  good  colleges  would  not  be  afraid 
of  their  graduates  not  passing  the  State  board,  and  no 
college  would  be  willing  to  try  to  thwart  the  move- 
ment, through  fear  lest  its  unwillingness  to  co-oper- 
ate might  be  recognized  as,  or  alleged  to  be,  the  re- 
sult of  incompetency. 

It  is  claimed  hj  many  that  a  co-ojieration  with 
the  homasoi^aths,  for  the  purpose  of  arranging  State 
examinations,  would  not  be  out  of  place  to  the  same 
degree  as  it  certainly  was  ten  years  ago.  For  there 
has,  of  late,  been  a  tendency  on  the  part  of  homcso- 
pathic  physicians  to  recover  from  the  incubns  of 
Hahnemannian  therapeutics.  Dynamization  by  mix- 
ture and  submixture,  division  and  subdivision,  is  no 
longer  sustained  as  a  princii^le.  "  Similia  similibus  " 
is  no  longer  claimed  as  a  dogma,  but  a  "  proposi- 
tion," as  it  was  called  by  a  correspondent  of  The 
Medical  Recokd  of  November  2(3,  18S1.  Diagnosis 
is  no  longer  declared  superfluous,  and  the  treatment 
of  mere  symptoms  by  the  administratioiT  of  medi- 
cinal agents,  the  effects  of  which  have  been  esti- 
mated by  the  eifects  of  large  doses  of  the  same  agents 
observed,  or  believed  to  have  been  observed,  in  the 
well,  is  said  to  have  been  given  up.  Besides,  the 
principles  of  medical  science,  anatomy,  physiology, 
etc.,  are  said  to  be  taught  and  studied  with  them,  as 
they  are  in  our  own  schools.  Thus  it  is  claimed  tliat 
now  the  questions  of  What  is  a  homoeopath?  What 
is  a  medical  man  ?  cannot  be  answei-ed  at  all.  When 
asked  What  is  a  homceopath  ? — at  least  the  <!orre- 
spondent  in  The  Record  so  answers — "  Twelve  per- 
sons would  give  yoti  twelve  answers."  If  that  be  so,  it 
is  not  our  fault,  but  that  of  those  who  are  as  anxious 
no  longer  to  be  called  Hahuemannians,  as  they  are  to 
retain  their  exclusive  title  and  denomination.  We 
are  told  that  homoeopaths  do  not  any  longer  practise 
"according  to  an  exclusive  dogma,"  but  that,  when 
the  consideration  of  the  question  of  homceopathy 
comes  up  among  us,  "  the  question  of  exclusive  dog- 
ma falls  ; "  but,  even  if  it  held,  it  would  be  our  busi- 
ness, before  recognizing  their  close  fellowship,  to 
show  that,  in  addition,  they  reject  the  "aids"  re- 
ferred to  in  our  code  of  ethics.  That  means  that  we 
have  no  right  to  refuse  the  fellowship  of  a  homoeo- 
pathic practitioner,  when  he  tells  you,  or  you  have 
reason  to  believe  that,  besides  his  usual  dosulic,  he 
may  give,  when  ho  sees  tit,  ten-grain  doses  of  calomel 
or  twenty-grain  doses  of  quinine. 

SOIENTIFIO   MEDICINE. 

But  homcBOpathy  does  not  become  scientific  medi- 
cine by  its  adherents  adopting  all  sorts  of  medicines. 


according  to  whim,  alleged  indications,  convenience, 
or  experience.  The  class  of  men  who  are  so  sub- 
missive to  the  desires  or  prejudices  of  the  public  as 
to  ort'er  treatment  according  to  "  either  of  the  sys- 
tems," or  so  uninformed  as  not  to  discriminate  be- 
tween scientific  induction  and  the  habits  of  routine, 
must  not  establish  the  standard  of  their  logical  ther- 
apeutics or  professional  ethics.  At  the  time  Hahne- 
mann lived,  the  strict  inductive  method  was  not  the 
basis  of  medical  science  and  thought.  When  therr- 
were  so  many  systems  and  schools,  the  founder  of 
homoeopathy  had  a  certain  ground  for  creating 
another  from  nothing  or  chaos.  But  the  last  thirty 
or  forty  years  have  worked  radical  changes  in  the 
scientific  conscience  and  consciousness  of  modern 
medicine. 

Not  the  last,  however,  of  the  branches  of  medical 
knowledge  which  have  been  modified  by  the  modern 
current  of  medical  thought  and  investigation,  is  that 
of  our  therapeutics.  It  has  become  exjierimental, 
and  a  part  of  experimental  physiology  and  ])athol- 
ogy.  In  this  movement  homoeopathy  has  taken  no 
part.  In  its  old  condition  it  had,  at  least,  a  rnle 
and  law  ;  in  its  new  form  it  has  no  shape,  no  steadi- 
ness. 

A  few  weeks  ago  the  Central  Committee  of  the 
medical  societies  of  Berlin,  Germany,  passed  a  reso- 
lution saying  :  "  It  is  self-evident  that  medical  men 
cannot  consult  with  those  who  call  themselves 
homfEopaths."  Now,  eveiw  homceopathic  physician 
is  not  of  necessity  an  ontright  knave  or  an  accom- 
plished ignoramus.  If  he  were  the  first,  the  question 
of  fellowship  between  him  and  gentlemen  could  not 
be  entertained  at  all.  If  he  were  ignorant,  fellowship 
and  the  meeting  at  the  bedside  would  not  in  itself  be 
impossible.  But,  in  the  President's  mind,  if  the  ques- 
tion of  con.sultation  and  fellowship  were  raised,  there 
was  an  objection  to  evei-y  man  who  is  not  satisfied 
with  the  name  of  ijhysician  or  medical  man.  Indeed, 
it  appeared  that  homoeopathic  practitioners  and 
societies  began  to  feel  as  he  did  in  this  matter, 
for,  the  Homtfopathic  Society  of  Northern  Ne-n 
York  has  dropped  the  word  homceopathy.  [Medical 
Eecokd,  November,  1881.] 

THE   QUESTION   OF   CONSrLT.\TION. 

This  question  of  consultation  has  often  been  raised. 
It  was  claimed  that  the  sick  man  had  a  right  to  select 
his  doctor.  Certainly,  but  the  doctor  has  a  right  to 
select  his  patient  also.  The  patient  knew  beforehand 
that  he  could  not  expect  a  consultation  between  his 
homceopathic  doctor  and  one  of  us,  and  he  took  his 
choice.  From  his  yoimgest  days  onward  he  had  had 
but  one  rule,  and  that  was :  to  be  governed  by  tlic 
law  of  his  profession.  The  medical  profession  is 
not  sufficiently  supervised  or  protected  by  political 
laws,  and  has  to  make  its  own  rules,  and  every 
member  is  expected  to  do  his  duty  to  them.  The 
self-made  rules  of  freemen  cannot  be  too  strict,  ami. 
thougli  they  may  have  been  too  strict  sometimes, 
and  he  added,  though  they  have  been  broken  too 
often  and  scandalously  by  many  whose  position  in 
life  and  standing  in  the  profession  might  have  been 
a  safeguard  against  temptation,  these  strict  laws  j 
have  done  an  immense  amoxint  of  good.  So  long  as  | 
these  laws  exist,  obey  them;  if  the  majority  does 
not  wish  to  obey  them  any  longer,  abolish  them 
when  the  time  has  come.  It  is  asserted  by  many 
that  this  time  has  come,  and  that  there  are  good 
reasons  for  abolishing  the  boundaries  between  the 
several  classes  of  medical  men.  I  do  not  spenk  of 
scJiools  of  medical  men,  for  modern  medicine  is  not 


THE   MEDICAL  EECORD. 


163 


divided  into  schools.  If  we  have  reason  to  believe, 
not  only  that  medical  science  is  one  and  indivisible 
and  based  upon  logic  and  experimentation,  but  that 
the  profession  of  the  State  of  New  York  are  sufKei- 
ently  imbued  with  that  spirit  of  logic  and  experi- 
mental science,  we  may  overlook  diilerences  and 
meet,  with  a  spirit  of  reconciliation,  those  who  do 
not  encounter  us  any  more  witli  the  dicta  of  a  school 
or  a  sect. 

THE   CODE   OP   ETHICS. 

We  are  not  the  only  class  of  what  the  State  calls 
"  hiwfully  qualified  practitioners."  It  is  in  our  in- 
terest, and  has  always  been  the  effort  of  the  profes- 
sional men  of  the  State,  to  better  the  condition  of 
the  profe.s6ion  and  the  public  by  the  elevation  of  the 
standard  of  education.  It  is  desirable  that  no  part 
of  the  medical  practitioners  should  be  excluded 
either  from  the  benefits  of  such  efforts  or  from  co- 
operating in  that  direction.  It  is  absolutely  neces- 
sary that  in  many  steps  to  be  taken  before  the  legis- 
lature, we  should  be  in  full  concord  with  those  who 
share  with  us  the  honor  of  being  called  lawful  prac- 
titioners. Such  changes  in  our  relations  to  those 
who  still  call  themselves  homoeopaths  could  not 
possibly  take  place  without  abrogation  of  or  amend- 
ments to  the  code  of  ethics.  The  consideration  of 
that  subject  was  in  the  charge  of  a  special  commit- 
tee elected  last  year,  and  consisting  of  eminent  and 
prudent  men.  Without  good  reasons,  therefore,  the 
society  would  not  make  a  change.  If  every  man  were 
a  gentleman,  and  every  woman  a  lady,  no  code  and 
few  laws  would  be  required.  If  the  public  be  wiser, 
more  dignified,  and  just  than  thirty  years  ago,  all 
the  paragraphs  referring  to  the  relations  between 
the  i^ublic  and  the  profession  might  just  as  well  not 
exist.  But  do  not  abolish  the  memory  of  those  de- 
serving and  great  men  who  wrote  the  book,  whatever 
other  action  may  be  taken. 

EXPERIMENTAL   MEDICINE. 

Amongst  the  other  merits  of  the  profession  was  its 
resistance  to  fanatical  obstacles  strewn  in  the  way  of 
quiet  development  of  medical  science.  He  hoped 
the  time  would  never  come  when  this  society  would 
cease  to  watch  the  fanatic  who  would  fain  gain  a 
victory  for  his  vanity  and  whims  over  experimental 
science. 

THE   WOMAN   QUESTION. 

This,  the  president  believed,  had  been  solved  to 
the  .satisfaction  of  every  one.  No  blame  could  be 
attached  to  the  medical  profession  for  resisting  for 
a  certain  time  full  and  free  admission  of  women  ; 
but  the  truth  was  that  the  lay  public  was  a  more 
pei'sistent  opponent  to  it  than  the  jjrofession  itself. 
It  was  only  just  that  no  one,  male  or  female,  should 
be  prevented  from  earning  his  or  her  livelihood  in 
whatever  manner  they  please.  Eight  is  light  under 
all  circumstances  and  for  everybody. 

HYGIENIC    MEASDKE.S. 

It  will  be  a  source  of  gi-atification  to  know  in  fu- 
ture that  the  medical  profession  has  always  stood  in 
the  front  rank  in  the  fight  for  the  prevention  of  sick- 
ness. The  tight  will  be  a  long  one  before  the  theory 
of  humanism  will  be  fully  practised.  It  is  true  that 
it  is  no  longer  lawful  to  throw  away  new-born  babies 
tnat  were  not  washed,  or  throw  to  the  bloodhounds 
the  old,  infirm,  and  moribund  ;  but  the  study  of  what 
occurs  every  day,  socially,  publicly,  officially,  in  the  I 
course  of  life,  within  the  limits  "of  law,  under  the 
rules  governing  industry  and  commerce,  amongst 


the  luxuriously  rich  and  the  abject  poor,  is  still  apt 
to  make  the  humanitarian  weep  and  the  moralist 
blush. 

"  To  live  fast  and  in  enjoyment,  though  to  one's 
injuiy,  and  so  peri;  h  fast,  is  better  than  to  live  in 
health  long  and  sedulously.  What  is  most  to  be 
feared  is  over-population  and  increasing  competition. 
There  is  no  harm  in  epidemics  and  wars  cutting  off 
the  poijulation  annually  ;  for,  such  is  the  charter 
of  our  times.  The  enthusiasts  in  tlie  cause  of  jjublic 
hygiene  fight  a  battle,  the  aim  of  which  is  too  high 
for  me  to  see.  In  that  respect  I  am  myopic.  I  may 
admire  the  battle  but  cannot  sympathize  with  it." 

Who  says  that  ?  A  man  who  has  been  able  to 
prove  that  suiJplying  the  medical  profession  of  the 
world  with  books,  and  some  good  books,  of  perform- 
ing old  operations  skilfully  and  devising  new  ones, 
does  not  redeem  him  from  coarse  thinking,  brutal 
feeling,  and  vulgar  talking — does  not  make  a  noble 
physician  out  of  a  mere  operator  and  literary  man. 
His  name,  I  am  sorry  to  say,  is  Billroth.  Through 
him  New  York  fanaticism  will  feel  amply  justified 
in  trying  to  prove  that  the  whole  profession  is  im- 
bued with  the  spirit  of  egotism  and  barbarism.  In 
the  face  of  .such  shocking  vulgarity,  in  the  presence 
of  the  noble  jjrofession  of  the  State  of  New  York,  in 
the  remembrance  of  the  tendencies  and  aims  of  the 
most  humanitarian  profession  in  existence,  I  may 
be  permitted  to  ask  your  co-operation  in  measures 
looking  toward  the  cure  of  disease  and  the  ameliora- 
tion of  the  suffering  of  human  kind. 

SPECIAL   HOSPITALS. 

In  this  connection  the  president  asked  for  the 
support  which  the  Society  might  give,  favoring  the 
establishing  of  .special  hospitals  for  the  treatment  of 
scarlet  fever  and  diphtheria  within  the  limits  of 
large  cities. 

The  last  topic  to  which  the  president  directed  at- 
tention was, 

THE   DANGER  TO  LIFE  AND  LIMB  OF  FACTORY  CHILDREN. 

Extended  reference  was  made  to  the  present  laws 
governing  the  admission  and  regulation  of  the  labor 
of  this  class  of  persons.  He  believed  them  to  be 
inefficient,  and  recommended  the  enactment  of  a  new 
law  which  should  embrace  the  following  i^oints  : 

1.  Children  employed  in  factories  should  be  under 
official  supervision.  In  large  cities  boards  of  health 
could  be  entrusted  with  it. 

2.  Before  being  admitted  to  factory  work,  a  child 
of  legal  age  ought  to  be  examined  physically  by  a 
medical  man.  Chlorotic,  ana?mic,  scrofulous,  crip- 
pled, and  phthisical  children,  and  those  under  nor- 
mal size  for  their  ages,  should  be  excluded. 

3.  No  night  or  Sunday  work  should  be  permitted. 
i.  Some  branches  of  work  are  to  be  forbidden 

entirely — those  which  are  known  to  interfere  with 
physical  development,  and  others  which  are  known 
to  prove  highly  dangerous  to  childhood  and  adoles- 
cence. 

The  earliest  age  at  which  the  young  ought  to  be 
admitted  to  manufacturing  emjjioyments  is  fourteen. 

The  address  was  closed  with  the  following  per- 
sonal reference  :  "  Twenty-eight  years  ago  a  young 
refugee  from  European  hostility  set  foot  ujion  the 
hospitable  shores  of  this  continent.  The  homeless 
wanderer  is  today  your  president;  for,  a  year  ago 
this  week  you  elected  him  to  the  most  honorable 
and  honored  position  the  profession  of  this  great 
State  can  fill."  Keference  was  then  made  to  the  in- 
fluence of  different  forms  of  government  upon  the 


164 


THE  MEDICAL  RECORD. 


subject,  and  the  speaker  said :  "  For  I  think  that 
those  who  are  born  and  bred  in  a  republican  com- 
muaity,  where  every  one  is  the  peer  of  the  other, 
respecting  his  neighbor  as  and  beeaiise  he  respects 
himself,  is  more  apt  to  become  also  a  conscientious 
citizen  of  the  republic  of  letters  and  science.  May 
that  spirit  remain  intact  and  chaste  for  the  last  quai-- 
ter  of  this  century,  and  for  centuries  to  follow,  in 
the  life  of  the  Medical  Society  of  the  State  of  Ne^fr 
York." 

On  motion  the  President's  address  was  referred 
to  a  special  committee. 

ANNOUNCEMENT   OP   COSniITTEES. 

The  President  then  announced  the  following  com- 
mittees : 

Business  Commitlee. — Dr.  D.  B.  St.  John  Eoosa, 
of  New  York,  Chairman ;  Drs.  W.  S.  Ely,  of  Ro- 
chester :  and  C.  B.  Lee,  of  Fulton. 

Committee  on  Credentials. — Drs.  Kobert  Frazier, 
of  Cimden ;  F.  E.  Bentley,  of  Cheshire  ;  and  Wil- 
liam Taylor,  of  Canastota. 

COM.\IUNIC.\TIONS   PKOH   COUNTY   MEDIC.\I;    SOCrETlES."i! 

Dk.  W.  M.  CAKPEsrEB,  of  New  York,  presented 
communications  from  the  Medical  Society  of  the 
County  of  New  York,  which  were  referred  to  the 
Committee  on  By-Laws  and  the  Committee  on  Legis- 
lation. 

REPORTS   OF   COMMITTEES. 

Dr.  Wey,  from  the  Special  Committee  on  the  Re- 
vision of  the  Code  of  Medical  Ethics,  presented  the 
rejiort,  which  was  made  a  special  order  for  the  even- 
ing session. 

Dr.  W.  S.  Elt,  of  Rochester,  read  the  rejiort  of 
the 

COMMITTEE   ON   PRIZE   ESS.4.YS. 

One  essay  only  had  been  submitted,  that  entitled 
"  Tubercle  and  Cancer,"  but  it  was  not  regarded  by 
the  committee  as  worthy  of  the  prize  offered  by  the 
society. 

Dr.  W.  S.  Ely  also  reported  as 

CENSOR   OF   THE   COLLEGE    OP    MEDICINE    OP    SYRACUSE 
UNIVERSITY. 

He  was  favorably  impressed  with  the  qualifica- 
tions of  the  students,  largely  to  be  attributed  to  the 
graded  system  of  instruction. 

Dr.  Daniel  Lewis,  of  New  York,  offered  the  fol- 
lowing resolution  concerning  the  legality  of 

ASSESSMENTS   IN   COUNTY   MEDICAL   SOCIETIES. 

Resolved,  That  this  society  be  requested  to  give 
an  opinion  as  to  the  legality  of  county  medical  socie- 
ties levying  assessments  in  excess  of  the  annual 
dues  prescribed  by  their  by-laws. 

Dr.  S.  O.  VanderPoel  thought  it  was  a  local  ques- 
tion, to  be  decided  by  the  county  societies  them- 
selves. 

On  motion  the  resolution  was  laid  upon  the  table. 

Dr.  S.  B.  Ward,  Chairman  of  the  Committee  of 
Arrangements,  proposed  the  following  as 

MEMliBRS  BY    INVITATION. 

Drs.  E.  C.  Seguin,  of  New  York  ;  John  B.  Stone- 
house,  William  Geoglian,  Theodore  P.  Bailey,  E.  B. 
Tefft,  and  Lewis  Balch,  of  Albany ;  and  Lucius  E. 
Felton,  of  Potsdam.  N.  Y. 

HINTS   AND   SUdOESTIO.NS   UPON    MEDICAL   EDUCATION, 

was  the  title  of  a  ]>aper  then  read  by  Dr.  F.  R. 
Sturois,  of  New  York.    The  speaker  took  issue  with 


the  claim,  so  often  made,  that  many  of  our  best  and 
most  successful  practitioners  have  come  from  among 
those  who  have  not  had  the  advantages  of  a  thor- 
ough preliminary  education.  The  relation  which 
the  question  sustains  to  the  profession  and  to  the 
schools  was  discussed  thoroughly  and  intelligently, 
and  the  position  taken  that  ttie  needed  reform  could 
never  be  secured  by  retrocession  of  college  faculties 
from  steps  taken  in  advance,  but  by  a  united  effort 
of  the  true  lovers  of  learning  and  the  promotion  of 
scientific  instruction  such  as  accompanies  a  finan- 
cial foundation  that  elevates  every  institution  above 
the  influence  of  self  and  the  selfish  action  of  all  or- 
ganizations rai.sed  especially  for  successful  commer- 
cial jjursuits.  The  jiaper  also  embraced  an  argu- 
ment in  favor  of  State  medical  examination  as  a 
necessary  qualification  for  the  practice  of  medicine, 
thus  separating  the  right  to  practise  fi'om  diplomas. 

Dr.  R00.SA,  of  New  York,  si^oke  of  emban-assments 
under  which  some  of  the  medical  colleges  labored, 
of  the  low  state  of  interest  manifested  by  laymen 
upon  the  subject  of  medical  education,  of  the  dis- 
position shown  by  some  medical  schools  to  decline 
any  proposition  looking  toward  a  closer  affiliation 
with  a  university,  as  among  the  obstacles  to  the 
more  desirable  organization  of  medical  schools  and 
the  securing  of  the  advancement  so  earnestly  looked 
for  upon  the  part  of  those  who  had  been  denomi- 
nated reformers. 

Dr.  Perkins,  of  Schenectady,  thought  that  the 
whole  matter  was  largely  in  the  hands  of  the  profes- 
sion itself,  and  that  if  every  young  man  was  urged  to 
prepare  himself  a  little  more  thoroughly  before  en- 
tering upon  the  study  of  medicine,  much  of  what  is 
now  desired  would  in  time  be  accomplished. 

Dr.  E.  M.  Moore,  of  Rochester,  reviewed  the  sub- 
ject at  some  length,  and  projjosed  the  organization 
of  a  Board  of  Examiners,  which  should  have  a  rep- 
resentative from  each  regular  medical  college  in  the 
State,  together  with  a  representative  from  the  Medi- 
cal Society  of  the  State  of  New  York,  acting  in  the 
capacity  of  a  medical  school. 

Dr.  H.  G.  Piffard,  of  New  York,  thought  that 
Dr.  ISIoore's  proposition  would  have  a  tendency  to 
tie  the  hands  of  the  regulars  while  the  irregulars 
could  go  on  without  restraint,  and  we  should  go 
back  to  as  bad  a  state  of  affairs  as  existed  when 
county  medical  societies  granted  licenses  to  prac- 
tise medicine  and  surgery. 

Dr.  Edward  R.  Squibb,  of  Brooklyn,  then  read  a 
paper  on 

CLINICAL   THERMOMETERS. 

The  aim  should  be  to  secure  an  instrument  which 
gives  a  degree  of  accuracy  sufficient  to  meet  all  the 
practical  demands  of  the  purpose  for  which  it  is 
used.  Attention  was  directed  to  some  of  the  sources 
of  error  in  the  construction  of  thermometers.  The 
contraction  of  the  glass  of  which  the  bulb  is  con- 
structed raises  the  mercury  so  that  the  register  is 
higher  than  it  should  lie.  A  thermometer,  there- 
fore, should  be  seasoned  for  thi-ee  years  before  it  is 
graduated,  as  after  that  time  the  error  is  so  slight 
that  it  need  not  be  taken  into  consideration.  Any 
physician  can  send  to  the  Thermometrical  Observa- 
tory at  Yale  College,  wliere  ho  can  have  his  ther- 
mometer tested  and  grailuated  and  certified  to. 

Certain  rules  were  tlien  given  for  the  selection  of 
thei-mometers,  such  as  if  the  glass  of  tl\e  bulb  be  too 
thin  tl\e  nxu-cury  will  rise  ra])idly,  whereas  if  it  is 
too  thick  the  mercury  will  rise  slow.  An  average  of 
six  to  eight  minutes  under  the  tongue  should  give 


J 


THE  MEDICAL  RECORD. 


165 


the  complete  elevation  of  the  mercury,  and  it  also 
indicates  that  the  glass  is  of  suitable  thickness  to 
resist  ordinary  exposures  and  accidents.  A  ther- 
mometer which  fills  its  register  within  foiir  minutes 
is  almost  certain  to  break  should  it  fall  upon  the 
carpet.  A  five  or  six  inch  length  thermometer  is 
most  convenient  for  reading. 

The  paper  was  discussed  by  Dr.  Maurice  Per- 
kins, of  Schenectady. 

Obituarv  notices  of  Levan  B.  Cotes,  by  Dr. 
Potter,  of"  Buiialo,  and  John  F.  Whitbeck,  by  Dr. 
H.  H.  Laugworthy,  were  read  by  title  and  referred 
to  the  Committee  on  Publication. 

The  Business  Committee  suggested  suspension  of 
the  by-laws  so  that  the  report  of  the  Committee  on 
Nomination  could  be  made  at  the  evening  session 
in  which  the  President's  address  is  delivered.  Ob- 
jection being  made,  the  resolution  was  not  adopted. 

Dk.  W.  S.  Ely,  of  Rochester,  then  read  a  brief 

NOTE   ON   BEEF-JCICE. 

His  method  of  extracting  it  was  to  take  fre.shly 
chopped  lean  beef,  heat  it  thoroughly  with  constant 
stirring,  and  then  quickly  transfer  to  a  cylinder  in 
which  screw-pressure  could  be  applied  as  in  pressing 
fruit.  The  fluid  thus  obtained  is  red,  has  a  specific 
gravity  of  1032,  acid  reaction,  and  contains  all  the 
albumen  and  salts  of  the  beef.  It  could  be  advan- 
tageously used  as  a  substitute  for  deflbrinated  blood 
for  rectal  alimentation. 

It  should  be  heated  to  a  degree  less  than  that 
which  coagulates  albumen,  namely,  60=  C.  or  143  F. 

Dr.  John  P.  Gray  suggested  the  addition  of 
claret  or  alcohol  in  small  quantity,  to  prevent  the 
early  decomposition  of  the  juice,  and  also  as  an  ad- 
dition to  its  medicinal  or  food  value.  Of  claret,  an 
ounce  to  the  pint  might  be  sufficient. 

Dr.  Ward,  of  the  Committee  of  Arrangements, 
then  announced  the  banquet  to  be  given  at  the  Del- 
avan  on  Wednesday  evening,  after  the  President's 
,  address. 

He  also  announced  the  following 

MEUBEBS  BY   INVITATION. 

Brayton  Babcock,  Alleghany  Co.;  S.  O.  Vander 
Poel,  jr.,  John  F.  Lockwood.  H.  E.  Starkweather, 
.  S.  R.  Morrow,  C.  F.  Huddleston,  Lorenzo  Hale. 
I  John  Thompson,  W.  J.  Nellis,  A.  B.  Huested, 
1  Otto  Eitzman,  P.  J.  Keegan,  J.  W.  Gould,  Albany ; 
I  Samuel  Peters,  Cohoes. 
I      The  .society  then  adjourned  to  meet  at  3  p.m. 


Tuesday,  Febru-Uit  7th — Afternoon  Session. 

The  society  was  called  to  order  at  3  p.m.  by  the 
President. 

The  following  were  announced  as  the  Committee 
on  the  President's  Inaugural  Address  :  Drs.  E.  M. 
Moore,  of  Monroe  County,  S.  O.  Vander  Poel,  of  New 
York  County,  and  John  P.  Gray,  of  Oneida  County. 

The  first  i)aper  was  read  by  Dr.  S.  O.  Vander  Poel, 
of  New  York,  and  entitled 

THE  PRESENT   CONDITION    OP   THE   TDBERCULOSLS   QUES- 
TION. 

In  this  paper  the  author  reviewed  the  opinions 
entertained  by  Niemeyer,  Laennec,  English  obsei-v- 
ers,  and  others.  Scrofula  is  the  key  to  the  explana- 
tion of  the  occurrence  of  phthisis  in  certain  patients 
under  certain  circumstances,  while  in  other  patients 
it  does  not  occur  under  like  circumstances.  How 
does  scrofula  become   tubercle  ?     At  some  distant 


part  has  originated  a  caseous  change  that  has  given 
rise  to  tubercle  or  another  disease  by  infection. 
There  is  localization  instead  of  a  constitutional  con- 
dition as  the  primal y  factor.  Three  varieties  of 
phthisis  were  recognized  : 

1.  Chronic  pneumonia  of  one  apex,  with  much 
dulness,  slight  nlles,  slight  fever. 

2.  Broncho-pneumonia. 

3.  Catarrh  of  the  apex. 

•  The  pajjer  was  discussed  by  Dr.  E.  M.  Moore, 
of  Rochester,  and  the  President,  and  chiefly  with 
reference  to  the  essential  nature  of  scrofula. 

A  biographical  .sketch  of  James  P.  Boyd,  M.D.,  of 
Albany,  by  Dr.  Thoiias  Hun,  was  referred  to  the 
Committee  on  Publication. 

The  President  then  announced  the  following  as 
the  Committee  of  Nominations  : 

From  the  Society  at  Large:  Wm.  C.  Wey,  of  El- 
mira. 

Elected  hy  the  Several  Se7>  atari nl  District  Meetings  : 
First  District,  Thomas  R.  Pooley,  of  New  Y'^ork ; 
Second  District,  J.  Foster  Jenkins,  of  Y'onkers ; 
Third  District,  Norman  L.  Snow,  of  Albany  ;  Fourth 
District,  B.  P.  Sherman,  of  Ogdensburg ;  Fifth  Dis- 
trict, Wm.  H.  Johnson,  of  Port  Leyden,  Lewis 
County ;  Sixth  District,  C.  L.  Stiles,  of  Owego, 
Tioga  County  ;  Seventh  District,  John  Gerin,  of  Au- 
burn ;  Eighth  District,  W.  W.  Potter,  of  Buffalo. 

members   by   lN%aTATtON. 

The  following  were  elected  :  Drs.  Franklin  Town- 
send,  of  Albanv  :  Edward  H.  Squibb,  of  Brooklvn  ; 
T.  Z.  Gibbs,  of  Fort  Ann,  and  D.  H.  Goodwillie',  of 
New  Y'ork. 

Dr.  E.  M.  Moore,  of  Rochester,  then  reported  a 
case  of 

EXTBAOKDINABY    BONE-DEVBLOPMENT. 

The  paper  will  be  published  in  fuU  in  a  subse- 
quent number  of  the  Reooed.  It  was  discussed  by 
Dr.  J.  S.  Wight,  of  Albany. 

The  next  paper  was  read  by  Dr.  E.  C.  Seguin,  of 
New  York,  and  entitled 

EFFECTUAL  DOSAGE  OF  CERTAIN  KEHEDIES  IN  THE  TREAT- 
MENT  OF   NERVOUS   DISEASES. 

Especial  attention  was  directed  to  the  dosage  of 
nitrate  of  silver,  Duquesnel's  aconitia,  and  conium. 
The  doses  which  he  had  employed  were  larger  than 
those  usually  recommended  in  text-books,  as  com- 
pared with  those  given  by  Stillc  and  Maisch,  Noth- 
nagel,  Gubler,  and  others.  He  was  very  favorably 
disposed  toward  nitrate  of  silver  in  locomotor  ataxia, 
and  used  it  in  from  one-fourth  to  one-half  grain  in 
pill  form,  combined  with  extract  of  nux  vomica  or 
taraxacum,  according  to  indications,  beiore  meals, 
t.  d.,  for  two  months,  and  then  allow  an  interval  of 
two  or  three  months,  to  be  followed  by  a  shorter 
course.  Given  in  that  way,  he  had  not  seen  any  un- 
pleasant effects  in  the  way  of  discoloration  of  the  skin, 
etc.  With  reference  tu  aconitia,  small  doses,  as  with 
all  potent  remedies,  should  be  administered  to  pa- 
tients at  first,  in  order  to  observe  the  susceptibility 
to  the  drug;  as  for  example,  -in  or  ji',,t  of  a  grain 
may  produce  marked  physiological  eft'ects.  One 
peculiarity  which  he  had  noticed  with  reference  to 
locomotor  ataxia  was  that  such  patients  had  not 
shown  the  physiological  effects  of  the  drug.  He  re- 
garded aconitia  as  the  best  of  our  present  resources 
in  trigeminal  neuralgia. 

Concerning  conium,  he  never  gave  it  in  less  than 
twenty-drop  doses  of  the  fluid  extract,  frequently  in 


166 


THE  MEDICAL  RECORD. 


sixty  to  one  hundred -drop  doses,  and  that  for  the 
purpose  of  obtaining  the  paralj'zing  effects  in  special 
convulsive  neurosis,  such  as  chorea. 

The  paper  was  discussed  by  Drs.  Squibb  and  Wal- 
ter B.  Chase,  of  Brooklyn ;'  Dr.  Gibney,  of  New 
York;  Dr.  Stoddard,  of  Rochester ;  and  Dr.  Allison. 

Dr.  C.  S.  Bull,  of  New  York,  then  read  a  paper  on 

SYPHILITIC   DISEASES    OF    THE    LACHRYMAL    APPARATUS. 

The  author  referred  to  two  published  cases  of 
syphilitic  disease  of  tlie  lachrymal  glands,  one  in 
v?hicli  he  had  observed  it  as  the  result  of  exten.sion 
from  the  periosteum,  and  the  other  as  syphilis  of  the 
caruncle,  of  which  two  cases  had  been  reported  by 
Dr.  R.  W.  Taylor,  and  these  he  gave  nearly  in  detail. 
He  also  spoke  of  syphilitic  affection  of  the  lachrymal 
sac  and  nasal  duct,  early  and  late  manifestations,  and 
the  tendency  of  the  duct  disease  to  extend  upward 
toward  the  sac.  Osteo  periostitic  gummosa  were  also 
studied,  and  the  treatment  of  the  affection  considered 
under  the  use  of  mercury  and  the  iodide  of  potas- 
sium. 

The  paper  was  discussed  by  Dr.  H.  D.  Noyes,  of 
New  York,  who  referred  to  the  obscurity  and  persist- 
ence of  certain  lachrymal  troubles  in  children,  usu- 
ally due  to  hereditary  syphilis. 

MEMBERS    BY   INVITATION. 

T.  L.  St.  John,  of  Troy ;  I.  N.  Goff,  of  Cazenovia ; 
L.  A.  Tourtelott,  of  Utica;  E.  A.  Bartlett,  Wm. 
Hailes,  W.  G.  Tucker,  T.  Featherstonhaugh,  W.  J. 
Levi,  O.  W.  Greene,  of  Albany. 

Dr.  Lucius  E.  Felton,  of  Potsdam,  exhibited 

A   NEW   GALVANIC   BATTERY. 

Remarks  were  made  by  Dr.  B.  F.  Sherman,  of 
Ogdensburg,  after  which  the  Society  adjourned  to 
meet  at  8  p.m. 


Tuesday,  February  7 — Evening  Session, 
report  of  the  committee  on  revision  of  the  code 

or   ETHICS. 

The  society  was  called  to  order  at  8  p.m.,  .ind  the 
following  report  of  the  Committee  on  the  Revision 
of  the  Code  of  Ethics  was  made  the  sjiecial  order  of 
business : — 

1. — THE    RELATIONS   OP   PHYSICIANS   TO    THE   PUBLIC. 

It  is  derogatory  to  the  dignity  and  interests  of  the 
profession  for  physicians  to  resort  to  public  adver- 
tisements, private  cards,  or  handbills,  inviting  the 
attention  of  individuals  affected  with  particular  dis- 
eases, publicly  offering  advice  and  mediciao  to  the 
poor  without  charge,  or  promising  radical  cures; 
or  to  publish  cases  or  operations  in  the  daily  prints, 
or  to  suffer  such  publications  to  be  made  ;  or, 
through  the  medium  of  reporters  or  interviewers, 
or  otherwi.se,  to  permit  their  opinions  on  medical 
and  surgical  questions  to  appear  in  the  newspajiers ; 
to  invite  laymen  to  be  present  at  operations  ;  to 
boast  of  cures  and  remedies ;  to  adduce  certiticates 
of  skill  and  success,  or  to  perform  other  similar  acts. 

It  is  equally  derogatory  to  professional  cliaracter, 
and  opijosed  to  the  interests  of  the  profession,  for  a 
physician  to  hold  a  patent  for  any  surgical  instru- 
ment or  medicine,  or  to  prescrilie  a  secret  nostrum, 
whether  the  invention  or  discovery  or  exclusive 
property  of  himself  or  of  others. 

It  is  also  reprehensible  for  physicians  to  give  cer- 


tificates attesting  the  efficacy  of  patented  medical  or 
surgical  appliances,  or  of  patented,  copyrighted  or 
secret  medicines,  or  of  proprietary  drugs,  medicines, 
wines,  mineral  waters,  health  resorts,  etc. 

n. — RULES  GOVERNING  CONSULTATIONS. 

Members  of  the  Medical  Society  of  the  State  of 
New  York,  and  of  the  medical  societies  in  affiliation 
therewith,  may  meet  in  consultation  legally  quali- 
fied practitioners  of  medicine.  Emergencies  may 
occur  in  which  all  restrictions  should,  in  the  judg- 
ment of  the  practitioner,  yield  to  the  demands  of  hu- 
manity. 

To  promote  the  interests  of  the  medical  profes- 
sion and  of  the  sick,  the  following  rules  should  be 
observed  in  conducting  consultations. 

The  examination  of  the  patient  by  the  consulting 
physician  should  be  made  in  the  presence  of  the 
attending  physician,  and  during  such  examination 
no  discussion  should  take  jilace,  nor  any  remarks 
as  to  diagnosis  or  treatment  be  made.  When  the 
examination  is  comjileted,  the  physicians  should 
retire  to  a  room  by  themselves,  and  after  a  state- 
ment by  the  attending  physician  of  the  history  of 
the  case  and  of  his  views  of  its  diagnosis  and  treat- 
ment, each  of  the  consulting  physicians,  beginning 
with  the  youngest,  should  deliver  his  opinion.  If 
they  anive  at  an  agreement,  it  will  be  the  duty  of  the 
attending  physician  to  announce-  the  result  to  the 
patient,  or  to  some  responsil;)le  member  of  the  fam- 
ily, and  to  carry  out  the  plan  of  treatment  agreed 
upon. 

If  in  the  consultation  there  is  found  to  be  an  es- 
sential difference  of  opinion  as  to  diagnosis  or 
treatment,  the  case  should  be  presented  to  the  pa- 
tient, or  some  responsible  member  of  the  family,  as 
plainly  and  intelligently  as  possible,  to  make  such 
choice  and  pursue  such  course  as  may  be  thought 
best. 

In  case  of  acute,  dangerous,  or  obscure  illness, 
the  consulting  physician  should  continue  his  visits 
at  such  intervals  as  may  be  deemed  necessaiy  by 
the  patient  or  his  friends,  by  him,  or  by  the  attend- 
ing physician. 

The  utmost  punctuality  should  be  observed  in  the 
visits  of  physicians  when  they  are  to  hold  consulta- 
tions ;  but,  as  professional  engagements  may  inter- 
fere or  delay  one  of  the  parties,  the  physician  who 
first  arrives  should  wait  for  his  associate  a  reasona- 
ble period,  after  which  the  consultation  should  be 
considered  as  postponed  to  a  new  appointment.  If 
it  be  the  attending  physician  who  is  present,  he  will 
of  course  see  the  patient  and  prescribe  ;  but  if  it  be 
the  consulting  physician,  he  should  retire,  except  in\ 
an  emergency,  or  when  he  has  been  called  from  a 
consideraVde  distance,  in  which  latter  case  he  may 
examine  the  patient,  and  give  his  opinion  in  writ- 
ing and  under  seal,  to  be  delivered  to  his  associate. 

nl. — THE   REL.\TI0NS   OF   PHYSICIANS   TO    EACH    OTHEB. 

All  practitioners  of  medicine,  their  wives,  and 
their  children  while  under  paternal  care,  are  entitle" 
to  the  gratuitous  services  of  any  one  or  more  of  th 
faculty  residing  near  them,  whose  assistance  may  1 
desired. 

Gratuitous  attendance  cannot,  however,  be 
jiected  from  physicians  called  from  a  distance,  n<( 
need  it  be  deemed  obligatory  w  hen  O])])osinl  by  hot' 
the  circumstances  and  the  preferences  of  tlio  paticnij 

The  affairs  of  life,  the  jnirsuit  of  lu-alth,  and  tbs 
various  accidents  and  contingencies  to  which  a  med- 
ical  man  is   i)eculiarly  exposed,  may  require   him 


THE  MEDICAL  RECORD. 


167 


temporarily  to  withdraw  from  his  duties  to  his  pa- 
tients, and  to  request  some  of  his  professional 
brethren  to  officiate  for  him.  Compliance  with  this 
request  is  an  act  of  courtesy  which  should  always  be 
performed  with  the  utmost  consideration  for  the 
interests  and  character  of  the  family  physician,  and, 
when  exercised  for  a  short  period,  all  the  pecuniary 
obligations  for  such  service  should  be  awarded  to 
him.  But,  if  a  member  of  the  profession  neglect  his 
business  in  quest  of  pleasure  and  amusement,  he 
cannot  be  considered  as  entitled  to  the  advantages 
of  the  frequent  and  long-continued  exercise  of  this 
fraternal  courtesy  without  awarding  to  the  physician 
who  oificiates  the  fees  arising  from  the  discharge  of 
his  professional  duties. 

In  obstetrical  and  important  surgical  cases,  which 
give  rise  to  unusual  fatigue,  anxiety  and  responsi- 
bility, it  is  just  that  the  fees  accruing  therefrom 
should  be  awarded  to  tlie  jihysician  who  officiates. 

Divei'sity  of  opinion  and  opposition  of  interest 
may,  in  the  medical  as  in  other  professions,  occa- 
sion conti-oversy  and  even  contention.  Whenever 
such  cases  unfortunately  occur,  and  cannot  be  im- 
mediately terminated,  they  should  be  refen-ed  to  the 
arbitration  of  a  sufficient  number  of  physicians  be- 
fore appealing  to  a  medical  society  or  the  law  for 
settlement. 

If  medical  controversies  are  brought  before  the 
public  in  newspapers  or  pamphlets,  by  contending 
medical  writers,  and  give  rise  to  or  contain  asser- 
tions or  insinuations  injurious  to  the  pei'sonal 
character  or  professional  qualitieations  of  the  par- 
ties, the  etfect  is  to  lower  in  the  estimation  of  the 
public  not  only  the  parties  directly  involved,  but 
also  the  medical  profession  as  a  whole.  Such  pub- 
lications should  therefore  be  brought  to  the  notice 
of  the  county  societies  having  jurisdiction,  and  dis- 
cipline inflicted,  as  the  case  may  seem  to  require. 

After  considerable  discussion,  during  which  a 
substitute  by  Dr.  Koosa  was  offered  and  lost,  the 
report  was  finally  adopted.  The  meeting  then  ad- 
journed until  Wednesday  morning. 

(To  be  continued.) 


ARMY  NEWS. 

Official  List  of  Changes  of  Stalioiis  and  Duties  of  Offi- 
cers of  the  Medical  Department,  United  States  Army, 
from  Jamiary  29,  1882,  to  February  4,  1882. 

Woodward,  Joseph  J.,  Major  and  Surgeon. 
Granted  leave  of  absence  for  six  months,  on  sur- 
geon's cei'tificate  of  disability,  with  permission  to 
go  beyond  sea.     S.  O.  23,  A.  G.  O,  January  30, 1882. 

Summers,  Jno.  E.,  Lieut.-Colonel  and  Surgeon, 
Medical  Director  Department  of  the  Platte.  Leave 
of  absence  further  extended  one  month.  S.  O.  20, 
C.  S.,  A.  G.  O. 


The  ME.iNEJG  of  Keith's  Aeaxdosment  of  Lister- 
ism. — According  to  a  correspondent  of  the  Boston 
Medical  and  Surgical  Journal,  Mr.  Keith,  in  announc- 
ing at  the  International  Medical  Congress  his  aban- 
donment of  the  spray,  failed  to  state  a  very  imioortant 
fact.  This  was,  that  he  had  been  using  a  solution  of 
carbolic  acid  one-tenth  stronger  than  that  ))rescribed 
by  Lister.  It  is  claimed  that  in  fairness  he  should 
have  made  this  .statement.  On  the  other  hand.  Lis- 
ter's failure  to  make  any  satisfactoiw  reply  is  ascribed 
m  part  to  his  not  being  acquainted  with  abdominal 
aurgery. 


ilctiicnl  Stents   anl)  Ucros. 


Tbeatjient  of  Stphilis  by  Hypodermic  In.ieition. 
— In  the  formula  given  for  the  use  of  bichloride  of 
mercury  with  peptone  and  animon.  chlorid.  (Medi- 
CAi,  Eeoobd,  December  24,  1S81),  our  attention  has 
been  called  to  the  fact  that  the  amount  of  glycerine 
and  water  is  insufficient.  This  can  be  increased, 
however,  according  to  the  judgment  of  the  pharma- 
cist or  physician.  The  main  thing  is,  of  course,  to 
get  a  clear,  non-irritant  solution,  which  is  to  be  in- 
jected in  doses  of  gr.  y^  to  gr.  1. 

Fkench  Eepokt  OS  THE  Hyglene  op  Schools. — In 
.June  last  the  French  Minister  of  Public  Instmction 
appointed  a  commission  to  inquire  into  the  causes 
of  the  rapid  increase  of  myopia  among  schoolchil- 
dren.  That  commission  has  made  its  report,  which 
contains  a  number  of  suggestions  regarding  light, 
desks,  writing  utensils,  books,  etc. 

Prognosis  in  Metastatic  Parotitis. — Dr.  John  A. 
Wyeth,  of  this  city,  writes  :  "  Apropos  to  the  inter- 
esting article  on  '  Metastatic  Parotitis,'  l)y  Dr.  E. 
C.  M.  Page,  in  The  Eecoed,  is  a  case  of  double  paro- 
titis complicating  typhoid  fever,  occurring  in  the 
service  of  M.  Laboidbfene.  Patient,  aged  seventeen, 
recovered.  Also  a  quotation  from  Trousseau's 
Lemons  Clinique,  in  which  he  says,  '  I  have  never 
seen  a  patient  recover  who  was  thus  aflected.'" — 
Gazette  des  Hopiiaux,  Ko.  87,  1881. 

Diploma  IMANfFACTrRE  in  Detroit. — Dr.  H.  S. 
Thomas,  the  Michigan  Avenue  cancer  doctor,  with 
others,  have  organized  an  aiJair  which  they  term 
"  Detroit  University,"  capital  .?30,000,  of  which 
.S15,000  is  paid  in  the  form  of  notes  signed  by  the 
several  stockholders.  The  University  will  confer 
degrees  in  law,  theology,  and  medicine.  It  is  stated 
that  Thomas  offered  the  degree  of  LL.D.,  to  the 
lawyer-  who  witnessed  the  articles.  Some  days  since 
one  of  the  announcements  of  the  above  aflair  was 
presented  to  our  notice.  As  the  late  Dr.  Buchanan, 
of  Philadelphia,  was  not  long  since  the  guest  of  Dr. 
Thomas,  while  playing  "hide  and  seek  "  with  the 
detective,  it  is  easy  to  see  whence  the  inspiration  of 
this  new  "university"  springs.  It  seems  more 
than  probable  that  Detroit  will  have  a  genuine  dip- 
loma-mill. Is  there  any  law  to  prevent  it  ?  None 
with  which  we  are  acquainted. — Detroit  Lancet. 

Professor  Fkeund,  of  Strasbiu-g,  has  been  offered 
the  Chair  of  Obstetrics  in  Breslau,  vacant  by  the 
death  of  Professor  Sj^iegelberg,  and  has,  it  is  re- 
jjorted,  accejjted  it. 

Fire  and  Blood. — It  used  to  be  said,  somewhat 
aphoristically,  that  Broussais  recognized  as  the 
cause  of  all  diseases,  inflammation,  and  as  the  cure, 
bloodletting.  He  was  called,  consequently,  the 
doctor  of  fire  and  blood. 

Philadelphia  Societies. — The  officers  of  the  Phil- 
adelphia County  Medical  Society  recently  elected  for 
1882  are :  President,  H.  Y.  Evans  ;  Vice-Pre.sidents, 
Charles  K.  Mills,  John  B.  Eoberts  ;  Treasurer,  Wil- 
liam M.  Welch  ;  Kecording  Secretary,  Henry  Leif- 
mann ;  Eeporting  Secretary,  Frank  A^'oodbury ; 
Corresponding  Secretary,  H.  Augustus  Wilson ; 
Assistant  Secretary,  J.  D.  Nash  ;  and  Librarian,  M. 
O'Hara. 

The  officers  of  the  Pathological  Society  of  Phil- 


168 


THE  MEDICAL  RECORD. 


adelphia  are :  President,  S.  W.  Gross  ;  Vice-Presi- 
dents, James  Tyson,  J.  Solis  Cohen,  F.  P.  Henry, 
J.  Ewing  Mears  ;  Secretary,  S.  F.  Hazelhurst ;  Treas- 
urer, M.  S.  French ;  Recorder,  O.  B.  Naucrede : 
Curator,  Carl  Seller. 

Polluted  Well- WArER  and  Typhoid  Fevee. — Dr. 
C.  R.  Agnewof  this  city  writes  :  "You  will  remember 
that  typhoid  fever  has  been  quite  prevalent  through 
Kentucky  and  Tennessee,  and  especially  connected 
with  that  condition  of  water-supply  which  follows  a 
drought.  Last  summer  the  drought  was  prolonged, 
and  the  typhoid  fever  correspondingly  prevalent. 
Dr.  W.  O.  Sweeney,  of  Lexington,  Kentucky,  Pro- 
fessor of  Chemistry  in  Hamilton  College,  in  that 
city,  has  told  me  that  he  has  the  records  of  eighty 
cases  occurring  in  his  practice  during  1880  and  1881 ; 
that  not  one  of  the  cases  occurred  in  persons  using 
cistern-water;  that  all  had  used  well- or  spring- 
water;  that  he  had  traced  seven  cases  directly  to 
one  polluted  well.  Of  course  we  know  that  such 
statements  are  not  new.  They  are  interesting,  how- 
ever, as  a  contribution  to  the  subject." 

A  Spanish  Medical  Congress  will  be  held  at  Se- 
ville, Ajjril  9,  1882.  Preparations  have  been  made 
on  a  large  scale  for  the  successful  carrying  out  of 
the  meeting.  The  programme  of  subjects  proposed 
for  discussion  includes :  the  relations  of  animal 
heat  to  the  nervous  system  ;  urea  ;  illuminating  ap- 
paratus ;  tuberculosis ;  infant  mortality ;  preven- 
tion of  scrofula ;  action  of  common  air  as  a  medi- 
cine ;  heat  as  a  medicine ;  diabetes ;  antiseptic 
treatment ;  color-blindness  ;  strabismus  ;  and  a  num- 
ber of  other  topics  under  almost  all  of  the  difterent 
specialties.. 

Bismarck  as  a  Patient.  —  The  Prince's  chief 
trouble,  as  is  well  known,  is  sciatica,  and  it  is 
greatly  dreaded  on  account  of  its  obstinacy.  Be- 
sides this,  the  Chancellor  suffers  at  times  from  an 
iufiammatory  swelling  of  the  veins  in  the  feet,  and, 
like  all  other  mortals,  occasionally  from  lighter  in- 
dispositions— colds  and  indigestion.  It  seems  that 
the  patient  is  as  inconsistent  regarding  the  methods 
of  his  treatment  as  he  is  in  other  matters.  With  the 
same  feeling  of  "  absolute  indifference  "  which,  ac- 
cording to  his  own  words,  lie  manifests  in  certain 
political  topics,  he  also  deals  with  the  exigencies  of 
the  medical  science.  Homoeopathy  or  allopatliy — 
it  is  all  one  to  him,  so  long  as  he  believes  oue  or  the 
other  will  cure  him.  It  has  even  happened  that  he 
allowed  himself  to  bo  treated  by  an  allopathic  phy- 
sician, and  soon  after  by  a  homreopathist.  When 
at  Friedrichsruh,  he  sends  for  Privy  Sanitary  Coun- 
cillor Dr.  Dohn,  of  Hamburg,  who  is  an  allopath. 
At  Varzin,  when  medical  attendance  is  needed,  the 
physician,  also  an  allopath,  in  the  adjacent  town  of 
Scidawe,  is  applied  to.  When  at  Kissengen,  the 
Prince  consults  the  well-known  Dr.  Diruf,  also  an 
adherent  of  the  old  school.  During  his  stay  at  Ber- 
lin, however,  he  inclines  to  homicopathic  treatment. 
— A  mericnn  Rugisti'.r. 

Some  Agreeable  Iron  PunrAHATioNs  that  should 
BE  Introduced  into  America. — Dr.  George  J,.  Wal- 
ton, in  a  letter  to  the  Bns/nyi  .Hfo/icril  iin<l  Snrrjical 
Jnm-Hnl,  highly  recommends  cprtain  German  prepa- 
rations of  iron,  and  urges  their  introduction  into 
America.  These  jireparations  are  "  Ferrum  oxy- 
datura  saccharatuni  solnbile "  or  "Iron  sugar," 
Tinctura  feni  pomata,  and  Syrupus  ferri  pyrophos- 
phorici  cum  ammonio  citrico. 


The  "Iron  sugar"  is  a  very  elegant  preparation. 
It  is  a  light  brown,  sweet- tasting  powder,  soluble  in 
water,  but  it  can  be  taken  in  its  natural  form.  It 
does  not  discolor  the  teeth,  and  may  be  taken  for 
any  length  of  time  without  disturbing  digestion.  It 
may  also  be  taken  with  milk.  The  full  directions 
for  preparing  this,  as  well  as  the  other  preparations, 
are  given  by  Dr.  Walton. 

Chxan  Turpentine  in  Cancer.  —  At  a  recent 
meeting  of  the  Baltimore  Medical  Association,  Dr. 
John  Morris  had  been  using  this  agent  in  a  case  of 
epithelioma  of  the  cervix  uteri.  He  found  that  the 
sample  obtained  in  this  city  was  very  different  from 
that  used  by  Clay.  Pills  of  the  former  passed  un- 
changed through  the  bowels,  while  those  made  from 
the  preparation  which  he  had  ordered  from  England 
dissolved  readily.  Another  characteristic  of  the  lat- 
ter preparation  was  the  very  marked  diuretic  action 
which  it  produced.  He  did  not  regard  the  domes- 
tic preparation  as  a  genuine,  article.  He  bad  not 
used  the  agent  sufficiently  to  speak  yet  of  its  value 
in  the  case  referred  to;  the  only  change  noted 
after  the  use  of  one  ounce)  was  the  less  amount  of 
opium  required  by  the  patient. —  Virginia  Medical 
Monthly. 

How  TO  Distinguish  Saliva-Spots  in  Clothes 
Fii.iM  I  li  ,n  i:s  OF  SiJilLAR  Appear.\nce. — Dr.  C'ervei:a 
( /;  U    /.   1/  Cir.  Prcict.)  gives  a  simple  mode  of 

ili  1  iii.'.m^iiUL.LC  salivary  stains  from  spermatic  and 
others  of  similar  appearance  with  which  they  may 
be  confounded.  This  distinction  is  often  of  impor- 
tance in  medico-legal  cases.  The  piece  of  cloth  con- 
taining the  spot  is  by  capillarity  moistened  with  a 
saturated  solution  of  ferric  chloride  ;  chemical  re- 
action will  give  rise  to  a  blood-red  color  in  the  case 
of  saliva,  but  not  in  stains  due  to  other  fluids. 
Carotid  saliva,  especially  after  meals,  contains  the 
sulphocyanide  of  potassium,  a  suostance  which 
strikes  an  intense  red  color  in  contact  with  ferric 
salts,  although  these  may  be  present  only  in  minute 
quantity.  Such  reaction  does  not  take  place  in  the 
case  of  saliva,  nasal  or  vaginal  mucus,  spermatic  or 
gonorrhoea!  fluid. —  Cron.  Med.-Quir.  de  la  Hah. 

Treatment  op  Amygdalitis  and  Tonsillar  Hy- 
pertrophy BY  THE  Bicarbonate  of  Sodium. — Dr. 
ArmengiiC  rei^orts  seven  cases  of  angina  tonsillaris 
cured  in  less  than  twenty-four  hours  by  the  bicar- 
bonate of  sodium  (?).  This,  therapeutic  measure 
was  known  to  Professor  Gine,  who  employed  the 
remedy  both  in  the  form  of  a  powder  and  as  a  local 
application.  The  author  asserts  that  frequent  appli- 
cations in  tonsillitis  and  tonsillar  hypertrophy  will 
produce  immediate  amelioration  in  -the  majority  of 
cases,  while,  in  other  instances,  cure  results  in  a 
little  while.  It  is  most  efficacious  when  apjilicd 
during  the  decline  of  the  inflammation,  although 
Dr.  .Vrmenguc  lias  .succeeded  witli  it  in  a'^orting  the 
morbid  process.  The  liicarbonate  does  not  dimin- 
ish the  predisposition  to  angina,  Imt  arrests  its  de- 
velopment. Amygdalotomy  the  author  believes  to 
be  a  useless  operation. — Oaz:.  Med.  di  Roma. 

Mechanical  Therapeittics. — A  company  has  been 
formed  to  introduce  Dr.  Zander's  .system  of  mechani- 
cal therapeutics  into  London.  Znnder  has  prac- 
tised his  system  in  Stockliolm  succcssl'ully  for  ninny 
years.  A  description  of  some  of  his  nuicbines  and 
appliances  has  appeared  in  The  Medk  al  P.ecord. 
There  is  no  doubt  of  the  usefulness  of  this  metliod 
of  ti-eatment  in  manv  forms  of  disease. 


Vol.  XXI.-No.  7. 
Feb.  18.  1888. 


THE  MEDICAL  RECORD. 


169 


©riginal  Cecturcs. 


ON  THE  EXTEACTION  OF  CATAEACT. 

Clinical,  Remarks  made  before  the  Class  of  Stu- 
dents AT  THE  New  York  Ophthalmic  and  Aukal 
Institute.  . 

By  HERMAN  KNAPP,  M.D., 


Gentlemen  :  Since  the  opening  of  the  pre.sent  winter 
course — October  12th— tliirty  extractions  of  cataract 
have  been  made  in  this  hospital,  namely,  one  by  Dr. 
Born  and  twenty-nine  by  myself.  Yoix  have  not  only 
witnessed  the  operations,  but  also  watched  the  after- 
treatment  and  the  course  of  healing  in  all  of  them, 
and  you  know  that  there  was  no  failure.  The  last 
operation  having  been  made  on  the  loth  of  Decem- 
ber, it  may  now  be  opportune  to  hold  a  general  ret- 
rospective survey,  while  the  details  are  still  fresh  in 
our  memory. 

All  the  cataract  extractions  performed  at  this  in- 
stitution are  entered  and  described  in  a  special 
record-book,  according  to  the  schedule  adopted  at 
the  meeting  of  the  American  Oi^hthalmological  So- 
ciety in  1872.  This  book,  containing  the  detailed 
histories  of  over  400  extractions,  I  place  before 
YOU,  and  will  do  so  as  willingly  before  any  one  who 
may  desire  to  use  it  for  scientific  purposes.  From 
it  I  have  made  a  synopsis  of  our  last  thirty  extrac- 
tions, to  serve  as  a  basis  for  some  comprehensive 
remarks. 

The  >/ounf/est  jjatient  was  a  servant  girl,  aged 
thirty-two  years,  whose  cataract  I  would,  under  or- 
dinary circumstances,  have  operated  on  by  division, 
but  as  she  was  blind  in  both  eyes,  had  only  recently 
come  to  this  country,  and  was  without  support,  I 
preferred  that  operative  procedure  which  restored 
her  sight  in  the  shortest  time.  There  were  three 
patients  between  forty  and  forty-eight  years  of  age. 
The  i-emainder  were  over  fifty.  The  oldest  was 
eighty-two. 

The  metliod  was  a  inore  or  less  linear  or  low-flap 
section,  with  a  broad  iridectoini/,  and  peripheric  open- 
ing of  the  capsule.  In  the  first  operations,  I  showed 
you  Graefe's  section,  beginning  and  terminating  one 
millimetre  in  the  corneo-scleral  junction,  its  apex 
being  at  the  transparent  margin  of  the  cornea, 
or  even  one  to  two  millimetres  below  it.  Gradually 
I  shifted  into  the  flap-section  which  De  Wecker  of 
Paris  recommends  as  the  best,  namely,  a  section 
with  a  Graefe's  knife,  situated  exactly  in  the  trans- 
parent margin  of  the  cornea,  extending  over  its  upper 
third.  For  full-sized  cataracts,  I  made  it  somewhat 
larger.  Gentlemen,  both  sections — the  linear  and 
the  flap — have  their  advantages  and  their  disadvan- 
tages ;  the  linear  does  not  incline  to  tilting,  and  shows 
a  very  accurate  coaptation,  but  as  its  ends  are  nearer 
to  the  insertion  of  the  iris,  it  is  more  liable  than  the 
flap  to  adhesions  and  incarcerations  of  the  iris  and  to 
cyclitic  processes.  With  regard  to  firm  closure  of 
the  wound,  one  of  the  most  important  factors  in  the 
whole  operation,  the  flap,  though  easily  gaping 
during  the  operation  and  soon  after  it,  has  one  re- 
deeming quality — it  cuts  the  lamelhe  of  the  cornea 
obliquely,  not  at  right  angles,  as  the  linear  section 
does.  You  know  that  this  principle  of  oblique  pier- 
cing is  frequently  made  use  of,  and  with  admirable 
ingenuity,  in  the  animal  organism.  Let  me  only  re- 
mind you  of  the  ductus  clioledochus  piercing  the 


wall  of  the  duodenum  obliquely,  by  which  contriv- 
ance the  bile  can,  without  obstacle,  flow  into  the 
gut,  but  the  food,  while  passing  from  the  pylorus 
onward,  will  press  the  inner  wall  of  the  valve-like 
opening  of  the  bile-duct  against  the  outer,  and  thus 
completely  close  the  aperture.  Somewhat  in  the 
same  manner  the  inner  lip  of  the  flap-section  is 
pressed  against  the  outer  by  the  contents  of  the 
globe,  whereby  a  firm  and  lasting  closure  may  be 
established.  Theorizing  is  a  fine  thing  in  its  way, 
but  worthless  without  the  test  of  experience,  because 
in  complicated  ijroblems  we  commonly  fail  to  know 
and  appreciate  the  quality  and  quantity  of  all  the 
co-operating  factors.  Wecker's  section  has  thus  far 
shown  us  very  kind  healings,  encouraging  to  further 
trial. 

The  iridectomy  in  almost  all  of  our  operations  was 
large.  When  the  corneal  section  and  the  opening 
of  the  capsule  are  peripheric,  it  must  be  large,  or 
the  columns  of  the  coloboma  will  be  an  obstacle  to 
the  exit  of  the  lens,  which,  if  overcome  by  force,  en- 
tails bruising  and  incarceration  of  the  iris.  When 
the  iris  is  being  cut,  it  ought  not  to  be  dragged  with 
the  forceps  into  the  corners  of  the  section,  since  there 
the  lips  of  the  wound  act  like  clamps,  holding  the 
iris-tissue  tight  between  them.  It  is  good  practice 
to  seize  the  iris  in  the  centre  of  the  section,  draw  it 
straight  up  and  cut  it  ofl'  close  to  the  cornea — care- 
fully avoiding  the  corneal  tissue  itself — in  one,  two, 
or  three  strokes,  as  may  prove  convenient,  and  after- 
ward, according  to  the  sufiicient  or  insufiicient  size 
of  the  coloboma,  either  reduce  or  exsect  iris-tissue 
which  may  still  lie  in  the  corners.  Such  tissue, 
even  after  a  clean  and  apparently  satisfactory  iridec- 
tomy, remains  hidden  in  the  wound  more  frequently 
than  we  imagine.  Proofs:  1.  The  anatomical  examina- 
tion of  eyes  on  which  iridectomy  had  been  made  for 
glaucoma,  or  combined  with  cataract  extraction, 
commonly  found  the  stump  of  the  iris  or  its  ad- 
jacent tissue  united  with  the  corneal  scar,  even  if 
no  outwaofd  inspection  could  discover  such  a  condi- 
tion. 2.  Many  times,  when  passing  the  cystotome 
from  the  corners  of  an  appai'ently  unobstructed  cor- 
neal section  toward  the  centre,  I  drew"  iris-tissue 
along,  which  was  either  the  ijeriphery  of  the  adjacent 
ii-is,  or  the  stump  of  the  part  which  had  been  re- 
moved. Such  jjortions,  of  course,  have  to  be  grasped 
■nnth  the  forceps  and  cut  oft'.  This  observation  lias 
taught  me  not  to  rest  satisfied  with  an  apparently 
correct  coloboma,  even  if  its  .sphincter  edges  are  in 
the  anterior  chamber,  but,  before  opening  the  cap- 
sule, to  clear  the  whole  extent  of  the  corneal  section, 
especially  the  corners,  of  iris-tissue,  which,  with  a 
delicate  jirobe  or  spatula,  may  be  stroked  back  into 
the  anterior  chamber. 

When  the  wound  is  clean  the  operator  takes  the 
fixing  forceps  in  his  own  hand,  presses  gently  with 
it  on  the  globe,  so  as  to  make  the  corneal  section 
slightly  gape,  and  /)a,sse,9  the  needle  cystotome  (see 
Fig.  1)  from  the  iiiner  coi-ner  of  the  section  to  the  outer, 
through  the  anterior  capsule  of  the  lens.  This  manceu- 
vre  has  to  be  closely  watched  ;  a  far-sighted  operator 
should  make  himself  near-sighted  by  convex  specta- 
cles, and  either  daylight  or  artificial  light  ought 
to  be  thrown  on  the  eye  by  a  large  convex  hand- 
lens,  so  that  the  point  of  the  cystotome  can  be  accu- 
rately followed  in  its  course  through  the  capsule. 
An  linsuflicient  capsulotomy  is  commonly  without 
consequences,  as  the  cataract  on  its  way  out  enlarges 
the  opening ;  only  in  tough  cajjsules  it  is  an  obsta- 
cle to  the  expulsion  of  the  lens,  and  may  lead  to 
prolapse  of  vitreous.     When  I  had  practised  this 


170 


THE  MEDICAL  RECORD. 


mode  of  opening  the  capsule  in^about  two  liundred 
cases,  I  varied  it,  not  because  I  was  dissatisfied  with 
its  results,  but  in  order  not  to  get  wedded  to  one 
particular  procedure.  There  is  no  conceivable  way 
of  opening  the  capsule  that  has  not  here  and  there 
been  tried.  The  one  just  described  is  the  simplest 
in  execution  and  the  least  injurious  to  the  eye,  but 
it  has  the  disadvantage  of  necessitating,  in  the  ma- 
jority of  cases,  an  after-operation,  viz.,  the  subse- 
quent central  splitting  of  the  cajisule.  In  order  to 
avoid  that,  I  have  lately  joined  to  the  horizontal  di- 
vision a  larger  vertical  one  than  I  made  a  few  years 
ago  while  practising  a  T-shaped  opening.  A  Vient 
needle  cystotome  is  introduced  into  the  antei-ior 
chamber,  and  the  capsule  slit  open  from  the  lower 
edge  of  a  middle-wide  pupil,  up,to  the  centre  of  the 
corneal  section.  In  order  not  to  let  the 
outcoming  lens  enlarge  the  upper  end  of 
the  capsular  wound  irregularly,  I  made  the 
horizontal  incision  in  one  case  with  a  deli- 
cate, sharp-pointed  scalpel,  the  point  of 
which  was  inserted  into  the  upper^eud  of 
the  vertical  incision  of  the  capsule  at  the 
centre  of  the  corneal  section,  pushed  for- 
ward toward  one  corner  of  the  wound,  and 
then,  by  raising  the  hilt,  one-half  of  the 
upper  margin  of  the  capsule  was  ripjied 
open.  In  the  same  way  the  other  half  was 
dealt  with.  In  another  case  I  made  the 
horizontal  incision  of  the  capsule  with  the 
needle  cystotome,  wliich  was  pa.ssed  first 
from  one,  then  from  the  other  comer  of  the 
coi'neal  section  through  the  capsule,  so  as 
to  meet  the  upper  end  of  the  vertical  cap- 
sular section.  If  the  cystotome  were  passed 
from  one  end  of  the  section  to  the  other,  it 
would  split  the  first  half  of  the  capsule,  bait 
most  likely  not  the  second,  for  when  fallen 
into  the  vertical  section  it  would  enlarge 
this  by  dragging  the  capsule  before  it  rather 
than  cut  it.  The  few  cases  thus  operated 
on  did  well  ;  the  first  one  .showed  some 
transient  adhesions  of  the  iris  to  the  shreds 
of  the  capsule.  It  remains  to  be  seen 
whether  a  greater  number  of  case^  will 
yield  as  smooth  recoveries,  and  better  per- 
manent vision,  than  the  other  now  well-tried 
method. 

The  expulsion  of  the  lens  is  effected  by 
pressing  with  a  hard-rubber  spoon  on  the 
Pio.  1.—  lowest  part  of  the  cornea.  You  know  it 
Xee'.iio  ,(ya^g  always  easy,  and  it  was  complete  in 
tome"  all  but  a  few  cases,  in  which  remnants  had 
to  be  squeezed  out  with  the  lower  lid.  Only 
one  accident  occurred  in  all  the  thirty  extractions. 
The  cataract  was  a  very  complicated  one :  corneal 
opacities  and  partial  adherent  leucoma  from  disease 
in  childhood  and  almost  lifelong  trachoma ;  the  upper 
part  of  anterior  (diamber  deej).  The  other  eye  was 
blind  from  irido-choroiditis.  Fair  perception  of  light 
in  the  first  eye,  and  total  helplessness  of  the  patient, 
a  woman  fifty-five  years  of  age,  determined  me  to 
give  her  the  chance  of  recovering  so  much  sight  as 
to  find  her  way  alone.  This  was  obtained.  ]?y  an 
oversight,  which  now  has  happened  to  me  four 
times,  I  liold  the  back  of  the  knife  up  instead  of 
down,  and  was  aware  of  it  oidy  when  the  counter- 
puncture  was  made.  .\s  in  the  other  cases,  T  pushed 
the  knife  through  as  far  as  possible,  then  turned  id 
one  huudro<l  and  eighty  degrees  on  its  axis,  and 
completed  the  section  as  if  the  cutting  edge  had 
been  turned  up  from  the  start.     Aa  soon  as  the  sec- 


tion was  finished,  the  lens  was  thrown  out  in  its 
capsule,  together  with  a  moderate  quantity  of  vitre- 
ous. I  at  once  removed  the  speculum,  closed  the 
eyelids  for  a  few  minutes,  then  carefully  cut  off  the 
protruding  iris  and  replaced  a  fmall  part  in  the  in- 
ner corner  which  I  could  not  cut.  The  wound  thus 
being  perfectly  clean,  I  applied  the  bandage.  It 
healed  without  any  reaction,  and  the  jjatient  was 
discharged  on  the  fourteenth  day  with  S.  «:T,\i.  In 
this  case,  evidently  the  zonula  Zinnii  had  been  frail 
and  defective.  The  low  acnteness  of  vision  was 
chiefly  owing  to  the  old  opacity  of  the  cornea,  but 
probably  also  to  opacity  of  the  vitreous,  and  will 
no  doubt  still  somewhat  improve. 

With  regard  to  reactive  processes,  there  was  iritis 
v'ith  spongy  exudation,  accompanied  by  repeated 
after-hemorrhage,  in  one  case — that  of  an  old  man, 
whose  other  eye  had  been  successfully  operated  on  a 
year  previously.  He  had  no  particular  pain,  biit 
became  homesick,  and  could  not  be  kept  longer  than 
three  weeks.  He  went  home  before  the  pupil  had 
cleared  up,  with  S.  ,,-,77,  and  has  not  been  seen  since. 
I  am  going  to  write  him,  for  I  trust  he  will  have 
good  sight  in  that  eye  also. 

Two  cases  showed  thickening  and  opacification  of 
(lie  capsule  ("capsulitis)  without  iritis  or  cyclitis. 
They  recovered  good  sight  by  subsequent  division 
of  the  capsule. 

One  case,  a  gentleman  seventy-six  years  of  age, 
from  Philadelphia,  showed  the  greatest  reaction  of 
all.  He  was  excessively  irritable,  and  could  not  ab- 
stain from  violently  pressing  his  lids  together,  both 
during  the  operation — which,  however,  was  without 
any  accident— and  afterward  when  the  bandage  was 
changed.  On  the  tenth  day  he  com}>lained  of  nightly 
pain  ;  the  ciliary  region  was  injected,  and  the  pupil 
somewhat  dull.  Leeches,  atropia,  and  anodynes 
kept  the  inflammation  down,  yet  in  several  days  a 
whitish  infiltration  and  mucoid  tissue  made  their  ap- 
pearance at  the  outer  corner  of  the  wound,  starting 
from  a  portion  of  incarcerated  iris.  Ten  days  later, 
three  weeks  after  the  extraction,  the  incarcerated 
iris  formed  a  conical  projection,  which  I  seized  and 
cut  off.  After  this  little  operation,  the  mucoid  tis- 
sue and  whitish  infiltration  disappeared  from  the 
wound,  the  patient  felt  more  and  more  comfortable, 
and  returned  home  five  weeks  after  the  extraction, 
his  eye  almost  completely  white,  his  pupil,  however, 
still  obstructed,  though  free  from  adhesions.  His 
vision  was  7. tin,  easily  to  be  improved  by  a  division 
of  the  opaque  capsule.* 

Two  other  cases  are  noteworthy,  and  may,  in  a 
few  words,  be  recalled  to  yoiir  minds.  The  one  was 
that  of  a  traumatic  dislocation  of  the  lens  into  the 
anterior  chamber,  where  it  had  lain  six  years,  at 
length  producing  glaucomatous  symi>toms.  It  was 
extracted  by  a  superi6r  flap-section.  A  moderate 
quantity  of  vitreous  escaped,  as  was  expected. 
Healing  undisturbed  ;  patient  discharged  with  S.  jS.i. 

The  other  case  was  that  of  a  lady,  eighty-two 
years  of  age,  who  for  thirty  years  had  had  chronic 
iritis.  Four  years  ago  I  made  an  upward  iridec- 
tomy in  both  eyes  to  put  a  stop  to  the  <'onstant  re- 
lapses, though  one  eye  had  already  lost  all  percep- 
tion of  light.  My  object  was  attained  ;  and  as  the 
cataract  in  the  other  was  now  so  far  advanced  that 
fingers  could  bo  recognized  only  imlistinctly,  I  ex- 
tracted tlie  lens  througli  a  full-sized  superior  sec- 
tion. Before  opening  the  capsule,  I  enlarged  the 
coloboma  by  exsecting  a  piece  of  the  adjacent  iris 

*  This  was  dono  .lanunry  18th,  nnd  to-day,  Janunty  22d,  the  pa- 
tient's S.  Is  '"/jo,  ond  he  rcade  finest  type. 


THE  MEDICAL  RECORD. 


171 


on  both  sides.  This  gave  a  large  coloboma,  admit- 
ting of  a  broad  peiipheric  opening  of  the  capsTile, 
and  a  very  easy  and  complete  exit  of  the  lens.  The 
healing  was  without  any  reaction.  Three  weeks 
later  I  divided  the  capsule  just  above  the  original 
piipiOary  membrane,  which  I  did  not  disturb  at  all, 
obtained  a  perfectly  clear  new  pupil  of  4  mm.  in 
diameter,  and  discharged  the  highly  delighted  old 
lady,  a  week  later,  with  S.  -/-,".;,  though  the  ophthal- 
moscope discovered  still  a  good  many  tioating  opaci- 
ties of  the  vitreous.  This,  gentlemen,  I  think  is  //le 
method  of  operating  for  calaracta  nccreta. 

I  pass  over  to  the  visual  i-psultti,  so  far  as  they  can 
be  determined  at  so  early  a  date. 

The  x^rimary  vision,  viz.,  that  tested  on  the  day  of 
discharge  of  the  jjatient,  was  S.  =  5i7  in  1  case,  tS  in 
2,  fg  in  3,  ia  in  7,  -ift,  in  4,  ;.^R;  in  7^  ^1,.  in  1,  ^fm  in  3, 
jj^  in  1,  3  5^  in  1.  We  see  that  24  out  of  the  30  ob- 
tained good,  and  6  imperfect  vision  ;  among  the 
latter,  three  cases  were  so  complicated  that  good 
vision  was  impossible ;  one,  the  lady  of  eighty-two 
years,  with  the  cataracta  accreta,  has  already  had 
her  vision  raised  fi'om  ;r^n  to  ifiro  by  a  subsequent  di- 
vision, and  two  more  can  fairly  expect  good  sight. 
In  eleven  cases  I  have  already  made  after-operations, 
which  brought  S.  to  i",  in  a  case  of  S.  =  =  5,  and  gave 
corresponding  improvement  in  the  other  cases  ex- 
cept one,  where  I,  perhajis  too  persistently,  endeav- 
oi-ed  to  cut  or  tear  a  tough  central  band  in  the  cap- 
sule. The  patient's  sight  was  lowered  fi-om  -|-,;';r  to 
5"ii'o,  yet  the  pupil  aliove  and  below  the  central  band 
is  clear,  and  when  the  reaction  has  passed,  his  sight 
will  probably  be  more  than  y-,',\,.  He  had  some  cyclo- 
hyalitio  reaction,  and  was  discharged  yesterday,  two 
weeks  after  the  second  operation,  his  eye  in  no 
danger,  but  not  cleared  up  yet. 

In  all  the  other  cases  the  after-operation  was  fol- 
lowed by  no  irritatioQ,  and  the  patients  were  dis- 
charged on  the  foiirth  or  fifth  day. 

ThS" af/e!--operiilioti,  the  subsequent  central  divi- 
sion of  the  capsule,  is  an  essential  feature  in  this 
mode  of  opei'ating  for  cataract.  AVithout  it  the 
method  could  not  stand,  as  it  has  also  ^-irtually  been 
abandoned  by  the  operator  who  first,  in  1873,  tried 
it  on  a  larger  scale,  namely,  Professor  Gayet,  of 
Lyons.  He  made  no  after  operations,  and  was  dis- 
satisfied with  the  imperfect  visual  results.  The 
empty  capsule  will  wrinkle  and  opacify,  requiring 
subsequent  splitting  in  the  majority  of  cases.  But 
then,  gentlemen,  the  visual  results  are  permanently 
good,  and  better  than  by  any  other  method,  except 
the  removal  of  the  lens  within  the  capsule,  which,  ac- 
cording to  its  warmest  advocate,  Dr.  Herman  Pagen- 
stecher,  is  indicated  in  thirty  per  cent,  of  the  patients 
only.  But  do  the  methods  with  central  opening 
of  the  capsule,  even  in  their  successful  cases, 
commonly  yield  good  vision  permanently?  By  no 
means.  With  them,  too,  the  capsule  will  wrinkle 
and  opacify,  and  vision  be  reduced  to  a  surprising 
degree.  As  an  example  I  may  remind  those  of  you 
who  attended  last  winter's  course,  of  the  case  of  a 
lady  from  this  State,  who,  a  year  previously,  had 
been  operated  on  by  no  less  a  man  than  Professor 
Schweigger,  in  Berlin.  The  operation  had  proved 
perfectly  successful,  and  the  lady  could  read  fine 
type — for  three  months.  Then  her  vision  became 
worse  and  worse.  When  she  came  here,  it  was  only 
iHfo.  The  anterior  capsule  showed  a  central  aper- 
ture, the  edges  of  which  were  united  to  the  posterior 
capsule,  and  the  whole  capsular  diaphragm,  though 
not  thickened,  was  so  much  wrinkled  and  uneven 
that  only  a  dim  and  distorted  image  of  the  fundus 


could  be  obtained.  A  division  of  the  ccpsule  gave 
her  in  five  days  "better  sight  than  she  ever  had 
before,"  namely,  |",  whicli,  as  she  lately  wrote  to- 
our  matron,  has  not  diminished  either  in  sharimef  s 
or  power. 

The  subsequent  division  of  the  capsiile  comprises 
not  only  its  anterior  but  also  its  posterior  half,  and 
therefore  gives  a  perfectly  unobstructed  pupil.  The 
imperfect  visual  results  after  the  primary  central 
division  of  the  anterior  capsule  have  always  been 
felt  by  tlie  profession  and  given  the  incentive  to 
ditt'erent  attempts  at  oVtviating  this  disadvantage, 
among  which  I  will  mention  the  puncture  of  the  vit- 
reous immediately  after  the  expulsion  of  the  lens, 
which  Professor  Hasner,  of  Prague,  has  made  for 
many  years,  and  which,  as  I  saw  last  summer,  has 
been  adopted,  on  trial  at  least,  by  Schweigger.  Both 
gentlemen  assert  that  this  procedure  is  not  danger- 
ous, but  neither  has,  as  yet,  piiblished  statistics  to 
convincingly  support  their  assertion.  The  saibse- 
quent  division  of  both  capsules  is  an  innocent  opera- 
tion. I  have  done  it  more  than  a  hundred 
times  ",  only  in  a  few  cases  the  reaction  from 
it  lasted  longer  than  a  few  days,  and  never 
was  the  vision  made  worse.  The  technique 
of  the  operation,  however,  is  jieeuliar  and  has 
to  be  learned.  The  ojieration  requires,  above 
all,  two  things,  without  which  nobody  should 
undertake  it :  first,  good  artiJicUil  Jii/lit,  thrown 
on  the  eye  with  a.  large  lens,  so  that  during 
the  operation  every  wrinkle,  dot,  and  stria  of 
the  capsule  can  be  seen,  as  well  as  the  course 
and  effect  of  the  needle ;  secondly,  a  slun-ji, 
irell-propoiiioned  sen/pel  needle  (see  Fig.  2) 
with  which  the  capsule  can  be  cut  without 
tearing.  I  first  make  a  horizontal  incision, 
then  a  vertical  one,  varying  them,  however, 
according  to  the  conditions  of  the  eajisule. 
No  aqueous  should,  none  need  escape.  You 
have  often  seen  the  little  operation  ;  more- 
over, I  have  described  it  in  the  Archives  of 
Oplillxdmolorii) ;  I  will,  therefore,  no  further 
dwell  upon  it. 

Xow,  in  conclusion,  a  word  or  two  on  anti- 
s/'p.iis  in  cataract  operidions.  I  have  never 
thought  much  of  the  specifically  imtiseptic 
substances  which  ophthalmology  has.  recently 
boiTOwed  from  general  surgery,  and  I  cannot 
yet  see  any  reason  to  change  my  opinion.  If 
the  adherents  of  the  antiseptic  method  affirm 
that  this  essentially  consists  in  the  careful 
observation  of  all  the  rules  that  secure  or  at 
lea.st  favor  union  by  first  intention,  they  have 
no  warmer  friend  than  me.  Those  rales,  you 
know,  are  no  modern  revelation,  and  in  no 
operation  have  they  been  more  carefully 
studied  than  in  the  extraction  of  cataract. 
If,  however,  antisepsis  means  "  bacteria- 
killing  " — to  express  it  in  one  word — and  its  advo- 
cates assert  that  all  their  methods  and  antiseptic 
substances  employed  before,  during,  and  after  the 
operation  have  this  fundamental  aim  and  object, 
then  I  think  they  hunt  a  phantom.  I  am  far  from 
denying  the  existence  of  micrococci  and  bacteria  ; 
they  are  on  and  in  all  open,  moist  tissues,  though 
the  conjunctival  sac  shows  them  less  than  most 
other  places  (see  Wernich's  instructive  book,  "  Die 
Desinfectionslehre  ").  I  do  not,  of  course,  deny  the 
existence  of  infectious  substances,  such  as  blennor- 

*  Reliable  needles  of  this  kind,  as  well  as  the  above-described  cysto- 
tf>me.  are  made  by  Tiemann  &  Co.,  Reynders  &  Co..  Ford  &  Co.,  in 
New  York:  Liier,  in  Paris;  and  others.^ 


Fig  2.— 
Scalpel- 
needle.* 


173 


•THE  MEDICAL  RECORD. 


rhoic,  even  dacryocystitic,  and  similar  secretions, 
as  well  as  decomposed  and  fermenting  bodies ; 
but,  gentlemen,  these  substances  are  but  one 
group  of  irrilanls,  which,  as  all  the  others,  ought 
carefully  to  be  guarded  against.  Besides  them, 
there  are  plenty  of  mechanical  and  chemical  irri-r 
tants,  which  have  equal  claims  on  our  consid- 
eration. The  great  modern  dictum,  "No  suppu- 
ration without  bacteria,"  which  was,  until  quite  re- 
cently, ardently  defended,  has  proved  untenable  ; 
even  its  most  zealous  advocates  had  to  concede 
that  croton-oil  and  other  substances  produced 
suppuration  without  any  co-operation  of  bacteria. 
One  of  the  latest  investigators  of  this  subject.  Dr. 
N.  Uskoff,  answers  the  question  whether  or  not  sup- 
puration is  possible  independently  of  low  organisms, 
l^ositively  in  the  affirmative  ( T7n7«o»,''s  Ai-chiv,  vol. 
lxsxvi.,p.  150,  etc.,  October,  1881),  and  does  so,  not 
from  theoretical  speculation,  but  based  upon  numer- 
ous experiments  made  by  ham  and  Professor  Pon- 
fick  at  the  Pathological  institute  of  the  University 
of  Breslau.  Some  weeks  ago,  gentlemen,  while  dis- 
cussing this  subject  before  you,  I  read  you  a  pas- 
sage from  Lister  himself,  who,  in  closing  the  discus- 
sion on  this  subject  at  the  last  International 
Medical  Congress,  said :  "  Solid  bits  of  dirt  are 
the  great  sources  of  danger  rather  than  certain  in- 
visible particles  that  float  in  the  air,  and  have,  per- 
haps, been  invested  with  more  deleterious  functions 
than  thev  really  possess  "  (British  Med.  Jour.,  October 
1,  1881,  p.  550). 

The  antiseptic  methods  which  have  conqiiered,  for 
good  reasons,  the  greater  jjart  of  the  surgical  world, 
have  also  many  adherents  among  the  first  names  in 
ophthalmology.  I  will  mention  to  you  only  Wecker, 
Horner,  Snellen,  Leber,  H.  Pagenstecher.  Alfred 
Graefe,  whose  early  paper  on  the  subject  in  Graefe's 
Archives  has  made  so  many  converts,  had  the  mor- 
tification to  see  that  the  good  results,  not  to  say  the 
good  luck,  which  had  attended  his  earliest  antiseptic 
procedures,  had  unaccountably  deserted  him  later,  so 
that  he  is  said  to  have  become  sceptical.  Horner  stated 
in  London  that,  apart  from  antiseptic  precautions, 
success  deiJended  upon  the  most  delicate  execution 
of  every  step  of  the  operation.  Now,  what  has  ex- 
perience to  say  on  the  question  of  antiseptics  in  oph- 
thalmology ?  Where  are  the  all-important  statistics 
to  support  it?  Gentlemen,  they  have  not  yet  come 
forward.  The  best  operators,  e.g.,  Wecker  and 
Horner,  still  concede  one  per  cent,  to  two  per  cent. 
of  total  loss  by  suppuration.  This  is  a  less  percent- 
age than  the  old  flap  showed,  but  not  less  than  is 
obtained  by  a  careful  execution  of  Graefe's  extrac- 
tion without  antiseptics,  and  the  results  in  this  in- 
stitution for  years  have  been  no  worse.  There  were 
two  cases  of  suppuration  in  the  last  hundred  extrac- 
tions I  reported  on.  Since  then — IMarch  ;i,  1880 — 
fifty-two  extractions  were  performed  witliout  the  oc- 
currence of  suppuration,  even  without  the  loss  of  an 
eye  from  any  cause.  Several  larger  series  of  opera- 
tions, performed  under  antiseptic  prec^autions,  have 
been  published  (Just,  Reymond,  and  others)  which 
are  quite  unfavorable.  Yet  this  subject  is  still  under 
discussion,  and,  tliough  I  am  not  prejudiced  in  favor 
of  the  bacteria-killing  contrivances,  I  shall  not  tire 
in  giving  the  question  how  to  secure  healing  by 
first  intention,  how  to  avoid  inflammation  in  general, 
my  undivided  attention.  In  order  not  to  judge  of 
the  subject  without  personal  experience,  I  shall  con- 
tinue to  give  antisepsis  a  fair  trial  until  facts  suffi- 
ciently numerous  pronounce  their  unambiguous  ver- 
dict. "  Every  alternate  operation  in  the  thirty  cases 


which  you  have  witnessed,  and  which  were  the  basis 
of  these  remarks,  was,  you  know,  performed  under 
antiseptic  precautions.  Thoiigh  I  shall  have  to  re- 
turn to  this  subject  later,  I  may  here  state  that  a 
diflference  in  the  course  of  healing  has  not  been  np- 
parent,  and,  if  you  asked  me  my  candid  opinion,  I 
would  say  that  the  best  antiseptic  is  twenty  years' 
experience.  I  do  not  say  this  pro  domo,  nor  to  dis- 
courage you,  for  Instruction  wants  less  time  to  trans- 
fer a  large  stock  of  knowledge  and  skill,  than  Indus- 
try requires  to  accumulate  it ;  and  I,  whom  you  have 
asked  to  teach  you,  have  almost  as  much  to  learn  as 
you  have  yourselves. 


©riginol  Communications. 


DRAINAGE-TU?E    IN    THE     CHEST     FOR 
TW'O   TV^EEKS.— RESECTION   OF   A    RIB 
NECESSARY  FOR  ITS  REMOVAL. 
By  ROBERT  ABBE,  M.D., 


TO  THE   OITT-1 


KEW  TOBK 


One  of  the  risks  attending  the  drainage  of  large 
cavities  by  rubber-tubing,  if  imperfectly  guarded,  is 
illustrated  by  the  following  case  : 

A  boy,  nearly  five  years  of  age,  was  the  subject  of 
empya?,ma  of  the  left  pleui'al  cavity,  for  which  his 
physician  incised  the  chest- wall  in  the  eighth  intercos- 
tal S23ace  two  mouths  ago.  There  was  a  fi'ee  evac- 
uation of  pus,  and  a  drainage-tube  was  inserted. 
This  served  well  for  six  weeks,  when  one  morning, 
on  changing  the  dressing,  the  tube  could  not  be 
found.  The  mother  had  fiequently  noticed  that,  on 
coughing  or  deep  breathing,  it  was  sucked   in  or 


pushed  out  a  couple  of  inches,  and  felt  sure  it  had 
slipped  in  in  this  way.  The  child  then  began  to 
cough  "  almost  every  five  minutes  ;  "  the  sinus  be- 
came smaller,  pus  was  i)oorly  evacuated,  and  hectic 
set  in.  Two  weeks  later  I  was  sent  for  by  the  phy- 
sician to  remove  the  tube  "if  it  was  in  the  chost." 

January  28,  1882. — The  boy  was  etherized.  On 
examiiuition  I  found  a  sinus  over  the  ninth  rib,  in 
the  axillary  lino.  The  bone  was  bare,  and  a  probe 
passed  above  it,  into  the  pleural  cavity,  but  revealed 
nothing  that  felt  like  a  tube.  The  sinus  was  dilated, 
and  dressing-forceps,  curved  and  straight,  were 
used  without  discovering  the  tube.  As  the  eighth 
interspace  was  much  too  small  to  admit  the  finger 
for  exploration,  I  excised  one  inch  of  the  ninth  rib 
after  the  following  nu^thod  :  An  incision,  two  inches 
long,  was  made  down  to  the  bone.  Its  periosteum 
was  stripped  back  and  the  rib  gnawed  away  by  rou- 


THE  MEDICAL  RECORD. 


175 


ijeurs  and  Langenbeck's  gouge  until  its  entire  thick- 
ness, one  inch  in  length,  had  been  removed.  Con- 
siilerable  care  was  required  in  pressing  the  perios- 
teum and  pleura  away  from  tiie  internal  face  of  tlie 
rib.  The  original  sinus,  in  the  eighth  interspace, 
was  then  enlarged  by  lateral  cuts  of  the  intercostal 
tissues,  and,  by  an  aneurism  needle,  two  stout  liga- 
tures passed  into  the  cavity  at  either  side  of  the 
wound  were  brought  out  in  the  ninth  space,  near 
the  cut  ends  of  the  rib.  These,  when  tied,  involved 
the  pleura-subcostal  iieriosteum  and  intercostal  ves- 
sels. The  part  V]etween  the  ligatures  M-as  then  cut 
through,  well  into  the  ninth  space,  and  this  opening, 
gained  without  hemorrhage,  readily  admitted  the 
little  finger.  The  tube  was  felt  lying  on  the  pos- 
terior wall  of  tlie  cavity,  jiarallel  to  tlie  spine,  a  fin- 
ger's length  from  the  opening.  It  was  quickly 
fished  out  by  a  stout  bent  probe  and  forceps,  and 
found  to  measure  seven  inclien  in  length. 

A  qiiantity  of  fetid  pus  and  decomposing  clot  was 
evacuated,  and  the  secretions  allowed  to  discharge 
into  loose  oakum.  The  accidental  introduction  of 
a  drainage-tube  into  a  cavity,  which  it  is  designed  to 
empty,  ought  not  to  happen,  if  its  end  external  to 
tlie  wound  be  transfixed  by  a  "  safety-pin  "  or  nee- 
dle, which  will  lie  flat  on  the  skin,  and  should  not 
cross  the  lumen  of  the  tube. 


PROLONGED   INSTEmiENTAL   COilPEES- 
SION  OF  THE  PEI^knTIVE  CAEOTID  AE- 
TEPY  AS  A  THEEAPEUTIC  AGENT. 
By  J.  LEONAUD  COENING,  M.D., 


I  wA.s  led  some  time  since,  by  considerations  of  an 
anatomical  and  physiological  character,  to  investi- 
gate the  significance  of  certain  phenomena  which 
point  to  a  disordered  condition  of  the  cerebral  cir- 
culation. My  first  experiments  were  on  epileptics. 
Having  noted  the  accession  of  blood  to  the  heacl,  and 
violent  throbbing  of  the  carotids,  observable  in  these 
patients  during  the  attack,  I  determined  to  ascer- 
tain by  actual  experiment  whether  there  is  any  co- 
sequence  between  the  sanguineous  redundancy  and 
the  epileptic  seizure.  To  this  end  I  constructed  a 
species  of  "  truss,"  with  which  it  is  possible  to 
compi-ess  both  common  carotid  arteries  for  any 
length  of  time.  With  this  and  similar  instruments 
I  compressed  continuously  (night  and  day)  the  caro- 
tid arteries  of  a  number  of  epileptics,  who  exhibited 
all  the  usual  symptoms  of  the  disease  (periodicity 
of  attack,  frothing  at  the  mouth,  biting  of  tongue, 
etc.).  Although,  at  the  time  I  began  my  experi- 
ments, some  of  these  patients  were  having  as  many 
as  three  attacks  every  twenty-four  hours,  I  was 
enabled  to  arrest  the  convulsions  entirely  during  the 
space  of  several  weeks — in  fact  as  long  as  compres- 
sion was  continued.  There  was  also  marked  im- 
provement in  general  health,  and  a  diminution  in 
the  fi'equency  of  the  attacks  for  a  considerable  length 
of  time  after  cessation  of  the  treatment.  I  have  also 
employed  prolonged  instrumental  compression  of 
the  carotids  during  congestive  headache,  with  the 
result  of  affording  immediate  and  continued  relief. 
The  procedure  did  not  prove  efficacious  in  the  con- 
vulsions of  general  paralysis.  I  have  tried  continu- 
ous compression  as  a  somnolent  agent  in  acute 
maniacal  excitement,  with  good  results.  On  this 
and  kindred  subjects  I  shall  have  more  to  say  here- 
after.    Temporary,  digital  compression  of  the  caro- 


tids, as  revived  by  Parry  in  1792,  possesses,  I  be- 
lieve, undoubted  efficacy  as  a  means  for  arresting 
various  forms  of  convulsive  attacks.  The  value  of 
the  procedure  as  a  means  for  aborting  epileptic 
attacks,  I  have  myself  had  abundant  opi)ortunity 
of  proving.  Indeed,  so  inipresi-ed  have  1  been  of 
the  great  utility  of  temporary  compression  in  con- 
vulsive attacks,  that  I  have  constructed  a  special 
instrument,  which  enables  the  attending  physician 
to  execute  the  necessary  manijnilation.s,  even  during 
the  most  violent  contractions  of  the  cervical  muscles. 
With  the  implement  in  question  I  have  frequently 
arrested,  in  from  three  to  eight  minutes,  attacks 
who.se  ordinary  persistency  was  from  thirty  to  forty- 
five  minutes.  This  instrument  possesses  value  for  the 
reason  that  it  is  frequently  quite  impossible  to  over- 
come, by  simple  digital  compression  alone,  the  ex- 
cessive sjaasm  existing  in  the  cervical  muscles  during 
the  attack.  The  chief  features  of  this  instrument 
are  two  curved  metallic  armatures,  to  each  of  whose 
extremities  is  attached  an  adjustable  pad.  The 
object  of  this  latter  device  is  to  permit  of  so  arrang- 
ing the  pads,  that  the  artery  is  compressed  an-ay 
from  the  jugular  vein  aiul  in  the  direction  of  the 
spinal  column.  A  handle,  to  which  are  attached 
the  other  extremities  of  the  armatures,  allows  the 
operator  to  exei-t  his  strength  to  the  best  possible 
advantage,  during  the  act  of  compressing. 


Author's  Carotid  Truss  (for  prolonged  compression). 

When  the  convidsions  are  unilateral,  the  com- 
pression of  the  carotid  on  the  opposite  side  may  be 
essayed  ;  but  should  there  be  no  alleviation,  both 
carotids  should  be  compressed.  It  is  not  advisable 
to  compress  both  carotids  to  the  same  degree  as 
either  of  those  arteries  singly. 

That  portion  of  the  continuity  of  the  common 
carotid  artery  which  I  have  found  best  suited  to  the 
application  of  instrumental  compression  is  situated 
opposite  a  point  which  is  located  slightly  above  the 
juncture  of  the  thyroid  with  the  cricoid  cartilage. 
The  operator  must  use  all  diligence  to  avoid  com- 
pressing the  internal  jugular,  and  although  much 
can  be  obtained  by  instruments,  the  final  success 
attending  their  use  will  depend  greatly  on  the  dex- 
terity of  the  practitioner  himself. 

Trousseau,  INIalapert,  and  others  have  at  one 
time  or  another  claimed  the  honor  of  having  dis- 
covered the  therapeutic  value  of  digital  compression 


174 


THF   MEDICAL  RECORD. 


of  the  carotids — not  being  cognizant  of  the  publica- 
tions of  Parry.  If  we  accept,  however,  the  rather 
vague  accounts  of  the  ancients,  I  think  we  must 
ascribe  the  honor  of  the  very  timely  j-e-discovei-i,',  at 
least,  to  Parry. 

The  instrument,  shown  on  page  173,  is  designed 
for  prolonged  compression,  and  consists,  in  the  lirst 
instance,  of  a  steel  spring,  which,  encircling  the 
neck,  supports  two  movable  armatures.  To  each  of 
these  latter  is  affixed,  by  means  of  a  ball  and  socket 
joint,  a  narrow  pad,  which  being  adjusted  to  the 
artery  is  held  in  place  by  the  elasticity  of  the  spring. 
The  tendency  of  this  elastic  force  is  to  press  the 
artery  away  from  the  jugular  vein  and  in  the  direc- 
tion of  the"  spinal  column.  An  absolutely  accurate 
adjustment  of  the  instrument  is  a  siitc  qua  non.  Care- 
ful digital  exploration  should  always  ijrecede  the 
application  of  aU  instruments  designed  to  compress 
these  arteries. 


CUEA.BILITY  OF  EsEBRIETY. 
By  T.  D.  CROTHERS,  M.D., 

HARTFORD,    CONS. 

For  years  the  fact  that  inebriety  is  curable  has 
been  demonstrated  in  all  stages  and  conditions  of 
life.  Take  a  common  incident  of  an  inebriate  of 
many  years'  standing,  who  suddenly  stojis  the  use 
of  all  spirits,  under  circumstances  the  most  adverse, 
and  continues  ever  after  a  temperate  life.  In  an- 
swer to  all  inquiries  he  will  say  that  he  made  up 
his  miud  to  stop,  and  although  it  was  a  severe 
strusgle  to  do  so,  he  was  determined  and  hence 
succeeded. 

In  another  case,  where  the  man  has  resisted  all 
the  influences  that  could  be  brought  to  bear  on  him 
for  many  year.s,  then  yields  at  last  to  some  insignif- 
icant entreaty,  signs  the  pledge,  and  although  in 
the  same  surroundings,  remains  temperate  the  rest 
of  his  life. 

A  third  case  who  is  in  chronic  sta.ges,  and  has 
signed  the  pledge  I'cpeatedly,  asserting  that  he 
would  stop  the  use  of  spirits,  failing  as  often,  will 
all  at  once  recover  and  remains  steadfast.  A  fourth 
case  will  change  all  his  habits  of  lining  from  the 
influence  of  conversion,  and  even  when  suti'ering 
from  the  extreme  entailments  of  alcohol,  will  ex- 
hibit astonishing  physical  changes,  and  revolution 
of  living.  Often  inebriates  in  a  semi-intoxicated 
condition,  unable  to  do  business,  or  reason  clearly 
on  any  ordinary  matter,  will  come  under  the  influ- 
ence of  powerful  religious  emotion  and  from  that 
time  recover  periuanontly. 

They  are  frequently  carried  away  in  the  current 
of  a  temperance  revival,  and  entirely  reform.  Many 
instances  have  been  noted  of  chi'onic  inebriatee 
who  under  the  influence  of  profound  mental  emotion 
have  seemed  to  recover  perfect  control  of  themselves 
and  ever  after  abstained.  The  following  arc  some  il- 
lustrative cases  which  are  more  or  less  common  : 
Tba  death  of  a  near  relative,  or  the  alarm  from  the 
fear  of  death,  either  from  severe  illness  or  a  stroke 
of  lightning,  a  railroad  accident  or  falling  into  a 
stream  of  water  ;  intense  disgust  at  anything ;  sud- 
den losi  of  property  ;  |)rotracted  vomiting;  debility 
from  any  cause,  or  a  knowledge  of  dangerous  ac- 
tions committed  during  intoxication.  These,  and 
many  other  conditions  tliat  are  merely  operations  of 
the  mind  upon  the  liody,  are  in  some  instances  more 
effectual  and  positive  in  their  eflects  than  medical 
means.     Tempei-ance  literature  is  full  of  tlie  history 


of  such  cases.  The  stock  and  store  of  all  gospel 
and  temperance  lectures  are  crowded  with  them. 
From  all  sides  these  cases  are  held  up  as  examples 
for  eveiy  one  to  follow. 

The  failure  of  ninety-five  out  of  every  one  hun- 
dred to  be  permanently  benefited  by  these  means 
is  attributed  to  the  insincerity  of  the  patient,  when 
in  reality  these  cases  are  cured  by  means  that  are 
psychological  and  almost  entirely  unknown,  and 
are  mere  exceptional  cases,  which  indicate  the  pos- 
sibilities of  cure  from  a  thorough  knowledge  of 
all  the  conditions  which  enter  into  this  problem. 
The  recovery  of  the  man  who  pledges  himself  not 
to  drink,  and  the  change  of  life  from  the  power  of 
conversion,  are  accepted  as  unmistakable  e\"idences 
of  vice,  and  the  capacity  of  the  patient  to  recover  at 
wiU.  Add  to  this  the  mystery  and  superstition  of 
the  past  ages,  out  of  which  have  grow7i  all  the  efforts 
to  reach  this  evil  by  moral  means  alone,  based  on 
the  most  profound  ignorance  of  both  the  condition 
and  character  of  inebriety. 

The  methods  to  cure  inebriates  in  the  i^ast  have 
varied  with  the  theories  of  its  causation.  Among 
the  ancients,  both  the  physical  and  spiritual  nature 
of  inebriety  were  abdicated,  and  methods  of  treat- 
ment, including  punishment  and  appeals  to  spuitual 
forces,  were  used,  and  the  frequent  reference  shows 
that  some  of  these  cases  recovered.  When  in- 
ebriety became  notorious  in  the  older  civilizations 
of  Egypt,  Greece,  and  Rome,  many  means  were 
adopted  to  check  it.  One  method  which  has  come 
down  to  modern  times,  and  clings  to  the  supersti- 
tions of  the  subject,  is  the  plan  of  forcing  the  inebri- 
ate to  use  food  and  drink  saturated  in  spirits  for  a 
long  time,  that  he  might  become  disyusted  and  thus 
be  cured. 

In  Solon's  time,  inebriety  was  punished  by  death. 
In  the  fourth  century,  it  was  thought  to  lie  an  evi- 
dence of  a  thorough  possession  of  the  devil,  from 
which  only  the  gi'eatest  spiritual  exertions  could 
liberate.  The  writings  of  the  fathers  show  that 
many  were  rescued  from  this  evd,  and  remained  ex- 
amples of  the  grace  of  God.  In  modern  times, 
many  of  these  views  and  theories  have  appeared 
again.  One  man  asserts  that  inebriety  is  a  disease 
of  the  stomach,  coming  entirely  from  adulterated 
spirits ;  as  evidence,  he  cites  cases  of  men  who  use 
pure  spirits  and  are  free  from  inebriety  a  lifetime, 
or  are  able  to  use  spirits  in  moderation.  A  class  of 
men  have  urged  that  inebriety  was  pm-ely  a  failure 
of  the  will-power,  and  that  its  cure  could  only  be 
accomplished  by  training  the  will  to  touch,  taste, 
and  handle  spirits,  but  not  tise  it. 

An  institution  was  established  on  this  faith,  and 
patients  were  treated  by  the  gradual  reduction  plan. 
Spirits  at  all  times  were  in  their  reach  and  canied 
about  with  them,  with  nothing  but  their  reason  to 
prevent  them  from  using  them.  It  has  been  claimed 
lay  reputable  authorities  that  permanent  cures  have 
followed  this  method — the  truth  of  which  cannot  be 
doubted  when  we  have  authenticated  instances  of 
bar-keepers  who  become  temperate  and  continue  in 
the  business. 

Instances  are  reported,  in  Sweden,  where  the 
method  of  disgusting  the  patient  by  putting  spirits 
in  everytlung  that  was  drank  or  eaten,  proved  siic- 
cessful.  This  ])lan,  tried  in  London,  caused  the 
death  of  two  persons  by  delirium,  and  ended  disas- 
trously to  tlio  others.  The  numerous  specifics 
which  have  been  put  on  the  market  by  unscrupu- 
lous quacks,  have  been  followed  with  some  success. 
Take  the  Cinchona  Cure  :  undoubted  instances  of 


THE   MEDICAL  RECORD. 


175 


recovery  have  followed  its  use.     The  following  is  a 
fair  illustration  of  the  power  of  these  remedies  :  A 
lady  wliose  husband  was  a  lawyer  of  much  talent, 
but  a  constant  inebriate,  persuaded  him  to  use  this 
much-vaunted  cure.     He  did  so,  and  claimed  great 
benefit  from  its  use.     One  day  his  wife  could  not 
procure  it  from  the  druggist,  but  a  substitute  being 
suggested  (a   watery  infusion   of  bark),   which  she 
gave,  with  the  same  results.     Later,  she  gave  him 
simjjly  colored  bitter  water,  and  he  recovered,  giv- 
ing this  drug  the  credit  of  his  cure.     Of  a  similar 
character  to  this  is  the  Carracus  Frog  Cure,  a  JJOW- 
dei-ed  infusion  of  hoi-ned  frog,  of  a  peculiar  charac- 
ter; taken  in  sijeeiSc   manner,   is  called  a  certain 
remedy.     Instances  are  reported  of  cures  from  this 
means.     Mineral   waters  and  water-cure   establish- 
ments can  always  refer  to  many  cases  who  claim  to 
be  cured  by  these  means.     Places  where  the  diet  is 
a  special  study  and  where  certain  specified  articles 
are  used  only,  to  the  exclusion  of  all  others,  claim 
the  same  results.     Faith-cures,  where  the  constant 
application  of  the  religious  emotion  is  applied,  refer 
to  many  cases  restored.     The  advocates  of  strict  re- 
straint,  as  in  insane  asylums,   and   the    friends  of 
op2)o.site  views,  who  trust  entirely  to  the  honor  of 
the  patient,  have  illustrated  cases  to  confirm  their 
views.     Even   the  Turkish-bath   men   will  jioint  to 
those  who  have  reformed  and  been  cured  under  their 
treatment.     A  method  once  used  commonly  was  to 
send  the  patient  to  sea,  where  he  could  be  under 
the  exact  discipline  of  ship-life,  and  his  habits  fully 
controlled.      Cases    of    inebriety   have    been    thus 
cured.     And    so   might   the  catalogue   of  different 
means  and  methods,  which  have  been  used  to  cure 
inebriety,  be  extended  to  a  gi-eat  length,  and,  in  a 
cei-tain  number  of  cases,  positive  cures  can  be  found 
which  are  ascribed  to  all  these  methods.     The  Eng- 
lish prison  committees  have  reported  a  number  of 
permanent  cures  from  the  worst  and  most  chronic 
stages  of  inebriety,  following  long  terms  of  impris- 
onment for  some  petty  crime  associated  with  ine- 
briety.    In  one  case,  a  man  fifty  years  of  age,  was 
santenced   ten   years   for   poaching.     From    twelve 
years  of  age  he  had  been  an  incorrigible  drunkard. 
From  the  time  of  his  release,  or  the  expiration  of 
his  sentence,  until  his  death,  at  seventy,  he  led  an 
exemplary  life.     Upon  this  was  based  a  long  essay 
on  the  necessity  of  having  inebriates  in  prison  for 
long  terms  of  service  as  the  most  curative  measure. 
Similar  instances  have  been  reported  in  this  coun- 
try.    One  having  a  wide  circulation  was  the  impris- 
onment for  one  year  of  the  son  of  a  noted  clergyman, 
the  cause  being  inebriety,  and  the  father  the  com- 
plainant.    At  the  close  of  his  term,  the  young  man 
entered   the   world  again,   and  became  a   reformed 
and  changed  person.     The  friends  gave  a  wide  pub- 
licity to  this  case  as  showing  what  jails  could  ac- 
complish for  inel)riates. 

There  are  no  reliable  statistics  of  the  results  of 
any  of  the  numerous  means  now  urged  for  the  cure 
of  inebriates  by  the  power  of  faith,  prayer,  or  the 
pledge.  The  temperance  movements  having  at- 
tracted much  attention,  are  estimated  variously  as  to 
actual  results.  The  advocates  claim  sixty  and  sev- 
enty per  cent,  of  pei-manent  recoveries.  Others 
place  the  figures  from  three  to  six  per  cent.  But 
no  confirmatory  jsroofs  have  been  produced  to  sus- 
tain either  statement,  which  are  based  almost  en- 
tirely on  observation.  A  gospel  temperance  move- 
ment in  a  New  England  town,  under  the  care  of  Mr. 
Moody,  enlisted  or  converted  one  hundred  and 
twenty  inebriates,  who  were  not  only  pledged  but 


claimed  to  be  new  men,  living  a  new  life,  fully  mas- 
tering all  their  appetites  and  impulses.  Three  years 
after,  ninety-eight  had  relapsed  and  were  drinking 
as  before.  At  the  end  of  five  years  only  five  were 
known  to  be  temjjerate  or  reformed  men. 

In  a  prominent  county  in  New  Tork  a  temperance 
organization  visited  every  district,  holding  lectures 
and  urging  all  to  sign  the  pledge.  One  year  over 
three  thousand  had  signed  the  pledge  and  claimed 
to  reform.  Six  years  thereafter  a  politician,  going 
over  the  same  ground,  made  diligent  inquiries  of 
the  persons  who  were  i^ledged,  and  found  only  fifty- 
eight  who  had  continued  temperate.  These  are 
merely  hints  of  the  possible  results  of  these  eflbrts 
which  must  be  settled  by  future  studies.  The 
asylum  treatment  of  inebriates  has  fnrni.'ihed  more 
positive  data  of  the  curability  of  inebriety  than 
from  any  other  source.  Dr.  Joseph  Parrish,  now  of 
Burlington,  N.  J.,  was  one  of  the  pioneers  in  the 
physical  treatment  of  this  class,  and  for  many  years 
had  charge  of  two  asylums.  Having  retired,  he  has 
made  careful  studies  of  a  large  number  of  cases 
which  were  under  his  charge,  reaching  the  conclu- 
sion that  from  thirty-eight  to  forty  jier  cent,  of 
these  cases  have  been  75ermanently  restoied. 

Dr.  Albert  Day,  of  Boston,  Mass.,  who,  for  eigh- 
teen years,  has  been  in  charge  of  inebriate  asylums, 
and  is  now  at  the  head  of  the  Washingtonian  Home, 
concludes,  from  a  study  of  over  two  thousand  cases, 
that  over  forty  ]>er  cent,  are  iiermanently  cured  who 
remain  tindei'  treatment  from  six  to  twelve  months. 
In  one  hundred  cases  who  had  been  under  his  care 
for  one  year,  forty-eight  were  yet  temperate  six  years 
after.  The  late  Rev.  John  Willett,  who  was  su)3er- 
intendent  of  the  Inebriates'  Home  at  Fort  Hamilton 
for  fifteen  years,  was  confident,  from  his  studies  and 
private  statistics,  that  over  thirty-five  per  cent,  of  all 
cases  who  were  treated  at  his  institution  were  per- 
manently restored. 

At  the  New  York  Inebriate  Asylum,  over  fourteen 
hundred  circular  letters  were  addressed  to  friends  of 
patients  who  had  been  Tinder  treatment  at  the  insti- 
tution five  years  previous.  The  answers  received 
showed  that  sixty-one  and  a  fraction  per  cent,  of 
that  number  were  restored.  With  this  result  at  the 
end  of  five  years,  the  inference  is  clear  that  a  certain 
number  would  remain  permanently  restored. 

These  are  some  of  the  conchisions  of  pioneers 
who  have  given  the  subject  close  study,  and  whose 
opportunities  have  been  superior  to  others.  Many 
of  the  most  eminent  men  in  the  profession  in  this 
country  have  been  very  emj^hatic  in  declaring  that  , 
inebriates  coidd  be  cured,  in  properly  managed  asy- 
lums, and  the  curability  would  be  found  fully  equal 
to  that  of  any  other  disease.  In  England,  many  of 
the  leading  psychologists  and  students  of  nervous 
and  mental  diseases  have  ))ronounced  the  same 
views.  The  mere  mention  of  the  names  will  suffice 
to  show  how  the  subject  is  regarded.  Among  them 
are  the  late  Drs.  Forbes  Winslow,  Francis  E.  An- 
stie,  Crichton  Browne,  Arthur  Mitchell,  David  Skae, 
Alexander  Peddie.  .Tohn  Nugent.  Thomas  B.  Chris- 
tie, Henry  Dixon,  Robert  Druitt,  Thomas  P.  Nelson, 
Sir  Thomas  Watson,  Su-  William  Gull,  Heniy  Mavids- 
ley,  and  others. 

The  following  resolutions,  embodying  views  of 
some  of  the  most  distinguished  physicians  in  the 
world,  show  that  the  treatment  of  inebriety  through 
jiliysical  means  gives  more  promise  of  jiermanency 
than  all  others.  The  British  Medical  Association, 
representing  nearly  seven  thousand  of  the  medical 
profession  in  the  United  Kingdom,  at  their  meeting 


176 


THE  MEDICAL  RECORD. 


in  August,  1877,  assert  that  "  excessive  intemper- 
ance is,  in  many  cases,  a  symptom  of  a  special  form 
of  insanity,  which  requires  special  treatment  witli  a 
view,  first,  to  the  recovery  of  those  affected,  and, 
second,  to  the  protection  and  advantage  of  them  and 
society." 

The  American  Medical  Association,  a  body  of 
physicians  representing  every  State  and  different 
sections  of  all  States  of  the  Union,  at  their  June 
meeting,  1870,  resolved,  "  That  special  treatment  in 
institutions  adapted  to  the  purpose  is  required  for 
the  cure  of  the  inebriate,  and  it  is  the  imperative 
duty  of  each  commonwealth  to  establish  and  main- 
tain public  institutions  for  the  treatment  and  cure 
of  inebriates." 

The  Association  of  Medical  Superintendents  of 
American  Institutions  for  the  Insane,  May,  187.^,  re- 
solved, "  That  it  is  the  duty  of  each  State  to  estab- 
lish and  maintain  a  State  or  public  institution  for 
the  custody  and  treatment  of  inebriates,  on  substan- 
tially the  same  footing,  in  respect  to  organization 
and  support,  as  that  upon  which  the  insane  are  or- 
ganized and  supjjorted,  and  that  they  shall  not  be 
almitted  for  ti-eatment  into  asylums  for  insane." 

The  American  Association  for  the  Cure  of  Inebri- 
ates, at  its  annual  meeting  in  1871,  resolved,  "  That 
it  is  the  duty  of  the  legislature,  as  a  measure  of 
State  economy,  to  provide  means  for  the  erection 
and  encouragement  of  hospitals  for  the  detention 
and  treatment  of  confirmed  inebriates." 

The  ten  inebinate  asylums  of  Great  Britain,  four 
in  Germany,  and  two  in  Australia,  all  unite  in  pre- 
senting the  most  positive  jiroof  of  the  curability  of 
this  disorder.  The  asylum  treatment  of  inebriety  is 
snrronndeJ  with  difficulties  of  the  most  formidable 
character.  Among  them  may  be  mentioned  want  of 
legal  power  to  continue  the  treatment  a  sufficient 
length  of  time.  In  one  State  only  in  the  Union  can 
patients  be  retained  legally  for  a  year  or  more,  and 
that  is  Connecticut.  The  only  country  in  the  world 
with  similar  laws  is  South  Australia. 

The  class  of  persons  who  come  to  these  asylums 
are  the  most  helpless  generally,  and  those  who  have 
exhausted  eveiy  other  resource  and  become  incura- 
bles. As  a  last  resort  they  try  an  inebriate  asylum, 
expecting  results  from  a  few  weeks'  treatment  that 
would  be  almost  miraculous.  Frequently  these 
cases  are  not  in  earnest  in  aiding  the  physician  in 
his  efforts  for  recovery.  But  they  expect  results 
without  any  exertion  on  their  part,  and  failing  in 
this,  become  bitterly  opposed,  relapsing  and  report- 
.  ing  the  most  extravagant  stories  of  the  weakness 
and  failures  of  such  institutions,  while  other  cases 
who  are  in  earnest  unite  cheerfully  with  the  physi- 
cian, remaining  a  sufficient  time  to  recover,  and  go 
out  into  active  lif»\  concealing  the  past.  In  one 
case  the  asylum  and  its  treatment  sutTors  from  the 
abuse  of  the  incurables,  which  is  not  neutralized  by 
the  examples  or  defence  of  those  recovered.  Hence 
the  real  value  of  asylum  treatment  cannot  be  esti- 
mated from  such  statements  and  the  current  of  pub- 
lic opinion.  Notwithstanding  the  incurable  char- 
acter of  a  largo  majority  of  all  the  patients  who 
come  for  treatment  in  these  asylums — the  want  of 
legal  control  over  the  patients  to  restrain  them  long 
enough  for  permanent  recovery,  with  the  imperfect 
buildings,  surroundings,  and  want  of  both  means 
and  appliances  to  reach  the  varied  needs  of  this 
class — the  general  incapacity  of  managers,  want  of 
public  sympathyand  support — the  actual  results  are 
really  remarkable. 

If  thirty  or  more  per  cent,  of  the  worst  cases  can 


be  cured  under  all  the  difficulties  which  at  present 
surround  this  method  of  treatment,  what  may  we 
not  expect  from  the  treatment  of  recent  cases  in 
well-organized,  well-appointed  asylums,  with  legal 
control,  managed  by  scientific  experts  and  capable 
men  ? 

The  conclusion  is  beyond  aU  doubt  that  while  in- 
ebriety may  be  cured  by  other  means,  yet  more  posi- 
tive results  wUl  come  from  the  treatment  through 
physical  means  in  asylums  and  hospitals.  The  gen- 
eral fact  which  is  supported  by  all  the  evidence  that 
can  be  obtained  up  to  this  time  is,  that  moral  means 
in  the  treatment  alone  which  includes  the  efforts  of 
churches,  societies,  faith  and  prayer  cures,  may  have 
from  two  to  five  per  cent,  of  cures.  That  physical 
treatment  in  asylums  consisting  of  positive  removal 
from  temptation  and  building  up  both  body  and 
mind  results  in  the  cure  of  from  twenty  to  forty  per 
cent.  These  conclusions  may  vary  when  the  subject 
is  more  thoroughly  understood,  but  under  all  cir- 
cumstances they  will  be  found  substantially  correct. 
The  cures  ascribed  to  moral  means  in  many  cases 
come  from  the  operations  of  physical  causes,  such 
as  the  influence  of  the  mind  over  the  body,  and  the 
shock  from  powerful  mental  emotions,  and  many 
psychological  conditions  at  present  unknown.  The 
cures  from  physical  forces,  such  as  restraint  in  asy- 
lums, and  building  up  the  nervous  system,  are 
simply  the  application  of  natural  means  along  the 
line  of  laws,  by  the  removal  of  all  sources  or  causes 
of  danger  and  the  building  up  of  the  body  to  resist 
these  influences  in  the  future.  In  both  cases  per- 
manent cures  will  follow.  In  the  former,  they  must 
of  necessity  be  less  ;  in  the  latter,  every  measure 
and  appliance  is  used,  and  the  results  must  exceed 
all  other  methods. 

This  may  be  illustrated  in  the  case  of  ten  men 
who  are  suffering  fi-om  fractured  legs.  The  appli- 
cation of  the  splint  and  bandage,  and  physical 
means  to  keep  the  parts  in  conjunction,  will  with 
much  certainty  be  followed  by  permanent  cures  in 
all  cases,  if  they  remain  under  treatment  a  snfficient 
length  of  time.  If  to  these  cases  nothing  but  the 
most  effective  moral  means  were  applied,  such  as 
the  power  of  prayer  and  the  pledge  to  remain  still, 
or  to  recover,  a  certain  number  would  rmdoubtedly 
without  other  means  be  restored. 

Inebriety  is  a  jjhysical  and  psychical  disease, 
which  demands  phy.sical  and  psychical  means  in 
the  treatment.  By  the  word  psychical  is  meant  the 
means  which  influence  the  mind,  rousing  it  up  to 
greater  faith  and  endeavor.  Inebriety  is  not  always 
positively  cured  by  the  best  means  in  the  best  asy- 
lums at  present,  because  the  means  are  very  imper- 
fect, and  a  knowledge  of  the  subject  is  limited. 

The  Inebriate  Asylums  or  Homes  of  to  day  are 
not  the  transient  schemes  of  enthusiasts,  but  places 
where  the  applications  of  exact  means  to  reach  a  great 
physical  necessity  can  be  made.  Five  hundred 
years  before  the  Christian  era  the  idea  of  physical 
treatment  for  inebriety  and  its  curability  was  con- 
ceived. To-day,  tlio  places  where  such  means  are 
practically  used  are  struggling  against  misrepresen- 
tation and  ignorance  of  the  true  character  of  the 
work.  The  failure  of  one  or  all  these  institutions 
does  not  change  the  truth  of  the  principles  upon 
which  they  aie  founded.  For  years  the  treatment 
of  insane  as  disea.sed  ])ersons  was  bitterly  denounced. 
The  stage  of  opposition  and  inditl'erence  which  all 
advances  of  science  must  encounter,  at  the  present 
time  invests  the  asylums  for  the  physical  treatment 
of  inebriates.     Notwithstanding  all   the  obstacles. 


THE  MEDICAL  RECORD. 


177 


they  are  proving  each  day  more  clearly  the  curabil- 
ity of  inebriety  from  the  application  of  means  that 
will  meet  all  the  demands  of  the  case.  The  plan  of 
treatment  in  these  asylums  is  no  mystery,  and  may 
be  summarized  in  the  following :  Removal  from  the 
exciting  cause — alcohol — and  full  control  of  all  sur- 
roundings and  habits  of  life  ;  rest :  building  up  the 
organism  and  nervous  forces,  through  the  use  of 
every  means  known  to  science  and  found  by  ex- 
perience of  great  value  ;  etfectually  quarantining  the 
patient  from  every  source  of  danger,  and  increasing 
both  physical  and  mental  vigor  to  resist  the  diseased 
impulses  in  the  future.  This  is  the  basis  of  all 
treatment,  aud  the  more  effectually  it  is  carried  out, 
the  more  certain  are  the  results.  Some  of  the  con- 
clusions which  are  apparent  from  the  above  state- 
ments may  be  grouped  as  follows  : 

First. — Inebriety  is  most  emphatically  curable  by 
means  as  varied  and  complex  as  the  causes.  The 
wider  and  more  practical  these  means,  the  greater 
the  results. 

Second. — The  teaching  of  all  experience  and  sci- 
ence point  to  the  value  of  physical  means  in  a  hos- 
pital especially  adapted  to  this  purpose,  where  may 
be  gathered  all  the  remedies  that  can  act  on  body 
and  mind. 

Third. — The  subject  of  inebriety  and  its  cure  is  a 
medical  one,  and  cannot  be  solved  from  a  moral 
stand-point  by  clergymen  and  reformers,  but  must 
be  studied  by  physicians  :  then  its  curability  can  be 
determined  beyond  the  field  of  speculation. 


tleijotts  of  ^0spitnl0. 


'^  Chian  Tttbpentdte  in  Ca>;ceb. — Dr.  John  Clay,  in 
a  recent  article  in  the  Lancp.t.  affirms  that  after  a 
further  experience  of  two  years  he  has  nothing  to 
take  back  as  regards  his  first  announcement  of  the 
value  of  Chian  turpentine  in  cancer. 

He  makes  the  following  statements  :  Nine  cases 
of  cancer  of  the  litems  have  been  under  his  treat- 
ment for  a  year.  They  are  now  convalescent.  The 
gi-owths  have  disappeared,  there  is  no  bleeding  or 
pain  on  touch,  and  the  parts  appear  to  be  covered 
with  mucous  membrane.  In  a  number  of  other 
cases  there  is  freedom  from  pain,  diminution  of 
hemorrhage,  and  sloughing  of  the  growth,  with  im- 
provement in  the  general  health.  A  number  of  ad- 
vanced cases  have  been  treated  and  the  patients 
died,  but  with  some  temporary  improvement  at  fiist. 

Dr.  Clay  thinks  that  Chian  turpentine,  on  the 
whole,  acts  quite  uniformly  in  cancer  of  the  uterus ; 
that  it  I'emoves  the  infiltration  about  the  growth 
and  prevents  its  progress.  The  eai-lier  the  case 
comes  under  treatment,  the  better  the  chances. 

A  number  of  drug-houses  still  advertise  and  war- 
rant as  pure  Chian  turpentine  substances  which  are 
not  genuine  at  all.  Southall  it  Barclay,  of  Birming- 
ham, prepare  the  drug  in  a  very  aocejitable  manner. 
Thev  prepare  an  essence,  one  teaspoonful  of  which 
contains  three  grains  of  the  drug. 

The  vagina  and  rectum  should  be  sponged  daily 
with  equal  parts  of  vinegar  and  water.  Astringent 
insufflations  should  be  used.  The  propriety  of  ex- 
cised cancerous  neck  is  doubtful.  For  pain,  opium, 
or  drachm  doses  of  tincture  of  Jamaica  dogwood 
may  be  used.  For  diarrhoea  or  dysentery,  the  oil  of 
eucalyptus,  in  five  minim  doses,  is  efficient. 

In  cancer  of  the  vulva,  Chian  turpentine  acts 
slowly.  In  cancer  of  the  breast,  the  drug  seems  to 
be  of  much  service,  but  need  hardly  supersede  the 
knife. ' 


HOSPITAL     OF     THE     UNIVERSITY      OF 
PENNSYLVANIA,   PHILADELPHIA,  PA. 

Sekvice  of  VVM.  GOODELL,  M.D., 

PBOFESSOU  OF   CLINICAL   GYNECOLOGY. 

(Reported  by  Guy  Hinsdale,  M.D.) 
CYSTITIS — DILATATION   OP   THE   UKETHBA. 

This  patient,  gentlemen,  is  thirty-one  years  of  age, 
and  has  borne  two  children.  Both  labors  were  dif- 
ficult, and  delivery  was  accomplished  by  the  use  of 
instruments.  Ever  since  her  first  labor  she  has  had 
an  irritable  bladder,  and  her  second  labor  made 
matters  worse.  The  patient  complains  of  frequent 
micturition,  with  burning  pain  ;  there  is  urinary 
tenesmus,  and  she  passes  bloody  urine.  For  six 
months  she  has  had  a  purulent  leucorrhcea  ;  she 
has  a  lacerated  cervix,  and  complains  of  pain  when- 
ever the  bladder  is  touched.  She  is  still  suckling 
the  child.  The  urine  has  been  examined,  and  con- 
tains albumen  and  pus.  The  albumen,  however, 
betokens  nothing  grave,  for  it  is  not  large  in  quan- 
tity, and  is  dependent  on  the  presence  of  fius  and 
blood. 

This  woman  has  passed  through  an  energetic 
course  of  treatment,  both  local  and  constitutional, 
adapted  to  modify  the  condition  of  the  urine,  but 
she  has  found  no  relief.  She  says  that  she  has  to 
get  up  very  often  to  pass  water — every  half-hour, 
according  to  her  statement,  but  that  I  can  hardly 
believe  ;  were  it  every  hour  at  night,  that  would  be 
a  great  tax  upon  her  sti-ength.  You  know  how  dif- 
ficult it  is  for  a  man  to  walk  a  thousand  miles  in  as 
many  hours :  the  broken  rest,  far  more  than  the 
continued  effort,  is  very  exhausting  to  the  whole 
system.  In  this  woman's  ease,  the  strain  of  nurs- 
ing, added  to  the  loss  of  rest,  is  altogether  too  much 
for  her. 

Why  did  labor  cause  this  cystitis  ?  It  is  possible 
that,  during  delivery,  the  traction  of  the  forceps 
was  not  made  in  the  axis  of  the  superior  strait,  or  in 
that  of  the  pelvic  curve  ;  but  we  cannot  say  that 
the  instruments  were  improperly  used.  The  slow 
passage  of  a  large  head  bruised  the  neck  of  the 
bladder  and  the  urethra  ;  as  a  consequence,  the 
parts  became  swollen,  stenosis  of  the  urethra  oc- 
curred, and  she  had  a  stoppage  of  the  urine.  Not 
only  this,  but  the  walls  of  the  bladder  were  para- 
lyzed by  pressure  ;  the  walls  of  the  abdomen  were 
weakened  and  tired  out  by  bearing-down  pains,  and 
so  the  abdominal  muscles,  which  you  know  are  the 
best  and  most  effectual  to  expel  the  urine — being,  in 
point  of  fact,  the  tnie  detrusor  muscles — from  sheer 
fatigue  allowed  her  water  to  accumulate. 

Often  and  often,  after  hard  labors,  women  are  not 
able  to  empty  their  bladders,  and  it  is  necessaiy 
to  catheterize  them.  Young  men,  however,  dislike 
to  pass  the  catheter,  and,  like  the  ostrich  sticking 
his  head  in  the  sand,  they  shut  their  eyes  to  the 
danger,  and  say  "  We'll  wait  a  while  ;  "  perhaps  they 
leave  it  twenty-four  or  thirty-six  hours,  and  often  an 
incurable  cystitis  follows  timidity  and  delay  of  this 
kind.  Never  have  any  hesitation  about  using  a 
catheter  ;  you  can  pass  it  along  your  finger,  as  I 
have  described  to  you  before,  or,  if  you  fail,  boldly 
call  for  a  light.  A  woman  who  has  been  pregnant 
once,  and  has  had  the  walls  of  the   bladder  over- 


178 


THE  MEDICAL  RECORD. 


stretched  after  a  tedious  labor,  by  neglect  of  this 
precaution,  is  never  the  same  woman  again.  When 
a  patient  of  yours  complains  after  labor  that  she 
wants  to  pass  water  and  cannot  do  it,  do  not  delay  re- 
lief. If  you  practice  in  the  country,  and  are  perhaps 
four  or  five  miles  away  from  your  pati«nt,  and  apjjre- 
hend  any  difficulty  of  this  kind,  you  can  insert  a 
Skene-Goodman  self-retaining  catheter.  By  attach- 
ing to  it  a  piece  of  tightly  fitting  gum-tubing,  and 
controlling  the  escape  of  urine  by  means  of  a  clip, 
you  can  have  her  water  drawn  at  stated  intei-vals, 
without  making  a  special  journey  for  that  purpose. 
A  suppository  containing  one  grain  of  the  aqueous 
extract  of  opium  and  one-third  of  a  gi'ain  of  the  ex- 
tract of  belladonna,  and  a  broad  poultice,  placed 
over  the  bladder,  you  will  find  to  afford  your  jjatient 
great  comfort  in  acute  cases  of  catarrh. 

I  shall  now  gently  examine  this  woman's  womb. 
As  I  touch  the  cervix,  I  find  a  tear  on  the  right  side, 
extending  down  to  the  junction  of  the  vagina.  There 
is  also  a  laceration  on  the  left  side,  but  it  is  not  so 
bad  as  the  one  on  the  right.  There  are  evidences 
here  of  a  previous  inflammation ;  plastic  matter  has 
been  thrown  out,  and  the  vagina  seems  to  have  lost 
its  elasticity.  I  wish  to  see  now  if  the  uterus  is 
pressing  in  any  way  on  the  bladder.  I  find  it,  how- 
ever, in  good  position ;  neither  the  fundus  nor  the 
cervix  is  pressing  upou  that  organ. 

As  I  find  no  extrinsic  cause  for  this  iiTitable  blad- 
der, I  am  going  to  dilate  the  urethra.  But  I  wish  to 
do  it  with  clean  hands  ;  I  do  not  care  to  cany  any 
vaginal  discharges  or  other  poison-germs  into  the 
bladder.     So  I  shall  use  soap  and  a  nail-brush. 

The  first  thing  to  be  done,  after  the  patient  is 
completely  etherized,  is  to  pass  in  a  uterine  dilator 
— Ellinger's  is  a  good  one  for  this  purpose — and 
gently  stretch  02Jen  the  urethra,  f>.s  I  am  doing.  This 
mode  of  treating  cystitis  is  a  very  successful  one.  It 
is,  to  be  sure,  not  infallible,  but  succeeds  in  a  large 
majority  of  cases.  A  case  in  which  this  operation 
failed^in  fact,  the  worse  case  of  cystitis  I  ever  saw, 
was  due  to  a  single  over-distention.  The  subject,  a 
lady,  had  travelled  a  whole  day  in  a  stage-coach,  and 
from  motives  of  delicacy  did  not  empty  her  bladder. 
By  and  by,  on  reaching  her  journey's  end,  she  found 
that  she  could  not  pass  her  water,  and  had  to  call  in 
a  physician  to  draw  it  off.  On  that  day  troubles 
began  which  have  lasted  many  years. 

I  think  the  most  grateful  man  in  the  world  is  the 
man  who  has  just  been  relieved  by  the  catheter  of 
over-distention  of  the  bladder.  So,  on  one  occa- 
sion, a  poor  widow  who  had  been  relieved  by  me  of 
an  irritable  bladder,  insisted  on  giving  me  more 
than  the  amount  of  my  biU. 

I  now  withdraw  the  dilator  and  introduce  my  little 
finger,  whioh  is  well-oiled.  By  a  slight  rotary  mo- 
tion I  slowly  pass  it  in. 

I  have  often  slightly  torn  the  anterior  margin  of 
the  meatus,  and,  in  one  instance,  quite  a  large 
amount  of  blood  e3ca})cd.  The  patient  came  into 
my  hands  while  she  was  pregnant.  Tliere  was  a 
slight  rent  of  the  meatus.  I  endeavored  to  sto]>  the 
bleeding  by  a  piece  of  ab.sorbont  cotton  moistened 
with  Monsel's'  solution,  but  no  astringent  that  I  ap- 
plied seemed  to  be  of  any  service,  so  I  passed  in  a 
needle  deep  down  to  the  bone,  and  closed  up  the 
wound  by  a  stitch.  In  pregnancy  all  the  veins  in 
this  portion  of  the  body  are  enlarged  and  engorged, 
so  that  the  slightest  rent  may  occasion  troiiblesome 
bleeding. 

Tliere  is  some  blood  here ;  the  urine  is  sliglitly 
tinged  with  blood.    What  has  caused  it  ?   There  has 


been  a  slight  lateral  tear.  In  my  book  I  say  that 
you  can  dilate  to  the  size  of  your  forefinger.  Perhaps 
I  should  modify  that  statement.  I  have  had,  in  one 
case,  a  loss  of  control  of  urine,  but  that  is  unusual. 
Now,  my  forefinger  is  of  medium  size.  It  is  not 
large,  nor  yet  is  it  jjarticularly  small.  I  think  that  if 
yoiu'  index  finger  is  of  large  size  you  had  better  not 
use  it  as  a  dilator,  but  limit  yoiu-self  to  your  little 
finger.  I  once  operated  upon  a  lady  whose  physi- 
cian, in  dilating  the  urethra,  had  used  his  thumb, 
by  means  of  whioli  the  part  was  over-stretched,  and 
loss  of  control  of  the  bladder  followed. 

I  think  that  I  have  ililated  the  urethra  sufficiently 
to  introduce  my  forefinger.  It  goes  in  very  easily, 
and  will  sufficiently  stretch  it.  I  am  now  able  to 
feel  the  inner  surface  of  the  bladder,  which  is  very 
much  roughened  l>y  contraction.  This  bladder  is  a 
pus-secreting  sui-face,  and  it  is  denuded  of  its  epi- 
thelium at  points.  I  can  feel  granulations.  You 
should  always  take  this  opportunity  to  explore  the 
bladder  for  stone,  or  other  foreign  bodies.  The 
finger  is  an  instrument  with  brains  in  it,  and  conse- 
quently worth  far  more  than  any  artificial  sound. 

This  operation  of  rapid  dilatation  for  the  relief 
of  cystitis  was  introduced  by  Mr.  Teale,  a  sur- 
geon in  Birmingham,  England.  What  is  the  ra- 
tionale of  it?  This  method  of  treatment  is  cer- 
tainly somewhat  empirical,  but  not  altogether  in- 
capable of  explanation.  When,  from  any  cause, 
there  is  imtation  of  the  bladder,  the  muscles  tend 
to  contract  spasmodically.  There  is  no  true  sphinc- 
ter here,  but  from  the  neck  of  the  bladder  to  the 
meatus  urinarius,  the  muscular  fibres  that  suiTound 
the  urethral  track  are  in  a  state  of  tonic  and  rigid 
contraction.  As  a  result  they  become  hypertrophied, 
just  as  in  some  jjeople  the  habit  of  constantly  wink- 
ing ijroduces,  after  a  while,  enlargement  of  the  palpe- 
bral muscles  of  the  eye.  The  treatment  of  cystitis 
by  dilatation  presupposes  the  presence  of  a  fissure 
in  the  neck  of  the  bladder,  the  presence  of  which  is 
almost  always  purely  a  matter  of  conjecture.  Wo 
can  rarely  tell  beforehand  whether  or  not  siu-h  a  le- 
sion exists.  The  muscular  fibres  surrounding  the 
urethra  are  overstretched  and  temporarily  stunned  by 
the  dilatation,  i^ermitting  the  escape  of  urine  with  as 
little  jiain  and  as  little  spasm  as  possible.  When  a 
permanent  cure  follows  dilatation,  I  tbink  we  may 
fairly  attribute  the  result  to  the  healing,  by  this 
operation,  of  some  pre-existing  fissure — jiist  as  fis- 
sures of  the  anus  are  cured  by  overstretching  the 
sphincters.  However  probable  all  this  may  be,  I 
have  never  yet  been  able  to  feel  what  I  could  swear 
to  as  a  fissure  in  the  neck  of  the  bladder.  The 
marked  improvement  following  a  forced  dilatation, 
made  for  the  relief  of  cervical  endometritis  and  dys- 
menorrhiea,  has  sometimes  led  me  to  foUow  out  the 
analogy,  and  to  think  that,  in  certain  of  these  cases, 
a  fissure  at  the  internal  os  might  be  the  cause  of  the 
trouble.  Let  me  take  this  opportimity  to  say,  in 
connection  with  this  subject,  that  fissure  of  the  anua 
is  of  frequent  occurrence  in  women.  Whenever  you 
have  an  examination  of  this  kind  to  make,  and  es- 
pecially, as  in  this  ca.se,  when  the  i)atient  is  under 
ether,  don't  fail  to  explore  the  rectum.  Where  one 
man  will  have  a  fissure  in  itno,  ten  women  will.  Two 
causes  bring  about  this  condition  :  first,  habital  con- 
stipation ;  second,  the  injuries  sustained  during 
labor.  The  dilated  mucMius  membrane  gets  torn, 
and  from  the  constant  irritation  to  which  it  is  sub- 
jected, the  raw  surface  fails  to  heal. 

IMv  forelinger  has  entered  this  urethra  without 
any  trouble.     I  often  have  had  to  force  my  way  in, 


THE  MEDICAL  RECORD. 


179 


my  finger  being  pinched  and  benumbed  in  the  oper- 
ation. I  think  I  never  had  to  deal  with  a  urethra 
into  which  I  introduced  my  finger  with  such  ease. 

You  might  suppose,  from  the  apparent  violence  to 
which  the  urethra  has  been  subjected,  that  the  first 
time  the  patient  passes  her  water  she  will  have 
great  pain.  On  the  contrary,  it  will  be  quite  the 
reverse  ;  the  muscular  fibres  have  been  temporarily 
paralyzed,  sensation  has  been  stunned  by  the  opera- 
tion. 

This  woman  has  had  medicated  injections  into  the 
bladder  through  a  double  canula.  This  plan  of 
treatment  is  very  good,  but  I  am  not  cognizant  of 
having  had  a  cure  fi-om  it. 

In  all  these  cases  it  is  well  to  make  use  of  an 
opium  and  belladonna  suppository ;  in  fact,  in  all 
these  operations,  especially  in  the  unmarried,  pull- 
ing on  the  parts  with  the  speculum  causes  some  sore- 
ness, which  the  supijository  relieves.  It  is  a  very 
good  thing  in  these  cases  to  have  your  opium  in  one 
suppository  and  the  belladonna  in  another.  In  that 
way  you  can  increase  or  diminish  the  quantity  of 
one  drag  without  aflecting  the  administration  of 
the  other.  Bat  the  j^reeautiou  pur  e.ccfUence  is  not 
to  allow  the  bladder  to  fill  too  much.  We  must  in- 
troduce a  catheter,  and  leave  it  there.  And  now  a 
point  about  its  introduction.  In  passing  the  in- 
strument, never  push  it  in  to  its  full  extent ;  it  will 
be  suflicient  if  its  eye  is  just  beyond  the  entrance  of 
the  urethra.  The  bladder  resents  every  foreign 
body  — if  the  catheter  is  pushed  in  too  far,  it  hits 
those  frightfully  sensitive  walls,  and,  of  course,  the 
patient  feels  it  instantly.  Sometimes  it  is  a  very  good 
plan  to  get  those  catheters  which  have  their'  oi^en- 
ing  at  the  tip ;  such  a  one  would  not  need  to  pro- 
ject into  the  cavity  of  the  bladder  at  all. 

Of  remedies  by  the  mouth,  atropia  is  by  far  the 
best ;  and,  by  the  way,  let  me  here  say  that  bella- 
donna is  a  good  stand-by  in  almost  every  form  of 
vesical  irritation.  I  usually  give  it  according  to  the 
following  prescription  : 

5-    Atropiie  sulph gi'-  .1- 

Alcohol 

Aqute   fut  fl.   ;  iv. 

M.  S. — Four  drops  before  each  meal,  in  a  wine- 
glassful  of  water.  To  be  increased  or  diminished 
according  to  the  constitutional  eft'ect. 

Bicarbonate  of  soda  and  sweet  sjiirit  of  nitre  may 
also  be  used  with  advantage.  Injections  into  the 
bladder,  in  my  own  experience,  have  not  been  very 
satisfactory.  Braxton  Hicks  uses  a  two-drop  solu- 
tion of  hydrochloric  acid,  injecting  it  daily,  an 
ounce  at  a  time,  and  repeating  it  until  the  "urine 
flows  off  clear.  He  then  follows  it  with  a  solution 
of  morphia  of  one  to  two  giains  to  the  fluid  ounce, 
which  obtunds  the  pain.  Others  employ  a  two- 
grain  solution  of  quinia  and  a  five-grain  one  of  chlo- 
rate of  potash.  A  solution  of  carbolic  acid— two, 
three,  or  four  drops  to  the  fluid  ounce — is  also  re- 
commended. In  obstinate  cases  of  chronic  cystitis,  I 
have  used,  with  benefit,  solutions  of  nitrate  of  silver. 
I  Beginning  with  a  two-grain  .solution,  slowly  increase 
j  the  strength  by  two  grains  every  other  day,  until 
you  reach  twenty  gi-ains  to  the  fluid  ounce.  Allow 
this  to  remain  in  but  a  short  time  (while  you  count 
ten  seconds)  and  then  let  it  come  out  with  a  double 
canula ;  if  the  pain  be  great  you  should  use  a  hypo- 
dermic of  morphia. 

I  do  not,  however,  consider  that  such  treatment 
IS  warranted  until  you  have  introduced  your  finger 
into  the  urethra,  and  attempted  a  cure  by' dilatation. 


|)r0gre)3!5  of  iHctiical  Scieitcc. 


Comparative  Qi'alities  of  the  Blood  in  Chloro- 
sis AND  Peegnancy. — Researches  are  now  being  very 
actively  conducted  with  the  view  of  determining  the 
comparative  i-ichness  of  the  blood  in  its  solid  and 
liquid  constituents  in  various  diseases  and  condi- 
tions, so  that  we  soon  shall  have  valuable  data  at 
hand  for  clinical  purposes.  One  of  the  most  recent 
investigations  isthat  of  Dr.  F.  Willcocks,  who  aimed 
at  determining  how  far  there  is  an  analogy  between 
the  well-defined  blood-change  of  chlorosis  and  less 
well-known  state  in  healthy  pregnancy,  and  to  de- 
termine how  the  diminution  of  the  coloring-matter 
in  either  ease  is  produced.  The  subjects  for  the 
experiments  were  out-patients,  twenty-nine  in  num- 
ber, connected  with  the  maternity  dejiartment  of 
King's  College  Hospital.  The  chromomcter  and 
hiemometer  of  Hayem  (Gower's  modification)  were 
used.  The  following  conclusions  were  enumera- 
ted: 1.  A  more  or  less  considerable  diminution  of 
haemoglobin  is  found  in  both  pregnancy  and  chloro- 
sis, esiJecially  in  the  latter,  but  beyond  this  fact  no 
oljvious  analogy  exists  between  them.  2.  In  preg- 
nancy, the  diminution  in  color  is  due  to  a  fall  in  the 
number  of  red  cells,  while  the  individual  cell  remains 
of  high  value.  In  chlorosis,  both  the  cells  and  the 
individual  value  are  reduced,  the  latter  being  in  ex- 
cess of  the  formei-.  3.  The  blood-state  of  healthy 
pregnancy  is  due  to  a  large  relative  increase  in  the 
water  of  the  plasma,  and  this  condition  does  not 
constitute  a  true  anosmia,  but  is  due  to  the  progres- 
sive enlargement  of  the  vascular  area  during  preg- 
nancy.— Lancet,  December  3,  1881. 

HTDROPHOBLi  :     ItS    SUCCESSFUL    TREATMENT,    AND 

y.Uiiors  Views  as  to  Prophylaxis  and  Treatment. 
— Mr.  Buxton,  a  surgeon  in  the  East  Indies,  reports 
a  very  remarkable  case,  which  seems  worthy  of  being 
classed  with  the  small  number  of  cures  that  are  now 
on  record.  A  boy,  between  five  and  six  years  of  age, 
was  bitten  in  1ST4  by  a  bull-lntch,  that  was  subse- 
quently killed.  The  bites  were  deep  and  severe, 
but  were  freely  cauterized  with  fuming  nitric  acid, 
causing  considerable  loss  of  tissue.  Carbolized  oil 
was  subsequently  employed  as  a  dressing.  A  month 
later  he  became  unconscious,  refused  to  drink,  and 
was  exceedingly  nervous.  Mr.  E.  finding  him  with 
saliva  is.suing  from  the  mouth,  suspected  the  worst, 
but  ordered,  as  a  temporary  measure,  the  tepid 
sheet  and  a  diaphoretic  mixture.  Tranquil  sleep 
and  diaphoresis  followed,  but  about  one  in  the 
morning  the  patient  awoke  screaming,  had  frequent 
convulsions,  refused  liquids,  and  foamed  at  the 
mouth.  Thinking  that,  as  a  palliative,  cannabis  in- 
dica  might  be  usefully  employed,  five  minims  of  the 
tincture  were  given,  and  a  short  sleep  followed.  This 
dose  was  repeated  after  an  interval  marked  by 
screaming  fits  and  saliva-spit  from  between  the 
teeth.  Deep  sleeji,  lasting  ten  hours,  now  ensued. 
On  awaking  he  recognized  his  mother — the  first  time 
for  twenty- seven  hours.  His  pupils  were  now  in- 
tensely contracted.  A  third  dose  of  five  minims  was 
given  on  the  evening  of  the  second  day  of  medi- 
cal attendance,  and  sleep  ensued  for  eighteen  hours. 
Pulse  and  respiration  remained  good  all  the  time. 
From  this  point  the  progi'ess  toward  recoveiy  was 
steady  and  continuous. 

Dr.  Ewart,  formerly  deputy  surgeon-general  in 
the  Bengal  army,  in  the  same  number  of  the  Brilisli 


180 


THE   MEDICAL  RECORD. 


Medical  Journal  (November  19,  1881),  states  that  lit- 
tle confidence  can  be  placed  in  drugs  after  the  symp- 
toms have  developed.  He  advocates  cauterization 
as  a  prophylactic  and  as  practised  successfully  by 
Youatt  in  "four  hundred  cases  ;  and  he  quotes  Sir 
William  Gull,  who  states:  "If  I  had  to  choose  for' 
myself,  I  would  inhale  ether  and  have  the  whole 
itrack  of  the  wound  destroyed  by  strong  nitric  acid 
or  nitrate  of  silver."  But  Ewart  places  himself  on 
■the  side  of  Sir  Joseph  Fahrer,  who  says  :  "  If  I  were 
bitten  by  a  dog  or  other  animal,  cpeti  suspected  of 
.rabies,  I'would  suck  the  wound,  put  in  a  ligature, 
inhale  ether  ....  and  have  the  bitten  part 
thoroughly  cut  out,  and  then  cauterized  with  nitric 
acid  or  nitrate  of  silver,  so  as  completely  to  disor- 
ganize any  virus  there  might  remain.  Excision,  lie 
remarks,  may  be  practised  successfully  after  the 
wounds  are  thoroughly  cicatrized." 

SwN.\ii  Arthropathy,  or  CH.\Rt'OT's  Joint  Disease. 
— A.t  the  meeting  of  the  Clinical  Society  of  London, 
held  October  U,  1881,  Mr.  C.  B.  Keetley  exhibited  a 
patient  having  the  curious  disease  which  was  first 
described  by  Charcot.  He  was  a  shopkeeper,  aged 
thirty-foui-,  had  been  married  ten  years,  and  had 
three  healthy  children.  Previous  to  October,  1880, 
he  had  experienced  the  following  symptoms:  slight 
weakness  in  the  legs,  attributed  to  "corns,"  and  of 
twelve  years'  duration  ;  pains  in  the  muscles,  de- 
scribed as  rheumatic  ;  attacks  of  diarrhcea,  occurring 
fortnightly.  In  October  of  1880  the  "corn"  ulcer- 
ated, and  the  great  toe  became  greatly  swollen.  A 
week  afterward,  the  hip,  groin,  and  thigh  became 
enormously  swollen,  but  were  painless.  A  fluctua- 
ting tumor  then  developed  in  the  lower  part  of  the 
front  of  the  tliigh,  and  finally  discharged,  liberating 
a  synovia-like  fluid.  After  two  months  the  patient 
was  able  to  move  again,  but  the  limb  was  shortened 
one  and  one-half  inch  ;  it  was  everted,  and  gave  a 
peculiar  crepitus.  Apparently  the  head  of  the 
femur  had  disajipeared.  Afterward  the  left  liii)  was 
aflfdcted  in  its  turn,  and  seemed  to  undergo  anatom- 
ical changes  similar  to  the  right.  Now  there  were 
some  symi^toms  of  tabes  dorsalis.  There  were  loss 
of  patella-reflex,  of  iris-reflex,  of  the  power  of  stand- 
ing with  the  heels  together  and  the  eyes  shut,  par- 
tial loss  of  sensation  on  the  outer  sides  of  both  feet, 
perverted  sensation  in  the  right  foot,  slight  deafness 
in  the  left  ear.  There  were  also  "  intestinal  cri.ses," 
as  indicated  by  the  j)eriodical  attacks  of  diarrhiea. 
The  treatment  had  been  iodide  of  potassium  and 
salicylate  of  soda,  of  each  five  grains,  three  times  a 
day.  Stress  was  laid  upon  the  fact  that  this  rare 
disease  may  and  doubtless  has  been  often  over- 
looked, especially  as  the  ocular  and  other  symiJtoms 
might  long  antedate  the  tabetic. 

A  SunsTiTUTE  FOR  Carhomo  Spray. — In  the  Ilril- 
ish  Medical  Journal  (October  15,  1881)  is  published 
a  paper  by  Mr.  H.  W.  Mayo  Kobson,  F.R.C.S.  ling., 
on  the  subject  of  substitutes  for  the  carbolic  s])ray. 
The  value  of  the  Listerian  method  of  dressing 
•wounds  is  recognized  by  all  surgeons,  but  its  disad- 
vantages and  dangers  are  also  apparent  to  many.  By 
its  use  the  operator  has  his  vision  obstructed,  and 
his  sense  ottow^h  impaired.  He  is  obliged  to  spend 
much  of  his  time  in  an  unpleasant  atmosphere.  To 
the  patient  the  risk  of  carbolic  acid  ])oisoning  is 
constant,  especially  in  abdominal  surgery.  The 
spray,  as  is  known,  has  been  abandoiu-d  by  Dr. 
Keith  in  ovariotomy.  Mr.  llobsou  himself  remarks 
that  he  has  known  deatli  to  be  caused  in  tlie  use 
of  the  spray  by  chilling  of  the  viscera. 


Mr.  Bobson  has  experimented  with  such  volatile 
substances  as  the  oil  of  eucalyptus,  cajuput,  and 
peppermint,  and  has  demonstrated  their  antiseptic 
powers.  Infusion  of  hay,  having  been  boiled,  was  sub- 
sequently placed — cajiped  with  cotton-wool — in  an 
incubator,  at  a  temperature  of  100  F.  The  infusion 
was  taken  from  the  incubator,  uncajiped,  and  difler- 
ent  specimens  were  placed  in  vessels  containing  a 
small  amount  of  oil  of  eucalyptus,  or  oil  of  cajuput. 

After  difierent  periods  of  time  the  specimens  were 
again  capped  with  cotton,  placed  in  an  incubator, 
and  then  examined  at  leisure.  The  following  results 
were  obtained  :  1.  Hay  infusion,  sterilized  August 
18th,  jjlaced  in  the  incubator  for  two  days,  exposed 
to  eucalyptus  air  for  two  hours  on  the  22d,  and  then 
placed  in  the  incubator  for  two  days.  Examined  on 
September  7th,  and  found  to  be  absolutely  fi'ee  fi'om 
living  organisms,  but  to  contain  what  appeared  to 
be  dead  micrococci  in  the  slight  sediment.  2.  Ster- 
ilized August  18th,  in  incubator  tiU  the  20th,  in 
eucalyptus  air  for  thirteen  hours,  in  incubator  till 
the  2i3d.  Examined  on  September  7th,  under  a  one- 
eighth  object-glass,  and  found  free  from  living  or- 
ganisms. 

Numerous  flasks  were  examined  with  like  results, 
showing  that  these  volatile  substances,  properly 
placed  and  handled,  may  render  the  atmosphere  of 
the  operating-room  aseptic,  if  not  antiseptic. 

A  New  Method  of  Eejioving  the  Coccyx  in  Cases 
OF  CoccYODYNiA. — A  Very  neat  and  satisfactory  me- 
thod of  removing  the  coccyx  has  been  devised  and  re- 
cently practised  by  Professor  James  E.  Garretson,  of 
Philadelphia.  The  woman,  according  to  Dr.  Gar- 
retson's  description,  had  sustained,  thirteen  years 
previously,  a  fall  from  a  carriage,  which  caused  a 
fracture,  or,  perhaps,  dislocation  of  the  coccyx.  The 
disjjlaced  bone  had  never  been  adjusted,  but  pro- 
jected forward  at  a  right  angle  to  the  sacrum,  and 
was  somewhat  movable.  Great  pain  and  general 
nervous  disturbance  had  existed  for  years,  so  that 
the  woman's  health  was  gieatly  deteriorated.  On 
December  1,  1881,  the  bone  was  removed  by  the  use 
of  a  powerftil  sui-gical  engine,  which  has  probably 
never  been  used  for  the  enucleation  of  any  bone  in 
this  manner. 

To  appreciate  the  i^rocedure,  it  is  necessai-y  to  re- 
call that  the  coccyx  is  enveloped  by  periosteum,  and 
separated  from  the  external  world  by  skin,  super- 
ficial fascia,  some  muscular  tissue,  and  dense  fibrous 
structures.  It  is  separated  from  the  rectum  by 
pelvic  fascia,  fibrous  tissue,  and  mupcnlar  fibres  of 
the  coccygeus  and  levator  ani  muscles. 

The  operation  was  done  as  follows :  after  etheri- 
zation, the  patient  was  placed  in  position  and  a 
median  incision  made  through  the  skin  and  supra- 
coceygeal  struc'tures  down  to  the  periosteum,  so  that 
the  bone,  with  its  periosteum  intact,  was  exposed 
from  base  to  apex.  This  was  accomplished  by  plung- 
ing a  bistoui-y  through  the  tissues,  over  the  middle 
of  the  bone,  and  enlarging  the  incision  upward  and 
downward  as  much  as  necessary.  The  next  step 
was  to  uncover  the  posterior  surface  by  loosen- 
ing the  tissues  laterally  as  far  as  the  margins  of  the 
bone  —this  was  done  with  a  few  strokes  of  the  knife. 
The  peinosteum  was  then  inci.sed  in  the  median  line 
along  the  whole  length  of  the  bone  and  detached  by 
means  of  a  chisel-shaped  knife,  as  is  done  in  osteo- 
plastic operations  for  cleft  palate. 

When  the  posterior  aspect  of  the  bone  had  been 
thus  exposed,  a  powerful  surgical  c>ngine  was  brought 
into  requisition,  carrying   in   the  mandril   a   biirr, 


THE   MEDICAL  RECORD. 


li-1 


having  a  cut  face  of  one-third  or  one-half  inch  in 
diameter.  This  was  given  ten  thousand  revohitions 
in  a  minute,  which  made  the  burr  appear  as  if  at 
rest.  To  the  exposed  coccyx  the  revolving  burr 
was  applied  and  can'ied  from  side  to  side,  ascending 
gradually  from  the  apex  to  the  sacro- coccygeal  artic- 
ulation. In  this  manner  the  bone,  in  a  few  mo- 
ments, was  removed  in  fine,  dust  like  particles,  and 
the  anterior  layer  of  periosteum,  with  its  attached 
muscles  and  fascia,  left  uninjured.  In  other  words, 
the  oifeuding  bone,  which  had  caused  neuralgia  of 
many  years'  duration,  was  taken  from  its  periosteal 
envelope,  as  cleanly  as  a  mailed  letter  is  removed 
from  its  envelope  through  a  single  incision.  The 
attachments  of  the  bone,  which  are,  of  course,  in- 
serted only  into  the  periosteum,  were  uninjured,  and 
the  uuimportant  wound  closed  by  sutures.  No  hem- 
orrhage of  sufficient  moment  to  demand  ligatures 
occurred. 

The  patient  subjected  to  this  operation  is  doing 
well,  and  will  probably  be  out  in  a  week  or  less 
after  the  day  of  operation. 

This  method  of  enucleation  is  certainly  more  ar- 
tistic than  the  ordinary  operation,  by  which  the 
bone  is  cut  loose  with  the  knife,  or  torn  from  its  at- 
tachments by  forceps  after  being  partially  freed. 
The  increasing  number  of  cases  to  which  the  surgi- 
cal engine  is  being  applied  shows  that  its  develop- 
ment from  the  original  dental  engine  was  a  distinct 
advance  in  operative  therapeutics. 

CorrNECTiON  of  Cardiac  and  Eenal  Disease. — 
The  Cinciyinati  J/erf/ca/ JV^ews  (November,  1881)  pub- 
Ushes  a  paper  on  the  above  subject,  by  Dr.  Robert 
T.  Edes,  read  be^re  the  Boston  Society  for  Medical 
Improvement,  May  0,  1881. 

Dr.  Bright  noticed  that  liypertrophy  of  the  heart 
was  especially  constant  with  that  form  of  kidney 
disease  known  as  interstitial  nephritis.  His  se- 
quence of  phenomena  was  "  renal  disease,  poisoning 
of  blood  from  imperfect  depuration,  increased  re- 
sistance, hypertrophy  of  heart."  But  Dr.  Edes  calls 
attention  to  the  fact  that  hypertrophy  of  the  heart 
exists  almost  constantly  with  that  form  of  kidney 
disease  where  depuration  is  not  prevented.  More- 
over, Grutzner  and  Litten  found  injection  of  urea — 
one  of  the  excrementitious  products — did  not  cause 
hvpertrophy,  though  it  increased  the  blood-pressure. 
Again,  chemical  analysis  of  the  blood  does  not  always 
show  superabundance  of  the  blood-excrement,  where 
the  cirrhotic  kidney  and  heart  enlargement  have  co- 
existed for  some  time.  Drs.  Gull  and  Sutton  liave 
found  a  thickening  of  the  arterioles  throughout  the 
body  to  accompany  interstitial  nephritis  ;  but  while 
others  doubt  this,  Ewald  demonstrates  that  the 
disease  in  the  vessels  of  the  kidney  is  of  a  different 
nature  from  that  of  other  parts  of  the  vascular  sys- 
tem. Mahomed  has  clinically  demonstrated  a  pulse 
of  high  tension  to  be  characteristic  of  Bright's  dis- 
ease, and  gives  for  the  cause  of  this  pulse  those 
agents  which  have  already  been  recognized  as  causes 
of  Bright's  disease,  viz.,  scarlatina,  lead,  alcohol, 
gout,  etc. 

According  to  this  view  the  sequence  of  phenom- 
ena is  the  reverse  of  Dr.  Bright's.  It  is  first  blood- 
poisoning  and  obstruction,  and  afterward  increased 
tension,  hypertrophy  of  the  heart,  and  arterial  and 
renal  disease. 

Nature's  I^-^^.SIBLE  Police. — A  very  interesting 
lecture  on  "  The  Intimate  Nature  of  Zymotic  Dis- 
eases," was  delivered  by  Dr.  .Tohn  Dougall,  at  the 
Glasgow  Eoyal  Infirmary  School  of  Medicine,  Oc- 


tober 26,  1881.  Whatever  zymotic  poison  really  is, 
it  differs  from  every  other  poisonous  substance  in 
that  it  renders  the  jjoisoned  person  poisonous.  The 
affected  body  is  an  alembic  in  which  a  special  virus 
is  elaborating  and  multiplying  enormously,  by  an 
apparent  destructive  distillation  of  the  blood  and 
.secretions,  so  that  the  tissues  may  literally  become 
soaked  and  the  body  enveloped  in  an  atmosphere  of 
infection.  This  poison  is  named  from  the  Greek 
word  ^i>f;,  or  leaven,  and  a  person  under  its  intlu- 
ence  is  held  to  be  in  a  condition  of  fermentation. 
Taking  small-pox  as  an  example,  we  see  how  closely 
the  zymotica'  resemble  fermentation.  1st.  A  sac- 
charine solution  is  fermented  by  the  addition  of  a 
minute  quantity  of  yeast.  The  human  blood  equally 
yields  to  the  small-pox  virus.  2d.  A  rise  in  tem- 
perature is  noticed  in  both  cases.  3d.  There  is  a 
great  multiplication  of  yeast  in  the  sweet  solution, 
and  of  the  smallpox  lymph  in  the  blood.  -Ith.  The 
yeast  frothing  to  the  surface  of  the  fluid,  and  the 
erujjtion  forming  vesicles.  5th.  Both  are  infectious 
— a  cell  of  the  new  yeast  can  cause  fermentation — a 
sj^eck  of  the  new  lymph  can  produce  small-pox  in  a 
susceptible  person.  6th.  The  sweet  solution  is  no 
longer  capable  of  fermentation,  the  small-pox  patient 
is  no  longer  susceptible  to  .small-pox  poison. 

Germ-theorists,  as  is  well  known,  hold  that  each 
zymotic  disease  has  its  special  poison,  and  that 
this  special  minute  organism  entering  the  blocd 
produces  morbid  changes,  which  result  in  the  par- 
ticular disease  of  which  it  is  the  genu.  Moreover, 
they  hold  that  the  air  is  tiUed  with  germs,  which 
alighting  in  a  proper  medium,  cause  putrefaction. 
On  the  other  hand,  the  believers  in  the  physico- 
chemical  theory  hold  that  all  such  organisms  are  the 
result  of  the  morbid  conditions  of  their  habitat. 
Their  grounds  are  :  1st.  That  these  organisms  are 
only  found  on  the  parts  of  animals  or  vegetables  of 
lowered  vitality,  or  in  their  dead  tissues.  2d.  That  on 
strengthening  the  vitality  in  living,  or  arresting  decay 
in  dead  parts,  they  disappear.  3d.  That  when  present 
in  infectious  matter  it  loses  its  power  to  infect,  as 
observed  in  small-pox  and  vaccine  virus.  On  these 
grounds  the  functions  of  such  organisms  fire  held  as 
beneficent,  and  Professor  Owen  calls  them  "Nature's 
Scavengers,"  for  maintaining  the  salubrity  of  our 
atmosphere,  and  "  Nature's  Invisible  Police  "  for  ar- 
resting the  fugitive  organized  particles,  and  turning 
them  back  into  the  ascending  stream  of  animal  life. 
— Medical  Press  and  Circidar,  November  16,  1881. 

MUKIATE    OF   PiLOCABPISE    DJ  WhOOPISG-CoTJGH. — 

According  to  Albrecht,  the  muriate  of  pilocarpine, 
when  given  at  a  sufficiently  early  period,  never  fails 
to  cut  short  the  most  serious  stage  of  whooping- 
cough,  namely,  the  period  of  stiffocative  attacks,  al- 
though the  duration  of  the  disease  as  a  whole  is  not 
materially  shortened  thereby.  The  formula  recom- 
mended is  pilocarjiin.  muriatic,  .025  grm. ;  cognac  f. 
champ.,  5.0  grms. ;  synip.  cort.  aurant.,  25.0  grms.  ; 
aq.  destill.,  70.0  grms.  ;  of  which  mixtiire  a  teaspoon- 
ful  up  to  a  tablespoonful  should  be  administered 
after  every  paroxysm,  the  dose  varying  with  the  age 
of  the  patient.  The  remedy  acts  very  prom|itly,  as 
mav  be  demonstrated  by  laryngoscoijic  examination, 
which  discloses  a  more  profuse  watei'V  secretion  and 
abatement  of  the  inflammatoi'y  appearances  in  the 
mucous  membrane.  The  drug  should  be  discon- 
tinued as  soon  as  the  paroxysms  attain  a  catarrhal 
character,  but  should  be  renewed  Mhenever  suffo- 
cative attacks  recur. — Al/qemeine  MedicinalzeUung, 
November  9,  1881. 


182 


THE   MEDICAL  RECORD. 


The  Medical  Recoud: 

2.  lUceklji  Journal  of  fllciiicine  anb  SuvgeiD; 


GEORGE  F.  SHRADY,  A.M.,  M.D.,  Editor. 


PUBLISHED   BY 
Win.  fVOOD  &  CO.,  No.  27  Great  Jones  St.,  N.  V. 

New  York,  February  18,  1882. 

THE   STATE    SOCIETY   AND    THE    N^W 
CODE. 

The  proceedings  of  the  recent  meeting  of  the  Med- 
ical Society  of  the  State  of  New  York,  were  interest- 
ing from  many  points  of  view.  As  will  be  seen  from 
our  completed  report  in  another  place,  many  matters 
of  scientific  as  well  as  of  medico-political  import 
were  fully  discussed  and  duly  acted  upon.  The  presi- 
dent's addres.ses  were,  as  might  have  been  antici- 
pated, full  of  suggestions  for  the  welfare  of  the 
Ijrofession  and  the  extended  usefulness  of  the  So- 
ciety. In  his  recommendations  there  was  a  breadth 
of  view  of  the  subjects  touched  upon,  which  proj)- 
erly  reconciled  the  soundest  conservatism  with  the 
most  progressive  liberality.  The  scientific  i)apers 
were  not  so  numerous  as  in  former  meetings,  but 
were  sufficiently  so  to  give  the  se.ssiou  its  most  im- 
portant, if  not  most  atti-active  features.  For  obvi- 
ous reasons  the  scientific  discussions  were  not  as 
we  might  wish  them  to  be,  the  fact  being  that  not 
enough  time  cotild  be  allotted  to  them. 

The  subjects  bearing  on  medical  politics,  consid- 
ering the  attention  they  received,  assumed  a  para- 
mount importance.  The  recommendations  from  the 
State  Society  bearing  upon  the  alteration  of  the 
present  State  law  regulating  the  practice  of  physic, 
also  tliose  having  reference  to  compulsory  State  ex- 
aminations, were  of  great  importance,  and  eventually 
received  the  necessary  amount  of  endorsement  for. 
prospective  advocacy  before  the  Legislature.  We 
can  at  this  time,  however,  only  refer  to  these  sub- 
jects in  passing,  reserving  the  elaboration  of  their 
purpose  and  spirit  for  another  occasion. 

l$at  what,  for  oljvious  reasons,  claimed  compara- 
tively greater  attention  and  invited  a  correspond- 
iugly  wider  range  of  discussion,  was  the  new  code  of 
ethics  offered  by  the  committee  appointed  at  the  last 
meeting  to  consider  the  subject.  The  full  text  of 
the  new  code  has  already  been  published  in  our  pre 


vious  issue,  and  opportunity  has  been  offered  for  its 
careful  perusal  and  for  a  quiet  study  of  its  contents. 
We  shall  not  now  attempt  to  discuss  the  details  of 
its  many  provisions,  but  be  content  to  refer  to  what 
may  be  considered  one  of  its  principal  features,  and 
this  has  reference  to  freedom  of  action  in  regard  fo 
consultations  with  legally  qualified  practitioners. 
The  ground  assumed  is  viewed  by  many  with  gi-eat 
surprise.  So  far  as  we  have  been  able  to  leain, 
the  surprise,  has,  however,  been  an  agreeable  one, 
is  very  generally  viewed  as  a  step  in  the  right  direc- 
tion, and  is  in  so  far  a  great  improvement  over  the 
American  code.  It  must  be  understood  that  the 
new  code  applies  only  to  this  State,  and  that  we 
must  consider  it  from  the  standpoint  of  State  medi- 
cal jiolitics  merely. 

Viewing  the  decision  of  the  State  Medical  Society 
in  regard  to  such  consultations  in  its  broader  sense, 
it  is  impossible  to  resist  the  cfinviction  that  it  is  one 
of  wise  liberality,  as  was  the  action  taken  by  the 
Koyal  College  of  Physicians,  to  which  we  recently  al- 
luded. But  they  are  by  no  means  identical.  We  have 
in  this  State  granted  liberty  of  action  to  every  medi- 
cal man  to  consult  with  whom  he  pleases,  but  without 
making  any  declaration  regarding  liberty  of  belief. 
The  Royal  CoUege  of  Surgeons  granted  liberty  of 
belief  and  practice,  but  restricted  its  members  from 
having  professional  communication  with  others  who, 
perhaps,  might  entertain  the  same  belief  but  who 
chose  to  trade  ujion  a  meaningless  name.  The  ac- 
tions of  the  two  liodies  are  supplementary  one  to  the 
other.  If  they  could  l)e  properly  reconciled,  there 
is  no  doubt  that  the  profession  of  medicine  would 
be  placed  in  a  still  better  position  before  the  pub- 
lic. On  the  general  principle  that  regular  medicine 
can  lose  nothing  by  being  liberal,  the  step  taken 
can  only  be  viewed  as  the  right  one  in  a  properly 
progi'essive  direction.  But  this  is  not  the  only  point 
to  be  considered  at  this  juncture.  There  are  those  who 
may  say  that,  not  understanding  the  so  called  homoeo- 
pathic doctrines,  and  not  being  familiar  with  the 
claimed  effects  of  their  medicines,  they  will  be  \mable 
to  hold  a  consultation,  so  called,  on  matters  of  treat- 
ment. This  is  certainly  true,  and  must  necessarily, 
for  the  present,  at  least  narrow  these  consultations 
to  questions  of  diagnosis.  If  the  treatment  is  to  be 
discussed  the  patient  must  make  his  choice  of  atteD- 
dant.  The  code  very  distinctly  provides  for  tliis. 
The  effect  of  these  constiltations  will,  undoubtedly, 
lead  to  a  better  acquaintance  on  both  sides  with  the 
therapeutical  methods  of  each.  The  regulars  can 
certainly  lose  nothing  by  knowing  more  of  homoeo- 
pathy, and  the  homa^opaths  will  gain  much  by  know- 
ing more  of  our  plans  of  treatment,  with  a  ])ropor- 
tionate  benefit  to  their  patrons  and  the  public  at 
large. 

It  remains  to  be  seen  what  attitude  the  homn'O- 
paths  may  assume  on  the  code.  The  wise  course 
for  them,  as  well  as  the  interest  of  the  public,  is  to 


THE   MEDICAL  RECORD. 


183 


recognize  the  fact  that  opinion  both  in  and  out  of  the 
profession  is  opposetl  to  bigotry  and  illiberality  from 
whatever  source.  Many  years  ago  the  homoeopaths 
adopted  as  their  code  of  ethics  the  code  of  the 
American  Medical  Association  without  change,  ex- 
cept as  regards  the  consultation  clause,  which  latter 
permitted  them  to  call  in  council  any  physician  whose 
opinion  might  in  any  manner  tend  to  benetit  the  pa- 
tient. The  present  code,  which,  so  far  as  this  State 
is  concerned,  suj>ersedes  the  code  of  the  American 
Medical  Association,  will  probably  come  befoi-e  them 
for  adoption,  baclvcd  by  similar  arguments  which 
prompted  the  adoption  of  their  existing  code.  There 
is  hardly  a  doubt  that  the  action  taken  by  this  State 
will  be  imitated  by  others  throughout  the  Union. 
At  least  there  ai-e  enough  indications  in  that  direc- 
tion to  predicate  such  a  drift  of  medical  opinion. 

The  relations  of  the  State  Society  with  the  Amer- 
ican Medical  Association  must  be  considered  in  this 
connection.  The  latter  association  may  decline  to 
receive  delegates  from  the  State  Society.  Whether 
it  will  or  no  i-emains  to  be  seen.  This  point  was 
seemingly  fully  considered  by  the  State  Society,  at 
least  this  much  can  be  assumed  in  view  of  the  radical 
step  which  it  has  so  deliberately  taken. 

In  this  whole  matter  it  is  well  to  note  that  a  large 
number  of  the  delegates  and  members  were  willing 
to  go  even  farther,  by  virtually  seeking  to  abolish  all 
codes,  and,  as  expressed  in  the  substitute  offered,  to 
base  the  right  of  discipline  upon  such  ethical  ques- 
tions only  as  were  comprehended  under  the  commis- 
sion of  acts  unworthy  a  physician  and  gentleman. 
This  substitute,  notn-ithstanding  the  warm  advocacy 
of  its  preseutor.  Dr.  Roosa,  failed  on  its  final  jjassage. 

The  discussion  concerning  the  probable  effects 
of  some  of  the  other  changes  engrafted  in  the  new 
code  must  necessarily,  to  avoid  an  undue  length  of 
this  article,  be  deferred  to  a  future  issue. 


THE   ANND.U.   liEPOKT   OF   THE    UNITED    ST.-ITES    MARINE 
H0SPIT.4.L   SERVICE. 

The  report  of  this  service  for  the  year  1881  con- 
tains some  features  which  give  it  considerable  in- 
terest. 

The  number  of  patients  ti'eated  duiing  the  year 
was  32,013,  being  an  increa.se  of  over  7,000  upon  the 
previous  year.  In  addition  to  the  medical  and  sur- 
gical treatment  given,  i,384;  pilots  were  examined 
for  color-blindness,  and  about  500  jiersons  were  ex- 
amined as  to  their  general  physical  condition. 

The  percentage  of  pilots  rejected  for  color-blind- 
ness was  2.G.  Since  the  total  number — IK)— must 
have  included  a  good  many  who  were  not  completely 
color-blind,  the  inference  may  be  drawn  that  color- 
blindness among  this  class  is  slightly  below  the 
general  average. 

The  surgeon- general  writes  vei-y  warmly  concern- 
ing the  necessity  of  a  physical  examination  of  sea- 


men before  they  are  .allowed  to  shij].  He  refers  to 
the  large  amount  of  money  expended  on  the  Life- 
Saving  Service,  and  argues  that  if  more  attention 
were  paid  to  securing  efficient  crews,  there  would 
be  fewer  wrecks,  and  less  demand  upon  that  service. 
It  is  estimated  that  from  one-tenth  to  one-sixth  of 
the  seamen  shipped  are  physically  incompetent  for 
very  active  or  severe  work. 

The  need  of  a  national  snug  harbor  for  aged  and 
iniii'm  seamen  is  shown,  and  action  urged  ujion 
Congi-ess;  There  is  also  a  rei|uest  for  the  erection 
of  a  hosi^ital  oi^  Bedloe's  Island,  New  York  Harbor, 
the  jiresent  buildings  being  in.suflicient  and  ill- 
adapted  for  their  puii^ose. 

A  new  feature  in  the  reports  of  this  service,  is  the 
introduction  of  a  large  number  of  medical,  surgical, 
and  sanitary  reports.  One  of  these  documents  con- 
sists of  an  account  of  over  one  hundred  and  thirty 
fatal  cases,  with  their  autopsical  records.  It  forms 
a  contribution  to  pathology  of  some  value,  although 
not  many  of  the  cases  ai'e  rare,  or  are  worked  up 
with  attention  to  microscopical  details. 

Some  cases  of  aneurism,  brain  tumors,  scurvy, 
splenitis,  gastric  ulcer,  and  syphilis  of  the  brain,  are 
of  special  interest.  A  case  is  reported  in  full  by 
Dr.  George  Purviance,  of  a  comijound  fracture  of  the 
skull,  with  elevation  of  the  fragments.  The  j^atient 
had  fallen  into  a  bucket  of  the  wheel,  and  struck 
the  side  of  his  head  on  a  spike.  A  large  fragment 
from  the  lower  part  of  the  parietal  and  upper  part 
of  the  temporal  was  found  elevated,  and  was  re- 
moved.    The  patient  made  a  rapid  recovery. 

By  far  the  best  contribution  to  medical  literature 
in  the  volume,  is  a  series  of  reports  upon  beri-beri. 
This  consists  of  a  report  of  the  cases  which  occurred 
at  San  Francisco,  and  a  report  upon  beri-beri  in 
Ceylon.  Plates  are  given  showing  the  microscop- 
ical appearances  of  the  blood.  There  is  also  a 
chart  showing  the  geographical  distribution  of  this 
disease.  * 


DYSPEPSIA    AMONG   OUR    FAUMEKS. 

In  the  last  annual  report  of  the  South  Carolina  Board 
of  Health  is  an  article  by  Dr.  S.  Baruch,  now  of 
this  city,  upon  the  "liver  complaint"  among  the 
farmers  and  laliorers  of  the  South.  It  contains  facts 
and  suggestions  which  have  a  wide  interest  and  im- 
portance. 

In  a  long  experience  among  the  niral  and  labor- 
ing population  of  South  Carolina,  the  author  had 
noticed  the  great  frequency  of  the  so-called  "liver 
complaint."  The  i)atients  presented  more  or  less 
of  the  following  symptoms  :  "  Face  pale,  skin  shriv- 
elled, tawny  or  tallowy,  lips  pallid,  white  of  eyes 
bluish  and  glistening,  tongue  covered  with  a  thin 
white  fur,  pain  and  fulness  at  pit  of  stomach  after 
eating,  nausea,  eructation  of  gas  or  hot  water  (water- 
brash),  o[)pression  of  chest  after  meals,  palpitation 


184 


THE  MEDICAL  RECORD. 


of  heart,  rapid  breathing  when  walking  fast,  consti- 
pated bowels,  languor,  loss  of  appetite,  wandering 
pains  in  various  parts  of  the  body,  etc." 

Now,  these  symptoms  indicated,  according  to  Dr. 
Baruch,  not  liver  trouble,  which  is  comparatively 
rare  in  the  South,  but  dyspepsia.  And  the  extreme 
frequency  of  this  dyspepsia  led  our  author  to  inves- 
tigate its  cause.  This  he  found  to  lie  in  three 
things :  improper  food,  improper  cooking,  and  too 
rapid  eating. 

The  food  of  the  Southern  laborer  is  chiefly  "  hog 
and  hominy,"  i.e.,  pork  and  corn-meal  in  various 
forms.  As  a  rule,  the  pork  used  is  salted.  This 
process,  according  to  Liebig,  as  quoted  by  Dr. 
Baruch,  diminishes  the  nutritive  value  of  the 
meat  one-half.  It  also  makes  it  less  digestible. 
In  addition  to  this,  the  constant  use  of  the  same 
kind  of  cooked  food  seems  to  have  an  injurious 
tendency.  The  Southern  farmer,  however,  not  only 
eats  this  pork  constantly,  but  eats  a  great  deal  of 
it  at  a  time.  The  remark  is  quoted  that  Ameri- 
can laborers  eat  as  much  animal  food  in  a  day  as 
would  supply  three  laboring-men  in  Europe.  Physi- 
ology indeed  confirms  what  observation  suggests, 
that  man  is  essentially  and  distinctively  a  glutinoais 
animal ;  and  the  .\merican  laboi-er  seems  to  be  a 
peculiarly  good  illustration  of  this  anthropological 
characteristic. 

Dr.  Baruch  describes  the  Southern  mode  of  cook- 
ing food.  His  endeavors  to  be  amiable  in  his  criti- 
cisms do  not  disguise  the  fact  that  the  counti-y 
housewives  make  bad  bread,  doubtful  pastiy,  and 
fry,  with  little  skill,  almost  everything  that  can  be 
cooked  by  that  dyspepsia-compelling  process.  The 
frying-pan,  however,  is  not  a  distinctively  Southern 
institution,  but  is  coextensive  with  the  American 
eagle  and  the  star-spangled  banner.  It  is  the  bete 
noir  of  the  hygienist,  and  has  received  deserved 
anathemas  from  every  quarter.  But  it  still  main- 
*  tains  the  supremacy  which  it  gained  in  the  kitchens 
of  our  fathers,  and  we  fear  is  likely  to  continue  to 
do  so. 

The  evil  results  of  rapid  eating  have  been  often 
told,  with  probably  some  good  effect,  especially 
upon  the  rising  generation.  It  is  children  who 
must  be  taught  to  eat  slowly,  and  the  dyspeptic 
parents  of  the  present  day  are  making  wise  teachers. 

The  prevalence  of  dyspepsia  among  the  rural  pop- 
ulation is  not  confined  to  the  South.  A  somewhat 
similar  account  to  that  of  Dr.  Biruch  was  given 
some  years  ago  l)y  Dr.  .Tohn  Ordronaux,  who.se  criti- 
cisms referred  to  New  York  and  New  England. 


SnpprrnATiojj  IvT>EPi5sr>EXT  op  MifRO-OROANrsjis. 
— Dr.  Uskoir  has  shown,  by  a  series  of  experiments 
recorded  in  Virchow's  Archivr.s,  that  suppui'ation 
may  occur  without  micro-organisms.  He  admit.s, 
however,  that  these  organisms  are  the  causes  of 
many  cases  of  suppuration. 


Htports  of  Socirtie«. 


MEDICAL   SOCIETY   OF    THE    STATE   OF 
XEW  YOEK. 

Serenty-Si.vth   Annual  Meelinq,  held  i}i  Alhant/,  Feb- 
ruary 7,  8,  and  9,  1882. 

Tuesday,  Febkuart   7th  —  FrnsT    Day  —  En-ening 
Session. 

The   society  was   called   to   order  at  8  p.m.  by  the 
President. 

The  special  order  for  the  evening  was  the 

BEPORT   OF   THE   SPECIAi   COIEVIITTEE    ON    AJIENDMENTS 
TO   THE   SYSTEM   OF   MEDICAL   ETHICS. 

The  report  of  the  committee  [see  Medical  Eec- 
ORD,  Februarv  11,  1882,  p.  166]  was  read  by  Dr.  H. 
G.  Piffard,  of  New  York. 

On  motion  by  Dr.  C.  R.  Agnew,  of  New  Y'ork,  the 
rei:)ort  was  accepted.  Dr.  Agnew  also  moved  that 
the  report  be  read  seriatim,  in  order  that  each  para- 
graph might  be  acted  upon  separately. 

Dr.  Roosa  moved  that  the  report  as  a  whole  be 
first  discussed,  and  the  amendment  was  adopted. 
He  then  took  the  floor  and  oflfered  the  following 

SUBSTITDTE  FOR  THE  REPORT  OF  THE  SPECIAL  COM- 
SIXTTEE  ox  AMEXD5LENTS  TO  THE  SYSTEM  OF  MEDI- 
CAL  ETHICS  ; 

"  The  Medical  Society  of  tlje  State  of  New  York, 
in  view  of  the  apparent  sentiment  of  the  profession 
connected  with  it,  hereby  adopt  the  following  de- 
claration, to  take  the  place  of  the  formal  code  of 
ethics  which  has,  up  to  this  time,  been  the  stand- 
ard of  the  profession  in  this  State  : 

"With  no  idea  of  lowering  in  any  manner  the 
standard  of  right  and  honor  in  the  relations  of  phy- 
sicians to  the  public,  and  to  each  other,  but,  on  the 
contrai'v,  in  the  belief  that  a  larger  amount  of  dis- 
cretion and  liberty  in  individual  action,  and  the 
abolition  of  detailed  and  specific  niles,  will  elevate 
the  ethics  of  the  profession,  the  medical  profession 
of  the  State  of  New  Y'ork,  as  here  represented, 
hereby  resolve  and  declare  that  the  only  ethical 
offences  for  which  they  claim  and  promise  to  exer- 
cise the  right  of  discipline  are  those  comprehended 
under  the  commission  of  acts  unworthy  a  physician 
and  a  gentleman. 

"  Resolved,  alio.  That  we  enjoin  the  county  socie- 
ties and  other  organizations  in  affiliation  with  us 
that  they  strictly  enforce  the  requirements  of  this 
code." 

In  suppoi-ting  the  substitute,  Dr.  Roosa  said  that 
he  believed  the  repoi-t  of  tlie  committee  presented 
a  great  advance  over  anything  which  had  been  of- 
fered to  the  profession  in  this  country.  But  his  ob- 
jection to  this  was  that  it  had  retained  nearly  every 
one  of  those  things  which,  in  the  progiess  of  time, 
had  become  distasteful  to  the  profession  of  our  day, 
and  that  against  it  the  same  intrinsic  objections  could 
be  raised  as  against  the  old  code.  He  believed  that 
tlie  sentiment  of  the  profession  of  the  Stjite  was  in 
favor  of  wiping  out  the  code  of  nieilical  ethii's  from 
its  beginning  to  the  end.  It  might  be  asked.  Vi'liat 
will  Ije  our  status  in  the  .\mcrican  Medical  .Yssocia- 
tion,  if  we  adopt  such  a  sweejjing  article  as  this 
substitute?  In  answer  it  nuKht  be  asked,  "What  will 
our  status  be  in  that  society  if  the  rc]iort  of  tlie  com- 
mittee is  adopted?     Without  doubt,  if  adopted,  the 


THE  MEDICAL  RECORD. 


185 


delegates  from  the  Medical  Society  of  the  State  of 
New  Yoi-k  will  be  ruled  out.  But  that  was  not  the 
question.  The  only  que.stion  was,  whether  it  was 
right,  and,  if  so,  let  the  State  of  New  York  lead  the 
van. 

Db.  PrFF.uiD  moved  that  the  substitute  be  re- 
ferred to  the  Standing  Committee  on  Ethics  to  be 
reported  upon  next  year.     Lost. 

The  discussion  was  continued  by  Dr.  SgrinE,  of 
Elmira,  who  thought  that  the  report  of  the  commit- 
tee came  far  short  of  what  was  necessary  for  a  code 
of  ethics,  because  it  did  not  contain  a  single  word 
concerning  the  importance  of  medical  education, 
and  permitted  consultation  with  legally  qualified 
practitioners  who  had  little  or  no  medical  education. 
Again,  there  was  nothing  in  it  to  show  that  there 
was  a  dividing  line  between  the  practice  of  medi- 
cine and  quackery.  Certain  lines  of  the  report  were 
then  read  and  criticised. 

Dr.  Vandek  Poetj  thought  that  when  the  real 
matter  of  fact  was  reached,  there  was  not  much  dif- 
ference between  the  report  of  the  committee  and  the 
substitute  ofl'ered  by  Dr.  Roosa. 

Dk.  Piffakd  thought  that  Dr.  Koosa's  substitute 
was  to  the  eft'ect  that  we  did  not  wish  to  have  any 
code  at  all.  He  then  discussed  the  question  :  Do 
we  need  a  code  at  all  ?  and  reached  the  conclusion 
that  some  form  of  code  was  a  necessity  in  order  to 
protect  the  interests  and  dignity  of  the  profession. 

Db.  Stcbgis,  of  New  York,  thought  there  was 
nothing  whatever  in  the  old  code,  practically,  which 
restrained  any  member  of  the  profession  from 
breaking  its  provisions,  and  he  was  imable  to  see 
that  the  proj^osed  code,  reported  by  the  committee, 
was  any  advance.  In  order  to  have  restrictions  of 
any  value,  a  penalty  must  be  attached  to  violations  of 
certain  rules :  but  no  penalty  was  attached  in  either 
instance.  He  believed  that  the  imwritten  was  much 
more  stringent  than  the  written  law,  unless  a  pen- 
alty was  attached,  and  that  without  a  penalty  the 
written  code  would  be  violated  continually. 

Db.  Moshek,  of  Albany,  asked  how  the  projiosed 
code  could  prevent  the  gross  irregularities  men- 
tioned in  the  old  code,  and  which,  as  had  been 
claimed,  would  be  committed  should  the  substitute 
be  adopted  and  the  code  swept  away  entirely  ?  The 
code  was  applicable  to  those  only  who  belonged  to 
medical  societies.  Others  could  do  as  they  jjleased 
concerning  advertisements,  etc.  If  it  could  restrain 
only  those  in  medical  societies,  did  we  need  it  ?  It 
was  proposed  to  establish  a  rule  permitting  consul- 
tations with  all  legally  qualified  practitioners  ;  would 
it  not  be  better  to  abolish  the  old  riile  V 

De.  E.  R.  Squibb  thought  that  if  the  medical  ])ro- 
fession  was  to  oi^en  its  doors  entirely  with  regard  to 
association  with  all  other  sects  in  medicine,  the 
same  liberality  should  be  extended  to  members  with 
reference  to  certificates  of  recommendation  for  medi- 
cines, foods,  health-resorts,  etc.  He  thought  Dr. 
Roosa's  substitute  was  more  harmonious  in  itself 
that  the  report  of  the  committee. 

Dr.  Agn'ew  thought  it  would  have  been  plainly 
outside  of  the  function  of  the  committee  if  it  had 
recommended  the  abolition  of  the  code.  So  far  as 
he  was  personally  concerned  he  leaned  in  the  direc- 
tion of  the  substitute  ofiered  by  Dr.  Roosa.  But 
the  question  was  whether  the  entire  profession  was 
ready,  or  whether  it  was  for  the  best  interests  of  the 
entire  profession  to  sweep  the  code  away  entirely. 

Db.  Notes,  of  New  I'ork,  thought  that  the  spirit  of 
the  substitute  was  that  of  such  rules  as  are  applica- 
ble to  the  present  status  of  the  medical  profession. 


He  was  sure  it  was  the  sense  of  the  meeting  to  abol- 
ish the  old  code. 

De.  Wet,  of  Elmira,  thought  that  some  positive 
written  law  must  guide  the  ijrofession.  We  have 
not  reached  that  degree  of  excellence  which  permits 
any  one  to  be  simply  restricted  by  that  golden  lule, 
"Do  unto  others  as  ye  would  that  others  should  do 
unto  you."  Some  written  code  is  necessary  to  reg- 
ulate the  conduct  of  men. 

De.  John  P.  Geat  thought  that  no  organization 
could  live  without  rules,  and  therefore  it  was  un- 
wise to  leave  the  members  of  the  Medical  Society  of 
the  State  of  New  York  to  be  guided  by  their  jier- 
sonal  judgment  alone.  The  question  was  further 
discussed  by  Dr.  Frazier  and  Dr.  Roosa. 

De.  Mooke,  of  Rochester,  moved  that  the  whole 
subject  be  referred  to  the  American  Medical  Asso- 
ciation. He  was  of  the  same  oiiinion  as  Dr.  Noyes, 
that  the  profession  had  entirely  outgrown  the  swad- 
dling clothes  of  the  old  code.  He  was  willing  to 
strike  it  all  out  and  leave  the  question  to  the  un- 
written law.  But  he  thought  it  unwise  to  reach  the 
conclusion  too  hastily,  or  dislocate  ourselves  in  this 
sudden  way  from  the  national  organization. 

Dr.  AciNEw  thought  that  a  question  of  this  kind 
should  not  be  carried  to  the  American  Medical  Asso- 
ciation. 

On  motion  by  De.  Elsbeeg,  Dr.  Moore's  motion 
was  laid  ujion  the  table. 

De.  Setsioie,  of  Troy,  moved  that  the  substitute 
otferred  by  Dr.  Roosa  be  laid  uison  the  table.     Lost. 

The  substitute  was  then  accejited  by  a  vote  of  39 
ayes,  37  nays,  but  was  declared  lost,  liecause  a  two- 
thirds  vote  is  required  to  amend  or  alter  the  by-laws. 
.De.  Piffabu  moved  that  the  report  of  the  com- 
mittee 1)6  adopted. 

De.  Squibb  moved  as  an  amendment  that  the  re- 
port, the  substitute,  together  with  the  discussion  be 
printed,  and  that  the  further  consideration  of  the 
subject  be  postponed  until  next  year. 

Dr.  Agnew  moved  as  an  additional  amendment  that 
the  report,  together  with  the  substitute  ofl'ered  by 
Dr.  Roosa,  the  ."jUggestions  made  by  Dr.  Squibb,  Dr. 
Noyes,  and  others  be  recommitted  to  the  committee, 
with  instructions  to  revise  their  rejiort  and  present 
it  to-morrow  at  12  o'clock. 

Dr.  Agnew's  motion  was  lost,  as  also  was  Dr. 
Squibb's. 

The  report  of  the  committee  was  then  adopted, 
ayes,  52  ;  nays,  18. 

The  society  then  adjourned  at  11.30  p.ii.,  to  meet 
on  Wednesday  at  10  a.m. 


WEriNESD.A.Y,  Febeu.-iet   8th  —  Second  Day — Morn- 
ing Session. 

The  society  was  called  to  order  at  10  a.m.  by  the 
Vice-President,  De.  WiLLUiJi  Govan,  of  Stony  Point. 

Prayer  was  offered  by  Rev.  Dr.  Wesley  E.  Davis. 

The  Committee  of  Ariangements  announced  the 
following  as 

MEMBERS   BY   IjniTATIOX. 

Drs.  S.  G.  De  La  Mater,  of  Duanesburg  ;  J.  P. 
Creveling,  of  Auburn  ;  J.  F.  Fox,  of  Cohoes  ;  A. 
Ennis,  of  Pattersonville. 

REPORTS   OF   committees. 

Dr.  William  C.  Wey,  Chairman  of  the  Committee 
on  By-Laws,  reported  that  the  amendments  to  by- 
laws submitted  by  the  counties  of  Rockland,  Greene, 
Fulton,  and  New  York,  were  in  accordance  with  the 


186 


THE  MEDICAL  RECORD. 


by-laws  of  the  Medical  Society  of  the  State,  and 
recommended  that  they  be  approved. 

The  recommendation  was  adopted. 

The  committee  also  offered  a  resolution  which 
the  society  adopted,  directing  such  county  societies 
as  had  not  .submitted  their  by-laws  since  1880,  to 
conform  to  the  reijuirements  of  the  by-laws  of  the 
State  Medical  Society  in  that  respect. 

RE.SOLCTION.S. 

Dr.  M.  Perkins,  of  Schenectady,  offered  a  reso- 
lution providing  for  the  appointment  of  a  committee 
to  confer  with  the  Director  of  the  Dudley  Observa- 
toiT  in  Albany,  and  endeavor  to  secure  the  neces- 
sary arrangements  for  correcting  and  verifying  clini- 
cal thermometers,  as  is  now  done  at  the  Winchester 
Observatory  at  New  Haven,  Conn. 

Dr.  E.  R.  Squibb,  of  Brooklyn,  believed  that  the 
multiplication  of  expensive  bureaus  would  defeat 
the  object  gained  by  the  great  expense  to  which  the 
Winchester  Observatory  had  been  in  procuring  the 
apparatus  necessary  for  the  proper  performance  of 
this  work. 

The  resolution  was  lost. 

Dr.  Roosa,  of  New  York,  offered  a  resolution, 
and  asked  that  it  l)e  laid  over  for  one  year.  It  pro- 
posed as  an  amendment  to  the  by-laws  the  follow- 
ing :  "  That  the  only  ethical  offences  for  which  they 
claim  and  promise  to  exercise  the  right  of  di.scipline, 
are  tliose  comprehended  under  the  commission  of 
acts  unworthy  a  physician  and  a  gentleman." 

Adopted. 

report  of  the  treasurer. 

Dr.  Charles  H.  Porter,  of  Albany,  Treasurer, 
read  his  annual  report,  which  showed  a  balance  in 
the  treasury  of  .?4.53.  It  was  refeiTed  to  an  au- 
diting committee,  consisting  of  Drs.  Perkins,  Beach, 
and  Piffard,  who  subsequently  reported  that  they 
had  examined  the  books  and  vouchers,  and  found 
them  correct. 

Dr.  Porter  also  reported  that  the  fund  for  the 

5IERRIT   H.  CASH   PRIZE    ESSAV 

had  reached  the  sum  of  §127.12. 

Db.  E.  V.  Stoddard,  of  Rochester,  made  a  verbal 
report  from  the 

COinilTTEE   ON    HYGIENE, 

to  take  the  place  of  the  formal  report  to  be  submit- 
ted in  writing  to  the  (lommittee  on  Publication. 

THE   COMIIITTEE   OK    EXPERIMENT-AL   MEDICINE, 

through  Dr.  John  G.  Curtis,  of  New  York,  pre- 
sented its  report,  containing  the  following  preamble 
and  resolutions,  which  were  adopted  : 

W/iereas,  There  is  reason  to  believe  that,  like  its 
predecessors,  the  Legislature  of  1882  will  be  asked 
to  pass  an  act  to  forbid  or  restrict  tlie  performing  of 
experiments  upon  animals  for  scientific  purposes. 

TV/terefia,  The  jjerforming  of  such  experiments  by 
uuijualitied  persons  is  already  illegal,  under  section 
10  of  the  act  apjiroved  April  12,  1807 ;  now,  there- 
fore, be  it 

liesohed,  by  the  Medical  Society  of  the  State  of 
New  York : 

First. — That  it  is  the  unanimous  opinion  of  the 
members  of  this  society  that  the  unrestricted  per- 
formance, by  qualified  medical  men,  of  scientific 
experimeuts  upon  animals  is  essential  to  the  main- 
tenance and  progress  of  the  science  and  art  of  medi- 
cine. 


Second. — That,  while  this  society  would  thus  set 
forth  to  the  Senators  and  Assemblymen  in  Legislature 
assembled  the  views  of  the  medicalprofession  of  the 
State  upon  this  subject,  it  also  calls  their  attention 
to  the  fact  that,  at  the  late  International  Congress  in 
London,  a  resolution  condemning  the  present  inter- 
ference with  experimentation  upon  animals  was 
adopted  by  more  than  three  thousand  official  repre- 
sentatives of  the  medical  profession  of  the  world. 

Third. — That,  in  the  event  of  the  introduction  of 
any  "  anti-vivisection  bill "  into  the  Legislature  of 
1882,  it  shall  be  the  duty  of  the  Committee  on  Ex- 
perimental Medicine  to  forward  a  certified  copy  of 
these  resolutions,  as  a  memorial  from  the  society 
to  the  Governor  of  the  State  of  New  York,  and  to 
each  House  of  the  Legislature  thereof.  Further  be  it 

Resolved,  That  it  is  the  duty  of  each  member  of 
this  society,  before  leaving  Albany,  personally  to  lay 
the  views  of  the  society  upon  the  so  called  "anti- 
vivisection"  agitation  before  the  Senators  and  As- 
semblymen who  represent  him  in  the  present  Le- 
gislature. 

Dr.  E.  B.  Squibb  offered  a  resolution,  which  was 
adopted,  authorizing  the  Committee  on  Experimen- 
tal Medicine  to  draw  from  the  treasury  a  sum  not  to 
exceed  -SlOO,  with  which  to  defray  their  contingent 
expenses  while  carrying  out  the  above  resolutions. 

Dr.  Agnew,  of  New  York,  moved  that  the  resolu- 
tions be  printed  immediately  and  distributed  among 
the  State  officers  and  members  of  the  Legislature, 

Dr.  Vanderveeb,  of  Albany,  from  the 

COMMITTEE   ON    LEGISL.\TION, 

reported  in  favor  of  holding  under  advisement  for 
another  year  the  amendments  to  the  law  of  1872,  and 
a  new  biU,  entitled,  "  An  Act  to  regulate  the  licens- 
ing of  Physicians  and  Surgeons,"  communicated 
to  the  Society  from  the  Medical  Society  of  the 
County  of  New  York. 

After  some  discussion,  the  subject,  on  motion  by 
Dr.  StilRgis,  of  New  York,  was  made  the  special  or- 
der for  11  o'clock,  Thursday, 

On  motion  by  Dr.  Roosa,  the  society  directed 
that  the  proj^osed  bills  be  printed  at  once,  and  dis- 
tributed among  the  members. 

Obituary  notices  of  Dr.  William.  S.  Hoffman,  of 
Port  Byron,  presented  by  the  Cayuga  County  Medi- 
cal Society,  and  Dr.  Lake  .T.  Zeffle,  by  Isaac  Par- 
sons, M.D.,  were  read  by  title,  and  referred  to  the 
Committee  on  Publication. 

Dr.  Da.viel  Lewis,  of  New  York,  then  read  a 
paper  on 

the   treatment   of   SCUiLATINA. 

It  will  be  published  in  a  subsequent  number  of 
The  Record. 

Dr.  W.  W.  Potter,  of  Buffalo,  read  a  paper  on  the 

OENU-PECTORAL    POSTURE   IN    RETRODISPnACEMENTS   OF 
the   UTERUS   AND   PROLAPSE   OP   OVARIES. 

The  author  of  the  paper  first  referred  to  the  means 
essential  to  the  successful  use  of  this  measure,  such 
as,  1st,  a  table ;  2d,  a  speculum  (he  preferred  Boze- 
man's) ;  3d,  double-curved  forceps  ;  ith,  cotton- 
pledgets,  pre|)ared  in  advance  ;  5th,  Albert  Smith's 
pessnries  of  different  sizes ;  t>th,  astringent  and  seda- 
tive solutions. 

His  conchisions  were  as  follows  : 

First. — That  in  a  large  number  of  cases  of  un- 
comiilicatcd  retroversion  or  of  ovarian  pro'npso.  the 
combined  action  of  gravitation  and  iitmospliciic  ex- 
pansion of  tlie  vagina,  obtained  through  the  medium 


THE  MEDICAL  RECORD. 


187 


of  the  knee-chest  position,  will  effect  replacement 
without  instrumental  aid. 

Second. — That  in  cases  of  retroflexion,  with  fixa- 
tion due  to  the  products  of  cellulitis  or  other  iutra- 
pelvic  viscera,  and  associated  with  prolapse  and 
incarceratiou  of  one  or  both  ovaries,  the  genu-pec- 
toral  posture  affords  the  most  rational  way  of  treat- 
ment, for,  in  this  jiosition,  the  vagina  can  be  most 
completely  packed  with  the  medicated  tampons, 
which,  by  gentle  pressure,  reduce  inflammation  and 
promote  absorption. 

Third. — That  in  cases  where  there  is  fixation  of 
the  fundus  uteri  in  the  hollow  of  the  sacrum,  with- 
out adhesion,  the  tamponade  of  the  vagina  with  the 
cotton-pledgets  furnishes  a  complete  and  simple 
way  of  overcoming  the  malposition. 

Fottrtli. — That  retroflexions,  after  a  course  of  treat- 
ment by  these  methods,  are  more  readily  straight- 
ened and  rendered  more  tractable. 

Fifth. — That  in  prolapse  of  the  ovaries,  replace- 
ment can  be  more  readily  obtained  in  this  posture 
than  in  any  other. 

Si.i-th. — That  the  adjustment  of  pessaries  is  more 
accurately  accomjjlished,  and  with  less  discomfort 
to  the  patient,  if  done  in  this  posture.  That  com- 
plete reduction  of  the  displaced  uterus  or  ovary,  or 
both,  is  a  condition  precedent  to  the  successful  em- 
ployment of  these  instruments,  and  in  this  posture 
such  reduction  is  absolutely  possible. 

Seren/h. — That  the  self-assumption  of  the  genu- 
pectoral  posture  by  the  jjatient  each  night,  or  even 
at  other  times,  may  l)e  made  a  serviceable  adjunct 
to  the  treatment.  Fui'thermore,  the  freqiient  self- 
assumption  of  this  position  establishes  the  "  habit  " 
of  replacement  of  the  intra-pelvic  organs  and  re- 
lieves pelvic  blood-stasis. 

AN  IMPKOVED  DKESSING  FOR  FRACTURED  CLAVICLE 

was  the  title  of  a  paper  read  by  Dk.  Lokenzo  Hale, 
of  Albany.  The  principle  of  the  plan  was  the  same 
as  jjresented  to  the  society,  in  1870,  by  Dr.  E.  M. 
Moore,  of  Rochester.  It  differed  from  it  in  being 
simply  a  suspender,  "  back  sling,"  so  a^jplied  as  to 
bring  the  fragments  into  apposition,  and  leave  the 
clavicle  exposed  to  view. 

Hold  one  end  of  a  naiTow  roller-bandage  against 
the  scapula  of  one  side,  passing  it  under  the  forearm 
of  the  injured  side  near  the  elbow,  the  elbow  being 
bent  and  drawn  far  back,  thence  \ip  the  same  fore- 
arm, across  the  back  to  the  axilla  of  the  sound  side, 
and  then  in  front  of  and  over  the  sound  shoiUder, 
uniting  the  end  at  the  place  of  beginning. 

The  dres.sing  was  endorsed  by  Dk.  Vandekveek  as 
one  which  had  given  excellent  results. 

Dr.  H.  Knapp,  of  New  York,  read  a  paper  on 

CBOCP   OF   THE   CON.JUNCTrVA,    WITH    REMARKS   ON    CON- 
TAGIOUS   FORMS   OF   CON.rONCTIVAIi   INFLAMMATION. 

Croup  of  the  conjunctiva  was  differentiated  from 
diphtheria  as  follows  : 

First. — In  diphtheria  the  lids  ai'e  stiff  and  hard  ; 
it  is  almost  impossible  to  evert  them,  whereas  in 
croup  the  lids  ai-e  suj^ple  and  easily  everted. 

Second. — A  diphtheritic  lid  is  unusually  hot  and 
excessively  painful  to  the  touch,  whereas  a  croupous 
lid  can  be  handled  without  much  pain. 

Third. — The  diphtheritic  exudations  are  continu- 
ous from  the  deposit  upon  the  surface  to  the  sujier- 
ficial  and  deeper  layers  of  the  conjunctiva,  whereas 
the  croupous  exudation  is  nearly  a  siu'face  deposit. 

Fourth. — The  diphtheritic  membrane  cannot  be 
easily  removed  and  must  be  pulled  off  with  some 
force,   and    leaves   the    subjacent    tissue    ragged ; 


whereas  a  croupous  membrane  can  be  wiped  away, 
leaving  an  uneven,  finely  granulated  surface. 

Fiftli. — The  tissue  of  a  diphtheritic  lid,  when  cut 
into,  is  aiiicmic  and  has  in  the  developed  cases  a 
white  lardaceous  appearance  ;  whereas  the  tissue  of 
a  croupous  lid  is  highly  congested  and  soft. 

Sixth. — The  diphtheritic  process  leads  to  mortifica- 
tion of  the  invaded  conjunctiva  ;  whereas  the  croup- 
ous process  leads  to  proliferation,  cauliflower,  poly- 
poid excrescences. 

Sevffiith. — Diphtheria  readily  extends  from  the  lids 
to  the  bulbar  conjunctiva  and  cornea ;  whereas 
crouj)  is  long  continued,  and  only  in  the  severest 
cases  affects  the  cornea. 

Dr.  Knapp  also  made  some  remarks  concerning 
the  utility  of  the  methodical  application  of  cold  in 
the  severer  forms  of  conjunctivitis,  and  the  general 
management  of  these  cases. 

They  are  all  contagious  and  yet  not  so  through 
infection,  but  only  by  inoculation. 

Under  j)/-w^/er  care  there  is  no  danger  of  transmis- 
sion even  from  one  eye  to  the  other.  The  patient 
[speaking  esjjecially  of  children]  should  never  be 
left  without  a  nurse. 

As  long  as  the  disease  is  upon  the  increase,  ab- 
stinence fi-om  the  use  of  local  remedies,  the  method- 
ical and  unintei'rujjted  application  of  cold,  and 
careful  cleansing  were  the  great  essentials  of  treat- 
ment. Cold  should  be  applied  by  means  of  thin 
cloth  compresses,  which  cover  nothing  more  than 
the  burning  lids,  and  made  cold  by  lying  upon  a 
block  of  ice.  These  should  be  apjilied  every  fifteen 
or  twenty  minutes  uninterruptedly. 

There  is  no  cleansing  material  equal  to  fine,  soft 
sponge,  and  to  see  that  they  are  properly  disinfected 
is  the  surgeon's  business,  and  nhinidance  of  water  is 
a  disinfectant  which  has  stood  the  test  of  time. 

As  soon  as  the  child  shows  a  tendency  to  open  the 
eyes,  encourage  the  efforts,  for  movements  of  the 
lids  are  beneficial  in  diminishing  congestion  and  in- 
filtration, anil  keeping  the  piu-ulent  secretion  out  of 
the  conjunctival  sac.  "When  the  child  opens  the  eyes 
the  danger  is  over.  The  aioplications  to  the  lids 
should  be  continued  until  the  swelling  and  the 
creamy  appearance  of  the  pus  have  disappeareil. 

jN'o  child  need  lose  its  et/es/i-om  ophthalmic  neonato- 
rum. But  incessant  care  is  necessary.  In  adults,  the 
treatment  saves  the  great  majority  of  cases.  The 
same  treatment  holds  good  for  croupous  and  dijih- 
theritic  inflammation.  And  in  tho.se  cases  the  gi'eater 
number  of  eyes  could  be  saved;  only  rarely  need 
eyes  be  lost  if  seen  early,  and  treatment  is  projierly 
continued. 

Dr.  C.  K.  Agnew,  of  Xew  York,  then  read  a  paper 
on 

COMMUNICABLE   EVE   DISEASE,    AND   SOME   OF   ITS   RELA- 
TIONS  TO   BLISDNESS   AND   P.^UPERISM. 

These  papers  were  discussed  by  Dr.  Chas.  S. 
Bull,  of  New  Y'ork,  who  thought  that  all  ophthal- 
mic surgeons  would  agree  with  Dr.  Knapp  as  to  the 
distinct  and  separate  processes  of  croup  and  diph- 
theria, and  the  persistent  apijlications  of  cold,  and 
also  the  very  great  necessity  of  watching  these  cases 
from  the  very  beginning,  never  leaving  the  patient. 
He  thought  there  was  no  necessity  of  losing  an  eye 
in  ophthalmia  neonatorum  if  the  surgeon  san:  the 
case  early  enough. 

Dr.  Notes,  of  New  York,  si^oke  of  the  positive  an- 
tiseptic influence  of  a  solution  of  boracic  acid  for 
cleansing  purposes,  and  of  its  .superiority  over  simjile 
water,  in  all  forms  of  ophthalmia. 


188 


THE  MEDICAL  RECORD. 


Dr.  Boosa,  of  New  York,  thought  that  the  basis 
ot  all  real  antiseptic  surgery  was  cleanliness,  and 
the  basis  of  cleanliness  was  water.  He  believed 
that  water  was  quite  as  bland,  and  on  the  whole  as 
efficacious  as  boracic  acid. 

Dr.  Sherwell.  of  Brooklyn,  was  of  the  opinion 
that  the  benefit  derived  from  the  boracic  acid  was 
due  to  its  stimulant  action. 

Dr.  Agn'ew.  of  New  York,  was  strongly  opposed 
to  the  application  to  the  eyes  of  water  slop  by  means 
of  rags.  He  had  seen  inflammation  of  tlie  external 
auditory  canal  caused  by  the  careless  use  of  water, 
some  of  which  found  its  way  down  into  the  ear  and 
produced  sei'ioits  consequences.  He  recommended 
bits  of  muslin  made  cold  by  being  placed  ujion  a 
block  of  ice  which  is  surrounded  by  a  towel,  so  that 
they  shall  contain  only  a  modei-ate  amount  of  mois- 
ture. 

Dr.  Squit.b  said  that  the  addition  of  a  small  quan- 
tity of  chloride  of  sodium  to  the  water  rendered  it 
more  comfortable  as  an  application  to  the  inflamed 
conjunctiva. 

The  paper  was  further  discussed  l>y  Drs.  Piffard, 
of  New  York,  and  W.  S.  Ely,  of  Rochester. 

Dr.  J.  O.  Roe,  of  Rochester,  then  read  a  paper 
on 

INTERN Ali   CESOPHAGOTOJIY.' 

It  will  appear  in  fall  in  a  subsequent  number  of 
the  Record.  It  was  disctissed  by  Drs.  A.  0.  Post 
and  L.  Elsberg  of  New  York. 

Dr.  S.  B.Ward,  of  the  Committee  of  Arrangements, 
nominated  tlie  following  gentlemen  for 

MEMBERS   BY   INTIT-ATION. 

Drs.  Henry  T.  Harris,  of  Laiirens ;  L.  H.  Hills, 
of  Cooperstown ;  T.  M.  Trego,  of  Albany ;  M.  L. 
Bates,  of  Canaan  Four  Corners  ;  John  E.  Burdick, 
of  Rockwood ;  Charles  W.  Hamlin,  of  lliddleville ; 
F.  .T.  Baker,  of  Youngstown. 

The  society  then  adjourned  to  meet  at  .3  p.m. 


Second  Day — Afternoon  Session. 

The  Society  was  called  to  order  by  the  President. 
The  first  paper  was  read  by  Dr.  L.  Elsberg,  of 
New  York,  and  entitled, 

THE     liARYNGEAL     MUSCLES     OF     THE    VOICE     AND     THE 
LARYNGOSCOPIC   LMAGES   OF   THEIR  PARALY.SES. 

The  pajisr  was  illustrated  upon  the  blackboard, 
and  consisted  of  an  anatomical  description  of  the 
organ  of  the  voice,  and  the  appearances  presented 
in  the  differential  diagnosis  of  paralysis  of  the  vari- 
ous muscles  of  the  larynx. 

LMPROVED     METHODS     IN     LABOR.^TORY "  TEACHING     AND 
DEMONSTRATIONS   IN   HISTOLOGY 

was  the  title  of  a  communication  made  liy  Dr.  Wil- 
Li.\M  Hailes,  Jr.,  of  .Vlbany.  The  speaker  confined 
himself  chiefly  to  the  /cchnii/iie  applicable  to  the 
working  laboratories  of  medical  schools,  and  de- 
scribed the  method  of  making  a  large  number  of 
sections  in  a  short  period  of  time,  liy  means  of  the 
freezing  microtome,  and  of  the  method  of  teaching 
by  means  of  outline  charts  suggested  by  Professor 
Sterling,  of  Scotland. 

The  paper  was  discussed  by  Dr.  Joseph  H.  Hunt, 
of  Brooklyn. 

.■Vn  obituary  notice  of  Seneca  Beebee,  M.l).,  by 
Dr.  F.  Hyde,  was  read  by  title  and  referred  to  the 
Committee  on  Publication. 


Dr.  Austin  Flint,  of  New  York,  then  read  a  pa- 
per on  "Physical  Diagnosis  by  jNIeans  of  Percussion 
and  Exploration  by  Puncture  in  Peritonitis,  with  or 
without  Perforation  of  the  Alimentary  Canal,  and 
the  Employment  of  Aspiration  in  Perforating  Peri- 
tonitis." 

TREATMENT  OF  DOUBLE  TALIPES  EQUlNO-VARnS  BY 
OPEN   INCISION. 

was  the  title  of  a  paper  read  by  Dr.  A.  M.  Phelps, 
of  Chateaugay.  It  will  ajipear  in  full  in  a  subse- 
quent number  of  The  Medic.IlL  Record. 

An  outline  of  the  history  of  eight  cases  was  given, 
with  illustrations.  The  operation  consists  in  making 
an  open  incision  across  the  sole  of  the  foot,  and  di- 
viding all  the  resisting  structures  do\vn  to  the  bones. 
In  certain  resisting  cases,  such  as  do  not  yield  to 
ordinaiw  means,  division  of  the  tendo-Achillis,  etc. — 
perhaps  one  in  ten  or  twenty — this  method  was  be- 
lieved to  be  applicable,  and  thus  far  it  had  given 
satisfactorv  results  (see  Medical  Record,  Vol  XX., 
p.  180). 

Dr.  Cieorge  H.  Fox,  of  New  York,  then  read  a  pa- 
per on 

THE   TREATJEENT   OF   WINE-M.4J4KS   BY   ELECTROLYSIS. 

The  object,  as  in  scarification  and  puncture,  is  to 
excite  sufficient  inflammation  to  destroy  the  fine  net- 
work of  blood-vessels.  A  simjile  needle,  or  an  in- 
strument containing  a  dozen  or  more  needles,  with 
points  upon  the  same  plane  and  about  two  milli- 
metres apart,  is  attached  to  the  negative  cord  of  a 
constant  battery.  These  are  quicldy  pressed  into 
the  skin  and  the  electrolytic  action  serves  to  destroy 
the  capillary  net-work.  The  instrument  used  is  a 
small  brass  disc,  which  carries  numerous  fine  cam- 
bric needles.  When  the  circuit  is  completed,  a 
blanching  of  the  tissue  for  a  small  space  around  the 
needles  is  immediately  observed.  With  ten  or 
twelve  cells  of  an  ordinary  zinc  and  carbon  battei7, 
the  needles  should  be  allowed  to  remain  ten  to  thirty 
seconds,  depending  upon  the  delicacy  of  the  skin  and 
the  effect  produced.  The  blanching  disappears  in  a 
few  moments.  The  effect  of  the  electrolysis  becomes  I 
evident  in  about  three  weeks.  In  aggravated  cases, 
there  might  be  a  return  of  the  color,  when  a  very 
fine  and  flexible  steel  needle,  introduced  in  an  ob- 
lique direction  beneath  the  skin  to  the  depth  of  a 
centimetre'or  moi-e,  should  be  used.  By  this  means 
he  destroyed  the  larger  vessels  from  wliich  the  supply 
of  the  capillai-y  ves.sels  was  received.  The  objec- 
tionable features  were  that  the  operation  was  a  some- 
what tedious  and  painful  one,  a  slight  danger  of 
causing  suppuration  and  siiperficial  sloughs,  and  a 
tendency  to  the  formation  of  small  keloidal-appear- 
ing  outgrowths,  and  sometimes  small  ulcers  and  de- 
pressed scars,  or  small,  firm  vascular  nodules.  The 
operation  does  not  leave  a  jierfectly  normal  skin,  bxit 
the  condition  may  be  greatlv  improved. 

Dr.  Sherwell,  of  Brooldyn,  thought  that  the 
same  results  could  be  obtained  by  multiple  punc- 
tui'e  with  a  needle  or  disc  of  needles,  the  ends  of 
which  had  been  tipped  with  a  caustic,  as  chromic  or 
carbolic  acid. 

Dr.  Knapp,  of  New  York,  suggested  that  if  the 
starting-point  of  these  marks  could  be  found  and  de- 
stroyed, the  remainder  would  be  obliterated.  An 
illustrative  case  was  cited. 

Dr.  Sherman,  of  Ogdensburg,  cited  a  case  in 
which  spontaneous  ulceration  occurred  at  the  point, 
and  produced  the  same  result  mentioned  by  Dr. 
Knapp. 


THE  MEDICAL  KECORD. 


189 


Db.  Vandbrveee,  of  Albany,  then  read  a  paper  on 

SUBCUTANEOrS   SECTION   OF   THE   FEMtTK. 

It  consisted  chiefly  of  the  surgical  history  of  a 
case.  The  patient  was  a  girl  nineteen  years  of  age, 
who  had  extreme  adduction  of  the  thigh,  as  the  re- 
sult of  inflammation  and  anchylosis  of  tlie  hip-joint, 
following  traumatism.  She  was  referred  to  hiai  by 
Dr.  Peters,  of  Cohoes,  and  entered  the  Albany  Hos- 
pital in  August,  1881.  Subcutaneous  section  of  the 
neck  of  the  femur  was  decided  upon,  and  the  opera- 
tion was  performed  with  the  assistance  of  Drs.Ward, 
Mosher,  Snow,  and  Hailes. 

Dr.  Shrady's  saw  and  trocar  was  used,  and  he  en- 
deavored to  divide  the  bone  above  the  trochanter. 
The  instrumeut  worked  in  a  perfectly  satisfactory 
manner  so  far  as  the  puncture  was  concerned,  and 
when  it  had  been  carried  between  the  femur  and  the 
blood-vessels  the  trocar  was  withdrawn,  and  the  saw 
introduced,  but  it  suddenly  broke  as  the  bone  was 
being  divided. 

Dr.  Vanderveer  then  immediately  enlarged  the  ex- 
ternal opening,  withdrew  the  piece  of  the  saw  with 
a  pair  of  forceps,  and  afterward  divided  the  bone 
with  an  ordinary  metacarpal  saw,  and  conclude<l  the 
operation.  The  tendons  of  the  adductor  muscles 
were  divided.  The  wounds  were  treated  anti-sejiti- 
cally.  No  complication  occun-ed  in  the  wound  made 
for  division  of  the  bone.  A  small  abscess  formed  at 
the  point  where  the  tenotomy  was  done. 

The  result,  one  hundred  and  seventeen  days  after 
the  operation,  was  that  the  patient  could  lie  natu- 
rally upon  the  bed,  could  walk  easily  with  a  cane, 
and  could  bend  forward  and  put  on  her  stocking. 
The  special  points  of  interest  were  (1)  the  fracture 
of  the  saw,  and  (2)  the  uncertainty,  for  a  time,  whether 
or  not  a  false  joint  would  be  formed. 

The  paper  was  discussed  by  Drs.  S.  B.  Ward,  of 
Albany,  and  Samuel  Peters,  of  Cohoes. 

Dr.  H.  D.  Notes,  of  New  York,  then  read  a  paper  on 

DmSIOX    OF   OPTIC    AND   CILIAliX    NEEVES   FOE   SYJIPA- 
THETIC   OPHTHALMIA. 

This  is  a  somewhat  less  severe  operation  than 
enucleation  of  the  eye,  and  had  been  practised  to 
such  an  extent  as  to  make  Dr.  Noyes  feel  justified 
in  throwing  it  into  the  cun-ent  of  general  medical 
knowledge.  The  author  of  the  paper  gave  a  brief 
summary  of  the  history  of  sympathetic  ophthalmia, 
and  spoke  of  the  two  forms,  (1 1  the  irritative,  (2)  the 
inflammatory.  The  imtative,  characterized  by  dif- 
ficulty in  using  the  eye,  jihotophobia,  lachrymation, 
perhaps  slight  superficial  inflammation,  could  be 
readily  removed  by  enucleation  of  the  offending  eye. 
The  more  severe  form  of  the  second  class  of  cases 
was  not  amenable  to  surgical  treatment.  The  two 
forms  might  merge  into  each  other.  The  causes 
were  found  chiefly  in  injuries  about  the  cUiary  re- 
gion. Enucleation  was  efi'ective  in  the  irritative 
form  of  the  aflection,  and  in  some  of  the  milder 
cases  of  the  inflammatory  form  of  the  disease,  but 
there  had  been  some  rare  disappointments. 

Ten  cases  had  been  reported  in  which  sympathetic 
ophthalmia  had  occurred  in  the  remaining  eye  a  con- 
sidei-aVile  period  of  time  after  enucleation  of  the  eye 
which  had  given  rise  to  the  trouble.  These  cases 
indicated  that  removal  of  the  eye  had  not  been  suc- 
cessful in  preventing  serious  mischief  from  occurring 
in  the  fellow-eye. 

The  history  of  the  operation  of  dividing  the  optic 
and  ciliarv  nerves  was  then  given,  and  the  method 
of  performing  it  described.     He  had  performed  it  in 


five  cases,  and  of  those  three  had  been  under  obser- 
vation for  some  time.  His  conclusions  were,  that 
the  operation  removes  tenderness  and  the  tendency 
to  repeated  attacks  of  inflammation  in  some  cases,  yet 
tenderness  has  returned  in  certain  cases,  and  thei  e 
are  three  cases  upon  record  in  which,  despite  the  oiJ- 
eration,  symjaathetic  inflammation  occurred  in  the 
sound  eye.  The  operation  was  to  be  regarded  as- 
still  under  trial,  but  the  evidence  was  in  its  favor  in 
certain  cases.  If  it  failed,  it  could  be  supplemented 
by  enucleation. 

'Dr.  Knapp,  of  New  York,  had  performed  the  op- 
eration in  nine  cases,  which  he  had  reported,  and 
all  did  well,  except  one  in  which  gangrene  of  the 
globe  occurred.  In  many  cases,  however,  the  oper- 
ation had  been  inefficient,  and  in  three  or  four  in- 
stances death  had  occurred  in  consequence  of  it,, 
according  to  reports  made  at  the  International  Med- 
ical Congress.  He  believed  that  experience  did  not 
warrant  ophthalmic  surgeons  in  substituting  this  for 
the  safer  and  more  efficient  operation,  enucleation. 

Dk.  Eoosa,  of  New  York,  also  believed  that  the 
opinion  of  ophthalmologists  was  decidedly  adverse 
to  any  further  trial  of  the  operation  as  a  substitute 
for  enucleation  in  the  prevention  of  sympathetic  oph- 
thalmia. 

Dr.  Notes  said  that  he  had  attempted  simply  to- 
convey  to  the  profession  at  large  the  facts  concern- 
ing the  operation  as  they  stand  at  the  present  time. 
Of  the  fatal  cases  he  had  not  had  any  knowleflge,. 
because  the  transactions  of  the  International  Con- 
gi-ess  are  not  yet  published,  but  was  thankful  for 
the  knowledgewhich  had  come  to  Dr.  Knapp,  and 
which  he  had  communicated  to  the  society.  The 
paper  was  further  discussed  by  Drs.  H.  Jewett,  of 
Canandaigua,  and  L.  Howe,  of  Buffalo, 

Dr.  L,  D.  Brrr.Kr.Ev,  of  New  York,  then  read  a  pa- 
per on 

the     MALIGNITT    of    SXPHILIS,    WITH    AN    ANALYSIS   OF 
FOCK   HUNDRED   AND   FIFTY   CASES, 

The  conclusion  reached  liy  the  author  of  the  paper, 
was,  that  syphilis  should  not  be  regarded  as  benign 
in  anv  sense  of  the  word.  Special  reference  was 
made' to  the  Prize  Essay  by  Dr.  C.  F.  Dana  on  the 
Benignity  of  Syphilis,  but  Dr.  Buckley  regarded  Dr. 
Dana's  concisions  as  those  based  upon  insufficient 
data,  and  the  result  of  too  slight  experience  to  be 
authoritative. 

An  obituary  notice  of  James  P,  White,  M,D.,  of 
Bulfalo,  by  Dr.  Austin  Flint,  was  read  by  title  and 
referred  to  the  Committee  on  Publication. 

MEMBERS   BY   INVITATION. 

Drs,  Isaac  DeZouche,  of  Gloversville  ;  A,  Nellis, 
of  Port  Jackson  ;  O,  D.  Ball,  of  Albany ;  D,  E. 
Walker,  of  Ilion  ;  and  C,  W,  Hamlin,  of  Middleville. 

The  society  then  adjourned  to  meet  in  the  Assem- 
bly Chamber  at  8  p.m.,  to  listen  to  the  President's 
address. 

Second  Day — Evening  Session, 

The  society  convened  in  the  Assembly  Chamber,, 
and  was  called  to  order  at  8  p.m.  by  the  Vice-Presi- 
dent, Dr.  William  Gov.an,  of  Stony  Point. 

The  President,  Dr.  A.  Jacobi,  of  New  York,  then 
delivered  his  address,  the  subject  of  which  was 

infant    FEEDING    AND   INFANT   FOODS. 

One  of  the  measures  contemplated  and  advised  in 
the  report  of  the  committee  appointed  to  co-operate 


190 


THE  MEDICAL  RECORD. 


witTi  the  Society  for  the  Prevention  of  Cruelty  to 
Caildren,  was  that  there  should  be  a  place,  or  places, 
in  larger  cities  where  infants  and  yoimg  children  of 
the  poor  might  be  supplied  at  cost  with  the  simple, 
though  sufficient  articles  of  food — milk,  barley,  oat- 
meal, eggs.  Their  value  had  been  considered  al- 
most as  an  axiom ;  to  make  it  so  had  been  one  of 
the  duties  of  his  life.  Truth,  however,  wa.s  fre- 
quently suspected  because  of  its  simplicity,  and 
often  did  we  see  complicated  means  and  measures 
resorted  to  in  preference  to  plain  and  direct  ones.  To 
render  the  results  hitherto  obtiined  available,  the 
normil  feeding  of  infants  possible,  and  to  protect 
them  from  the  injuries  inflicted  by  ill-directed  love, 
ignorance,  and  evil-devised  plans  and  frauds  of  what 
is  called  commerce  and  industry,  was  the  object  of 
his  rem  irks  concerning  the  dangers  to  which  infants 
are  exposed. 

Tlie  spaaker  then  refen-ed  to  the  gi-eat  mortality 
among  infants,  and  also  to  the  additional  fact  that 
of  all  that  die  before  one  year  of  age,  death  is  the 
result,  in  forty  to  fifty-thi-ee  per  cent.,  of  diseases  of 
the  organs  of  digestion.  It  was  an  axiom  that  breast 
milk  of  the  mother  or  wet-nurse  was  the  best  pre- 
ventive against  such  diseases.  Tlie  mother  who 
refused  to  nurse  her  baby  during  the  first  two  months 
of  its  life,  was  an  accomplice,  perhaps  the  only 
cause  of  the  death  of  her  offspring.  Intestinal  dis- 
ease, however,  might  occur  despite  nursing  at  the 
breast,  and  babies  might  also  be  sick  because  of  be- 
ing at  the  breast.  It  was  with  these  cases  that  both 
mother  and  physician  should  be  familiar.  Attention 
was  then  directed  especially  to  the  great  dangers 
attending  the  use  of  breast-milk  of  the  mother  or 
wet-nurse.  Long  ago  had  he  formulated  his  views 
in  the  words,  "  Milk  secreted  from  an  insufficient 
mamma  by  a  woman  not  in  full  health  and  vigor,  by 
an  old  woman,  by  a  very  young  woman,  by  an  anae- 
mic woman,  by  a  convalescent  woman  who  has  con- 
sumed a  large  amount  of  her  albumen,  by  a  neurotic 
womin,  milk  which  has  not  the  normal  transforma- 
tion of  the  elements  of  the  mammary  glands,  but 
consists  of  more  or  less  transuded  serum,  is  apt  to 
be  impregnated  with  elements  circulating  in  the 
blood." 

Infants  who  are  deprived  of  breast-milk  should 
be  supplied  with  food  as  nearly  like  mother's  milk 
as  possible.  The  differences  between  cow's  milk 
and  human  milk  were  then  pointed  out,  such  as  the 
variation  in  the  percentage  of  fat,  casein,  etc.,  and 
therefore  it  required  considerable  modification  be- 
fore it  was  suitable  for  infant  food.  The  percent- 
age of  fat  and  casein  was  larger  in  cow's  than  in  hu- 
man milk,  and  there  was  no  known  process  by  which 
the  absolute  quantity  could  be  reduced  without  ren- 
dering the  remaining  part  unfit  for  use.  The  objec- 
tion to  cow's  milk  depended  upon  it-t  chemical 
composition  and  physical  properties,  and  yet  those 
could  not  be  changed  by  the  most  studious  and 
successful  procuring  of  as  uniform  and  pure  article 
as  possible. 

But  he  was  far  from  saying  that  cow's  milk,  given 
pure  or  mixed  with  water,  was  absolutely  injurious 
to  babies.  The  fact  that  many  babies  thrive  upon  it 
whose  general  health  remained  good,  certainly  would 
disprove  such  an  exaggerated  opinion.  Yot  tliere 
were  many  infants  who  anpeared  to  thrive  better 
than  they  actually  did.  There  was  no  food,  how- 
ever, upon  wliich  a  certain  number  of  infants  would 
not  thrive.  I?ut  it  simply  proved  tliat  nature  did 
no  tontine  work,  that  the  sum  total  of  vital  pocesses 
did  not  respond  to  certain  occurrences  or  influences 


like  reagents  in  a  chemical  test.  Cow's  milk,  as  a 
universal  substitute  for  human  milk,  had  lost  its 
credit  with  many,  though  the  differences  in  the 
article,  so  long  as  no  adulterations  were  perpetrated, 
were  very  much  less  than  in  the  same  secretion  of  the 
human  being.  If  that  were  not  so,  how  did  it  occur 
that  all  over  the  civilized  world  substances  were 
sought  for  and  ofl'ered,  though  milk  be  as  cheap 
and  easily  obtained  as  anything  else  ?  Why  was  it 
that  to  cure  the  evils  alluded  to,  untold  risks  were 
run  in  the  procuring  of  more  expensive,  more  im- 
known,  and  more  unreliable  vegetable  compositions, 
which  seldom  kept  the  promises  loudly  displayed 
upon  the  labels  ?  An  ideal  article  of  food  must  serve 
two  purposes,  and  contain  two  classes  of  constit- 
uents. It  must,  in  the  infant,  supply  the  growing 
tissue  with  material  suflicient  to  take  the  place  of 
that  constantly  being  wasted,  and  allow  a  surplus 
for  increase  ;  and,  secondly,  supply  fuel  for  the  pur- 
pose of  keeping  up  the  jaroduction  of  an  eqiiable 
temperature  and  the  functions  of  the  organs,  mainly 
those  of  respiration.  The  first  indication  was  ful- 
filled by  the  albuminous  substances,  and  the  other 
by  the  carbohydrates.  The  first,  in  milk,  was  rejire- 
sented  by  casein,  and  the  second  by  fat  and  sugar. 
In  vegetables  the  first  class  was  rei>rescnted  by 
gluten,  and  the  second  mainly  by  starch.  In  the 
ideal  food  the  proportion  of  the  first  to  the  second 
class  is  about  1 :  i. 

The  changes  in  tliese  substances  were  then  studied 
as  they  occur  in  the  laboratory  and  in  the  process  of 
digestion.  Sj^ecial  attention  was  then  directed  to 
the  numerous  artificial  foods,  and  in  general  terms 
all  were  condemned.  He  hoped  that  the  extensive 
fraud  could  be  stopped  and  the  nefarioiis  traific  be 
suppressed.  With  regard  to  the  growing  evil,  which 
had  assumed  such  vast  projiortions,  the  profession, 
to  a  certain  extent,  were  at  fault.  There  were  but 
few  who  were  not  aware  of  the  inexpediency  and 
sometimes  danger  attending  the  exclusive  feeding 
with  cow's  milk  and  sought  for  other  substances. 
Professionally  we  had  come  to  look  upon  the  sale  of 
patented  foods  as  something  quite  unobjectionable. 
Those  imbued  with  the  strictest  sense  of  ethics,  who 
would  not  patent  an  invention  nor  tolerate  the  fellow- 
ship of  a  professional  man  who  did  so,  and  frowned 
upon  patented  medicines,  forgot  their  habits  and 
principles  when  the  question  of  patent  right  and 
secresy  came  up  with  regai'd  to  patented  foods. 

Many  of  the  scientific  journals  in  Europe,  dedi- 
cated to  the  study  of  diseases  of  children,  were  fre- 
quently used  for  the  purpose  of  discussing  the 
merits  and  effect  of  some  new  infant  food,  and  it 
only  showed  to  what  extent  the  evil  had  grown. 
Many  of  the  articles  oft'ered  were  unmitigated  frauds, 
and  only  a  very  few  had  an  available  composition. 
Although  the  rule  held  good  that  food  for  infants 
should  be  largely  diluted,  it  did  not  follow  that  water 
alone  was  the  pro)ier  diluent  for  the  casein  of  cow 's 
milk.  To  secure  the  ordinary  loose  flikes  of  casein 
which  existed  in  mother's  milk,  there  must  be  added 
to  cow's  milk  some  farinaceous  substance,  and  of 
those  he  had  onlv  two  to  recommend,  namely,  barky 
and  oatmeal.  Tlie  reasons  for  recommending  thef-c 
articles  were  then  given.  Reference  was  also  nindi' 
to  the  necessity  and  importance  of  adding  chloridr 
of  sodium,  tlio  more  important  the  more  the  milk 
was  mixed  with  a  vegetable  substance. 

It  was  not  wise  to  forget  that  nature  was  repub- 
lican in  princi]>lo  and  democratic  in  jiractice.  If  too 
often  there  was  no  oquaUty  before  a  court  of  justice, 
there  was  equality  before  that  of  physiological  law. 


THE   MEDICAL  RECORD. 


191 


On  motion  bv  Dr.  S.  O.  Vander  Poel,  of  New  York, 
a  vote  of  thanks  was  tendered  to  the  President  for 
his  vahiable  and  instructive  paper. 

The  society  then  adjourned,  after  which  the  An- 
niial  Banquet  was  given  at  the  Delavan  House. 


Thtrsdat — FEBKrAKY  9th — ■Thuu)  Day. 

The  society  was  called  to  order  at  10  a.m.,  by  the 
President,  and  praver  was  oftered  by  Rev.  James 
H.  EcOB. 

A  communication  fi-om  Otsego  County  was  pre- 
sented by  the  Secretary,  and  referred  to  the  Com- 
mittee on  By-Laws. 

KEPORT     OF     THE      COMJIITTEE      ON     THE      PRESIDEXT's 
ADDRESS. 

The  committee  submitted  its  report,  which  con- 
tained the  following  resolutions  : 

Resolrecl,  That  this  .society  endorses,  to  the  fullest 
extent,  the  sentiment  expressed  by  the  President  in 
relation  to  the  employment  of  children  of  tender  age 
or  immature  develoiiment  in  factories  and  manufac- 
turing establishments,  and  request  that  the  Com- 
mittee on  Legislation  prepare  a  bill  for  jiassage 
by  the  Legislature  which  shall  include  the  sugges- 
tions of  the  President, 

Sesoh-ed,  That,  from  the  extreme  contagiousness 
of  scarlet  fever  and  diphtheria,  a  contagiousness 
which  is  probably  limited  to  a  restricted  area,  and  not 
conveyed  to  any  distance  atmospherically,  this  so- 
ciety favors  the  absolute  isolation  of  such  cases  of 
sickness,  even  in  instances  where  every  attainable 
luxury  and  comfort  sun-ounds  the  patient,  and  ex- 
presses the  urgent  necessity  for  the  erection  of  spe- 
cial hosjiitals  for  the  care  of  patients  sick  with 
these  diseases ;  and,  further,  that  from  the  feeble 
dissemination  of  these  poisons  by  the  atmosphere, 
such  hospitals  may  be  erected  with  safety  to  others, 
even  in  thickly-settled  parts  of  cities. 

Resolved,  That  with  a  view  to  the  elevation  of  the 
standard  of  attainment  of  those  entering  the  i:irofes- 
sion,  and  also  the  establishment  of  a  uniform  grade, 
as  far  as  possible,  the  conferring  of  the  title  of  Doctor 
in  Medicine  should  be  liy  Medical  Colleges,  only 
after  the  examination  and  recommendation  of  an  in- 
dependent board  of  examiners,  which  board  shall  be 
common  to  all  the  colleges. 

Signed,  E.  M.  IMoore. 

S.  O.  "N'ander  Poel. 
Wflliam  C.  Wey. 
John  P.  Gray. 

The  resolutions  were  unanimously  adojited. 

The  committee  appointed  to  co-operate  with  the 
Society  for  the  Prevention  of  Cruelty  to  Children, 
reported  progress,  and  the  President  appointed  Dr. 
C.  K.  Agnew  to  till  the  vacancy  made  by  the  death 
of  Dr.  James  P.  White. 

VACCINATION. 

Dr.  a.  Flint,  of  Xew  York,  offered  the  following 
preamble  and  resolution,  which  were  adopted  : 

Whereas,  Efforts  have  recently  been  made  in  this 
country  to  excite  in  the  minds  of  ignorant  jioople  a 
prejudice  against  vaccination. 

Resolved,  That  this  matter  be  referred  to  the  Com- 
mittee on  Experimental  Medicine,  and  that  this 
committee  be  empowered  to  take  such  measures  as 
may  seem  to  its  members  requisite  for  the  protec- 
tion of  public  health. 

On  motion,  Dr.  Flint  was  added  to  the  Committee 
on  Experimental  Medicine. 


EXPERT  TESTmONX. 

Dr.  John  P.  Gray,  of  Utica,  offered  the  following 
preamble  and  resolution,  which  were  unanimously 
adopted  : 

In  view  of  the  important  relations  of  the  medical 
profession  to  the  administration  of  justice,  the  time 
has  arrived  when  this  society  should  declare  its 
opinion  upon  the  proper  functions  and  Limits  of 
medical  expert  testimony.     Therefore  be  it 

Resolved,  That  the  true  function  of  the  medical 
expert  is  to  exjiand  and  interpret  the  results  of 
pathological  conditions,  and  that  in  the  absence  of 
disease  he  is  not  justified  m  drawing  conclusions  as 
to  civil  responsibility  from  moral  manifestations  of 
conduct,  that  department  belonging  exclusively  to 
law. 

Upon  resolution  Dr.  Gray  was  requested,  and  as- 
sented, to  prepare,  and  read  a  paper  on  the  above 
subject  at  the  annual  meeting  in  1883. 

P.APERS   by   title. 

The  following  were  read  by  title,  and  refei-red  to 
the  Committee  on  Publication  :  "  The  Early  Diag- 
nosis of  Pott's  Disease,"  by  V.  P.  Gibney,  of  New 
York ;  "  The  Significance  of  Pain  Referred  to  the 
Ear,"  by  D.  B.  St.  John  Roosa,  of  New  York  ;  "  Cases 
of  Glaucoma,  in  which  Iridectomy  on  one  Eye 
Seemed  to  Precipitate  an  Attack  of  Acute  Glaucoma 
in  the  Fellow  Eye,"  by  D.  "Webster,  of  New  York  ; 
"  A  Few  Original  Thoiights  on  Cholera,"  by  H.  Ray- 
mond Rogers,  of  Dunkirk ;  "  Facial  Paralysis  Oc- 
curring in  Connection  with  Aural  Disease,"  by  S. 
Sexton,  of  New  York:  "Inflammation  of  the  Shoul- 
der Joint,  Resulting  from  Hemiplegia,"  by  L.  E. 
Felton,  of  Potsdam  ;  "Report  of  a  Case  of  Mollus- 
cum  Fibrosum,"  by  George  G.  Hopkins,  of  Brooklyn. 

THE  LENGTH  OP  PAPERS  AT  FUTURE  SESSIONS  OF  THE 
SOCIETY. 

Db.  E.  R.  Squibb,  of  Brooklyn,  offered  the  follow- 
ing preamble  and  resolutions,  which  were  unani- 
mously adopted  : 

Whereas,  The  rule  adopted  in  this  annual  meeting 
of  limiting  the  time  of  reading  for  each  paper  to 
twenty  minutes  has  very  materially  facilitated  the 
business  of  the  sessions,  and  enabled  the  Society  to 
avail  itself  of  all  the  material  offered  ;  therefore 

Be  it  Resolred,  That  it  recommend  to  readers  of 
papers  for  future  sessions  of  the  Society  either  to 
limit  the  length  of  the  paper  to  twenty  minutes,  oi-, 
when  this  cannot  be  done,  to  prepare  an  abstract 
which  can  be  read  within  the  prescribed  time. 

Resolved,  That  any  motion  to  extend  the  pre- 
scribed time  shall  not  be  in  order. 

Dr.  D.  H.  Goodwillie,  of  New  Y'ork,  then  read  a 
paper  entitled, 

application  by  insufflation  OF  MEDICATED  POW- 
DERS TO  THE  UPPER  AIR  PASSAGES,  FOR  THE  RELIEF 
OF   CATARRHAL   CONDITIONS. 

The  author  of  the  paper  believes  that  naso-pharyn- 
geal  catarrh,  as  met  with  by  the  general  practitioner, 
begins  in  most  cases  in  childhood.  He  also  be- 
lieves that  the  affection  can  be  treated  most  effi- 
ciently by  means  of  powders,  when  sufficiently  fine 
and  properly  applied.  It  is  absolutely  essential  that 
the  powders  be  as  nearly  impalpable  as  possible. 
The  only  place  at  which  properly  triturated  powders 
can  be  obtained  is  P.  H.  Schmidt's  instrument  store, 
corner  of  Broadway  and  Thirty-fourth  Street,  New 
York. 


192 


THE   MEDICAL  RECORD. 


The  following  formulae  were  given  : 

5 .    Benzoin 3  j. 

MorphiEe  muriate gi'.  ri- 

Bismuth  subnit., 

Potas.  nitrat aii  3  ss. 

M.  et  triturate. 

Valuable  for  its  sedative  action  and  to  be  used  in 
hypenemic  condition  with  pain.  In  the  beginning 
of  an  attack  of  rhinitis,  coat  the  mucous  membrane 
thoroughly  with  it. 

If .    Alum 3  ss. 

Gum  acacite,  , 

Bismuth  subnit., 

Potass,  nitrat aa  3  ij. 

M.  et  triturate. 

Useful  where  a  strong  astringent  is  indicated.  In 
cases  of  hemorrhage,  remove  all  the  clot,  and  apply 
the  powder  abundantly  until  the  bleeding  ceases. 

The   powder-blower  which  he  i-ecommended  was 
that  devised  by  Dr.  Andrew  H.  Smith,  of  New  York. 
Dr.  Koosa  said  that  a  powder-blower,   identical 
with  Dr.  Smith's,  was  invented  by  Dr.  Ely,  of  Roch- 
ester, about  sixteen  years  ago. 

Dr.  E.  H.  M.  Sell,  of  New  York,  then  read  a  paper 

ON   THE   USE   OP   AVENA   SATIVA. 

The  reader  spoke  of  the  history  and  medicinal 
properties  of  the  drug,  and  gave  them  as  laxative, 
tonic,  and  stimulant,  especially  a  nervous  stimulant. 
The  concentrated  tincture  was  the  most  available 
preparation,  and  he  had  used  it  with  extraordinarily 
favorable  results  in  the  treatment  of  inebriety  and 
the  opium-habit.     Cases  were  given. 

Dr.  E.  R.  Sqitbb  objected  to  the  reception  of  the 
paper  and  its  appearance  in  the  transactions,  be- 
cause it  contained  statements  so  broad  and  so  ex- 
traordinary, without  corroboration  by  testimony  other 
than  that  given  by  the  reader  of  the  paper. 

Dr.  Sell  being  a  delegate,  the  President  ruled  that 
the  objection  could  not  be  entertained,  but  that  the 
Coramittea  on  Publication  had  discretionary  power. 

The  hour  having  arrived  for  the  special  order, 
namely — 

COMMUNICATION   FEOM    THE    MEDICAL    SOCIETY   OF    THE 
COUNTY   OF    NEW   YORK. 

Dr.  W.  INI.  Carpenter  offered  the  following  pre- 
amble and  resolution,  which  were  seconded  by  Dr. 
Squibb  and  subsequently  adopted  : 

Where' IS,  The  Moliea'l  Society  of  the  County  of 
New  Y'ork,  iu  its  efforts  to  enforce  the  medical  law 
passed  May  2!),  18S(),  have  found  that  it  is  ineflS- 
cient  in  certain  respects  relating  to  the  conviction 
and  punishment  of  illegal  prachitioners. 

And  Whereas,  Tl»e  belief  is  that  an  act  can  be  so 
drawn  as  to  promote  the  interests  of  the  medical 
profession,  secure  the  conviction  and  i)unishment  of 
illegal  practitioners,  and  eft'ectually  aid  in  the  sup- 
pression of  fiuackery. 

III!  it  Reso/re,/,  That  the  i\Iedical  Society  of  the 
State  of  New  Y'ork  svmpathi/.es  with  the  movements 
of  the  Medical  Society  of  the  Cminty  of  New  Y'ork 
already  made  in  its  efforts  to  cari-y  out  the  i)rovi- 
sions  of  the  medical  law  passed  May  iU.  1880,  and 
also  approves  of  the  continued  efforts  of  tliat  society 
to  secure  the  enactment  of  such  amendments,  or  the 
passage  of  a  new  bill,  as  will  aid  in  the  conviction 
and  punishment  of  illegal  practitioners,  and  in  the 
suppression  of  tjuaekery. 

Dr.  STURfiis  explained  as  to  the  objects  sought 
after  in  the  proposed  new  bill  to  regulate  the  licens- 


ing of  physicians  and  surgeons,  and,  on  motion,  they  , 
were  approved  of,  and  the  bill  was  recommitted  to 
the  Committee  on  Legislation,  with  instructions  to 
perfect  it  by  the  aid  of  legal  counsel,  and  recom- 
mend that  it  become  a  law. 

On  motion,  the  jjroposed  act  to  amend  "  An  Aclr 
Relating  to  the  Examination  of  Candidates  for  the 
Degree  of  Doctor  of  Medicine,"  chap.  7i6  of  the 
laws  of  1872,  was  approved  and  i-ecommitted  to 
the  Committee  on  Legi.slation,  to  be  recommended 
for  passage  by  the  Legislature. 

Dr.  Thoma-s  E.  Pooley,  of  New  York,  then  read 
the  following 

REPORT   OF   the   COMMITTEE   ON   NOMINATIONS. 

For  President. — Harvey  .Jewett,  of  Canandaigua. 

For  Vice-President — E.  D.  Feigusnn,  of  Troy. 

For  Setrretarii  — William  Manlius  Smith,  of  Man- 
lius. 

For  Treasurer. — Charles  H.  Porter,  of  Albany. 

For  Censors. — Southern  District :  -J.  "\V.  S.  Gou- 
ley,  C.  R.  Agnew,  Austin  Flint,  of  New  York. 
Eastern  District :  C.  E.  Nichols,  M.  H.  Burton,  W. 
S.  Cooper,  of  Troy.  Middle  District  :  Alonzo 
Churchill,  S.  G.  Wolcott,  J.  K.  Chamberlavue,  of 
Utica.  Western  District :  C.  C.  Wyckott',  Thomas 
F.  Rochester,  of  Buffiilo ;  Henry  Lapp,  of  Clarence, 

Commitlee  of  Arranyeinenls. — S.  B.  Ward,  and  J. 
S.  Mosher,  of  Albany  ;  and  William  S.  Ely,  of  Roch- 
ester. 

Committee  o/i  By-Laws. — William  C.  Wey,  of  El- 
■mira ;  Alexander  Hutchins,  of  Brooklyn  ;  William 
Manlius  Smith,  of  Manlius. 

Commitlee  on-  Ilyoiene. — E.  V.  Stoddard,  of  Roches- 
ter ;  Stephen  Smith,  of  New  Y'ork  ;  Jacob  S.  Mosher, 
of  Albany ;  J.  Foster  Jenkins,  of  Y'onkers ;  Caleb 
Green,  of  Homer;  Edward  Hutchinson,  of  Utica; 
Theodore  Dimon,  of  Auburn. 

Committee  on  Legislation. — William  H.  Bailey  and 
A.  Vandervecr,  of  Albany ;  F.  R.  Sturgis,  of  New 
Y'^ork. 

Committee  on  Medical  Ethics. — C.  R.  Agnew,  of 
New  York ;  E.  M.  Moore,  of  Rochester ;  S.  O.  Vau- 
der  Poel,  of  New  Y'ork. 

Committee  on  Prize  Essays. — Thos.  F.  Rochester, 
of  Buffalo  ;  W.  S.  Ely,  of  Rochester ;  W.  W.  Potter, 
of  Buifalo. 

Committee  on  Publication. — Wm.  Manlius  Smith, 
of  Manlius;  Chas.  H.  Porter,  of  Albany;  H.  D. 
Didama,  of  Svracuse  ;  J.  Foster  Jenkins,  of  Y'onkers. 

Censor  of  College  of  Medicine,  Syracuse  University. 
— John  W.  Whitbeck,  of  Rochester. 

For  Permanent  Members. — First  District  :  G.  H. 
Fox,  F.  R.  Sturgis,  Louis  Elsberg,  of  New  York  : 
John  D.  Rushmore  and  F.  W.  Rockwell,  of  Brook- 
lyn. Second  District  :  E.  H.  Loughrar,  of  Kings- 
ton ;  Samuel  Swift,  of  Y'onkers.  Third  District:  F. 
C.  Curtis,  of  Albanv  ;  W.  S.  (hooper,  of  Troy.  Fourtli 
District  :  Lucius  E.  Felton,  of  Potsdam  ;  F.  L.  R. 
Chapin,  of  Glens  Falls.  Fifth  District:  Wm.  H. 
Joimsnn,  of  Port  Levden  ;  D.  Pardee,  of  Fulton. 
Sixth  District :  B.  F.  Smith,  of  Mt.  Upton.  Seventh 
District  :  .Joseph  P.  Creveling,  of  Aulnirn.  T'.ighth 
District  :  Thos.  M.  Johnson,  of  Buffalo  ;  J.  O.  Roe, 
of  Rochester. 

For  Honorary  Members. — Chas.  N.  Hewett,  of  Bed 
Wing,  Minn.;  Roberts  Bartholow,  of  Philadelphia; 
Sidney  Ringer,  of  London. 

Eligible  to  Honorary  Membership. — Theodore  G. 
Wormley,  and  William  Goodell,  of  Philadeliihia. 

Delegates  to  State  ^fedicat  Societies. — New  .Terser  : 
N.  C.  Husted,  of  Tarrytown  ;  Wm.  Govan,  of  Stony 


THE   MEDICAL  RECORD. 


193 


Point ;  Jas.  C.  Hutchison,  of  Troy.  Massacliusetts  : 
G.  G.  Monroe,  of  Craiy's  Mills  ;  E.  N.  Brush,  of 
Utica  ;  Peter  V.  S.  Pruyn,  of  Kinderhook.  Ohio  : 
Thos.  E.  Pooler,  of  New  York.  Pennsylvania  :  H. 
C  May,  of  Corning  ;  Solomon  Van  Etten,  Port  Jer- 
vis  ;  J.  W.  Moore,  of  Cohoes.  Vermont :  Lyman  Bar- 
ton, of  WiUsborough  :  A.  M.  Phelps,  of  C'hateaugay. 
New  Hampshire  ;  Wm.  M.  Chamberlain,  of  New 
York. 

Delegates  to  the  Canadian  Medical  Association. — 
John  Gerin,  of  Auburn  ;  D.  V.  O'Leary,  of  Albany  ; 
L.  E.  Felton,  of  Potsdam  ;  L.  C.  Dodge,  of  Eouse's 
Point. 

Delegates  to  the  American  Medical  Association. — 
Wm.  C.  Wer,  of  Elmira ;  0.  E.  Agnew,  S.  O.  Van- 
der  Poel,  H.  G.  Piifard,  D.  B.  St.  John  Eoosa,  F.  E. 
Sturgis,  A.  Jacobi,  F.  H.  Hamilton,  Fordyce  Barker, 
L.  A.  Sayre,  Wm.  M.  Chamberlain,  L.  I).  Bulkley, 
A.  V.  B.  Lockrow,  and  Daniel  Lewis,  of  New  York ; 
E.  E.  Sqiiibb,  and  J.  C.  Hutchison,  of  Brooklrn ; 
Wm.  H.  Bailey,  of  Albany ;  E.  M.  Moore,  of  Eoch- 
ester ;  E.  S.  Howe,  of  Black  Brook  ;  Harvey  Jew- 
ett,  of  Canandaigua  ;  John  P.  (Jray,  of  Utica  ;  T.  B. 
Eeynolds,  of  Saratoga  ;  N.  C.  Husted,  of  Tarrytown  ; 
Geo.  J.  Fisher,  of  Sing  Sing ;  J.  Foster  Jenkins,  of 
Youkers  ;  Thos.  F.  Eochester,  of  Buffalo  ;  Frederick 
Hvde,  of  Cortland  ;  G  H.  B.  Spencer,  of  Watertown ; 
Maurice  Perkins,  of  Schenectady ;  Theo.  Dimon,  of 
Auburn  ;  and  J.  H.  Chittenden,  of  Binghamton. 

On  motion  by  Db.  Satre  the  report  was  accepted, 
and  the  secretary  was  instructed  to  cast  an  affirma- 
tive ballot  for  all  the  candidates  placed  in  nomination. 

On  motion  by  Dr.  John  P.  Gray,  the  thanks  of  the 
Society  were  tendered  to  the  Committee  of  AiTange- 
ments  for  the  efficient  manner  in  which  they  had 
discharged  tlieir  duties. 

On  motion  by  Dk.  Sturgis,  the  boards  of  censors 
of  the  county  societies  were  asked  to  report  their 
proceedings  to  the  Committee  on  Legislation  on  or 
before  January  5,  1883,  in  order  that  the  work  might 
be  summarized  before  the  occurrence  of  the  next  an- 
nual meeting. 

The  Business  Committee  announced  that  there  was 
no  further  business,  and  recommended  that  the  so- 
ciety adjourn. 

The  President  thanked  the  members  for  the  uni- 
form kindness  and  coiirtesy  which  he  had  received 
at  their  hands,  and  declared  the  society  adjourned, 
to  meet  in  the  City  of  Albanv  on  the  first  Tuesdav 
in  Februarv,  1883. 


Acute  Glaucoma  Cured  by  Eserine. — Dr.  C.  J. 
Lundy  reports  a  case  of  acute  glaucoma  of  the  left 
eye,  occuiTing  in  a  young  man  of  good  health  ajid 
steady  habits.  The  patient  was  seen  three  days 
after  the  symptoms  appeared.  These  symptoms 
had  been  congestion,  irritability,  pain,  and  impaired 
vision.  When  seen,  the  eye  was  causing  intense 
pain.  There  was  ciliary  congestion,  profuse  lachi-y- 
mation,  dilated  and  immovable  pupil ;  the  eyeball 
of  a  stony  hardness ;  vision  blurred,  colored  rings 
being  seen  when  looking  at  a  light.  The  case  was 
considered  one  of  acute  glaucoma.     The  patient  re- 

I    fused  to  allow  an  O25eration. 

I  Local  depletion  was  employed,  and  a  few  drops  of 
a  two-grain  solution  of  eserine  were  instilled  into 
the  eye  every  fifteen  minutes.  It  was  then  used 
every  hour.  Next  day  he  was  much  better.  The 
eserine  was  continued  eveiy  two  hoars.  In  four 
days  all  glaucomatous  symptoms  had  disappeared. 
Dr.  Lundy  thinks  that  eserine  is  a  good  substitute 
for  iridectomy  in  a  certain  proportion  of  cases. 


€oxxtQTpontimct. 


THE   QUESTION    OF    REFLEX    DISTURB- 
ANCES FROJj:  GENITAL  lEEITATION. 
A  Eeplt  to  Dk.  Gray. 

To  THE  Editor  of  The  Medical  Eecoei>. 
Dear  Sir  :   The  points  at  issue  between  Dr.  Gray 
and  myself  can  be  briefly  stated. 

He  publishes  an  essay  on  "The  Effect  of  Genital 
Irritation  in  the  Production  of  Nei'vous  Disorders,"  * 
without  any  reference  to  my  contributions  f  upon 
the  same  subject.  Dr.  Gray,  who  does  not  deny  that 
he  knew  of  the  existence  of  these  jjapers  when  he 
wrote  his  essay,  adojited  very  much  the  same  line  of 
thought  and  "covered"  very  much  the  same  ground 
that  I  did  in  my  articles.  In  a  note  to  the  Eecord 
(.January  14th)  I  called  attention  to  these  matters, 
and  the  reeult  is  shown  in  his  equivocal  reply  of  the 
1th  inst. 

Dr.  Gray  does  not  disprove  any  of  my  charges. 
He  does  not  tell  us  why  it  is  that  in  his  essay,  which 
lie  says  in  his  reply  contains  "a  long  review  of  the 
literatui'e  of  the  subject,"  he  made  no  reference  to 
my  papers.  He  makes  isolated  and  disjointed  quo- 
tations from  the  most  unimportant  parts  of  my  con- 
tributions, and  misrepresents  me  by  saying  that  I 
have  "  distinctly  stated  "  that  which  I  never  stated. 
Those  who  have  read  Dr.  Gray's  essay  and  my  papers 
will  plainly  see  wherein  he  has  followed  me.  Those 
who  have  not  done  so  would  scarcely  be  entertained 
by  a  long  series  of  quotations  from  the  subject  mat- 
ter of  our  i^apers.  It  would  be  a  very  easy  matter, 
however,  to  establish  the  identity  of  ideas  by  direct 
quotations. 

I  will  briefly  notice  some  questions  raised  by  Dr. 
Gray  in  his  reply. 

In  the  closing  paragraph  of  his  letter,  Dr.  Gray 
ignores  the  fact  that  my  connection  with  the  edito- 
rial staff  of  the  Ajinals  gave  me  the  pri\llege  of 
knowing  whether  the  unpublished  i^ortion  of  his 
essay  contained  any  reference  to  my  papers.  Ivnow- 
ing  that  it  did  not,  and  as  my  comiDlaint  was  ad- 
dressed to  the  readers  of  the  Eecord,  who  had  nearly 
two  months  jireviously  seen  its  extensive  report  of 
Dr.  Gray's  remarks,  I  felt  that  if  I  was  going  to  ad- 
dress the  readers  of  the  Eecord  at  all  I  ought  not 
to  delay.  Dr.  Gray's  reply  plainly  indicates  that 
my  action  was  in  no  way  jJremature. 

I  regret  very  much  that  Dr.  Gray  should  have  re- 
sorted to  actual  misrepresentation  in  his  reply.  He 
says  that  I  have  "  distinctly  stated  that  this  cause" 
(of  reflex  paralysis)  "is  always  a  lateral  sclerosis  with 
ataxia."  I  made  use  of  no  such  exjjression,  and  the 
word  "ataxia"  is  not  to  be  found  in  my  i^ajjers. 

What  I  did  say  in  my  first  paper  was  this  (page 
21G) :  "Among  the  many  cases  of  so-called  reflex 
paralysis  that  I  have  seen  I  have  found  none  that 
did  not  prove  to  be  a  lateral  sclerosis  of  the  cord, 
with  a  greater  or  less  modification  of  co-ordinatoi-y 
power.  In  some  in.stances  the  lack  of  co-ordination 
would  be  so  slight  that,  under  erdinai-y  circumstan- 
ces, no  deviation  from  the  normal  would  be  noticed. 
Some  movements  would  be  awkwardly  executed,  es- 
pecially those  developed  by  running  or  jumping,  or 

•Vide  Medical  Record.  Novemher  in.  llssl.  and  The  .\nnal3  of 
.^li.itomy  and  Surgery,  J.^nuaiy  and  February.  ISS'i. 

+  Indiscriminate  Circumcision  (editnrifil).  Anna].'?  of  Anatomy  and 
Surgery.  May.  ISSl :  and  Genital  Irritation  (editorial),  Aiinals  of 
Anatomy  and  Surgery,  July,  1881. 


194 


THE   MEDICAL  RECORD. 


tbere  would  be  a  slig?d  akucic  movement  of  one  or 
both  the  lower  extremities  in  the  ordinary  move- 
ments." I  have  italicised  "  paralysis  "  and  "  a  slight 
ataxic  movement"  for  obvious  reasons. 

I  am  at  loss  to  know  how  Dr.  Gray  could  refer  to 
the  paragraph  containing  the  phrase  "  a  slight  ataxic 
movement"  as  an  "  original  desci^ption  of  a  lateral 
sclerosis  with  ataxia." 

In  the  minds  of  some  the  woi-d  "  ataxia  "  has  a 
restricted  meaning,  and  is  associated  with  "  loco- 
motor ataxia."  By  transforming  the  word  "ataxic" 
into  "ataxia,"  Dr.  Gray  would  attempt  to  bring  ridi- 
cule upon  my  papers,  which  he  has  been  willing  to 
follow  quite  closely  without  giving  that  credit  which 
the  courtesy  of  the  profession  demands. 

From  the  earliest  writers  to  the  present  time,  the 
adjective  "ataxic"  has  been  used  in  its  etymological 
sense.  The  unauthorized  appropriation  and  re- 
stricted application  of  it  by  some  neurologists  have 
resulted  in  confusion,  of  which  Dr.  Gray  is  willing 
to  avail  himself;  But  this  does  not  excuse  the  Tin- 
waiTantable  substitution  of  the  noun  "  ataxia,"  which 
I  do  not  use.  for  the  adjective  "ataxic." 

The  latest  authoritative  dictionary — that  now 
being  issued  by  the  New  Sydenham  Society — thus 
defines  "ataxic":  "Of  or  belonging  to  ataxy,  as 
occurring  in  the  progress  of  diseases  or  the  natirral 
animal  functions;  irregular."  "  Ataxy  "  is  defined  : 
"  Irregularity  ;  want  of  oi-der."  Ataxic  aphasia, 
ataxic  fever,  ataxy  hysterical,  ataxy  locomotor,  etc., 
are  then  separately  defined.  And  the  definition  of 
"  ataxia  "  is  thus  stated  :  "  A  term  for  irregularity, 
want  of  order,  especially  of  the  pulse."  All  the 
standard  French  and  English  dictionaries  that  I 
have  consulted  give  very  much  the  same  definitions 
as  the  New  Sydenham.  Bartholow,  Roberts,  Aitken, 
Trousseau,  and  many  other  authoritative  writers  on 
general  medicine,  also  use  "  ataxic  "  in  its  general 
sense. 

It  may  be  unnecessary  for  me  to  state  that  in  using 
the  ijhrase,  "  a  slight  ataxic  movement,"  I  used  the 
word  "  ataxic  "  in  its  pi-oper  sense. 

Referring  again  to  Dr.  Gray's  statement  that  I 
have  "  distinctly  stated  that  the  cause  is  always  a 
lateral  sclerosis  with  ataxia,"  I  beg  to  call  his  atten- 
tion to  the  fact  that  in  my  first  paper  I  made  a  suffi- 
cient distinction  between  reflex  paralysis  and  reflex 
si/mploms  not  paretic.  In  my  second  article  (-p.  48), 
after  describing  a  case  of  post  diphtheritic  paralysis, 
"cured"  by  circumcision,  I  say:  ".\nd  so  it  has 
proved  in  every  case  of  '  reflex  paralysis  '  \re  have 
seen.  A  careful  inquiry  into  the  details  of  the  pre- 
vious histoi'v,  a  painstaking  study  of  tlie  symptoms 
and  condition,  develops  a  cause  for  the  '  reflex  par- 
alysis'  wholly  unconnected  with  the  undeveloped 
genital  organs  of  childhood." 

Dr.  Gray  formulates  the  following  conclusions  at 
the  end  of  liis  es.say  proper  (page  85) : 

"  First. — There  is  no  proof  that  genital  irritation 
can  produce  a  reflex  paralysis." 

There  is  not  a  page  in  my  editorials  in  the  Annals 
from  whicli  I  conhl  not  quote  to  demonstrate  that 
l)oth  my  ])aper8  were  written  for  tlie  i)urpose  of  es- 
tablishing this  conchision — which  is,  in  reality,  the 
only  important  one,  all  the  otlu.rs  being  more  or  less 
corollaries.  I  know  of  no  otlier  writer  who  antici- 
pated me  in  my  remarks  bearing  on  this  point.  Nor 
does  Dr.  Gray,  in  his  reply, -attempt  to  prove  that 
my  contributions  upon  this  essential  point  were  not 
original. 

Dr.  Gray's  remaining  conclusions  are  as  follows  :' 

"Second. — That  while  it  is  probable  that'^slight 


nervous  disorders,  as  incontinence,  retention,  diffi- 
cult micturition,  erratic  movements  and  slight  ner- 
vous disturbances  can  be  produced  by  genital  imta- 
tion,  the  proof  is  not  yet  comjjlete. 

"  Third. — That  operations  for  the  removal  of  gen- 
ital irritation  may  be  beneficial  even  in  organic 
nervous  disease. 

"  Fourth. — That  we-^should  therefore  i-emove  such 
genital  irritation  if  it  exist  in  any  case  whatever, 
and  thus  give  our  patients  the  benefit  of  the  doubt. 

"  Fifth. — That  in  all  cases  with  accompanying 
genital  ii-ritation  we  should  not  regard  the  latter  as 
the  cause  of  tlie  former  until  all  probable  and  even 
possible  caTises  have  been  rigidly  excluded. 

"  Si.rth. — That  operations  upon  the  genitals,  even 
where  there  be  no  genital  irritation,  may  prove  to 
be  a  useful  therapeutic  measure  in  certain  cases." 

I  made  no  claim  to  have  "covered"  all  of  Dr. 
Gray's  conclusions.  I  said  "the  most  important." 
I  make  no  comments  whatever  upon  these  conclu- 
sions (except  the  first;.  Those  who  have  read  my 
papers  will  see,  however,  that  they  are  tlie  legiti- 
mate outcome  of  my  original  position  that  there 
was  no  such  condition  as  i-efle.r  parali/sis  from  geni- 
tal irritation,  and  it  can  easily  be  demonstrated  that 
the  most  important  of  these  conclusions  were 
"  covered  "  by  my  editorials. 

These  six  conclusions  that  I  have  thus  quoted  are 
those  stated  by  Dr.  Gray  in  the  Annals.  In  his  re- 
ply to  my  letter  in  The  KEconD  of  February  4th,  he 
omits  the  First,  the  Second,  and  the  Fifth,  and  states, 
without  their  accompanying  numliers,  the  Third, 
the  Foitrth,  and  the  Si.cih,  thus  conveving  the  im- 
pression that  these  were  all  of  his  conclusions.  Why 
does  he  omit  the  Fir.ft,  the  Second,  and  the  Fifth? 
I  think  no  one  will  deny  that  they  are  "  the  most 
important."  Was  it  not  that  these.  "  the  most  impor- 
tant conclusions  reached  by  Dr.  Gray,"  had  been  so 
evidently  "  covered  "  by  the  .articles  he  had  so  com- 
pletely ignored,  that  he  would  have  convicted  him- 
self had  he  reproduced  them  in  his  defence  ? 
Very  truly  yours, 

Newton  M.  Shaffek. 


RELAXATION  OF  DORSAL  MUSCLES, 
AGGRAVATED  DOUBLE  HERNIA, 
CHRONIC  CYSTITIS,  AND  CONVUL- 
SIONS DUE  TO  A  CONTRACTED  PRE- 
PUCE. 

To  THE  Editor  of  The  Medical  Record. 

Sir  :  Dr.  Chas.  A.  Hart's  cases  of  uricmic  poison  in  an 
infant,  and  death  from  convulsions — reported  Janu- 
ary 21st  in  the  Medic.^i,  Record — prompts  me  to 
give  the  following  cases  that  have  recently  come  un- 
der my  own  observation,  and  to  em]ihasize  more  em- 
phatically liis  statement  that  abnormalities  of  the 
prepuce  are  a  frequent  cause  of  obscure  nervous 
troubles  in  children.  Tlie  able  paper  written  by 
Dr.  Lewis  Sayre  years  ago  juit  me  on  the  trail.  And 
I  have  often  verified  his  statements,  and  promj^tly 
given  relief  by  circumcision  to  children  who  had 
been  dosed  in  vain  with  spirits  of  nitre  for  retention 
of  urine,  as  well  as  by  other  expedients  equally  as 
unwise  and  as  unreasonable.  These  may  be  trite 
statements  to  the  veterans,  but  they  are  facts  to  be 
remembered  by  new  recruits,  even  as  the  command- 
ments of  lyioses  (who  early  recognized  the  impor- 


THE  MEDICAL  RECORD. 


195 


tance  of  circumcision)  must  be  repeated  again  and 
again  to  those  who  would  be  versed  in  all  the  law, 
and  know  their  whole  diity.  The  first  patient  was 
the  son  of  a  lawyer,  aged  two  and  one-half  rears, 
with  relaxation  of  the  dorsal  muscles,  presenting  an 
anterior  curvature  of  the  spine,  and  with  a  hernia  on 
each  side  that  were  with  difficultv  retained  by  a 
truss,  and  were  made  worse  by  the  frequent  bearing- 
domi  or  straining  efforts  to  urinate,  owing  to  the 
mechanical  obstruction  produced  by  an  elongated 
and  contracted  prepuce.  For  months  he  had  chronic 
cystitis,  and  suffered  much.  A  simple  operation, 
with  the  removal  of  considerable  smegma,  has  cor- 
rected most  of  the  troubles  above  referred  to. 

The  other  case  was  of  the  .same  age.  I  recognized 
the  condition  some  time  ago  by  his  frequent  calls, 
and  some  neiwons  symptoms  threatening  i:horeii,  all 
attriljutable  to  the  retlex  irritation  of  a  constricted 
prepuce  that  could  not  be  retracted.  My  neglect  was 
sharply  reproved  by  his  having  retention  and  a  pre- 
putial inflammation  producing  sjjasms.  The  next 
day  Drs.  Forman  and  Green  excised  the  prepuce  at 
my  request,  and  the  conversion  of  a  pin-hole  aper- 
ture into  an  uncovered  gland  gave  him  that  prompt 
relief  he  would  have  had  long  ago  if  he  had  not  been 
mv  own  child. 

S.  H.  HuxT,  M.D. 

Long  Branch,  X.  J..  J.immrv  ol.  18S5. 


ARMY  NEWS. 


Official  List  of  Changes  of  Stations  and  Duties  of  Offi- 
cers of  the  Medical  Department,  United  States  Army, 
from  February  5,  1882,  to  February  11,  1882. 

WooDHULi;,  A.  A.,  Major  and  Surgeon.  The  leave 
of  absence  granted  him  in  S.  O.  227,  and  A.  G.  O. , 
1881,  is  extended  one  rnpnth  and  ten  davs.  S.  O. 
27,  A.  G.  O.,  February  3,  1882. 

Tbemaine,  W.  S.,  Capt.  and  Asst.  Surgeon,  who 
reported  at  these  headquarters  Januai'y  9, 1882,  per 
par.  12,  S.  O.  C.  S.,  A.  G.  O.,  will  await  further  or- 
ders in  New  York  City  from  date  of  his  so  reporting. 
S.  O.  20,  Department  of  the  East,  February  7, 1882. 

GoMEGTS,  E.  T.,  Capt.  and  Asst.  Surgeon.  To  be 
relieved  from  temporary  duty  at  Columbus  Barracks, 
Ohio,  on  receipt  of  order,  and  to  report  in  person  to 
Commanding  General,  Department  of  the  Missoiu'i, 
for  assignment  to  duty.  S.  O.  82,  A.  G.  O.,  Febru- 
ary 9,  1882. 

Wood,  M.  W.,  Capt.  and  Asst.  Surgeon.  The 
seven  days  leave  granted  him  on  4th  instant,  by  Post 
Commander,  Fort  Brady,  Mich.,  is  extended  twenty- 
three  days.  S.  O.  19,  Department  of  the  East,  Feb- 
ruary 6,  1882. 


How  We  Sometimes  Get  Paid  for  Our  SEK'^^CES. 
— Enter  your  grocer's  on  some  balmy  morning,  when 
all  nature  seems  responsive  to  the  joyous  heart  of 
man,  and  say  to  him:  "  My  dear  sir,  I  feel  deeply 
gi'ateful  for  your  kindness  during  the  past  month. 
All  the  vegetables  with  which  you  have  favored  me 
have  been  of  the  choicest  quality,  and  duly  appre- 
ciated. Although  I  cannot  repay  you  in  ready 
money,  yet  I  shall  always  remember  you  with  the 
deepest  gratitude."  What  would  be  that  grocer's 
reply  ?  Yet  this  is  the  coin  which  many,  who  can 
afford  to  do  better,  expect  the  physician  not  only  to 
receive  as  legal  tender,  but  even  with  a  thankful 
heart. 


iJlctrical  3tcm0   antJ  Kcws. 


Contagious  Diseases  —  Weekly  Statement.  — 
Comparative  statement  of  cases  of  contagious  diseases 
reported  to  the  Sanitaiy  Bureau,  Health  Department, 
for  the  two  weeks  ending  February  11,  1882. 


Week  Euding 

si 

1 

Is 

> 

1. 

1 

1 

1 

S. 

i 

1 

r- 

li' 

9, 

sa 

% 

^ 

^ 

0 

6 

32.5 

o 
4 

21.5 

121 

m 
3G 

Feb.     4,  1883. 

0 

Feb.  11,  1882. 

9 

9 

305 

5 

198 

116 

49 

0 

The  St.  Joseph  College  of  Physicians  akd  SrR- 
GEONS. — We  copied  recently  a  'widely  circulated 
item,  to  the  efi'ect  that  the  Illinois  State  Board  of 
Health  had  refused  to  acknowledge  dii^lcmas  from 
the  College  of  Physicians  and  Surgeons  of  St.  Josejih, 
Mo.  We  are  informed  that,  instead  of  St.  Joseph, 
it  is  the  College  of  Physicians  and  Surgeons  of  Joss- 
lyn,  Mo.,  which  is  not  recognized. 

.\xoTHER  Elephaxt  Born  IN  C.ArirviTT.  —  The 
second  baby- elephant  ever  born  in  this  country  was 
dropi^ed  at  Stamford,  Conn.,  by  one  of  Barnum's 
elephants,  last  week.  The  animal  was  thirty  inches 
high  and  weighed  one  hundred  and  forty- five 
pounds.  The  trunk  was  only  seven  and  one-half 
inches  long. 

A  Saxitaet  Convention,  under  the  ausj^ices  of 
the  State  Board  of  Health,  will  be  held  on  February 
isch  and  March  1st.  at  Ann  Harbor,  Mich.  Manu- 
facturers of,  and  dealers  in,  all  kinds  of  sanitary  aj]- 
paratus  or  appliances  are  invited  to  send  specimens 
of  their  articles  for  exhibition  at  the  convention, 
and  certificates  of  merit  will  be  awarded  to  such  ar- 
ticles as  are  deemed  worthy. 

Congressman  Smith  has  introduced  a  bill  provid- 
ing that  the  National  Board  of  Health  .shall  furnish 
vaccine  virus  free  of  charge.  The  object  of  the  bill 
is  to  prevent  a  "  corner  "  in  vaccine  virus. — Cliictujo 
Medical  Rerieu: 

Women  Medical  Stitjents. — It  is  reported  that 
lady  medical  students  in  Paris,  France,  are  to  be  al- 
lowed to  compete  for  house  surgeonships,  a  privi- 
lege hitherto  denied  them. 

Caring  for  Contagious  Diseases  in  Brooklyn. 
— "To-day  a  stranger,  if  taken  with  a  contagious  dis- 
ease, must  die  on  the  street  or  break  the  laic:  it  is  un- 
lawful for  him  to  take  a  public  conveyance,  and 
every  hospital  in  the  city  is  obliged  by  law  to  close 
its  doors  against  him."  So  says  7'he  Pathologist  for 
January.  Is  it  not  about  time  that  this  state  of 
things  should  come  to  an  end '?  It  tlie  jmblic  au- 
thorities continue  to  neglect  the  crying  need  that 
exists  for  an  infectious  disease  hospital,  will  not 
some  liberal-minded  private  citizen  of  wealth  take 
it  to  heart  and  win  for  himself  an  undying  name  in 
this  community?  To-day,  I  may  be  a  gentleman, 
and  to-morrow  a  pariah,  if  I  shall  have  been  taken 
with  a  fever,  in  the  eye  of  the  law  and  the  charities. 
— Proceedings  of  Medical  Society  cf  Kings  County. 

Meeting  op  the  New  Y'ork  MEDico-LECiAL  So- 
ciety.—The  regular  monthly  meeting  was  held 
February  1,  1882.     The  first  business  of  the  society 


196 


THE   MEDICAL  EECORD. 


was  a  report  of  a  committee  appointed  to  consider  a 
protest,  filed  at  the  previous  meeting,  against  the 
validity  of  the  election  of  the  President,  Clark  Bell, 
Esq.,  and  of  two  trustees.  This  committee  re- 
ported that  the  election  was  a  valid  one.  A  series 
of  "  whereases"  ending  in  resolutions  declaring  the 
election  void  was  then  read  by  JSIr.  M.  F.  EUer. 
These  resolutions  were  tabled  and  the  original  re- 
port of  the  committee  accepted.  The  addresses  of 
the  retiring  President,  Dr.  C.  S.  Wood,  and  of  the 
President-elect,  occupied  the  rest  of  the  session. 
Mr.  Bell,  in  the  course  of  his  address,  proposed 
among  other  things  that  each  member  should  give 
one  bound  volume  annually,  or  its  equivalent,  to  the 
library ;  that  an  appeal,  on  behalf  of  the  library, 
should  be  issued  to  members  of  the  Bar  and  physi- 
cians generally,  and  that  the  aid  of  the  press  be  in- 
voked to  give  publicity  to  the  memorial.  He  also 
recommended  that  the  publication  of  the  Bulletin 
be  discontinued,  and  to  issue  the  papers  read  before 
the  society  in  a  New  York  medical  journal.  Mr. 
Bell  discussed  the  modifications  of  the  law  of  coro- 
ners, advocated  by  the  society's  committee  on  that 
subject,  and  referred  to  the  Guiteau  trial  as  an  illus- 
tration of  the  extreme  necessity,  not  only  that  ex- 
pert testimony  should  be  more  carefully  managed, 
but  also  that  a  closer  preliminary  inquiiy  should  be 
made  after  a  crime  has  been  committed.  A  thorough 
medical  inquisition  as  to  Guiteau's  sanity  instituted 
immediately  after  the  shooting  of  President  Gar- 
field would,  in  his  opinion,  have  averted  the  specta- 
cle that  the  trial  has  in  some  respects  presented. 

MURDEK   OF   AN    AsTLPM   SurEBISTENDENT. — Dr.  E. 

A.  Adams,  Assistant  Medical  Sujicrintendent  of  the 
Michigan  Asylum  for  the  Insane,  at  Kalamazoo,  was 
fatally  stabbed  by  a  patient  in  one  of  the  wards 
while  making  his  daily  rounds,  January  6th.  The 
patient  was  hitherto  supposed  to  be  hai-mless.  The 
stabbing  was  done  with  a  large  pocket-knife  which 
•was  recently  lost  by  one  of  the  attendants. 

Paim  and  Nausea  Pkoduced  bi  a  Wish-bone. — 
Dr.  H.  D.  Ingraham,  of  Buffalo,  sends  the  follow- 
ing :  "  Mrs.  L ,  healthy,  began  to  have  pain  in  the 

bowels  about  4  p.m.  It  increased  in  intensity,  was 
sharp  and  piercing,  and  accompanied  with  slight 
nausea  when  she  retired  at  about  10  p.m.  The  pain 
continued  through  the  night,  prevent<>d  the  jiatient 
from  sleeping,  finally  became  located  in  the  rectum, 
and  made  her  think  tliat  she  was  suffering  from 
hemorrhoids,  although  she  had  never  been  afflicted 
with  that  disease.  The  nausea  continued,  but  did 
not  increase  in  severity.  About  seven  o'clock  the 
next  morning  she  discovered,  while  ajiplying  vase- 
line to  the  anus,  that  something  unnatural  protruded, 
and,  on  removing  it.  found  that  it  was  the  wish-bone 
(furcula)  of  a  small  fowl.  Immediately  upon  its 
removal  the  pain  and  nausea  subsided.  The  patient 
then  remembered  that  while  at  a  party  in  the  even- 
ing before,  she  first  felt  the  pain.  She  ate,  among 
other  things,  quail.  She  had  no  recollection,  how- 
ever, of  any  unusual  sensation  while  swallowing,  or 
otlier  symptoms  which  would  indicate  tliat  she  had 
taken  a  bone  of  that  size  into  her  stomach  ;  yet  it 
seemed  altogether  probable  that  it  was  swallowed  at 
that  time." 

lowA  State  Medicai,  Society'. — The  Thirteenth 
Annual  SMsion  of  the  Iowa  State  Medical  Associa- 
tion convened  in  Des  Moines,  Iowa,  .lanuary  '25th 
and  20th,  tlio  President,  Dr.  T.  J.  Caldwell,  in  the 
chair.     Some  nine  or  ten  papers  were  read  in  fuU, 


and  a  number  more  by  title.  Forty-one  new  mem- 
bers were  admitted,  making  the  total  number  in  the 
aseociation  over  four  hundred.  The  meeting  this 
year  was  markedly  better  in  every  way  than  that  of 
a  year  ago. 

M.  Charcot  has  been  appointed  to  the  newly 
created  chair  of  Clinical  Professor  of  Diseases  of  the 
Nervous  System  in  the  Faculty  of  Medicine,  Paris. 

A  New  Hospital  Do'n'N-TovrN. — The  ti-ustees  of 
the  New  York  Hospital  propose  to  erect  a  new  hos- 
pital down-town  in  idace  of  the  present  one  in 
Chambers  Street.  This  latter  is  insufficient  for  the 
demands  now  jnit  upon  it. 

Dr.  G.  E.  Metcalf,  of  Syracuse,  N.  1'.,  has  re- 
signed the  chair  of  Materia  Medica,  Therapeutics, 
and  Clinical  Medicine  at  the  College  of  ^Medicine, 
Syracuse  University,  and  has  removed  to  New  Y'ork 
to  assume  the  sanitary  director.ship  of  the  Hudson 
tunnel,  now  in  process  of  construction  between  New 
Y'ork  and  Jersey  City. 

Where  ls  There  an  Epidemic  op  Diphtheria  ? — 
Drs.  H.  C.  Wood  and  Formad  desire  to  know  of  the 
existence  of  an  epidemic  of  malignant  diphtheria,  in 
order  that  they  may  continue  their  research  upon  the 
nature  of  the  diphtheritic  poison.  Dr.  Formad  will 
go  to  any  locality  within  eight  hundred  miles  of 
Philadelphia.  Letters  may  be  directed  to  the  Uni- 
versity of  Pennsylvania. 

The  Medical  Annals,  of  Albany,  with  its  usual 
enterprise,  issued  daily  editions  of  the  proceedings 
of  the  late  meeting  of  the  Medical  Society  of  the 
State  of  New  Y'ork. 

Death  of  Dr.  Theodore  L.  Mason.- — Dr.  Theo- 
dore Lewis  Mason  died  at  his  residence,  in  Brook- 
lyn, of  pneumonia,  last  week.  Dr.  Mason  was  bom 
in  1803.  He  giaduated  in  medicine  at  the  College 
of  Physicians  and  Surgeons,  of  this  city,  in  1825. 
He  was  prominent  in  the  erection  of  the  Brook- 
lyn Hosjjital,  and  of  the  Long  Island  College.  He 
had,  however,  shown  especial  interest  in  the  subject 
of  inebriety  as  a  disease,  and  was  President  of  the 
Inebriate  Home  of  Kings  County,  and  later  was 
President  of  the  American  Association  for  the  Cure  of 
Inebriates.  He  was  a  resident  Fellow  of  the  New 
Y'ork  Academy  of  j\Iedicine,  a  member  of  the  Medi- 
cal Society  of  the  County  of  Kings,  and  was  jiresi- 
dent  in  1812  and  18-13.  He  was  a  permanent  mem- 
ber of  the  American  Medical  Association  and  of  the 
Medical  Society  of  the  State  of  New  Y'ork.  He  was 
one  of  the  founders,  life  member,  and  director  of 
the  Long  Island  Historical  Society,  a  member  of 
the  American  Colonization  Society,  and  its  vice 
president  in  1871. 

Suu'LE  Continued  Fe\t3R. — IJ.  Acid,  hydrobrom., 
3  j. ;  Syr.  simplicis,  3  ij. ;  Aq.  ad.  3  j.  M.  Sig. — 
Every  hour. — Fothergitt. 

Dr.  Fothergill,  in  speaking  of  the  above  formula, 
says  it  will  probably  constitute  par  excfllmicc  the 
fever  mixture  of  the  future.  It  is  especially  indi- 
cated where  there  is  cerebral  disturbance. 

CvsTiTis. — -B.  Acidi  benzoiei,  Sodii  biboratis,  iT.5 
gr.  X. ;  Inf.  buchu,  3  ij.  This  amount  three  or  four 
times  a  day. — A.  J.  ('.  Skene.,  M.D. 

This  may  almost  be  called  specific  in  its  influence 
in  the  earlier  stages  of  cystitis,  aftbrding  rapid  mid 
lasting  relief.  The  diet  should  be  carefully  regu- 
lated, and  the  skin  and  bowels  kept  in  active  con- 
dition. 


Vol.   XXI.-No.  8. 
Feb.  25,  1882. 


THE  MEDICAL  KECORD. 


197 


(DriiVmal  lectures. 


ACUTE   CmCUMSCREBED  INFLA:\BL4.TI0N 
OF     THE     jMEATUS    AUDITORIUS     EX- 

TERNUS. 

A  Lectuee  delivered  at  the  Manhatt.4N  Eye  .\xd 
Ear  Hospital,  New  York. 

Bs    OEEN   D.  POMEROY,  M.D. 


■  (Phono^aphically  reporteil  for  the  Recorb.  ) 

Gentlemes  :  Circumscribed  acute  inflammation  of 
the  external  meatus,  as  the  name  imijlie.s,  is  an 
acute  inflammation  resembling  in  most  of  its  charac- 
teristics the  ordinary  furuncle,  or  boil.  The  locality 
of  this  is  usually  in  the  outer  portion  of  the  meatus. 
Authorities  difl'er  widely  as  to  whether  it  is  located 
in  the  anterior,  ipsterior,  inferior,  or  superior  por- 
tion. The  truth  seems  to  be  that  the  furuncles  are 
scattered  about  promiscuously  in  the  outer  portion  of 
the  meatus.  They  seem  to  occupy  the  site  of  a  hair- 
follicle  or  sebaceous  gland.  They  may  be  quite 
superficial,  being  simply  subcutaneous.  In  that 
case  they  are  not  nearly  as  jjainful  or  serious  in  their 
nature  as  the  other  varieties.  Again,  we  have  them 
in  the  subcutaneous  connective  tissue.  In  that  case 
the  condition  is  one  of  simple  cellulitis ;  but  the 
most  serious  of  all  are  located  beneath  the  perios- 
teum, if  situated  far  enough  in  to  be  opposite  the 
osseous  portion  of  the  meatus  ;  if  a  little  farther 
out,  they  will  be  beneath  the  perichondrium.  In 
that  case  they  are  not  so  amenable  to  treatment, 
and  are  exquisitely  painful.  This  variety,  however, 
is  extremeh"  rare. 

The  symptoms  are  as  follows  :  the  meatus  appears 
completely  closed,  so  it  is  with  difficulty  you  detect 
anything  but  the  closure  of  the  meatus,  accom- 
panied, of  course,  by  more  or  less  pain.  But,  in 
the  majority  of  instances,  if  you  examine  carefully, 
you  will  iind  that  there  is  a  little  tumor  or  nodular 
swelling,  one  or  more,  located  somewhere  in  the 
outer  portion  of  the  canal.  If  you  touch  these 
swellings  with  a  probe,  you  will  elicit  a  great  deal 
of  tenderness  and  pain,  thus  localizing  the  seat  and 
nature  of  the  affection  with  great  exactness.  If  the 
attack  is  severe,  we  have  systemic  disturbances,  and 
tliere  will  be  considerable  fever.  The  whole  side  of 
the  head  may  be  painful.  Dragging  upon  the  auri- 
cle will  elicit  pain.  If  the  patient  performs  the  act 
of  deglutition,  there  will  be  pain.  If  the  canal  is 
swollen  so  as  to  be  closed,  there  will  be  deafness 
from  mechanical  obstruction  ;  otherwise,  little  deaf- 
ness accompanies  this  affection.  Unless  of  the  se- 
verer varieties,  after  one,  two,  or  three  days  the 
furuncle  will  burst.  The  rule  is  that  the  rupture  is 
an  extremely  small  one  and  the  discharge  of  pus 
moderate  in  quantity,  and,  as  to  consistency,  quite 
thick. 

In  reading  the  test-books,  you  will  find  a  great 
deal  about  the  core  of  the  boil.  You  know  this  is 
nothing  more  than  a  mass  of  connective  tissue  which 
has  been  separated  by  the  destructive  process  from 
its  suiToundings,  and  is  in  a  more  or  less  decom- 
posed state.  I  rarely  have  seen  anything  in  the 
auditory  canal  corresponding  to  this  description 
My  experience  is  that  the  furuncle  contains  thick 
pus,  sometimes  almost  of  a  che^sy-like  consistency, 
considerably  thicker  than  cream.  As  I  have  said,  in 
spontaneous  rupture  the  opening  will  be  extremely 


small,  and  it  will  be  necessary  to  squeeze  out  the 
contents  of  the  boil  to  get  relief;  this  will  need  to 
be  done  frequently.  Again,  if  this  condition  of 
things  goes  on,  and  the  case  is  neglected,  the  in- 
flammation may  extend  to  the  whole  of  the  canal, 
producing  a  difl'use  inflammation.  The  site  of  the 
rupture  may  be  tilled  witli  granulations,  which  may 
reach  the  size  of  a  true  polypus  after  a  time.  If  the 
boil  is  located  deep  in  the  canal,  we  are  very  likely 
to  have  inflammation  of  the  tympanic  cavity. 
Then,  very  naturally,  we  will  have  considerable  low- 
ering of  the  hearing,  and  some  change  in  the  quality 
of  the  inflammation.  The  discharge  that  comes 
from  the  boil  smears  the  part  and  acts  as  an  irritant. 
It  also  macerates  the  epidermis  of  the  lining  of  the 
canal,  and  soon,  if  the  jjatient  is  not  attended  to,  he 
will  have  true  otitis  externa  diflusa  ;  what  I  mean  is 
that  he  will  have  an  external  otorrhcea  coming  from 
the  walls  of  the  canal.  Tinnitus  aurium  sometimes 
accompanies  this  disease,  although,  as  a  rule,  it  is 
absent. 

Tlte  dirigno.tis  of  this  affection  will  sometimes  give 
us  a  little  trouble.  In  a  decided  case  of  acute  in- 
flammation of  the  tympanum,  the  canal  of  the  ear 
will  be  swollen,  so  that  it  is  impossible  by  insijec- 
tion  to  make  out  anything  very  exact,  and  in  those 
cases  it  will  sometimes  give  you  much  trouble  to 
diS'erentiate  between  the  furuncular  disease  and  the 
tympanic.  If  you  cleanse  carefully  with  a  bit  of 
cotton  on  a  probe,  and  then  touch  tlie  canal  along  its 
whole  course  and  do  not  elicit  tenderness,  and  in  a 
given  case  you  do  have  a  good  deal  of  deafness  and 
tinnitus  aurium,  you  are  quite  sure  you  are  dealing 
with  a  case  of  tympanic  disease,  and  not  furuncular. 
On  the  other  hand,  if,  after  you  have  cleansed  the 
canal,  the  hearing  is  materially  improved,  and  by 
feeling  here  and  there  with  the  probe  you  detect 
spots  of  exquisite  sensibility,  you  are  quite  sure  you 
have  a  case  of  furuncular  trouble.  More  than  that, 
the  suspected  swelling  in  furuncular  disease  natu- 
rally will  be  of  a  red  color,  though  it  may  not  always 
be  so.  The  apex  of  the  furuncle  may  be  a  little 
softened,  and  possibly  a  trifling  discharge  may  have 
taken  place  upon  the  surface,  so  as  to  prevent  the 
red  color  from  displaying  itself.  But,  if  you  touch 
the  canal  with  the  jjrobe  at  various  parts  and  find 
soft  spots,  the  diagnosis  of  pus  is  almost  certain. 
If  you  take  two  probes  and  imitate  with  them  the 
movements  of  two  fingers  in  detecting  fluctuation 
elsewhere,  you  may  be  able  to  detect  it  here.  Some- 
times we  have  an  ostotic  tumor  of  the  meatus.  It 
may  sometimes  be  red  and  tender,  but  if  you  touch 
it  with  a  probe  you  will  find  it  of  bony  hardness.  I 
remember  some  time  since  seeing  a  case  where  there 
was  a  dispute  as  to  whether  a  given  .swelling,  which 
gave  rise  to  considerable  pain,  was  furuncular  or 
not.  My  opinion  was  asked.  I  confess  I  was  some- 
what troubled  in  arriving  at  a  definite  conclusion. 
The  swelling  was  circumscribed  and  tender,  and  it 
seemed  to  be  a  furuncle;  but  when  I  touched  it  with 
a  probe,  it  was  found  ab.'Jolutely  solid.  There  being 
doubt  thrown  on  the  diagnosis,  the  tumor  was  punc- 
tured, when  there  was  no  uncertainty  about  the 
nature  of  the  swelling.  Again,  if  you  are  dealing 
with  an  exostosis,  you  are  likely  to  frequently  find  it 
in  both  ears. 

T/ie  cause  of furimcular  diseaseissomevh&t  ohscMTe. 
There  are  hardly  two  authors  who  agree  as  to  what 
gives  rise  to  this  affection.  Certain  points,  how- 
ever, are  reasonably  well  fettled.  The  injudicious 
application  of  strong  solutions  of  nitrate  of  silver  to 
the  external  meatus  is  sometimes  sufficient  to  pro- 


198 


THE  MEDICAL  RECORD. 


duce  a  furuncle.  Mild  ear-washes  are  said  to  have 
produced  it,  but  I  am  doubtful  whether  this  is  possi- 
ble. The  general  effect  of  cold  upon  the  ear  may 
give  rise  to  furuncle.  Bnt  I  do  not  put  this  down 
as  amounting  to  very  much.  The  strumous  diathesis 
is  certainly  a  predisposing  cause  of  this  affection; 
Painful  dentition  in  children  is  sometimes  asserted 
to  be  a  cause.  Wounds  or  injuries  to  the  meatus 
externus  are  sufficient  to  produce  furuncle.  I  cer- 
tainly have  known  patients  to  cause  severe  local  in- 
flammation of  the  meatus  externus  by  attempting  to 
cleanse  their  own  ears,  by  using  a  stick  or  some  other 
instrument  with  or  without  cotton  wound  upon  it. 
It  is  astonishing  what  trifling  violence  the  meatus 
can  endure.  Another  cause,  which  I  believe  to  be 
more  important  than  most  of  those  already  enumer- 
ated, is  a  generally  depressed  condition  of  the  vital 
energies — the  same  cause  which  gives  rise  to  furun- 
cles elsewhere.  I  think  the  larger  number  of  furun- 
cles I  have  seen  and  treated  have  occurred  in  warm 
iveather.  At  this  season  of  the  year  we  have  de- 
pressing influences  brought  to  bear  upon  the  pa- 
tient ;  and  secondly,  I  have  thought  that  the  exces- 
sive perspiration  of  the  part,  possibly  being  suddenly 
checked,  may  give  rise  to  the  affection  by  obstruc- 
tion to  the  glands.  Again,  I  have  seen  so  large  a 
number  of  cases  at  a  given  time  of  the  year,  that  it 
seemed  to  me  almost  epidemic.  This  was  also  in 
summer. 

The  treatment  requires  as  much  nice  judgment 
and  skill  as  any  affection  of  the  ear.  The  treatment 
of  a  furuncle  before  pus  has  formed  is  sometimes  a 
little  discouraging,  and  is  quite  difficult  to  accomplish 
successfully.  We  do  not  succeed  with  our  remedies 
here  as  we  "do  with  acute  diseases  of  the  tympanum. 
A  leech  will  sometimes  do  considerable  good  ;  again, 
it  seems  to  do  little  or  nothing.  It  should  be  ap- 
plied at  the  border  of  the  external  meatus,  some- 
where within  the  cavity  of  the  concha,  and  not  on 
any  account  outside  of  the  auricle.  I  make  this 
point  positive,  for  so  many  aural  surgeons  scatter 
leeches  promiscuously  about  the  auricle  when  leech- 
ing the  eai\  If  applied  some  little  distance  from 
the  mesitus,  it  does  almost  no  good  whatever.  If 
there  are  no  indications  to  the  contrary,  the  leech 
should  be  applied  to  the  posterior  face  of  the  tragus  ; 
but,  if  you  And  swelling  on  the  back  side  of  the 
canal,  put  the  leech  on  as  near  to  the  swelling  as 
possible.     You  may  use  one,  two,  or  three  leeches. 

A  good  plan  is  to  follow  one  leech  up  with  another, 
if  sufficient  alleviation  of  pain  does  not  residt  from 
the  ttrst  or  second.  In  applying  a  leech,  do  it  with 
groat  carefulness.  If  you  hurt  the  patient  by  harsh 
manipulation,  you  will  set  his  car  throbbing  again, 
and  make  it  worse  than  before.  I  am  sometimes 
compelled,  in  sheer  desperation,  to  apply  leeches 
mvself,  for  the  reason  that  professional  leechers  in 
this  city  not  infrequently  inflict  so  much  violence  as 
to  make  patients  worse  ;  or,  in  applying  styptics  for 
the  arrest  of  the  hemorrhage  following  the  leech- 
bite,  they  will  make  too  much  pressure,  or  in  some 
way  liurt  the  patient,  so  as  to  more  than  counter- 
balance the  good  done  by  the  application  of  the 
leeches,  .\fter  leeching,  we  think  of  warm  appli- 
cations. They  may  be  moist  or  dry.  The  first  may 
be  applied  by  means  of  a  douche,  such  as  that  of 
Clark  or  Thudichum.  The  water  should  be  al- 
lowed to  run  gently,  not  violently,  upon  the  parts 
for  ten  or  fifteen  minutes  at  a  time.  It  should  not 
be  continueil  too  lou'^,  but,  as  soon  as  a  little  relief 
is  experienced,  stop  for  a  while.  We  will  avoid,  by 
all  means,  any  prolonged  soaking  or  macerating  of 


the  parts,  because  this  softens  the  epidermis,  and 
may  give  rise  to  an  otorrhoea.  Hot  poultices  of  flax- 
seed meal  may  be  used,  but  they  must  not  be  con- 
tinued long,  for  the  reason  just  given.  A  roasted 
onion,  with  the  heart  taken  out,  and  pushed  by  its 
pointed  extremity  gently  into  the  canal,  is  often  quite 
serviceable.  A  rubber  bag  filled  with  hot  water  is  a 
very  convenient  mode  of  applying  dry  warmth. 
Here  you  have  this  added  factor  :  your  capacity  for 
making  the  temperature  of  the  water  exactly  that  de- 
gree which  feels  most  comfortalde  to  the  patient, 
which  at  all  times  is  indicated.  This  is  an  extremely 
important  point,  for  if  it  is  too  hot  it  will  be  painful ; 
if  it  is  too  cold  it  will  also  be  painful.  There  is  a 
middle  point  which,  by  experience,  you  will  readily 
reach.  A  bag  containing  heated  salt  is  a  very  good 
method  of  applying  dry  warmth.  Painting  the  fu- 
runcle with  nitrate  of  silver,  if  of  the  subcutaneous  or 
superficial  variety,  will  sometimes  discuss  it ;  it  will 
frequently  relieve  pain  in  an  admirable  manner. 
The  solution  should  be  very  strong ;  it  may  be  satu- 
rated. You  should  be  extremely  careful  not  to 
apply  the  solution  on  adjacent  parts.  Tincture  of 
iodine  may  be  used  in  the  same  manner.  It  has  the 
disadvantage  of  being  sometimes  quite  i^ainful.  The 
objection  to  nitrate  of  silver  is  that  it  leaves  a  black 
incrustation,  which  will  act  as  an  irritating  foreign 
body.  Will  you  incise  these  furuncles  before  there 
is  any  evidence  of  the  formation  of  pus?  I  have 
done  it  many  times.  It  is  a  fearfully  painful  opera- 
tion to  incise  one  of  these  funmcles  before  any  mat- 
ter has  formed — much  more  so  than  afterward.  It  is 
true  that  you  will  cause  a  certain  amount  of  hemor- 
rhage, which  may  give  some  relief.  It  is,  frequently, 
also  true  that  you  add  to  the  patient's  sufferings  vei-y 
much,  the  throbbing  and  pain  of  the  part  after  in- 
cision being  much  worse  than  before.  Y'ou  know 
the  old  practice  of  incising  carbuncles  or  furuncles 
before  the  matter  is  formed,  and  which  sometimes 
aggravated  the  cases  very  much.  It  really  seems  to 
me  that  the  oijeration  is  at  least  heroic.  I  am  not 
in  favor  of  incising  furuncles  of  the  auditory  canal 
before  the  formation  of  \ms.  I  have  done  it  too 
many  times  to  be  in  favor  of  the  operation. 

At  this  juncture  you  may  be  under  the  necessity 
of  administering  a  sufficient  amount  of  moiqdiine  to 
relieve  the  pain.  I  do  not  like  to  do  this  unless 
other  measiires  have  failed,  although  opium  is  an 
antiphlogistic  to  these  acute  affections  of  the  ear. 
As  soon  as  you  have  determined  by  the  rules  already 
laid  down  that  there  is  pus.  even  though  it  be  not 
more  than  a  single  drop,  I  would  recommend  you  to 
incise  the  furuncle.  I  would  do  it  as  follows :  intro- 
duce a  sjieculum  and,  after  exposing  the  part  to  view 
with  a  forehead-mirror,  carefully  cleanse  the  part.  I 
would  feel  of  the  tumor  with  the  probe,  finding,  if 
possible,  the  soft  part  of  it ;  then  take  a  Graefe's 
cataract  knife  fwhich  you  know  is  one  of  the  most 
exquisite  of  all  knives),  poise  it  carefully  in  your 
hand,  and  penetrate  the  tumor  with  a  sudden  and 
delicate  thrust.  Y'ou  may  not  produce  an  opening 
a  line  in  diameter,  but  it  will  be  sufficient.  Do  not 
put  your  patient  against  a  solid  wall,  for  he  may 
jump  toward  the  instniment  and  do  himself  harm. 
Be  sure  and  grasp  the  knife  gently,  so  that  if  it 
meets  with  any  special  obstruction,  it  will  slip  in  the 
grasp  and  not  inflict  violence.  You  will  frequently 
find  that  no  pus  escapes  from  the  opening,  even 
when  it  is  pressed  upon.  When  this  is  the  case,  I 
take  a  small-sized  probe  and  thrust  it  gently  into 
the  opening  made  by  the  puncture,  and  move  it 
about  so  as  to  allow  the  pus  to  escape  more  readily. 


THE  MEDICAL  RECORD. 


199 


It  may  then  be  squeezed  out  by  pressing  upon  it  witli 
a  probe.  I  object  very  miich  to  large  incisions  here 
for  more  reasons  than  I  feel  like  giving  you  at  pres- 
ent. This  evacuating  of  the  pus  should  be  done  at 
first  twice  a  day,  if  necessary.  If  the  patient's  ear 
begins  to  throb  after  a  few  hours,  you  can  infer  that 
the  opening  has  closed  and  the  mattar  is  collecting 
and  causing  i)ressure,  which  gives  rise  to  the  pain. 
The  indications  will  be  then  to  introduce  a  small- 
sized  probe  into  the  opening  and  evacuate  the  mat- 
tsr  again.  This  sliould  be  done  as  frequently  as  it 
becomes  necessary.  The  relief  from  puncture  is  most 
signal  and  gratifying.  You  will  frequently,  after  the 
disease  has  been  relieved  by  this  method,  have  a 
discharge  from  the  ear,  which  may  proceed  from  the 
whole  of  the  canal.  The  epidermis  will  become  de- 
tached, and  the  drum-membrane  itself  may  have  a 
sodden  appearance.  The  discharge  may  last  for 
some  little  time.  Then  the  general  treatment  of 
otorrhosa  of  the  meatus  externus  may  be  practised. 
Astringent  wa.shes  may  be  used :  acetate  of  lead, 
two  to  live  grains  to  the  ounce  of  water,  poured  into 
the  ear  a  couple  of  times  a  day  after  syringing ;  the 
sulphate  of  zinc,  two  gi'ains  to  the  ounce,  used  in 
the  same  manner ;  even  nitrate  of  silver  in  weak 
solutions,  two  grains  to  the  ounce,  may  be  used,  al- 
though this  stains  the  part  unless  you  rinse  it  with 
salt  and  water  afterward  ;  but  this  renders  it  some- 
what objectionable. 

Better  than  that  mode,  however,  is,  after  syring- 
ing the  ear  carefully,  introduce  your  cotton  wound 
on  a  probe  and  wipe  off  eveiy  particle  of  discharge, 
which  is  often  thickened  and  adheres  to  the  canal. 
In  wiping  this  off,  you  will  also  remove  a  good  many 
detached  epidermic  scales,  which  prevent  your  wash 
from  coming  directly  in  contact  with  the  diseased 
parts.  Then,  if  you  dip  the  cotton  on  the  end  of 
the  probe  into  the  solution  and  wipe  the  whole  of 
the  canal,  you  will  accomplish  much  more  than  to 
pour  the  wash  into  the  ear.  I  wish  I  could  teach 
you  the  value  of  nice  manipulations  in  cleansing  the 
ear  with  cotton-wool.  It  is  worth  a  great  deal  to  the 
patient.  In  these  cases  I  have  invariably  found  that 
the  simple  wiping  of  the  canal  in  this  way  affords 
miich  relief,  even  from  pain,  for  by  this  means  we 
get  rid  of  the  discharges  and  detached  epidermic 
scales,  which  act  as  foreign  substances  and  produce 
irritation.  If  the  furuncle  is  considerably  swollen 
and  the  canal  narrowed,  you  may  think  that  it  will 
be  impossible  to  proceed  in  the  way  I  have  just  rec- 
ommended ;  but  when  you  come  to  consider  that 
the  smallest  amount  of  cotton  can  be  wound  upon  a 
probe,  you  will  at  once  see  that  it  is  possible  to 
wipe  out  the  canal  in  any  case,  no  matter  how  great 
the  swelling  may  be.  Frequently  you  will  find  that 
the  site  of  the  furuncle  remains  as  an  open  ulcera- 
tion, from  which  granulations  sometimes  spring, 
and  which  may  grow  to  the  size  of  tnie  aural  poly- 
pi. It  will  interest  you  as  microscopists  to  find 
that  these  are  identical  with  the  polyps  which  come 
from  the  tympanum  ;  only,  instead  of  being  covered 
with  epithelium,  they  are  really  covered  with  a  fine 
and  delicate  epidermis  similar  to  that  of  the  skin 
of  the  part,  yet  the  i^hysical  characteristics  of  each 
are  the  same.  This  point  has  been  rather  carefully 
studied  up.  The  treatment  is  simply  to  remove 
them  and  cauterize  their  bases,  like  any  other  l^oly- 
pi.  For  this  purpose  I  use  the  forceps,  and,  gener- 
ally, nitrate  of  silver  will  be  found  sufficient  for  cau- 
terizing purposes.  If  you  feel  like  using  fuming 
nitric  acid,  you  should  take  the  smallest  possible 
amount  of  cotton  on  the  end  of  a  probe,  dip  it  in 


the  acid,  wipe  away  all  excess  on  paper,  and  touch 
only  the  polyp  base.  The  adjacent  parts  will  toler- 
ate being  touched  with  nitrate  of  silver,  but  not  w  ith 
nitric  acid.  Besides  this,  the  canal  may  be  left  in  a 
state  of  more  or  less  subacute  or  chronic  inflamma- 
tion, which  will  require  treatment  appropriate  to  this 
condition.  The  remedy  I  have  the  most  faith  in  is 
the  tincture  of  iodine.  It  should  be  used  with  the 
following  precaution  :  it  is  a  jjainful  remedy.  In 
the  ear  it  will  not  only  produce  a  gi-eat  deal  of  burn- 
ing, but  may  cause  deep-seated  throbbing,  extend- 
ing quite  to  the  middle  ear,  and  i^erhaps  to  the 
throat.  To  apply  the  iodine  properly,  when  you 
have  dipped  the  cotton  in  the  solution,  you  should 
wipe  off  most  06  it  upon  a  piece  of  blotting-paper, 
or  any  other  appropriate  substance,  then  touch  the 
part  slightly  and  observe  the  effect.  It  is  desirable 
to  produce  a  little  heat  and  burning  ;  but,  if  a  tlirob- 
bing  pain  results,  it  has  been  used  too  freely,  and,  in 
that  case,  the  ear  may  be  syi-inged  with  tepid  water, 
which  will  give  relief.  I  woaild  advise  that  an  ear 
which  has  been  the  seat  of  furuncle  should  be  pro- 
tected from  the  cold.  A  loose  piece  of  cotton  may 
be  thrust  into  the  canal  and  worn  constantly.  If 
there  is  a  discharge,  the  cotton  may  be  removed 
several  times  a  day,  so  as  to  keej^  it  always  dry.  As 
to  the  constitutional  treatment,  you  all  know  how  to 
proceed.  You  will  think  of  quinine  as  almost  a  spe- 
eifio  in  the  prophylaxis  and  cure  of  this  affection. 
Where  there  is  a  liability  to  recurrence  of  the  furun- 
cles, we  feel  helpless  to  relieve  the  patient  by  local 
treatment  alone.  AVe  want  to  prevent  their  recur- 
rence. The  exhibition  of  quinine,  in  my  opinion, 
does  more  good  than  any  other  one  drug ;  but,  if  the 
patient  has  lieen  worked  hard,  he  should  take  re- 
creation. If  he  has  not  been  sufficiently  fed,  he 
should  be  supjilied  with  an  abundance  of  nourishing 
food.  If  he  has  been  confined  in-doors,  he  should 
go  out,  but  should  always  be  well  protected  from 
cold.  Everything  should  be  done  to  elevate  his 
general  condition,  which  will  act  as  a  prophylaxis  to 
future  trouble  and  facOitate  recovery  from  the  pres- 
ent attack. 


Locomotives  and  theie  Influence  on  Malabia. — 
Dr.  William  S.  King,  Surgeon  U.  S.  Army,  has 
written  us  a  letter  in  which  he  claims  that  the  arri- 
val and  dejiarture  of  locomotives,  with  their  attend- 
ant trains,  in  the  vicinity  of  our  towns  and  cities, 
may  account  for  the  non-occurrence  of  malaria!  ef- 
fects in  localities  where  all  the  necessary  conditions 
for  their  development  seem  to  be  furnished.  While 
selecting  a  place  of  residence  for  his  family,  his  at- 
tention was  calleil  to  West  Philadelphia,  that  por- 
tion of  it  adjacent  to  the  Schuylkill  Kiver.  On 
inquiry  he  ascertained  that,  notwithstanding  the 
nearness  of  the  low-lands,  the  residents  enjoyed 
immunity  from  malarial  affections.  The  theory  he 
advances  in  support  of  the  fact  is  as  follows  :  the 
heated  locomotives,  by  continually  passing  through 
the  infected  districts,  rarefy  the  air,  and  create  a 
constant  atmo.spheric  disturbance  by  inducing  warm 
upward  currents,  such  currents  acting,  wdth  the 
pure  air  which  rushes  in  from  all  directions,  as 
agents  in  the  dispersion  or  annihilation  of  the  mias- 
matic influence.  As  this  is  the  first  allusion  made 
to  the  effect  of  such  agencies  on  malaria,  it  is  one 
which  justly  claims  attention,  in  order  that  the  the- 
ory given  above  may  be  verified  or  disproved  ac- 
cording as  the  testimony  of  those  who  are  favorably 
situated,  proves  to  be  in  favor  of  or  adverse  to  it. 


200 


THE  MEDICAL  RECOED. 


©rigiiml  ComnumicaticrnQ. 


CASE  OP  VAEICOSE  AKEUEISM— ONE  OF 
THE  SINUSES  OF  VALSALVA  COMJMUNI- 
CATING  WITH  THE  CAVITY  OF  THE 
RIGHT  VENTRICLE. 

By  H.  G.  BEYER,  M.D.,  M.E.C.S., 

G.  G ,  a  seaman  in  the  United  States  Navy,  aged 

thirty-thi-ee,  and  a  native  of  the  city  of  New  York, 
was  admitted  to  the  Brooklyn  Naval  Hospital  on 
December  2-J:,  1881,  at  5  p. St.,  in  a  comatose  condi- 
tion. At  this  time  nothing  could  be  ascertained 
abowt  his  illness. 

It  was  impossible  to  obtain  any  information  re- 
garding his  family  history.  According  to  the  re- 
cords of  this  hospital,  he  had  an  attack  of  adenitis, 
and  was  treated  here  for  the  same  between  the 
months  of  January  and  April,  1879.  Dr.  Ames,  the 
surgeoa  of  his  last  ship,  informs  me  that,  on  August 
11,  1880,  he  was  admitted  to  the  sick-list  with  trau- 
matic orchitis,  caused  by  a  blow  received  from  a 
handspike,  and  was  ill  for  twenty  days  ;  that  he  was 
next  admitted  November  7,  1880,  with  acute  rheu- 
matism, affecting  his  left  knee  only ;  it  yielded  readily 
to  treatment  with  salicylic  acid,  and  was  considered 
a  light  attack,  patient  not  being  sick  enough  to  be 
confined  to  his  hammock.  September  last,  while  in 
New  York,  on  leave  of  absence,  he  suft'ered  from 
an  inflmnmation  of  his  eyes,  and  was  treated  by  an 
oculist  there  ;  it  is  presumed  he  also  had  a  syjihil- 
itic  history,  tlating  from  his  early  career  in  the  ser- 
vice, but  his  record  pkijsicalh/  on  board  his  ship  had 
been  excellent. 

In  this  account  no  mention  is  made  of  the  ex- 
istence of  heart  disease,  nor  of  anything  that 
might  lead  one  to  suspect  it,  with,  perhaps,  the 
exception  of  his  rheumatism.  December  last,  while 
again  on  leave  of  absence,  and  living  in  a  down- 
town boarding-house  in  New  Y''ork,  he  was  taken 
with  violent  vomiting,  and  sent  for  Dr  Simon  J. 
Walsh,  whom  he  informed  of  the  fact  tliat  he  had 
been  on  a  "  sjjree "  in  Boston  lately,  and  that  his 
sickness  was  probably  the  effect  of  that.  Dr.  Walsh 
made  a  careful  examination  of  his  chest  and  abdo- 
men, and  diagnosed  mitral  disease  of  the  heart,  with 
gastro-enteritis ;  for  the  latter  affection,  as  he 
kindly  informed  me,  ho  ordered  bismuth.  His 
friends  at  the  boarding-house  also  mention  that  on 
December  20th,  the  day  preceding  his  sickness, 
wliile  out  walking  with  a  friend,  he  was  suddenly 
overcome  by  a  fainting-spell,  and  would  have  fallen, 
had  he  not  been  supported  by  the  person  a<ro]n- 
panying  him  ;  he  was  only  partially  unconscious, 
rallied  quickly,  and  walked  home.  On  Dercmber 
23d,  the  day  before  his  transfer  to  the  hospital.  Dr. 
Walsh  found  him  sitting  up,  and,  upon  being  told 
that  he  was  "  all  right  now,"  did  not  deem  it  neces- 
sary to  continue  his  calls. 

From  all  that  could  be  learned,  I  found  that  G 

had  been  in  the  habit  of  going  out  daily,  and  had 
always  been  bright  and  cheerful  until  December 
20th,  the  day  of  the  fainting  spell.  On  December 
24th  he  lapsed  into  the  unconscious  state,  during 
which  he  was  brought  to  this  hospital  by  Dr.  Kufus 
Tryon,  U.S.N. 

On  his  admission,  and   while  under  the  care  of 


Dr.  Charles  A.  Siegfried,  U.S.N.,  G presented 

the  following  symptoms  and  physical  signs,  viz.  : 
General  surface  livid,  cheeks  flushed ;  unconscious, 
but  could  be  jjartially  aroused  ;  there  was  no  paral- 
ysis, moved  his  head  and  extremities  when  pricked  ; 
pupils  were  evenly  dilated ;  temjierature,  97°  F.  ; 
pulse  at  wrist  was  absent  the  greater  part  of  the 
time,  when  present,  scarcely  perceptible ;  heart- 
beat only  at  long  intervals,  making  one  or  two  very 
tumiiltuous  revolutions ;  loud  murmurs  with  both 
sounds  of  the  heart  were  plainly  audible;  breathing 
was  frequent  and  noisy;  was  unable  to  swallow  any- 
thing, and  medicines  were  administered  with  great 
difficulty.  A  few  ounces  of  urine  were  taken  from 
him  with  a  catheter,  and  found  one-fourth  albumi- 
nous, and  very  dark  colored,  from  admixture  of  red 
blood-corpuscles. 

The  treatment  consisted  in  external  heat  applied 
in  the  shape  of  hot  blankets  and  internal  .stimulants. 

Disease  of  the  heart  was  clearly  diagnosed,  and 

the  existence  of  aneurism  strongly  suspected.    G 

expired  at  8  p.m.,  about  three  hours  aftfer  his  admis- 
sion, never  having  spoken  nor  been  roused  from  his 
unconscious  state.  The  next  morning,  at  the  request 
of  Dr.  Siegfried,  I  made  the  autopsy. 

AutOfisy  was  made  fourteen  hours  after  death. 
Rigor  mortis  well  marked  ;  body  well  nourished  and 
exhibiting  signs  of  good  nuiscular  development ; 
surface,  with  the  exception  of  two  small  scars  upon 
buttocks  and  sacrum,  presented  nothing  abnormal ; 
.skullcap  normal. 

Brain. — Membranes  opaque  and  covered  with 
recent  lymph  at  base  as  well  as  over  the  vertex,  and 
here  and  there  the  arachnoid  was  found  adherent  to 
the  pia  mater.  The  substance  was  intensely  injected 
and  blood  was  flowing  freely  from  the  jjuncta  vascu- 
losa  on  cutting  open  the  brain  ;  the  ventricles  con- 
tained but  a  slight  amount  of  fluid  ;  a  clot  was  found 
in  the  superior  longitudinal  sinus  ;  weight,  fifty-six 
ounces. 

Diaphragm. — On  right  side  at  upper  border  of 
sixth  rib,  on  left  side  in  fifth  intercostal  space;  but 
few  ounces  of  dark-colored  fluid  in  abdominal  cavity 
and  a  lesser  amount  in  right  jdeural  cavity. 

Heart. — Pericardium  contained  three  and  one-half 
ounces  of  a  serous  straw-colored  fiuid  ;  heart  flabby 
and  but  imperfectly  contracted  ;  valves  sufficient ; 
right  aviricle  of  a  dark,  purplish  color,  and  firmly 
contracted ;  muscular  substance  of  a  pale  reddish 
brown  color ;  the  endocardium  smooth  and  glis- 
tening but  opaque,  and  a  very  copious  deposit  of 
recent  lymjih  was  foiuid  in  the  cavity  of  the  right 
auricle.  About  one  inch  below  the  posterior  seg- 
ment of  the  semilunar  valves  of  the  pulmonary  ar- 
tery, a  well-definefl  and  perfectly  round  ulcerative 
opening,  of  about  three-eighths  of  an  inch  in  diame- 
ter, and  showing  recent  granulations,  presented  it- 
self to  view.  This  opening  was  very  nearly  in  the 
centre  of  a  little  thin- walled  pouch,  ])rojecting  from 
the  posterior  w.all  of  the  right  ventricle  into  its 
cavity.  A  pi-obe  passed  into  this  opening,  and 
pushed  slightly  backward,  upward,  and  to  the  right, 
was  seen  to  emerge  above  the  right  anterior  segment 
of  the  semilunar  valves  of  the  aorta.  On  farther  ex- 
amination it  was  found  that  the  right  anterior  sinus 
of  Valsalva  was  veiT  much  dilated,  and  formed  a 
pocket,  the  size  of  a  walnut,  which  contained  a 
fibrinous  clot.  The  little  finger  passed  into  this 
pocket  could  almost  directly  be  pushed  on  into  the 
right  ventricle,  through  the  ulcerated  ojiening  above 
mentioned.  On  further  examining  the  left  anterior 
sinus  of  Valsalva,   it  was  also   found  dilated  ;   this 


THE  MEDICAL  EECORD. 


201 


pocket,  somewhat  smaller  than  the  preceding,  led 
to  a  little  space  between  aorta  and  pulmonary  ar- 
tery, and  was  closed  only  by  a  layer  of  semi-trans- 
parent pericardium,  which  prevented  it  from  com- 
municating directly  with  the  cavity  of  the  pericar- 
dium, and  would  probably  have  been  ruptured 
within  a  very  short  time  had  the  patient  continued 
to  live. 


Lungs. — Extensive  old  adhesions,  costal,  and  dia- 
phragmatic on  left  side,  and  hemorrhagic  infarction 
of  entire  lower  lobe,  the  rest  was  highly  redematous 
and  congested  ;  right  side  free,  except  slight  recent 
adhesions  over  upper  lobe  with  intense  general  con- 
gestion and  oedema. 

Spleen. — Congested  and  but  slightly  enlarged, 
weighing  eight  ounces. 

Kidneys. — Left,  eight  ounces  ;  right,  six  ounces  ; 
capsule  easily  detached ;  both  were  congested  and 
fatty. 

Inteslines. — Stomach,  large  and  small  intestine 
deeply  injected  and  filled  uniformly  with  a  coffee- 
colored,  semi-solid,  gelatinous  mass,  and  covered 
throughout  with  mas.ses  of  recent  lymph.  The  large 
intestine,  which  was  removed  to  within  an  inch  of 
the  anus  was,  at  certain  places,  firmly  contracted  to 
the  extent  of  from  one  to  eight  inches,  there  beuig 
no  stricture.  From  the  sigmoid  flexure  down  to 
the  sphincter,  it  was  uniformly  contracted,  the  lu- 
men hardly  admitting  my  little  finger. 

Liver. — Weight,  four  pounds  and  four  ounces  ; 
was  of  a  very  da7'k  brown  color  and  congested,  and 
of  a  granular  outside  appearance ;  apparently  cir- 
rhotic ;  gall-bladder  filled  with  bile,  and  normal. 

Microscopical  examination  was  made  tioth  from 
fresh  material,  mounted  in  a  one-per  cent,  solution 
of  chloride  of  sodium,  and  from  hardened  tissues 


stained  with  picro-caimine  and  mounted  in  glyce- 
rine. 

Heart. — Muscular  fibrilho  show  here  and  there 
foci  of  fatty  degeneration  ;  there  is  a  very  thick 
layer  of  subjjericardial  and  subendocardial  adipose 
tissue,  extending  into  the  muscular  substance  of 
the  organ,  surrounding  the  blood-vessels,  and  also, 
to  a  certain  extent,  the  muscular  fibrilhe  ;  connective 
tissue  seems  slightly  proliferated  ;  blood-vessels  show 
a  distinct  thickening  of  the  adventitia,  also  media 
to  a  moderate  extent,  with  a  corresponding  pucker- 
ing of  the  intima ;  in  some  places  they  appear 
irregularly  compressed,  being  surrounded  by  large 
clear  spaces,  evidently  indicating  serous  efi'usion. 
Near  some  of  the  largest  arterioles,  I  notice  a  newly 
formed  tissue,  rich  in  nuclei,  and  the  cells  compos- 
ing it  are  partly  round,  partly  spindle-shaped  ;  this 
tissue  does  not  seem  to  surround  the  calibre  of  the 
vessels  completely,  and  although  adjacent  to,  and 
apparently  continuous  with  the  adventitia,  can 
hardly  be  called  part  of  the  latter. 

Aorta. — Nothing  abnormal  was  observed  in  the 
coats  of  the  aorta. 

Kidneys. — Capillaries  and  veins  choked  with  blood- 
corpuscles  ;  connective  tissue  moderately  jirolifer- 
ated ;  renal  epithelium  fattily  degenerated. 

JJ,ver. — Blood-vessels  crowded  with  blood-corpus- 
cles ;  connective  tissue  increased  considerably,  the 
resulting  cirrhosis  being  of  the  multilobular  variety 
of  Dreschfeld,  or  the  cirrhose  vulgaire  of  Charcot, 
described  by  Hanot ;  the  corpuscular  elements  of 
the  liver  show  granular  and  fatty  degeneration,  also 
a  good  deal  of  pigment. 

Remarks. — Varicose  or  communicating  aneurism 
was  first  defined  by  Stokes  as  that  variety  of  the 
disease  in  which  blood  passes  from  one  portion  of 
the  vascular  system  to  another.  In  accordance  with 
this  definition  the  present  example  may,  I  believe, 
be  safely  described  under  that  head. 

I  have  been  able  to  find  but  two  examjjles  of  vari- 
cose aneurism  that  bear  a  real  resemblance  to  the 
one  in  hand.  Hope,  quoted  by  Hayden,  in  1839, 
piiblished  a  remarkable  case  of  aneurism  of  the 
aorta  immediately  above  the  valves,  communicating 
with  the  right  veotriele  by  two  apertures  ;  the  symp- 
toms and  signs  which  followed  a  strain  in  lifting  a 
weight,  and  a  "  creak  in  the  heart,"  accompanied 
by  faintness,  were  lividity,'  a-dema,  jerking  pulse, 
purring  tremor,  double  murmm-,  and  a  continuous 
iiimble  to  the  left  of  the  sternum  from  the  second 
to  the  fourth  rib. 

The  second  case  came  under  the  notice  of  Dr. 
Hayden  himself  through  his  friend.  Dr.  Stokes,  and 
is  described  in  full  on  page  759  of  the  second  volume 
of  Dr.  Hayden's  work  on  "  Diseases  of  the  Heart 
and  Aorta."  This  aneurism  was  of  the  size  of  a 
tennis-ball,  arising  from  one  of  the  aortic  sinuses, 
and  communicating  with  the  right  ventricle  by  an 
aperture  of  the  size  and  shape  of  a  "shirt-button- 
hole." The  .symptoms  were  general  congestion  and 
oedema ;  physical  sign.s,  fremissement,  with  a  loud 
and  double  murmur  at  midsternum;  the  case  being 
under  obsei-vation  for  some  time,  the  diagnosis  of 
aneurism,  opening  into  one  of  the  ventricles,  was  pre- 
sumptively made. 

The  latter  instance,  to  which  my  attention  was 
very  kindly  called  by  Dr.  G.  L.  Peabody,  only  dif- 
fers from  my  own  in  this,  that  it  was  somewhat 
larger,  only  one  of  the  aortic  sinuses  was  involved, 
and  the  aperture  by  which  the  aorta  communicated 
with  the  right  ventricle,  was  of  the  shape  of  a  "  .shirt- 
button-hole."     In  my  case,  the  sac  was  smaller,  two 


202 


THE  MEDICAL  RECORD. 


of  the  aortic  sinuses  were  involved  (altliougli  no 
communication  existed  between  them),  and  the 
opening  was  perfectly  round,  and  its  margin  beset 
witli  recent  granulations,  indicating  ulceration. 

Cases  of  varicose  aneui'ism  having  a  more  remote 
relation  to  the  present  one  have  been  reported  at 
various  times  and  in  different  countries  by  Beau- 
chene.  Wells,  Curling,  Munro,  Keid,  Thuniam,  Pea- 
cook,  Rokitansky,  McDowel,  and  others. 

The  present  example  of  varicose  aneurism,  then, 
derives  its  interest  and  importance  mainly  from  the 
rarity  of  the  pathological  specimen  which  it  has 
furnished  us  in  the  shape  of  the  heart.  It  lias  l)een 
forwarded  to  the  Surgeon-General,  Philip  S.  Wales, 
U.  S.  Xavy,  who  will  probably  place  it  in  one  of 
the  museums  at  Washington,  D.  C. 

As  to  the  causes  of  the  disease  in  the  present  in- 
stance, it  is  reasonable  to  suppose,  that  rheuma- 
tism, syphilis,  and  the  free  use  of  alcoholic  stimu- 
lants, may  have  more  or  less  predisposed  to  the 
trouble,  while  the  exciting  cause  was  doubtless  an 
injury.  The  sudden  violent  physical  exertions  inci- 
dent to  his  i)osition  of  gunner's  mate  on  board  of 
a  man-of-war  warrant  this  conclusion. 

With  regard  to  the  symptoms  which  G pre- 
sented during  life,  the  faintingspells  which  he  ex- 
perienced while  out  walking,  the  day  before  the 
diagnosis  of  heart  disease  was  made,  possibly  marks 
the  time  of  occurrence  of  perforation  of  the  aneu- 
rismal  sac.  The  fact  that  the  perforation  of  the 
aneurismal  sac  was  of  recent  date  finds  also  partial 
support  in  the  character  of  the  granulations  cover- 
ing the  margin  of  the  aperture. 

CuHSe  of  death. — Paralysis  of  right  heart  from 
over-distention,  and  the  great  general  disturbance 
in  the  nutrition  of  all  the  internal  organs  and  vis- 
cera consequent  thereon. 


HEAET-LESIONS    IN  EHEUIMATIC  FEVER. 
By  W.  S.  CHEESMAN,  M.D., 

Though  systematic  wi-iters  are  careful  to  declare 
that,  in  rheumatic  fever,  pericarditis  and  endocar- 
ditis are  as  truly  local  manifestations  of  the  general 
disease  as  are  the  joint-lesions,  yet  it  is  their  custom 
to  treat  of  them  as  complications,  along  with  plew- 
risy,  pneumonia,  and  peritonitis.  Thus  the  notion 
has  gained  currency  that  these  heart-lesions  are  ac- 
cidents, and  to  be  prevented  by  special  local  or  gen- 
eral medication.  In  view  of  tlie  practical  as  weU  as 
theoretical  consequences  of  this  error,  it  seems  im- 
portant to  emphasize  tlie  idea  that  heart  diseases  are 
not  mere  complications  of  rheumatic  fever,  like  oph- 
thalmia in  cerebrospinal  meningitis,  or  hypostatic 
pulmonary  congestion  in  typhoid  fever,  but  are  local 
expressions  of  the  disease  process  quite  as  character- 
istic, if  not  so  common,  as  arthritis. 

It  may  be  worth  while  to  inquire  iipon  what  facts 
this  conception  is  based.  In  the  first  place,  upon 
ttie/reguenci/  with  which  acute  rheumatic  arthritis 
is  attended  by  heart  disease.  Especially  is  this 
noticeable  in  the  young.  Said  Watson:  "With 
perhaps  one  exception,  I  never  know  the  disease 
(rheumatism)  to  oc<^ur  in  unei|uivocaI  form  before 
puberty,  witliout  its  being  attended  witli  inflamma- 
tion of  the  lining  or  investing  membrane  of  the 
heart."  Since  his  day  all  ob.servers  have  testified  to 
similar  purpose,  if  not  in  so  sweeping  generaliza- 
tion. In  adults,  also,  rheumatic  heart  disease  is  suffi- 


ciently common,  though  its  frequency  is  variously 
estimated,  difl'erent  writers  claiming  its  occurrence 
in  from  seventeen  to  fifty-five  per  cent,  of  the  cases. 
Surely,  when  any  lesion  is  so  usual  a  concomitant  of 
a  disease  it  rises  above  the  rank  of  an  accidental 
complication  to  the  imj)ortance  of  a  characteristic 
local  manifestation. 

And  this  is  still  more  plainly  suggested  by  the 
frequently  coincident  appearance  of  heart  and  joint 
lesions,  and  especially  by  those  cases  wherein  the 
heart  aSection  j^recedes  the  joint  trouble,  or  in  which 
it  is  the  only  local  evidence  of  the  rheumatic  dis- 
ease. That  such  instances  do  occur  is  admitted 
pretty  generally.  I  have  myself  reported  a  case  of 
rheumatism  of  the  pericardium  which  existed  two 
weeks  V;efoi-e  any  joint  afl'ection  occurred  to  stamp 
its  character,  and  which  promptly  yielded  to  the 
salicylate  of  soda  (see  Medic.vl  Kecobd,  November 
27,  1880).  I  can  now  give  notes  of  two  analogous 
cases. 

C.iSE  I. — I  was  called  to  see  a  boy,  Aged  sixteen, 
who  complained  only  of  headache  and  malaise.  Ex- 
amination of  the  chest  was  negative.  Temperature 
101  F.,  and  not  reducible  by  quinine.  On  the  third 
day  I  made  out  a  mitral  systolic  murmur,  had  the 
patient  put  to  bed,  and  carefully  examined  his  heart 
twice  a  day.  The  temperature  remained  elevated, 
and  the  physical  signs  of  heart  disease  became  more 
and  more  intense.  The  interpretation  of  the  case 
as  one  of  rheumatism  of  the  endocardium  alone  did 
not  occur  to  me  until,  after  a  week's  illness,  the 
right  knee  became  swollen  and  painful.  Then  I 
recognized  the  condition,  and  salicylate  of  soda 
promptly  reduced  tlie  temperature  and  stopped  the 
arthritis.  The  patient  recovered  with  a  damaged 
heart,  which,  when  last  examined,  was  undergoing 
compensatoiw  hyjiertrophy. 

Case  II. — Twenty-four  hours  after  being  caught 
in  a  shower  while  rowing,  a  gentleman  observed  a 
slight  creaking  sound  as  he  was  sitting  quietly  read- 
ing. For  some  time  he  gave  it  no  attention,  but,  on 
finally  seeking  its  source,  he  noticed  that  it  was  syn- 
chronous with  his  own  pulse,  and,  in  short,  jiro- 
ceeded  from  his  o\\-n  chest.  It  was  loudest  when  he 
leaned  forward.  No  jiain  nor  any  other  symjjtom 
was  observed.  The  next  day,  in  addition  to  hearing, 
he  could  distinctly  feel  an  intra-thoracic  friction. 
He  was  examined  by  a  distinguished  New  York 
diagnostician,  who  cleurly  heard,  at  a  distance  of 
four  feet  from  the  patient's  chest,  a  sound  which  re- 
sembled the  crunching  of  snow  imder  foot  on  a  cold 
winter  day.  It  was  loudest  when  he  loaned  forward, 
but  was  to  be  heard  and  felt  at  all  other  times.  The 
diagnosis  was  of  jiericarditis  without  effusion,  and 
the  patient  was  ordered  to  Vied,  and  to  take  ten 
grains  of  sodic  salicylate  every  four  hours.  Some 
palpitation  was  felt  tliat  evening,  but  recovery  was 
rapid,  and  on  the  fifth  day  the  friction  was  felt  for 
the  last  time,  during  forced  expiration,  -n-ith  the 
arms  above  the  head. 

I  refrain  from  comment  on  this  interesting  casi, 
save  to  urge  the  point  that  here  apparently  was  a 
rheumatism  of  the  pericnrdiiuii  uncom})licated  by 
arthritis,  a  view  concurred  in  by  the  well-known 
medical  gentleman  wlio  saw  the  case. 

In  considei'ation  of  these  fact.-;,  probably  none 
would  be  inclined  to  dispute  the  position  clearly 
enunciated  by  Flint,  that  while  it  may  be  "  con- 
venient to  speak  of  these  affections  as  complica- 
tions, they  are,  properly  speaking,  to  be  reckoned 
among  the  local  manifestations  of  the  disease  :  that 
is,  they  are  dependent  on  the  same  internal  deter- 


THE  MEDICAL  RECORD. 


203 


mining  cause  to  which  the  affection  of  the  joints  is 
to  be  referred." 

I  am  not  aware,  however,  that  any  one  is  willing 
to  accept  the  logical  consequence  of  this  position, 
viz.,  that  ,«o  long  as  the  rheiinhilic process  conthiues,  it 
were  as  idle  to  think  of  i)reventing  its  manifesting 
itself  in  the  endocardium  or  pericardium,  as  to  seek 
to  protect  any  particular  individual  joint  from  its 
attack.  If  the  general  disease  may  find  local  ex- 
pression in  inflammation  of  any  or  all  of  these  parts, 
there  might  reasonably  seem  quite  as  much  hope  of 
preserving  whole  by  topical  or  other  measures  the 
right  wrist  (let  us  say)  as  of  thus  keeping  the  heart 
sound.  Arthritis,  and  not  seldom  cardiac  diseases 
occur  with  pys^mia  :  who  would  pretend  to  protect 
the  heart  while  pyjemia  survives  ?  In  like  manner, 
the  vaunting  of  any  treatment  as  able  to  shield  the 
heart,  while  it  does  not  destroy  the  rheumatic  poi- 
son which  attacks  the  heart,  seems  iinphilosophical. 
First  antidote  that  poison,  and  then,  and  not  before, 
should  the  lining  and  enveloping  membranes  of  the 
heart,  as  well  as  the  other  serous  structures,  be 
thought  safe. 

These  d  priori  considerations  are,  it  must  be  con- 
fessed, not  contradicted  by  facts.  As  might  have 
been  expected,  in  sjiite  of  all  the  means  used  to 
prevent  them,  heart  diseases  occur  in  rheumatic 
fever  with  about  the  same  frequency  as  when  Gull 
and  Sutton  investigated  the  matter  by  the  exhibition 
of  mint  water,  and  were  led  to  urge  the  expectant 
treatment  of  rheumatism.  It  has  been  the  boast  of 
every  new  plan  of  therapeusis  that  it  met  this  cry- 
ing need,  yet  neither  belladonna  plasters  to  the  jjre- 
cordium,  nor  blistering,  nor  saturation  with  the 
alkalies,  nor  any  other  mea.sure,  enjoys  the  confi- 
dence of  the  profession.  If  the  recent  debate  of  the 
London  Medical  Society  ]iroved  nothing  else,  I  be- 
lieve it  jjroved  abundantly  that  we  have  no  means 
for  averting  the  cardiac  manifestations  of  acute 
rheumatism,  just  as  we  have  none  for  averting  any 
single  arthritic  manifestation — except  bii  stoppiin(i 
the  rheumatism.  Herein  would  seem  to  lie  the  only 
rational  hope  :  to  check  the  disease  before  the  heart 
can  become  affected.  It  must  be  remembered  that 
cardiac  trouble,  when  it  occurs  at  all,  begins  usually 
in  the  first  week  of  the  disease  ;  hence,  if  we  are  to 
prevent  it,  treatment  must  be  instituted  at  the  out- 
set, and  the  disease  aborted  as  sjjeedily  as  possible. 
When  it  is  considered  that  patients  seldom  apply  to 
hospitals  in  the  first  week  of  their  sickness,  we  can 
understand  why  the  salicylates,  which  certainly  are 
our  most  promjit  anti-rheumatic  agents,  are  not 
shown  by  hospital  statistics  to  be  very  much  more 
efficient  in  keeping  the  heart  structures  whole  than 
are  the  older  forms  of  treatment. 

If  this  reasoning  be  well  founded,  it  were  not  too 
much  to  expect  that  we  should  hear  no  more  of 
those  various  plans  of  local  or  general  treatment 
which  medical  literatiu-e  urges  for  the  special  pro- 
tection of  the  cardiac  structures  in  rheumatic  fever; 
and  it  would  seem  the  plain  duty  of  the  profession, 
laying  aside  such  hopes  as  vain  and  unwarrantable, 
to  address  itself  to  the  all-important  task  of  check- 
ing, at  the  earliest  possible  stage,  the  general  dis- 
ease whereof  lesions  of  the  heart  and  of  the  joints 
are  alike  the  local  manifestations. 


Professor  Hayem,  of  Paris,  has  Ijeeu  transferred 
from  theCliair  of  Therapeutics  to  that  of  Pathologi- 
cal Anatomy,  vacant  by  the  nomination  of  Charcot 
to  the  new  Chair  of  Nervous  Diseases. 


ALCOHOL    AS    AN    ANESTHETIC. 
By  J.  T.  SEAKCY,  A.M.,  M.D., 

TUSEALOOSA,  ALA. 

What  constitutes  the  physiological  action  of  alcohol 
in  the  body  is  always  a  question  full  of  interest  and 
of  jiractical  importance.  The  study  of  the  mode  of 
its  action  is  interesting  to  the  physician  in  his  ad- 
ministration of  it  as  a  medicine.  He  is  also  inter- 
ested in  it  as  an  agent  that  brings  to  his  door  as 
many,  if  not  more  patients  than  any  other  one  cause. 
The  world  at  large,  considering  the  immense  inter- 
ests at  stake,  are  continually  demanding  of  sanitary 
medicine  information  as  to  its  actual  value  as  a  bev- 
erage— for  which  object  it  is  mostly  used — until  it 
is,  in  fact,  one  of  the  "livesf  questions  of  the  day. 
It  is  very  evident  to  one  revie^^ing  the  subject, 
that  professional  opinion  has  been  "changing  base  " 
decidedly,  even  within  the  past  ten  or  fifteen  years. 
From  time  immemorial  it  has  been  customary  to  set 
down  alcohol  as  a  "stimulant"  in  the  strictest  sense 
of  the  term.  Now  we  find  many  of  the  best  men  of 
the  profession  declai'ing  that  it  is  not  a, stimulant  in 
any  of  the  stages  of  its  action.  We  find  it  now  fight- 
ing tenaciously  for  its  own  claims  as  a  vutrient, 
though  it  is  very  evident  it  is  driven  very  strongly 
to  the  wall  to  prove  them,  and  there  are  many  ready 
to  deny  that  it  is  in  any  sense  a  food. 

I  do  not  propose  to  go  into  the  argument  to  prove 
its  stimulating  or  its  nourishing  value,  but  briefly 
call  attention  to  its  present  status  as  an  aniesthetic. 
In  the  first  place,  alcohol  is  born  in  the  same  re- 
tort, and  has  physical  properties  and  a  chemical 
composition  so  similar  to  a  large  number  of  agents 
of  modern  discovery,  whose  effects  in  the  system  are 
called  aniesthetic  and  nothing  else,  that  naturally  we 
would  assign  it  to  that  family,  and  j^robably  this 
would  be  more  readily  and  rajiidly  done  if  the  cau- 
tious conservatism  of  medicine  did  not  always  move 
slowly.  More  than  any  other  profession  it  is  "  ad- 
dicted to  swear  in  the  words  of  a  master." 

Ethylic  alcohol  is  the  form  most  frequently  met 
with  and  used.  It  occurs  in  all  the  popular  drinks 
of  the  day,  in  very  variable  projjortions,  ranging 
all  the  way  from  two  or  three  to  fifty  per  cent. 
We  may,  in  a  practical  point  of  view,  regard  them 
all  as  mixtures  of  alcohol  and  water,  associated  with 
other  substances  of  minor  importance. 

Compared  with  the  anoesthetics  in  most  frequent 
use  — as  chloroform,  chloral,  ether,  nitrous  oxide, 
and  the  like — alcohol  seems  to  differ  from  them  not 
so  much  in  the  salient  points  of  its  action  as  in  its 
tardiness  and  slowness.  Each  one  is  of  course  pe- 
culiar to  itself  in  minor  points,  but  their  leading 
features  are  very  similar.  Alcohol  is  slower  in  its 
action  than  chloral,  which  is  .slower  than  ether,  and 
ether  than  chloroform,  and  chloroform  than  nitrous 
oxide.  This  tardiness  of  action  renders  alcohol  the 
least  dangei-oats  ;  and,  although  called  alcohol  by  the 
Arabs  because  of  its  svhtiUii,  it  is  really  the  least  sub- 
tile of  them  all.  It  seems,  thoiigh.  to  have  been  very 
stibtle  in  assuming  titles  and  attributes  that  have 
served  to  cover  up  its  true  character.  Because  of 
its  tardiness  of  action,  its  different  stages  are  more 
open  to  inspection,  and  make  it  an  excellent  "pro- 
totype" by  which  to  study  anesthetics. 

The  recent  number  of  Wood's  Library,  on  "  Anaes- 
thetics." by  Professor  Lyman,  is  a  most  excellent 
work,  taking  up  the  whole  subject,  and  the  following 
reflections  have  been  most  profitably  informed,  sup- 
ported, and  encouraged  by  its  perusal. 


204 


THE  MEDICAL  RECORD. 


Before  we  consider  the  ansesthetic  action  of  alco- 
hol, a  condensed  review  of  some  of  our  physiology- 
is  relative  to  the  subject. 

Tissue-change,  whether  you  call  it  cell-action, 
molecular  motion,  or  what  not,  constitutes  the  es' 
sential  for  life.  To  support  and  continue  this  ac- 
tion harmoniously,  "  naturally,"  is  the  direct  and  the 
indirect  object  of  the  greater  part  of  the  machinery 
of  the  body.  The  magnitude  of  these  processes,  si- 
lently, and  in  health  harmoniously  going  on,  we  are 
very  apt  to  overlook  or  forget.  Action — cellular, 
molecular,  tissue  action — constant,  continuous,  and 
harmonious,  in  accordance  with  natural  processes, 
constitutes  healthy  life.  And  we  might  be  bold 
enough  to  say  that  disturbed  natural  action,  whether 
it  go  so  far  as  to  produce  destructive  changes  visi- 
ble to  the  eye  or  not,  makes  or  constitutes  disease. 

The  blood  carries  the  pabulum  to  support  these 
natural  processes,  and  is  the  vehicle  to  remove  the 
waste  products.  The  most  important  organ  in  the 
body  is  the  nervous  system — the  cerebro-spinal, 
sympathetic,  vaso-motor,  and  all  are  a  whole  indis- 
solubly  interwoven  and  bound  together.  Control  is 
its  principal  function.  It  controls  and  regulates 
not  only  the  supply  of  blood  to  the  tissues,  but  even 
regulates,  to  a  greater  or  less  extent,  cellular  action 
itself.  The  cerebrum,  with  its  hemispheres,  its 
grav  and  white  matter,  is  the  head-centre,  its  corti- 
cal portion  principally  cellular,  and  its  white  mat- 
ter principally  composed  of  nerve-fibres.  Lying  on 
the  plate  before  you,  it  appears  to  be  a  very  homo- 
geneous mass,  when  in  truth  it  is  the  most  complex 
of  all  complexities.  Its  cortical  portion,  principally 
cellular,  "having  functions  past  finding  out,"  is  the 
meeting  ground  between  mind  and  matter.  Every 
cell  appears  to  be  connected  with  every  other  cell 
by  the  nerve-fibres  in  the  whiter  portion,  and  also 
through  them  and  their  connections  unites  all  ner- 
vous structures  into  one,  and  makes  tlie  body  a 
whole.  So  intricate,  complex,  and  multiplied  are 
the  parts  that  "'with  how  much  art  the  windings 
run  and  where  the  regular  confusion  ends"  is  a 
most  perplexing  question  in  physiology.  And  the 
multiplied  complex  character  continues  even  out- 
side the  cranium  in  the  rest  of  the  nervous  .system, 
descending  in  order  of  importance.  The  whole 
body  is  united  into  a  complete  whole  by  the  ner- 
vous system,  which  exerts  its  control  over  all.  Its 
several  portions  differ  in  cellular  structure  and  in 
molecular  motion  according  to  function. 

We  have  some  agents,  none  more  decidedly  than 
the  ana33thetics,  that  make  exhibition  of  their  prop- 
erties by  influencing  the  nervous  centres.  The  study 
of  the  action  of  such  drugs  is  particularly  interest- 
ing, and  the  explanation  of  it  does  not  appear  to  be 
nowadays  nil  theory.  The  order  and  the  degree  in 
which  certain  portions  of  the  nervous  system  are 
affected,  is  beautifully  exjjlained  by  the  paralyzing 
influence  of  such  drugs  over  their  cellular  motion, 
more  here  and  less  there,  as  the  natural  motions  of 
particular  parts  are  more  or  less  interfered  w'ith  by 
the  difl'erent  agents  used. 

On  the  lowe-it  forms  of  living  existence— simple 
protoplasm — alcohol  produces  instant  death,  unless 
largely  diluted.  Apparently  it  does  so  by  its  affinity 
for  water.  It  will  become  "hydratia"  if  it  has  to 
take  the  water  from  living  sources.  Colloidal  albu- 
minous substances,  not  living,  are  coagulated  by  it 
in  the  same  way.  If  largely  dilated  to  at  least 
twenty  per  cent,  in  the  watery  solution,  it  does  not 
destroy  struct\iro,  but  arrests,  either  permanently 
or  for  a  time,   the   natural  molecular  motion.     It 


produces  paralysis.  The  stronger  the  solution  the 
more  decided  and  rapid  the  effect,  and  vice  versa. 
The  antiseptic  property  of  alcohol  when  ai^plied  to 
wounds,  and,  in  the  arts,  its  property  to  arrest  fer- 
mentation, are  due  to  this.  It  renders  dormant,  if 
it  does  not  entirely  destroy,  the  germs  whose  "cata- 
lytic "  ijresence  makes  the  fermentation  in  the  one 
case,  and  does  injury  to  reparative  action  in  the  ex- 
posed tissues  in  the  other.  The  antiseptic  inopei'- 
ties  of  alcohol  were  known  before  the  days  of  the 
good  Samaritan,  and  are  still  highly  endorsed  by 
many  surgeons,  though  carbolic  acid  and  other  sub- 
stances sujiiilant  it  for  many  reasons. 

Taken  into  the  stomach  the  same  "hydrating" 
affinity  of  alcohol  shows  itself  at  once,  if  the  stronger 
mixtures  are  taken.  Hence,  when  this  is  the  case, 
■we  find  the  mucous  coat  "  shrivelled,"  "  comigated," 
and  "hardened."  It  may  go,  if  not  .sufficiently 
diluted,  not  only  so  far  as  to  produce  mucous 
catan'h  in  that  organ,  but  also  injure  the  deeper 
tissues ;  and  gastritis  in  all  its  phases  we  see  follow- 
ing its  use.  Because  of  the  same  projjerty  many 
explain  its  hurtful  effects  upon  the  liver,  which  it 
reaches  immediately  after  leaving  the  stomach,  and 
through  which  it  is  sifted  by  the  innumerable  capil- 
laries of  the  portal  vein.  Also  the  blood-corpuscles 
change  shape,  and  the  fibrin  is  sometiilies  seen  co- 
agulated for  the  same  reason. 

Entering  the  circulation,  one  of  the  first  apparent 
effects  of  alcohol  on  the  nervoiis  system  is  its  pa- 
ralysis of  vaso-motor  control.  It  reaches  in  the 
capillaries  that  portion  first,  though  its  transit 
through  the  body  is  so  rapid  that  it  reaches  the 
higher  centres  almost  as  soon,  and  we  see  them  ex- 
hibiting disturbed  action.  The  result  of  vaso-motor 
paralysis  is  to  dilate  the  cai^illaries,  hence  there  is 
increased  flow  of  blood  to  the  periphery,  and  the 
heart  takes  on  increased  action  to  supply  the  de- 
mand. The  increased  vascular  supply  of  blood  to 
the  surface  or  to  the  capillaries  seems  to  produce 
an  increased  degree  of  temperature,  particularly  of 
the  external  parts,  the  deeper  ones  not  changing.  It 
is  just  here  that  the  stiniulnlinf/  properties  of  alcohol 
come  in,  if  it  have  any,  but  ether  or  chloroform  can 
put  in  the  same  sort  of  a  claim,  though  the  stages 
of  their  action  are  much  shorter.  If  there  is  in  the 
first  flush  of  blood-supply  increased  general  tissue- 
change  and  there  is  some  increased  warmth,  the 
specific  paralyzing  effect  soon  follows  and  the  general 
temperature  is  lowered. 

The  higher  nervous  centres  show  disturbance  ac- 
cording to  function.  In  the  brain,  mental  aberra- 
tion exhibits  itself,  excited  action,  and  not  a  complete 
balance  of  mental  control,  is  shown.  The  higher 
mental  jjowers  seem  to  topple  first.  Eeason  and 
self-control  lose  their  hold  on  man  in  proportion  to 
the  amount  of  the  dnig  taken,  and  he,  in  a  certain 
sense,  is  left  to  the  impulses  of  his  lower  instincts. 
We  have  every  degree  of  lo.ss  of  mental  control, 
ranging  all  the  way  from  a  slightly  hilarious,  talka- 
tive, silly,  or  stupid  condition,  to  complete  loss  of 
all  consciousness.  As  might  be  expected,  good  nor- 
mal brain  power,  representing  force  of  mental  tone 
and  control,  peculiar  to  and  different  in  dift'erent 
individuals,  will  give  varying  exhibitions  in  the  loss 
of  such  control.  The  drinking  man  is  noted  for 
all  sorts  of  dei)artui(>s  from  his  normal  condition  of 
mental  balance,  and  weaker  peculiarities  of  mind 
are  shown  in  greater  prominence  when  tJiey  exist. 
Descending  in  the  order  of  importance  in  the  ner- 
vous system,  the  centres  of  special  sense,  of  general 
sensation  and  of  motion  and  of  the  various  "  vegeta- 


THE   MEDICAL  RECOED. 


20 


tive"'  fanctions,  show  the  paralyzing  influence  of 
the  drug.  Motion  and  sensation  will  go  through 
progressing  stages  of  paralysis.  The  sympathetic 
systems  controlling  respiration  and  circulation  and 
general  tissue  change  are  slowest  to  yield.  All  the 
anassthetios  seem  to  follow  this  order.  Paralysis  to 
produce  complete  loss  of  consciousness  and  destroy 
all  sensation  is  harder  to  produce  with  alcohol  than 
the  others. 

In  the  administration  of  all  anaesthetics  there  is  a 
stage  of  pleasurable  feeling ;  when  we  reach  a  cer- 
tain lack  of  sensation  it  seems  to  be  peculiarly  grate- 
ful. Many  drugs  have  this  pleasant  stage  in  their 
action,  a  stage  of  general  good  feeling,  besides  those 
usually  called  autesthetics,  as  opium,  hyoscyamus, 
hashish,  and  tobacco,  the  li.st  is  a  long  one.  I  men- 
tion those  most  often  used.  To  obtain  this  stage  in 
the  paralyzing  action  of  these  medicines,  the  whole 
world  has  been  led  into  many  "bad  habits."  Men 
like  the  "  good  feelings  "  thus  produced,  and  will 
use  the  agents  regardless  of  the  consequences.  The 
use  of  such  agents  is  naturally  cumvdative.  A  fre- 
quent disturbance  of  the  nerve-centres  of  sensation, 
as  well  as  the  general  cellular  action  in  the  body, 
begets,  of  course,  a  more  or  less  constant  feeling  of 
pain  or  discomfort,  and  the  user  of  such  anodynes 
or  aniestheties  has  to  repeat  his  doses.  Many  of 
the  neurotic  troubles  freqiient  in  the  uses  of  such 
drugs  can  be  attributed  to  such  sources,  and  as 
long  as  the  maxim  holds  good,  "  like  father,  like 
child, "  we  will  have  in  our  midst  the  neurotic 
troubles,  notably  increasing  in  our  day  and  genera- 
tion, that  we  are  charitably  inclined  to  attribute  to 
other  causes,  but  which  we  cannot  ascribe  to  a  bet- 
ter one  than  that  the  use  of  such  drugs  extensively 
in  the  i^ast  two  hundred  years  has  done  much  to 
produce  them. 

It  is  the  anaesthetic  action  of  alcohol,  as  explained 
above,  and  not  any  "  stimulating  "  or  "  nutrient  " 
properties  attached  to  it,  that  makes  it  sought  after 
and  used  in  the  popular  drinks  of  the  day.  And 
much  might  be  done  for  sanitary  medicine,  if  we 
would  call  it  by  its  jjroper  name,  and  insist  that  its 
toxic,  paralyzing  influence  so  largely  overshadows 
the  others  that  they  ai-e  of  minor  consideration,  even 
when  admitted  at  all. 


Early  Indications  op  Phthlsis. — Dr.William  Por- 
ter, of  St.  Louis,  sends  us  an  article  on  "  Early  Indica- 
tions in  Phthisis,"  in  which  he  does  not  state  anything 
new,  but  rather  enforces  the  necessity  of  early  recog- 
nizing the  initial  lesions  of  the  disease,  and  of  using 
proper  means  for  their  relief  or  cure.  He  states 
that  since  phthisis  has  been  more  thoroughly  un- 
derstood, its  average  duration  has  increased.  Hueter 
found  among  10,000  autopsies,  780  cases  of  healed 
tuberculosis,  showing  quite  a  large  percentage 
of  recoveries.  This  brings  to  mind  the  theory  of 
"  self-limitation  of  the  disease."  as  supported  by  Pro- 
fessor Flint.  The  remaining  salient  points  in  his  pa- 
per relative  to  treatment,  are  as  follows  :  1.  Thor- 
ough protection  of  the  body  from  injurious  atmos- 
pheric or  telluric  influences.  2.  Correction  of  a  faulty 
condition  of  the  digestive  organs,  for  the  purpose  of 
securing  a  proper  assimilation  of  nutritions  food. 
3.  Early  removal  of  the  patient  to  a  climate  which 
will  tend  to  invigorate  the  physical  forces.  It  is 
certainly  true  tliat  these  rules,  when  strictly  ob- 
served, are  productive  of  greater  benefit  to  the  pa- 
tient than  hyper-medication. 


HOMCEOPATHY.* 
Br  A.  T.  SPEER,  M.D., 

NEWARK,    OHIO. 

The  subject  that  I  have  chosen  for  my  paper  to  day 
is  one  that  has  occupied  my  thoughts  lor  a  long 
time,  and  to  it  I  ask  your  earnest  attention. 

I  am  not  unmindful  of  the  position  m  which  it  may 
place  me,  nor  of  the  bitter  feelings  that  may  be  en- 
gendered thereby ;  but  having  in  mind  the  one  ob- 
ject that  should  be  the  aim  of  the  physician,  viz., 
the  curing  of  disease,  I  announce  my  subject,  the 
homoeopathic  doctrine  of  shtiilia  simHihuis  curanlnr. 
I  will  not  weary  you  by  mentioning  the  numerous 
theories  that  have  from  time  to  time  been  advanced 
to  explain  the  actions  of  medicines  upon  the  sys- 
tem, each  one  being  accejited  for  a  time  by  a  greater 
or  less  number  of  the  profession  as  a  satisfactory 
exjilanation,  only  to  be  superseded  by  some  later 
theory,  until  to-day  we  are  almost  as  ignorant  of  the 
action  of  medicine  upon  disease  as  we  were  one  hun- 
dred years   ago.      In  1797  Hahnemann  announced 
the   principle  which   has  made   him  famous.     Al- 
though it  has  been  received  with  derision  by  a  vast 
majority  of  the  medical  world,  it  has  steadily  pro- 
gi-essed  in  favor,  overcoming  obstacle  after  obstacle, 
I   until  to-day  the  system  of  medicine  founded  upon 
j   it  numbers  among  its  patrons  and  steadfast  friends  a 
I  large  proportion  of  the  more  intelligent  and  cultured 
people  of  each  community.     It  is  recognized  in  some 
J   of  our  universities.     Our  State  Boards  of  Health  are 
in  i^art  composed  of  homcpopathists.     Some  of  our 
State  institutions  are  controlled  by  tljt m,  and  in  a 
I  late  number  of  The  Medical  Record  it  is  announced 
that  the  Bingliamton  Asylum  for  the   Insane   has 
I   been  placed  under  the  medical  charge  of  a  homoeo- 
pathist.    This  is  the  second  asylum  for  the  insane  in 
the  State  of  New  York  under  honioeoijathic  control. 
Consultation  with   homceopathists   has  been  advo- 
cated  by   such  men  as  Jonathan  Hutchinson  and 
John  Tyer  Bristow.     With  such  facts  staring  us  in 
the  face,  it  becomes  our  duty,  as  honest  practition- 
ers of  the  healing  art,  to   investigate,  calmly  and 
thoroughly,  the  claims   of  homoeopathy,  and'  if  we 
find  that  it  teaches  the  use  of  any  remedies  which, 
used  according  to  this  .system,  are  more  successful 
in  the  cui'e  of  disease  than  those  remedies  we  have 
been  taught  to  prescribe,  we  are  bound  by  honor, 
duty,  to  say  nothing  of  self-interest,  to  use  them. 
The  subject  is  too  vast  to  be  considered  in  a  single 
Jiaper.     I  shall,  therefore,  select  two  medicinal  sub- 
stances, viz.,  aconite  and  mercury,  and  shall  try  to 
prove,  by  our  own  standard  authorities,  that  when 
we  are  successful  in  treating  diseases  with  them,  it 
is  in  accordance  with   the  homoeopathic  doctrine, 
and  although  all  sorts  of  explanations  are  advanced 
as  to  their  modus  operand!,  the  plain  simple  fact  is, 
that  Hahnemann  gave  the  symptoms  and  treatment 
years   ago  that  Professors  Bartholow  and  Ringer 
now  emphasize. 

Are  we  better  qualified  to-day,  so  far  as  having  a 
definite  knowledge  why  we  use  certain  drugs,  in 
curing  disease  than  we  were  fifty  years  ago  ? 

Will  any  gentleman  present  explain  to  me  why  be 
uses  mercury  in  any  disease  ?  Have  we  really  made 
any  progress  in  the  practice  of  medicine  excejit  what 
has  been  forced  upon  us  by  those  whom  we  regard 
as  irregular  practitioners? 

These  are  serious  questions  and  should  command 

*  Read  before  the  Licking  Connty  lleilioal  Society,  by  A.  T.  Si  ccr, 
M.D.,  President,  January  3,  1862. 


206 


THE  MEDICAL  RECORD. 


our  earnest  atteation.  Bat  I  have  digressed,  and 
will  now  resume  my  subject.  First,  aconite.  It  is 
only  within  the  last  few  years  that  this  drug  has 
been  used  to  any  extent  by  the  regular  profession. 
Binger  says,  "  Therapeutics,"  6th  edition:  '•Per- 
haps no  drug  is  more  valuable  than  aconite."  I 
will  ask  your  attention  to  a  few  of  the  many  uses 
which  he  gives  for  this  remedy.  He  says,  "  the 
power  of  aconite  to  control  inflammation  and  sub- 
due the  accompanying  fever  is  remarkable.  It  will 
sometimes  cut  short  an  inflammation.  Though  it 
will  not  remove  the  jjroduets  of  iuflLimmation,  yet 
by  controlling  inflammation,  aconite  will  j^revent 
their  formation,  so  saving  the  tissues  from  further 
injury.  The  results  of  aconite  are  most  apj^arent 
when  the  inflammation  is  not  extensive,  or  not  very 
severe,  as  in  the  catarrh  of  children,  in  tonsillitis, 
or  in  acute  sore  throat.  In  these  comparatively 
mild  diseases,  e.specially  if  the  aconite  is  given  at 
the  earliest  stage,  when  the  chill  is  still  on  the  pa- 
tient, the  dry,  hot,  and  burning  skin  becomes  in  a 
few  hours  comfortably  moist,  and  then  in  a  little 
while  is  bathed  in  profuse  persjjiration.  With  the 
sweating  comes  speedy  relief  from  many  of  the  dis- 
tressing sensations — as  restlessness,  chilliness,  heat 
and  dryness  of  the  skin,  aching  pains  and  stiffness  ; 
the  quickened  pulse  simultaneously  becc-mes  far 
less  frequent,  and  in  a  period  varying  from  twenty- 
four  to  forty-eight  hours,  both  pulse  and  tempera- 
ture reach  theii'  natural  state.  If  caught  at  the 
commencement,  a  quinsy  or  sore  throat  rarely 
fills  to  succumb  in  twenty-four  or  forty-eight  hours. 
If  administered  early  enough,  the  beneficial  eflects 
of  the  drug  soon  become  strikingly  apparent. 
Thus  large,  livid,  red,  glazed,  and  dry  "tonsils,  will, 
in  twenty-four  hours,  present  the  aspect  indicative 
of  the  subsidence  of  the  acute  stage  of  the  inflam- 
mation, the  disappearance  of  the  swelling  with 
much  redness,  whilst  the  membrane  becomes  moist 
and  bathed  with  mucous  or  pus.  Its  efifects  on  ca- 
tarrhal croup,  or,  as  it  is  sometimes  called,  spas- 
modic laryngitis,  are  just  as  conspicuous.  It  re- 
moves the  urgent  dyspniea  in  a  few  hours,  and 
shortly  afterward  subdues  the  fever,  and  almost  ex- 
tinguishes, in  a  few  hours,  an  attack  lasting  usually 
three  or  four  days.  Aconite  is  equally  serviceable 
in  severe  colds,  with  much  chilline-ss,  great  aching 
of  the  limbs,  a  Iiot  dry  skin,  and  quick  pulse.  To 
those  who  may  not  have  tried  it,  these  visible  ef- 
fects on  inflamed  tonsils,  etc.,  may  seem  exagger- 
ations, but  any  one  who  will  employ  the  aconite  in 
the  way  we  are  about  to  point  out,  can  verify 
my  statements.  In  pneumonia,  pleurisy,  and  the 
graver  inflammations,  the  effects  of  this  valuable 
drug,  though  not  so  rapid,  are  often  manifest  in 
pericarditis  accomi)anied  with  violent  tlirolibiug 
and  extreme  pain.  Aconite  will  speedily  quiet  the 
undue  action,  and  so  relieve  the  ])ain." 

He  says:  "The  method  of  employing  the  drug 
has  much  to  do  with  its  etBcacy.  It  should  be 
given  witliout  delay  at  the  very  onset  of  the  disease, 
every  hour  being  important.  Half  a  drop  or  a 
droj)  of  the  tincture  in  a  teaspoonful  of  water  sliould 
be  given  every  ten  minutes  or  ipiarter  of  an  hour 
for  two  hours,  and  afterward  hourly,  but  if  there  is 
much  prostr.ation,  witli  feeble  and  weak  pulse,  a  still 
smaller  dose." 

After  mentioning  a  number  of  acute  afTections  over 
which  aconite  exerts  a  marked  influence,  he  says : 
"  .\conite  proves  useless  in  certain  epidemics'  of 
febrile  inflammatory  sore  throat.  These  cases  are 
met  with  chiefly  during  the  prevalence  of  scarlet 


fever.  The  throat  is  much  swollen,  of  a  very  dusky 
red  color,  and  the  pulse  is  very  frequent  and  very 
weak.  There  is  great  j^rostration,  and  the  symptoms 
are  of  a  marked  typhoid  character.  Here  stimiilants, 
with  the  application  of  a  strong  solution  of  nitrate 
of  silver,  do  most  good." 

If  Dr.  Kinger  had  inve.stigated  this  condition 
more  carefully,  he  would  have  found  that  belladonna 
l^roduces  just  as  remarkalile  results  in  this  as  aco- 
nite in  the  other  variety  of  sore  throat. 

Professor  Bartholow  says :  "  The  monopoly  by 
homceopathic  practitioners  of  the  use  of  aconite  has 
aroused  a  prejudice  against  it  which  has  discour- 
aged its  employment.  Aconite  is,  however,  an  an- 
tagonist to  tlie  fever  jirocess.  It  is  not  ajjplicable 
in  accordance  with  the  so-called  law  of  similars.  It 
is  used  by  these  quacks  because  it  is  a  powerful 
agent,  which  will  produce  manifest  eflects  in  small 
doses  that  may  easily  be  disguised."  He  advises  its 
use  in  the  same  class  of  cases  as  Ringer,  and  in  the 
same  doses,  only  at  longer  intervals.  Dr.  Bartholow 
recognizes  the  condition  of  inflammation  when  the 
parts  are  a  dusky  red,  and  circulation  languid,  and 
there  advises  belladonna. 

According  to  homoeoiiathic  authorities,  "  the 
grand  sphere  for  aconite  is  found  in  all  diseases  that 
emanate  from,  or  have  their  starting-point  in,  the 
cerebrospinal  nervous  system,  and  are  of  a  conges- 
tive, inflammatory,  or  rheumatic  character,  with  full, 
bounding  pulse,  much  heat,  dry,  burning  skin, 
agonized  tossing  about,  violent  thirst,  red  face, 
shortness  of  breath,  and  great  nervous  excitability." 
Vide  Burt's  "  Characteristic  Materia  Medica,"  1873, 
Art.  Aconite. 

"Meicury,"  Professor  Bartholow  says,  "has  a  se- 
lective action  on  the  lymphatic  glandular  system, 
and  notably  on  the  salivary  glands  and  pancreas. 
Among  the  earlier  symptoms  of  the  action  of  mercury 
are  an  increase  of  the  salivary  secretion,  an  altera- 
tion of  its  quality,  fetor  of  the  breath,  swollen 
tongue,  swelling  of  the  parotid,  sublingual  and  sub- 
maxillarv  glands,  etc."  In  the  "Therapy"  he  says  : 
"  The  acute  glandular  aflections  of  the  throat  and 
neck,  tonsillitis,  parotitis,  inflammation  of  the  sub- 
maxillary and  sublingual  glands,  are  often  speedily 
removed  by  mercurial  preparations.  One-twentieth 
of  a  grain  of  calomel,  the  one-fifth  of  a  grain  of  mer- 
cury and  chalk  may  be  given  every  two  hoTirs  "  Now, 
how  are  we  to  know  from  the  above  description  in 
what  form  of  tonsillitis,  parotitis,  etc.,  to  use  the 
mercurials  ?  The  rule  is  a  simple  one  :  where  you 
find  the  symptoms  presented  resembling  those  ob- 
served from  the  eflects  of  mercniy,  yow  may  be 
assured  that  the  frequent  administration  of  minute 
doses  of  mercuiy  will  be  attended  with  the  happiest 
results. 

Kinger  says  :  "  Small  doses  of  mercury  yield  ex- 
cellent results  in  a  form  of  diarrhu-a  con  nion  in 
children.  The  child's  health  is  bad,  the  digestion 
is  imperfect,  generally  with  annoying  flatulent  dis- 
tention, and  three  or  four  ))ale,  clayey,  pasty,  stink- 
ing motions  are  ]>assed  in  a  day.  A  single  grain  of 
bichloride  of  mercury  dissolved  in  half  a  pint  of 
water,  and  a  teaspoonful  of  this  solution  given  each 
hour,  or,  still  better,  one-third  of  a  gray  powder 
every  hour  or  two  hours,  will  in  one  or  two  days 
limit  the  number  of  stools,  and  restore  their  natural 
bilious  color,  even  though  they  have  been  clay-col- 
ored for  weeks.  The  same  weak  bichloride  of  mer- 
cury solution  of  a  single  grain  in  ten  ounces  of 
water,  in  doses  of  a  teaspoonful,  is  veiy  eflioient  in 
another  serious  form  of  diarrhLva  common  in  cliil- 


THE  MEDICAL  RECORD. 


ac7 


dren.  The  chataeteristics  of  this  form  arcTery  slimy 
stools,  especially  if  mixed  with  blood,  and  accom- 
panied by  paiu  and  stsaiuinjj.  The  salient  indica- 
tion for  employing  the  bichloride  is  the  sliniv 
character  of  the  motions  ;  sometimes  the  slime  is 
described  by  the  mother  as  '  hirlips  of  flesh.'  This 
affection  may  be  acute  or  it  may  be  chronic,  and  last 
for  months  ;  but  in  either  case  the  bichloride  cures 
with  remarkable  si^eed  and  certainty.  A  similar 
treatment  relieves  the  dysentery,  acute  or  chronic, 
of  adults,  provided  the  stools  are  slimy  and  bloodv. 
One-hundredth  of  a  grain  of  the  bichloride,  given 
hourly,  or  every  two  hours,  according  to  the  sever- 
ity of  the  case,  is  generally  sufficient,  rarely  failing 
to  free  the  stools  from  blood  and  slime,  although,  in 
some  cases  a  diai-rhosa  of  a  diiierent  character  may 
continue  for  a  slioi-t  time  longei',  requiring,  perhaps, 
other  treatment  to  control  it.  One-sixth  of  a  gi'ain 
of  gray  jjowder  given  hourly  is  of  great  service  in 
infantile  cholera,  characterized  by  incessant  sick- 
ness, with  profuse  and  almost  continuous  diaiTho?a, 
very  offensive  and  copious  motions,  watery,  almost 
colorless,  or  of  a  dirty,  muddy  aspect.  Under  this 
treatment,  the  vomiting  generally  soon  ceases,  and 
the  diarrhoea  shortly  afterward.  Mercury,  as  we 
hare  seen,  proves  very  serviceable  iu  most  forms  of 
infantile  diarrluea,  both  acute  and  chronic.  I  have 
endeavored  to  point  out  categorically  the  circum- 
stances when  one  mercurial  jjrepai'ation  is  preferable 
to  another.  It  may  be  urged  that  as  in  both  severe, 
acute,  and  chronic  diarrbc^a  the  same  pathological 
conditions  are  found,  that  the  same  form  of  mercury 
suitable  for  one  case  would  equally  benefit  another. 
But  though  the  pathological  state  is  held  to  be 
identical,  still  some  hitherto  umletected  differences 
there  must  be,  either  in  the  nature  of  the  disease 
itself  or  of  the  part  it  affects,  for  surely  it  requires  a 
differ-ent  pathological  condition  to  produce  in  one 
case  slimy  stools,  in  another  watery,  and  in  another 
green,  curdy  stools.  These  differences  displayed  iu 
the  symijtoms,  though  at  present  not  discriminated 
pathologically,  require  somewhat  different  treatment. 
Hence,  though  in  each  kind  of  diaiThoea  all  form.s  of 
mercury  are  useful,  it  is  found  that  in  some  cases 
bichloride  of  mercury  is  greatly  to  be  preferred,  and 
in  other  cases  gray  powder." 

Xow,  gentlemen,  after  the  statement  of  Professor 
Kinger,  that  in  one  form  of  diarrhoea  bichloride  of 
mercury  acts  more  satisfactorily,  and  in  another 
form  gray  powder,  where  shall  we  go  to  obtain  some 
explanation  or  reason  for  this  ?  Have  we  an  author 
who  will  point  it  out  to  us  ?  If  we  have,  I  have 
failed  to  find  him.  On  the  contrary,  the  more  I  stud- 
ied the  matter,  the  gi-eater  was  my  confusion,  until  I 
sought  in  homoeopathic  works  for  a  solution,  and 
then  I  found  it  clear  and  simple  ;  and  I  may  say  tliat 
the  indications  for  the  use  of  the  different  mercurial 
preparations,  as  pointed  out  by  the  earlier  homceo- 
pathic  writers,  are  those  by  which  they  are  now 
governed  in  practice.  We  adopt  the  treatment  em- 
pirically, and  are  in  a  measure  successful ;  but  not 
recognizing  the  law  by  which  it  is  administered,  we 
use  the  remedy  at  a  great  disadvantage. 

There  are  two  things  in  homteopathy  that  at  once 
antagonize  the  regular  phvsician.  T!ie  similia  prin- 
ciple, and  the  size  of  the  dose  administered  ;  and  the 
feeling  is  so  bitter,  that  scarcely  a  physician  can  be 
found  who  will  make  the  least  investigation  of  it. 
The  principle  of  similia,  etc..  no  matter  how  much 
.we  may  deny  it,  is  still  the  only  one  by  which  we 
can  explain  the  action  of  many  of  our  most  potent 
remedies.   Second,  in  administering  drugs,  we  aim  to 


give  just  enough  to  prove  cnrative  in  the  disease  -ne 
are  treating.  No  school  of  medicine,  I  believe,  at- 
tempts to  do  more.  Homa?opathists  claim  that 
their  method  of  jireparing  drugs  is  supeiior  to  ours, 
and  that  they  can  obtain  the  .'^ame  results  with  mucli 
smaller  doses.  Dr.  Marcy  ("Homoeopathic  Theory 
and  Practice  of  Medicine,"  jjage  110,  1S50),  writing 
on  this  subject,  says  :  "  The  advantages  which  we 
obtain  from  a  minute  subdivision  of  cnide  substances 
are  as  follows  : 

"Fir^t. — We  develop  evei-y  part  of  the  active 
principle  pertaining  to  the  substance  by  breaking  up 
all  natural  organization  or  arrangement  between  its 
molecules,  and  thus  exposing  a  large  amount  <  f 
active  surface  which  would  otherwise  have  remained 
latent. 

"Second. — By  distributing  these  molecules  inti- 
mately throughout  an  inert  vehicle  (sugar  or  water), 
they  are  far  more  readily  absorbed  by  the  delicate 
lacteals  and  absorbents  than  coarse  and  irritating 
particles  of  matter. 

"  Third. — When  these  minute  atoms  have  been 
conveyed  by  the  blood  to  those  parts  with  which 
they  have  an  affinity,  they  penetrate  the  smallest 
vessels,  impress  the  minutest  sentient  nerves,  atd 
become  productive  of  results  entirely  unattainable 
by  drugs  in  a  cnide  form. 

"Fourth. — During  the  act  of  subdivision,  it  is  not 
improbable  that  the  atoms  of  drugs  sometimes  be- 
come oxidized,  and  thus  acquire  new  and  increased 
powers. 

"Finally. — We  infer  that  no  new  properties  are 
developed  by  the  homa-opathic  method  of  preparing 
drugs,  except  sucli  as  arise  from  the  mere  .subdivi- 
sion of  their  particles,  and  that  all  ideas  respecting 
fpirituali zation,  di^inuiiizalion,  and  mogneiisni  in  the 
preparation  of  medicines  are  erroneous  and  unten- 
able. In  regard  to  the  reijetition  of  doses,  we  aie 
to  be  guided  by  the  aoite  or  chronic  nature  of  the 
malady,  the  urgency  and  danger  of  the  symptoms, 
and  the  effects  produced  by  the  medicine." 

Dr.  H.  G.  Piffard,  Professor  of  Deimatolcgy,  ITni- 
versity  of  New  York,  in  his  "Materia  Medica  and 
Therapeutics  of  the  Skin  "  (article  Mercury},  says  : 
"  Since  we  have  used  the  triturations,  however,  in 
preference  to  the  ordinary  pills,  patient  more  rarely 
complains  of  disagreealjle  sensations.  We  have  fur- 
ther been  enabled  to  materially  reduce  tie  size  of 
the  dose  in  order  to  obtain  the  desired  effect.  In 
other  words,  a  larger  proportion  of  the  drug  is  util- 
ized for  specific  purposes,  while  but  a  small  amount 
remains  to  give  rise  to  local  irritiition."  "I  have 
nothing  to  add  to  this  (he  says),  except  that  I  con- 
tinue to  use  triturations  of  mercui-y  and  other  sub- 
stances with  increasing  satisfaction." 

Dr.  Piffard  began  with  the  first  and  second  deci- 
mal triturations  ;  how  much  higher  he  goes  he  does 
not  say. 

These  are  all  the  drugs  to  which  I  shall  allude  in 
this  paper.  Of  my  own  personal  experience  in  the 
use  of  them  I  shall  s^y  nothing.  My  only  wish  is 
that  we  mav  investigate  the  subject  carefully  and 
wisely,  and  if  we  find  that  the  principle  of  "  similia 
similibus  chrantur,"  even  to  a  limited  extent,  is 
correct,  it  is  our  drrty  at  once  to  admit  it.  And  if 
the  administration  of  dnigs  in  minute  doses,  in  the 
foim  of  dilutions  and  triturations,  is  more  beneficial 
than  when  given  in  the  usual  form  and  way,  we 
should  at  once  acknowledge  it :  and  not  only  that, 
we  should  make  good  use  of  them,  so  far  as  they 
may  go,  in  treating  those  who  may  be  placed  in  our 
care. 


206 


THE  MEDICAL  RECORD. 


To  alleviate  the  pain  and  distress  of  the  sick  in 
the  easiest  and  pleasantest  manner  possible,  ought 
to  be  the  constant  study  of  the  physician,  and  the 
simple  excuse  for  not  investigating  this  subject,  that 
so  much  prejudice  has  been  aroused  by  it,  is  un- 
worthy the  dignity  of  the  medical  profession.  In 
conclusion,  I  wish  it  distinctly  understood  that  I  am 
opposed  to  the  recognition  of  homceopathy  as  prac- 
tised by  most  of  its  advocates  ;  but  that  there  is 
good  in"  it  I  am  firmly  convinced,  and  I  again  repeat 
that  it  is  our  duty  as  physicians  to  thoroughly  inves- 
tigate it,  and  if  we  find  tliat  it  is  to  be  preferred  to 
the  recognized  mode  of  treatment,  there  is  but  one 
course  left  for  us,  and  that  is  to  assign  it  its  proper 
place  in  the  treatment  of  disease. 


Xtss  0f  itU^ical  Science. 


Effects  on  the  Heakt  op  Occlusion  op  the 
Coronary  Arteries. — The  experiments  which  Von 
Bezold  and,  at  a  later  date,  Samuolson  conducted 
on  rabbits  for  the  purpose  of  determining  the  con- 
sequences resulting  from  an  arrest  of  the  circulation 
in  the  nutrient  vessels  of  the  heaxt,  showed  that 
after  ligation  of  the  coronary  artery  the  heart  ceased 
to  pulsate,  the  left  ventricle  coming  to  a  standstill 
a  few  moments  before  the  right,  both  ventricles, 
however,  resuming  their  functions  if  the  ligature 
were  removed  after  the  lapse  of  one  or  two  minutes, 
and  care  taken  to  insure  the  circulation  of  blood 
through  the  previously  occluded  artery.  In  other 
respects  the  conclusions  arrived  at  by  the  two  inves- 
tigators difi'ered.  With  a  view  to  reconciling  these 
differences,  Oohnheim  and  von  Schulthess-Rechberg 
performed  an  analogous  series  of  experiments  on 
dogs,  these  animals  offering  particularly  favorable 
objects  for  investigation,  as  their  coronary  arteries 
course  superficially  beneath  the  pericardium  and 
can  be  isolated  without  any  dissection  worth  men- 
tioning. It  must  be  remembered  that  botli  in  dogs 
and  rabbits,  as  well  as  in  man,  the  individual 
branches  of  the  coronary  arteries  are  true  terminal 
arteries,  so  that  the  ligation  of  any  one  of  these 
branches  shuts  off"  the  circulation  entirely  from 
some  part  of  the  heart,  and  tlius  artificially  induces 
a  condition  identical  with  that  which  obtains  in  man 
in  cases  of  sclerosis  of  the  coronary  arteries  when 
the  contraction  of  their  calibre  has  progressed  to 
such  an  extent  that  any  particular  part  of  the  heart 
is  thereby  deprived  of  the  quantity  of  blood  requi- 
site for  the  performance  of  its  functions.  The  dogs 
experimented  on  were  curarized  and  artificial  respi- 
ration kept  up,  the  heart's  action  being  registered 
upon  Hei-ing's  kynaographion.  The  results  noted 
were  as  follows  :  .\fter  ligation  of  a  branch  of  a  coro- 
nary artery  an  immediate  olfect  was  observed  in  no 
instance.  Toward  the  end  of  the  first  minute,  how- 
ever, an  occasional  beat  was  dropped,  then  the  ac- 
tion of  the  heart  became  markedly  arhythniic  and  at 
the  same  time  retarded,  the  arterial  jircssure  mean- 
while retaining  its  ordinary  heii^lit  until  the  irregu- 
lar rhythm  was  well  established,  when  the  pres- 
sure sank  slightly.  ,\ftor  an  average  lapse  of  10.") 
seconds  after  tighteuiug  of  the  ligature  the  heivrt, 
which  until  then  was  contractiiig  vigorously,  sud- 
denly ceased  to  i)ulsate,  and  the  arterial  pressure 
rapidly  sank  Ui  zero.  Both  ventricles  stopped  beat- 
ing at  exactly  the  same  instant  in  the  condition  of 
diastole,  the  auricles  continuing  to  contract.     From 


ten  to  twenty  seconds  later  very  active  twitching 
iuovements  manifested  themselves  in  the  muscular 
mass  of  the  ventricles,  and  after  persisting  for 
forty  to  fifty  .seconds,  ceased.  Neither  these  twitcL- 
ings  nor  the  contractions  of  the  auricles  have  any 
influence  whatever  upon  the  arterial  pressure.  Once 
brought  to  a  standstill  the  ventricles  cannot  be  mac^e 
to  resume  their  function  by  any  means  employee-. 
In  this  respect,  as  also  in  the  simultaneous  arrebt 
of  both  ventricles,  Cohnheim's  and  von  Schulthess- 
Rechberg's  results  diil'er  very  materially  from  thoEe 
of  von  Bezold  and  Samuelson.  Indeed,  in  the  for- 
mer's experiments,  the  arrest  of  pulsation  reinain(  d 
permanent  even  when  the  ligature  was  removed 
during  the  period  of  arhythmia,  before  the  bleed- 
pressure  sank  to  a  marked  degree.  After  discussirg 
and  negativing  the  various  explanations  ofl'ered  as 
to  the  causation  of  the  above  phenomena,  CoLnheim 
and  von  SchulthessKeehberg  conclude  that  the  ar- 
rest of  function  is  due  to  the  accumulation  of  a  di- 
rectly toxic  agent  in  the  parts  deprived  of  blood. 
They  demonstrate  that  this  is  not  carbonic  acid 
gas,  but  decline  to  hazard  any  opinion  as  to  its  ex- 
act nature  or  composition.  The  same  authors  pei- 
formed  similar  experiments  on  rabbits,  and  found 
that  one-third  of  the  cases  followed  the  same  typi- 
cal course  as  was  observed  in  dogs ;  in  other  cases 
the  blood-pressure  sank  gradually,  the  heart's  action 
also  ceasing  by  degrees,  and  both  ventricles  not  be- 
ing arresteel  simultaneously.  In  the  former  cases 
the  animals  were  strong  and  vigorous,  having  a  high 
blood-pressure,  while  in  the  remaining  cases  the 
subjects  were  weak,  etc.  In  other  words,  a  vigor- 
ously acting  heart  succumb.s  more  rapidly  after  oc- 
clusion of  a  coronary  artery  than  eloes  a  debilitateel 
or  primarily  weak  organ.  This  explanation  also 
serves  to  reconcile  the  differences  noted  in  the  ex- 
periments of  the  authors  anel  those  of  previous  in- 
vestigators, the  dog's  heart  being  by  far  more  pow- 
erful and  resistant  (widerstandsfahig)  than  that  of 
the  rabbit.  At  the  close  of  their  paper  Cohnheim 
and  von  Schulthess-Rechberg  claim  that  the  results 
noteel  in  their  experiments  may  be  applieel  directly 
to  human  pathology,  anel  .serve  to  explain  many  of 
those  cases  of  sudelen  death  which  occur  in  appa- 
rently perfectly  healthy  and  previously  robust  indi- 
viduals, in  which  the  only  pathological  post-mortem 
change  discoverable  is  sclerosis  of  the  coronary  ar- 
tery.— Biologisches  Cenlralblatt ,  November  15,  1881. 

PHTSioLociiCAii  Effects  op  Hyoscine. — Guauck's 
experiments  on  healthy  individuals  with  this  drug  (a 
proeluct  of  the  elecomposition  of  hyose^yamine)  show 
that  it  possesses  many  effects  in  common  with  atro- 
pine and  hyoscyamine,  but  eliffers  in  one  important 
particular.  All  three  proeluce  a  sense  of  pressure  in 
the  head,  dizziness,  elryness  of  the  throat,  thirst, 
nausea,  oppression,  anel  eliminished  frequency  of 
respiration,  flushing  of  the  face,  elilatation  of  the  pu- 
pils, staggering  gait,  elelirium,  etc.  Both  hyoscya- 
mine anel  hyoscine  also  induce  a  .sense  of  fatigue  and 
sleep.  B\it  while  hyoscyamine  anel  atropine  increase 
the  fre(iueney  of  the  pulse,  hyoscine  always  has  a 
contrary  effect,  even  in  very  large  doses.  Further, 
hyoscine  manifests  its  action  promptly  and  power- 
fully, but  the  elVocts  do  not  last  long.  They  vary 
very  much  in  elilferent  iiidivieluals,  and  in  the  same 
individual  at  different  times.  Sometimes  the  mi- 
nute dose  of  0.0001  gramme  produces  alarming 
symptoms,  while  the  minimal  dose  (/.*?.,  the  least 
quantity  requireel  to  produce  any  appreciable  result) 
of  hyoscyamia  is  ten  times  as  great.     At  other  times 


Tife  MEDICAL  RECORD. 


209 


0.0025  of  the  former  are  well  borne.  As  regards  the 
individual  symptoms,  the  retardation  of  the  pulse 
amounts  to  as  much  as  20  beats  per  minute,  reaching 
its  maximum  in  from  ten  to  twenty  minutes  after 
the  administration  of  the  drug,  and  disappearing 
almost  completely  in  about  the  same  length  of  time. 
Dilatation  of  the  pupils  is  a  very  frequent,  but  not  an 
invariable  symptom  :  it  usually  besins  at  the  time 
that  the  pulse  is  regaining  its  normal  frequency,  and 
gradually  increases :  but  not  even  large  doses  of 
hyoscine  act  as  efficiently  in  this  respect  as  do  com- 
paratively small  doses  of  hyoscyamine.  From  five 
to  ten  minutes  after  the  pulse  has  begun  to  return 
to  its  normal  rate,  a  sense  of  fatigue  appears  and 
leads  to  a  deep  and  quiet  sleep,  lasting  from  one  to 
two  hours.  On  the  whole,  Gnauck  concludes  that 
the  action  of  hyoscine  most  resembles  that  of  atro- 
pine. It  is  doubtfnl  whether  the  former  may  be  of 
use  as  a  hypnotic  in  cases  of  insanity,  for,  although, 
it  is  undoubtedly  efficient  in  this  respect,  the  varia- 
tions in  individual  sensitivity  and  the  intensity  of 
the  numerous  secondary  effects  in  small  doses  are 
so  great  as  to  render  inadmissible  the  employment 
of  sutKciently  large  doses. — AllriPineine  medical  Can- 
trcdzeitnng,  November  12  and  IG,  1881. 

The  Digestion  and  Absorption  of  Fat  in  the 
HuinN  Body. — Mr.  Critchett  Bartlett  has  made  a 
series  of  interesting  experiments  on  the  animal  di- 
gestion of  fats  and  oils,  and  rejjorts  the  following 
conclusions  as  the  results  of  his  investigations  : 

The  formation  of  even  the  most  perfect  emulsion 
of  fat  or  oil,  with  water  does  not  of  itself  render  any 
portion  of  them  soluble  in  water,  nor  do  they  take 
up  any  of  the  latter  except  mechanically,  to  become, 
so  to  term  it,  hydrated. 

The  addition  of  alkalies  to  fixed  oils  or  fats  at 
common  temperatures,  whether  the  alkalies  are  as 
hydrates  or  salts,  does  not  affect  such  transformation. 

Mixtures  of  fixed  oils  or  fats  with  water  and  the 
solids  of  the  pancreatic  fluid,  when  kept  for  long 
periods,  promote  the  separation  of  the  fatty  acids 
from  the  glycerine.  Tliis  decomposition  is,  how- 
ever, effected  by  the  disgusting  butyric  fermenta- 
tion, which  is  set  up  in  the  presence  of  putrefyin.g 
nitrogenous  matters  supplied  by  crude  panoreatin, 
and  is  never  found  in  a  healthy  state. 

Siponification  is  not  the  only  natural  solution  of 
fatty  matters  in  water  at  the  temperature  of  the 
body. 

Fatty  matters  are  found  in  the  pancreatic  fluid 
and  in  the  pancreas,  in  a  tree  state  ;  in  solution  with 
water  (hydrated)  ;  and  are  also  slightly  saponized 
in  the  intestine.  These  or  some  of  these  different 
forms  of  fat  are  distinguishable,  in  combinations  of 
various  proportions,  m  the  intestine,  the  pancreatic 
gland,  the  thoracic  duet,  and  while  the  fat  or  oil  is 
passing  through  the  walls  of  the  absorbents. — Epi- 
tome of  Laboratory  Xotes.     London,  1877. 

A  ScccEssFui  Case  of  Intra- Aetebiai/  Transfu- 
sion OF  AN  Ai-kamne  Solution  of  CniiORiDE  of 
Sodium. — Bischoff  reports  the  following  case.  The 
patient,  a  woman  of  thirty-one,  primipara,  was  de- 
livered with  forceps  on  October  Sth.  of  a  dead  child 
welshing  3,4.50  grammes.  The  bag  had  already  rap- 
tured, forty-one  hours  previously,  the  abdomen  hav- 
ing been  vei-y  sensitive  for  several  days.  This  sensi- 
tiveness continued  to  increase  after  the  evacuation 
of  the  fetid  waters.  On  October  7th,  toward  even- 
incr,  the  temperature  had  risen  to  38.1'  C,  the 
pulse  being  100.  On  the  morning  of  October  8th, 
a  chill  occurred,  with  a  temperature  of  40'  C,  the   i 


latter  falling  shortly  before  delivery,  at  five  p.m.,  to 
38.7°  C.  The  birth  of  the  child  was  followed  by 
considerable  hemorrhage,  and  fifteen  minutes  later 
the  placenta,  firmly  adherent  to  the  right  side  of  the 
fundus  uteri,  was  extracted  manually,  during  which 
IJrocedure  an  additional  quantity  of  blood,  weighing 
1,400  gi-ammes,  was  lost.  The  uterus  now  contracted 
firmly  and  no  more  blood  e.=ca2)ed,  but  the  patient 
was  in  a  state  of  extreme  collapse,  the  pulse  being 
at  times  not  perceptible,  at  others  156  in  the  min- 
ute ;  respiration,  42  ;  extremities  cold,  etc.  Postu- 
cal  treatment  with  the  head  low,  stimulants,  etc., 
had  no  effect.  The  left  radial  artery  was  then  ex- 
posed, incised,  and  the  central  end  ligatured  ;  a 
hard-rubber  canula  was  now  passed  into  the  jjeriph- 
eral  end  of  the  artery,  and  through  this,  by  means 
of  a  glass  funnel  and  a  tube  of  india-rubber  (previ- 
ously immersed  in  dilute  carbolic  acid),  1,250 
grammes  of  a  six-tenths  per  cent,  solution  of  com- 
mon salt,  to  which  a  coujile  of  drops  of  liquor  potassse 
had  been  added,  were  injected  in  the  cour.se  of  just 
one  hour.  During  the  transfusion  the  patient  ral- 
lied considerably,  the  pulse  gi-adually  falling  to  122, 
and  the  restlessness  j^assing  otf  completely.  Ex- 
cepting a  transient  and  slight  attack  of  perimetritis 
and  incipient  mastitis,  patient  recovered  without  a 
bad  symptom.  Bischoff' calls  attention  to  the  fact 
that  no  sign  of  oppression,  etc.,  such  as  usually  oc- 
cur during  and  after  transfusion  of  blood  wa.s'  ob- 
served in  this  case.  Of  course  the  operation  is  not 
indicated  in  acute  anaemia  with  impaired  function 
of  the  h:ematogenic  organs,  such  as  the  spleen  and 
maiTOW.  The  quantity  employed  should  be  at  least 
500  grammes,  and  the  solution  should  be  rendered 
alkaline,  as  pointed  out  by  Schwartz,  'Worm-Miiller, 
and  Goltz.  preferably  by  the  addition  of  the  hy- 
drated oxide  of  sodium,  which  was  not  used  in  the 
case  above  cited  simply  liecause  it  was  not  at  hand. 
The  reason  why  an  artery  is  to  be  sekcted  in  pre- 
ference to  a  vein  is  because  the  subcutaneous  veins 
are  found  with  great  difficulty  in  cases  of  extreme 
acute  anaimia. — Coii-esprmdenz  blatt  fuer  Schveieer 
Ae}-zte,  December  1,  1881. 

An  Epidemic  of  Erysipelas  and  DrPHTHEHiA. — 
According  to  Dr.  J.  G.  Meachem,  of  Eacine,  Wis., 
the  Northwest  has  lately  been  visited  by  more  or 
less  severe  epidemics  of  diphtheria  and  erysipelas, 
which  have  been  connected  with  one  another  in 
a  singular  manner.  For  a  period  of  six  months 
Eacine  was  the  point  selected  for  this  strange  visita- 
tion— one  disease  following  or  preceding  the  other 
in  attacking  the  same  family ;  sometimes  both  visit- 
ing different  members  at  the  same  time.  Of  eight 
cases  detailed,  the  following  is  one  of  the  most 
remarkable  :  A  gentleman,  fifty  years  of  age.  was 
staying  with  his  brother,  when  a  violent  fever,  in- 
troduced by  a  chill,  set  in,  and  shortly  afterward 
diphtheritic  exudations  were  detected.  On  the 
fourth  day  ei-ysipelas  appeared  upon  the  cheek  and 
nose,  extending  finally  over  the  whole  hairy  scalp. 
"While  convalescing,  a  niece  .showed  evidence  of  diph- 
theria, and  then  the  brother  fell  a  victim  to  eiwsip- 
elas,  while  the  wife  in  her  turn  had  diphtheria. 
Thus,  in  a  family  of  four,  there  were  three  examples 
of  diphtheria  and  two  of  erysipelas  at  or  about  the 
same  time— one  indi%-idual  having  first  diphtheria 
and  then  ery.sipelas.  The  writer  is  inclined  to  be- 
lieve that  the  two  poisons  are  identical,  but  obsei-ves 
that  in  a  practice  of  forty  years  he  had  never  before 
seen  this  curious  inter-relation  of  the  affections. — 
Trai'sactioyi.t  Slate  Medical  Society  of  ^Viscon^in,  1883. 


210 


THE  MEDICAL  RECOftD. 


The  Medical  Recoud: 


Z  lUccklM  Journal  of  JllcMcine  anb  Suvgcvg 


GEORGE  F.  SHRADY,  A.M.,  M.D.,  Editor. 


PUBLISOED    BY 
W.n.  WOOD  &  CO.,  No.  27  Great  Jones  SI.,  N.  H. 


New  York,  February  25,  1882. 


JIEDICAL  LEGISLATION. 

The  results  of  the  variou.s  attempts  made,  in  this 
and  other  States,  to  regulate  the  practice  of  medi- 
cine, have  not  been  very  striking.  Still  it  must 
be  admitted  that  substantial  jjrogress  has  Vieen  made 
in  the  right  direction.  At  least  we  are  beginning  to 
learn  what  can  possiblv  be  obtained,  and,  conse- 
quently, are  not  given  so  much  as  formerly  to  make 
impracticable  demands.  The  public  is  being  edw- 
cated  to  the  necessity  of  protecting  itself  against 
fraud  and  quackery,  and  is  showing  a  willingness  to 
listen  to  ai'guments  to  that  end.  The  groundwork 
is  a  broad  one,  and  must  be  carefully  worked  over 
before  the  ultimate  results  are  obtainable.  The  en- 
couragement to  the  medical  profession  to  go  on  is, 
however,  signiiieant  and  substantial.  Tlie  history 
of  medical  legislation  in  this  State  proves  this,  not- 
withstanding the  oft-ropeated  assertion  of  some 
that  all  attempts  at  legislating  in  behalf  of  legiti- 
mate medicine  are  failures.  The  present  law  is  by  no 
means  a  perfect  one,  that  is,  so  far  as  the  practical 
enforcement  of  its  provisions  are  concerned  ;  but  it 
is  a  great  advance  on  anything  heretofore  attempted. 
Experience  has  shown  its  defects,  and  measures  will 
be  tak(m  ere  long  to  remedy  them.  The  perjury 
clause  will  be  made  more  comprehensive  and  more 
stringent,  so  that,  in  case  the  proposed  bill  passes, 
there  will  be  little  if  any  chance  of  escaping  the 
panalties  by  an  aj^peal  to  legal  technicalities. 

Thus  much  having  been  effected,  the  way  wiU  be 
prepared  for  other  enactments  looking  toward  projjer 
qualifications  for  practice.  Foremost  among  these 
will  be  compulsory  State  examinations  for  license. 
There  is  no  doubting  the  fact  that  the  profession  is 
almost  a  unit  on  this  point.  Impartial  examination 
is  the  only  trustworthy  guarantee  for  professional 
qualifications  of  any  kind.  Without  wishing  to  cast 
any  reflection  upon  the  methods  of  faculty  examina- 


tions, we  must  admit  that  they  are  open  to  grave 
abuses.  The  colleges  shorJd  be  nothing  more  than 
schools  for  teaching.  Their  charters  empower  them 
to  grant  diplomas,  biit  the  licensing  power  need  not 
be  coupled  with  this  privilege.  They  can  certainly 
be  separated  without  casting  any  particular  reflec- 
tion upon  the  mere  ability  of  a  given  faculty  to  judge 
of  the  qualifications  of  its  candidates  for  gradua- 
tion. 

There  is  a  law  in  this  State  providing  for  inde- 
pendent examinations  by  a  board  appointed  by  the 
regents  of  the  university,  but  such  examinations  are 
not  compulsory.  It  has  been  recommended  by  the 
Medical  Society  of  the  County  of  New  York  that  an 
alteration  in  the  present  law  be  made  to  meet  what 
appears  now  to  be  a  necessity.  There  is  hardly  a 
doubt  that,  when  the  time  comes,  it  will  receive  the 
endorsement  of  the  majority  of  the  profession  of  the 
State.  The  only  possible  opposition  may  come 
from  the  colleges ;  but  the  leading  medical  schools 
will  hardly  consider  it  good  policy  to  object  to  rea- 
sonable tests  of  a  high  standard  of  acquirements. 
The  greater  the  number  of  graduates  that  can  pass 
a  strictly  impartial  board,  the  better  it  must  be  for 
the  reputation  of  the  institution  educating  them. 
The  graduates  of  the  leading  schools  could  certainly 
pass  such  a  board,  while  mediocre  colleges  would 
either  be  spuiTed  to  greater  diligence  in  training 
their  students,  or  would  drop  out  of  the  lists  alto- 
gether. Such  pruning  would  certainly  do  no  harm, 
save  to  incompetent  teachers.  Once  establish  State 
examinations  by  boards  appointed  for  the  purpose, 
and  we  adopt  one  of  the  surest  methods  of  suppress- 
ing quackery  and  illegal  practices  that  is  possibly 
obtainable.  "We  are  certainly  working  in  that  direc- 
tion. Definite  action  on  this  point  was  delayed  by 
the  State  Society,  at  its  recent  meeting,  only  for 
the  simple  reason  that  it  was  not  quite  prepared  to 
do  so.  But  the  necessary  action  is  quite  certain  to 
be  taken  at  the  nest  annual  session,  and  with  pos- 
sibly little  or  no  opposition  on  the  part  of  the  mem- 
bers. 

We  see  no  reason  why  medical  graduates  should 
not  be  subjected  to  the  same  tests  as  are  graduates 
from  our  law  schools.  Formerly  it  was  the  practice 
to  admit  to  the  bar  all  who  received  their  diplomas 
from  the  law  faculties.  Now,  however,  an  extra  and 
independent  examination  is  demanded  by  a  board  of 
judges  before  a  license  can  be  obtained.  Tlie  direct 
result  of  this  has  been  the  raising  of  the  standard> 
and  the  weeding  out  of  incompetent  practitioners. 
The  result  would  be  the  same  in  the  ranks  of  medi- 
cine, and  no  one  would  be  legally  cpialified  to  prac- 
tise his  ju'ofession  who  was  not  thoroughly  competent 
to  do  so,  and  the  punishment  of  tlie  unqualified 
man  or  the  pretentious  quack  would  be  a  compar- 
atively easy  matter.  Such,  after  all,  is  the  real  end 
of  all  efforts  to  regulate  the  practice  of  medicine 
and  protect  the  public  against  quackeiy. 


THE  MEDICAL  RECORD. 


211 


THE  NEW   YOUK   PHTSICIANS    llUTUAIi   AID   ASSOCIATION. 

^\'e  have  received  the  thirteenth  anniial  report  of 
the  above  association,  and  learn  from  it  that  the 
past  year  has  been  one  of  nuusnal  prosperity.  The 
increase  of  membership  is  doxible  tliat  of  the  pre- 
vious year,  and  the  permanent  fnnd  has  been  in- 
creased to  nearly  nine  thousand  dollars.  It  is 
greatly  desired  that  this  amount  be  increased  to 
ten  thousand  dollars,  since  not  till  then  can  the 
proceeds  from  it  be  utilized.  The  sum  of  five  hun- 
dred dollars  has  already  been  oflfered  by  one  gentle- 
man, on  condition  that  the  remaining  amount  be 
made  \\p  by  the  ti-ust^es. 

The  work  and  oV)jects  of  the  Physicians' Aid  As- 
sociation have  often  been  alluded  to  by  us.  Its  aim 
is  to  atford  pecuniary  aid  to  the  widows  and  chil- 
dren of  its  deceased  members,  by  a  regular  system 
of  assessments  upon  the  living.  It  is  a  kind  of 
mutual  life  in.surance  company  upon  a  moderate 
scale,  but  conducted  with  the  gi-eatest  economy,  and 
not  attended  with  the  risks  of  the  larger  corpora- 
tions. At  present,  on  the  death  of  a  member,  all 
the  other  members  admitted  under  fifty  years  of 
age  are  assessed  one  dollar ;  all  those  admitted  when 
above  fifty  years  of  age  are  assessed  two  dollars.  In 
this  way  there  was  obtained  and  paid  to  the  estates 
of  deceased  members  last  year  the  sum  of  SI, 540.  In 
some  cases  members  can  be  helped  also  when  they 
are  sick.  As  soon  as  the  permanent  fund  reaches 
ten  thousand  dollars,  money  can  be  used  to  help  the 
widows  and  children  of  deceased  members. 

It  is  needless  to  say  that  the  objects  of  the  associ- 
ation are  most  praiseworthy,  and  that  it  has  already 
done  much  good.  As  nothing  succeeds  like  success, 
there  is  a  particularly  good  prospect  before  the 
society,  now  that  the  pei'manent  fund  is  so  large,  that 
it  can  soon  be  utilized.  The  officers  of  the  society 
have  worked  faithfully  and  hard,  and  they  well  de- 
serve the  reward  of  success  and  appreciation  likely 
to  be  tendered  them. 


QrACKS   .VXD   REUGIOUS   PEOPLE. 

Ix  a  paper  on  the  subject  of  "  Quackery,  Ancient 
and  Modern,"  read  by  JMr.  Nelson  Hardy  before  one 
of  the  London  branches  of  the  British  Medical  Asso- 
ciation, the  following  proposition,  among  others, 
was  formulated  :  "  Quackery  most  readily  finds  its 
victims  among  the  highest  and  lowest  social  strata, 
not  among  the  more  intelligent  middle  classes ; 
readili/  also  among  religioiui  people;  hence,  certain 
quacks  always  advertise  largely  in  the  (so  called)  re- 
ligious periodicals." 

Mr.  Hardy  refers  in  the  above  to  the  advertise- 
ments, not  of  quack  nostnims,  but  of  quacks  them- 
selves— persons  who  proclaim  that  they  can  cure 
"  catarrh,"  or  consumption,  or  cancer,  or  the  various 
physical  aberrations  of  "  erring,  but  noble  young 
men."     The  statement  made  that  these  persons  ad- 


vertise more,  proportionately,  in  religious  journals 
than  in  any  other  class,  is,  we  fear,  a  correct  one, 
both  for  this  country  and  England. 

If  it  is  a  fact,  it  is  one  that  deserves  attention  from 
the  clergy  and  the  religious  press.  There  is  nothing 
criminal  or  wrong  in  a  person's  being  imposed  upon 
by  quacks ;  and  it  may  even  be  to  one's  credit  that 
he  does  not  live  in  an  altidude  of  constant  sharp- 
ness and  suspicion.  The  mental  altitude  of  the 
Christian,  whether  devout  or  otherwise,  is,  as  a 
rule,  one  of  confidence  and  faith  toward  religious 
teachers  and  writers,  and  all  connected  therewith. 
He  would  beHeve  the  professions  of  one  who  claimed 
to  cure  consumption,  if  made  in  his  religious  jour- 
nal, when  he  would  not  if  it  were  seen  elsewhere. 
Ought  the  religious  press  to  take  advantage  of  this 
fact  •? 

We  commend  to  the  Christian  public  Mr.  Hardy's 
conclusion  :  that  religious  people  are,  through  the 
agency  of  their  jjieriodicals,  the  most  imposed  upon 
of  almost  all  classes. 


THE   FIRST   KESECTIOS    OF    THE    STOMACH    FOB    GASTRIC 
TLCER. 

On  November  21,  1881,  Dr.  Rydygier,  of  Ktilm, 
performed  the  operation  of  partial  resection  of  the 
stomach  in  a  case  of  perforating  gastric  ulcer  with 
dilatation.  The  fact  that  the  patient  has,  up  to  the 
present  time,  been  greatly  benefited,  gives  some 
justification  to  this  most  radical  and  ventiiresome 
mode  of  treatment,  and  the  oi^eration,  as  thus  applied, 
in  a  new  class  of  disease,  may,  in  a  certain  minor  de- 
gree, be  considered  an  epochal  one.  The  patient 
was  a  married  woman,  thirty  years  of  age.  In  1878 
the  first  symptoms  of  gastric  trouble  came  on,  but 
they  were  not  severe  until  the  beginning  of  1880. 
She  then  commenced  to  have  acid  eructations  and 
frequent  vomiting.  In  February  she  vomited  blood 
and  had  bloody  stools.  After  that  date  the  vomiting 
kei^t  up  in  a  very  regular  manner.  The  patient 
would,  for  a  few  days  feel  tolerably  well,  the  abdo- 
men would  increase  in  size,  then  she  would  be  fever- 
ish, and  feel  ill  for  two  or  three  days  ;  finally,  the 
whole  culminated  in  attacks  of  vomiting,  in  which 
the  stomach  emptied  itself  of  eight  or  ten  quarts  of 
liquid  and  solid  matters. 

When  the  patient  was  examined,  previous  to  the 
operation,  the  bodily  organs  were  found  to  be 
healthy,  with  the  excejition  of  the  stomach.  Five 
litres  of  water  were  poured  into  this  organ,  and  its 
boundaries  well  marked.  The  greater  cui-vature 
reached  to  the  symphysis,  the  lesser  to  a  point  just 
above  the  navel.  The  diagnosis  was  :  ulcer  of  the 
pyloric  end  of  the  stomach,  with  consequent  con- 
striction of  the  pylorus  and  great  dilatation  of  the 
rest  of  the  organ. 

The  patient  was  prepared  for  the  operation  by 
daily  washuig  out  the  stomach  with  salicylic  acid 
water. 


213 


THE  MEDICAL  RECORD. 


The  details  of  the  operation  are  given  by  Dr.  Eydy. 
gier,  with  great  minuteness,  in  the  Berliiiei-  lihiische 
Wocherischrifl,  where  tlie  case  is  reported. 

The  abdominal  wall  was  divided  in  the  linea  alba 
for  the  distance  of  10  ctm.,  the  larger  half  of  the  in- 
cision being  above  tli  ^  navel  ;  the  drawing  out  of  the 
I)_vloru3  was  then  accomplished  with  no  gi'eat  diffi- 
culty. The  separation  and  removal  of  the  diseased 
part  was,  however,  attended  with  much  trouble  and 
delay.  The  pylortis  was  immensely  thickened,  and 
firmly  bound  ijosteriorly  to  the  pancreas,  so  that 
a  portion  of  that  organ  had  to  be  removed,  as  also 
some  of  the  omentum.  The  whole  pyloric  sphincter, 
with  the  part  of  the  posterior  wall  in  which  lay  the 
ulcer,  was  removed.  The  piece  measured  anteriorly, 
1.7  ctm.  ;  posteriorly,  .5  ctm.  in  length.  It  contained 
the  pyloric  orifice,  whose  lumen  just  admitted  a  No. 
0  bougie.  The  ulcer  was  two-thirds  of  an  inch  deep, 
and  nearly  two  inches  long. 

The  stomach  was  united  to  the  duodenum  by 
thirty-two  internal  and  twenty-nine  external  catgut 
ligatui-es.  The  lines  of  union  were  powdered  with 
iodoform. 

The  i)rogress  of  the  patient  after  the  operation 
was  almost  uninterruptedly  favorable.  There  was  a 
little  vomiting  for  the  first  few  days.  Food  was 
given  by  the  rectum  for  the  first  four  days,  then  soiip 
was  taken  by  the  mouth  ;  two  days  later  there  was  a 
passage  from  the  bowels.  The  temj^erature  rose  at 
times  to  102'  or  103°. 

Six  weeks  after  the  ojjeration  there  had  been  no 
return  of  the  attacks  of  vomiting,  the  digestion  was 
good,  and  the  patient  was  rej^orted  to  consider  her- 
self well. 

Dr.  Bvdvgier"s  operation  must  be  considered  a 
most  brilliant  feat  of  surgery,  looked  at  from  what- 
ever point  of  view.  There  are,  however,  very  few 
cases  of  gastric  ulcer  which  present  just  the  combi- 
nation of  pathological  conditions  which  might  indi- 
cate resection.  The  actual  permanent  benefit  of  the 
present  operation  has  also  yet  to  be  determined. 
The  regulating  action  of  the  j)ylorus  is  likely  to  be 
iuterfered  with,  and  pyloric  incontinence,  as  Ebstein 
has  shown,  is  a  condition  which  may  excite  many 
bad  symptomp. 


THE   OrERATIOX    FOR   EXTIRPATION   OP   THE   KIDNEVS. 

In  a  paper  read  before  the  Giittingen  Society  of 
Medical  Sciences,  Dr.  J.  Rosonbach  reviews  the  sub- 
ject of  extirpation  of  the  kidney,  and  contributes  a 
case  of  his  own.  Dr.  Rosenbach  naturally  thinks 
that  the  operation  is  not  performed  as  often  as  it 
should  be.  He  finds  in  surgical  literature  the  rec- 
ords of  sixty-five  cases.  Before  Simon's  nei)hrec- 
tomy  in  1860,  there  had  been  only  two  cases,  one  in 
18G1  and  one  in  1868.  After  Simon's  case,  the  op- 
oration  was  performed  two  or  three  times  every  year 
until  1878. 


The  general  introduction  of  antiseptic  precautions 
at  that  time  increased  the  number  of  cases.  In 
1878  there  were  five  ;  in  1879,  eight ;  in  1880,  fif- 
teen ;  and  in  1881,  nineteen  nephrectomies  reported. 

The  indications  for  the  operation,  as  shown  by  the 
histories,  are  quite  numerous.  They  are  enumer- 
ated by  Rosenbach  as  follows:  1,  tumors;  2,  wan- 
dering kidney  wlien  it  causes  serious  disturbance  ; 
3,  cystic  kidney ;  4,  urinary  fistulse  ;  5,  calculi  in  the 
pelvis  of  one  kidney  ;  6,  painful  afiections  of  one 
kidney,  not  due  to  calculi ;  7,  pyelitis,  or  suppura- 
tive kidneys,  with  or  without  calculi ;  8,  tubercu- 
losis of  the  kidney ;  0,  early  injuries ;  10,  intimate 
union  with  abdominal  tumors  which  have  to  be  re- 
moved. 

The  mortality  from  the  operation  of  nephrectomy 
is  not  so  serious  as  might  be  supposed.  In  the 
65  cases  reported,  28  died  and  37  recovered.  The 
mortality,  however,  ought  not  to  be  considered 
apart  from  the  conditions  which  led  to  the  operation. 
Thus,  out  of  the  13  cases  in  which  kidneys  were  re- 
removed  on  account  of  tumors,  9  died  and  4  got 
well.  In  the  9  operations  for  wandering  kidney, 
2  died  and  7  recovered.  In  9  extirpations  of  hydro- 
nephrotic  and  cystic  kidneys,  there  were  3  deaths 
and  6  cures.  In  17  cases  of  suppurative  kidneys, 
with  and  without  stones,  there  were  7  deaths  and  10 
cures. 

The  operation  for  the  latter  class  of  cases  is  the 
one  most  frequently  performed,  and  so  far  it  has  had 
the  best  results.  Dr.  Rosenbach's  case  was  one  of 
this  kind.  The  patient  was  a  man  forty-two  years 
of  age,  who  gave  a  history  of  perfect  health  until 
the  renal  trouble  appeared.  The  diagnosis  of  a 
unilateral  i)yelitis,  probably  from  calculus,  was 
based  upon  the  following  facts  :  attacks  of  renal 
colic  occurred  upon  the  right  side  alone  ;  the  pa- 
tient at  times  passed  perfectly  clear  urine,  which 
contained  no  casts  and  was  of  normal  specific  gi'av- 
ity ;  the  right  kidney  was  painful  and  tender,  the 
left  was  not. 

The  operation,  which  was  performed  essentially 
according  to  Simon's  method,  was  successful,  and 
confirmed  the  diagnosis.  The  patient  recovered, 
and,  four  months  later,  was  doing  well.  The  daily 
amount  of  urea  and  iirine  passed  was,  as  is  usually 
the  case,  about  the  same  as  normal. 


TiTE  Transfusion  of  Saline  Solftions  in  Casks 
OP  Hemouriiacie. — Several  years  ago  Goltz  tried  to 
show  that  in  severe  hemorrhages  the  cause  of  death 
was  not  so  much  tlie  lo.ss  of  red  V)lood-cori)U.«icles  ns 
the  emptying  the  arteries  of  fluid,  so  that  their 
cavities  were  incomiilotoly  filled.  Dr.  E.  Schwartz, 
of  Halle,  acting  upon  this  view,  experimented  with 
dogs,  and  found  that  when  they  were  almost  mori- 
bund from  loss  of  blood  the  injection  of  alkaline 
saline  solutions  restored  them,  rapidly  raised  the 
blood-pressure  and  relieved  the  symjitoms.  The 
next  thing  is  to  try  it  on  man. 


THE  MEDICAL  RECORD. 


218 


Hrports  of  Socirtieg. 


NEW  YOKK  ACADEMY  OF  JIEDICESTE. 

Sfaird  Meethui,  Febriuny  16,  1882. 

FoBDYiE  Barkek,  M.D.,  LL.D.,  President,  in  the 
C'haib. 

The  Librarian  reported  that  there  had  been  donated 
to  the  library,  since  the  last  stated  meeting,  117 
bound  and  7  unbound  volumes,  15  i^amphlets,  and 
545  medical  journals. 

The  President  introduced  Dr.  Murray,  U.S.A.,  and 
Dr.  Richardson,  of  Rome,  Ga.,  and  invited  them  to 
seats  uiion  the  platform. 

Dk.  a.  a.  SiUTH  then  read  a  paper  entitled 

CLrNIC.\I/   OBSERVATIONS   ON   DIAUETES   MELLITUS. 

"Within  the  last  thi-ee  years /o(«-  cases  of  diabetes 
mellitus,  under  the  observation  of  Dr.  Barker  and 
himself,  gave  very  similar  histories  : 

Case  I. — Mr.  X ,  sixty  years  of  age,  suffered 

from  mental  depression,  disturbed  sleejj,  inability 
to  concentrate  his  thoughts  upou  his  woik,  and  had 
an  unusual  sense  of  muscular  fatigue.     He  had  lost 
flesh   markedly,    had    considerable   thirst   -nithout 
much  perspiration.     There  had  been  no  special  in- 
crease in  the  quantity  of  urine,  no  increase  of  ap- 
petite— if  anything  it  was  less  than  usual.     He  came   j 
for  treatment  because  of  disturbances  of  digestion 
and  mental  depression.     He  was  irritable  and  ner- 
V0U.S,  and  constantly  had  a  feeling  that  something 
terrible  was  about  to  occur.     He  was  a  good  liver,   j 
had  been   accustomed   to   use  wine   more   or  less   j 
freely,  especially  of  the   sweet  variety,  and  eham-   \ 
pagne.     He  had  at  times  hepatic   and  gastric  dys- 
pepsia.    He  had  not  liad  any  special  mental  strain,    i 
no  injury,  severe  or  sudden  shock  to  the  nervous 
system,   had   never   had   malaria,  and  was  without 
hereditary  tendency  to   disease.     His  urine  had  a 
specific   gravity  of  103i,  contained  a  considerable 
quantity  of  sugar,  no  albumen,  microscopical   ex-   \ 
amination  was  negative,  and  the  quantity  passed  in   , 
twenty-four  hours  was  sixty-five  ounces.  i 

Case  II. — Mr.  Y .   forty-nine  years  of  age,  a   | 

literaiy  gentleman  and  hard  student,  came  com- 
plaining of  intense  mental  depression.  He  was 
naturally  inclined  to  take  a  very  serious  view  of 
everything.  He  had  suffered  from  severe  attacks  of 
headache  from  childhood.  He  had  already  tried  a 
process  of  dieting,  and  upon  the  use  of  farinaceous 
articles  his  symptoms  had  increased  in  severity. 
He  had  always  been  excessively  fond  of  sweets.  He 
had  thirst,  his  skin  was  dry,  and  the  quantity  of 
urine  was  increased  to  from  two  liundred  to  two 
hundred  and  thirty  ounces  in  twenty-four  hours. 
He  had  mai'ked  muscular  weakness,  and  had  lost 
thirty-four  pounds  of  flesh  within  four  months. 
He  had  never  had  gout  or  rheumatism.  The  urine 
had  a  specific  Kra\'ity  of  1036,  and  contained  sugar. 

Case  III. — Mr.  Z •  had  substantially  the  same 

symptoms  as  presented  in  the  above  ca.ses.  He  had 
had  one  distinct  attack  of  gout ;  aside  from  that  no  se- 
vere illness,  or  accident,  or  severe  shock  to  the  ner- 
vous system.  He  was  excessively  fond  of  sweets.  He 
had  no  hereditary  tendency  to  any  disease,  and  had 
no  skin  affection.  His  urine  had  a  specific  gravity 
of  1035,  contained  considerable  sugar,  and  the  quan- 
tity passed  in  twenty-four  hours  was  eighty  ounces. 


THE   TREATMENT. 

The  treatment  adopted  in  all  these  cases  eonsisted 
in  the  administration  of  coclei a  one- fourth  of  a  grain 
t.  i.  d.,  gi-adually  increased  to  one  grain  thiee  tines 
a  day ;  the  tincture  of  the  chloride  of  iron,  twenty 
drops  t.  i.  d.;  and  a  laxative  pill  consisting  of  aloes, 
nux  vomica,  and  hyoseyamus.  The  patients  were  al- 
lowed to  drink  as  much  water  as  they  desired.  The 
diet  was  that  ordinarily  prescribed  for  diabetic  pa- 
tients and  such  as  can  be  found  in  the  diflerent 
books  upon  the  subject. 

These  patients  came  under  observation  at  nearly 
the  same  time  and  were  subjected  to  the  same  plan 
of  treatment,  and  in  each  there  was  a  marked  im- 
provement manifested  promptly,  atd  at  the  end  of 
four  months  sugar  had  entirely  disappeared  frt  m 
the  urine,  the  specific  gravity  was  respectively  1022, 
1020,  and  1018,  and  the  j^atients  expressed  them- 
selves as  feeling  entirely  well.  The  treatitent  was 
continued  for  three  months  longer,  and  the  iron  wss 
continued  still  further  on  account  of  the  aramia. 
More  than  a  year  had  elajised  since  sugar  disap- 
peared from  the  urine  and  it  had  not  reappeared. 

One  point  of  interest  was  the  fact  that  in  these 
three  cases  the  patients  were  hard-working  men 
mentally,  suffered  from  disturbances  of  digestieu  ard 
mental  depression,  and  led  a  sedentary  life,  with  but 
little  muscular  exercise. 

Their  histories  seemed  to  point  to  elisturbances  of 
the  nervous  .system  as  connecteel  with  the  causation 
of  the  diabetes. 

All  these  patients  were  excessively  fond  of  sweets, 
an  important  fact  in  connection  with  diet  as  a  cause 
of  the  disease.  If  a  mere  coincidence,  it  was  a  sin- 
gular one. 

The  order  of  events  in  these  cases  seemed  to  be  : 
(1)  continuous  strain  upon  the  nervous  system  ;  (2), 
disturbances  of  gastric  and  hepatic  eligestion,  with 
excessive  fondness  for  sweets ;  and  (3),  sugar  in  the 
urine. 

The  speaker  then  refeiTed  to  the  emaciation  so 
uniformly  present  in  diabetes,  and  asked.  Is  it  not 
probable  that,  in  those  cases  in  which  emaciaticn 
goes  on  rapidly,  there  is  disease  of  the  pancreas, 
either  as  cause  or  effect '? 

At  this  point  reference  was  made  to  the  case  of 
the  mother  of  a  family,  who  had  had  unusual  and  ex- 
cessive anxiety  from  domestic  causes.  Her  nrine 
had  a  specific  gravity  of  103i,  contained  sugar  in 
abundance,  and  the  quantity  passed  was  200  ounces 
in  twenty-four  hoiirs.  The  treatment  adopted  was 
the  same  as  that  already  reported,  with  the  addition 
of  five  drops  of  the  tincture  of  belladonna,  because 
of  the  drowsiness  jn-oduceel  by  the  codeia,  and  the 
omission  of  the  iron.  The  urine  rajjidly  diminished 
in  quantity,  as  also  did  the  sugar,  and  at  the  end  of 
three  weeks  the  specific  gravity  was  1,028,  and  the 
patient  felt  so  well  that  she  could  not  be  induced  to 
continue  treatment  any  longer.  She  was  without 
treatment  twenty-three  days,  when  the  former  symp- 
toms began  to  return,  the  specific  gravity  of  the 
urine  was  1,032,  the  quantity  passed  in  twenty-four 
hours  150  ounces,  and  it  contained  sugar  in  abun- 
dance. The  treatment  was  resumed,  and  again  the 
general  condition  of  the  patient  was  improving. 
The  case  was  still  under  observation. 

Case  IV. — A  gentleman,  first  seen  in  1873.  He 
had  lost  fifty  pounds  in  weight.  His  urine  had  a 
specific  gravity  of  l.Oi-l,  contained  sugar  in  great 
abundance,  and  the  quantity  passed  in  twenty-four 
hours  varied  from  200  to  220  ounces.  He  was  placed 
upon  the  use  of  codeia,  the  proper  diet,  and  the  free 


214 


THE  MEDICAL  RECORD. 


use  of  claret  with  his  meala,  and  in  eighteen  months 
he  gained  in  weight  thirty-flve  pounds,  and  the  spe- 
cific gravity  and  quantity  of  the  urine  had  reached 
the  normal,  sugar  had  disappeared,  and  at  tlie  pres- 
ent time  he  was  in  excellent  physical  condition.     . 

From  the  results  in  these  cases,  Dr.  Smith  tliought 
we  should  take  a  more  favoralile  view  of  this  disease, 
with  reference  to  prognosis,  than  had  heretofore 
been  done.  Either  they  had  been  fortunate  in  get- 
ting oases  early,  or  in  getting  exceptional  cases,  or 
else  the  course  of  treatment  pursued  had  been  very 
successful. 

An  analysis  of  the  cases  showed  tliat  all  occuiTed 
in  counection  with  disturbances  of  the  nervous  sys- 
tem. In  none  was  there  any  injury  or  sudden  shock, 
but.  continuous  mental  strain.  All  exhibited  dis- 
turbances of  gastric  and  liepatic  digestion  ;  in  none 
had  there  been  malaria,  albuminuria,  rheumatism, 
nor  addiction  to  the  use  of  alcohol ;  in  none  was 
there  any  trouble  with  vision  ;  iu  none  was  there  any 
skin  affection ;  thirst  was  marked  in  only  one ;  he- 
reditary trouble  was  traceable  iu  only  one ;  and  in 
none  was  there  any  increase  of  appetite. 

Dr.  Smith  then  gave  the  history  of  a  case  reported 
by  Dr.  Gaspar  Griswold,  in  which  glycosuria  existed 
without  increase  in  the  quantity  of  urine,  or  other 
symptoms  commonly  pi-esent  in  diabetes.  Sugar 
was  present  in  quantities  varying  from  three  to 
twelve  grains  to  the  ounce  of  urine. 

The  iiaper  being  before  the  Academy  for  discussion. 
Dr.  Austln  Fl,i;jt  said  that  diabetes  mellitus  either 
occurred  with  greater  frequency  than  formerly,  or 
else  it  was  more  frequently  recognized  than  it  hith- 
erto had  been.  He  had  seen  more  cases  within  the 
last  five  or  six  years  than  in  almost  his  whole  previ- 
ous professional  life.  He  thought  that  the  explana- 
tion was  in  the  fact  that  the  disease  was  formerly 
often  ovei-looked,  because  examinations  of  the  urine 
were  not  so  commonly  made  as  now.  If  there  were 
no  special  circumstances  to  suggest  the  examination 
of  the  ui'ine  for  sugar,  the  examiner  had  u.snally  been 
content  with  an  examination  concerning  albumen 
and  casts,  not  always  testing  for  specific  gravity. 
Another  reason  was  that  in  a  certain  proportion  of 
cases  of  diabetes,  certainly  at  some  stages  of  the 
disease,  thei-e  may  ba  no  increase  in  the  quantity  of 
urine,  no  thir.st.  nor  other  special  symptom  to  ex- 
cite suspicion  of  the  existence  of  the  disease.  Sev- 
eral sucli  cases  had  come  under  his  obseiwation,  and 
the  discovery  of  sugar  in  the  urine  had  been  acci- 
dental rather  than  otherwise.  He  then  related  a 
case,  that  of  a  patient  who  had  no  symptom  except 
slight  itching,  persistent,  at  the  end  of  the  penis. 
In  that  case  recovery  took  place  within  a  sliort  time, 
and  the  sugar  had  not  returned  in  the  urine,  al- 
though when  first  examined  it  was  present  in  abun- 
dance. In  several  cases  which  he  had  seen  not  only 
was  the  urine  not  increased  in  quantity,  but  its  spe- 
cific gravity  was  not  above  the  normal.  He  was  able 
to  concur  with  the  author  of  tlio  paper  concerning  a 
favorable  prognosis  in  a  con.si<lerable  i)roportion  of 
cases  of  diabetes.  He  had  notes  of  sevoi-al  cases  in 
which  rei!ovei".v,  apparently,  was  ])ersistent.  He  liad 
also  found  that  dietetic  treatment  caused  sugar  either 
to  disappear  entirely,  or  to  be  reduced  to  a  very  small 
quantity  in  a  short  space  of  time.  Ho  regarded  the 
important  treatment  to  be  dietetic,  and  had  been  led 
t-1  believe  that  faihire  had  been  due,  in  a  very  large 
measure,  if  not  entirely,  to  lack  of  thoroughness  in 
its  being  carried  out.  The  diet  should  bo  made  sat- 
isfactory to  the  patient,  as  well  as  rigidly  adhered 
to.    His  rule  was  to  give  the  ])atient  a  list  of  articles 


of  diet  which  he  might  take,  and  also  a  list  of  the 
articles  of  which  he  must  not  take,  .so  that  both  lists 
could  be  referred  to  constantly.  General  directions 
concerning  diet  were  quite  certainly  not  eft'ectually 
carried  out.  But  there  should  be  such  a  ccmbinp.- 
tion  and  variation  in  the  articles  of  diet  as  to  render 
it  satisfactory  to  the  palate.  It  would  require  con- 
siderable care  to  accomplish  this,  but  it  was  an  es- 
sential part  of  the  treatment.  So  far  as  his  experi- 
ence went,  there  were  hut  few  patients  who  wculd 
be  content  with  taking  bread  made  from  pure  husk 
of  wheat ;  therefore  he  advised  such  persons  as  coiild* 
not,  to  take  bread  made  from  flour  which  is  not  ab- 
solutely free  from  .starch.  As  regards  medicinal 
treatment,  he  had  not  ufed  codeia  syi-tenialically, 
as  recommended  bv  Paw,  and  adopted  hr  Dr. 
Smith. 

Within  the  last  few  years  Dr.  N.  C.  Husted,  for- 
merly of  New  York,  now  of  Tarrytown,  and  who  had 
been  afflicted  with  the  disease,  had  recommended 
the  sulphide  of  culcinm  in  the  treatment  of  diabetes 
as  a  remedy  which  possesses  a  great  deal  of  efficacy. 
Dr.  F.  had  prescribed  it  in  perhaps  a  dozen  cases, 
and  had  been  led  to  entertain  a  strong  imjircssion 
that  the  remedy  was  one  which  had  a  certain  degree 
of  curative  power  in  this  affection. 

Another  point  of  interest  in  connection  with  dia- 
betes was  the  sudilen  occurrence  of  symi>toms  pro- 
duced by  some  toxical  agency,  a  condition  called  hy 
some  MTiters  aceton.-emia.  Of  such  cases  he  had  seen 
several,  and  the  prominent  symptoms  had  been  corca 
suddenly  developed,  embarrassment  of  respiration, 
without  anything  recognizable  bv  physical  explora- 
tion of  the  thorax  to  account  for  it.  The  urine  was 
sufficiently  abundant,  and  the  proportion  of  urea 
present  sufficient  to  exclude  urfemia. 

With  reference  to  ju-ognosis,  he  knew  of  halt  a 
dozen  patients  in  the  city  who  had  had  diabetes,  and 
were  in  the  enjoyment  of  a  comfortable  degree  of 
health.  Most  of  them  found  it  necessary,  however, 
to  continue  to  observe  more  or  less  sti-ictly  the 
dietetic  treatment.  He  believed  that,  with  proper 
means  and  proper  care,  permanent  cure  would  re- 
sult in  a  certain  proportion  of  cases,  and  that  if 
recovery  did  not  take  place  the  disease  conid  he 
kept  in  abeyance,  and  a  comfortable  degree  of  health 
maintained  for  an  indefinite  period. 

Dr.  S.  T.  Hubbard  had  had  two  cases  under  ob- 
servation, one  for  four  and  the  other  for  two  years. 
The  patients  were  fifty  and  sixty  years  of  age,  women 
in  easy  circumstances,  and  had  never  been  subjected 
to  any  great  mental  strain  so  far  as  he  knew.  The 
treatment  had  been  to  take  a  tablespoonful  of  brew- 
ers' vf  ast  thi-eo  or  four  times  a  day. 

Some  years  ago  he  saw  a  well-marked  case  in  a 
child  two  years  of  age.  It  progressed  rapidly  to  a 
fatal  termination. 

In  none  of  his  cases  had  cure  been  etTected. 

Dr.  V.  P.  (!inNEY  referred  to  a  case  of  infantile 
par.ilysis  in  a  girl,  and  diabetes  developed  when  the 
])atient  was  aboiit  fourtei>n  years  of  age.  She  came 
from  a  decidcdlv  neurotic  family,  and  it  was  thou.ght 
by  some  pliysicians  that  tlicre  was  a  connection  be- 
tween the  nervous  disease  and  the  diabetes,  but  no 
direct  relation  of  cause  to  etVect  could  be  made  out. 

Dr.  KiNNictTT  thought  it  important  to  bear  in 
mind  tliat  there  were  two  distinct  forms  of  tl)e  af- 
fection :  1st,  th.at  in  which  there  is  ability  to  digr ft 
only  a  moderate  quantity  of  saccharine  food,  a  form 
readily  controlh^l  by  strict  observation  of  dietetic 
rales';  and  2il,  that  in  which  there  is  serious  perver- 
sion Tof   the  glycogenic  function  of  the   liver,  anii 


THE  MEDICAL  RECORD. 


215 


•which  was  never  fully  controlled.  In  the  latter  cases 
prognosis  should  be  especially  guarded,  as  the  pa- 
tients were  constantly  in  danger,  from  sliglit  causes, 
such  as  over-exercise,  of  the  production  of  the  condi- 
tion called  diabetic  coma  or  collapse,  so  uniformly 
fatal.  With  reference  to  acetona-mia,  he  had  lately 
seen  in  an  Austrian  journal  the  report  of  a  case  in 
which  acetone  was  found  in  the  urine  and  glycosuria 
could  not  be  detected,  a  fact  which  showed,  so  far  as 
it  went,  that  diabetic  coma  was  not  aceton;etnia. 

Dr.  John  C.  Peters  thought  that  Dr.  Barker  and 
Dr.  Smith  had  in  one  direction  builded  better  than 
they  thought.  For  there  were  cases  which  had  been 
benefited  by  aloes,  a  series  of  cases  that  had  been 
relieved  by  rhubarb,  and  a  large  number  of  cases  in 
which  relief  had  been  afforded  by  nux  vomica.  The 
pill  which  they  had  used  in  connection  with  codeia 
contained  two  of  those  drugs.  He  had  rather  adopted 
the  view  that  the  disease  was  of  nervons  origin,  and 
had  been  led  to  regard  nux  vomica  as  the  best  remedy 
for  it. 

He  agreed  with  Dr.  Kinnicutt  with  reference  to 
the  existence  of  two  forms  of  the  disease,  one  in 
which  improvement  followed  a  proper  diet,  and  an- 
other in  which  little  or  no  benefit  was  derived  from 
dietetic  treatment.  His  observation  had  been  that 
the  di.sease  was  milder  in  old  than  in  young  patients, 
and  also  more  amenable  to  treatment.  In  the  obese 
patient,  also,  the  disease  was  more  manageable  than 
in  the  lean,  spare  jiatient,  in  whom  it  was  usually  very 
nnmanageable. 

He  regarded  the  basis  of  the  disease  as  a  vaso- 
motoi-  disturbance,  and  believed  that  by  the  aid  of 
vaso-motor  tonics,  such  as  nux  vomica,  pihysostigma, 
perhaps  digitalis  and  ergot,  the  best  results  were  to 
be  obtained. 

The  Presedext  added  another  case  to  those  re- 
ported by  Dr.  Smith,  in  which  the  same  method  of 
treatment  yielded  equally  satisfactory  results. 

Dk.  a.  C.  Post  asked  with  regard  to  the  frequency 
of  the  occurrence  of  gangi-ene  in  connection  with 
diabetes. 

Dr.  Flint  recalled  three  cases  of  gangrene  of  the 
lower  extremities. 

Db.  Peters  recalled  one  case  of  gangrene  of  the 
leg. 

Dr.  William  H.  Draper  thought  that  the  nervous 
theory  of  the  etiology  of  diabetes  was  the  one  which 
must  be  accepted,  when  the  experimental  researches 
made  in  the  artificial  production  of  the  disease  in 
animals,  and  also  the  clinical  histories  of  cases  were 
taken  into  consideration.  A  considerable  number 
of  cases  had  been  due  to  traumatism  of  the  brain, 
and  in  many  cases  the  di.sease  could  be  distinctly 
traced  to  some  nervous  shock  as  its  starting-point. 
But  after  all  the  liver  appeared  to  be  the  organ  which 
was  the  chief  instrument  in  the  production  of  the 
affection,  and  his  remarks  were  made  with  regard  to 
the  association  of  diabetes  with  another  form  of  dis- 
ease which  Bence  Jones  had  described  as  the  sour 
disease,  in  contradistinction  to  the  sweet  disea.se.  In 
other  words,  he  thought  that  the  clinical  experience 
of  most  observers  showed  that  the  great  majority  of 
cases  of  diabetes  were  associated  with  lithiemia ; 
that  there  was  an  error  in  the  digestion  of  nitrogen- 
ous as  well  as  the  carbonaceous  foods.  He  thought 
it  could  be  .shown  that  in  many  cases  of  the  graver 
forms  of  diabetes  there  was  a  hereditary  history  of 
gout,  or  the  disease  was  already  illustrated  in  pa- 
tients themselves.  It  would  be  found  in  these 
cases  that  there  was  not  only  sugar  in  the  urine,  but 
also,  very  often,  an  excess  of  urea  and  uric  acid.    In 


the  milder  forms  of  diabetes,  the  inteimittent,  Le 
thought  the  association  of  these  two  conditions  was 
more  marked  than  in  the  .'■evere  variety  of  the  afiec- 
tion.  It  would  also  be  found  that  these  patitnts 
had  been  subject  to  tiue  gouty  letions,  or  cutaneous 
or  catarrhal  or  arthritic  lesions. 

Another  circumstance  which  went  to  show  the 
association  of  these  two  maladies,  was  that  the  dia- 
betic patient  and  the  gouty  patitntwere  )elifcVfd  ly 
the  same  kind  of  diet  and  medication  ;  that  lie  ni- 
trogenous diet  is  that  upon  which  these  patients 
thrive  best,  paradoxical  as  it  might  feem.  As  an 
item  in  the  inooi  of  that  statement,  it  was  only  ne- 
cesary  to  refer  to  the  renown  which  alkaline  springs 
Lad  obtaiiied,  and  justly  so,  in  the  treatment  ol  these 
two  diseases. 

He  agreed  with  Dr.  Flint  as  regards  the  superi- 
ority of  the  dietetic  management  of  diabetic  casts. 
He  thought  that  until  we  could  reach  a  true  estin  ate 
of  the  utility  of  medicines  without  dietetic  treatment, 
it  was  not  possible  to  estimate  exactly  the  value  of 
medicines  in  the  treatment  of  this  disease.  Almost 
always  those  remedies  which  had  obtained  the 
greatest  reputation  in  the  treatment  of  diabetes, 
outside  of  alkalies,  had  been  used  in  conjunction 
with  dietetic  treatment. 

Another  fact  which  had  a  bearing  upon  the  view 
that  lith:emia  and  diabetes  were  associated  diseases, 
was  that  the  different  forms  of  medication  which  had 
been  used  for  diabetes  were  those  which  were  moie 
or  less  applicable  to  functional  disorders  in  gouty 
persons.  With  regard  to  the  cqjium  treatment,  he 
had  not  had  a  large  experience.  Although  Dr. 
Pavy  had  attached  great  importi-nce  to  it,  Dr.  Dick- 
inson had  not  had  equal  success  in  its  use.  Dr. 
Draper  had  hael  some  experience  in  the  use  of  sul- 
phide of  calcium,  and  had  been  much  pleased  with 
the  results.  The  remedy,  however,  was  not  used 
without  restricting  the  diet.  In  the  grave  forms  of 
the  disease  he  did  not  believe  there  was  any  remedy 
which  did  any  good. 

Dr.  Smith,  in  closing  the  discussion,  said  that 
while  he  took  the  view  that  in  the  great  majority  of 
cases  diabetes  hael  its  origin  in  the  nervous  system, 
he  was  not  prepared  to  say  that  in  some  cases  it  did 
not  have  its  origin  in  some  other  organ  of  the  body, 
and  it  had  seemed  to  him  that,  from  recent  observa- 
tions, the  pancreas  might  be  the  organ  sometimes  at 
fault.  With  reference  to  diet  he  did  not  agree  with 
Dr.  Draper,  that  gouty  anel  diabetic  patients  could 
digest  the  same  foods  equally  well. 

With  regard  to  codeia,  he  thought  that  it  was  ap- 
plicable in  grave  as  well  as  in  mild  cases.  Even  in 
those  in  which  sugar  was  produced  from  a  meat 
diet,  he  believed  that  codeia  placed  the  nervous  sys- 
tem in  such  a  condition  that  the  sugar  was  not  pro- 
duced to  such  an  extent  as  it  would  be  were  the 
drug  withheld.  Although  the  view  was  theoretical, 
he  believed  that  it  had  been  sustained  by  clinical 
obseiwations. 

The  academy  then  adjourned. 


The  Treatment  of  Phthisical  Larvk  orris  by 
iodoform,  which  has  been^mployed  by  Lincoln, 
Bosworth,  anel  others  in  th*  city  for  several  years, 
is  now  being  adopteil  by  the  Germans.  Dr.  Beetz,  in 
an  article  upon  the  therapeutics  of  this  di.'ease,  dis- 
cusses anel  commends  the  use  of  iodoiOrm,  which 
possesses  almost  a  specific  action  against  syjihilitic, 
scrofulous  and  tubercular  ulcers. 


216 


THE  MEDICAL  RECORD. 


NEW  YOEK  PATHOLOGICAL  SOCIETY. 

Anniversary  Meeting,  January  11,  1882. 

Dr.  T.  E   Satterthwaite,  President,  in  the  Chair. 

.abdominal  tcmor. 

Db  John  P.  Gabrish  presented  a  tumor,  removed 
post-mortem  from  the  body  of  an  unmarried  woman, 
aged  forty-three,  and  with  the  following  history  :  The 
patient  had  enjoyed  good  health,  had  operated  with 
a  sewing  machine  from  eight  to  ten  hours  daily  dur- 
ing the  last  seventeen  or  eighteen  years,  and  seven 
months  ago,  for  the  first,  suflered  from  pain  in  the 
lower  part  of  the  abdomen.  She  then  consulted  a 
physician,  who  told  her  that  probably  there  was 
some  peritonitis  which  caused  the  pain.  After  a 
little  time  the  physician  discovered  a  tumor  in  the 
region  of  the  uterus.  It  gradually  enlarged,  and  an 
operation  was  proposed  for  its  removal.  The  patient 
declined  the  proposal,  and  came  under  the  care  of 
Dr.  Garrish  on  October  15,  1881,  who  detected  a 
tumor  extending  from  the  pelvis  upward  nearly  to 
the  umbilicus,  sufficiently  large  to  entirely  fill  the 
lower  part  ot  the  abdominal  cavity,  and  exceedingly 
hard.  Menstruation  had  been  regular  up  to  the 
time  the  patient  came  under  Dr.  Garrish's  ob.°erva- 
tion.  She  had  leucorrhoea.  There  was  an  abrasion 
or  ulceration  of  the  cervix  of  sufficient  size  to  more 
than  cover  the  field  of  an  ordinary-sized  speculum, 
and  it  bled  readily  when  touched  with  cotton.  Ni- 
trate of  silver  was  applied  twice  a  week,  the  ulcera- 
tion or  abrasion  healed  entirely,  and  the  leucorrhoea 
was  arrested. 

The  patient's  general  condition  also  improved, 
and  she  continued  to  visit  the  doctor'  at  his  office 
until  early  in  December,  when  she  was  taken  with 
severe  pain,  referred  to  both  iliac  regions.  There 
was  no  difficulty  in  urination  throughout  the  course 
of  the  disease.  At  one  time  the  stomach  was  so  ir- 
ritable that  it  became  necessary  to  resort  to  rectal 
alimentation  for  a  few  days,  after  which  the  patient 
w.is  able  to  retain  food  while  she  lived.  The  chief 
complaint  which  the  patient  made  was  of  a  "  tire- 
some feeling,"  and  the  only  position  which  gave  her 
any  ease  was  lying  upon  the  abdomen.  She  died  of 
exhaustion  on  December  21,  1881.  \t  the  autopsy, 
the  tumor,  the  stomach,  the  intestines,  and  the  pel- 
vic organs  were  found  firmly  adherent  to  each  other, 
and  were  removed  ere  masse. 

The  specimen  was  referred  to  the  Committee  on 
Microscopy.  Dr.  Garrish  thought  it  was  carcino- 
matous. 

THE  LONGlTUniNAIi  WHITE  LINE  IN  THE  CORTICAL  LAYER 
OF   THE   liKAlN. 

Dr.  John  C.  D.alton  presented  several  sections  of 
the  brain  which  showed  the  longitudinal  white  line 
present  in  the  cortical  layer  in  some  parts  of  tlie 
occipital  lolins.  There  were  two  things  about  this 
line  which  of  late  had  attracted  his  special  atten- 
tion. 

First,  it  ia  confined  to  the  convolutions  bordering 
upon  the  fissure  of  Oalcarini.  It  had  been  long 
known  that  it  was  noticeable  esjiccially  in  the  convo- 
lutions of  the  occipity  lobe :  but  he  had  not  seen 
any  statement  in  whicn  the  fissure  of  Calcarini  was 
mentioned  in  connection  with  it. 

.\gain,  why  tliis  structure  should  be  just  here  and 
nowhere  else,  he  did  not  know  ;  nor,  so  far  as  he  had 
been  able  to  determine,  had  a  satisfactory  answer 
been  given  to  that  question,  although  the  line  was 


very  distinct.  It  had  been  examined  microscopi- 
cally by  different  observers,  but  the  results  had  been 
unsatisfactory. 

Dr.  E.  C  Seguin  remarked  that,  upon  examination 
of  sections  of  difl'erent  parts  of  the  larain,  one  sees  a 
number  of  lines  made  up  of  nervous  fibres.  He 
had  always  supposed  that  this  white  line  was  com- 
posed of  an  exaggeration  of  these  ccmmissurnl  fibres, 
as  they  were  usually  regarded,  of  which  distinct 
bundles  can  be  seen  in  almost  any  section  of  the 
cortex.  Thirty  years  ago  some  observers  described 
from  four  to  six  distinct  layers  in  the  convolutions, 
as  seen  without  special  preparation  or  staining.  It 
was  interesting  to  know  that  this  line  is  limited  to 
the  particular  part  of  the  brain  mentioned. 

T0MOR    or   THE   ANTRUM. 

Dr.  John  A.  Wteth  presented  a  specimen  re- 
moved from  the  right  antrum  of  Highmore  of  a 
German  aged  thirty-five.  The  disease  attracted  the 
attention  of  the  patient  three  months  before  admis- 
sion to  the  hospital.  The  operation  was  performed 
by  removing  a  portion  of  the  bone,  and,  in  addition, 
it  became  unexpectedly  necessary  to  remove  the 
whole  of  the  superior  maxilla,  the  right  palate  and 
malar  bone,  and  a  part  of  the  ethmoid  and  sphenoid. 
As  a  jjreparatory  step,  tracheotomy  was  performed, 
and  the  pharynx  packed  full  of  sponge,  to  prevent 
the  blood  from  gravitating  into  the  larynx.  The 
hemorrhage  was  considerable,  was  somewhat  con- 
trolled by  ligatures  and  the  Paqnelin  cautery,  and 
the  operation  lasted  more  than  two  hours.  The 
patient  never  x-allied,  and  died  thirty-eight  hours  af- 
terward. 

The  specimen  was  referred  to  the  Microscopical 
Committee.  Dr.  Wyeth  thought  it  was  carcinoma- 
tous. 

Dr.  Be\'erlt  Robinson  presented  a 

heart  weighing  fobty-three  OrNCES, 

removed  from  the  body  of  a  middle  aged  man,  who 
presented  the  symptoms  usually  accompanying  ex- 
tensive and  varied  cardiac  lesions.  Both  ventricular 
cavities  were  dilated,  and  the  aortic  valves  illustrated 
thickening  and  vegetations.  Four  murmurs  were 
heard. 

fatty  heart  ;  interstitial  nephritis — waxy  liver  j 
djtebstitial  hepatitis. 

Dr.  Robinson  also  presented  a  heart,  the  muscu- 
lar tissue  of  which  had  been  markedly  encroached 
upon  Ijy  the  deposition  of  fat  externally.  The  wall 
of  the  right  ventricle,  particularly,  was  very  thin. 
The  specimen  was  accompanied  by  a  portion  of  the 
liver,  which  illustrated  waxy  degeneration  and  syph- 
ilitic hepatitis. 

Notes  of  the  following  history  were  furnished  by 
Dr.  W.  C.  Campbell,  house  physician  at  St.  Luke's 

Hospital.    F.  \. ,  aged  forty  six,  native  of  United 

States,  and  a  clerk,  was  admitted  December  17,  1881. 
The  patient  gave  a  history  of  syphilis.  He  had  had 
gonorhoca  several  times,  and,  since  1871),  rheumatism 
in  neaily  all  of  his  joints  at  different  times.  Five 
months  before  admission  he  began  to  lose  strength, 
became  pale,  and  at  times  suffered  from  dizziness. 
Micturition  was  increased  in  frequency,  and  the 
quantity  of  urine  somewhat  more  than  normal. 
About  a  month  later  the  patient  had  attacks  of 
vomiting,  which  occurred  at  intervals  of  two  weeks 
or  more  and  lasted  about  twenty-four  hours.  There 
were  no  distinct  cerebral  symptoms.  Ki  the  same 
time  his  ankles  began  to  swell,  and  the  ivdema  s-nb- 


THE  MEDICAL  RECORD. 


il7 


sequently  extended  to  the  knees  and  then  gradually 
disappeared. 

Six  days  previous  to  admission  the  patient  had  a 
severe  diarrhoea,  which  reduced  his  strength  very 
much.  He  made  water  six  or  seven  times  in  twenty- 
four  hours,  without  pain  or  special  change  from  the 
normal  in  quantity. 

At  no  time  during  his  life  had  he  suffered  from 
paliiitation  or  pain  in  the  priecordial  region,  nor  had 
he  ever  had  severe  cough.  When  admitted  he  com- 
plained only  of  extreme  prostration.  He  was  much 
emaciated.  There  was  no  tedema  of  any  part  of  the 
body.  Physical  examination  of  the  lungs  was  nega- 
tive. The  cardiac  impulse  was  feeble,  but  no  mur- 
murs were  detected.  The  urine  ho  i  a  specifio  gravity 
of  1010,  was  acid,  and  contained  ten  per  cent,  of  al- 
bumen. Stimulants  and  tonics  were  administered, 
but  the  patient's  condition  did  not  improve. 

On  December  27th  the  patient  was  seized  with  a 
severe  pain  in  the  epigastric  region,  and  soon  began 
to  vomit.  The  vomiting  persisted  desjiite  remedial 
measures,  the  patient  grew  weaker  rapidly,  and  died 
at  1  P.M.,  December  29th,  respiration  continuing 
after  the  heart  had  ceased  to  beat. 

At  the  autojisy  the  body  was  emaciated,  rigor 
mortis  and  mottling  absent.  The  walls  of  the  right 
ventricle  of  the  heart  were  very  thin,  and  they  were 
covered  with  a  thick  layer  of  fat.  The  valves' of  the 
heart  were  normal,  and  the  oi-gan  weighed  foiu'teen 
and  one-half  ounces. 

The  limits  were  normal.  The  liver  weighed  five 
pounds,  was  hard  and  lobulated,  and  was  the  seat  of 
amyloid  change,  as  demonstrated  by  the  iodine  test. 

The  kidne_i/s  were  small,  capsule  not  adherent, 
surface  granular.  There  was  an  abscess  in  the  right 
kidney  about  three-eighths  of  an  inch  in  diameter. 

The  spleen  was  very  much  enlarged,  was  lii'mly 
adherent  to  the  diaphragm,  and  throughout  its  pul]) 
were  fo»ind  hard  pus-points. 

When  the  intestines  were  lifted  from  the  abdom- 
inal cavity,  an  unusual  deposit  of  adipose  tissue  was 
seen  to  cover  the  entire  posterior  abdominal  wall,  at 
least  one  or  two  centimetres  thick  in  places. 

The  interesting  features  of  the  case  were  the  ema- 
ciation, with  extensive  deposit  of  fat  internally,  the 
lobulated  appearance  oi  the  liver  in  connection  with 
a  syphilitic  history,  and  the  chronic  interstitial  ne- 
phritis without  cardiac  hypertrophy. 

Dr.  Peabodt  asked  if  the  kidneys  were  not  the 
seat  of  amyloid  change  as  well  as  the  liver.  If  so, 
the  absence  of  cardiac  hypertrophy  with  interstitial 
nephritis  could  be  readily  explained,  for  it  was  char- 
acteristic of  amyloid  kidney  with  diffuse  nephritis 
n')t  to  be  accompanied  with  hypertrophy  of  the  walls 
of  the  left  ventricle  of  the  heart 

The  President  remarked  that  the  kidneys  were 
not  examined  with  reference  to  amyloid  degenera- 
tion ;  that  the  muscular  tissue  of  the  heart  was  in  the 
condition  of  fatty  degeneration,  especially  that  of 
the  right  ventricle,  and  that  the  liver-tissue  exhib- 
ited the  ordinary  reaction  with  iodine.  There  was 
no  cirrhotic  change  manifest,  except  at  the  points 
already  pointed  out  by  Dr.  Robinson,  but  it  did  not 
seem  to  be  the  cirrhosis  usuallv,  so  far  as  his  obser- 
vation extended,  seen  in  syphilis,  where  the  connec- 
tive tissue  penetrates  all  through  the  organ.  He 
was  inclined  to  regard  the  specimen  as  one  of  old 
hepatitis  beginning  upon  the  outside  and  gradually 
extending  inward. 

Dr.  Peabody  remarked  that,  according  to  his  ob- 
servation, waxy  change  in  the  kidneys  was  invariably 
accompanied  with  changes  in  the  interstitial  tissue. 


as  well  as  the  epithelium,  and,  no  matter  how  far 
advanced  the  interstitial  nejihritis,  it  was  not  accom- 
panied by  cardiac  hypertrophy. 

The  Preshjent  said  his  experience  showed  that 
waxy  change  was  always  accompanied  by  chronic 
ditluse  changes  in  the  kidney  structure,  although 
that  view  was  not  accepted  by  all  observers. 

Dr.  Eii'LET  said  that,  in  the  syphilitic  livers  which 
he  had  had  opportunity  to  examine,  the  hepatitis 
was  most  marked  iipon  the  surface,  and  diminished 
in  projiortion  to  the  situation  of  the  tissue  beneath 
the  surface  ;  that  more  or  less  circumscribed  areas 
of  interstitial  change  existed,  whereas  in  ordinary 
cirrhosis  the  hejjatitis  was  more  uniformly  diffused 
throughout  the  organ.  He  tliought  that  in  Dr.  Rob- 
inson's specimens  the  liver  was  too  large  to  indicate 
that  the  lobulated  condition  it  presented  was  due  to 
changes  occumng  in  gummatous  tumors. 

The  President  remarked  that,  with  gummata  in 
the  liver  and  subsequent  retrogi-essive  changes,  there 
was  usually  a  little  nodule  of  cicatricial  tissue  left, 
which  was  stained  of  a  yellowish  white  color.  'So 
such  points  were  found  in  the  specimen  presented 
by  Dr.  Robinson. 

The  puckering  occu2iies  lai-ger  circumscribed  areas 
in  syphilitic  than  in  ordinary  hepatitis,  and  in  the 
intervening  spaces  there  might  be  tolerably  healthy 
tissue. 

The  society  then  went  into  executive  session. 


JIATERIA  MEDICA  SOCIETY. 

Stated  Meeting,  Decemher  29,  1881. 
Dr.  Pibtard,  President,  in  the  Chaib. 

iodoform   in   GTNa;COL0GICAIj   PRACTICE. 

Dr.  Foster,  in  a  paper  on  the  above  .subject,  stated 
that  for  the  past  two  years  or  so  he  had  had  con- 
siderable experience  in  the  local  use  of  iodoform  as  a 
sorbefacient  in  cases  in  which  chronic  extra-uterine 
exudation  and  its  sequela'  were  the  chief  factors  in 
jn-oducing  the  symptoms  complained  of.  The 
jiromptest  and  most  satisfactory  results  were  ob- 
tained in  instances  of  palpable  pelvic  exudation. 
These  cases,  however,  did  better  under  the  more 
usual  methods  of  treatment  than  those  in  which  the 
exudation  was  not  to  be  detected  by  paljiatiou,  but 
was  infeiTed  to  be  present  from  conditions  not  to 
be  explained  by  any  other  theoiT.  Nevertheless, 
bulky  exudations  sometimes  proved  utterly  rebel- 
lious to  treatment.  Recent  or  remote  formation,  a 
point  not  always  easily  determined,  was  a  matter  to 
be  considered.  Dr.  Foster  was  convinced  that  these 
cases  of  chronic  extra-uterine  exudation,  occurring 
princifially  in  patients  of  an  out-door  service,  in 
women  of  low  social  status  and  unfavorable  sur- 
roundings, did  progress  more  favorably  than  they 
would  have  done  under  the  same  circumstances 
without  the  use  of  iodoform.  In  the  majority  of 
cases,  vaginal  injections  of  wami  water  were  iJre- 
scribed,  but  in  many  instances  probably  neglected 
by  the  patients.  In  even"  case,  however,  in  which 
they  were  opjered,  the  author  took  it  for  gianted 
that  they  were  faithfully  used.  When  therefore  he 
stated  his  imjiression  that  in  this  jjarticular  set  of 
cases  iodoform  was  more  serviceable  than  any  of 
the  other  remedies  employed,  he  did  not  wish  to  be 
understood  as  denying  the  jjaramount  value  of  hot 
water,  properly  and  conscientioxisly  used.  Such  an 
em23loyment  being  assured,  he  esteemed  the  three 
gi'eat  remedies  for  extra-uterine  pelvic  inflammation 


218 


THE  MEDICAL  RECORD. 


in  the  following  order  :  (1)  hot  water ;  (2)  iodoform  ; 
(3)  galvanism.  He  preferred  to  apply  the  iodoform 
to  the  upper  part  of  the  vagina,  and  tamjion  the 
whole  vaginal  canal  with  wicking,  as  described  in 
the  yen-  Vork  Medical  Journal,  June,  1880.  The 
tampon  was  of  great  service  by  its  mechanical  ac- 
tion, and  also  tended  to  shut  in  the  odor.  The  taste 
of  the  drug  thus  applied  was  sometimes  complained 
of  immediately,  indicating  that  it  had  either  made 
its  way  into  the  uterine  cavity,  or  been  more  promptly 
absorbed  by  the  vagina  than  other  medicaments  usu- 
ally were.  In  dysmenorrhcea  tlie  relief  afibrded  by 
rectal  suppositories  of  iodoform  was  sometimes 
striking,  but  the  remedy  could  not  be  relied  uj^on 
to  control  the  pain  in  successive  menstruations.  In 
pruritus  vulvie,  hyperiesthesia  of  the  vulvo-vaginal 
orifice,  and  inflammation  of  Bartholin's  gland,  it  was 
more  serviceable  than  any  other  single  application 
used.  In  cases  of  pelvic  pain  without  appreciable 
structural  abnormality,  or  in  which  examination  was 
unadvisable,  iodoform  in  the  form  of  suppositories, 
though  inferior  to  opium,  was  free  from  the  latter's 
objectionable  qualities.  In  a  case  of  oophoralgia 
great  relief  was  not  obtained.  In  catarrhal  affec- 
tions it  was  useless.  In  cervical  hyperplasia,  the 
author  placed  considerable  confidence  in  iodoform 
as  a  discutient,  although  he  did  not  regard  it  supe- 
rior to  other  measures  in  common  use.  The  con- 
tinual use  of  rectal  suppositories  of  this  drug  was 
objectionable  on  account  of  the  odor  ;  in  many  cases, 
however,  their  employment  was  a  valuable  resource. 

Dk.  Smith  referred  to  several  cases  of  membranous 
dysmenorrhcea  in  which  iodoform  had  been  employed 
with  exceedingly  gratifying  results.  He  alluded  to 
the  case  of  one  of  Dr.  Barker's  patients,  a  married 
lady,  who  had  been  afflicted  for  seven  years  with  this 
trouble.  Upon  one  occasion  she  passed  a  sufficient 
quantity  of  membrane  to  have  specimens  of  it  sent 
to  the  professors  of  gynecology  in  the  three  New 
York  schools.  A  complete  cure  followed  the  iodo- 
form treatment.  He  knew  of  two  other  cases  in 
which  equally  good  results  had  been  obtained.  Four 
cases  he  saw  himself.  Applications  were  made  twice 
a  week,  and  every  day  for  a  few  days  before  men- 
struation. Complete  relief  followed.  In  one  in- 
stance the  patient  tasted  the  drug  within  sixtv 
seconds  after  its  application.  Speaking  of  the  odor 
of  iodoform,  he  stated  his  doubts  as  to  the  possibility 
of  repressing  it  by  ])acking  the  drug  in  the  vagina 
with  a  tampon.  He  had  tried  ether  and  found  that  it 
controlled  the  odor  until  the  ether  evaporated. 
Balsam  of  Peru  was  the  liest  deodorizer,  and  supe- 
rior to  balsam  of  tolu.  He  had  used  a  mixture  of 
iodoform  and  Peruvian  balsam  in  uterine  practice 
with  apparent  success,  and  also  employed  it  as  a 
local  application  to  the  larynx.  In  carcinoma  uteri 
it  certainly  relieved  iiain  and  substituted  its  own 
odor  for  that  of  cancer. 

Du.  Bronson  stated  that  the  essential  point  in  re- 
pressing the  odor  was  to  make  the  powder  into  a 
paste,  thus  rendering  it  impossible  to  scatter.  It 
might  be  made  so  with  glycerine  and  mucilage  to 
which  the  essential  oil  of  peppermint  or  winter- 
green  was  added.  As  .soon,  however,  as  tlie  scent 
of  the  essential  oil  had  disappeared,  the  iodoform 
odorasserted  itself  to  a  greater  or  less  degree.  He 
had  used  Peruvian  balsam,  but  found  it  did  not  con- 
trol tlie  odor  bettor  than  the  paste.C 

1)k.  Morrow  had  seen  it  stated  that  hydrated 
chloral  in  combination  with  iodoform  would  act  as 
a  deodorizer. 

I)it.  MtiNi)f;  had  used  iodoform  extensivelv  in  dis- 


pensary and  office  practice,  but  did  not  find  that 
patients  objected  very  much  to  the  odor.  The  drug 
was  very  carefully  applied  to  the  cervix,  and  the 
vagina  well  packed.  Although  he  got  a  good  deal 
of  the  odor  himself,  his  patients  rarely  complained  ; 
but  if  they  themselves  did  not  notice  the  odor,  their 
fi-ieuds  would.  He  had  used  the  drug  combined 
with  glycerine  and  oil  of  peppermint,  but  the  scent 
of  peppermint  was  quite  as  disagreeable  as  the 
iodoform  odor,  and  attracted  quite  as  much  atten- 
tion. He  now  used  tannin  with  the  drug  ;  tannin 
controlled  the  odor  and  was  synergistic  to  the  iodo- 
form. He  had  emjjloyed  iodoform  with  success  in  cer- 
vical erosion  and  eudotrachetitis.  A  most  useful  for- 
mula was  that  mentioned  by  Dr.  Smith  :  a  drachm 
of  iodoform,  and  half  a  drachm  of  the  balsam  of 
Peru,  to  one  ounce  of  glycerine.  This  was  about 
as  inodorous  a  preparation  as  could  be  obtained. 
He  thought  that  in  his  experience  he  had  obtained 
better  results  from  the  healing  effect  of  iodoform  in 
cervical  erosion  and  its  soothing  action  in  carcinoma 
than  when  employed  as  a  sorbefacient.  In  in- 
stances of  chronic  pelvic  exudations  he  was  always 
very  much  in  doulit  as  to  whether  the  diminution  in 
size  of  the  uterus  and  its  increased  mobility  were 
due  to  plugging  the  vagina  and  painting  the  roof  I 
with  tincture  ot  iodine,  or  to  the  effects  of  the  iodo- 
form. Still,  he  thought,  besides  relieving  pain,  it 
increased  the  rapidity  of  absorption  and  the  return 
of  uterine  mobility.  The  best  success  was  obtained 
in  simple  catarrhal  erosion  of  the  cervix,  either  with 
or  without  eudotrachetitis.  He  first  cured  the  eu- 
dotrachetitis and  afterward  applied  iodoform  alone 
or  combined  with  tannin,  simply  applying  these 
over  the  surface  of  the  canal  every  other  day  or 
twice  a  week.  He  mentioned  a  case  of  membranous 
dysmenorrhcea  in  which  considerable  relief  resulted 
from  the  use  of  iodoform  pencils.  Cure,  however, 
was  completed  by  local  galvanization,  inasmuch  as 
the  taste  of  iodoform  proved  objectionable.  Dr. 
Mundf  had  used  the  drug  in  vulvar  and  vaginal  dis- 
eases, chiefly  in  eases  of  erosion  of  the  parts  depen- 
dent upon  vaginitis  or  profuse  discharge,  also  in  a 
case  of  hyperresthesia  of  the  caruncle  of  the  meatus. 
No  special  benefit  was  derived  from  its  employment, 
and  on  account  of  its  odor  it  was  abandoned.  He 
looked  upon  iodoform  as  a  useful  drug,  but  as  one 
which  should  be  used  only  as  auxiliary  to  other 
remedies.  He  thought  it  was  of  value  in  erosion  of 
the  cervix,  in  chronic  eudotrachetitis,  and  in  carci- 
noma (employed  in  the  shape  of  powder)  ;  in  chronic 
pelvic  peritonitis,  with  tampons  saturated  with  the 
mixture  of  Pei-uvian  b.alm  and  iodoform,  good  re- 
sults were  obtained  after  long  trial. 

Dr.  Lti.sK  was  in  the  habit  of  using  iodoform  in 
fissure  of  the  anus  in  children,  and  looked  upon  it 
as  a  specific.  It  cured  more  speedily  than  any 
other  remedy.  Applied  to  lampwick  and  drawn 
into  the  fissure  it  gave  complete  relief  in  the  course 
of  twenty- four  hours,  the  fissure  healing  in  a  few 
days.  Tearing  of  the  sphincter  was  thus  done  away 
with.  This  treatment  was  also  ap])licable  to  gi-own 
persons. 

Dr.  Bosworth  thought  the  best  way  to  use  iodo- 
form was  in  solution  in  glycerine. 

Dr.  WEnsTKR  asked  wliy  the  taste  of  iodoform 
was  ai)precinteil  sooner  after  a  uterine  than  after  a 
vaginal  application,  and  whether  the  drug  appeared 
in  tlie  saliva. 

Dr.  Foster  stated  iiis  opinion  that  the  uterine 
mucous  membrane  absorbed  the  iodoform  more  rap- 
idlv  than  the  vaginal.      He  had  notes,  however,  of 


THE   MEDICAL  RECORD. 


219 


cases  in  which  the  taste  was  perceptible  immediatelv 
after  a  vaginal  application.  In  some  cases  the  vag- 
inal mucous  membrane  absorbed  more  promptly 
than  the  uterine.  He  thought  it  probable  that  iorlo- 
form  was  secreted  in  the  saliva  after  local  applica- 
tion. He  had  not  treated  any  cases  of  membra- 
nous dysmenon-hcea  since  adopting  iodoform.  In 
order  to  re2>ress  the  odor  lie  had  used  an  ointment 
containing  Peruvian  balm,  and  had  also  employed 
the  drug  in  combination  with  tannin.  He  had 
seen  it  recommended  to  keep  it  in  a  bottle  with 
tonka  bean,  and  had  tried  that.  He  had  given  all 
the  methods  mentioned  a  trial,  with  the  exception 
of  the  hydrated  chloral,  and  held  them  to  be  abso- 
lutely worthless  ;  he  believed  nothing  could  jirevent 
the  patient  from  exhaling  the  odor  of  iodoform.  In 
regard  to  the  use  of  iodoform  in  endotrachetitis,  he 
had  come  to  the  conclusion  that  it  was  of  no  ser- 
vice, and  had  abandoned  it.  Perhaps  he  had  en- 
countered very  rebellious  cases  at  the  outset. 

Dr.  Sexton  stated  that  he  had  given  the  drug  a 
pretty  thorough  trial  six  or  seven  years  ago.  He 
had  used  it  mainly  in  suppurative  inflammation  of 
the  middle  ear,  especially  where  granulation-tissue 
was  abundant.  After  a  rather  unsatisfactory  ex- 
perience of  two  or  three  years,  its  use  was  aban- 
doned. Dr.  Sexton  did  not  think  it  possessed  any 
advantages  over  bromine  or  nitrate  of  silver.  He 
did  not  think  much  of  it  in  aural  practice.  He  had 
frequently  noticed  that  patients  referred  to  tasting 
the  drug  soon  after  its  insufflation.  Other  strong 
substances  acted  in  a  similar  way  ;  even  the  intro- 
duction of  a  jjrobe  caused  a  metallic  taste. 

Dr.  Brosson  had  had  some  experience  with  iodo- 
form administei-ed  externally  and  internally,  and  was 
convinced  that  it  possessed  valuable  sorbefacient  and 
anresthetic  properties.  Its  intei-nal  use  was  indi- 
cated by  Dr.  Berkeley  Hill  in  syphilitic  ulcerative 
disease  of  the  tongue.  Dr.  Bronson  had  used  it  in 
two  or  three  cases  of  ulcerative  disease  of  the  tongue, 
and  in  disease  of  this  organ  associated  with  kera- 
tosis, hypertrophy  of  the  lingiial  epithelium.  In  a 
few  cases  the  efJ'ect  was  remarkable.  In  one  case  of 
marked  thickening  and  deep  fissures  through  the 
epithelium,  associated  with  impairment  of  the  sense 
of  taste,  the  remedy  was  liegnn  in  doses  of  one  grain 
t.  i.  d.,  subsequently  increased  to  three  grains  t.  i.  d. 
The  patient  took  the  drug  for  a  week,  and  an  almost 
complete  cure  resulted  ;  the  iodoform,  however,  was 
discontinued,  on  account  of  the  intolerable  imjires- 
sion  produced  upon  the  gustatory  and  olfactory  or- 
gans. In  other  cases  of  ulcerative  disease  its  effects 
were  very  gratifying  where  mixed  treatment  was  un- 
availing. Two  theories  had  been  broached  as  to  the 
action  of  iodoform ;  according  to  one  it  acted  as 
iodoform,  according  to  the  other  as  iodine.  It  was 
claimed  by  some  that  it  was  absorbed  as  iodide  of 
starch.  Dr.  Bronson  thought  it  acted  both  as  iodine 
and  as  iodoform :  that,  in  addition  to  the  properties 
of  iodine,  it  exhibited  effects  peculiar  to  itself.  He 
had  had  extensive  experience  with  iodoform  in 
chancres,  orchitis,  and  diseases  about  the  anus,  es- 
pecially fissure  and  jiruritis.  In  fissure  of  the  anus 
he  did  not  consider  it  a  specific,  as  Dr.  Lusk  did. 
but  rather  a  valuable  adjuvant.  In  several  cases  in 
which  he  had  used  it,  it  controlled  spasm  almost 
completely,  diminished  reflex  irritability  of  the  uri- 
nary organs,  and  enabled  him  to  treat  by  caustics 
cases  of  deep  laceration.  His  experience  in  pruritus 
vulvas  had  been  disappointing.  He  had  used  the 
remedy  with  ether,  collodion,  etc.,  but  thought  it 
inferior  to  carbolic  acid.    In  orchitis  its  sorbefacient 


qualities  were  marked.  In  most  cases  with  consid- 
erable enlargement  of  the  epididymis,  in  which  the 
inflammation  was  not  of  so  high  a  grade  as  to  in- 
volve the  skin  of  the  scrotum,  the  eflects  were  quite 
notable.  He  had  used  it  in  the  New  York  Dispen- 
sary, employing  it  in  combination  with  camphor, 
and  made  uj:)  into  an  ointment  with  vaseline.  The 
camphor  was  subsequently  discontinued,  the  advan- 
tage of  the  combination  not  being  vei-y  apparent. 
The  formula  was  iodoform,  3j.,  camphor,  I  j.,  vase- 
line, 5  j.  When  treated  in  this  way  a  great  ameli- 
oration was  experienced  in  the  majority  of  cases ; 
there  was  marked  subsidence  of  the  swelling,  and 
cessation  of, the  pain  in  the  course  of  a  week.  It 
had  been  claimed  that  iodoform  was  of  no  utility  in 
phageda^na.  Dr.  Bronson's  experience  was  that, 
while  in  some  forms  of  this  disease  no  remedy  was 
of  avail,  in  the  common  phagedena  liealing  might 
be  brought  about  more  rajjidly  by  iodoform  than  by 
any  other  remedy.  The  best  results  in  chancre  (hard 
or  soft)  were  obtained  from  iodoform. 

Db.  Mobbow's  experience  with  iodoform  had  prin- 
cipally been  with  chancrous  sores.  He  had  used  it  in 
the  Female  Dispensary  of  the  New  York  Service  for 
several  years.  He  had  employed  it  in  half  a  dozen 
cases  of  tissure  of  the  anus  complicated  with  ulcera- 
tion, and  had  obtained  excellent  results.  He  had 
been  in  the  habit  of  exposing  the  ulcerated  surfaces 
with  the  speculum,  and  ajiplying  the  remedy  by 
means  of  the  powder-bottle.  The  odor  was  very  ob- 
jectionable, but  still  the  remarkable  results  obtained 
had  induced  patients  to  persist  in  this  treatment  de- 
spite of  this  inconvenience. 

Dr.  Fox  had  had  much  the  same  exi^erience  as  Dr. 
Bronson,  and  agreed  with  his  statements  in  regard 
to  genital  sores — chancres  and  chancroids.  Slight 
phaged.'ena  seemed  to  be  promptly  checked  by  iodo- 
form. The  old  practice  of  cauterizing  every  suspi- 
cious sore  was  fast  becoming  obsolete,  for  there  was 
no  lesion  upon  the  penis  or  labium  which  would  not 
heal  more  ra))idly  under  iodoform  than  when  cau- 
terized. Dr.  Fox  thought  iodoform  was  of  benefit 
in  pruritus,  esi^ecially  in  pruritus  vulvae,  but  sup- 
jiosed  that  it  would  be  inefficacious  when  employed 
with  collodion,  because  of  the  layer  interposed  be- 
tween the  drug  and  the  surface. 

Ether  rather  served  to  increase  the  itching.  L'sed 
in  vaseline,  he  had  seen  good  results  in  a  number  of 
these  cases,  and  also  in  chronic  eczema.  In  regard 
to  its  use  in  epididymitis,  he  had  employed  it  ac- 
cording to  the  plan  of  Alvarez.  Having  obtained 
no  desired  effect  whatever,  he  had  abandoned  it  in 
favor  of  other  remedies.  As  an  application  to  ulcer- 
ations, the  ether  solution  was  the  best,  as  it  carried 
the  remedy  among  the  granulations.  He  had  re- 
cently used  it  with  success  in  lupus  upon  the  ex- 
tremities, as  recommended  by  some  German  author- 
ity, first  scraping  the  surfaces  slightly,  then  applying 
the  iodoform  in  ])owder,  and  covering  them  with 
cotton  for  forty-eight  or  seventy-two  hours.  He  had 
not  had  sufEcient  experience  in  lupus  to  make  de- 
cided statements.  Where  the  application  of  a  tight 
b.indage  was  jiossible,  this  jiroccdure  might  be 
adopted. 

Dr.  Webster  stated  that  Dr.  Agnew  and  himself 
had  used  iodoform  in  suppurative  otitis  media.  His 
exjjerience  was  that  of  Dr.  Sexton  ;  if  it  did  good 
at  all,  it  was  certainly  not  superior  to  other  reme- 
dies. They  finally  abandoned  its  use.  He  knew  of 
a  case  of  acute  otitis  media  in  which  it  certainly 
was  of  no  value.  He  had  also  used  it  in  cases  of 
granular  lids,  pannus,  and  ulcer  of  the  cornea.     It 


220 


THE  MEDICAL  RECORD. 


had  been  highly  recommended  in  these  cases.  In 
granular  lids  the  lid  was  to  be  turned  over  and  the 
iodoform  dusted  upon  the  palpebral  conjunctiva, 
and  in  ulcer  of  the  cornea  upon  the  cornea,  every  day 
or  every  other  day.  After  several  trials  this  proce- 
dure was  discontinued,  not  so  much  on  account  of 
objections  on  the  part  of  the  patient  under  treat- 
ment as  by  reason  of  the  remon.strauces  of  the  rest 
of  the  difnlUe  who  subsequently  visited  the  office. 
Dr.  Webster  had  not  used  iodoform  in  office  iirac- 
tice  for  the  last  three  years. 

Dr.  Mu.vde  agreed  with  Dr.  Fox's  opinion  that 
collodion  might  interfere  with  the  action  of  iodo- 
form. 

Db.  Foster,  in  reply,  referred  to  blistering  collo- 
dion as  a  proof  of  the  fact  that  collodion  would  not 
act  in  the  manner  sujjposed. 

Dr.  Sexton  asked  how  soon,  after  application  to 
the  uterus,  iodoform  was  tasted. 

Dk.  Foster  stated  that  the  taste  of  the  drag  was 
appreciable  to  the  patient  immediately  after  leaving 
the  table,  and  expressed  the  opinion  that  the  remedy 
passed  through  the  circulation  in  the  meantime. 

Dr.  Sexto.v  related  a  case  in  which  on  iodofoi-m 
application  a  peculiar  sensation  passed  from  the 
right  ovarian  region  to  the  ear,  an  indefinite  taste, 
not  of  iodoform,  being  experienced  at  the  same  time. 
When  applied  to  the  ear,  Dr.  Sexton  thought  iodo- 
form produced  this  sensation  of  taste  through  ner- 
vous transmission. 

Dr.  Foster  stated  that  patients  often  likened  the 
taste  to  the  sensation  produced  by  a  galvanic  bat- 
tery. After  what  Dr.  Sexton  had  said  in  regard  to 
the  sensation  in  the  mouth,  produced  by  passing  a 
probe  into  the  ear,  he  was  inclined  to  think  the 
taste  produced  was  a  phenomenon  of  nervous  trans- 
mission. He  supposed  other  applications  than  iodo- 
form to  the  uterus  would  give  rise  to  it. 

Dr.  Mus-de  stated  that  patients  had  complained  of 
a  metallic  taste  after  the  apijlication  of  iodine  to 
the  uterus. 

Dr.  Bosworth  thought  iodoform  was  of  no  value 
in  reducing  hypertrophy  or  in  checking  catarrhal 
secretions.  It  was  of  exceedingly  great  efficacy  in 
bfoken  surfaces,  erosions  of  the  cervix,  fissures  of 
the  anus,  and  chancre.  He  had  observed  that  iodo- 
form was  rapidly  absorbed  by  the  uterus.  In  ulcer- 
ative syphilis  of  the  air-passages  he  had  obtained  bril- 
liant results,  a  single  application  to  a  superficial  ulcer 
relieving  pain  and  enabling  the  patient  to  swallow. 
In  laryngeal  Tilcer,  fissure  of  the  tongue,  and  kerato- 
sis, good  effects  were  obtained.  It  certainly  relieved 
pain  and  corrected  fetor  in  carcinoma,  but  did  not 
alfect  the  disease.  Dr.  Bosworth  cauterized  no 
ulcer  but  the  mucous  i)atch  :  all  others  were  amena- 
ble to  iodoform  He  did  not  find  that  patients  ob- 
jected much  to  the  use  of  the  drug,  which  he  now  . 
employed  extensively.  A  case  of  ulcer  of  the  leg  of 
thirteen  months'  standing  was  ciired  by  iodoform  in 
seven  days. 

Dk.  Fox  stated  that  he  had  had  one  case  himself, 
and  had  seen  two  or  three  ref)orted,  in  which  there 
were  symptoms  referable  to  the  toxic  action  of  iodo- 
form. In  one  of  the  latter  instances,  a  case  of  exci- 
sion of  the  knee-joint,  these  symptoms  had  followed 
the  procedure  of  packing  the  wound  with  a  large 
quantitv  of  the  pure  jjowdor. 

Dk.  Piffaki)  had  had  but  little  experience  with 
iodoform  in  gyniocological  jiractice.  Ho  had  given 
up  the  use  of  iodoform  in  hard  chancres.  He 
thought  that  if  a  recent  chancroid  were  cauterized 
in  an  efficient  mannor,  a  healing  .surface  would  be 


left  on  separation  of  the  slough.  Where  the  cau- 
tery has  not  been  used  he  had  seen  chancroids  last- 
ing for  weeks,  months,  or  even  years  as  chronic 
chancroid.  He  did  not  think  iodoform  with  collo- 
dion was  as  odorous  as  when  in  the  form  of  an  oint- 
ment, or  as  powder.  The  difficulty,  however,  was 
that  the  iodoform  soon  settled.  The  objection 
raised  as  to  the  efficacy  of  iodoform  combined  with 
collodion  was  one  of  interest,  and  was  answered  by 
Dr.  Foster's  reference  to  blistering  collodion.  Dr. 
Piff"ard  had  been  experimenting  with  various  collo- 
dion preparations,  and  had  found  them  to  be  very 
efficacious  and  active  locally.  He  thought  iodoform 
was  more  efficacious  in  the  form  of  a  fine  powder 
than  in  any  other  dry  form.  The  difficulty  was  to 
find  a  druggist  who  would  care  to  reduce  it  to  this 
condition.  Coumarine,  derived  from  the  tonka 
bean,  was  recommended  as  a  deodorizer  for  iodo- 
form. 

The  society  then  adjourned. 


THE  EE\1SI0N  OP  ITS  SYSTEM  OF  I\IEDI- 
CAL  ETHICS  BY  THE  :\IEDIC.\L  SOCIETY 
OF  THE  STATE  OF  NEW  YOEK. 

To  TOE  Editor  of  The  Medical  Record. 
De.\k  Sib  :  There  seems  to  be  a  misapprehension  in 
the  minds  of  some  of  the  WTiters  ujjon  the  recent 
debate  in  the  State  Medical  Society  which  ended  in 
the  adoption  of  the  Code  of  Ethics,  reported  by  thi' 
sj^ecial  committee  appointed  for  that  purpose.  \ 
think  I  can  correct  this  misapprehension  by  a  brief 
statement  of  facts  taken  from  the  report  of  tlie 
proceedings  of  the  society  published  in  your  own 
columns.  It  is  not  quite  correct  to  say  that  tin- 
substitute  oflered  by  Dr.  Roosa  failed  on  its  final 
passage,  for  there  never  was  any  attempt  made  to 
put  it  on  a  final  passage.  After  a  discussion  of 
nearly  thi'ee  hours,  the  substitute  was  carried  by  a 
majority  of  two,  the  ayes  and  nays  having  been 
called.  The  President  ruled  that  this  substitute  re- 
quired a  two-thirds  vote  for  its  passage,  because  it 
was  virtually  an  amendment  to  the  by-law,  which 
presci'ibes  that  the  society  shall  be  governed  by  the 
Code  of  Ethics  of  the  American  Medical  Association 
as  well  as  the  System  of  Medical  Ethics  of  the 
Medical  Society  of  the  State  of  New  York.  I  tlun 
held,  and  still  believe,  that  the  substitute  bavin 
been  carried,  the  report  of  the  committee  was,  ^ 
to  speak,  out  of  court,  that  the  next  step  was  to 
amend  the  by-law  so  that  it  might  accord  with  tlio 
will  of  the  majority,  and  that,  failing  in  this,  t'lc 
whole  subject  was  left  as  though  nothing  had  liccii 
done.  But,  rather  than  continue  an  already  mucli- 
protracted  discussion,  and  rather  tlian  imperil  the 
adoption  of  the  report  of  the  committee,  which  con- 
sisted of  a  code  greatly  in  advance  of  the  one  for- 
merly governing  the  society,  the  friends  of  tlie  sub- 
stitute urged  each  other  to  acce])t  the  ruling  of  tlic 
chair  and  support  the  revised  code,  and  thus  seeuir 
for  it  the  requisite  two-thirds  vote.  It  will  readilv 
be  seen  that  tlie  report  of  the  committee  must  ha\< 
miserablv  failed  of  passage  had  the  friends  of  the 
substitute  refused  to  sup))iirt  it ;  for  39  voted  for 
the  substitute  and  only  Wl  tiniilly  for  the  report  of  the 
committee.  If  we  deduct  the  W)  votes,  or,  to  be  jier- 
fectly  fair,  lU  votes,  of  the  sustainers  of  the  substitute 


THE   MEDICAL  RECORD. 


221 


from  the  52,  it  will  be  seen  that  only  18  were  fownd 
who  were  tinqualifiedly  in  favor  of  the  revised  code 
as  reported  by  the  committee.  The  sentiment  of 
the  society  was,  therefore,  in  favor  of  the  substi- 
tnte.  The  report  of  the  committee  was  accepted 
only  under  the  belief  that,  at  that  late  hour,  noth- 
ing better  could  be  had.  Whatever  ^•ietory  there 
may  have  been  bekings  to  the  friends  of  the  substi- 
tute, to  those  who  believe  that  a  hand-book  of 
etiquette  is  not  needed  by  the  profession,  and  who 
tliink  with  Dr.  Squibb  that  if  the  barriers  as  re- 
gards consultations  are  thrown  down,  all  other  re- 
strictions might  properly  be  left  to  the  discretion  of 
coTinty  societies  to  determine.  I  will  also  state  that 
it  is  an  incorrect  idea,  found  in  a  Philadel]ihian 
and  some  other  journals,  that  only  the  Xew  York 
city  members  were  in  favor  of  the  substitute  and 
the  report  of  the  committee.  Analysis  of  the  yeas 
and  nays  will  show,  I  think,  that  the  sentiment 
throughoxit  the  State  was  as  much  in  favor  of  a  ttior- 
ough  revision  as  in  the  City  of  Kew  York.  The 
friends  of  the  old  code  will  find  that  the  majority  in  I 
the  State  Society  i-epreseuts  tlie  feeling,  not  of  the 
profession  in  Xew  York  and  Brooklyn  alone,  but  of 
the  entire  State,  the  votes  being  well  distributed 
through  the  counties. 

I  am,  sir,  yours  very  respectfully, 

D.  B.  St.  John  Eoos.i. 

New  York.  Febnmry  20,  ISSa. 


ARE   THERE    SCHOOLS  OF  MEDICINE  ? 

To  THE  Editor  of  The  Medical  Record. 
Sn) :  Dr.  Maurice  Eaynaud,  in  his  address  prepared 
for,  and  read  in,  the  International  Congress  at 
London,  expressed  a  doubt  in  regard  to  the  dis- 
appearance of  all  tendency  to  the  maintenance,  in 
our  day,  of  medical  systems.  We  may  accept  the 
designation  of  one  at  least  of  those  which  he  named, 
physiological  medicine  ;  and  add  two  others  as  now 
extant — clinical  empiricism  and  expectancy,  or  the- 
rapeutic nihilism. 

But  the  question  appears,  in  some  quarters,  to 
have  taken  a  still  wider  range.  All  are  now  familiar 
with  the  action  of  Dr.  Quain,  and  the  later  utter- 
ances of  Dr.  Bristowe  and  Mr.  Jonathan  Hutchinson, 
in  reference  to  consultations  with  those  who  pro- 
claim themselves  as  belonging  to  a  school  hitherto 
not  at  al]  recognized  by  the  regular  profession. 
These  gentlemen  do  not,  as  we  understand  them, 
propose  exactly  to  admit  the  legitimacy  of  homoeo- 
pathy. But  the  question  presses  :  What  can  be  the 
logical  and  ethical  basis  of  such  consultations,  in 
the  absence  of  this  recognition  ? 

Let  us  suppose  a  case.  A  gentleman  occupying  a 
good  social  position,  and  usiTally  attended  by  a 
homceopathic  practitioner,  is  taken  ill  with  severe 
malarial  remittent  fever.  He  is  alarmed,  and  asks 
for  a  consultation  with  Dr.  Pimento  or  Dr.  Corundum. 
These  gentlemen  declining.  Professor  Janus  is  pre- 
vaOed  upon,  by  motives  of  humanity  and  regard  for 
an  influential  patient,  to  attend.  Such  a  sequence 
as  the  following  may  occur.  They  make  together 
their  visit  to  the  room  of  the  patient ;  all  inquiries 
and  examinations  are  completed,  and  they  retire  to 
the  library,  with  closed  doors. 

Scene. 

Dk.  Lactix. — ^An  ill  man,  doctor,  is  he  not  ? 

Dr.  Jantjs. — Decidedly  so.  Y'ou  know  him  well, 
I  suppose  ;  constitution  sound,  I  hope  ?  Habits 
good? 


Dk.  Lactin, — Pretty  fair.  No  moie  champagne 
than  his  neighbors,  I  believe.  Only  about  sixty 
years  of  age. 

Dr.  Janu.s. — I  don't  like  that  crepitant  i  ale.  It 
complicates  the  matter  badly.  What  have  jou  been 
—  has  he  been— ah,  excuse  me;  I  forgot,  for  a 
moment,  your  position.  We  agree  in  the  diagno- 
sis, I  believe? 

Dk.  Lactin.  —  Entirely  ;  remittent,  with  pneu- 
monia, early  stage,  right  lung.  Very  high  fever, 
and  active  delirium  ;  106°  in  the  axilla.  I  confess  I 
don't  like  it,  doctor. 

Dk.  J.\nus, — Well,  what  are  we  going  to  do? 

Dr.  Lactin. — What  would  you  do  ? 

Dr.  Janus. — Five  grains  of  quinine  every  two 
hours,  doctor,  for  four  doses  :  dry  cups  to  the  right 
side,  followed  by  a  large  2J0ultice  ;  and  then- 

Dr.  Lactin. — The  jjoultice,  well.  But  do  you 
suppose  it  jiossible  that  a  disciple  of  the  immortal 
Hahnemann  can  give  an  unattenuated  grain  of  (pii- 
nine,  even  to  an  elephant  or  a  whale  ? 

Dr.  Janus. — Why  no,  sir.  I  beg  you  pardon, 
sii-.  Of  course  not.  Y'ou  must  be  consistent  ;  I 
honor  your  consistency.  Y'ou  will  do  just  exactly 
what  you  please.     Will  he  leave  a  large  estate  ? 

Dr.  Lactin. — Two  millions,  they  say.  A  large 
family,  however,  besides  the  wid — I  should  say  the 
wife. 

Dr.  Janus.  —  Well,  I  have  an  aiipointment  at 
twelve  ;  I  must  go. 

Dr.  Lactim. — I  will  ask  a  favor  of  you,  doctor.  I 
am  greatly  obliged  for  this  consultation,  I  assure 
you.  Will  be  glad  at  any  time  to  reciprocate. 
Please  do  me  the  further  kindness  to  communicate 
your  prognosis  to  the  family,  will  you  ? 

Dr.  Janus. — Certainly  :  with  much  pleasure. 

Dr.  Lactin. — And  also  our  agreement  in  diag- 
nosis ? 

Dr.  Jants. — Certainly. 

Dr.  Lactin. — I  am  very  much  obliged  to  you, 

{Rcctait,  shaking  hands  cordially,  and  going  down 
stairs  together.) 

Putting  this  into  sober  English,  it  appears  to  be 
oijvious  that  the  only  common  ground  upon  which 
a  regular  physician  can  stand  with  a  he  nireoiiath,  in 
the  consideration  of  a  case  of  disease,  is  the  province 
of  diagnosis  and  prognostication.  Since  the  latter, 
moreover,  is  conditioned  in  part  upon  the  results  of 
treatment,  diagnosis  is  left  as  the  only  region 
wherein  there  can  be  conceived  between  them  any 
rational  modus  rivendi. 

For  the  realization  of  this  in  practice  better  than 
a  consultation,  as  not  like  that  involving  any  recog- 
nition of  the  professional  claims  of  the  homoeopathic 
attendant,  will  be,  in  every  instance,  a  ^pecialb/  ar- 
ranged ri.<tl,  simply  for  diagnostic  examination  of 
the  case  by  the  consultant,  in  the  absence  of  the 
practitioner  who  has  charge  of  the  treatment  of  the 
case.  Even  this  will  be  repugnant  to  most  members 
of  the  profession  ;  but  it  may  be  projierly  open  for 
consideration  whether  this  much  might  not  be,  in 
certain  instances  at  least,  conceded  to  the  often  un- 
reasoning demands  of  the  public  at  large. 

O,  F„  M,D. 

Phlladelphm.  P-^. 

Honors  to  a  Veterinary  Surgeon. — M.  Bouley, 
member  of  the  Paris  Institute,  Inspector-General  of 
the  Veterinary  Schools,  has  been  raised  from  the 
rank  of  Oflficer  to  that  of  Commander  of  the  Legion 
of  Honor. 


223 


THE  MEDICAL  RECORD. 


Sennet    on   laceration    of  the 
cervix  uteri— a  correction. 

To  THE  Editor  of  Thb  Medical  Recokd. 

Sib  :  In  the  current  issue  of  The  Medical  Kecord, 
page  155,  there  is  a  quotation  from  the  Urillsh  Medi- 
cal Journal,  November  26,  1881,  entitled  "  Bennet 
on  Laceration  of  the  Cervix  Uteri."  As  this 
article  will,  in  all  probabilty,  be  very  extensively 
quoted,  I  request  the  privilege  of  cori-ectiug  a  wrong 
impression  it  may  convey.  It  is  unfortunate  that 
Dr.  Bennet  should  i)ermit  such  a  publication  to  go 
forth  after  his  most  decided  recantation  of  the  views 
of  his  paper  He  distinctly  avowed  (in  the  presence 
of  Drs.  Playfair,  of  London  ;  Hodgen,  of  St.  Louis  ; 
Marcy,  of  Boston,  and  many  others  whom  I  do  not 
remember)  in  his  speech,  closing  the  debate  on  his 
paper,  that  for  th.e  past  twenty  years  lie  had  paiil  com- 
paralirely  little  attention  to  (lynecologiviil  subjects  ;  and 
that  he  felt  satisfied  that  during  this  period  he  had 
not  kept  pace  with  the  advances  made.  He  further 
declared  himself  to  be  less  oj^posed  to  the  opera- 
tion than  when  he  read  his  paper.  All  this  took 
place  in  the  Obstetric  Section  of  the  International 
Congress,  held  in  London  last  August,  and  Dr.  Bennet 
found  himself  arrayed  against  Playfair,  of  London  ; 
jMarcy,  of  Boston,  Mass.;  Goodell,  of  Philadelphia; 
Munde,  of  New  York,  and  others  whom  I  do  not 
now  recall.  In  the  remarks  I  made  on  the  afternoon 
of  the  discussion,  I  took  issue  with  every  objection 
raised  by  Dr.  Bennet,  and  he,  openly  and  frankly, 
accorded  me  the  position  of  having  converted  him — 
his  statement  was  about  as  follows  :  "  Dr.  Fallen,  who 
read  his  extraordinary  paper  at  the  meeting  of  the 
British  Medical  Association,  held  at  Cambridge,  in 
1880,  rather  startled  me  by  his  advocacy  of  the 
treatment  of  laceration  of  the  cervix,  in  contra- 
distinction to  the  views  of  his  compatriot,  Dr. 
Marion  Sims,  who  has  equally  surpi'ised  us  by  advo- 
cating the  division  of  the  cervix  for  certain  troubles. 
But  I  now  find  I  misapprehended  the  conditions  as 
then  detailed  by  Dr.  Fallen,  and  if  I  was  wrong  in 
the  views  I  enunciated  in  this  paper,  I  think  Dr. 
Fallen  should  be  thankful  that  I  gave  him  such  an 
opportunity  to  air  his  opinion.s.  Admitting  that  I 
have  failed  to  keep  pace  with  advances  made  by  the 
gynecologists  of  the  last  twenty  years,  I  do  not  like 
to  have  my  errors  so  emphatically  denounced  as 
they  have  been  by  Drs.  Fallen  and  others,"  etc. 

I  appeal  to  Drs.  Hodgen,  Marcy,  and  the  other 
Americans,  as  well  as  Drs.  I'layfair,  Williams,  and 
other  English  gentlemen  who  were  present,  if  I  do 
not  substantially  quote  the  remarks  of  Dr.  Bennet 
as  he  made  them. 

The  authorized  transactions  of  the  International 
Medical  C/ongress  will  soon  be  in  this  country,  and  I 
hops,  Mr.  Editor,  that  you  will  publish  the  debate 
in  full  on  Dr.  Beniiet's  paper.  I  feel  somewhat  in- 
terested in  this  matter,  because  it  was  in  reply  to  my 
paper  on  "The  Etiology  and  Treatment  of  Lacera- 
tions of  tlio  Cervix  Uteri."  read  in  the  obstetric  sec- 
tion of  the  British  Medical  .\ssociation.  at  Cambridge, 
in  August,  1880,  that  Dr.  Bonnet  read  his  essay  to  the 
Obstetrical  Section  of  the  International  Congress, 
last  August,  in  London. 

I  reiterate  here  what  I  stated  there,  that  Dr.  Ben- 
net, in  his  paper,  tenaciously  clung  to  the  theories 
he  advanced  forty  years  ago,  without  ever  having 
made  the  operation  for  closure  of  a  lacerated  cervix; 
and,  after  promulgating  such  views  in  his  final  re- 
marks, frankly  admitted  he  was  not  a  proper  judge, 
because  of  never  having  operated,  and  because  of 


the  overwhelming  testimony  given  by  so  many  gyne- 
cologists against  his  "  inflammation  theory." 

In  plain  Anglo-Saxon,  he  renounced  his  old  notions 
in  his  last  speech,  and  arrayed  himself  on  the  side  of 
the  jjrogi-essive  school  of  gynecology.  I  honor  him 
for  his  candor,  and  if  he  has  omitted  to  present  a 
copy  of  his  remarks  (when  acknowledging  his  mis- 
taken opinions)  to  the  secretary  of  the  obstetrical 
section  of  the  Congress,  I  earnestly  beg  of  him  to 
communicate  it  to  the  medical  public  at  his  earliest 
convenience.  Very  respectfully, 

Montrose  A.  F.^llen. 
118  Madison  Avenue,  N.  Y.,  Febi-nary  llth. 


©bituarg. 


SAMUEL  WHITALL,  M.D., 

NEW    TOBK. 

Dr.  Samuel  Whitall  died  at  his  residence,  607  Lex- 
ington Avenue,  on  the  18th  inst.,  of  acute  capillary 
bronchitis,  complicated  with  malarial  fever.  He  was 
born  at  Marlton,  N.  J.,  August  28,  1840,  and  gradu- 
ated in  medicine  at  the  College  of  Physicians  and 
Surgeons,  New  York,  in  the  spring  of  1866.  Soon 
after  his  graduation  he  was  appointed  Visiting  Phy- 
sician and  Superintendent  of  the  Colored  Home, 
positions  which  he  ably  and  conscientiously  filled 
up  to  the  time  of  his  death.  In  addition  to  his 
duties  in  this  institution,  he  engaged  in  private 
practice,  and  was  more  than  ordinarily  successful. 

Of  an  exceedingly  fraU  constitution,  he  had  re- 
cently been  greatly  overworked,  and,  at  the  time  of 
his  last  illness,  was  so  exhausted  as  to  offer  but  fee- 
ble resistance  to  disease.  Probably  no  member  of 
the  profession  in  the  city  of  equal  merit  was  so  little 
known  as  he.  Naturally  reticent  and  retiring,  these 
characteristics  became  more  marked  with  increasing 
years.  Although  a  keen  disputant,  and  an  interest- 
ing conversationalist,  he  never  mingled  in  society. 

As  a  medical  practitioner  he  stood  in  the  very 
foremost  rank.  His  skill  as  a  diagnostician  was 
recognized  by  all  who  knew  him.  He  was  self-reli- 
ant and  positive,  but  his  opinions  were  always  based 
on  careful  and  thorough  investigation.  His  contri- 
butions to  medical  literature,  although  not  numer- 
ous, are  models  of  clinical  observation. 

As  a  man  he  was  rigidly  honorable  in  all  his  deal- 
ings, and  peculiarly  sensitive  to  any  infringement 
upon  his  rights  by  others.  He  was  a  devoted  mem- 
ber of  the  orthodox  Society  of  Friends,  and  died,  as 
he  lived,  a  consistent  Christian.  J.  H.  K. 


ARMY   NEWS. 
Official  List  of  Changes  of  Stations  and  Duties  of  Offi- 
cers of  the  Medical  Department,  United  Slates  Army, 
from  February  12,  1882,  to  February  18,  1882. 
Campbell,  Johm,    Lient.-Colonel    and    Surgeon, 
Medical  Director  l)e)iartment  of  the  South.  Granted 
leave  of  ab.scnco  for  fifteen  davs  from  l:5th  inst.    S. 
O.  17,  Department  of  the  South,  February  11,  1882. 
Gardner,  William  H.,  Captain  and  Assistant  Sur- 
geon.    Assigned  to  duty  as  Post  Surgeon  at  Fort 
Concho,  Tex.    S.  O.  13,  Department  of  Texas,  Feb- 
ruary, 6,  1882. 

Bartholf,  John  H.,  Captain  and  Assistant  Sur- 
geon. Fort  Lapwai,  Idaho.  Granted  leave  of  absence 
for  fifteen  davs.  S.  O.  12,  Department  of  the  Colum- 
bia, January  25,  1882. 


THE  MEDICAL  EECORD. 


2-Z3 


Maus,  L.  M.,  Captain  and  Assistant  Surgeon.  The 
leave  of  absence  granted  him  in  S.  O.  222,  A.  G.  O., 
October  1,  1881,  extended  one  month.  S.  O.  36, 
A.  G.  O.,  Februai-y  U,  1882. 

B.iNisTER,  John  M.,  First  Lieutenant  and  As- 
sistant Surgeon,  Fort  Eeno,  Ind.  Ter.  The  leave 
of  absence  granted  him  in  Par.  1,  S.  O.  18,  De- 
partment of  the  Missouri,  January  24,  1882,  is  ex- 
tended one  month.  S.  O.  16,  Military  Division  of 
the  Missouri,  February  15,  1882. 


.^Uiiiciil  Jtcms   anlr  XltxoQ. 


The  First  Anti-Vacoinatign  Lbague  of  Asiebica 
met  in  this  city  and  talked  last  week. 

Deaths  fbom  Axjssthetics. — The  daily  papers  of 
February  16th  reported  a  death  from  chloroform  at 
Marion,  Ohio,  and  a  death,  possibly  from  ether,  in 
this  city.  The  latter  case  was  a  patient  at  the  New 
York  Dispensary,  who  was  put  under  ether  in  order 
to  return  a  dislocated  shoulder. 

DiSTRIBtTTION    OP    THE    SuNDAY    HOSPITAL    FuND. — 

The  officers  in  charge  have  distributed  tins  year's 
Hospital  Fund  as  follows :  St.  Luke's  Hospital, 
S5,000  ;  Mount  Sinai  Hospital,  .S3,000 ;  Presbyterian 
Hospital,  82,900  ;  House  of  Rest  for  Consumptives, 
§2,000;  Home  for  Incurables,  §2,000;  St.  Mary's 
Free  Hospital  for  Children,  §2,000  ;  Home  of  the 
Holy  Comforter,  .$1,500  ;  New  York  Eye  and  Ear 
Infirmarv,  81,000 ;  New  York  Litirmary  for  Women 
and  Chikb-en,  .§1,000  ;  New  York  Ophthalmic  Hos- 
pital, 81,000 ;  New  York  Ophthalmic  and  Aural  In- 
stitute, 81,000  ;  Orthopedic  Hospital,  81,000  ;  Man- 
hattan Eye  and  Ear  Hospital,  81,000 ;  Hahnemann 
Hospital,  .81,000.  The  total  amount  distributed  was 
$25,400. 

Further  Conclusions  Eeg.\kding  the  Iodoform 
Treatmekt. — Mosetig-Moorhof,  in  a  recent  commu- 
nication in  the  Wiey^er  med.  Wocheiischrift,  comes 
to  the  following  conclusions  regarding  the  iodoform 
treatment :  1.  It  is  almost  a  specific  against  local 
tuberculous  processes  ;  2.  Fungous  granulations 
should  be  removed  before  it  is  applied  ;  3.  Iodoform 
placed  upon  non-fungous  surfaces  is  the  sui'est  anti- 
septic ;  4.  It  is  absorbed  and  excreted  through  the 
kidneys  ;  5.  It  excites  a  painless  and  rapid  granu- 
lation process  and  prevents  septic  absorption  ;  6. 
The  heating  process  is  general  afebrile ;  the  pow- 
der sprinkled  on  the  surfaces  of  the  wound  does  not 
prevent  primary  healing  ;  7.  Drainage  is  necessary  ; 
8.  Eedness  and  swelling  occur  rarely,  and  then  from 
retention  of  secretions  ;  9.  No  other  disinfectant  is 
necessai-y ;  10.  The  iodoform  treatment  is  the  cheap- 
est and  surest  of  any  ;  iodoform  keeps  for  a  year ; 
11.  Iodoform  is  the  antiseptic  for  operations  in 
cavities — i.e.,  the  mouth,  bladder,  rectum,  etc.  ;  12. 
It  can  be  deodorized  with  tonca  bean. 

The  German  Government  appropriates  this  year 
over  840,000  for  the  support  of  medical  education 
and  work  in  the  seven  universities  of  Berlin,  Konigs- 
berg,  Halle,  Kiel,  Gottingen,  Marlburg,  and  Bonn. 

The  Society  of  German  Surgeons  meets  this  year 
in  Berlin,  from  May  31st  to  June  3d. 

Obesity  in  a  Child. — Dr.  Hillairet  exhibited  in 
Paris,  not  long  ago,  a  girl,  five  years  old,  who 
weighed  one  hundred  and  twenty-four  pounds,  and 
i  measured  four  feet  round  the  waist.  The  child  was 
healthy  in  other  respects,  but  somewhat  scant  of 
breath. 


TBI0HIN2E  IN  German  Swine. — The  last  official  bul- 
letins regarding  the  above  make  the  i^roportion  of 
trichinosed  swine  1  to  1,510. 

The  Extent  and  Futube  Spbead  op  Small-Pox  in 
this  country  is  discussed  by  Dr.  T.  C.  Minor  in  the 
Cincinnali  Lancet  and  Clinic.  In  this  country  up  to 
November,  1879,  there  had  been  very  few  ca.«es  re- 
ported, though  the  disease  was  widely  prevalent  in 
Em-ope.  In  1880  there  were,  according  to  Dr- 
Minor's  careful  estimates,  about  700  deaths  from 
small-pox.  Five-sixths  of  the  mortality  was  in  the 
northeast  section  of  the  country.  Philadelphia 
suffering  most.  During  the  past  year  it  is  esti- 
mated that  there  have  been  15,000  cases  in  the 
United  States,  with  4,000  deaths.  The  cities  .suffer- 
ing most  have  been  Philadelphia  with  1,319  deaths  ; 
Chicago,  822 ;  New  York,  453 ;  Pittsburg,  444 ; 
Hudson  County,  202  ;  Piichmond,  144. 

Dr.  Minor  thinks  that  the  disease  is  travelling 
west  and  south,  and  that  before  the  winter  of  1S83, 
Cincinnati,  Louisville,  St.  Louis,  Nashville,  Mem- 
phis, Vicksburg,  and  New  Orleans,  will  feel  the 
eifect  of  the  present  epidemic  wave. 

A  Place  Where  More  Doctors  are  Wanted. — 
Americans  travelling  in  Italy  complain  that  it  is  al- 
most impossible  to  get  the  attendance  of  a  good 
physician,  especially  in  the  larger  cities  like  Eome 
and  Florence.  One  American  lady,  while  taken  ill 
with  typhoid  fever  in  the  latter  city,  could  not  secure 
medical  attendance  except  by  the  special  interposi- 
tion of  the  consul. 

"Our  Continent." — We  are  pleased  to  see  that 
Dr.  Brinton,  the  well-known  editor  of  our  esteemed 
contemporary,  the  Philadelphia  Medical  and  Surgical 
Repwler,  has  become  engaged  in  a  new  literai-y 
enterprise,  a  weekly  literary  journal  recently  started 
in  Philadelphia,  and  entitled  Ovr  Coniitient. 

Aluimni  Association,  Albany  Medical  College. 
— The  annual  dinner  of  the  Alumni  Association  of 
the  Albany  INIedical  College  will  take  place  at  the 
Delavan  House,  Wednesday,  March  1,  1882,  immedi- 
ately after  the  commencement  exercises  at  Tweddle 
Hall. 

State  Emigrant  .\stlum.  Ward's  Island,  N.  Y. 
— Dr.  Alexander  Trautman,  late  Assistant  Superin- 
tendent of  the  Northern  State  Hospital  for  the  In- 
sane of  Wisconsin,  has  been  appointed  Medical  Su- 
perintendent of  the  State  Emigrant  Asylum  at 
AVard's  Island,  N.  Y. 

Premiums  on  Births. — Brussels  gives  every  mother, 
not  a  chromo,  but  a  sanitary  tract  each  time  a  new 
baby  is  born.  The  effect  on  the  bii'th-rate  has  not 
yet  been  noted. 

Dr.  Burq,  the  originator  of  metalloscopy  and  me- 
tallotherapy,  has  been  gazetted  Chevalier  of  the 
Legion  of  Honor. 

Guy's  Hospital. — Dr.  F.  A.  Mahomed  has  been 
appointed  Assistant  Physician,  and  Mr.  C.  J.  Sy- 
monds  Assistant  Surgeon  to  this  institution. 

M.  Camille  Godard  has  left  820,000  to  be  devoted 
to  the  creation  of  a  l)otanical  garden  at  Bordeaux, 
for  the  use  of  the  Faculty  of  Medicine.  He  has 
also  bequeathed  an  annual  sum  of  8600,  for  prizes. 

New  Blood-Cokpuscles  are  now  found  at  the 
rate  of  about  two  a  year.  The  last  variety  is  de- 
scribed by  Bizzozero,  of  Turin.  His  name  suggests 
oval  corpuscles,  and  such  he  has  found.  They  are 
oval,  pale,  disc-shaped  or  lenticular,  and  one-half 
or  one-third  the  size  of  the  red  corpuscle.     They 


224 


THE  MEDICAL  RECORD. 


were  discovered  in  the  mesentery  of  chloralized  rab- 
bits and  giunea-pigs,  and  may  be  observed  m  freshly 
drawn  blood,  but  rapidly  become  gi-anulav  -Pro- 
fessor B.  thinks  thev  may  contain  the  fabrm  factors 
thought  by  Schmidt  to  be  in  the  white  corpuscles. 

Mr  Lister  has  been  elected  President  of  the 
London  Clinical  Society  for  the  ensuing  year. 

PiLOCARPmE  has  been  used  without  any  success  m 
hydrophobia. 

'Sra  Er.vsmus  Wilson  has  given  $50,000  for  the 
purpose  of  founding  a  Chair  of  Pathological  Anat- 
omy in  the  University  of  Aberdeen. 

That  CiiiNiCAL  Thermo jieters  may  carry  disease 
and  ought  to  be  disinfected  is  the  last  note  of  warn- 
ing from  the  sanitarians. 

M.vLARi.vL  Keratftis.— At  a  meeting  of  the  Chi- 
cago Medical  Society,  January  10,  1882,  Dr.  1 .  O. 
Holzread  a  paper  on  the  above  subject.  Hesaul 
that  in  this  disease  the  ulcer  of  the  cornea  is  raised, 
and  may  creep  on  the  entire  surface  ;  there  is  severe 
pain,  photophobia,  and  lachrymation.  It  extends 
for  a  few  weeks,  and  reparation  may  require  a  tew 
months.  This  takes  place  through  an  elongation  ot 
the  deeper  blood-vessels.  This  ulcer  is  just  as  char- 
acteristic as  the  patches  found  in  the  mouth  m  sy- 
philis Malarial  or  remittent  fever  may  or  may  not 
accompany  or  precede  this  affection  ;  as  a  rule  it 
does,  and  quinine  is  especially  successful  as  a  con-  , 
stitutional  treatment,  even  after  local  treatment  has 
failed.  Several  illustrative  cases  were  reported. 
Other  members  of  the  society  confirmed  Dr.  Holz  s 
vie-vrs.— Chicago  Medical  Journal  and  E.caminer. 

Vaccination  after  Small-Pos.— Dr.  J.  W.  Col- 
lins, of  Toronto,  Ohio,  wTites  :  Ha%-ing  read  m  The 
Medical  Record  of  February  •1th,  Dr.  Bristoe  s  ex- 
periment on  himself  with  vaccine  vims  after  having 
small-pox,  and  as  information  on  this  subject  is 
much  sought  for  by  the  laity  as  well  as  physicians 
just  now,  I  will  state  that  Mrs.  Margaret  Kell,  of 
this  place,  had  a  severe  attack  of  confluent  smaU- 
pox  in  the  spring  of  1873.  I  vaccinated  her  Janu- 
ary 4  1882,  and  she  had  all  the  symptoms  of  a  per- 
fect vaccination.  I  used  virus  from  the  vaccine 
farm  of  Johnston  Bros.,  Fox  Lake,  Wis. 

A  Xov-Odorocs  DissECTiNG-Koojr.— The  Boston 
correspondent  of  the  Chicago  Mrdical  Journal  and 
Ecaminer  describes  at  some  length  the  pathological 
building  just  finished  in  connection  with  the  new 
colleo'e  building.  It  is  unique  in  several  respects, 
but  caiierty  in  the  fact  tliat  there  are  an-angements 
for  removing  all  foul  gases,  and  for  flooding  and 
cleansing  the  room  whenever  necessary.  The  post- 
mortem tables  are  depressed  in  the  centre,  where 
there  is  a  large  opening  covered  with  a  gratrng. 
This  leads  down  through  a  large  porcelain-hned 
cylinder,  which  conducts  to  the  trapped  opening  of 
a"  large  drain.  To  secure  the  escape  of  the  gases 
there"is  tlie  following  ingenious  arrangement : 

Some  feet  down  the  cylinder,  and  nearly  half  way 
to  its  lower  end,  is  a  large  aperture  mouthing  into  a 
lateral  shaft  placed  just  Vielow  the  floor  of  the  post- 
mortem room.  This  shaft  runs  horizontally,  and 
terminates  fifteen  feet  away  in  a  special  chimney, 
which  passes  upward  through  a  small  room  adjoining 
the  autopsv  department.  In  this  anteroom  is  a  win- 
dow let  into  the  chimney.  Opening  the  window,  you 
find  in  the  chimney  a  series  of  ten  gas-jets.  Lighting 
these,  and  waiting  a  few  moments  for  the  warming 
of  the  air  in  tlie  chimney,  you  hokl  a  Viit  of  burn- 
ing paper  over  the  opening  in  the  table,  and  are 


surprised  by  the  force  with  which  the  flame  is  drawn 
dovn  the  hopper.  And  this  is  the  manner  m  which, 
during  the  examination,  of  a  body,  gases  and  odors 
leave  the  room,  its  air  remaining  pure.  The  au- 
topsy table  is  supplied  with  every  convenience  to 
secure  cleanliness,  a  small  hose  being  the  chief. 
The  floor  of  the  room  is  of  asphalt,  the  washboards 
are  glass,  so  that  the  whole  place  is  frequently  del- 
uged with  water,  which  runs  ofl'  by  means  of  scup- 
pers and  gi-atings  which  communicate  with  the  main 
drain. 

Death  of  a  Woman  in  Pcterperal  Conviilsions 
FROM  "Fatty  Metamorphosis."— Happening  in  Pro- 
fessor  Carl   Braun's   obstetrical   and  gynecological 
clinic,  I  heard  the  report  of  a  patient  who  had  died  m 
six  davs  after  confinement,  from  fatty  metamorphosis 
of  heart  and  other  organs.  She  had,  in  all,  about  fifty 
eclamptic  convulsions.     These  came  on  before  de- 
livery,  which   was   effected   with  forceps,  without, 
however,  influencing  the  spasms.    She  then  had  hot 
bath  and  purgatives,   without  effect.     Then  thirty 
grains  of  chloral  were  given,  which  checked  them  for 
two  hours,  when  thev  recurred,  and  the  dose  was  re- 
peated until  two  drachms  had  been  taken  without 
benefit,  or  only  of  a  temporary  character.     Then  slie 
was  bled  several  ounces,  to  have  the  blood  tested  for 
ammonium  carb.,  when  the  convulsions  ceased  for 
several  hours,  and  recurred.     The  examination  did 
not   reveal  ammonium  carb.      The  convulsions  re- 
curred, and  these  and  other  remedies  were  used, 
alone  and  in  combination,  but  the  pul.se  gi-ew  weaker 
and  faster  until  the  patient  expired.     The  lecturer 
remarked  that  the  patient  did  not  die  of  medicine, 
albuminuria,   septicemia,  etc.,  but  fatty  metamor- 
phosis.    The  lecturer  had  given  up  venesection  lor 
many  years,  having  no  faith  in   its  efficacy,     lew 
patients  recover  who  have  convulsions  before  de- 
livery.—Vienna  cor.  of  Chicago  Medical  Journal  and 
Examiner, 

An  Applicatios  in  Small-pox.— Mr.  C.  ^y.  Thorp 
writes  (BriL  Med.  Journ.)  that  he  has  found  the  car- 
boUc  acid  glycerine  of  the  British  Pharmacopoeia, 
diluted  with 'four  times  its  weight  of  glycerine,  a 
most  useful  application  in  small-pox.  It  not  only 
makes  the  patient  less  repulsive,  but  lessens  the 
amount  of  pitting.  It  should  be  applied  as  soon  as 
the  pustules  begin  to  fill,  and  be  continued  until 
thev  desquamate. 

Female  Phtsici/VNS  in  Kussia.— According  to  a 
daily  journal,  medicine  is  much  studied  by  tlip 
middle-class  women  of  Russia.  Each  year  seventy 
female  students  are  admitted  to  the  medical  ^f^HeKf. 
and  twice  that  number  apply  for  admission.  The  ex-  ^ 
aminers  endeavor  to  stop  this  over-supply  by  raising 
the  examination  fees  and  by  increasing  the  seventy 
of  the  examinations,  but  the  number  of  applicants 
increases.  Of  the  9.51  female  students  who  have  at- 
tended the  medical  lectures,  only  four  have  been 
implicated  in  political  troubles,  while  of  the  281 
women  who  have  been  graduated,  and  the  1:>2  wUO 
have  been  iiermitted  to  practise,  not  one  has  been 
arrested.  During  the  Kusso-Turkish  war  Uyeni^- 
five  female  physicians  were  sent  to  the  front.  l"e>r 
devotion  to  tlie  wounded  attracted  the  attention  of 
the  late  Czar,  and  many  of  them  were  decorated  wiU» 
medals  for  valiant  services.— CA/Vw/o  Mcdiccd  Ixeview. 
A  Pathoonomonic  Symptom  of  Diahetes.— Dr. 
Magilot,  as  the  residt  of  many  examination.s,  con- 
siders that  a  peculiar  osteo-periostitis  of  the  a  veolar 
border  of  the  jaw  is  a  constant  early  and  pathogno- 
monic sign  of  diabetes  mellitus. 


Vol.  XXI.-No.  9. 
March  4.  1882. 


THE  MEDICAL  KECORD. 


225 


©rigtnnl  Cccturc©. 


THE    GENEEAL    M.^AGEMENT    OF    THE 
PAETURIENT  STATE. 

By  WILLIAM  M.  POLK,  M.D., 


(Phonographically  reported  for  The  Medical  Record.) 

Gentlemen  :  If  it  is  asked  what  is  the  chief  end 
or  principle  to  be  kept  in  view  in  the  management 
of  a  puerperal  case,  I  would  say  the  prevention  of 
puerperal  fever.  If  you  can  avoid  that  contingency, 
nature,  under  ordinary  circumstances,  will  provide 
very  weU  for  the  patient.  In  order,  however,  that 
she  may  avoid  puerperal  septicaemia,  and  return  to 
her  usual  condition  in  full  health,  certain  precau- 
tions are  necessary. 

In  the  first  place,  in  taking  into  consideration 
the  measures  for  the  proper  management  of  your 
patient,  your  precautions  should  always  date  back 
into  the  pregnant  period,  for  the  reason  that  if  she 
be  under  your  ob.servation  during  the  last  two  or 
three  months  of  pregnancy  you  can  so  watch  over 
her  various  functions  as  to  have  them  all  in  proper 
working  order  at  the  time  of  labor,  and  consequently 
during  the  parturient  period.  According  to  the  old- 
fashioned  way  of  managing  these  cases,  the  physician 
rarely  saw  his  patient  until  just  aliout  the  time  labor 
began ;  therefore,  there  might  be  a  number  of  path- 
ological conditions  present,  more  or  less  severe, 
which  could  but  exercise  a  deleterious  influence 
upon  the  woman  during  the  parturient  period.  By 
careful  attention  during  the  last  six  weeks  or  two 
months  of  pregnancy  you  may  be  able  to  correct  va- 
rious pathological  conditions  which  may  be  present 
during  that  time,  so  that  when  labor  comes  on  your 
patient  will  be  in  the  vei-y  best  physical  condition 
that  can  possibly  be  attained. 

With  regard  to  labor  itself,  there  are  certain  pre- 
cautions to  be  borne  in  mind  having  a  direct  bearing 
upon  the  individual's  favorable  recovery.     For  in- 
stance, in  the  first,  the  worst  stage  of  labor,  nothing 
so  comforts  and  aids  the  woman  as  properly  directed 
care  and  sympathy  on  the  part  of  the  physician.     It 
is  not  necessary  to  rush  into  the  room,  make  a  vag- 
ioal   examination,   turn   around  hastily  and  say   to 
the  friends  that  all  is  right,  and  dash  out  again.    You 
should  remain  long  enough  not  only  to  find  out  the 
position  and  presentation  of  the  child,  but  also  to 
1   take  into  considei-ation  the  nervous  condition  of  the 
'    patient,  and  to  impress  upon  her  mind  that  she^s  in 
the  very  best  possible  state  for  favorable  delivery. 
;   A  great  many  women  approach  the  period  of  labor 
j   with  the  feeling  that  death  will  surely  be  the  end  of 
I   their  suffering.     Xow,  this  assiarance  on  the  part  of 
j   the  medical  attendant  will  tend  greatly  to  insure 
I   that  quiet  state  of  the  neiwous  system  of  the  patient 
'  which  is  so  necessary  to  the  most  favorable  termina- 
I  tion  of  labor.     If,  however,  the  mere  assertion  by 
I  the  physician,  that  all  is  well,  is  not  sufficient  to 
j  quiet  her  nervousness,  then  do  not  hesitate  to  em- 
I   ploy  some   quieting  remedy,   among  which  I  have 
'  already  mentioned  chloral  as  answering  this  purpose 
I  better  than  any  other.     It  has  a  soothing  influence 
i  upon  the  nervous  system,  and  acts  as  an  ana?sthetic 
upon  the  labor  pains  while  perhaps  it  may  have  no 
such  effect  upon   any  other  portion  of  the  body, 
1  and  its  influence  upon  the  secretions  and  the  system 


generally  is  better,  in  my  mind,  than  that  of  opium. 
Fifteen,  thirty,  or  sixty  gi-ains  may  be  administered 
in  broken  doses,  according  to  the  indications  of  the 
case ;  it  is  unnecessary  to  mention  the  size  of  doses 
now,  having  done  that  at  previous  lectures.  In  some 
cases,  as  in  extreme  suffering,  it  may  be  jireferable 
to  employ  opium.  Coming  to  the  second  stage  of 
labor,  if  the  patient  be  strong  and  capable  of  getting 
along  without  an  an!v>sthetic,  it  is  better  that  she 
should  do  so,  and  I  am  in  the  habit  of  encouraging  her 
to  dispense  with  it  unless  there  be  special  indica- 
I  tions  for  its  use.  When  chloroform  is  used,  it  should 
be  given  only  in  sufficient  quantity  to  give  rest  and 
relief  from  the  severe  j^ain  from  which  the  patient  is 
suft'ering.  It  should  be  remembered,  too,  that  in 
cases  in  which  chloroform  has  been  administered 
there  is  always  a  little  more  risk  of  postpartum 
hemorrhage  than  in  those  cases  in  which  it  has  not 
been  employed.  There  is  no  question  that  chlcro- 
form,  when  administered  in  considerable  amount, 
has  a  marked  tendency  to  the  i^roduction  of  uterine 
inertia.  You  will  bear  in  mind,  therefore,  that  while 
your  chief  object  during  this  stage  is  to  guard  against 
post-partum  hemorrhage,  that  that  should  not  be  the 
sole  object  to  keep  in  view,  but  that  contraction  of 
the  uterus  must  be  insured  after  the  delivery  of  the 
placenta,  in  order  that  no  clots  may  form  within  its 
cavity.  If  clots  are  allowed  to  form  and  remain 
here,  they  are  liable  to  undergo  decomposition,  Vireak 
down,  and  excite  septicremia.  In  fact,  a  blood-clot 
remaining  within  the  cavity  of  the  uterus  and  under- 
going decomposition,  is  just  as  potent  to  set  up  sep- 
ticiemia  as  is  a  portion  of  the  placenta  under  the 
same  circumstances.  In  order  to  prevent  the  forma- 
tion of  blood-clots  within  the  cavity  of  the  uterus 
you  must  not  only  see  that  the  uterus  has  contracted 
after  the  expulsion  of  the  placenta,  but  that  an  hour 
at  least  after  the  expulsion  of  that  organ  it  still  re- 
mains contracted. 

After  delivei-y  it  is  important  to  see  that  for  the 
first  twenty-four  hours  the  patient's  rest  is  not  dis- 
turbed by  the  presence  of  any  protruding  ha?mor- 
rhoids,  this  being  a  time  when  rest  and  sleep  is  most 
important  in  the  puerperal  state. 

5lake  it  a  rule  in  evei-y  case  after  delivery  to  care- 
fully examine  the  condition  of  the  genital  passages, 
to  see  how  much  laceration,  especially  of  the  cervix, 
has  taken  place.  If  there  be  much  relaxation  of  the 
cervical  tissue  it  may  be  somewhat  difficult  to  de- 
termine to  what  extent  laceration  may  have  taken 
place.  If  there  be  sufficient  laceration  in  the  lower 
portion  of  the  vaginal  canal,  particularly  of  the  peii- 
neum,  to  require  repairing,  it  should  be  done  at 
once.  You  wiU  remember  that  it  is  not  all  cases  of 
laceration  of  the  perineum  that  require  the  passage 
of  the  silver  suture ;  but  having  before  mentioned 
the  degrees  of  rupture  which  require  surgical  inter- 
ference, I  will  not  mention  them  again  to-day. 

The  next  question  is,  how  can  you  secure  to  your 
patient,  just  after  childbirth,  twelve  hours  of  unin- 
terrupted rest  ?  If  she  happen  to  belong  to  that 
class  of  peojjle  who  are  able  to  set  apart  a  room  for 
the  parturient  woman  alone,  I  would  advise  by  all 
means  that  the  new-born  child  be  taken  into  another 
room  rather  than  leave  it  with  the  mother  to  disturb 
her  rest.  If  then  there  be  any  disposition  to  wii];e- 
fulness  give  her  a  dose  either  of  chloral  or  of  chloro- 
dyne,  according  as  the  one  or  the  other  agrees  best 
I  with  the  patient,  and  leave  instructions  with  the 
I   nurse  to  give  another  dose  if  the  first  one  does  not 

produce  the  requisite  rest. 
I       As  to  the  bandage  it  is  hardly  necessary  to  refer  to 


2-ilJ 


THE  MEDICAL  RECORD. 


that  again  ;  the  nurse  -will  usually  apply  that  under 
your  directions.  It  should  be  drawn  suflSoiently 
tight  simply  to  give  support  to  the  abdominal  viscera. 
You  know  that  when  the  abdominal  cavity  has  been 
emptied  of  any  large  accumulation,  whether  it  be 
ascitic  fluid,  a  tumor,  or  a  child  within  the  uterus, 
there  is  a  relaxation  of  the  vena  cava  and  smaller 
ves^sels,  and  the  accumulation  of  a  large  amount  of 
blood  within  them.  These  patients,  therefore,  require 
a  support  around  the  abdomen  in  the  form  ofaband- 
a^re,  which  should  be  drawn  just  tight  enough  to 
give  comfort. 

Having  observed  these  precautions,  you  can  take 
yo  ir  departure,  to  return  and  see  your  patient  again 
within  ten  or  twelve  hours.  Before  considering  the 
duties  which  we  shall  have  to  perform  from  this 
time  OQ,  let  us  cast  our  eyes  over  the  condition  of  the 
various  organs  of  the  patient's  body  during  this  and 
the  whole  of  the  parturient  period.  What  is  the 
condition  of  the  blood,  of  the  nervous  .system,  of  the 
various  secretions,  of  the  uterus,  etc.  V  A  proper 
appreciation  of  the  state  of  these  organs  will  enable 
us  to  direct  our  treatment  more  intelligently.  Im- 
mediately after  labor  the  condition  of  the  blood,  of 
course,  differs  little  from  what  it  was  before  that 
occurrence  ;  but  within  a  very  short  time,  within  a 
few  hours  afterward,  it  contains  a  larger  proportion 
of  excrementitious  material.  The  lai-ge  amount  of 
material  which  before  went  to  the  nourishment  of 
the  child  is  no  longer  used  for  that  ijurjiose,  but  is 
turned  directly  upon  the  mother's  circulation,  and  as 
it  contains  a  large  amount  of  fibrin  and  excrementi- 
tious material,  it  must  be  gotten  rid  of  by  the  excre- 
tory organs,  else  it  will  act  as  a  jjoison.  The  state  of 
the  nervous  system  will  differ  in  different  patients  ac- 
cording to  their  individual  neiwous  organization. 
There  is  always  a  certain  amount  of  shock  consequent 
upon  delivery ;  the  greater  the  amount  of  siiffering 
the  greater  the  amount  of  shock.  The  shock  of  labor 
differs  in  no  respect  from  the  shock  which  you  are 
familiar  with  in  surgical  procedures ;  of  course, 
however,  that  of  labor,  unless  after  instrumental  de- 
livery, is  rarely  sd  great  as  that  after  severe  surgical 
operations ;  but  it  is  simply  a  difference  in  degree, 
not  of  kind.  The  shock  which  occurs  after  a  simple 
labor  is  usually  not  sufficient  to  cause  any  gi-eat 
amount  of  apprehension,  but  that  which  occurs  after 
graver  operations,  as  version  or  craniotomy,  is  some- 
times sufficient  to  terminate  fatally  shoi-tly  after  de- 
livery. In  fact,  a  number  of  cases  have  been  recorded 
in  which  the  sole  cause  of  death  was  shock  which, 
as  already  said,  was  identical  with  surgical  shock. 
In  most  women  this  condition  manifests  itself  soon 
after  delivery  by  the  following  symptoms  :  restless- 
ness, indisposition  to  sleej),  or  rather  an  inability  to 
sleep  ;  sense  of  weakness  or  litter  exhaustion.  If  a 
woman  in  this  condition  be  annoyed,  say  by  the  cry- 
ing of  a  fractious  infant,  or  by  the  too  assiduous  at- 
tentions of  solicitous  friends,  you  can  readily  .see 
that  that  condition  of  nerve -fatigue  or  exhaustion 
will  be  aggravated,  and  when  the  proper  time  for 
sleej}  arrives  she  cannot  obtain  it ;  she  lies  abed  with 
her  eyes  wide  open,  tlie  cerebrum  perhaps  unduly 
excited  from  the  influence  of  the  various  narcotic 
remedies  which  may  have  been  administered  during 
labor,  as  chloral,  opium  ;  and  now,  upon  giving 
those  as  hypnotics,  they  may  fail  to  give  the  patient 
a  sufficient  amount  of  rest  and  sleep.  Such  patients 
are  the  ones  who  are  liable  to  pass  into  a  state  of 
puerperal  mania.  I  mention  these  facts  to  .show 
tliat  after  every  case  of  labor  there  is  a  condition  of 
aliock  in  some  degree,  and  you  are  therefore  to  give 


her  that  attention  which  will  enable  her  quickly  to 
rally  from  the  effect  produced  upon  her  nervous 
system.  Extreme  shock,  when  present,  indicated  by 
clamminessof  the  surface,  etc.,  demands  stimulation. 

"We  can  derive  a  certain  amount  of  information  re- 
specting the  condition  of  our  patients  in  nearly  all 
cases  by  studying  the  pulse.  You  will  find  that  im* 
mediately  after  delivery  there  is  normally  a  sinking 
of  the  jnilse-rate.  If  during  labor  the  pulse  has 
been,  as  it  so  often  is,  ninety  or  a  hundred  per  min- 
ute, immediately  after  delivery  it  wUl  drop  to  about 
seventy,  sixty,  or  even  fifty.  Now  the  slow  pulse, 
remember,  is  the  normal  pulse  of  a  parturient  woman, 
and  should  you  find  it  persisting  at  ninety  or  one 
hundred  you  may  be  sure  that  something  is  wrong  ; 
if  immediately  after  delivery,  it  is  generally  indica- 
tive of  a  tendency  to  hemorrhage.  Therefore  it  is 
stated  in  many  text-books,  and  by  many  teachers, 
that  when  such  a  pulse  is  present  the  patient  should 
not  be  left  for  several  hours,  as  post-partum  hemor- 
rhage may  occur  at  any  time. 

The  temperature  is  slightly  elevated  during  labor  ; 
a  considerable  degree  of  muscular  action  has  taken 
place,  and  you  know  that  this  tends  to  increase  the 
temperatxire  (as  does  all  tissue  change).  After  labor, 
•when  the  patient  has  entered  upon  a  state  of  rest,  it 
is  natural  that  the  temperature  should  fall  a  little, 
perhaps  to  half  a  degree  below  normal.  If  it  go  be- 
low that  point  you  may  be  sure  that  it  is  one  of  the 
evidences  of  consi  'erable  shock.  Where  an  abnor- 
mal degree  of  shock  has  not  occurred,  the  tempera- 
ture will  probably  remain  half  a  degree  below  nor- 
mal for  a  few  hours  and  gradually  return  to  the  nor- 
mal standard.  The  temperature  of  the  parturient 
woman  should  not  normally  stand  higher  dming  the 
first  two  days  and  a  half  than  from  98 '  to  99'  F.  If 
it  go  above  that  point,  say  to  100.5'  or  101'  and  re- 
main there,  yoii  may  be  sure  that  some  septic  ele- 
ment is  at  work,  and  act  accordingly.  I  have  ab-eady 
spoken  to  you  of  the  treatment  in  such  a  case,  and 
it  is  hardly  necessaiy  to  repeat  it. 

About  the  third  day  after  delivery  there  is  a  ten- 
dency to  a  slight  elevation  of  the  temperature,  be- 
cause of  the  incoming  of  the  milk.  In  some  women 
there  will  be  no  elevation  of  the  temperature  at  this 
time  whatever  ;  in  otliers,  there  will  be  rather  a  de- 
cided febrile  reaction.  The  temperature  may  rise 
to  100',  or  even  to  101'.  This,  if  it  be  due  simply  to 
the  incoming  of  the  milk,  will  subside  as  soon  as  the 
milk  begins  to  flow ;  if  it  continue  a  longer  time  it 
is  rather  an  indication  of  some  degree  of  sepsis  also. 

A  word  or  two  with  reference  to  the  secretions  in 
general.  They  are  all  increased  immediately  after 
delivery.  Y'ou  will  find  that  the  skin  acts  moi-e 
freely  than  during  labor ;  the  flow  of  the  urine  is 
greater.  Possibly  the  alimentary  eanal  will  show  a 
disposition  to  act ;  but,  although  the  excretions  by 
way  of  this  channel  may  be  increased,  as  a  rule, 
there  is  no  outward  evidence  of  this.  The  tendency 
after  delivery  is  to  constipation.  The  reason  for 
this  apparently  is  the  habit  of  most  women  to  con- 
stii)ation  during  pregnancy,  and  to  the  fact  that  as 
the  cliild's  head  passes  down  through  the  pelvis  it 
produces  a  certain  amount  of  temi)oraiy  paresis  of 
the  rectum  by  pressure.  Because  of  this  tendency 
to  inactivity  of  the  bowel  after  delivery,  the  old 
fasliion  was  to  administer  a  cathartic  in  the  form  of 
Epsom  salts  or  castor-oil,  but  the  fastidiousness  of 
the  women  of  the  present  day  rather  leads  them  to 
favor  the  use  of  the  enema,  and  since  the  trouble  is 
chiotly  due  to  inactivity  of  the  rectum  itself  rather 
than  to  other  parts   of  the  alimentary  canal,  this 


THE  MEDICAL  RECORD. 


227 


method  of  relieving  the  constipation  seems  to  be  the 
more  af)propriate. 

When  you  return  to  see  the  patient  after  the  first 
twelve  hours,  make  it  your  rule,  as  soon  as  you  have 
felt  the  pulse,  to  inquire  as  to  the  condition  of  the 
bladder.  You  wUl  find  in  not  a  few  cases  that  there 
is  a  tendency  to  retention,  even  though  labor  may 
have  been  natural,  and  it  is  due  to  pressure  of  the 
child's  head  upon  the  bladder  or  the  urethra  during 
delivery,  producing  temporary  paresis.  If  you  find 
that  the  bladder  has  not  acted,  you  must,  of  course, 
resort  to  some  means  to  bring  about  its  acti'vity,  for, 
as  is  well  known,  in  some  of  these  cases  retention 
continues  until  the  bladder  becomes  sufficiently  dis- 
tended to  reach  as  high  as  the  umbilicus,  and  a  drib- 
bling of  urine  from  overflow  exists.  Now,  the  fh'st 
thought  which  wiU  suggest  itself  to  you  will  be  to 
introduce  the  catheter,  and  draw  off  the  water.  That 
certainly  is  the  simplest  method,  but  the  bladder  is 
a  queer  kind  of  organ,  for  the  reason  if  once  you  use 
the  catheter  in  these  cases,  the  chances  are  you  will 
have  to  resort  to  it  half  a  dozen  times  in  succession. 
Of  coui'se  if  the  paresis  of  the  urethra  be  complete, 
you  will  be  compelled  to  resort  to  the  catheter  ulti- 
mately, but  it  will  be  well  to  remember  the  fact  that 
there  are  one  or  two  other  means  which  may  be  em- 
ployed, and  enable  us  oftentimes  to  avoid  the  use 
of  this  instrument.  Before  speaking  of  these  means, 
however,  I  might  say  that  another  objection  to  the 
use  of  the  catheter  is  the  fact  that  it  often  gives  rise 
to  cystitis.  It  nearly  always  causes  a  certain  amoimt 
of  irritability  of  the  bladder,  and  in  certain  women 
it  produces  a  violent  cystitis,  sufficient  to  give  you  a 
great  deal  of  trouble  during  the  whole  of  the  par- 
turient period. 

There  is  a  tendency  of  the  bladder  to  empty  itself 
at  the  same  time  that  the  rectum  does  ;  therefore,  it 
is  my  rale,  on  visiting  the  patient  twelve  hours  after 
confinement,  and  finding  the  bladder  has  not  yet 
acted,  to  tell  the  nurse  to  administer  an  enema, 
using,  if  necessary,  as  much  as  three  pints  of  water, 
or  even  four,  to  be  injected  slowly  into  the  rectum, 
so  that  as  much  as  possible  may  be  retained.  When 
that  enema  passes  away  it  is  found  that  in  the  large 
majority  of  cases  the  bladder  also  empties  itself,  and 
when  this  viscus  has  once  acted  in  these  cases  you 
will  find  that  it  will  continue  to  perform  its  func- 
tions normally.  In  connection  with  the  use  of  the 
enem.t,  you  can  often  obtain  beneficial  results  by  ap- 
plying hot  cloths  or  a  hot  flax-seed  poultice  over  the 
region  of  the  bladder,  which,  by  its  relaxing  ef- 
fects, tends  to  correct  any  spasm  which  may  exist 
and  give  rise  to  retention.  If  these  means  do  not 
sucoeed,  nothing  will  remain  to  be  done  but  to  in- 
troduce the  catheter. 

Are  any  sj)ecial  applications  required  for  the 
breasts?  If  the  secretion  of  milk  be  normal,  none. 
There  is  sometimes  a  good  deal  of  fulness  about  the 
breasts,  occasioning  a  considerable  degree  of  pain. 
This  is  due  simply  to  the  extreme  congestion  of  all 
the  lacteal  vessels.  Where  this  is  very  troublesome, 
I  you  can  derive  greater  relief  by  warm  fomentations 
I  than  from  any  other  measure.  Simply,  a  piece  of 
hot  flannel  applied  over  the  breasts  and  covered  by 
oiled-silk  will  generally  suffice.  The  normal  means 
I  of  procuring  relief  is,  however,  the  api^lication  of 
the  child  to  the  breast,  and  in  this  connection  we 
might  speak  of  at  how  early  a  period  it  is  necessary 
to  put  the  infant  to  the  breast.  Some  advise  never 
before  the  secretion  of  the  milk  has  become  estab- 
lished, stating  that  the  child  is  not  likely  to  receive 
any  special  nourishment  from  the  contents  of  the 


breast  before  that  period,  and  that  it  is  merely  an 
annoyance  to  the  mother.  But  let  your  rule  be  to 
apply  the  child  to  the  breast  as  soon  as  the  mother 
has  had  an  opportunity  to  rest  from  her  labor ;  that 
is,  at  any  time  from  six  to  eight  hours  after  delivery. 
This  not  only  serves  to  stimulate  the  secretion  of 
the  milk  (you  know  that  the  law  holds  good  with 
reference  to  this  secretion  the  same  as  with  refer- 
ence to  all  others,  that  it  is  increased  by  normal 
stimulation),  but  it  is  of  actual  benefit  to  the  child, 
in  that  it  derives  from  the  breast  colostrum  which 
unquestionably  contains  certain  elements  of  nutri- 
tion, and  l)e8ides  has  certain  cathartic  projierties, 
which,  by  acting  upon  the  bowels,  enable  them  to 
get  rid  of  the  accumulations  of  meconium.  After 
the  child  has  once  been  put  to  the  breasts,  it  is  not 
necessary  to  do  so  oftener  than  every  four  or  five 
hours  until  the  milk  has  become  established.  That, 
as  said  before,  takes  place  about  the  thii  d  day,  after 
which  it  will  be  necessary,  both  for  the  nutrition  of 
the  child  and  for  the  benefit  of  the  mother,  to  let  it 
nurse  as  often  as  every  two  hours,  or  two  and  one- 
half  hours.  Such  shoiild  be  the  rule  during  the  first 
month  of  parturition. 

TMiile  speaking  of  the  secretions  and  excretions 
of  the  paturient  woman,  it  is  jiroper  to  refer  to 
the  lochial  discharge.  From  the  time  that  delivery 
is  completed,  there  is  for  at  least  the  first  three  or 
four  days  a  bloody  discharge — a  sanious  discharge, 
more  properly  speaking— which  comes  from  the 
ca^•ity  of  the  uterus.  After  five  or  six  days  this 
discharge  changes  color,  becoming  greenish,  and 
finally  yellowish.  It  retains  this  appearance  in  gen- 
eral for  the  remaining  three  weeks  of  the  patuiient 
period;  at  the  end  of  that  time  it  usually  ceases. 
If  the  bloody  lochial  discharge  continue  for  a  longer 
period  than  five  or  six  days — say  for  ten  or  fourteen 
days — the  probabilities  are  that  it  is  due  to  some 
abrasion  of  the  cervix — a  laceration,  perhaps,  from, 
which  there  is  an  oozing  of  blood.  Such  a  condition' 
of  things,  it  is  likely,  would  call  for  treatment.  The- 
normal  lochial  discharge  is  nothing  more  than  tho- 
detritus  that  results  from  the  breaking  down,  so  to  • 
speak,  of  the  tissues  in  the  womb  in  the  neighbor- 
hood of  the  placental  insertion,  and  is  probably 
derived  in  part  also  from  the  process  of  fatty  de-- 
generation  going  on  in  the  structure  of  the  uterus- 
itself,  due,  in  other  words,  to  the  state  of  involution,, 
which  is  nothing  more  than  a  fatty  degeneration  of 
those  structures  that  were  largely  developed  in  tho- 
uterus  during  pregnancy,  and  which  gave  to  it  its 
size  and  strength,  the  muscular  structure  and  struc- 
tures concerned  in  the  lymphatic  circulation,  and 
that  of  the  blood,  the  veins  and  arteries,  together' 
with  a  large  increase  of  connective  tissue. 

.\t  the  time  of  delivery  the  uterus  measures  about 
twelve  inches  in  length,  and  the  thickness  of  its 
walls,  even  at  the  thinnest  part,  is  a  quarter  of  an 
inch.  Now,  when  the  organ  contracts,  its  size  is- 
reduced  to  about  that  of  the  two  fists,  which,  of 
course,  greatly  thickens  its  walls.  From  this  state.- 
it  must  undergo  such  a  change  as  to  become  dimin- 
ished sufficiently  to  measure  only  three  inches  in 
length,  and  an  inch  and  a  half  at  most  in  its  trans- 
verse diameter.  A  part  of  this  structure,  of  course, . 
as  it  undergoes  fatty  degeneration  or  involution,  is 
carried  off  by  the  lymjjhatics  and  the  blood-vessels 
into  the  general  circulation,  and  is  excreted  through 
the  kidneys,  through  the  skin,  and  apparently  also 
through  the  alimentary  canal.  But  a  certain  por-- 
tion  of  it  unquestionably  passes  out  with  the  lochial 
discharge.     The  relation  which  the  lochial  discharge. 


ZiS 


THE  MEDICAL  RECORD. 


has  to  this  process  is  perhaps  not  unlike  that  which 
the  expectoration  of  spnta  bears  to  the  resolution  of 
pneumonia.  During  the  first  few  days  this  discharge, 
when  normal,  has  scarcely  any  odor.  ;After  that 
time  it  possesses  an  odor  which  is  not  exactly  offen- 
sive, but  which  leans  in  that  direction.  In  some 
women  it  may  be  offensive  even  as  a  physiological 
process,  but  in  the  majoxity  of  cases  it  does  not  be- 
come extremely  offensive  save  as  an  indication  of 
decomposition,  and  when  this  is  true  it  calls  for  the 
extended  use  of  antiseptic  remedies. 

Now,  how  are  we  to  treat  this  lochial  discharge  ? 
Are  we  to  allow  it  to  flow  xmmolested  over  the  geni- 
tal tract,  or  are  we  to  make  use  of  measures  which 
have  for  their  object  the  protection  of  the  genital 
tract  from  the  evil  influences  of  the  decomposing 
material  which  it  contains  ?  Some  adopt  the  rule 
of  using  vaginal  injections  in  every  case  of  delivery ; 
others  say  that  injections  should  be  employed  only 
in  cases  in  which  there  is  decomposition  in  the 
lochia,  evidenced  by  the  strong  odor  before  men- 
tioned. Now,  it  seems  to  me  that  no  harm  can 
come  from  the  employment  of  the  carbolized  douche 
after  every  case  of  delivery,  provided  you  take  this 
precaution,  to  have  each  patient  2>rovided  vdth  her 
own  glass  tube  or  nozzle  and  syringe.  There  will 
then,  it  seems  to  me,  be  no  danger  of  infection. 
The  great  objection  which  has  been  made  to  vaginal 
douches  is  that,  as  claimed  by  some,  instances  have 
occurred  in  which  the  tissues  were  actually  infected 
by  it.  But  almost  all  patients  are  able  to  purchase 
a  new  syringe  for  themselves,  and  when  this  is  done 
there  is  no  danger  of  infection,  if  it  be  carefully 
washed  before  using  it,  so  as  to  get  rid  of  any  par- 
ticles of  dirt  that  may  be  upon  it.  Use,  then,  the 
douche  ia  every  case,  commencing  say  twenty-four 
hours  after  delivery.  It  is  rarely  necessary  to  begin 
sooner  than  this,  because  decomposition,  except  in 
rare  cases,  does  not  take  place  until  the  expiration 
of  that  period.  But  if,  owing  to  the  season  of  the 
year  or  some  predisposition  of  the  patient,  you  have 
reason  .to  believe  that  deoomposition  will  occur,  or 
has  occurred  before  that  time,  then  do  not  hesitate 
to  employ  the  douche  sooner — even  six  or  twelve 
hours  after  delivery.  As  to  the  manner  of  employ- 
iug  this,  I  have  told  you  already,  and  it  is  only 
necessary  to  repeat  that  it  is  to  wash  out  the  vaginal 
canal  and  the  vaginal  jjortion  of  the  cervix,  not  to 
wash  out  the  cavity  of  the  uterus.  How  to  make 
intra-uterine  injections  T  explained  to  you  when 
speaking  of  septicinmia,  and  it  is  only  in  that  state 
that  you  are  to  employ  them. 

What  shall  be  the  regimen  of  these  patients  ?  It 
used  to  be  the  plan  to  put  thera  upon  broths  and 
light  soups  for  the  first  forty-eight  or  seventy-two 
honrs  after  delivery,  until  the  secretion  of  milk  had 
become  fairly  established.  Under,  however,  a  better 
study  of  the  clinical  history  of  these  cases,  we  are 
now  more  disposed  to  consult  the  individual  fancy 
aud  taste  of  the  patient.  My  rule,  therefore,  is  to 
say  to  them :  if  you  care  for  solid  food,  take  it ;  if 
you  do  not,  wait  until  the  desire  is  upon  you.  Gen- 
erally, during  the  first  twelve  hours  they  care  for 
nothing  more  than  beef-tea  or  milk,  with  perhaps 
gruel.  After  that  time,  as  a  rule,  they  are  quite 
willing  to  take  solid  food,  and  then  there  is  no  ob- 
jection to  beef-steak,  mutton-chop,  or  game,  oi"  any 
of  the  maats  which  we  kuow  to  bo  easily  digested. 
Oi'er-feeding,  of  course,  is  to  be  avoided,  as  is  also 
starving. 

Now,  by  following  out  the  precautions  and  sug- 
gestions which  I  have  given  with  reference  to  the 


management  of  the  parturient  period,  taking  into 
consideration  the  condition  of  the  woman,  not 
merely  after  delivery,  but  during  and  before  delivery, 
I  believe  that  you  will  do  a  great  deal  toward  di- 
minishing the  mortality  of  childbirth.  It  has  been 
estimated,  I  believe,  by  one  of  the  best  authorities, 
that  one  out  of  every  one  hundred  and  twenty  wo- 
men die  in  labor.  In  certain  other  statistics  it  has 
been  estimated  that  the  proportion  of  deaths  is  even 
greater.  Taking  now  the  large  majority  of  these 
deaths,  it  is  found  that  they  do  not  come  from  de- 
formities of  the  pelvis.  They  do  not  come,  there- 
fore from  what  may  be  called  unavoidable  conditions 
and  accidents ;  but  the  large  majority  of  them  do 
come  from  avoidable  conditions  —  conditions  that 
can  be  traced  in  eveiy  case  to  neglect,  either  on 
the  part  of  the  patient,  on  the  part  of  the  nurse,  or 
on  the  part  of  the  medical  attendant.  This  being 
the  case,  you  see  how  important  it  is  to  attend  to  all 
of  the  little  details  of  which  I  have  spoken  in  con- 
nection with  the  management  of  the  parturient 
period. 

The  average  period  of  time  that  the  patient  ia 
kept  under  observation  is  about  nine  days  from  de- 
livery. I  am  speaking,  of  course,  of  cases  in  which 
no  complication  has  arisen.  The  rule  with  a  large 
number  of  practitioners,  I  believe  to  be  this :  they 
make  daily  visits,  say  nine  days.  If,  at  the  end  of 
that  period,  the  patient  is  what  they  ordinarily  call 
well,  the  lochial  discharge  in  good  condition,  and 
all  the  functions  being  performed  naturally,  they 
dismiss  her  as  cured,  and,  perhaps,  never  see  her 
again  until,  it  may  be,  she  comes  to  engage  their 
services  in  another  confinement,  or  perhaps  for  a  leu- 
corrhoea,  which  she  thinks  is  more  excessive  than  it 
should  be.  Now,  the  wiser  plan  is  this  :  to  see  the 
patient  for  six  or  nine  days  daily,  see  that  her  con- 
dition is  what  it  should  be  at  that  period,  that  she 
is  in  a  fair  condition  of  strength,  the  appetite  good, 
the  fmietions  being  performed  naturally.  Say  to 
her,  however,  that  I  wish  to  see  you  about  five  or 
six  weeks  hence,  in  order  to  examine  the  condition 
of  the  genital  passages,  to  find  out  whether  there  is 
remaining  any  laceration  of  the  cervix,  and  whether 
the  litems  is  in  a  state  of  subinvolution.  By  ob- 
serving this  precaution,  you  will  save  many  a  woman 
from  an  ache  and  a  pain  which  can  always  be  traced 
to  the  lesion  in  question,  or,  rather,  which  can  in 
many  cases  be  traced  to  the  lesion  in  question.  In 
this  way  you,  in  the  first  place,  assure  your  jiatients 
of  your  interest  in  them  ;  and,  in  the  second  place, 
you  place  it  in  your  power  to  secure  a  perfect  cure. 
If  you  dismiss  your  patient  six  or  nine  days  after  de- 
liver>' witli  the  condition  I  speak  of,  jjossibly  she  will 
not  come  back  into  your  hands,  but  pass  into  the 
handsof  some  specialist,  who  will  call  attention,  per- 
haps, to  a  piece  of  bungling  midwifery,  which,  of 
course,  will  not  react  very  favorably  upon  your  repii- 
tation.  Now,  it  is  unnecessary  to  say  that  the  making 
of  these  cases  of  laceration  may  not  be  because  of 
any  special  fault  on  your  part;  but  that  is  not  so 
much  the  point  as  is  the  fact  that  by  seeing  the  wo- 
man after  five  or  six  weeks  you  may  put  her  in  a  po- 
sition to  correct  any  difficulty  that  may  be  jiresent. 

These  precautions  having  been  taken,  it  seems  to 
me  that  you  will  have  done  your  whole  duty  with 
regard  to  the  parturient  state. 


Fouit  Deaths  iixder  Chlorofobm  have  been  re- 
ported recently  as  occurring  in  various  parts  of 
England. 


THE  MEDICAL  RECORD. 


229 


©rtjgiuol  Comtnuuicatioits. 


EXTRACTION  OF  TWO  PIECES  OF  GLASS 

FEOM  THE  AUDITORY  CA^AL. 

Remarks  on  its  Acoustic  Disturbances. 

By  EDWARD  S.  PECK,  A.M.,  M.D., 

Vi.sITIN'G  SURGEON  TO   CHARITY  HOSPITAL. 

Ik  September,  1880,  a  gentleman,  tliirty-nine  years 
ot  age,  was  sent  to  me  with  the  following  aui'al  con- 
ditions :  The  left  auditory  meatus  was  so  swollen 
that  a  surgeon's  probe  could  not  be  made  to  pass 
the  constriction,  except  with  difficulty.  The  j^ain  in 
the  ear  was  deep,  and  so  severe  that  the  patient  got 
bat  little  sleep;  there  was  a  constant  throbbing  syn- 
chronous with  the  jjulse  at  the  wrist — evidently  the 
pulsation  of  the  carotid  artery ;  and  a  thick,  not 
free,  discharge.  In  addition,  patient  complained  of 
a  very  unpleasant  sensation  of  fulness  and  pressure, 
aaterior  to  the  tragus,  from  which  he  tried  to  get 
relief  by  a  sei'ies  of  efforts  of  mastication,  grinding 
ot  the  teeth,  and  gaping.  The  nnte-aural  portion  of 
the  face  was  swollen  as  far  as  the  temporo-malar  ar- 
ticulation, and  was  painful  on  pressure.  On  exam- 
ination there  were  two  scars  running  vertically 
across  the  zygoma — one  an  inch,  the  other  one  and 
one  -  half  inch  long  ;  the  higher  curve  of  the 
helix  of  the  ear  had  been  cut,  and  had  healed 
by  vicious  union,  so  that  the  normal  curve  was 
broken,  and  granulation-tissue  h;id  overgrown  the 
wound.  There  was,  in  addition,  a  vertical  cica- 
trix, one  inch  long,  over  the  mastoid  region.  Func- 
tional examination  proved  the  patient  so  deaf  in 
this  ear,  that  my  watch — heard  at  twenty-four  feet 
with  one  ear  in  a  large  office  at  the  rear  of  the 
house,  furnished  with  book-cases,  table,  desk,  chan- 
delier, etc. — was  not  heard  by  the  patient  on  firm 
contact  with  the  ear.  Laid  over  the  temporal  re- 
gion, the  watch  was  heard  very  faintly,  while  the 
ticking  was  not  recognized  over  the  mastoid.  [It  is 
a  well-known  fact  that  all  soft  fabrics  used  in  furnish- 
ing, projecting  furniture,  many  and  large  windows, 
and  the  distance  of  the  examining-room  from  the 
street,  are  essential  factors  of  disturbance  of  the 
wave  conduction  of  sound,  and  by  so  much  they 
change  the  pitch  and  the  quality  of  its  register.] 
The  gentleman  alleged  that  about  one  month  ago  he 
stepped  from  a  horse-oar  under  the  Chatham  Square 
Elevated  Railway  station,  where  it  is  usually  dark, 
and  where  are  a  number  of  fluted  iron  columns  sup- 
porting the  structui-e.  Wishing  to  retrace  his  steps 
in  order  to  make  the  sidewalk,  he  turned  about 
quickly,  and  struck  the  side  of  the  face  and  head 
violently  against  an  upright  column,  committing 
the  damage  described.  The  severe  otalgia  and 
otorrhcea  began  about  five  days  previous  to  his  first 
visit,  or  nearly  four  weeks  after  the  injury.  A  diag- 
nosis of  traumatic  suppurative  inflammation  of  the 
external  meatus  was  made,  about  whose  symi:)toms 
there  was  the  manifest  ineonginiity  of  a  late  devel- 
opment of  pus.  The  history  of  the  case  would  jii-e- 
clude  the  supposition  of  a  foreign  body.  Very  hot 
water  was  ordered  to  the  meatus  in  continuous 
stream,  from  the  Fayette  douche,  until  the  pain 
ceased,  after  which  a  hot  solution  of  sulpho-carbolate 
of  zinc,  gr.  x.  ad.  5  j.,  was  instilled.  In  a  few  days 
the  severity  of  the  otalgia  had  passed  away,  there  was 
less  discharge,  and  the  infiltration  had  somewhat 
subsided. 


By  lateral  pressure  of  a  probe  the  drumhead 
could  be  seen  complete  in  its  two  post-malleal  quad- 
rants. On  a  careful  examination  with  the  probe  bent 
at  the  point  ( the  ear  being  tlioroughly  clean ),  aforeigv 
body  was  felt,  evidently  thin  and  brittle,  as  the  tone 
communicated  to  the  ear  of  the  operator  was  reso- 
nant and  of  a  high  pitch.  It  conld  be  but  one  of  two 
things  :  either  an  exfoliation  of  part  of  the  auditory 
process  of  the  temporal  bone,  or  a  foreign  body,  with 
the  larger  i^robability  of  the  latter.  [Oaries'of  the 
external  plate  takes  place  here,  as  elsewhere  in  the 
cranial  tables,  by  slow  and  iirogressive  disintegra- 
tion. One  finds  now  large,  now  small  roughened 
masses  of  the  spongy  diploc,  or  very  small  granular 
dfibris,  when  caries  is  established.  A  true  exfolia- 
tion of  the  i)rocessus  auditorius  in  whole  or  in  part 
is  uncommon.  Occasionally  a  flat  or  bevelled  specu- 
lum of  bone  finds  its  way  out  of  the  meatus,  as  a 
result  of  necrotic  changes ;  but  this  is  not  the  rule. 
In  those  rare  cases  of  spontaneous  exfoliation  of  the 
bony  sti-ucture  of  the  ear,  the  cochlea  has  been  the 
most  frequent  sequestrum.  In  Agnew's  case,'  the  la- 
mina spiralis  of  the  right  cochlea,  with  two  semi- 
circular canals,  formed  the  sequestra.  In  Gruber's 
case  ■'  both  cochleje  were  separated  by  exfoliation 
after  scarlet  fever,  in  a  lad  of  seven  years.  Toynbee  ' 
reported  two  cases  of  exfoliation  of  tlie  coclilea  of 
one  side.  Sii'  Philip  Cr.impton'  removed  a  piece  of 
loose  bone  from  the  meatus  of  a  young  lady,  which 
proved  to  be  the  whole  internal  ear,  consisting  of  the 
cochlea,  vestibule,  and  semicircular  canals,  with  a 
small  part  of  the  inner  wall  of  the  tympanum.  Gru- 
ber''  removed  exfoliations  of  the  mastoid  and  squa- 
mous portions  of  the  temporal  bone;  Toynbee,'  the 
major  part  of  the  petrous  portion  ;  Boeck,'  a  neci  osed 
bit  of  the  meatus :  Michael  *  describes  and  illustiates 
a  sequestrum  of  the  inner  wall  of  the  tymiianum  and 
of  the  mastoid  process,  which  had  fallen  out  while 
the  child's  ear  was  syringed  at  home  ;  while  Lucic. 
Meniere,  Patterson,  Cassels,  Jacobi,  and  others,  have 
reported  cases  of  neurotic  exfoliation  of  larger  or 
smaller  parts  of  the  bony  structure  of  the  ear.] 
I  then  introduced  an  angular  aural  forceps,  and 
succeeded  in  removing  a  wedge-shaped  piece  of 
;/lass,  5  mm.  long  and  3+  mm.  broad.  This  had 
been  lodged  five  weeks  in  a  crypt  of  the  superior 
wall  of  the  auditory  canal,  in  the  subcellular  tis.sue 
of  the  integument.  This  crypt  was  situated  just 
within  the  isthmus  of  the  canal,  or  at  an  approxi- 
mate distance  of  five-eighths  of  an  inch  from  the 
external  world.  Believing  there  was  more  glass 
in  the  ear,  a  flat,  blunt  curette,  with  large  curvature, 
such  as  is  used  by  oculists,  was  introduced  into  this 
sinus,  and  there  was  removed,  after  some  minutes, 
another  and  larger  wedge-shaped  bit  of  glas.^, 
measuring  10  mm.  (1  ctm.)  in  length  and  2*  mm. 
in  breadth.  A  look  of  inquiry  and  sui-jirise  on  my 
part  elicited  the  following  confession  :  Patient  did 
not  run  against  the  pillars  of  the  Elevated  Rail- 
way, as  alleged,  but,  in  a  dispute  at  billiards,  was 
struck  violently  across  the  zygoma,  ear,  and  mas- 
toid region  with  a  beer-glnss,  held  in  the  hand  of 
his  assailant.  The  glass  was  shattered  into  frag- 
ments, and  the  wedge-shaped  pieces  were  either 
from   the   angles  at  its  sides,  or  from   where   the 


^  The  American  iredical  Times,  vo!.  vi..  No.  16. 

"  Arch.  f.  Ohrenheilk.,  Bd.  IX.,  pp.  238  et  seq. 

>  Ibid.,  Bd.  I.,  p.  115. 

'  Wilde's  Aural  SnrRcry,  p.  370.     1S53. 

5  Wiener  Mcdicinalhalle.    1S6S. 

'  Arch.  f.  Ohrenheilk,  Bd.  I.,  p.  117. 

'  Ibid.,  Bd.  IX..  pp.  2.38  ct  seq. 

"  Arch.  o(  Otolog}-,  vol.  be.,  No.  3,  p.  222.     Translation. 


230 


THE  MEDICAL  RECORD. 


handle  joins  the  glass.  In  a  few  days  hearing  was 
partially  restored,  equal  to  A  by  the  watch,  or  33 
per  cent.  The  pulsating,  swashing  sound  abated, 
but  persisted  to  such  degree,  at  the  time  of  his  dis- 
charge, October  lilth,  as  to  annoy  him,  particularly 
at  night.  Patient  was  engaged  in  the  manufacture 
of  pianos,  and  devoted  part  of  his  time  to  the  detec- 
tion of  chromatic  aberrations  of  tones  in  the  differ- 
ent registers.  This  accident  interfered  with  his 
acuteness  of  hearing,  both  by  a  diminution  of  the 
number  of  sound-waves  (interference  in  pitch)  and 
by  the  quality  of  timbre,  so  that  the  patient  had 
contused  perception  of  tone  (paracusis  monauralis, 
Knapp),  and  failed  to  catch  the  nunncus  of  the  higher 
notes,  to  which  his  ear  had  by  practice  become 
nicely  adjusted. 

35  West  TniBTr-EiGiiTn  Street,  January,  18S2.    . 


TREATMENT    OF    FR.\CTURE   OF   THE' 
CLAVICLE   WITHOUT  APP.ARATUS. 

Br  R.  C.  NEWTON,  M.D., 


ASSISTANT  SnRGEON,   D.S 


A  CASE  of  fracture  of  the  clavicle  has  recently  come 
under  my  notice,  which,  so  far  as  the  treatment  and 
result  go,  mav  prove  of  interest. 

W.  P.  S— — ,  a  private  of  I  Troop,  Fourth  U.  S. 
Cavalry,  aged  twenty-eight,  medium  size,  liealthy, 
while  on  detached  service,  was  thrown  from  ahorse, 
and  sustained  a  simple  fracture  of  the  left  clavicle, 
at  the  junction  of  its  middle  and  outer  thirds. 

The  man  did  not  wish  to  "go  on  sick  report,"  and 
so  essayed  to  treat  himself  by  simple  embrocations. 
On  January  15,  1882,  however,  he  sought  advice. 
This  was  on  the  third  day  after  the  injury.  Dr. 
Elbrey,  U.S.A.,  post-surgeon  at  Fort  Union,  N.  M., 
where  the  accident  occurred,  saw  the  case.  On  the 
following  day  the  doctor  made  out  the  fracture,  and 
put  it  up  firmly,  using  bandages  of  adhesive  plaster 
and  a  pad  in  the  axilla.  On  the  day  after  (January 
17th)  the  patient  set  out  on  horseback  for  Fort 
Stanton,  N.  M.,  a  distance  of  over  two  hundred 
miles.  The  dressings  upon  his  arm  annoyed  him 
in  riding,  and  on  the  fifth  evening  he  removed  them. 
This  was  the  ninth  day  since  the  accident,  and  the 
sixth  since  the  application  of  the  bandages.  After 
this  he  continued  his  journey  as  before.  He  merely 
favored  his  left  arm  by  carrying  the  hand  in  his 
breast  as  he  rode  ;  he  did  not  use  a  sling. 

On  January  28th  he  reached  Fort  Stanton.  On 
January  2!ltli  his  name  was  entered  on  the  sick  re- 
port, but  he  did  not  present  himself  until  the  fol- 
lowing day,  as  he  did  not  consider  his  trouble  seri- 
ous, and  only  complained  of  pain  in  the  seat  of 
fracture  upon  exertion. 

On  January  30tii  he  was  carefully  examined.  A 
large  deposit  of  callus  marked  the  point  of  fracture. 
The  fragments  were,  liowevor,  in  good  apposition, 
and  union  was  complete.  To-day  (February  4, 1882) 
he  is  doing  light  duty,  i.e.,  is  excused  from  heavy 
labor.  He  expects  to  do  full  duty  in  a  few  days. 
He  complains  of  a  "  stitch  "  near  the  point  of  frac- 
ture on  riding  a  horse,  and  that  the  motions  of 
his  left  .arm  are  somewhat  restricted.  This  result, 
twenty-three  days  after  the  fracture,  seems  remark- 
ably good. 

This  history  has  suggested  two  or  three  questions 
to  me  : 

Pirsl — Has  not  this  case  made  a  good  recovery 
without  any  treatment  that  we  have  l)ccn  taught  to 
consider  at  all  adequate?     For,  as  I  have  always 


believed,  the  bony  fragments  were  no  more  in  a  con- 
dition to  go  without  snj)port  on  the  ninth  day  after 
the  injury  than  on  the  second.  Probably  he  in- 
stinctively earned  his  arm  in  such  a  way  as  to  cause 
the  least  pain,  which,  no  doubt,  was  the  best  posi- 
tion for  it  to  take. 

Second. — Did  not  this  result  come  about  under 
very  unfavorable  circumstances?  The  patient  rode 
on  horseback  over  two  hundred  miles,  slept  on  the 
ground,  etc. 

Third. — If  both  these  questions  be  answered  in 
the  affirmative,  why  not  throw  away  and  condemn  to 
oblivion  the  majority  of  the  complicated  and  confus- 
ing apparatuses  for  the  treatment  of  fractured  cla- 
vicle, which  are  described  in  our  text-books,  and 
allow  the  embryo  surgeon  to  burden  his  mind  with 
something  3im2iler  than  descriptions  of  the  marvels 
of  ingenuity  referred  to  ? 

Of  course,  it  cannot  be  denied  that  treatment, 
though  brief,  may  have  had  some  effect.  But  it 
seems  to  me  that  we  are  justified  in  estimating  this 
effect  as  quite  inconsiderable,  and  in  asserting  that 
there  is  at  least  a  fair  probability  that  the  result 
would  have  supervened  had  no  treatment  been  made 
use  of. 

FOBT  Stanton,  N.  M. 


THE  OBSTACLES  TO  THE  ABOLITION  OF 
IVIECHANIC.AL  RESTRAINT  IN  OUR  IN- 
SANE ASYLmiS. 

Bt  JOHN  S.  WOODSIDE,  M.D., 

MEDICAL    SurEBINTENDE.S'T    HOSPITAL    FOR   INCDItARLES,    FLATBC9H, 

Before  considering  the  obstacles  to  the  abolition  of 
mechanical  restraint,  let  us  see  if  it  is  a  fact  that 
restraint  w  used  to  excess  in  the  asylums  of  this 
country.  Dr.  H.  B.  Wilbur  has  tabulated  returns 
from  twenty-six  of  our  asylums  which  settles  this 
question  conclusively.  Let  it  be  noted  that  these 
returns  are  from  the  sni^erintendents  themselves,  in 
answer  to  a  circular  letter,  who  would  certainly  be  the 
last  people  in  the  woi-ld  to  exaggerate  tlie  amount 
used.  The  table  shows  that  in  26  asylums,  containing 
13,967  patients,  restraint  was  used  on  5,080  occasions 
during  ove  wo-nth.  Taking  this  as  the  average,  we 
have  61,068  during  the  year ;  in  other  words,  in  only 
26  out  of  88  asylums  almost  as  many  ajiplications  of 
restraint  as  there  are  patients  in  the  whole  country. 
Whereas  the  report  of  tlie  English  Lunacy  commis- 
sioners for  1880  shows  that  in  29  English  asylums, 
with  an  insane  poiwlation  of  17,756,  restraint  was 
not  used  once  during  a  ir!iole  year  1  By  another 
comparison.  Dr.  Willnir  shows  that  the  majority  of 
individual  asylums  in  this  country  aise  more  re- 
straint than  is  used  in  all  the  county  and  borough 
asylums  of  England  collectively,  containing  on  an 
average  38,000  patients !  A  few  months  ago  I 
visited  a  State  asylum  containing  about  500  patients, 
with  apparently  ample  facilities  for  their  proper 
treatment,  and  found  the  following  condition  : 

The  assistant  physician  was  starting  on  his  morn- 
ing rounds,  carrying  a  stout  hickoiy  walking-stick, 
which  he  seemed  to  think  necessary  for  self-pro- 
tection, and  he  led  me  through  a  scene  that  only 
required  some  burning  brimstone  and  the  gloom  of 
niglit  to  convert  it  into  a  veritable  hell  on  earth. 
Straps,  belts,  handcuffs,chains,  and  cami.soles  dangled 
from  numerous  pegs  in  passageways  and  halls,  con- 
venient for  emergency.  Instead  of  the  minority  of 
the  patients  being  in  restraint,  it  appeared  to  me 


THE  MEDICAL  RECORD. 


231 


that  the  majority  were.  Tliey  were  seen  lying  cnrled 
up  in  all  sorts  of  places  and  positions,  some  wearing 
wristlets  fastened  bv  a  chain  to  their  ankles,  or  with 
wristlets  merely  and  fastened  to  the  chair  or  bench 
on  which  they  were  sitting  liy  the  lielt,  others  walking 
around  in  camisole  or  with  hands  confined  to  a 
chain  or  belt  around  the  waist.  One  poor  creature 
was  lying  quietly  on  his  back,  wearing  iron  anklets 
from  which  a  short  chain  extended  to  be  hitched  to 
an  upright  post.  It  was  almost  impossible  for  him 
to  get  on  his  feet,  or  if  there,  to  remain  so  long.  The 
two  "worst"  characters  were  confined  in  a  small 
compartment  about  fourteen  feet  by  six  feet.  One 
burly  fellow  wore  an  iron  or  steel  collar,  from  which 
extended  a  chain  to  another  chain  around  his  waist 
— ^his  hands  also  being  fastened  to  this  iron  belt — 
and  thence  stretched  to  be  attached  to  a  heavy  pair 
of  iron  anklets.  This  chain  extending  from  the  col- 
lar to  the  anklets  was  so  short  that  if  the  man  conld 
stand  at  all,  it  could  only  be  in  a  crouching  position. 
He  was  lying  doubled  up  on  the  fioor  when  I  saw 
him.  From  the  central  chain  around  his  body  one 
proceeded,  about  three  or  four  feet  long,  to  a  staple 
in  the  masonry  of  the  wall.  His  companion  was 
similarly  caparisoned,  but  he  did  not  suffer  the 
ignominy  of  being  chained  to  the  stajile  like  a  dog. 
Wlien  we  know  that  such  a  condition  a.s  this  exists 
in  one  State  asylum — in  how  many  more  we  know 
not — is  it  not  full  time  that  the  non-restraint  sys- 
tem should  receive  careful  consideration  and  honest 
trial  by  those  who  are  suitably  situated  to  do  so,  in- 
stead of  their  siipercilions  sneers?*  Enough  for 
the  e.i-itstfuce  of  restraint. 

The  chief  obstacles  in  the  way  of  the  extension 
and  application  of  non  restraint  in  the  asyhims  of 
the  United  States  to-day  is  not  to  be  found  in  the 
character    of    our  patients  as  alleged,   but  in   the 
character  of  our  superintendents.      "When   asylum 
superintendents   cultivate    sutficient  independence 
to  enable  them  to  cease  to  be  political  and  social 
sycophants,  to  aim  at  being  more  scientific  physi- 
cians, and  to  take  a  look  at  the  question  from  the 
broad  platform  of  hnm^nitarian  justice  to  the  most 
unfortunate  class  of  their  fellow-beings  in  existence, 
then,  and  not  imtil  then,   are  we  to    expect    the 
attainment   of  that    enlightened   course   of  action 
t    which  the  best  instincts  of  the  best  men  of  past  and 
present  times  have  been  striving  for.     There  are  a 
few  estimable  superintendents  who  are  actually  in 
favor  of  non-restraint,  but  who  permit  themselves  to 
be  classed  in  the  ojiposition,  thinking  that  otherwise 
I    they  commit  themselves  to  an  absolute  policy,  and 
I   by  so  doing  they  lend  the  prestige  of  their  names  to 
bolster  u])  and  continue  a  record  of  the  most  abomi- 
nable and  systematic  cruelty. 
,       The  revered  Connolly,  after  seven  years'  experi- 
ence with  absolute  non-restraint,  lays  down  the  fol- 
lowing conditions  as  essential  to  its  being  properly 
carried  out :  "  One  of  the  first  of  these  is  a  properly 
constructed  building,  in  which  the  patients  enjoy 
the  advantages  of  light  and  air,  a  cheerful  prosjiect 
I  and  am))le  space  for  exercise,  and  of  classification, 
I  and  of  the  means  of  occupation  and  recreation.  The 
'•  next  is  the  constant  and  watehfTil  superintendence 
i  of  humane  and  intelligent  olHcers,  exercising  full, 
I  but  considerate  and  just,  control  over  an  efficient 
body  of  attendants"  (Memoir  by  Clark,  p.  32).    Now, 
the  first  of  these  essentials  is  to  be  found,  at  least 
at  every  State  institution  in  this  country,  and  in  all 

*  I  do  not  mean  to  pay  th.at  the  abnve  condition  is  common  in  o'.ir 
.■»i7lnms.  bnt  is  it  not  a  £rit;htful  fact  that  snch  is  to  be  found  in  a  few 
inRtances  i    The  caee  deficribed  i«  not  the  only  one. 


the  large  private  corijorate  institutions,  hut  the 
second  qualification  seems  to  be  sadly  lacking. 
When  restraint  is  the  order  of  the  day  in  such  insti- 
tutions, the  blame  rests  solely  with  the  superintend- 
ents, not  on  the  character  of  their  patients,  whom 
they  would  fain  make  us  believe  are  of  such  a  high- 
strung,  independent  temperament,  as  compared  with 
their  Saxon  cousins  in  England — are  so  impressed, 
before  becoming  insane,  with  the  free  and  reckless 
spirit  of  rejiublican  liberty,  that  it  is  necessary  to 
apply  the  soothing  camisole,  to  quiet  them  with  tie 
click  of  buckles  and  the  clank  of  manacles  !  Very 
ajjpropriate  treatment,  is  it  not,  for  a  free-born  man, 
whose  will-power  is  weakened  by  disease,  but  who 
is  capable  of  reasoning  with  more  or  less  acuteness, 
on  the  first  evidence  of  an  excitement  which  he  is 
unable  to  control  to  be  violently  laid  hands  on  and 
pinioned  like  some  vile  criminal,  without  a  word  of 
advice  or  reason,  or  the  least  notice  taken  of  his  re- 
monstrances? It  seems  to  me  there  are  many  phy- 
sicians who  labor  under  the  mistaken  impression 
which  awes  the  heart  of  the  laity,  that  every  insane 
man  is  a  madman  without  "rhyme  or  reason," 
whereas  the  fact  is  such  casOs  are  exceptional.  The 
large  majority  of  insane  patients  can  be  advised  and 
reasoned  with.  It  is  this  course  of  unreasoning 
stupidity  which  keeps  some  of  the  wards  in  our  asy- 
lums howling  pandemoniums. 

There  seems  to  be  an  unreasonable  opposition  on 
the  part  of  superintendents  to  the  acceptance  of  the 
principle  of  non-restraint,  for,  while  even  the  most 
mechanical  among  them  will  admit  that  the  lea^t 
amount  of  restraint  is  the  piropier  amount,  they  will 
not  carry  out  the  result  of  their  own  reasoning,  and 
permit  it  to  convince  them  of  the  practicability  of 
none  at  all.  There  is  only  one  way  of  practising 
non-restraint,  that  is,  by  abolishing  all  tempting  ap- 
pliances, and  giving  it  an  honest,  energetic,  and 
rigid  trial.  A  tippler  who  wants  to  refrain  from 
drinking  keeps  no  liquor  in  his  house.  I  may  here 
note  the  salient  features  of  the  introduction  and 
continued  practice  of  this  system  by  Dr.  J.  C.  Shaw, 
at  the  Kings  County  Asylum.  Kestraint  was  fijst 
reduced  gradually  and  carefully,  until  Dr.  Shaw 
liecame  convinced  that  it  coidd  be  entirely  abolished. 
He  then  issued  his  order,  "  Let  there  b«  no  restraint," 
and  there  has  been  none  since.*  "V\'e  all  knew — 
assistants  and  attendants — that  the  doctor  meant 
what  he  said;  if  we  didn't  like  it,  we  knew  the  alter- 
native. Consequently  every  one  did  their  best,  and 
we  soon  found  that  the  ditficultiee  were  chiefly  m 
our  own  minds. t  In  this  manner — and  in  this  way 
alone,  in  my  opinion — can  non-restraint  be  intro- 
duced and  carried  out.  It  deisends  on  whether  the 
superintendent  is  in  earnest  or  not,  whether  he  is 
willing  to  sacrifice  his  own  prejudices  and  comforts 
for  a  conscientious  trial  of  a  system  which  the  or- 
dinary dictates  of  humanity  recommends,  the  sci- 
entific world  approves,  and  ample  experience  has 
shown  to  be  feasible.  The  principle  of  restraint 
cannot  be  used  without  being  abused.  Excess  creeps 
in  so  insidiously,  there  are  so  many  sheltering  re- 
fuges for  it  to  inrk  under,  that  the  only  safety  is 
the  principle  of  non-restraint,  and  those  who  prac- 
tise it  honestly  will  not  find  themselves  often  com- 
pelled to  break  the  rale. 

There  is  a  prevailing  impression  among  those  who 
have  no  knowledge  of  practical  non-restraint  that 

*  All  the  re-straining  apparatu-^  in  the  asylum  was  burned  up,  ?o  that 
there  was  no  temptation  from  that  .source. 

+  For  details,  see  article  by  Dr.  Shaw,  in  Proceedings  of_Eighty- 
seventh  -Annual  Conference  of  Charities,  1580. 


233 


THE  MEDICAL  RECORD. 


there  really  can  be  no  sucli  thing,  that  those  who 
claim  to  practise  non-restraint  are  merely  suljstitut- 
ing  one  form  of  coercion  for  another,  and  they  ring 
in  harangues,  with  amusing  absurdity,  about  "  mus- 
cular force,"  "chemical  restraint,"  "cell-seclnsion," 
etc.,  when  the  real  fact  is  that,  with  the  abolition 
of  mechanical  restraints,  accompanied  by  absolutely 
necessary  judicious  management,  the  cause  for  such 
is  also  abolished.  Arbitrary  conduct  on  the  pari  of 
attendants  is  the  chief  cause  of  violence  among  the 
patients ;  the  more  coercion  used  the  more  is  needed. 
The  independent  Yankee  spirit,  which  brooks  no  in- 
terference, is  not  subjected  to  the  hug  of  muscular 
attendants ;  but,  by  giving  him  the  greatest  amount 
of  liberty  possible,  by  kind,  yet  firm  discipline, 
judicious  therapeutics,  out-door  exercise,  and, 
finally,  what  cannot  be  laid  too  much  stress  on,  a 
suitable  classification  of  patients  to  attendants,  he 
is  led  to  conduct  himself  in  as  orderly  a  manner  as 
cin  be  expected.  Because  a  man  breaks  a  window, 
knocks  down  another  patient  or  a  nui-se,  tears  liis 
clothing,  or  insults  the  physician  in  charge,  is  no 
reason  why  he  should  be  grabbed  and  stuffed  into  a 
camisole  for  days  and.  weeks,  often  months  and 
years,  following.  The  act  is  but  the  impulse  of  the 
moment,  is  not  remedied  by  such  a  procedure,  but, 
instead,  it  adds  a  new  and  personal  grievance,  to  be 
revenged  at  the  first  opportunity.  Some  of  the  old 
attendants  have  frequently  made  such  a  remark  as 
the  following  to  me :  "  Isn't  it  queer,  doctor,  that 
we  don't  get  any  of  the  '  tough  nuts'  like  we  used 
to  have."  The  "  tough  nuts  "  are  the  product  of  re- 
straint and  harsh  treatment. 

Some  idea  can  be  had  of  the  methods  of  managing 
the  insane  without  restraint,  if  we  but  think  of  the 
nuoiberless  subterfuges  which  are  necessary  in  the 
mmagement  of  equally  irresponsible  individuals — 
babies.  They  denude  their  bodies  of  clothing,  they 
break  and  smash  and  tear  everything  within  their 
reach,  they  are  filthy  in  their  habits,  they  refuse  to 
eat  what  is  olfered  them,  they  are  noisy  and  obstrep- 
erous, but  who  would  think  of  mechanically  re- 
straining a  baby  ?  Some  bad  mothers  do  use  seda- 
tives to  get  rid  of  the  trouble  and  bother,  and  some 
bad  superintendents  of  insane  a.sylums  do  use  re- 
straint in  the  treatment  of  their  patients  for  the 
same  reason.  "Restraints  and  neglect  may  be  con- 
sidered as  synonymous ;  for  restraints  are  merely  a 
general  substitute  for  the  thousand  attentions  re- 
quired bv  troublesome  patients"  (Connolly). 

Dr.  Wilbur,  in  the  article  already  referred  to, 
comlusively  shows  that  in  the  Scotch,  English,  and 
American  asylums  where  mechanical  restraint  is 
leist  used,  there  also  the  use  of  sedatives  and  nar- 
cotics are  at  a  minimum.  The  diminution  in  the 
quantity  of  these  drugs  found  necessary  after  the 
ablution  of  restraint  in  the  Kings  County  Asylum 
was  very  marked. 

H'i  also  shows  that  suicides  are  four  times  as  com- 
mon in  an  American  asylum  population  of  seventeen 
thou -land  p.atients,  protected  by  all  the  ingenious 
paraphernalia  of  mechanical  appliances,  as  it  is  in 
an  insane  population  of  .13.000  in  England,  where 
non-restraint  is  the  order  of  the  day  ! 

I  may  state  that  in  this  institution,  where,  on  an 
averaore.  cisrht  or  ten  straight-jackets  were  in  use  daily 
until  last  July,  when  Dr.  John  \.  Arnold  tools  cliarge, 
they  have  all  been  abolished  by  the  doctor  and  my- 
a<)lf,  without  much  troul)le,  and  non-restraint  is  now 
practised.  There  are  at  present  three  hundred  and 
thirty  eight  patients,  chronic,  incurable  cases,  with 
a  goo.l  sprinkling  of  epileptics.     The  building  is 


poorly  adapted  for  carrying  on  the  system,  as  the 
grounds  are  very  limited,  the  building  much  over- 
crowded, and  all  the  patients  have  to  sleep  in  com- 
mon dormitories,  there  being  no  single  rooms. 

"The  infliction  of  mechanical  restiaint  dtn.or- 
alizes  those  who  use  it  and  those  who  suffer  it, 
giving  rise,  in  the  long  run,  to  negligence  and  bru- 
tality in  the  former,  and  to  dirty  habits,  noise,  and 
excitement  in  the  latter  "  (Lochart  Robertson). 

"  I  certainly  do  not  hesitate  to  express  a  strong 
personal  conviction  that  the  use  of  mechanical  re- 
straint in  any  asylum,  public  or  private,  is  an  indi- 
cation of  a  badly  managed  institution  "  (Maudsley). 

Janunry  31,  1882. 


tleports  of  ^05)jitals. 


HOSPITAL     OF    THE     UXTVERSITY     OF 
PENNSYLVAl^IA,  PHILADELPHIA,  PA. 

Service  of  JOHS  ASHHURST,  JR.,  M.D., 

PROFESSOa    OF   CLINICAL   SORGERT. 

(Reported  by  Guy  HixSDiLE,  M.D.) 

EPILEPriFOEM    CONVULSIONS    FOLLOWING    LIGATION    OF 
THE   CAROTID   ABTEBT. 

I  TAKE  the  opportunity  to-day  of  showing  you  a  pa- 
tient more  for  what  has  been  done  than  for  what  you 
can  now  see.  This  young  man  received,  nearly  a  year 
ago,  a  stab  in  the  neck,  where  you  see  this  deep 
scar.  He  did  well  for  eleven  days,  when  a  profuse 
secondary  hemorrhage  occurred,  and  was  several 
times  repeated.  I  was  asked  to  see  him.,  with  a  view 
to  adopt  permanent  means  to  stop  the  bleeding.  He 
was  too  ill  to  be  moved  :  the  weather  was  intensely 
hot ;  he  was  blanched  and  puft'y  under  the  eyelids 
from  the  loss  of  blood,  and  the  only  course  which 
oSered  a  prospect  of  success  was  to  tie  the  left  com- 
mon carotid  artery. 

I  had  the  assistance  of  Dr.  J.  W.  Taylor  and  Dr. 
David  Merritt,  under  whose  care  the  patient  was. 
The  operation  was  a  very  difficult  and  a  very  trying 
one.  In  this  manner  the  hemorrhage  was  efiiec- 
tually  controlled.  He  was  lying  on  the  floor,  and 
it  was  not  possible  to  raise  him  even  to  the  bed. 
The  scar  on  the  inner  side  of  the  sterno-cleido- 
mastoid  muscle  marks  the  line  of  incision.  Con- 
valescence was  slow,  the  ligature  not  commg  aw;iy 
for  six  weeks,  j^fter  this  a  salivaiy  fistula  formed, 
but  Dr.  Taylor  has  succeeded  in  getting  that  well  by 
the  use  of  cauterization  and  pressure.  Subfpqneiitly 
the  patient  lost  his  voice ;  six  weeks  ago,  however, 
it  returned,  but  only  in  whispers.  A  laryngoscopic 
examination,  Dr.  Taylor  tells  me,  has  been  impos- 
sible, because  of  the  stift'ness  of  the  patient's  jaws. 

On  January  2,  1881,  the  i)atieut  had  what  liis 
friends  describe  as  a  fainting-fit,  followed,  on  Maul: 
15th,  April  2;)th,  and  once  during  the  present  month, 
by  similar  attacks  of  unconsciousness.  Those  fits 
last  from  five  to  fifteen  minut«s,  during  which  his 
eyes  turn  up  and  his  han<l8  and  feet  are  moved.  The 
last  of  these  epileptiform  attacks  came  on  while  he 
was  jilaying  ball,  unconsciousness  continuing  for| 
ten  minutes,  and  being  accompanied  by  stertorous] 
breathing.     He  did  not  bite  his  tongue.  | 

I  think  the  curious  feature  of  this  case  is  that 
these  attacks  should  occur  six  months  after  the 
operation.    We  are  apt  to  have,  after  ligation  of  thel 


THE  MEDICAL  RECORD. 


233 


carotid,  somnolence  and  sometimes  coniailsions,  due 
to  cerebral  amemia,  from  the  cutting  off  of  the  blood- 
supply.  But  in  this  case  there  apjiears  to  have  been 
some  more  permanent  change  in  the  lirain,  manifest- 
ing itself  by  disturbed  innervation  when  the  patient 
is  subjected  to  excitement. 

TR.\CHEOTOirc  IN  A  CA.SE  OF  LARTNCIE-VL  BNCHONDKOMA, 

with  remarks  by  Prof.  Pepper  upon  the  post-mor- 
tem specimens. 

In  performing  this  operation,  great  care  must  be 
exercised  not  to  injui'e  important  structures  in  the 
neighborhood  of  the  trachea,  and,  in  order  to  avoid 
risk,  I  prefer  that  the  patient  should  be  thoroughly 
etherized.  It  occasionally  happens,  however,  as  in 
some  cases  of  croup,  that  the  patient  is  already  im- 
consoious,  and  then  ether  is  not  needed. 

I  prefer  to  stand  behind  the  patient,  whose  head 
is  made  prominent  by  means  of  a  thick  roll  placed 
under  it.  I  make  an  incision  strictly  in  the  median 
line.  One  of  the  most  important  things  is  to  have 
the  head  firm,  so  that  it  cannot  be  twisted  out  of 
position.  In  dividing  the  subcutaneous  fat  and 
areolar  tissue,  care  .should  be  taken  to  avoid  an}- 
superScial  veins ;  then  cautiously  separate  the  sterno- 
hyoid and  sterno-thvroid  muscles,  using  either  the 
handle  of  the  knife  or  the  director.  The  trachea 
will  then  be  exposed. 

It  is  always  best  to  arrest  all  bleeding  before 
opening  the  trachea,  for  if  blood  should  enter  the 
air-passages  it  might  complicate  the  operation  very 
much.  I  can  understand  that,  in  some  urgent  cases, 
it  may  be  necessary  to  open  the  trachea  before  the 
bleeding  can  he  entirely  aiTested  ;  but  in  such  a  case 
as  this  we  should  proceed  cautiously.  I  always  like 
to  see  the  trachea  white  before  I  make  the  final  in- 
cision. This  last  step  is  accomplished  by  drawing 
forward  the  trachea  with  a  tenaculum,  then,  thrust- 
ing in  the  knife,  edge  upward,  the  necessary  number 
of  rings  are  divided .  The  tube  is  then  at  once  inti-o- 
duced. 

The  operation  is  a  vei-y  simple  one  when  you  go 
about  it  slowly  and  cautiously,  taking  care  to  .see  the 
trachea  laid  bare  before  making  any  opening  through 
its  rings.  Warm  weather  is  favorable  to  this  opera- 
tion. In  winter  especial  care  should  be  taken  to 
have  the  patient  in  an  atmosphere  of  uniform 
warmth.  One  of  the  most  frequent  causes  of  fatal 
termination  after  tracheotomy  is  pneumonia. 

At  the  hospital  clinic,  one  week  later.  Professor 
Pepper,  lender  whose  care  the  last  patient  had  been 
previous  to  the  operation,  informed  the  class  of  the 
fatal  termination  of  the  case,  and  presented  speci- 
mens for  examination. 

Professor  Pepper  said  :  The  patient  who  was  the 
subject  of  my  lecture  last  week,  and  upon  whom,  at 
my  request,  Professor  Ashhurst  performed  trache- 
otomy, died  of  double  jineumonia  on  the  sixth  day 
after  the  operation. 

I  think  the  rapid  termination  of  the  case  is  partly 
due  to  the  violent  atmospheric  changes  of  the  past 
week.  On  Tuesday  and  Wednesday  the  tempera- 
ture was  terrific — away  up  in  the  nineties,  and  then 
came  the  sudden  change  ;  the  mercui-y  falling  to 
fifty  in  a  few  hours.  Within  twenty-four  hours  he 
began  to  have  a  feeble,  flickering  pulse,  and  there 
were  evidences  of  solidification  of  the  posterior  por- 
tions of  his  lungs  ;  he  became  cyanotic,  and  in  two 
or  three  hours  died. 

In  children  this  fatal  result  after  tracheotomy  is 
much  more  common  in  cases  even  where  there  is  no 
blood-dyscrasia.     In  the  adult,  the  mortality  after 


tracheotomy  is  small.  But  in  this  case  we  look  to 
several  things.  The  man  was  in  an  exhausted  .state. 
It  may  be  that  it  would  have  been  better  for  him  to 
have  rested  in  bed  for  a  few  days.  His  prolonged 
illness  and  anxiety,  his  long  joiirney  to  the  city  with 
his  lungs  deprived  of  their  proper  exei'cise,  and  sup- 
plied with  only  half  the  requisite  amount  of  air,  less- 
ened his  vitality.  Prostrated,  he  was  subjected  to 
frightful  heat;  then  came  the  sudden  atmospheric 
change  ;  the  mercury  fell  forty  degi-ees ;  be  sank  im- 
mediately, and  never  for  one  moment  reacted. 

The  specimens  which  I  present  show  that  the  mu- 
cous membrane  is  healthy  at  the  point  of  operation, 
the  aperture  was  large  enough  for  the  tube  and  the 
edges  of  the  wound  are  not  inflamed.  The  obstruc- 
tion was  even  greater  than  we  supposed.  The  tumor 
is  on  the  right  side  of  the  larynx  and  attached  by  a 
broad  base.  The  left  side  is  free,  so  that  the  vocal 
cord  moved  freely. 

The  tumor  is  an  enchondroma,  a  typical  speci- 
men, organically  connected  with  the  thyroid,  cricoid, 
and  ai-ytenoid  cartilages.  It  is  a  rather  rare  foim 
of  laryngeal  tumor.  You  will  notice  that  it  is  a 
slightly  nodulated  projection,  filling  up  the  right 
side  of  the  opening  of  the  larynx,  and  extending 
over  toward  the  left,  leaving  only  a  narrow,  crescen- 
tic  chink,  through  which  the  patient  was  able  to 
breathe.  It  does  not  extend  down  into  the  trachea ; 
it  does  extend  along  the  posterior  i^ortion  of  the 
larynx.  The  growth  is  an  inch  in  diameter.  Dur- 
ing life  the  left  vocal  cord  was  seen  to  move  ;  it  was 
not  affected.  It  is  evident  that  nothing  less  than 
the  extirpation  of  the  entire  larynx  would  have  suf- 
ficed for  the  removal  of  the  giowth. 

On  examining  the  lungs  we  find  that  the  patient 
has  had  an  old  local  alveolar  catarrh.  There  are 
small  calcareous  nodules  through  both  apices. 
These  are  the  remains  of  cheesy  matter,  atd  when  I 
pick  them  out,  you  notice  the  little  fibrous  sac  in 
which  they  are  imbedded.  The  organic  part  of  the 
exudation  has  been  removed,  and  the  small,  calcare- 
ous nodule  remains,  with  a  layer  of  thickened,  puck- 
ered, and  indurated  tissue  surrounding  it.  It  is  a 
case  of  imperfectly  cured  catarrhal  pneumonia.  Be- 
low, we  come  to  the  evidences  of  croiipous  pneumo- 
nia. The  hang  is  dense,  solid.  I  squeeze  it  and  no 
air  escapes.  A  piece  of  this  lung  would  sink  in 
water.  It  is  an  excellent  example  of  red  hepatiza- 
tion. The  lung-tissue  is  softened  and  tears  readily, 
as  you  see.  The  vesicles  are  filled  with  an  exudate. 
The  posterior  portions  of  the  lungs  are  in  only  the 
early  stages  of  the  process — there  is  intense  engorge- 
ment. The  color  is  mottled,  and,  as  I  cut  the  lung, 
I  find  it  heavy.  There  is  scarcely  any  crejsitation  ; 
nevertheless  pieces  float  in  water.  It  is  not  true  hepa- 
tization, but  only  an  inflammatory  engorgerrent,  and 
was  associated  with  the  true  crepitant  rale.  The 
calcareoxis  nodule  has  nothing  to  do  with  the  laryn- 
geal condition.  It  is  latent.  The  capsule  is  dry, 
and  contains  nothing  but  a  gritty  lump.  It  is  as 
harmless  as  an  encysted  pebble- stone,  and  yet,  in  ao 
earlier  stage,  prior  to  the  removal  of  all  the  organic 
matter,  it  is  a  condition  which  will  give  rife  to 
phthisis.  These  local  alveolar  catarrhs  are  very 
common,  and,  in  delicate  persons,  whose  lungs  are 
unable  to  fortify  themselves  against  the  foreign  body, 
the  process  will  not  tend  to  become  limited,  but  ul- 
ceration takes  i^lace  and  softening  of  the  lung  follows, 
with  the  formation  of  a  cavity. 

In  the  case  before  us,  however,  healthy  inflamma- 
tion occurred,  giving  rise  to  good  lymph,  which 
formed  a  perfectly  impermeable  sac  ;  the  liquid  was 


23-i 


THE  MEDICAL  RECORD. 


gradually  absorbed  and,  as  it  disappeared,  the  sur- 
rounding envelope  became  contracted  and  puckered 
from  its  occupying  a  smaller  space. 

This  condition  did  not  give  the  patient  any  trou- 
ble ;  for  all  that  he  might  have  lived  to  be  a  hundred 
years  old.  But  when  it  became  necessary  to  per- 
form a  serious  oi^eration,  the  shock  to  the  exhausted 
system  and  the  subsequent  intense  atmospheric 
changes  induced  first  congestion,  then  red  hepatiza- 
tion of  both  lungs  simultaneously,  and  the  patient 
passed  away  easily  and  unconsciously. 


fJrogrcss  0f  iHetrical  Scicnct 


An  EsperiuentaIj  Eeseakch  on  Tuberculosis. — 
After  a  series  of  experiments  on  the  true  nature  of 
tuberculosis  and  its  products,  Dr.  C.  Kobinson  has 
arrived  at  the  following  conclusions  : 

Tuberculosis  artificially  produced  in  animals  is 
not  due  to  a  specific  virus. 

To  produce  tuberculosis  in  animals  inoculation 
with  tubercular  matter  is  not  necessai'y. 

Failures  to  produce  tuberculosis  by  inoculation 
with  substances  other  than  tubercular  are  in  the 
same  proportion  as  failures  with  true  tubercular 
matter. 

The  introduction  under  the  skin  of  any  foreign 
substance  capable  of  exciting  an  inflammation,  or 
any  traumatic  injury,  can  produce  tuberculosis,  pro- 
vided the  animal  is  of  scrofulous  habits. 

Scrofulosis  in  animals  is  expressed  by  an  inflam- 
mation, terminating  in  the  production  of  a  cheesy 
mass. 

Animals  not  generally  scrofulous  (cats  and  dogs) 
may  become  so,  and  then  only  tuberculosis  can  be 
produced  in  them. 

Miliary  tubercles  are  simply  aggregations  of  cells 
of  any  simple,  ill-nourished  granulation  tissue  com- 
pressed into  small  nodes.  The  arrangement  into 
nodes  represents  a  true  ante-mortem  act  of  cells,  to 
which  any  young  inflammatory  connective  tissue  is 
liable. 

Under  favorable  conditions  of  nutrition,  tubei'oles 
in  animals  may  undergo  a  higher  organization,  be- 
coming converted  into  small,  harmless  fibromata. 

Tubercles  artificially  produced  in  animals  are  his- 
tologically strictly  identical' with  those  occurring  in 
man.  —  PIdladdpkia  Medical  Times,  December  3, 
1881. 

Dowelil's  Method  fok  the  K.\uio.\l  Cure  op 
Hernia. — For  the  performance  of  this  operation  only 
a  needle  and  ligature  are  required.  The  needles  are 
curved  and  double-pointed,  with  an  eye  at  either  ex- 
tremity, and  are  about  three  inches  long.  The  liga- 
ture passes  through  both  eyes.  Let  us  suppose  a  pa- 
tient before  us  and  the  operation  to  be  ujiou  a  left 
inguinal  hernia.  The  surgeon,  standing  at  the  pa- 
tient's left,  explores  the  condition  of  the  external 
ring  by  invaginating  the  scrotum  with  the  left  fore- 
finger. The  needle  is  now  entered  directly  over  the 
ring,  carried  into  and  along  the  superficial  fascia, 
and  drawn  out  at  the  outer  border  of  the  ring. 
It  is  now  pushed  forward  until  the  terminal  end 
has  disajtpeared  at  the  point  of  entrance.  The 
left  forefinger  again  invaginatos  the  scrotum  and  is 
carried  to  the  entrance  of  the  ring,  where,  by  its 
presence,  it  can  feel  and  guide  the  needle,  which  is 
now  reversed  in  its  course  and  directed  through  the 


external  pillar,  through  the  neck  of  the  hei-nia, 
through  the  internal  pillar,  and  made  to  reappear  on 
the  internal  line.  The  third  step  is  now  to  with- 
draw the  needle  at  the  inner  line  until  its  point  has 
escaped  the  internal  pillar,  when  the  needle  is  again 
reversed,  carried  to  where  it  originally  entered,  i.e., 
dii'ectly  over  the  ring,  and  then  entirely  withdrawn. 
It  will  thus  be  seen  that  the  needle  has  entered 
directly  over  the  point  of  rupture,  traversed  both 
pillars  and  the  neck  of  the  hernia,  and  reappeared 
at  the  point  of  entrance  without  having  been  en- 
tirelv  withdrawn. — Annnls  of  Anatomy  and  Sitrgery, 
December,  1881. 

In.turtes  to  the  Head. — Dr.  John  C.  Schapps,  in 
reporting  twenty  cases  of  injuiy  to  the  head,  gives 
the  following  summary  :  Injiiries  to  the  head  are 
serious,  not  in  projiortion  to  the  amount  of  damage 
suffered  by  the  skull,  but  more  nearly  to  that  expe- 
rienced by  its  contents.  The  injury  to  the  intra- 
cranial tissue  may  be  produced  by  the  same  force,  at 
the  same  time  as  that  injuring  the  skull,  as  rupture 
of  a  vessel  may  be  occasioned  by  the  same  force  that 
causes  a  fracture.  The  injury  may  be  in  conse- 
quence of  that  to  the  bone,  as,  primarily,  lacera- 
tion or  comjjression  of  the  membranes  and  brain 
by  a  fragment  of  bone ;  secondarily,  by  the  inter- 
vention of  inflammatory  processes,  as  meningitis, 
caused  by  an  irritation  from  abnormal  conditions  of 
bone.  It  may  be  partly  concomitant  with  that  of 
the  bone  and  partly  caused  by  it,  with  or  without 
the  intervention  of  inflammatory  action.  It  may 
occur  without  any  injury  to  the  skull,  as  intra- 
cranial hemorrhage,  or  meningitis  following  a  blow 
upon  the  head. — AnnaU  of  Anatomy  and  Surgery, 
December,  1881. 

The  Localization  or  Atrophic  Paraly.ses. — After 
presenting  a  series  of  interesting  eases  of  muscular 
paralysis  and  their  spinal  localization.  Dr.  David 
Ferrier  {Jourtial  of  Neurohgi/,  vol.  iv..  No.  3)  makes 
the  following  statements  on  progressive  muscular 
atrophy.  "  The  commencement  of  muscular  atrophy 
is  usually  in  the  intrinsic  muscles  of  the  hand,  and 
according  to  most  observations,  in  the  ball  of  the 
thumb  and  first  interossei.  From  the  hand  it 
spreads  to  the  muscles  of  the  forearm,  specially  af- 
fecting the  flexors  and  pronators,  and  relatively 
sparing  the  extensors  and  supinators.  This  mode 
of  advance  is  precisely  in  accordance  with  progres- 
sive invasion  of  the  spinal  segments,  corresponding 
to  the  fir-st  dorsal  and  eighth  cervical  roots.  Though 
the  extensors,  and  particularly  the  extensor  ossis 
metacarpi  pollicis,  are  more  or  less  implicated,  yet, 
even  when  the  atrophy  has  advanced  to  almost  com- 
plete disappearance  of  the  intrinsic  muscles  of  the 
hand  and  long  flexors,  the  extension  of  the  wrist 
and  fingers  may  be  carried  out  with  considerable 
force.  Though,  as  has  been  stated,  the  extensors,  as 
being  synergic  with  the  intrinsic  muscles  and  long 
flexors,  are  represented  in  the  eighth  cei-vical  seg- 
ment, yet,  as  they  are  again  represented  in  the 
fourth  and  fifth  cervical  segments,  they  will  natu- 
rally retain  considerable  power  so  long  as  these  seg- 
ments are  intact.  But  when  those  are  invaded, 
entailing  atrophy  also  in  the  deltoid  and  other  mus- 
cles of  the  upper  arm,  the  extensors  also  wa.ste,  and 
the  characteristic  '  wain  n  griffe '  does  not  occur. 
The  escape  of  the  s\ipinator  longus,  relatively  more 
sti-iking  than  that  of  the  extensor  group,  is  also 
readily  explicable  by  its  representation,  along  with 
the  flexors  of  the  forearm,  in  the  upper,  two  cervical 
segments.     The  supinator  longus  should,  according 


THE  MEDICAL  RECORD. 


235 


to  these  data,  go  with  the  flexors  of  the  forearm, 
deltoid  and  other  muscles  of  the  upper  arm,  and  of 
this  association  there  are  manj  examples  already  on 
record. 

"  It  has  been  remarked  by  Duchenne  that  the  tri- 
ceps is  the  last  muscle  to  be  afifected  by  muscular 
atrophy.  This  is  also  in  accordance  with  the  posi- 
tion and  representation  of  this  muscle  in  the  various 
segments  of  the  cervical  enlargement.  Being  repre- 
sented in  the  eighth,  seventh,  and  sixth  cervical 
roots,  and  more  frequently  than  any  of  the  other 
muscles  which  have  their  centres  here,  it  is  natural 
that  it  should  retain  its  functional  activity  and  nu- 
trition in  some  degree,  till  tlie  whole  of  this  region 
has  become  invaded.  And  as  it  seems  to  Vie  the 
rule  for  the  degeneration  to  proceed  either  from  the 
lower  or  upper  end  of  the  cervical  enlargement,  or 
it  may  be  from  both  simultaneously,  the  centres  for 
the  triceps  will  naturally  be  long  in  being  com- 
pletely involved.  The  order  in  which  the  muscles 
are  successively  attacked  by  progressive  atrojjhy  is 
thoroughly  in  harmony  with  the  mode  of  collocation 
and  order  in  which  they  are  represented  in  the 
spinal  segments,  and  with  the  advance  of  a  de- 
generative process  in  the  multipolar  cells  of  the 
anterior  cornua  from  below,  upward  or  above, 
downward;  whereas  it  is  altogether  impossible  to 
reconcile  the  facts  with  Friedreich's  hypothe.sis 
of  a  ijrimary  myositis  spreading  merely  per  co»- 
tifjiti/aleiii  and  limited  by  the  large  joints.  Fried- 
reich's view  that  the  changes  in  the  anterior  comua, 
which  have  been  founil  in  a  certain  number  of  cases, 
are  merely  secondary  to  the  degeneration  primarily 
originating  in  the  muscles,  so  far  finds  sujjport  in 
the  apparently  demonstrated  absence  of  morbid 
changes  in  the  spinal  cord  in  other  cases.  But  we 
have  good  reasons  for  believing  that,  in  futux'e,  cases 
of  muscular  atrophy  without  changes  in  the  anterior 
horns  will  be  less  frequently  recorded  than  hereto- 
fore, if  the  various  segments  of  tLf  '  r  .nal  cord  are 
investigated  with  the  requisit.-^  '■-,.(  of  >  'l-  and 
minuteness." — hrainjyol.  iv 

Cranial  Osteophytes  in  v  iiills.- 

.\t  a  meeting  of  the  Medical  feo> ..  ^  ^  ,  Ion,  heitl 
November  28th  last.  Dr.  Crocker  exhibii-.i.!  an  in- 
fant, eleven  months  old,  with  symmetric;,  .weous 
thickenings  each  about  one  and  one-hi.'t  ■"i.-':h  in 
diameter,  and  located  on  the  frontal  bone.  The 
anterior  boundaries  of  the  fontanelles  were  thick, 
but  the  posterior  were  thinner  than  normal,  these 
latter  conditions  pointing  to  the  possibility  of 
an  intermingling  of  the  two  aflfections,  rickets  and 
syphilis,  since  in  the  latter  the  edges  of  the  fonta- 
nelles, as  described  by  ]M.  Parrot,  are  nodular  and 
thickened,  while  in  the  former  they  are  ti.iu  and 
shelving. — Lancet,  December  10,  1881. 

Anjssthetics  pkom  a  Medico-Legal  F. 'r,T  or 
View. — The  following  conclusions,  pr&seuied  by 
Dr.  J.  G.  Johnson,  of  Brooklyn,  are  worthy  of  careful 
consideration,  as  they  involve  questi''i  s  that  have 
an  important  bearing  on  the  practical  relations  of 
patient  and  medical  attendant : 

Anaesthetics  do  stimulate  the  sexual  functions  ; 
the  ano-genital  region  being  the  last  to  give  up  its 
sensitiveness.  Charges  made  by  females  under  the 
influence  of  an  anpesthetic  should  be  received  as  the 
testimony  of  an  insane  person  is.  It  cannot  be  re- 
jected, V)ut  the  corpus  deltcli  aliunde  rule  should  be 
insisted  on.  Denti-sts  or  surgeons  who  do  not  pro- 
tect themselves  by  having  a  third  person  present,  do 
not  merit  much  symjiathy. 


Deaths  from  administration  of  chloroform  after 
a  felonious  assault,  tmless  the  wounding  were  an 
unmistakably  fatal  one,  reduces  the  crime  of  the 
prisoner  from  murder  to  a  felonious  assault. 

The  sui-geon  has  no  right  to  use  chloroform  to 
detect  crime,  against  the  will  of  the  prisoner. 

But  the  army  surgeon  has  the  right  to  use  chloro- 
form to  detect  malingerers. 

The  medical  expert,  notwithstanding  he  is  sent  by 
order  of  court,  has  no  right  to  administer  an  anass- 
thetic  against  the  wish  of  the  plaintifi'  in  a  personal 
damage  suit,  to  detect  fraud. 

Gross  violations  of  the  well-known  rules  of  ad- 
ministering anaesthetics,  life  being  lost  thereby,  will 
subject  the  violator  to  a  trial  on  the  charge  of  man- 
slaughter. 

A  surgeon  allowing  an  untrained  medical  student 
to  administer  ana'Sthetics,  life  being  thereby  lost, 
will  subject  the  .surgeon  himself  to  a  suit  for  dama- 
ges. What  he  does  thi'ough  his  agent  he  does  him- 
self. 

The  physician  who  administers  an  anaesthetic 
should  attend  to  that  part  of  the  business  and  noth- 
ing else.  He  should  have  examined  the  heart  and 
lungs  beforehand.  He  should  have  the  patient  in 
the  reclining  position,  with  his  clothes  loose,  so  as 
not  to  interfere  with  respiration  ;  should  have  his 
rat-tooth  forcejis,  nitrite  of  amyl  and  ammonia,  and 
know  their  uses,  and  when  to  use  them  and  how  to 
perform  artificial  respiration. 

In  operations  on  the  ano-genital  region  and  the 
evulsion  of  the  toe-nail,  complete  loss  of  sensation 
in  these  j^arts  should ,  never  be  allowed,  and  no 
operation  on  these  parts  at  all  should  be  had  under 
an  anresthetic,  unless  by  the  approval  of  a  full 
consultation  who  have  a  knowledge  of  the  dangers. 

Chloroform  cannot  be  administered  by  a  person 
who  is  not  an  expert,  to  a  person  who  is  asleep  with- 
out awaking  him.  Experts  themselvef=,  with  the 
utmosE  care,  fail  more  often  than  they  succeed  in 
chloroforming  adults  in  their  sleep.  —  Annals  of 
Anatomy  and  Sargery,  December,  1881. 

Statistics  in  Thirty-two  Consecutive  Ovakioio- 
r.siES.— During  the  year  1881,  Dr.  John  Homans,  of 
Boston,  has  undertaken  to  ojierate  upon  ovarian 
tumors  on  thirty-five  different  occasions.  In  three 
of  them  exploratory  incisions  were  made,  and  fur- 
ther oi:)erative  procedures  abandoned.  These  \>a,- 
tients  all  subsequently  recovered.  Of  the  thirty- 
two  cases,  twenty-nine  recovered.  The  tumors 
varied  in  weight  from  five  to  forty-two  and  one-half 
pounds.  In  twelve,  adhesions  existed.  Among  the 
sucaessful  operations  was  one  upon  a  lady  seventy- 
three  years  of  age. — Boston  Medical  and  Surgical 
Journal,  January  26,  1882. 

BROWN-SfeQTTAItD   ON   GeNEB.VL  OE   LoCAL   CoNlEAC- 

TCEES  AFTEK  De.-ith.— The  following  conclusions  are 
advanced  in  the  above  subject  :  A  genuine  contrac- 
ture can  ensue  after,  as  well  as  before  de  'h,  and 
this  condition  may  last  a  long  while,  passinj.'  to  a 
state  of  cadaveric  rigidity  ;  or  it  may  disappe.j  ■:'  ■ 
pletely  and  subsequently  give  rise  tocontini!  •_.  mus- 
cular irritability.  Of  all  portions  of  the  enj-.-  aalic 
mas.s,  the  cerebellum  is  most  potent  in  pru>.iucing 
contractures  after  death.  The  maintenance  of  a 
peculiar  attitude,  as  is  sometimes  seen  after  dt-ath 
in  soldiers  that  have  died  on  the  field  of  battle,  does 
not  depend  on  the  sudden  intervention  of  cadaveric 
rigidity,  but  on  the  occurrence  of  a  genuine  contrac- 
ture.— La  France  Medicate,  Januarv  5,  1882. 


236 


THE  MEDICAL  RECORD. 


TnE  Medical  Record-. 

^31  lUccklii  3oitvnal  of  iittcbiciut  anb  Suvgerg 


GEORGE  F.  SHRADY,  A.M.,  M.D.,  Editor. 


PUBLISHED   BY 
ATM.  WOOD  &  CO.,  No.  27  Great  Jones  St.,  N.  If. 


New  York,  March  4,  1882. 


THE   EVIDENCE  THAT  VACCIXATIOX 

PROTECTS. 
The  continued  i^revaleuce  of  small-pos  naturally 
keeps  the  subject  of  vaccination  before  the  public 
mind.  But  it  has  been  made  additionally  promi- 
nent by  the  noise  of  a  few  anti-vaccinators.  These 
latter  "gentlemen  talk  bravely,  and  there  is  so  wide 
an  ignorance  of  the  actual  truths  regarding  vaccina- 
tion, that  they  secure  a  much  larger  audience  than 
they  deserve. 

The  practitioner  is  not  unfrequently  called  upo° 
to  tell  why  he  believes  in  vaccination  ;  and  possibly 
at  times  some  puzzling  statements  are  made  to  him, 
furnished  the  laity  by  a  demagogical  philanthropy. 

The  opponents  of  vaccination,  aside  from  the 
falsehoods  which  they  tell,  get  the  basis  for  their 
arguments  in  the  following  facts  : 

One  vaccination,  contrary  to  the  hopes  of  Jenner, 
does  not  in  all  cases  protect  for  a  life-time.  Many 
neglect  re-vaccination,  consequently  there  is  a  very 
large  number  of  vaccinated  adults  who  are  still  sus- 
ceptible to  small-po.x. 

Vaccination  is  too  often  poorly  performed,  oi;  else 
the  virus  is  not  good. 

Statistics  can  be  easily  manipulated,  and  it  is  in 

the  ingenious  twisting  of  these,  in  suppressing  and 

perverting  tacts,  or  in  drawing  unfair  inferences, 

that  the  greatest  talent  has  been  shown    by  anti- 

accinators. 

The  parading  of  individual  and  exceptional  cases, 
the  statistics  of  special  epidemics,  broad  ass  ertions 
regarding  subjects  of  which  we  have  no  complete 
statistics,  such  as  the  old-time  prevalence  of  small- 
pox--all  these  go  to  swell  the  indictment. 

We  present  now  some  of  the  statistics  regarding 
the  edicaoy  of  vaccination,  for  the  most  part  not 
given  in  a  previous  editorial  upon  this  subject. 
A'll  first,  as  regards  the  reduction  of  mortality 


without  reference  to  the  frequency  of  the  disease. 
There  are  no  absolutely  accurate  figures  showing 
the  general  prevalence  of  small-pox  in  Europe  pre- 
vious to  Jenner'8  time.  The  mortality  rates  of  the 
great  city  of  London,  however,  are  known.  In  the 
years  1629-35,  in  that  city,  the  deaths  from  smaU- 
pox  were  about  16,000  per  million  inhabitants  an- 
nually. In  1728-57,  and  1771-80,  the  rate  was  about 
18,000  per  million.  On  the  other  hand,  during  the 
forty-two  years  from  1837  to  1879  this  rate  was  only 
410  deaths  per  million  inhabitants,  a  decrease  to 
one-fortieth. 

Other  facts  show  this  not  to  be  simply  a  coinci- 
dence or  a  decrease  in  the  malignancy  of  the  dis- 
ease. In  England  and  Wales,  in  the  years  1838  to  ^ 
1853  (except  1843-40),  prior  to  compulsory  vaccma- 
tiou,  the  deaths  from  small-pox  were  420  per  million 
inhabitants.  From  1854  to  1879,  after  compulsory 
vaccination  had  been  introduced,  the  rate  feU  to 
208.5  per  million,  or  less  than  one-half. 

To  show  still  further  the  influence  of  vaccination 
on  mortalitv,  we  may  cite  the  facts  regarding  the 
mortalitv  among  children.  Between  1848  and  1852 
a,bout  GO  per  cent,  of  the  deaths  from  small-pox  in 
England  were  among  children  under  five  years  of 
age.  In  the  years  1873-77,  after  compulsory  vac- 
cination (which  was  applied  chiefly  to  children),  the 
mortality  among  this  class  fell  to  13  per  cent,  of  the 

total. 

As  regards,  now,  the  actual  prevention  of  the  dis- 
ease, as  well  as  its  diminished  virulence,  there  are 
the  following  facts : 

Among  15,171  cases  of  small-pox  seen  in  the  Lon- 
don hospitals  between  1876  and  1879,  about  three- 
fourths  were  among  the  vaccinated  and  one-fourth 
among  the  unvaccinated.  But  96  per  cent,  of  the 
English  population  are  vaccinated ;  hence,  if  these 
latt°er  took  the  disease  with  equal  readiness,  there 
should  have  been  twenty-four  times  as  many  cases 
among  them,  instead  of  only  three  times.  But  fur- 
ther, the  term  vaccinated  includes  all  who  have  a 
mark  on  the  arm,  no  matter  how  old  or  how  poor  it 
is.  It  is  stated  that  among  the  above  post-vaccinal 
cases  there  was  no  instance  in  which  the  marks  were 
of  the  best  character,  showing  efficient  vaccination. 
And  finally,  despite  the  poor  vaccination,  the  mor- 
tality amoiig  the  vaccinated  cases  was  only  8.8  per 
cent",  while  among  the  remainder  it  was  44.4  per 

cent.  _,    -, 

According  to  the  familiar  figures  of  Mr.  Moraon, 
among  13,765  cases  of  post-vaccinal  small-pox  there 
were  only  1,505  who  had  efficient  marks,  and  of 
these  only  13  died. 

In  the  Stockwell  and  Homerton  Hospitals,  in  i.iHi 
cases  the  mortality  among  those  with  good  marks 
was  less  than  four  per  cent.,  and  this  seems  to  be 
the  rate  usually  found. 

The  figures  given  regarding  small-pox  in  the  Eng- 
lish army  and  navy  show  conclusively  that  by  vac- 


THE  MEDICAL  RECORD. 


237 


cination  and  revaccination  the  disease  has  simply 
been  stamped  out.  It  is  well  kno^^^^  that  in  the 
last  centnrv  small-pox  used  at  times  completely  to 
cripple  the  navy.  In  1878,  among  -IB.-iOO  .seamen 
■who  were  not  rarely  exposed,  there  were  only  nine 
eases,  and  these  were  mild.  In  the  army,  since  1805, 
there  has  been  an  average  of  one  case  per  year 
among  80,000,  excepting  the  years  1871-72,  when 
smaU-pos  was  severely  epidemic  in  England. 

The  facts  showing  the  jjrotective  jjower  and  ne- 
cessity of  yeraccination  are  very  important.  It  is 
since  the  introduction  of  revaccination  in  the  army 
and  navy  that  small-pox  has  practically  ceased  to 
exist  there.  In  small-pox  hospitals  it  is  always  the 
rule  to  revaccinate  the  nurses  and  attendants.  The 
result  is  that  among  the  revaccinated  attendants  of 
over  40,000  cases  of  small-pox,  covering  a  period  of 
many  years,  there  is  no  instance  in  which  the  disease 
was  taken. 

It  will  be  seen  from  the  foregoing  that  all  statis- 
tics, candidly  studied,  show  that  vaccination  pro- 
tects. They  also  show  that  thorough  vaccination 
and  revaccination  are  necessary.  It  is  the  opinion 
of  Mr.  Ernest  Hart,  who  has  most  ably  summed  up 
the  evidence  for  vaccination  in  a  report  on  the  sub- 
ject, that  one  revaccination  at  about  the  time  of  jni- 
berty  is  sufficient  to  protect  for  the  remainder  of 
one's  life-time. 

The  statistics  we  have  given  relate  to  the  use  of 
humanized  lymph.  The  efficacy  of  bovine  lymph 
was  originally  tested  and  demonstrated  by  Jenner. 
There  are  not  as  yet  many  facts  collected  regarding 
the  bovine  lymph,  now  so  extensively  employed  in  this 
country.  All  the  evidence,  however,  so  far  obtained, 
goes  to  show  that  it  is  efficient.  Dr.  Janes,  of  the 
New  York  City  Health  Board,  has  recently  stated 
that,  of  166  cases  of  small-pox  admitted  to  the  hospi- 
tal in  this  city,  51.2  per  cent,  were  among  vaccinated 
and  47  per  cent,  among  unvaccinated  persons. 
Forty-eight  deaths  occurred  among  the  latter,  and 
only  one  among  the  former. 

It  is  very  plain  that  what  the  profession  and  the 
people  should  seek  is  to  secure  efficient  vaccinations 
and  revaccinations.  The  time  sjjent  in  demonstrat- 
ing the  protective  power  of  cow-pox  would  be 
wasted,  were  it  not  for  the  obstinacy,  stupidity,  and 
we  fear  often  the  dishonesty  of  the  pretentious  op- 
ponents of  vaccination. 


NERVE-STRBTCHIXG. 

The  rapid  spread  among  neurologists  and  surgeons 
ot  the  opsratioa  of  nerve-stretching  illustrates  alike 
the  barrenness  of  our  therapeutics  and  the  zeal  of 
the  profession.  It  is  thirteen  years  since  Billroth, 
unexpectedly  to  himself,  cured  a  case  of  reflex  epi- 
lepsy by  stretching  the  sciatic  nerve.  Thi'ee  years 
later,  in  1872,  Nussbaum  reported  a  case  in  which 
he  had   cured  a  spastic   paralysis  of  the  arm  by 


stretching  the  lower  cervical  nerves.  Nevertheless, 
as  late  as  1877,  when  Vogt  first  published  his  mono- 
graph upon  nerve-stretching,  he  could  collect  only  ten 
reported  cases.  In  these  cases  nerve-stretching  had 
been  done  chiefly  for  painful  or  spasmodic  troubles- 
The  popularity  of  the  operation  became  first  es- 
tablished in  1879,  when  Langenbeck  published  his 
case  of  nerve-stretching  for  locomotor  ataxia.  In  so 
hopeless  and  painful  a  disease  as  this  almost  any 
remedial  measure  which  otYei-ed  any  promise  would 
be  eagerly  adopted.  Langenbeck  found  many  imi- 
tators, and  the  operation  soon  became  widely  known. 
Dr.  Carl  Gussenbauer,  reviewing  its  histoi-y  in 
the  Prager  Medicinische  Wochenschrift,  states  that  al- 
ready about  two  hundred  cases  of  nerve-stretching 
for  various  diseases  have  been  reported. 

The  application  of  nerve-stretching  has  now  been 
widely  extended  in  its  application  to  disease.  Neu- 
ralgias of  the  fifth  cranial  neiTe,  intercostal  neu- 
ralgia, sciatica,  and  traumatic  neuralgias  of  the  arm 
have  been  treated  by  this  method  ;  also  epilepsies 
and  paralysis  agitans,  spasms,  contractures,  and 
ansesthesias,  whether  of  central  or  peripheral  ori- 
gin. Central  diseases,  such  as  myelo-meningitis, 
transverse  myelitis,  lateral  sclerosis,  multiple  scle- 
rosis, progressive  muscular  atrophy,  athetosis,  etc., 
are  reported  as  having  been  more  or  less  benefited 
by  nerve-stretching.  Langenbeck,  who  has  oper- 
ated in  about  thirty  cases,  rejiorts  rapid  and  com- 
plete cure  of  a  case  of  chronic  pemphigus,  and  also 
of  senile  pruritus,-  by  this  new  procedure.  De 
Wecker,  of  Paris,  has  even  devised  an  operation  for 
stretching  the  optic  nerve,  and  it  seems  as  though 
the  surgeon  would  soon  have  his  hands  on  every 
nerve  in  the  body. 

Of  the  absolute  therapeutical  value  of  the  proced- 
ure it  is  impossible  to  speak  positively  as  yet,  except 
that  in  ataxia  the  results  are  discouraging.  Gussen- 
bauer, however,  furnishes  some  facts  regarding  what 
results  have  so  far  been  accomplished.  In  nerve- 
stretching  for  neuralgia — trigeminal,  intercostal, 
sciatic,  etc. — in  65  cases  there  were  38  cures  and  14 
improvements. 

In  reflex  epilepsy,  clonic  spasms,  and  painless 
contractures,  among  23  cases  there  were  12  cures 
and  9  improvements  reported. 

In  trismus  and  tetanus,  among  28  cases,  only  8 
were  relieved ;  the  remainder  died,  8  with  some  jjre- 
vious  evidences  of  improvement. 

Many  cases  of  ansesthesia  have  been  improved. 
Lawrie,  of  Calcutta,  reports  30  cases  in  which  nerve- 
stretching  had  been  done  to  relieve  the  antesthesia 
of  lejirosy.    The  results  were  more  or  less  favorable. 

The  reasonableness  of  nerve-stretching  as  a  thera- 
peutical measure  can  be  better  understood  when  we 
remember  that  it  is  simply  a  mechanical  procedure, 
allied  in  kind  to  nerve-pounding,  massage,  power- 
ful electrical  currents,  etc. 


238 


THE  MEDICAL   RECORD. 


The  nerve  is  a  ribbon  of  slight  elasticity,  but 
qnite  extensile.  The  sciatic  nerve  can  be  stretched 
10  ctm.  with  a  weight  of  sixty  pounds  (Vogt).  The 
ulnar  nerve  can  be  stretched  one-twenty-fifth  of  its 
length,  and  it  will  then  resume  its  original  length'  if 
the  stretching  is  not  prolonged.  The  extension  of 
the  nerve  affects  various  parts  differently.  It  slides 
in  its  sheath,  and  Vogt,  without  good  grounds,  con- 
siders this  to  be  the  chief  thing  that  happens  in 
nerve-stretching.  If  stretching  is  slight,  and  does 
not  go  beyond  the  limits  of  the  normal  elasticity  of 
the  nerve-structures,  this  sliding  may  be  all  that 
happens.  But  if  nerve- stretching  is  violent  or  pro- 
longed, not  only  the  relations  of  the  sheath  and 
the  elasticity  of  the  tissue,  but  the  cohesion  of  the 
nerve-tissue  itself  is  aff"ected.  Mici-oscopical  exam- 
inations of  stretched  nerves  show  that  there  may  be 
a  more  rapid  coagulability  of  the  medullai-y  sheath 
(Schleith),  a  separation  of  this  sheath  from  the 
neurolemma  (Valentin),  or  a  solution  in  the  con- 
tinuity of  the  axis-cylinder  and  medulla,  as  a  result 
of  the  violence  done. 

The  question  whether  by  stretching  the  nerves 
the  cord  can  be  appreciably  moved,  is  not  settled. 
There  is  about  an  equal  number  of  experimenters 
upholding  each  view.  Some  of  the  evidence,  pro 
and  con,  was. given  at  the  last  meeting  of  the  Neu- 
rological Society,  repoi-ted  in  this  issue.  It  is  quite 
certain,  at  any  rate,  that  the  stretching  affects  the 
cord  in  some  way,  in  a  minority  of  cases. 

What  the  results  of  nerve-stretching  upon  the  func- 
tion or  nutrition  of  the  coi'd  may  be  is  also  doubt- 
ful. So  far  it  seems,  as  a  rule,  to  have  been  very 
slight.  Its  effect  upon  the  nerve-tranks,  however, 
is  a  direct  and  ajipreciable  one.  Many  experimenters 
have  confirmed  the  fact  that  stretching  a  nerve  im- 
pairs or  destroys  temporarily  its  irritability,  and 
this  independent  of  the  circulation.  We  know,  also, 
that  it  can  break  up  the  inflammatory  adhesions  of 
a  perineuritis,  and  can  alter  the  relations  of  the 
nerve  with  its  blood-sui^ply. 

It  is  evident,  on  the  whole,  that  we  have  in  nerve- 
stretching  an  addition  of  some  value  to  mechanical 
therapeutics. 

Furthermore,  it  seems  probable  that  the  so-called 
subcutaneous  nerve-stretching  may,  in  many  cases, 
take  the  place  of  the  cutting  operation.  This  will 
make  the  procedure  a  veiy  simple  one. 

It  should  be  added  that  American  neurologists 
and  surgeons  have  added  not  a  little  to  our  knowl- 
edge of  the  value  of  tins  operation,  as  may  be  seen 
by  the  recent  paper  road  at  the  Neurological  Society 
by  Dr.  Jlorton,  and  by  a  recent  article  of  Dr.  Ash- 
hnrst's  in  the  Philadel])hia  Medical  Times. 


PEDE3TU1ANISM    AND   THE   PHYSIOLOGY   OF   WALKINO. 

Thk  pedestrian  exhibition  which  has  been  going  on 
in  this  city  during  the  jiast  week  has  provoked  un- 
usual interest.     It  has   been   claimed   that  this  is 


justified  in  part  by  the  scientific  facts  which  such 
displays  of  physical  endurance  bring  out.  We  do 
not  hesitate  to  say  that  such  claims  are  mere  hum- 
bug. It  is  already  known  what  the  human  system 
can  endure,  and  whatever  facts  might  result  from  a 
study  of  the  physiological  monstrosities  now  dis- 
playing themselves  could  be  more  easily  obtained 
without  the  painful  and  demoralizing  spectacles 
proffered  in  the  name  of  sport  and  science.  Never- 
theless, the  present  interest  in  pedestrianism  will  jus- 
tify some  brief  discussion  of  certain  physiological 
points  connected  with  the  physiology  of  walking, 
and  of  the  muscular  exercise. 

The  erect  position  of  the  biped  man  is  favorable 
to  progression.  No  four-footed  animal  of  equal 
weight  can  hold  out  so  long.  Man  is  almost  per- 
fectly poised  upon  his  feet.  The  line  of  gravity  for 
the  head  and  trunk  falls  a  little  behind  the  centre 
of  a  horizontal  line  joining  the  hip  articulations,  so 
that  there  is  natiu'ally  a  slight  tendency  for  this  part 
to  topple  backward.  But  this  line  of  giavity  for 
the  whole  body  strikes  the  ground  a  little  in  front 
of  the  ankle-joints,  consequently  the  muscles  of  the 
calves  and  of  the  back  of  the  thighs  have  to  be 
brought  slightly  into  play  in  order  to  preserve  tlit- 
equilibrium.  On  the  whole,  therefore,  the  body  is 
quite  well  balanced.  There  is  slight  tendency  for  it 
to  fall  forward,  but  this,  although  it  calls  for  some 
muscular  action,  helps  locomotion.  In  quadrupeds 
the  weight  of  the  trunk  falls  obliquely  on  the  legs, 
tending  to  doiible  them  up.  To  prevent  this  the 
muscles,  fascia;,  and  ligament's  which  keep  this  ex- 
tension rigid  must  play  a  larger  part  than  in  man. 

In  walking,  the  body  goes  through  a  double  series 
of  undulations,  which  form  curves  somewhat  analo- 
gous to  those  in  the  flight  of  a  bird.  There  is  a  ver- 
tical or  Tip  and  down  movement,  the  highest  point 
being  reached  when  the  body  is  vertically  over  the 
supporting  or  active  leg.  The  other  movement  is  a 
lateral  one,  resulting  from  the  necessity  of  keeping 
the  centre  of  gravity  (which  is  just  in  front  of  the 
sacral  promontory)  over  the  supporting  leg.  The 
hips  being  comparatively  wider  in  women,  this  lat- 
eral movement  must  be  greater.  It  auiovmts  some-  i 
times  to  a  waddling  gait.  The  natural  movement  of 
the  arms  assists  this  change  of  the  centre  of  gravity 
from  side  to  side. 

In  a  "step"  one  leg  gives  the  body  a  slight  pro- 
pulsion ;  it  then  swings  forward  like  a  pendulum, 
very  little  mu.ccular  effort  being  required.  In  tlu' 
model  "  O'Leary  style"  of  walking,  the  swinging  is 
done  by  the  trunk  muscles,  which  are  made  to  mov(^ 
the  whole  pelvis ;  thus  the  leg-  and  thigh-muscli  > 
are  saved.  It  is  called  walking  with  the  hips.  Tin' 
foot  is  also  carried  nearly  parallel  to  the  ground, 
and  is  not  brought  down  sharply  on  the  heel,  n 
practice  which  indiuatos  the  non-expert.  This 
swinging  leg  is  called  tlio  "  passive  leg."  Tlie  other, 
or  "  active  leg,"  at  this  time  supports  the  whc^U 


THE  MEDICAL  RECORD. 


239 


weight  of  the  body,  which  meanwhile  is  carried  for- 
ward, until  the  centre  of  gi-avity  is  nearly  over  the 
spot  to  which  the  passive  leg  has  been  brought.  An- 
other i^ropulsion  is  now  given  by  the  "active"  leg, 
which  then  becomes  "  passive,"  and  so  the  motions 
continue.  The  muscular  mechanism  by  which  the 
propulsive  movements  are  given  forms  a  lever  of 
the  second  class,  the  weight  being  between  the  ful- 
crum (heads  of  metatarsals)  and  the  power  (exten- 
sors of  foot).  It  is  one  of  the  few  instances  of  this 
kind  of  lever  in  the  body.  Most  muscular  mechan- 
isms form  levers  of  the  third  and  weaker  class. 

In  a  slow  walk  there  is  always  one  period  when 
two  feet  are  on  the  ground,  and  another  when  only 
one  foot  supports  the  body.  The  more  rapid  the 
walk,  the  shorter  the  time  in  which  both  feet  are 
down  together,  until  in  very  rapid  walking  this  in- 
terval i)raetically  disapjiears,  and  the  body  is  all  the 
time  supported  by  one  or  the  other  foot  alone.  In 
very  rapid  walking,  also,  there  is  not  only  propul- 
sion by  the  hind-foot,  but  a  kind  of  traction  or  pull- 
ing forward  by  the  fore-foot  as  it  is  put  down.  This 
brings  into  play  the  flexors  of  the  foot  and  causes 
the  i^ain  often  felt  in  the  front  of  the  leg  after  rapid 
walking. 

In  running  there  is  always  a  time  in  each  step 
when  neither  foot  touches  the  ground.  This  is 
brought  about  by  a  spring  of  the  hind-foot,  which 
raises  the  body  from  the  ground.  In  this  spring, 
however,  the  body  is  thrown  forward  much  more 
than  it  is  elevated.  Consequently  there  is  a  great 
gain  in  speed.  Professional  runners  cultivate  a  gait 
in  which  there  is  the  least  possible  elevation  of  the 
body  and  the  greatest  possible  propulsion,  the  time 
when  the  body  is  clear  of  the  ground  being  reduced 
to  a  minimum.  By  such  a  gait  the  greatest  feats  in 
pedestrianism  have  been  accomplished. 

The  amount  of  work  (physiologically  speaking) 
done  by  pedestrians  in  these  six-day  contests  is 
enormous.  An  ordinary  man  without  special  prac- 
tice can  rarely  walk  more  than  twenty  miles  a  day 
without  the  greatest  fatigue.  In  doing  this  he  de- 
velops an  amount  of  work  represented  by  about 
seven  hundred  calorics  or  heat-units,  making  for 
the  total  day's  work  of  the  body  about  thirty-tive 
hundred  heat-units.  A  pedestrian  who  walks  one 
hundred  miles  a  day  will  produce,  approximately, 
sixty-live  hundred  calorics,  or,  in  other  words,  the 
equivalent  of  enough  heat  to  boil  one  hundred  and 
twenty  pounds  of  ice-cold  water. 

In  such  work  as  this  the  tissue-changes  are,  of 
course,  extremely  active.  This  change  is  mostly 
shown  in  the  increase  of  the  carbonic  acid  thrown 
off  by  the  lungs.  According  to  the  views  of  the 
present  day,  this  gas  measures  quite  closely  the 
musciilar  work.  The  daily  amount  excreted  can  be 
increased  so  that,  instead  of  the  normal  eight  hun- 
dred or  nine  hundred  gi'ammes,  it  becomes  twice  or 
even  four  times  that  sum.     This  carbonic  acid  rep- 


resents, of  course,  the  oxidation  of  carbon  in  the 
tissues  and  fluids  of  the  body.  Muscular  contraction 
is  a  kind  of  explosion  of  the  muscle-elements.  It  is 
attended  with  the  evolution  of  heat  and  motion  ;  to 

\  which  are  correlated  a  splitting  up  of  the  myosin-fac- 
tors  and  an  oxidation  of  the  carbohydrates  into  car- 

'  bonic  and  sarcolactic  acid.  These  latter  are  swept 
away  by  the  blood.  But  the  products  of  the  proteid 
changes  are  thought  to  be  built  up  into  muscle-tis- 
sue again,  in  large  part.  So  that  muscular  action 
does  not  waste  muscle  unless  it  be  excessive,  when 
it  is  worn  away  just  like  the  iron  parts  of  the  steam- 
engine.  This  view  is  supported  by  the  fact  that,  in 
muscular  exercise,  the  excretion  of  urea  is  only 
slightly  increased.  As  urea  is  a  measiue  of  proteid 
decomposition,  it  is  inferred  that  there  can  be  very 
little  destruction  of  muscle-tissue. 

This  explanation,  however,  has  been  somewhat 
contradicted  by  the  experiments  of  Flint,  and  lately 
by  those  of  Wolf  and  Kellner.  Nor  does  it  explain 
satisfactorily  the  fact  that,  in  hard  work  and  in  train- 
ing, a  very  nitrogenous  diet  is  necessary.  It  is  here 
that  experiments,  carefully  conducted  in  connection 
with  walking  matches,  might  be  of  value  to  physi- 
ology. But,  since  Flint,  no  one  seems  inclined  to 
undertake  them. 


Ufuinus  anti  Itoticcs  of  C)Ook53. 


A  Tbe.^tise  on  HtMAN  Physiology.  Designed  for 
the  Use  of  Students  and  Practitioners  of  Medi- 
cine. By  Joss  C.  Dalton,  M.D.  Seventh  edi- 
tion. With  two  hundred  and  fifty-two  illustra- 
tions. Philadelphia  :  Henrv  C.  Lea's  Son  i  Co. 
1882. 

Pkofessok  Dalton  has,  in  the  present  edition,  im- 
proved his  book  more  than  ever  before.  It  now  has 
claims,  in  many  respects,  to  be  considered  a  scien- 
tific treatise,  as  well  as  "  a  text-book  for  students," 
by  which  term  it  has  been  previously  best  charac- 
terized. 

The  author  has  added  considerable,  but  has  judi- 
ciously taken  away  more,  so  that  the  book  is  shorter. 
The  new  parts  consist  of  slight  modifications  in 
various  chapters,  and  some  important  additions  to 
the  physiology  of  the  nervous  system  and  to  embry- 
ology. The  mimite  anatomy  of  the  brain  and  cord, 
and  especially  their  connection  with  each  other,  are 
given  in  some  detail.  The  phenomena  of  nervous 
degeneration  are  rather  too  conspicuously  put  for- 
ward. In  embryology,  a  number  of  new  cuts  and 
considerable  new  matter,  taken  chiefly  from  KoUi- 
ker,  are  given. 

The  abandonment  of  the  term  "proximate  prin- 
ciple," and  of  the  cumbersome  classification  of  these, 
is  an  especial  good  feature  of  the  present  edition. 
This  part  of  the  book  is  now  properly  designat-ed  as 
"physiological  chemistry."  As  such,  it  forms  an 
interesting  and  readable  treatise  on  that  subject, 
though  it  is  very  far  from  being  scientifically  accu- 
rate. 

The  merits  of  Prof.  Dal  ton's  text-book,  his  smooth 
and  pleasing  style,  the  remarkable  clearness  of  his 


240 


THE  MEDICAL  RECORD. 


descriptions,  which  leave  not  a  chapter  obscure,  his 
cautious  judgment  and  the  general  correctness  of 
his  facts,  are  perfectly  known.  They  have  made  his 
test-book  the  one  most  familiar  23erha2)s  to  Amer- 
ican students. 

The  successive  editions  of  this  phy.siology  have 
shown,  previous  to  this  one  at  least,  some  laggard- 
ness  in  appropriating  the  last  results  of  scientific 
work.  Even  now  it  is  not  above  criticism.  The 
chapter  upon  general  nerve  physiology  is  crude  and 
imperfect.  The  relations  of  the  nervous  system  to 
the  different  organs  of  the  body  are  also  but  briefly 
discussed.  The  nervous  mechanisms  of  secretion, 
circulation,  resjiiration,  the  mechanics  of  digestion, 
of  the  secretion  of  urine,  as  well  as  muscle-physics, 
receive  less  attention  than  they  really  merit. 

Medical    Com>iu.vic.\tions   op   the    JIassacitosetts 

Medical  Society,  Vol.  XII.,  No.  VII.  1881. 
This  volume  contains  the  addresses  delivered  at  the 
centennial  meeting  of  the  Massachusetts  Medical 
Society  last  summer,  with  an  account  of  the  pro- 
ceedings of  the  society  at  that  time  ;  a  list  of  the 
members,  officers,  etc.,  is  also  given.  The  addressee 
by  Drs.  Green  and  Warren  form  the  substance  of 
the  volume.  These  have,  however,  been  fully  re- 
ported and  criticised  in  the  Eecord. 


Eepotts  of  Soctcticsi. 


NEW  YORK  NEUROLOGICAL  SOCIETY. 

Stated  Meeting,  February  2,  1882. 

Dr.  Landon  Carter  Gray,  President  pro  tem.,  in 
THE  Chair. 

The  paper  of  the  evening  was  read  by  Dr.  "Wm.  J. 

Morton,  and  was  entitled, 

A  contribdtion  to  serve-stretching  in  lateral 
sclerosls,  paralysis  agitans,  athetosis,  chronic 
transverse  myelitis,  sciatica,  reflex  epilepsy.  ;  , 

The  speaker  said  that  the  operation  of  nerve- 
stretching  had  not  yet  attained  a  fixed  position  in 
medicine.     Our  knowledge  of  it  was  chiefly  clinical. 

Prompted  by  the  success  of  the  operation  in  loco- 
motor ataxia,  the  writer  made  a  trial  of  it  in  the 
analogous  disease,  lateral  sclerosis  or  spastic  spinal 
paralysis. 

The  following  is  the  history  of  the  case: 

Case  I. — Spastic  sjjinn!  parnli/sis. — Synopsis  of  his- 
tory :  Paresis ;  spastic  gait ;  muscular  tension  ;  ex- 
aggerated reflexes ;  absence  of  marked  sensitive 
irritations  ;  stretching,  at  different  times,  of  both 
sciatic  nerves,  with  remarkable  relief  of  all  the 
symptoms. 

Patient  was  a  man,  aged  fifty,  and  gave  the  fol- 
lowing history :  Present  troulile  began  ten  months 
ago,  after  exposure.  While  heated  from  excessive 
labor  and  the  weather,  lie  went  to  sleep  in  a  cold 
collar.  At  first  he  seems  to  have  had  pain  which  he 
tliought  was  rheumatism.  The  joints,  however, 
were  not  red,  swollen,  or  hot.  "AH  the  bones  in 
his  V)ody  ached,"  "  his  tongue  was  thick,"  the  ex- 
tremities cold  ;  had  also  "  tremendous  stinging  "  and 
shooting  pains  along  tlie  track  of  the  sciatic  nerves. 
At  the  same  time  he  had,  as  now,  twitching  and  cramps 
in  liis  legs  and  arms,  and  an  interlocking  of  the  heels 
in  walking ;  his  legs  "  wore  like  stakes."  Tliere  soon 
supervened  a  feeling  of  numbness  and  tingling  in 


the  hands  and  feet,  together  with  much  loss  of 
power.  During  the  last  four  months  the  general 
numbness  and  tingling  had  ceased,  but  the  loss  of 
iwwer  had  decidedly  increased  and  settled  almost 
entirely  in  the  legs  ;  they  were  heavy,  stiff  and  un- 
manageable. 

His  gait  was  slow  and  shambling,  and  he  had  to 
use  a  cane. 

When  examined,  April,  1881,  all  the  leg  muscles 
were  in  a  spastic  condition  and  the  tendinous  reflexes 
exaggerated.  Any  attempt  at  passive  motion  was  met 
by  involuntary  muscular  resistance  which  had  to  be 
slowly  overcome,  and  such  an  attempt  provoked  at 
the  same  time  Naolent  shaking  of  the  member.  If,  in 
the  sitting  posture,  the  leg  was  caused  to  rest  upon 
the  toes,  violent  trembling  ensued.  No  disturbances 
of  sensibility. 

Operation  was  performed  June  16,  1881.  The  pa- 
tient was  etherized,  an  incision  made  through  the 
gluteus  maximus,  and  the  sciatic  nerve  of  the  7-ight 
side  lifted  out  of  the  sciatic  notch  on  the  forefinger, 
and^vigorously  stretched. 

It  required  a  very  profound  anesthesia  to  over- 
come the  involuntary  shaking  of  the  legs.  The  glu- 
teus maximus  was  excessively  thick,  and  apparently 
normally  hypertrophied  by  constant  spasmodic  ac- 
tion. The  nerve  presented  nothing  abnormal  in  its 
appearance.  The  finger  was  intentionally  used  to 
stretch  with,  in  order  to  avoid  local  laceration  of 
nerve-tissue.  As  far  as  can  be  judged  by  pulling  on 
a  spring  balance  for  comparative  measurement,  a 
force  of  about  forty  pounds  was  exerted  in  pulling 
on  the  nerve.  This  was  continued  about  five  minutes, 
until  a  sense  of  something  "  giving "  was  experi- 
enced. 

The  wound  was  closed  by  wire  sutures,  dressed 
with  carbolic  oil,  and  the  patient  walked  a  number 
of  blocks  on  his  way  home.  No  immediate  effect  in 
his  walking  could  be  obsei-ved.  There  was  no  numb- 
ness, and  the  patellar  reflex  was  still  as  exaggerated 
as  before. 

The  wound  healed  by  fir.st  intention. 

The  patient's  symptoms  were  almost  immediately 
relieved.  (.)n  the  sixth  day  he  walked  over  a  mile. 
The  patient  steadily  improved  until  about  August, 
when  his  left  leg  began  to  get  bad  again.  October 
11,  1881,  the  left  sciatic  was  stretched.  He  steadOy 
improved,  and  on  Januai-y  23,  1882,  had  only  a 
slight  weakness  in  the  left  knee  and  ankle,  with 
slight  exaggeration  of  the  tendon  reflexes. 

Case  11.— Farali/sis  agilaiif:. — Patient,  a  planter, 
aged  forty-three ;  family  and  personal  liistory  good. 
Present  trouble  began  in  1875,  with  "  drawing"  sen- 
sations in  left  shoulder  and  dragging  of  left  leg. 
Soon  left  leg  and  then  arm  began  to  shake. 

In  1877,  about  the  same  symptoms  appeared  in 
the  right  side,  .\bout  1879  the  whole  body,  except 
the  head,  liegau  to  bo  comiiaratively  rigid,  and  the 
difficulty  in  walking  increased.  In  the  spring  of 
1881  all  his  symptoms  had  become  more  pronounced, 
and  he  could  not  dress  himself,  cut  his  meat,  feed 
himself,  etc.  The  head  h.'id  become  fixed  and  bent 
forward,  and  the  trembling  more  severe  and  gen- 
eral. Walking  was  difficult  and  clumsy.  He  could 
assign  no  cause  for  his  trouble.  Had  had  no  fright 
or  other  emotional  trouble. 

When  seen  by  the  speaker,  his  condition  was  as 
follows  :  Rhythmical,  continuous  trendiHng  of  both 
arms,  severest  in  hands.  Brief  intermissions  occur 
while  lying  down  ;  the  sliglitest  attempt  at  pur- 
jiosed  movements  excites  a  violent  shaking  of  the 
arms,   which  increases  u])  to  a  maximum.     Emo- 


THE  MEDICAL  RECORD. 


241 


tional  disturbances  have  the  same  efl'ect.  The  head 
never  trembles.  Trembling  ceases  during  sleep. 
Propulsion  and  retropulsion  marked,  especially 
when  tired.  Gets  greatly  fatigued.  Walks  but  little, 
and  that  with  assistance.  The  rigid  and  "  soldered 
together"  look  of  the  patient's  body,  as  described 
by  Charcot,  exists  to  a  marked  degree. 

Patient's  hands  are  the  characteristic  "  writing 
hands  "  of  Charcot.  Muscular  jjower  well  retained, 
but  slowly  brought  into  action.  Speech  .slow  and 
not  understood,  except  by  those  familiar  with  it. 
Tendon  reflex  normal,  but  response  slow.  No  alter- 
ations in  general  sensibility.  Electro-mu.scular  con- 
tractility normal. 

Patient  had  already  experienced  every  treatment 
familiar  to  the  speaker  in  medicine :  nitrate  of  silver, 
chloride  of  gold,  hyoscyamia,  various  bromides,  zinc, 
strychnia,  phosphorus,  etc.,  and  he  had  tried  galva- 
nism, but  continued  to  gi'ow  steadily  worse.  Dr. 
Morton  first  treated  him  with  static  electricity.  For 
about  a  month  this  produced  considerable  relief,  far 
more  than  by  any  other  treatment.  The  patient 
then  relapsed. 

It  was  therefore  determined  to  try  nerve-stretch- 
ing. This  was  done  October  18,  1881.  The  incision 
was  made  at  the  junction  of  the  lower  and  middle 
third  of  thigh,  where  it  is  much  easier  to  reach  the 
nerve,  and  the  operation  is  a  simple  one. 

There  was  a  very 

PECULIAR   APPEAB.\XCE   TO   THE   EXPOSED   NEE'^'E. 

It  was  large,  round,  and  of  a  dirty  yellowish 
bfown  color.  To  the  touch  the  nei-ve  was  hard,  firm, 
stilf,  and  unyielding,  and  gave,  when  stretched,  a 
creaking  or  gritty  sensation.  The  speaker  thought 
it  was  in  a  condition  of  sclerosis.  The  nerve  was 
stretched  to  a  weight  of  about  forty  pounds,  and 
pulled  from  centre  to  periphery  and  rice  i-ersa.  Tre- 
mor ceased  during  etherization.  Ether  was  borne 
remarkably  well.  The  nerve,  now  .serpentine,  was 
laid  back  in  its  bed  and  four  silver-wire  sutures  and 
carbolic-oil  dressing  applied.  On  recovering  from  the 
eSects  of  the  ether  patient  had  very  imperfect  use 
of  his  leg.  The  toes  drooped,  the  foot  swung  in- 
ward, and  he  could  not  advance  or  draw  back  the 
leg ;  sensation  was  nearly  abolished.  The  w-ound 
suppurated  for  several  days — the  patient  was  worse. 
Then  the  paralysis  began  to  mend. 

November  26th. — Walking  had  greatly  improved, 
the  general  rigidity  was  nearly  gone.  Tremor  less 
severe,  with  longer  periods  of  rest ;  mental  irrita- 
bility less.  On  February  1st,  three  and  one-half 
months  after  the  operation,  he  was  reported  "  a  good 
deal  better  than  before  the  operation."  Dr.  INIor- 
ton,  in  commenting  on  the  case,  said  that  he  did  not 
report  the  case  with  any  recommendation  as  to  a 
further  adoption  of  such  a  plan  of  treatment.  He 
would  wish  each  one  to  decide  as  to  its  value  upon 
the  facts  presented. 

Case  III. — Athetosis,  right  side. — The  patient  was 
a  historic  one,  being  the  first  case  of  athetosis  ob- 
served after  Dr.  Hammond's  description  of  the  dis- 
ease. Dr.  W.  T.  Gairdner,  of  Glasgow,  reported  it 
in  the  Journal  nf  Mmtal  Science,  July,  1873  : 

"  At  the  age  of  three  it  was  noticed  that  the 
right  leg  gave  way,  causing  him  to  fall.  He  had  no 
convulsions  or  loss  of  consciousness.  Until  eleven 
years  of  age  was  vei-y  lame,  then  walked  better. 
Three  months  after  thie  right  leg  was  first  afTected 
the  right  hand  began  to  .show  peculiar  movements. 
It  would  unintentionally  close  on  objects  and  hold 
them  fast.     Then  the  liand  and  fingers  began  "  to 


twist  and  work,"  particularly  when  he  attempted 
purposed  movements.  This  hand,  as  far  as  he  rec- 
ollects, has  never  been  better  nor  worse  up  to  this 
day." 

When  seen  by  the  speaker  the  most  obvious  feat- 
ure was  the  movements  characteristic  of  athetosis. 
Dr.  Morton  called  attention  to  the 

COMPOUND    CHAKACTER 

of  these  movements,  i.e.,  a  flexion  of  one  part  of  the 
hand  with  extension  of  another.  In  this  respect 
there  was  a  marked  diflerence  from  the  single  move- 
ments of  chorea.  Static  electricity  caused  only  tem- 
porary improvement.  It  was  resolved  to  stretch  the 
ulnar  and  median  nerves.  This  was  done  November 
16,  1881,  the  nerves  being  vigorously  jmlled. 

November  25th. — Hand  quiet  for  the  first  time  in 
the  patient's  memory. 

January  2.''),  1882. — The  continuous  and  compound 
movements  are  now  totally  abolished  ;  but  there  is 
at  times  still  a  very  slight  twitch  of  the  thumb.  The 
position  of  the  fingers  is  in  an  easy  and  natural 
flexion.  Some  numbness  of  the  hand  persists.  Pa- 
tient says  that  it  is  a  great  deal  less  trouble  to  him 
than  formerly,  and  that  he  prefers  it  a  thousand 
times  in  its  present  condition. 

Case  IV. —  Chronic  transverse  myelitis. — Reported 
from  Dr.  Hammond's  clinic.  The  patient  a  man, 
aged  sixty-four.  In  1861  first  noticed  a  tingling  sen- 
sation in  his  two  feet;  this  gradually  extended  up 
the  legs.  During  the  last  two  years  has  had  twitch- 
ing in  the  legs,  great  loss  of  sensation,  sense  of  con- 
striction around  the  waist,  much  wasting  of  the 
muscles,  trouble  in  retaining  his  urine,  consti2:)ation, 
and  great  difliculty  of  locomotion.  Condition,  when 
first  seen,  was  as  above,  with  exaggerated  reflexes, 
especially  patellar  tendon  reflex,  a  sensation  of  walk- 
ing on  soft  ground,  ataxic  gait,  coldness  and  bluish 
red  color  of  the  legs,  and  atrophy  of  the  muscles. 
Never  had  pain  in  bis  legs.  Electric  irritability  of 
nerve  and  muscles  neither  quantitatively  nor  quali- 
tatively altered.  On  August  4,  1881,  the  right  sci- 
atic nerve  had  been  stretched  by  Dr.  Osborn  with 
excellent  results.  On  September  18,  1881,  Dr.  Mor^ 
ton  stretched  the  left  sciatic  nerve.  The  operation 
was  performed  without  an  anpesthetic.  The  fol- 
lowing very  curious  and  favorable  results  followed 
the  two  operations :  Cutaneous  sensation  returned 
immediately  upon  the  stretching.  The  legs,  five 
minutes  previously  insensible  to  the  cut  of  a  knife, 
were  now  sensitive  to  the  slightest  prick  of  a  pin. 
During  the  operation  the  patient  located  the  pain  of 
the  incision  and  handling  of  the  nerve  to  the  region 
of  the  anus.  After  stretching  he  located  painful 
sensations  correctly. 

An  immediate  sequence  of  the  return  of  sensation 
was  the  return  of  the  knowledge  of  the  relation  of  the 
.soles  of  his  feet  to  the  ground,  hence  the  power  of 
locomotion  seemed,  as  it  were,  miraculously  restored 
to  him. 

One  month  later  patient  was  still  much  improved. 

January  27.  1882. — Very  little  benefit  remains  firm 
the  operation.  The  ansesthesia  is  not  as  complete 
as  before,  but  the  other  symptoms  are  nearly  as 
prominent  as  previously. 

The  case  suggested  two  reflections.  In  the  first 
place,  tlie  operation  did  no  harm,  and  temporary 
benefit  was  derived. 

In  the  second  place,  it  is  not  unlikely  that  a  por- 
tion of  the  benefit  indubitably  derived  in  locomotor 
ataxy  above  and  beyond  the  relief  of  the  fulgurating 
pains  is  due  to  a  return  of  cutaneous  sensation,  per- 


242 


THE  MEDICAL  RECORD. 


haps  also  muscular  sense,  and  hence,  consequently, 
increased  power  of  locomotion. 

Case  V. — Idiopathic  sciatica. — The  patient,  a  man 
aged  thirty-three,  was  attacked  with  sciatica  ou  the 
left  side,  eight  months  before  applying  to  Dr.  Mor- 
ton for  relief.  The  case  was  severe  and  olxitinate. 
The  pains  lasted  for  three  months,  then  left  him  for 
about  two  months,  then  returned  again.  He  was 
treated  for  a  while  at  Roosevelt  Hospital,  and  got 
some  relief,  but  finally  left  that  institution.  Dr. 
Morton  first  treated  him  with  static  electricity, 
which  absolutely  relieved  ])ain  for  a  day,  but  it  then 
returned.  After  two  weeks'  treatment,  though  some- 
what improved,  nerve-stretching  was  decided  upon, 
and  performed  October  22,  1H81.  The  nei-ve,  when 
laid  bare,  was  found  lobe  red  and  vascular.  It  was 
stretched  for  five  minutes  with  force  sufficient  to 
raise  the  leg  from  the  table.  No  signs  of  tortuous 
veins  remained  after  stretching.  Pain  at  once  dis- 
appeared. Three  months  after  operation  the  patient 
remained  free  from  pain  and  cui-ed. 

Case  VI.  —  Rerlcxepikpsti/. — Stretching  of  brachial 
plexus.  Patient,  a  man  aged  forty,  came  to  Dr. 
Hammond's  clinic  February  .5,  1880.  For  ten  years 
he  had  been  subject  to  numerous  daily  attacks  of 
spasms.  Occurred  mostly  in  bed  between  3  and  6 
A.M.  There  was  no  loss  of  eonsciou.sness.  An  aura 
always  existed.  The  main  peculiarity  of  the  attack 
was  that  it  could  be  induced  usually  at  will  by  pa- 
tient or  physician,  or  accidentally  by  a  liystauder, 
by  touching  various  points  of  what  a23pears  to  be  a 
true  epileptic  zone  of  Brown-Sfquard.  The  touch 
of  the  barber  to  the  right  side  of  the  neck,  or  of  one 
of  his  children  on  his  shoulder,  often  broTight  on  an 
attack.  Urination  sometimes  brought  on  an  attack 
(irritation  of  neck  of  bladder?). 

No  neuropathic  history ;  no  knowledge  of  injury 
to  any  part  of  the  body  ;  used  to  drink  to  excess,  and 
thinks  tliis  caused  his  disease ;  has  no  specific  his- 
tory ;  children  healthy  ;  never  falls,  loses  his  senses, 
or  bites  his  tongue.  Irregular  eating  and  drinking 
increase  number  of  attacks.  Mind  good,  though 
thinks  his  memory  is  slightly  impaired ;  no  head- 
aches and  no  vertigo. 

He  was  treated  with  bromides,  glonoin,  static  elec- 
tricity, etc.,  with  temporary  good  results.  But  he 
finally  began  to  get  worse,  and,  as  a  last  resort, 

STRETCHING   OF   THE   BRACHIAL   PLEXUS 

was  attempted.  The  operation  was  performed  as 
follows : 

After  dividing  the  skin  and  subcutaneous  cellidar 
tissue,  the  aponeurosis  was  divided  on  a  director, 
and  the  axillary  vein  and  artery  exposed.  The  me- 
dian, ulnar,  and  internal  cutaneous  nerves  were  sep- 
arately extracted  and  hooked  over  the  end  of  a 
silver  catheter;  then  the  finger  was  passed  beneath 
them  aad  they  were  vigorously  stretched  and  jjulled 
from  the  centre,  with  a  view  of  stretching  the  entire 
brachial  plexus  and  cervical  cord.  The  wound  was 
then  closed  with  wire  sutures  and  dressed  with  car- 
bolic oil. 

The  time  since  operation  was  too  short  to  draw 
any  conclusions  as  to  its  eifect.  The  attacks  liad 
been  much  fewer  in  number,  though  occurring 
daily. 

The  speaker  then  discussed  some  of  the  surgical 
aspects  of  the  question.  It  is  necessary  to  stretch 
for  some  time,  throe  to  five  minutes,  and  to  use  con- 
siderable force.  The  finger  is  the  best  instrument 
for  the  purpose.  The  brachial  plexus  of  the  cadaver, 
according  to  Trombetta,  will  stand  a  strain  of  -18  to 


81  pounds  ;  the  crural,  83  pounds  ;  the  sciatic,  184 
pounds.  The  main  strain,  after  resistance  to  the 
natural  adhesions  is  overcome,  is  upon  the  posterior 
roots. 

IS   THE   SPINAL   COBD   STRETCHED  ? 

Harless  and  Huber,  Valentin  and  Conrad  are  cited 
by  Chauvel  as  saying  it  is  not.  But  functional  dis- 
turbances created  on  the  other  side  of  the  body  in 
certain  reported  experiments  would  seem  to  indicate 
that  the  spinal  cord  is  in  reality  pulled  downward. 
According  to  Ciillette,  the  medulla  oblongata  in  a 
cadaver  was  felt  to  move  when  the  sciatic  was  imlled 
upon. 

Regarding  the  effects  of  stretching,  the  speaker 
drew  the  following  conclusions  from  his  own  expe- 
rience : 

First. — That  moderate  stretching  of  the  nerve  pro- 
duces merely  a  temporary  motor  paralysis,  easily 
recovered  from,  and  a  very  considerable  paralysis  of 
sensation,  likewise  easily  recovered  from. 

Second. — That  severe  stretching  produces  a  marked 
motor  paralysis  of  long  continuance  (months),  and  a 
toleralily  complete  j^aralysis  of  sensation,  much  more 
quickly  recovered  from  than  is  the  motor  paralysis. 
Cases  of  spasm  should  therefore  be  stretched  vigor- 
ously. 

Third. — In  Dr.  Morton's  cases  motor  paralysis  had 
been  more  persistent  than  the  sensory. 

Fourth. — That  profound  cutaneous  anaesthesia 
may  be  removed  for  months,  perhaps  permanently. 

The  speaker,  in  conclusion,  referred  to  some  of 
the  unfavorable  reports  regarding  the  operation 
from  Germany ;  also  to  the  so-called  subcutaneous 
method  of  stretching.  He  considered  nerve-sti-etch- 
ing  to  be  one  of  the  mechanical  forms  of  treatment 
allied  to  pounding,  kneading,  electi-icity,  etc. 

The  discussion,  by  request,  was  opened  by  Dr. 
John  A.  W'yeth,  who  said  that  he  had  stretched  the 
sciatic  nerve  in  a 

case   op   locomotor    ATAXIA 

in  the  month  of  September  last.  It  was  a  case  of 
six  or  seven  years'  standing,  accompanied  by  intense 
pains  in  both  lower  limbs.  The  operation  was  done 
as  had  been  described  by  Dr.  Morton,  and  both 
nerves  were  stretched.  In  the  left  leg  the  nerve  was 
stretched  and  pulled  much  more  severely  tlian  in 
the  right.  The  result  was  that  in  the  left  limb  the 
pains  ceased  entirely,  and  did  not  return  for  three 
months  when  they  were  much  lighter,  while  in  the 
right  they  recun-ed.  There  was  no  improvement  in 
the  gait  or  in  co-ordination.  The  patient  was  in  bed 
for  ten  days  after  the  ojjeration. 

Dr.  a.  p.  Gerster  reported  a  case  of  nerve- 
stretching  in  locomotor  ataxia.  The  patient  was  a 
German,  aged  forty-five,  a  carpenter,  who  came  to 
the  German  Hospital,  September  19,  1881.  The 
characteristic  symptoms  of  the  disease  were  })resent : 
absence  of  tendon  reflex,  ataxic  gait,  anaesthesia  of 
feet  and  legs,  fulgurating  pains  which  cau.-icd  great 
distress.  Rectal  and  vesical  action  normal.  Both 
sciatic  nerves  were  stretched  vigorously,  the  leg  be- 
ing lifted  up  by  the  nerve.  The  wound  healed  veiT 
sluggishly,  as  though  there  was  some  trophic  dis- 
turbance. The  sutures  came  away,  the  edges  not 
uniting,  yet  there  was  no  good  suppuration,  but 
only  a  kind  of  serous  discharge. 

The  result  of  the  operation  was  :  no  improvement 
(or  increase)  in  ataxic  gait  or  anaisthesia,  but  con- 
siderable relief  from  the  pains,  up  to  four  months 
after  the  operation. 


THE  MEDICAL  RECORD. 


243 


Db.  G.  M.  Bkart)  asked  if  nervp-stretching  had 
been  used  in  tlie 

TREAT>[ENT   OF   WP.rrEK's   CEAIIP. 

He  tbonglit.  that  it  might  prove  useful  in  that  dis- 
ease, and  would  not  hesitate  to  ti-y  it.  He  consid- 
ered nerve-stretching  to  be  a  form  of  mechanical 
treatment  which  did  not  differ  in  kind  from  those 
formerly  used,  such  as  acupuncture,  electro-punc- 
ture, electricity,  massage,  etc.  The  speaker  be- 
lieved that  nerve-stretching  would  take  its  place 
permanently  in  the  therapeutics  of  nervous  diseases. 

Dk.  Wii.  A.  Hamjiojtd  said  that  he  had  stretched 
two  sciatic  nerves  in  the  same  person  for  locomotor 
ataxia.  The  jjatient,  a  lady,  was  unable  to  walk, 
and  the  pains  were  simply  atrocious.  The  symp- 
toms were  confined  to  the  lower  extremities.  At 
times  there  was  both  rectal  and  vesical  sjjhincter 
paralysis.  He  stretched  both  sciatic  nerves  vigor- 
ously. A.s  in  all  his  other  cases  (now  seven  or  eight), 
the  wound  )ieal&<l  by  first  intention,  though  he  had 
not  used  any  antiseptic  treatment.  There  was  no 
improvement,  either  in  locomotion  or  in  the  pains. 

IN    SCIATICA 

the  speaker  had  stretched  the  nerve  in  a  jiatient 
with  immediate  favorable  result.  Tlie  case  W'as  a 
very  bad  one.  He  had  repeatedly  stretched  the 
nerve  by  flexing  the  thigh  upon  the  pelvis,  keeping 
the  leg  perfectly  straight.  He  found  it  necessary 
however,  to  give  ether,  for  the  operation  was  a  pain- 
ful one,  and  besides,  there  was  antagonistic  effort  on 
the  part  of  the  patient.  By  this  method  the  speaker 
thought  that  the  sciatic  could  be  stretched  as  well 
as  by  cutting  down  upon  it,  and,  in  his  opinion,  the 
former  method  would  supplant  the  latter  in  most 
cases.  In  large  and  fat  men  the  cutting  operation, 
however,  would  probably  still  have  to  be  performed. 

The  speaker  referred  to  Dr.  Morton's  rej5orted 
case  of  lateral  sclerosis,  which  he  had  seen,  and 
thought  the  result  a  remarkable  one.  [The  patient 
was  exhibited  to  the  Society.] 

Db.  C.  L.  Dana  related  an  experiment  performed 
by  him  to  test  the  question  whether 

STRETCHING   THE   SCIATIC   MOyES   THE   CORD, 

as  is  asserted  by  some.  A  dog  weighing  twelve 
pounds,  which  had  been  dead  twenty  hours,  was 
taken,  the  skull-cap  removed,  and  one  sciatic  nerve 
exposed  and  pulled  upon  strongly.  There  was  no 
movement  of  any  part  of  the  brain.  The  brain  was 
removed,  and  the  medulla  exposed,  both  sciatics  were 
found  and  both  pulled  upon  powerfully  and  simul- 
taneously, but  not  the  slightest  movement  could 
be  obtained.  The  spinal  cord  was  then  exposed 
in  the  dorsal  region.  The  most 'powerful  traction 
failed  to  move  the  cord  either  when  lying  in  the 
canal,  or  when  raised  out  of  it  upon  a  knife-handle. 
The  cord  was  cut  in  the  lower  dorsal  region,  but  no 
movement  of  the  lower  segment  could  be  obtained. 
Tlie  tissues  were  not  softened. 

The  speaker  said  that  no  positive  inferences  could 
be  drawn  from  such  an  experiment.  Still,  if  pow- 
erful traction  (over  seventy-five  pounds)  upon  both 
sciatics  of  a  twelve-pound  dog  failed  to  move  the 
cord  appreciably,  it  might  be  inferred  that  ordinary 
nerve-sh-etching  in  human  beings  did  not  move  it. 

[Dr.  Dana  writes  that  a  few  days  later  a  similar 
experiment  was  made,  in  connection  with  Dr.  W. 
H.  Porter,  upon  the  human  cadaver.  The  brain 
was  removed  and  the  meduUa  exposed.  Dr.  Porter 
drew  this  forward  so  as  to  put  the  cord  slightly  on 


the  stretch.  The  sciatic  nerve  was  then  found  and 
traction  made  upon  it,  but  with  no  efl'ect  whatever 
ujion  the  medulla.  A  broomstick  was  finally  twisted 
into  the  nerve,  and  two  men  pulled  until  the  nerve 
V)roke,  but  no  motion  of  the  medulla  could  be  de- 
tected. The  sciatic  of  the  other  leg  was  tried  in  the 
same  way,  with  similar  results.  The  subject  was  a 
large  man,  about  lifty  years  of  age,  who  died  from 
cirrhosis  of  the  liver.] 

De.  W.  a.  Hammond  said  that  while  the  last 
speaker's  observation  was  no  doubt  correct,  it  did 
not  prove  that  some  of  the  fibres  in  the  cord  con- 
necting with  the  sciatic  were  not  moved.  The  mo- 
tion might  be  slight  and  unappreciable. 

Dr.  AYveth  asked  what  was  the  mortality  rate 
from  the  operation. 

Dr.  W.  J.  Morton  said  that,  so  far,  five  fatal  cases 
had  been  reported.  Of  these  three  were  indistinctly 
attributable  to  the  operation,  while  two  were  dis- 
tinctly attributable  to  surgical  procedures. 


NEW  YOEK   SUEGICAL   SOCIETY. 

Sla/ed  Meeting,  December  27,  1881. 
Dr.  T.  M.  Maekoe,  President,  in  the  (Ihaie. 

NAS0-PH.4ETNGEAL   POLlTrS. 

Dr.  George  A.  Peters  presented  the  patient,  who 
was  brought  before  the  society  in  March,  1881, 
and  fi'om  whom  he  had  removed  a  naso-pharyngeal 
polypus  that  occupied  the  fauces,  jjosterior  nares, 
and  presented  in  the  anterior  nares.  The  patient 
first  came  under  his  observation  last  January,  after 
several  attempts  had  been  made  to  remove  the  tu- 
mor, but  only  vein-  small  portions  had  been  taken 
away.  He  entered  St.  Luke's  Hospital,  where  Dr. 
Peters  operated  for  its  removal  by  cutting  through 
the  soft  j^arts  in  the  ordinary  way  for  removing  the 
upper  jaw;  that  is,  inserting  the  knife  just  below 
the  inner  canthusiipon  the  left  side,  cutting  through 
all  the  tissues  to  the  bone  on  the  line  of  junction  be- 
tween the  cheek  and  nose,  pa.ssing  around  the  left 
ala  into  the  opening  in  the  nostril ;  thence  along  the 
junction  of  the  skin  and  mucous  membrane  to  the 
middle  line,  and  along  the  latter  to  the  free  margin 
of  the  upper  lij],  which  was  completely  divided. 
This  flap  was  dissected  uj),  the  bone  beneath  fully 
exposed  and  removed  by  means  of  a  saw  and  for- 
ceps. After  the  bone  was  removed  it  was  found  that 
the  tumor  was  extensively  attached  to  the  basilar 
jjrocess  of  the  occipital  and  to  the  sjshenoid  bones, 
and  it  was  removed  with  the  scissors,  scrapers,  and 
the  fingers.  It  was  veiT  vascular,  and  the  hemor- 
rhage was  profuse,  but  not  a  drop  of  blood  entered 
the  trachea  or  laiynx,  because  of  the  i^i'ecaution 
taken  to  introduce  a  tube  into  the  crico-thyroid 
space  and  crowding  a  large  piece  of  sj^onge  into 
the  posterior  fauces.  The  disease  was  pronounced, 
after  microscopic  examination,  to  be  a  fibroma. 
The  patient  recovered  and  passed  from  under  obser- 
vation. After  a  time  he  reappeared,  when  Dr.  Peters 
noticed  that  there  was  a  recurrence  of  the  disease, 
which  went  on  increasing  in  size  until  early  in  July, 
when  he  came  under  Dr.  McBurney's  observation, 
and  the  original  operation  was  repeated,  with  the  ex- 
ception, of  course,  of  removing  the  portion  of  bone. 
The  tumor  at  that  time  was  rather  larger  than  it  was 
at  the  original  operation.  The  operation  which  Dr. 
McBumey  performed  was  also  avery  bloody  one,  but 
the  wounds  healed  readily.     The  disease  had,  how- 


244 


THE  MEDICAL  EECORD. 


ever,  recurred,  but  had  been  destroyed  by  burning 
it  down  with  the  actual  cautery,  wliich  had  been  ap- 
plied seven  or  eight  times  at  intervals  of  two  or 
three  weeks,  and  each  time  it  seemed  to  recur  from 
less  sjjace,  and  the  prospect  was  that  it  would 
finally  be  entirely  cured.  The  growth  was  still  very, 
vascular,  but  there  was  no  hemorrhage  attending 
the  use  of  the  cautery  provided  the  cauteiy  iron  was 
kept  at  a  cherry-red  heat. 

Dr.  McBurnet,  in  reply  to  a  question,  stated  that 
he  was  not  able  to  say  positively  whether  the  second 
specimen  was  precisely  like  the  original  tumor ; 
but,  at  all  events,  it  had  exactly  the  same  gross  ap- 
pearance. 

TWO  FRACTURES  OF  THE  S.4.ME  PATELLA. 

Dr.  Jasies  L.  LrriLE  presented  a  patient  with  the 
following  history :  A  young  man,  in  1879,  fell  from 
the  fourth  story  of  a  building,  and,  striking  upon 
his  feet,  so  bent  his  knee  as  to  produce  a  transverse 
fracture  of  the  patella.  He  entered  St.  Luke's  Hos- 
pital where  he  was  treated  for  the  accident  in  the 
usual  manner,  and  made  a  good  recovery  with  liga- 
mentous union.  Nine  months  afterward  he  received 
a  second  fracture  of  the  patella,  aboiit  half  an  inch 
above  the  point  whei-e  the  original  fracture  occurred. 
It  was  difficult,  at  the  time,  to  ascertain  which  was 
the  recent  and  which  was  the  old  fracture,  there 
being  three  movable  fragments.  He  was  treated  for 
the  second  fracture  and  made  a  good  recovery,  and 
has  been  out  of  the  hospital  for  two  years.  There 
could  be  distinctly  felt  three  fragments  of  the  pa- 
tella ;  with  two  ligamentous  bands,  aboiit  half  an 
inch  in  length,  uniting  the  fragments.  The  useful- 
ness of  the  limb  was  almost  completely  restored,  al- 
though the  patient  had  some  difficulty  in  going  up 
and  down  stairs. 

Dr.  McBdrnby  then  read  a  paper  on 

FISTULA   IJJ   THE   ANTERIOR   PORTION   OF    THE   UBETHEA. 

It  contained  the  histories  of  two  cases  of  fistula 
in  the  floor  of  the  urethra  anterior  to  the  scrotum. 

The  first  case  was  that  of  G.  W.  C ,  forty-eight 

years  of  age,  who  presented  himself  for  treatment  in 
April,  1879.  A  phagedenic  ulcer  of  venereal  origin, 
which  had  appeared  five  months  previously,  had 
healed  after  opening  into  the  urethra  just  at  the 
right  of  the  frsenum.  The  fistula  remaining  was  .sur- 
rounded by  cicatricial  tis.iiie,  and  was  large  enough 
to  admit  a  No.  22  French  Vmlbous  bougie.  The  mea- 
tus was  contracted  to  No.  20  French,  .and  .strictures 
of  long  calibre  existed  at  21,  2'},  and  3^  inches  be- 
hind the  meatus.  The  meatus  was  first  enlarged 
and  the  strictures  divided  until  a  No.  lU  French 
steel  sound  could  be  easily  passed  into  the  bladder. 

Three  months  later  the  fistula  was  closed  in  the 
following  manner.  The  ui'ethra  was  opened  in  the 
perineum  to  provide  against  the  passage  of  urine 
over  the  seat  of  operation.  The  foreskin  was  then 
pulled  tightly  backward,  and  the  surface  around  the 
fistula  to  the  extent  of  about  half  an  inch  square 
was  completely  rawed.  On  the  inner  surface  of  the 
foreskin,  a  corresponding  raw  surface  was  made,  the 
base  of  which  reached  the  posterior  edge  of  the  fis- 
tula. The  foreskin  being  now  rolled  forward,  the 
two  raw  surfaces  wore  brouglit  in  contact,  the  edges 
were  stitched  together  and  tlie  penis  enveloped  in 
lint  Boaked  in  carbolized  oil.  After  this  the  urine 
was  caroftilly  drawn  through  the  perineal  opening 
several  times  daily.  At  the  end  of  fourteen  days 
union  was  found  to  be  complete,  and  thirteen  daVs 
later  the  perineal  wound  had  completely  healed. 


The  second  case  was  that  of  William  B ,  forty- 
seven  years  of  age,  who  presented  himself  for  treat- 
ment in  November,  1875.  In  this  case  a  fistula 
existed  just  anterior  to  the  scrotum,  the  loss  of 
substance  in  the  floor  of  the  urethra  being  three- 
fourths  of  an  inch  long,  and  as  wide  as  the  urethra. 
This  had  resulted  from  urinary  infiltration,  and  was 
surrounded  in  every  direction  by  dense  cicatricial 
tissue.  The  fistula  was  finally  closed  by  a  series  of 
operations,  the  first  of  which  was  designed  merely 
to  surround  the  fistula  with  healthy  integument,  in 
order  that  subsequent  plastic  operations  could  be 
performed  to  supply  the  loss  of  substance.  This  hav- 
ing been  accomi)lished,  a  second  operation  was  per- 
formed to  construct  a  floor  to  the  urethra.  This  was 
done,  after  the  method  of  Szymanowski,  by  turning  a 
large  flap  of  skin  so  as  to  present  integumental  sur- 
face to  the  urethra.  A  small  opening  was  still  left 
anterior  to  this  new  floor,  and  another  small  one 
posterior  to  it.  These  were  closed  by  similar  opera- 
tions, in  closing  the  posterior  opening  a  flap  being 
taken  from  the  scrotum.  At  each  operation  the 
perineum  was  opened  to  allow  of  the  free  passage 
of  urine  posterior  to  the  fistula.  The  perineal 
wound  healed  in  each  instance  with  great  rapidity. 
One  year  after  the  last  operation  a  careful  examina- 
tion of  the  patient  was  made,  and  it  was  found  that 
No.  26  French  sound  could  be  passed  readily  into 
the  bladder.  No  twisting  or  bending  of  the  penis 
occun-ed,  even  when  erection  took  jjlace. 

Dk.  a.  C.  Post  referred  to  a  case  which  came  un- 
der his  observation  in  the  New  York  Hospital  as 
long  ago  as  when  Dr.  George  A.  Peters  was  house- 
surgeon.  It  was  a  fistula  in  the  anterior  part  of  tlie 
urethra,  just  behind  the  glans  penis,  following  ex- 
tensive sloughing.  He  succeeded  in  closing  it,  first 
supplying  a  triangular  flap  of  integument  from  the 
scrotum,  passing  it  forward  through  tlie  seat  of  the 
fistula,  and  then  making  two  semi-elliptical  flaps, 
and  drawing  them  together  so  as  to  form  a  crest, 
and  including  them  between  two  splints  of  perfor- 
ated sole-leather.  After  the  splints  were  removed, 
the  surfaces  receded  .so  as  to  leave  a  flat  surface  with 
a  mere  pin-hole  opening,  which  continued  while  the 
patient  was  under  his  observation,  but  he  believed 
that  it  ultimately  closed,  for  the  patient  jiromised 
faithfully  to  return  if  it  did  not  heal  completely. 
He  thought  it  was  Difienbach  who  first  suggested 
bringing  flaps  together  by  broad  surfaces  instead  of 
uniting  them  at  their  edges.  Dr.  Post's  case  was 
published  in  the  Medical  Gazette  of  New  York,  Feb- 
ruai-y  7,  1880,  p.  8.5. 

Dr.  Weir  referred  to  four  cases  of  urethral  fistulee, 
some  of  which  were  already  known  to  members  of 
tlie  society.  Two  of  them  were  treated  successfully 
by  the  method  '  first  practised  by  Szymanowski, 
which  consists  in  prin('iple  of  double  superimposed 
flaps ;  in  one  of  these  cases  there  was  another  open- 
ing in  the  perineum  through  which  urine  escaped, 
that  was  subsequently  cured  by  a  sliglit  modification 
of  the  same  method,  performed  by  Dr.  Sabin.  In 
both  the  cases  the  opening  was  ante-scrotal.  The 
third  case  was  one  in  which  there  was  a  small  open- 
ing I'ust  at  the  corona  glandis.  In  that  instance  he 
made  broad  surfaces,  united  them  by  means  of  the 
quill  suture,  as  suggested  by  Duplay,  using  for  the 
quill  a  piece  of  rubber,  being  very  careful  not  to 
make  the  sutures  very  tight.  It  did  very  well, 
although  there  was  sloughing  at  one  point.  The 
fourth  case  occurred  last  summer  in  the  New  York 
Hospital,  and  there  was  quite  an  extensive  ante- 
scrotal  opening.     The  plan  of  treatment  by  making 


THE  MEDICAL  RECORD. 


245 


broad  surfaces  was  employed,  and  these  were  held 
in  position  by  metallic  sutures  and  also  by  means  of 
quill  sutures,  but  the  result  was  an  absolute  failure. 
His  individual  preference  was  for  the  superimposed 
flaps. 

Dr.  LrrxLE  referred  to  a  case  which  he  had  had 
under   observation  for  the  last  five  years.     It  was 
one  of  extensive  perineal  fistuhe,  in  which  there  were 
a  number  of  sinuses  running  in  various  directions, 
the  longest   one  opening  near  the  left  trochanter.   I 
There  was  also  considerable  loss  of  tissue  in  the  cen- 
tral portion  of  the  perineum,  and  also  a  communica- 
tion between  the  membranous  portion  of  the  urethra  I 
and  the  rectum.      When  the  patient  urinated,  the 
urine  issued  from  six  ditferent  sinuses  in  the  peri- 
neum  and   its   vicinity.      Several   ojierations   were 
performed  which  succeeded  in  closing  all  the  sinuses 
except  the  opening  into  the  rectum  and  one  in  the 
perineum.     Before  attempting  to  close  the  perineal 
opening  he  deemed  it  best  to  close,  if  possible,  the 
recto-urethi-al  fistula.    This  opening  was  large  enough   ! 
to  allow  the  passage  of  a  No.  U  sound  (English). 
Two  operations  were  performed  at  different  times 
by  paring  the  edges  of  the  opening  in  the  rectum 
and  closing  the  wound  by  silver  sutures.     Both  of  ' 
these  operations  were   unsuceessfiil.      On  June    7, 
1879,  aViout  eight  months  after  the  last  operation. 
Dr.  Little  performed  Szymanowski's  operation  in  the 
rectum.     This  is  an  operation  very  similar  to  that 
described   by  Dr.    McBurney.      The    patient    was 
placed  on  his  left  side  and  the  rectum  kept  oi^en  by 
a  Sims'  speculum.      After  the  operation  the  urine 
was  drawn  otf  through  the  iserineal  opening.     The 
flaps  did  not  unite,  and  the  patient  left  the  hospital 
a   month    later,   with    the   wound    surrounded    by 
healthy  granulations.     Six  or  eight  months  after- 
ward he  returned,  and  the  opening  had  so  closed  th.at 
only  an  ordinary  probe  could  be  passed.     Dr.  Little 
then  applied  nitric  acid  several  times  to  the  edges 
of  the  small  fistula  remaining,  and  the  last  time  he 
saw  the  patient  three  weeks  had  elapsed  without  any 
nrine  passing  through  the  rectum.    He  expected  the 
patient  to  return,  when  he  would  attempt  to  close 
the  remaining  fistula  in  the  perineum  according  to 
the  plan  described  in  the  paper  of  the  evening. 

Dij.  H.  B.  SiKDS  .said  that  four  years  ago  he  ob- 
tained success  in  the  treatment  of  a  case  of  urethral 
fistula  by  a  method  not  usually  recommended.  The 
patient  was  a  young  man  who  had  had  a  close  stric- 
ture, probably  of  traumatic  origin,  just  in  front  of 
the  peno-scrotal  junction.  For  the  relief  of  this. 
Dr.  Sands  had  performed  external  urethrotomy,  but 
the  woiuid  did  not  heal,  and  a  fistulous  opening  was 
left  which  would  admit  of  a  large-sized  urethral 
bougie.  For  the  closure  of  that  fistula  he  performed 
the  operation  known  as  Xelaton's,  which  consists  in 
making  in  front  of  and  behind  the  fistulous  orifice  a 
transverse  incision  about  three-fourths  of  an  inch  in 
length  and  detaching  a  bridge  of  integument,  which 
is  slid  forward  and  retained  in  position  with  sut'ares 
in  such  a  manner  that  the  orifice  in  the  integument 
and  the  deeper  orifice  do  not  correspond.  The 
operation  failed.  He  then  succeeded  in  closing  the 
fistula  by  the  use  of  the  actual  cautery,  a  large-sized 
bougie  was  inserted  into  the  urethra,  and  the  cautery 
applied  quite  freely  to  the  edges  of  the  opening,  only 
one  application  was  made,  after  which  the  fistula 
rapidly  contracted,  so  that  at  the  end  of  ten  or  four- 
teen days  it  was  closed  entirely.  No  contraction  of 
the  urethra  followed  the  use  of  the  cautery.  He 
had  seen  the  patient  repeatedly  since,  and  a  No.  28 
French  sound  could  be  easUy  i^assed  into  the  blad- 


der. Such  an  operation  as  this,  of  course,  could 
only  be  expected  to  succeed  in  a  case  in  which  there 
was  no  loss  of  substance.  He  had  no  doubt  that  in 
cases  such  as  were  alluded  to  l)y  Dr.  McBurney,  the 
operation  performed  by  him  was  the  most  promising 
of  good  results. 

TKADMATIC   STBICTUBE   OF   THE   UKETHKA. 

Dr.  G.  a.  Peters  referred  to  a  case  now  in  the 
New  York  Hospital :  a  boy,  five  or  six  years  of  age, 
in  company  with  several  other  boys,  tied  a  string 
around  the  penis  in  order  to  see  which  one  could 
endure  it  the  longest.  The  result  was  sloughirg, 
and  when  Dr.  Peters  examined  the  penis  he  found  a 
close  stricture,  not  more  than  one  inch  behind  the 
meatus,  which  would  admit  only  the  finest  filiform 
bougie.  The  patient's  temperature  at  seme  parts 
of  the  day  was  105°  F.,  and  the  urine  was  continu- 
ally dribbling.  He  was  anxious  to  relieve  the  pa- 
tient, but  how  to  operate  was  a  question  upon  which 
he  would  like  some  information  from  the  society. 
He  thought  that  the  operation  to  be  performed  lay 
between  divulsion  and  external  incision.  Divulsion 
he  looked  upon  with  a  good  deal  of  apprehension, 
because  he  thought  it  would  be  exceedingly  danger- 
ous and  somewhat  difficult  to  perform. 

Dk.  E.  L.  ICeyes  suggested  a  linear  incision  be- 
hind the  stricture,  catheterism  from  that  point  for- 
ward, and  cutting  upon  the  blunt  end  of  the  instru- 
ment at  the  meatus  inteiTius,  leaving  the  linear 
Oldening  to  heal  of  its  own  accord,  which  it  probably 
would  do  without  trouble. 

Dr.  a.  C.  Post  thought  that  the  external  incision 
was  the  safest  operation  to  jierform. 

[Dr.  Peters  completed  the  history  of  the  case 
Januaiy  10,  1S82.  He  found  that  he  was  able  to 
slip  a  tiinnelled  sound  of  small  size  over  the  whale- 
bone guide,  and  with  a  moderate  amount  of  force 
to  carry  it  beyond  the  obstruction.  It  was  evident 
that  the  stricture  was  linear.  Believing  it  to  be 
better  to  cut  than  to  divulse  in  this  case,  he  intro- 
duced an  Otis  instrument  to  about  eighteen  and  then 
drew  the  blade  through,  which  enabled  him  to  pass 
a  No.  15  French  through  the  stricture.  A  sound 
of  that  size  had  been  introduced  daily  since  the 
operation,  the  high  temperature  present  before  the 
operation  had  subsided,  never  going  above  101°  F., 
and  there  was  no  evidence  of  trouble  of  any  kind. 
Dr.  Peters  thought  it  was  the  smallest  iirethra  the 
cutting  instrument  had  ever  been  used  in,  and  he 
was  surprised  at  the  facility  with  which  the  operation 
could  be  performed. 

The  President  remarked  that  he  was  present  at 
the  operation,  and  that  it  was  an  extremely  satisfac- 
tory result  of  what  promised,  at  the  outset,  to  be  a 
delicate  and  drfBcult  procedure.] 

refkacttjre  op  the  radius. 

De.  James  L.  Little  narrated  a  case  as  follows  : 
A  woman,  thirty  years  of  age,  received  a  Colles'  frac- 
ture, and  it  was  treated  as  a  sprain,  resulting  in 
great  deformity.  Subsequently  she  was  examined 
by  a  physician,  who  told  her  to  let  it  alone,  and  ad- 
vised against  a  refracture  because  so  long  a  time 
had  elapsed  since  the  receijit  of  the  original  injury. 
Although  it  had  been  six  weeks  since  the  original 
fracture  occurred.  Dr.  Little  attempted  refracture, 
succeeded  after  resorting  to  considerable  forcible 
manipulation,  and  rej^laced  the  fragments  almost  in 
their  normal  position.  Union  took  place  with  very 
slight  deformity,  only  a  slight  projection  of  the 
lower  extremity  of  the  ulna  remaining.     Previous 


246 


THE  MEDICAL  RECORD. 


to  this  case  he  had  always  failed  in  attempting  to 
refracture  in  deformity  from  Colles'  fracture  at  a 
period  later  than  three  or  four  weeks  after  the  origi- 
nal injury. 

The  patient  suffered  great  pain  in  the  wrist  and 
hand  before  the  operation,  but  this  symptom  was 
entirely  relieved  after  the  fragments  were  placed  in 
their  normal  position. 

SABCOMA   OF   THE   FOREAEM. 

Dr.  Euskine  Masos  presented  a  specimen  with 
the  following  history  :  It  was  removed  last  July, 
from  a  femile  patient,  fifty- four  years  of  age.  Her 
condition  was  one  of  great  feebleness,  being  reduced 
by  the  excessive  pain  which  the  tumor  had  lately 
caused,  as  well  as  from  repeated  profuse  hemor- 
rhages. The  growth  had  abeady  been  removed 
three  times.  The  first  operation  was  performed 
twenty-three  years  ago,  the  second  twelve  years  ago, 
and  the  third  five  years  ago.  The  growth  always 
occurred  within  one  inch  of  the  seat  of  the  original 
tumor.  After  the  first  operation  the  disease  re- 
mained absent  for  nearly  four  years,  after  the  second 
operation  it  did  not  occur  until  one  year,  and  after 
the  third  operation  it  reappeared  within  one  month, 
and  grew  very  slowly  until  within  one  or  two  months 
prior  to  the  time  of  removing  the  forearm.  The 
specimen  was  examined  by  Dr.  Delafield,  who  re- 
ported that  the  tumor  was  not  connected  with  the 
periosteum,  but  was  subcutaneous.  It  was  com- 
posed of  dense  connective  tissue,  the  bundles  of 
fibres  running  along  in  different  directions  ;  along 
the  fibres  were  fusiform  cells  and  long  oval  nuclei 
in  large  numbers.  Since  the  operation  the  patient 
had  remained  well. 

STRICTURE   OP  THE   CESOPHAGTJS. 

Dr.  "Weir  presented  a  specimen  embracing  the 
trachea,  oesophagus,  and  stomach,  which  showed  a 
narrowing  of  the  cesophagns  as  the  result  of  swal- 
lowing oil  of  vitriol.  It  was  removed  from  the 
body  of  a  man  aged  forty  years,  who  came  into  the 
New  York  Hospital  in  December,  1880,  several 
months  after  the  accident,  for  the  relief  of  dyspha- 
gia. For  a  time  he  was  under  the  charge  of  Dr. 
Sands,  who  was  unable  to  definitely  locate  the  nar- 
rowing of  the  cesophagus,  but  believed  that  the  con- 
striction was  at  its  ujjper  portion.  When  Dr.  Weir 
came  on  service  he  renewed  the  attempts  to  define 
the  size  and  locality  of  the  stricture,  but  failed  in 
accomplishing  either.  Urethral  olivar'y  bougies  of 
different  sizes  were  arrested  just  below  the  cricoid 
cartilage,  but  none  covikl  be  made  to  engage  in  the 
supposed  stricture.  His  examinations  occupied 
several  days,  and  after  one  of  his  attempts  to  in- 
troduce a  bougie  the  patient  said  he  could  swallow 
very  much  better,  and  his  improvement  was  such 
that  he  was  able,  within  a  week,  to  swallow  milk 
more  readily.  A  few  days  afterward  he  was  able  to 
swallow  bread,  the  crust  as  well  as  the  soft  part. 
The  patient  continued  to  improve  in  general  condi- 
tion so  much  that  the  idea  of  an  operation  was  en- 
tirely dismissed,  and  he  left  the  hospital  soon  after. 
On  last  Thursday  the  specimen  was  brought  to 
Dr.  Weir  by  Dr.  Tuttle,  formerly  house  surgeon 
in  the  New  Yoi-k  Ho.spital,  and  at  piosent  phy- 
sician in  chief  at  the  Emigrant  Hospital,  who 
told  him  that  throe  or  four  weeks  ago  this  man  was 
brought  into  his  wards  with  a  cough  and  a  profuse 
purulent  expectoration,  and  with  considerable  diffi- 
culty in  swallowing.  Ho  was  able  to  get  down  only 
one  pint  of  milk  a  day.     At  different  times,  after 


coughing  considerably,  soon  after  swallowing  milk, 
it  was  noticed  that  there  were  streaks  of  milk  in  the 
expectoration,  and  the  idea  suggested  itself  that  there 
was  a  communication  between  the  cesophagus  and 
the  air-passages.  On  examinatioii,  after  death,  it 
was  found  that  the  stricture  began  about  one  inch 
below  the  cricoid  cartilage,  and  extended  downward 
about  two  inches,  at  which  point  thei-e  was  an  ojien- 
ing  that  was  said  to  have  communicated  with  cavi- 
ties at  the  apices  of  the  lung.  At  the  time  of  the 
autopsy,  as  reported  by  Dr.  Tuttle,  an  instrument 
not  larger  than  a  lead-pencil  could  be  introduced 
through  the  stricture.  Now,  after  some  two  weeks' 
soaking  in  Wickersheimer's  fluid,  a  No.  34  bougie  « 
hoiile  defined  the  stricture.  There  was  evidence  of 
ulceration  in  the  a-sophagus,  below  the  stricture. 
The  specimen  was  specially  interesting  from  the 
fact  that  it  belonged  to  a  class  in  which,  if  seen 
when  the  symptoms  were  urgent,  gastrostomy  or 
oeaophagotomy  might  have  been  successfully  per- 
formed. 

Dr.  H.  B.  Sands  remarked  that  the  specimen  was 
somewhat  unsatisfactory  in  its  present  condition. 
The  account  given  was  that  at  the  autopsy  a  close 
stricture  was  found  near  the  cricoid  cartilage  ;  but 
it  was  difficult  to  see  how,  farther  down,  the  uesoi^ha- 
gus  could  be  so  much  dilated  in  the  absence  of  stric- 
ture below  the  point  of  ulceration.  It  was  difficult 
to  understand,  if  there  was  no  stricture  below  the 
ulceration,  why  that  ulceration  should  have  existed, 
unless  as  a  result  of  some  manipulation  of  which 
there  is  no  account  in  the  clinical  history.  The  im- 
pression which  he  received  when  he  examined  the 
man,  now  a  little  more  than  a  year  ago,  was  that 
the  stricture  was  very  close  and  high  up,  for  he 
succeeded  but  once  in  passing  a  bougie  below  the 
point  at  which  the  stricture  seemed  to  begin.  At 
that  time  a  whalebone  instrument  passed  through 
the  constriction,  and,  using  this  as  a  guide,  he  slipped 
over  it  two  olive-shai^ed  sounds,  but  was  unable  to 
pass  them  through  the  stricture.  Some  bleeding 
followed  the  attempt,  so  that  he  was  afraid  to  repeat 
it,  and  the  patient's  condition  was  not  urgent  enough 
to  call  for  any  operative  interference. 

Dr.  Sands  recalled  a  case  which  showed  that  there 
were  some  exceptions  to  the  rule  that  these  stric- 
tures always  go  on  from  bad  to  worse.  In  the  begin- 
ning of  the  year  1875,  a  lady  consulted  him  concern- 
ing a  stricture  of  the  cesophagus,  caused  by  the 
swallowing  of  an  alkali.  He  put  the  patient  under 
the  influence  of  ether,  and  succeeded  in  passing  only 
a  small  urethral  bougie,  about  No.  6  or  No.  7.  The 
patient  at  that  time,  and  subsequently,  was  unable 
to  swallow  anything  except  food  in  a  liquid  state, 
and  subsisted  upon  milk,  with  occasionally  the  ad- 
dition of  a  r.iw  egg.  She  was  under  Dr.  Sands'  care 
between  six  and  nine  months,  during  which  period 
he  succeeded  in  dilating  the  stricture  so  that  it 
would  admit  a  No.  24  or  No.  25  urethral  bougie,  but 
was  never  able  to  insert  an  oesophageal  sound.  The 
use  of  the  instrument  was  always  attended  with  dis- 
comfort, sometimes  followed  by  an  increase  in  the 
ditlicultv  of  swallowing,  and  he  felt  constantly  afraid 
of  making  a  false  passage.  The  patient  was  told  that 
probably  the  stricture  would  become  closer,  and  the 
question  of  opening  the  stomach  was  presented  to 
her.  .\ftor  full  consideration,  she  decided  to  let  the 
stricture  take  its  own  course,  and  returned  liome, 
afterward  submitting  to  no  treatment  whatever. 
Nevertheless,  slio  did  not  grow  worse,  but  improved 
in  health,  increased  in  weight  about  twenty  pounds, 
bore  two  children,  and  died  suddenly,  in  June,  1880, 


THE  MEDICAL  RECORD. 


247 


nearly  five  years  after  treatment  bad  been  discon- 
tinued, from  embolism  following  pneumonia.  The 
patient  continued  to  swallow  without  increasing  dif- 
ficulty up  to  the  time  of  her  fatal  illness. 

Dk.  Mason,  with  reference  to  the  ability  to  swal- 
low bread,  recalled  a  case  which  he  saw  at  the 
Colored  Hospital  some  years  ago.  The  patient  had 
a  tight  stricture,  through  which  only  a  small  ure- 
thral bougie  could  be  passed.  It  was  decided  to 
open  the  stomach,  but  the  day  before  the  oi^eration 
the  jjatient  was  able  to  swallow  the  soft  part  of 
several  oysters  readily.  The  day  previoiis  to  that 
he  was  able  to  take  milk  only,  and  on  the  day  pro- 
posed for  the  operation  he  drank  milk  ■nithout  diffi- 
culty. From  the  fact  that  he  swallowed  so  well,  the 
operation  was  abandoned.  Two  or  three  days  after- 
ward the  man  was  found  dead^in  his  bed.  At  the 
autopsy,  epithelioma  of  the  etsophagus  was  found, 
which  had  caused  a  tight  annular  stricture.  How 
the  oysters  and  milk  were  swallowed  had  always 
been  a  conundrum. 

Dr.  Post  referred  to  the  case  of  a  child,  who  had 
stricture  as  the  result  of  swallowing  lye.  Dilatation 
was  practised  by  means  of  a  flexible  bougie,  and  in 
the  course  of  a  year  there  was  manifest  improve- 
ment, so  much  so  that  the  patient  was  regarded  as 
being  out  of  danger.  He  also  referred  to  a  patient 
in  whom  there  was  a  deep-seated  stricture,  caused 
by  pressure  from  without.  It  was  evident  from  the 
sensation  that  the  difficulty  was  low  do^^•n.  The  pa- 
tient was  able  to  swallow  liquids  in  small  quantity, 
but  not  readily.  Dr.  Post  afterward  heard  of  his 
having  died  as  a  result  of  the  disease.  But  a  short 
time  before  death  there  was  rupture  of  an  abscess 
into  the  cesophagus,  from  which  a  large  quantity  of 
matter  was  discharged  by  the  mouth,  and  the  jiatient 
after  that  was  able  to  swallow  with  a  great  deal  more 
ease  than  he  had  formerly  done.  The  case  was  in- 
teresting as  showing  the  effect  produced  by  an  ex- 
ogenous stricture. 

Db.  Little  referred  to  a  form  of  stricture  which 
he  did  not  fuUy  understand.  In  illustration  he  gave 
the  history  of  a  case  as  follows  :  The  patient,  some- 
what emaciated,  had  been  unable  to  swallow  solid 
food  for  several  weeks.  Liquid  food  would  usually 
pass  down,  but  ;  ometimes  it  would  be  regurgitated. 
The  introduction  of  the  bougie  failed  to  detect  nar- 
rowing of  the  oesophagus,  but  a  few  successive  in- 
troductions of  the  instrument  relieved  the  patient 
completely,  and  since  that  time  he  had  been  able  to 
take  food  without  difficulty.  He  had  seen  a  number 
of  such  cases  iu  Burlington,  Vt.  In  all  of  them  the 
(Esophagus  seemed  to  hug  the  bougie  quite  snugly  at 
the  first  two  or  three  introductions.  There  was  no 
evidence  whatever  of  organic  stricture,  nor  did  it 
seem  to  him  that  they  belong  to  the  class  ordinarily 
known  as  spasmodic  strictures. 

Db.  Weir  and  The  President  thought  that  the 
cases  described  by  Dr.  Little  belonged  to  the  class 
of  spasmodic  strictures. 

The  society  theu  proceeded  to  the  transaction  of 
misceUaneouR  business. 


Nerve  Stretching  in  Traumatic  Tetanus. — If 
one  can  judge  by  the  reported  cases,  nerve-stretching 
is  a  very  successful  remedy  in  traumatic  tetanus. 
According  to  Mr.  Henry  E.  Clark,  of  Glasgow,  this 
procedure  has  been  resorted  to  in  about  twelve  re- 
ported oases.  In  most  of  these  the  result  has  been 
a  cure. 


MEDICAL  SOCIETY  OF  THE  COUNTY  OP' 
NEW  YORK. 

Stated  Meeting,  Fehruari/  27,  1882. 

Dr.  F.  K.  Sturgis,  President,  in  the  Chaib. 

The  paper  of  the  evening  was  read  by  Dr.  George 
H.  Fox,  on 

THE   PERMANENT   REMOVAL   OF   SUrEEFLUOUS   HAIK. 

It  will  be  published  in  full  in  a  subsequent  num- 
ber of  the  Record. 

first   aid   TO   THE   INJURED. 

The  society,  on  recommendation  of  the  Comitia 
Minora,  approved  of  the  plan  of  proi)osed  instruc- 
tion to  be  given  by  the  State  Charities  Aid  Associa- 
tion, with  the  view  to  giving  intelligent  aid  to  (he 
injured  before  the  arrival  of  the  surgeon  or  physi- 
cian. 

THE     RETOBT    OF    THE    DELEGATES    TO    THE     MEDICAL 
SOCIETY   OF   THE   STATE 

was  then  read  by  Dr.  A.  V.  B.  Lockrow,  secretary 
of  the  delegation,  and  consisted  of  an  abstract  o'f 
the  proceedings  with  reference  to  questions  in  which 
the  Medical  Society  of  the  County  were  specially 
interested. 

Dr.  a.  Jacobi,  Ex-President  of  the  Medical  So- 
ciety of  the  State,  then  presented  the  subject-mat- 
ter of  "  Legislation  Looking  to  the  Protection  of  Fac- 
tory Children,"  and  ofl'ered  the  following  resolutions, 
which  were  unanimously  adopted  : 

"Resolved,  That  the  Medical  Society  of  the  County 
of  New  York  recommends  and  insists  upon  the  pas- 
sage of  a  bill  protecting  all  children  under  a  certain 
age,  and  all  those  of  unsound  body,  from  employ- 
ment in  factories,  and  urges  upon  the  Legislature  of 
the  State  the  necessity  of  preventing  the  physical 
and  intellectual  deterioration  consequent  uijon  pre- 
mature factory  labor,  which  will  unavoidably  crip- 
ple or  decimate  the  laboring  population  of  the  Ke- 
public  in  all  the  future. 

"Eesoli-ed,  That  the  Committee  on  Legislation  of 
the  Medical  Society  of  the  State  of  New  York  be  re- 
quested to  present  a  suitable  bill  to  the  Legislature 
of  the  State  of  New  York." 

Dr.  Jacobi  also  presented  the  subject-matter  of 
"  Legislation  Looking  to  the  Establishing  of  Special 
Hospitals  for  Scarlet  Fever  and  Diplitheria,"  and  of- 
fered the  following  resolutions,  which  were  seconded 
by  Dr.  Woolsey  Johnson,  Health  Commissioner,  and 
unanimously  adopted : 

"Resolveii,  That  the  Medical  Society  of  the  County 
of  New  Y'ork  declare  as  follows  : 

"That  both  scarlatina  and  diphtheria  are  highly 
dangerous  diseases,  even  in  their  mild  forms  ; 

"  That  they  are  intensely  contagious,  and  that  a 
mild  case  may  communicate  a  severe  form  to  others  ; 
"That  the  poison  is  intensified  by  the  patient  re- 
maining in  the  same  room  through  the  whole  course 
of  the  disease,  and  by  the  accumulation  of  a  number 
of  cases  in  the  same  room  ; 

"  That  the  best  protection  of  those  still  well  is  the 
removal  of  the  well,  or  the  strictest  isolation  of  the 
sick  ; 

"That  this  strict  isolation,  and  the  great  care  re- 
quired in  the  treatment  of  these  cases,  are  not  at  all 
obtainable  for  the  great  majority  of  the  patients  in 
a  large  city  full  of  tenement  houses,  and  are  so  with 


248 


THE  MEDICAL  RECORD. 


difficulty  only,  and  at  a  great  extra  expense,  in  the 
residences  of  well-situated  families  ; 

"  That  therefore  public  institutions  must  be  estab- 
lished for  the  purpose  of  admitting  diphtheria  and 
scarlatina  cases,  and  are  urgently  required  ; 

"  That  any  delay  or  loss  of  time  in  transfen-ing  pa- 
tients from  their  homes  to  such  an  institution  may 
be,  and  certainly  in  many  cases  is,  fatal ; 

"That  such  an  institution  must  therefore  be 
located  within  the  city  limits  ; 

"  That  such  an  institution  is  not  in  the  least  dan- 
gerous to  the  neighborhood,  in  fact,  not  more  so  than 
a  fever-stricken  private  residence  is  to  its  neighbors, 
in  consequence  of  the  easy  diffusion  of  infecting 
poisons  when  carried  away  by  the  air,  the  infection 
rather  adhering  to  solid  bodies  (fomites). 

"  That  such  institution,  when  suitably  adapted  to 
various  purposes  and  claims,  will  prove  a  blessing 
not  only  to  the  poor,  who  are  directly  benefited,  but 
also  to  tlie  rich,  who  will  learn  to  prefer  the  recovery 
of  their  children  in  a  hospital  to  their  death  in  their 
infected  homes  ;  to  the  community,  which  will  count 
a  smaller  number  of  infected  and  infecting  places; 
to  society,  which  recognizes  the  right  of  life  and 
health  ;  to  humanity,  which  shudders  at  so  much 
young  life  wasted  and  bright  hope  blasted  ;  that 
this  society,  and  every  individual  member,  will  favor 
and  support  every  feasible  plan  to  accompUsh  the 
end  in  view,  and  that  the  Comitia  Minora  are  di- 
rected to  report  on  ways  and  means." 

The  Secretary  then  read  the  following  commainica- 
tion  from  the  New  York  Medico-Chimrgical  Society, 
which  was  accepted  and  ordered  to  be  entered  upon 
the  minutes : 

"ResolBed,  That,  as  a  society,  we  avail  ourselves  of 
this,  the  first  opiiortunity,  to  formally  expi-ess  our 
satisfaction  and  uni-eserved  concuri-ence  with  the 
action  of  the  last  annual  meeting  of  the  New  York 
State  Medical  Society,  in  reference  to  the  question 
of  medical  ethics. 

"  It  has  thus  adopted  a  standpoint  which  we,  indi- 
vidually and  as  a  society,  have  always  earnestly  ad- 
vocated, and  it  seems  to  us  that  no  other  attitude  is 
consistent  with  a  disposition  to  honest  investigation 
and  true  science. 

"  We  think  it  self-evident  that  any  organization 
which  requires  belief  or  disbelief,  or  any  specified 
method  for  the  practical  application  of  knowledge 
as  a  qualification  for  membership,  thereby  rejects 
the  very  essential  of  a  scientific  standing,  and  con 
have  no  claim  to  such  consideration." 

The  Secretary  announced  tire  apijointraent  by  the 
President  of  Dr.  Charles  S.  Ward  as  Chairman  of 
the  Committee  on  Ethics,  in  place  of  Dr.  James  R. 
Learning,  who  was  unable  to  serve  the  society  in  that 
capacity. 

The  society  then  adjourned. 


Correspnnlrrnce. 


THKUArEnnas  Sr^^>LIFIED. — "  There  is  not  a  stu- 
dent," says  Raspail,  "  who  does  not  remember  how 
Bosquillon,  physician  to  the  HotelDieu  and  an 
apostle  of  simplicity  in  therapeutics,  said  to  his 
students,  as  he  entered  the  wards  one  morning : 
'Well,  gentlemen,  what  shall  we  do  to-day?  Hold, 
we  will  purge  every  one  on  the  right  side  of  the 
ward  and  bleed  every  one  on  the  loft.'" 

The  anecdote  suggests  that  of  the  Jewish  phy- 
sician, two  hundred  years  ago,  who  said  to  Lord 
Bacon :  "  Your  lOnglisli  jihysicians  are  like  the 
bishops :  they  hold  tlio  keys  which  bind  and  loose." 


A  NATIONAL  EXAMINING  BOAED. 

f  To  THE  Editor  of  Th£  Medical  Record. 

SrB  :  There  seems  to  be  such  an  honest  determina- 
tion to  raise  the  standard  of  medical  education  and 
examination  all  over  the  country,  that  there  appo.irs 
to  be  no  good  reason  why  a  national  medical  exam- 
ining board  should  not  be  immediately  organized. 

The  Medical  Corps  of  the  Army  and  Navy  are  ex- 
cellent bodies  from  which  to  select  members  who 
would  be  indi-pevdcnt,  iivprejiidked,  and  t^e/f-siistain- 
ing,  but  I  would  also  suggest  that  the  American 
Medical  Association — representing  the  profession  in 
the  United  States — be  empowered  to  select  or  elect 
medical  men  of  known  ability  to  serve  as  civilian 
members  of  such  examining  board.  As  o\ir  country 
is  so  laige,  and  as  medical  examinations  take  place 
about  the  same  period  of  each  year,  candidates 
would  be  saved  much  time,  trouble,  and  expense,  if 
the  "  board  "  was  divided  into  four  examining  bodies 
— say  of  four  or  more  members  each — so  that  exam- 
inations could  be  held  8imultaneou.=ly,  North,  South, 
East,  and  West. 

The  medical  officers  of  the  board  would  not  re- 
ceive any  additional  pay,  but  one-half  or  one-fourth 
of  the  members  who  would  be  civilians  should  re- 
ceive the  same  compensation  (while  on  duty)  as 
members  of  the  National  Board  of  Health,  to  which 
office  all  retui-ns  should  be  made.  Examinations 
should  be  made  obligatory  upon  all  physicians  and 
surgeons  who  have  been  less  than  ten  or  twenty 
years  in  reputable  practice,  and  a  national  diploma 
or  certificate  might  be  issued,  which  would  not  in- 
terfere with  the  usual  collegiate  examinations  or  de- 
grees, but  would  be  simply  an  independent  testimo- 
nial of  medical  proficiency,  that  would  soon  be 
eagerly  sought  after  by  all  men  who  desired  a  higher 
certificate  of  medical  standing  than  it  is  now  possi- 
ble to  obtain. 

Navis. 


MEDICAL  NOTES   ON   EASTERN  AND 
SOUTHERN  ASIA. 

To  THB  Editor  of  The  Medical  Record. 

Sns :  Twenty  years  ago,  notes  on  the  climate,  sani- 
tary condition,  and  diseases  of  this  section  of  the 
globe,  would  have  possessed  but  little  interest  for 
others  than  students  of  geographical  medicine. 
The  opened  Suez  Canal,  however,  and  the  impulse 
thus  given  to  steam  navigation  of  the  heretofore 
remote  seas  of  the  East,  has  been  followed  by  a  cor- 
responding increased  flow,  to  the  countries  border- 
ing on  them,  of  representatives  of  Western  natirns. 
as  merchants,  missionaries,  and  travellers,  and  their 
congi-egation  into  numerous  and  flourishing  settle- 
ments which  a  quarter  of  a  century  ago  had  no  ex- 
istence. • 

Under  these  circumstances  we  have  ventui'ed  to 
assume  that  a  few  notes  "  by  the  way  "  on  the  sani- 
tary and  general  health  conditions  of  some  of  these 
communities  would  not  be  ^\Tithout  interest  to  many 
of  the  readers  of  the  Recohd,  many  of  whom,  un- 
doubtedly, have  friends  or  acquaintances  who  have 
taken  up  their  abodes  in  these  parts. 


THE  MEDICAL  RECORD. 


249 


Beginning  with  Japan  as  our  natural  starting-point, 
we  have  to  describe  it  as  a  group  of  islands  stretch- 
ing along  the  eastern  coast  of  Asia,  from  the  thirty- 
tirst  to  the  forty-first  paraUel  of  north  latitude,  corre- 
sponding to  that  portion  of  the  United  States  lying 
between  Concord,  N.  H.,  and  Charleston,  S.  C. 
The  general  character  of  the  climate,  however,  es- 
pecially on  the  Pacific  side  of  the  larger  islands 
comprising  the  group,  is  milder  and  more  equable 
than  our  own  in  the  same  latitude.  Thus,  the  most 
northern  portion  of  Niphon  has  an  average  mean 
temperature  of  Washington,  while  Kiusliiu,  the  most 
southern  island  of  the  empire,  does  not  dili'er  ma- 
terially in  its  climate  range  from  that  of  the  Caro- 
linas.  Of  the  five  open  ports  where  foreigners  re- 
side, one  is  located  near  each  of  the  two  extremes 
above  mentioned,  while  the  other  thi-ee  are  nearly 
midway  between  them. 

All  those,  with  the  exception  of  Tokio,  are  situ- 
ated on  deep  bays  at  the  foot  of  high  ranges  of  hills 
or  bluff:!,  tlie  sides  of  which  afford  beautiful  and 
picturesque  sites  for  residences,  while  the  narrow 
bit  of  land  below  is  occupied  by  the  warehouses  and 
docks  of  the  traders.  Though  a  large  native  town 
is  in  close  proximity  to  each  of  these  settlements, 
they  are  sufficiently  separate  and  distinct  not  to  af- 
fect the  sanitary  condition  of  the  latter.  Taken  as 
a  whole,  I  believe  the  cUmate  of  Japan  can  be  sur- 
passed by  no  country  in  tlie  world. 

The  seaport  of  Yokohama,  which  contains  twice 
as  many  foreign  inhabitants  as  all  the  others  to- 
gether, necessarily  furni.shes  the  largest  field  for 
observation  of  the  etfect  of  the  climate  on  them, 
and  of  ths  class  of  diseases  to  which  they  are  most 
liable.  Mild  and  equable  as  we  have  already  de- 
scribed the  climate  to  be,  it  is  enervating  and  debili- 
tating to  the  great  majoi'ity  of  foreigners  who  come 
here  to  reside.  This  may  be  ascribed  not  so  much 
to  the  excessive  high  range  of  temperature  at  any 
one  time,  but  to  the  long  continuance  of  the  sum- 
mer heat,  and  the  mild  character  of  the  winters. 
Even  the  air  of  the  lowest  temperature  is  moist  and 
wanting  in  that  bracing  quality  necessary  for  health- 
ful invigoratioa  and  recuperation.  Ladies,  and  es- 
pecially those  bearing  children,  feel  this  most  sen- 
sibly. This  is  seen  in  their  inability  to  nurse  their 
offspring,  in  a  majority  of  cases,  for  more  than 
three  or  four  months,  and  even  then  but  insufficiently. 
It  not  infrequently  happens,  too,  that  from  the 
very  start  the  supply  of  milk  is  so  small  and  poor 
that  artidciul  feeding  is  necessaiy.  They  "get  up" 
slowly  after  confinement,  and  a  discolored  uterine 
discharge  either  continues  much  beyond  its  usual 
time,  or,  when  it  has  ceased,  reappears  from  slight 
and  app.irently  insufficient  causes.  A  somewhat 
curious  fact  I  have  often  noticed  is,  that  the  moth- 
er's milk,  though  it  may  be  abundant,  disagrees  with 
the  child,  producing  indigestion,  colic,  and  diar- 
rhcea,  which  is  relieved  only  by  weaning  or  artificial 
feeding.  The  cow's  milk  of  the  country,  though 
from  foreign  stock,  is  in  manj"  cases  also  badly  borne 
by  children  born  here.  I  think  I  may  safely  say, 
that  children  thrive  as  a  whole  much  better  here  on 
"  condensed  milk,"  with  barley,  rice,  or  oatmeal 
w.iter,  than  on  either  the  mother's  or  fresh  cow's  milk. 

In  nearly  twenty  years  of  family  practice  here,  I 
have  never  seen  a  single  case  of  puerperal  fever. 
Puerperal  malarial  fever  is,  however,  very  common, 
eight  out  of  ten  of  all  my  parturient  women  requir- 
ing quinine  during  the"  first  fortnight.  In  some 
cases,  the  fever  has  been  accompanied  by  profuse 
uterine  hemorrhage,  coming  on  some  days  after  the 


cessation  of  the  ordinary  discolored  discharges. 
This  brings  me  to  the  notice  of  malarial  affections 
generally,  as  met  with  in  this  countiy.  So  varied 
are  its  manifestations  litre,  both  in  natives  and  fo 
eiguers,  that  we  might  easily  devote  several  pages 
to  its  consideration. 

We  shall,  however,  defer  this,  and  briefly  notice 
now  some  facts  of  general  interest  bearing  upon  this 
subject. 

The  extensive  cultivation  of  rice  in  Japan  suggests 
at  once  the  prevalence  of  malarial  aflections  as  a 
natural  resialt.  The  great  variety  of  forms  which  ma- 
larial poisoning  assumes  when  acting  upon  the  ani- 
mal economy  are  too  well  known  to  need  mention 
here.  Still,  all  medical  men  in  Japan  have  been 
impressed  with  what  may  be  called  the  peculiarities 
of  its  manifestations,  which  were  to  be  clearly  un- 
derstood and  appreciated  only  after  some  years'  re- 
sidence here.  Frank,  quartan  or  tertian  ague  is 
rarely  met  with,  and  the  fatal  congestive  form  is  still 
more  uncommon,  except  in  children  (Japanese), 
many  of  whom  die  with  symptoms  of  cerebral  dis- 
ease, clearly  traceable  to  malarial  origin. 

In  these  cases,  the  hypodermic  injections  of  the 
bi'omide  of  quinine  I  have  found  to  act  with  great 
jjromptness,  and,  when  properly  administered,  saves 
a  majority  of  otherwise  fatal  cases. 

In  a  word,  the  vast  majority  of  all  malarial  affec- 
tions assume  what  are  known  as  masked  forms,  often 
completely  defying  a  correct  diagnosis  without  a 
trial  of  quinine. 

Acute  inflammatory  diseases  of  all  kinds  are  very 
rare  among  foreigners  in  Japan.  Dysentery  and 
diarrhcea,  except  of  a  very  mild  form,  are  also  rare 
among  the  well-to-do.  Filth  and  infectious  diseases 
are  by  no  means  common.  In  fact,  there  has  not 
been  a  single  case  of  small-pox,  measles,  or  scarlet 
fever  in  the  town  of  Yokohama,  among  foreigners 
or  natives,  for  over  five  years,  which  has  not  been 
imported. 

Indeed,  it  is  exceedingly  doubtful  if  scarlet  fever 
exists  in  Japan  at  all,  except  in  a  very  mild  form, 
which  may  be  due,  however,  to  its  being  mostly  be- 
low the  isothermic  line  of  the  prevalence  of  the  dis- 
ease elsewhere. 

Malignant  diphtheria  among  foreigners  is  also 
rare,  the  whole  number  of  cases  in  over  two  hundred 
families  during  the  last  six  or  eight  years  not  ex- 
ceeding five  or  sis.  The  foreign  settlements  of 
Japan  may,  in  fact,  be  regarded  as  an  asylum  of 
safety  for  children,  as  in  the  space  of  six  years  I 
have  in  my  own  practice  lost  but  two  children,  and 
those  in  a  weakly  family.  I  think  the  rest  of  the 
profession  here  have  had  about  the  same  experience. 
Among  the  fatal  diseases  aneiirism  ranks  first,  more 
deaths  having  occurred  from  this  than  any  other  one 
cause.  Cholera,  though  isrevailing  epidemically  for 
three  successive  years  in  all  the  open  ports  of  Japan, 
claimed  as  its  victims  but  very  few  foreigners,  not 
over  a  dozen  in  all. 

Of  the  general  healthfulness  of  the  Japan  ports, 
no  better  proof  is  wanting  than  the  fact  that  they 
are  the  sanitaria  of  the  vessels  of  war  of  all  nations 
cruising  in  Eastern  Asia. 

The  English  and  German  Governments  have  both 
finely  located  naval  hospitals  here.  Even  the  United 
States  has  one,  it  being  the  only  instance,  we  believe, 
where  our  Government  owns  a  foot  of  ground  or  a 
building  out  of  her  own  domain. 

Duaj;b  B.  Simmons,  M.D. 

Yokohama.  Japan,  January,  1SS2. 


250 


THE  MEDICAL  RECORD. 


QUESTION  OF  REFLEX  DISTURBANCES 
FROM  GENITAL  IRRITATION— A  RE- 
JOINDER TO  DR.  SHAFFER. 

To  THE  Editor  of  The  Medical  Record. 
Sir  :   I  shall  take  up  but  very  little  of  your  space 
this  time. 

The  following  is  Dr.  Shaffer's  only  attempt  at  proof 
of  his  statements  about  my  alleged  plagiarism : 
"Those  who  have  read  Dr.  Gray's  essay  and  my 
papers  will  plainly  see  wherein  he  has  followed  me. 
Those  loho  have  not  done  so  would  scarceh/  he  enter- 
tained by  a  long  series  of  quotalions  from  the  subjecl- 
matter  of  our  papers.  It  would  be  a  very  easy  matter, 
however,  to  establish  the  identity  of  ideas  by  direct 
quotations." 

In  other  words,  Dr.  Shaffer,  having  made  a  grave 
attack  upon  me  without  any  detailetl  proof,  is  met 
by  what  I  claim  to  be  the  only  proof  in  the  matter, 
and  shirks  the  issue  by  the  above  evasions ;  and  then 
proceeds  to  till  two  of  your  long  columns  with  what 
he  thinks  will  be  of  more  interest  to  your  readers 
than  a  substantiation  of  his  original  allegations. 

Dr.  Shaffer  asserts  that  I  made  no  allusion  to  his 
papers.  He  does  not  seem  to  have  read  my  reply — 
indeed,  this  is  noticeable  throughout  his  letter  — 
and  therefore  forces  me  to  repeat.  In  the  Annah 
of  Anatomy  and  Surgery,  January,  1882,  p.  -iO,  he 
will  find  the  following  sentence  :  "  Dr.  Newton  M. 
Shaffer  has  expressed  the  same  opinion  " — i.e.,  of 
having  never  seen  a  case  of  reflex  paralysis  from 
genital  irritation — "  in  a  late  article."  lu  the  Febru- 
ary number  of  the  Annals,  p.  78,  he  will  also  find, 
as  I  stated  in  my  former  reply,  that  I  have  said : 
"  The  patient  usually  obtains  rest,  as  has  been  sug- 
gested by  Dr.  Shaffer." 

I  merely  call  attention  to  Dr.  Shaffer's  admission 
that  he  made  use  of  his  privileges  as  editor  to  attack 
a  paper  as  yet  unpublished,  but  about  to  be  pub- 
lished in  his"  own  journal,  and  prejudice  the  profes- 
sion against  it  in  advance. 

Dr.  Shaffer  might  as  well  lay  claim  to  being  thp 
founder  of  the  English  language  as  to  affirm  that 
with  him  originated  the  idea  of  reflex  paralysis  being 
due  to  organic  disease.  My  warrant  for  this  asser- 
tion is  contained  in  my  former  reply. 

As  to  all  the  other  quibbles,  clouds  of  words,  up- 
heavals of  immaterialfiuicalities,  repetitions,  explana- 
tions, and  defences  of  that  curious  lateral  sclerosis 
with  ataxic  movements  but  without  ataxia,  and  yet 
with  mu.scular  inco-ordinatiou.  Dr.  Shaffer  is,  so  far 
as  I  am  concerned,  quite  welcome  to  all  the  benefit 
that  may  accrue  to  him  from  them. 
Very  truly  yours, 

Landon  Carteb  Gkat. 

Bbooelyk,  Tcbrurtry  18,  1SS2. 


ARMY  NEWS. 
Official  List  of  Changes  of  Stations  and  Duties  of  Offi- 
cers of  the  Medical  Department,  United  States  Army, 
from  February  19,  1882,  to  February  25,  1882. 

MoFPATf,  Pkteb,  Capt.  and  Asst.  Surgeon.  Re- 
lieved from  duty  at  Camp  Spokane,  W.  T.,  to  pro- 
ceed to  Fort  OfPiir  d'Alene,  Idaho,  and  relieve 
Asst.  Surgeon  Spencer  from  duty  at  that  post.  S. 
O.  20,  Department  of  the  Columbia,  February  11, 
1882. 

FiNLET,  J.  A.,  Capt.  and  Asst.  Surgeon,  Fort 
Adams,   B.  I.,   granted  leave  of  absence  for  one 


month.    S.  O.  29,  Department  of  the  East,  Febni- 
aiy  20,  1882. 

Spencek,  William  G.,  Capt.  and  Asst.  Surgeon. 
Granted  leave  of  absence  for  one  month,  with  per- 
mission to  apply  for  an  extension  of  one  month,  to 
Division  Headquarters,  and  for  an  extension  of  lour 
months  to  the  Adjutant-General  of  the  Army.  S.  O. 
19,  Department  of  the  Columbia,  February  10,  1882. 

RAyMONi>,  H.  I.,  First  Lieut,  and  Asst.  Surgeon. 
Relieved  from  duty  at  the  Presidio  of  San  Francisco, 
and  assigned  to  duty  at  Alcatraz  Island,  Cal.  S.  O. 
28,  Middle  Division  of  the  Pacific  and  Department 
of  California,  Februaiy  15,  1882. 


illcliical  3tcm3   autr  XUxoi 


Contagious  Dihbases  —  Wkeklt  STATKMmrr.  — 
Oomparative  statement  of  cases  of  contagious  diseases 
reported  to  the  Sanitary  Bureau,  Health  Department, 
for  the  two  weeks  ending  February  25,  1882. 


Week  Bndisg 

1 

S3   > 

i 

ft 
£.9 

S 

1 

S 

i 

CQ 

tS 

Feb.  18,  1882. 

2 

7 

30.3 

6 

228 

iia 

51 

0 

Feb.  25,  1882. 

2 

7 

229 

10 

197 

107 

44 

0 

The  Next  Intebnational  Congress,  which  is  to 
meet  in  1883,  at  Copenhagen,  has  already  begun  its 
organization.  Professor Panum  has  been  nominated 
President,  and  Carl  Lange  secretary. 

Iodine  in  Acute  Malabia. — Dr.  Robert  B.  Mori- 
son  reports  the  result  of  using  iodine  for  acute  ma- 
laria at  the  University  of  Maryland  Dispensary. 
Fifteen  minims  were  given  three  times  a  day,  in  a 
mixture  largely  diluted.  It  was  given  in  250  cases, 
of  whom  100  were  heard  from  a  second  or  third  or 
more  times.  Of  these,  84  are  on  record  as  cured,  2 
cases  not  cured,  and  14  cases  not  cured  by  iodine  or 
the  cinchonidia  mixture  of  the  dispensary. 

Anotheb  Successful  Gasteotomt  was  recently 
performed  by  Prof.  Albert,  of  Vienna,  upon  a  boy 
aged  eleven,  who  suffered  from  stricture  of  the 
cesophagus,  brought  on  by  swallowing  caustic  pot- 
ash. The  case  was  exhibited  before  the  Society  of 
Physicians  in  Vienna. 

Professor  Kunbrat,  of  Gratz,  will,  it  is  said,  be 
appointed  to  the  Chair  of  Pathological  Anatomy  in 
Vienna,  formerly  occupied  by  Rokitansky.  Prof. 
Ivlebs,  of  Prague,  a  disajipointed  candidate,  has  re- 
ceived a  call  to  Zurich.  Ziegler,  Professor  of  Path- 
ological Anatomy  of  Zurich,  has  accepted  a  call  to 
Tilbingen.  Professor  Trendelenburg,  of  Rostok,  has 
accepted  the  chair  at  Bonn  held  by  the  late  Prof. 
Buseh. 

BoRNraa  OF  the  Kings  Countt  Insane  Asiluji. — 
A  fire  in  the  easternmost  wing  of  the  Kings  County 
Insane  Asylum  last  week  resulted  in  the  partial  de- 
struction of  the  building,  the  deatli  of  two  inmates 
of  tlie  asylum,  and  the  serious  injury  of  one  of  the 
employees. 

There  were  333  inmates  cf  this  wing,  and  175  in 


THE  MEDICAL  RECORD. 


251 


the  part  where  the  fire  caught.  The  alarm  was  given 
early  in  the  morning,  when  the  patients  were  at 
breakfast.  Strange  to  say,  no  jianic  was  excited 
among  the  patients,  and  the  wards  were  cleared  in  a 
very  short  time.  One  of  the  insane  patients,  named 
Steams,  rushed  into  a  burning  ward  and  I'escued  a 
bedridden  patieut.  One  of  the  j^atients  who  was 
killed  was  bedridden  and  speechless.  In  the  haste 
and  confusion  he  was  overlooked  by  the  attendants. 
The  other  person  killed  was  a  very  excitable  patient, 
who  ^suffered  from  epilepsy.  It  is  thought  that 
fright  may  have  been  partly  the  cause  of  his  death. 

Dr.  Shaw  thinks  the  lire  might  have  been  pre- 
vented  and  the  two  lives  saved  had  the  Supervisors 
done  as  he  has  repeatedly  requested  them  to  do — 
furnish  stand-pijie  and  hose  on  each  floor  of  the 
building,  for  use  in  case  of  fire. 

The  Health  Officer's  Fee.s. — It  has  been  de- 
cided that,  although  the  Health  Officer  of  this  port 
gets  excessive  fees,  yet  these  fees  cannot  be  utilized 
for  the  support  of  quarautine.  Consequently,  an  ef- 
fort is  to  be  made  to  reduce  the  amount  of  fees  lifty 
per  cent. 

New  Eemedies  for  Beight's  Disease. —  Dr.  S. 
\eumann,  assistant  to  Prof.  Schrotter  in  the  Vienna 
Hospital,  reports  upon  the  use  of  fucusin,  amyl  ni- 
trite, and  pilocarpin  in  Bright's  disease.  He  found 
them  all  of  very  little  use. 

Gray's  Axatomy  has  been  translated  into  Chinese 
and  published  in  six  volumes  at  Foochow. 

NcTRiENT  SiTPOsiroBiES.  —  Mr.  H.  E.  Spencer 
recommends  the  use  of  nutrient  suppositories  for 
administering  food  per  rectum.  Artificially  di- 
gested meat  is  mixed  with  a  little  was  and  starch 
and  made  into  a  suppository.  These  supj>ositories 
are  of  such  size  that  the  digested  and  soluble  part 
of  twenty  ounces  of  lean  meat  is  contained  in  about 
five  suppositories.  Mr.  Spencer  has  used  them  suc- 
cessfully for  a  fortnight  and  over. 

A  Dental  Deparime^t  has  just  been  added  to  the 
University  of  California. 

Morphine  in  the  Treatment  of  .Puerperal 
EcLAMPSLi. — Dr.  George  W.  Orr,  of  Central  Mine, 
Mich.,  sends  us  the  history  of  a  case  which  illus- 
trates very  pointedly  the  efficacy  of  morphine,  at 
times,  in  puerperal  eclampsia.  Dr.  Orr's  letter  was 
suggested  by  the  report  of  a  similar  case  by  Dr. 
Cooley  in  the  Kecord  of  December  24,  1881. 

The  patient  in  question  was  a  primipara,  aged  19, 
who  had  been  in  labor  for  several  hours,  with  very 
little  progress  made.  Dr.  Oit  was  then  summoned 
in  haste  and  found  her  in  convulsions.  He  adminis- 
tered chloroform  freely,  and  exerted  every  eflort  to  di- 
late the  OS,  with  but  little  success.  Dr.  Lanbaugh  was 
sent  for  and  arrived  late  in  the  afternoon.  Despite 
all  efforts  the  patient  had  twenty-two  convulsions. 
At  six  o'clock  Dr.  L.  suggested  morphia  sulph., 
and  a  fourth  of  a  grain  was  given  hyiiodermically. 
She  immediately  dropped  off  into  a  quiet  sleep, 
which  was  continued  for  nearly  an  hour.  The  os 
was  then  found  to  be  soft  and  yielding.  As  the  pa- 
tient was  becoming  restless,  one-fourth  of  a  grain 
was  again  administered  and  soon  after  she  was  de- 
hvered  of  a  small  male  child.  She  was  then  resting 
well.  Dr.  Orr  remained  the  greater  part  of  the 
night,  and  administered  sal.  brom.  and  chloral  hy- 
drate at  irregular  intervals.  She  had  no  convul- 
sions after  morphia  was  administered.  Her  recov- 
ery was  rapid  and  complete. 


'       M.  Paul  Bert  has  established  at  the  College  de 
I   Fi-ance   a   Laboratory  of  Physical  Biology.     MM. 

Brown-Sequard  and  d'Arsonval  have  been  appointed 

directors. 

Hydrobkomic  Aero  in  Fever. — Dr.  D.  W.  C. 
Wade,  of  Holly,  Mich.,  writes  :  "'R'ill  you  have  the 
kindness  to  publish  the  following  : 

"  From  The  Medical  Eecord,  February  18,  1882  : 
'Simple  Continued  Fever. —  IJ.  Acid,  hydrobrom., 
Sj.  ;  syr.  simplicis,  ;  ij. ,  aq.  ad.  Jj.  M.  Sig. — 
Every  hour. — Fothei-gilt. 

"  'Dr.  Fothergill,  in  speaking  of  the  above  formu- 
la, says  it  will  probably  constitute  par  excellence  the 
fever  mixture  of  the  lutui'e.  It  is  especially  indi- 
cated when  there  is  cerebral  disturbance.' 

"From  the  British  Medical  Journal,  July  8,  1876  ; 
Braithicaite's  Relrofpect,  January,  1877  : 

"  'Bromohydric  acid.  By  Dr.  J.  Milner  Fothergill, 
Assistant  Physician  to  the  West  London  Hosjntal, 
etc.  The  utility  of  the  bromide  of  ijotassium  is  now 
generally  acknowledged  by  the  profession,  and  its 
effects  ujjon  _the  nervous  system  are  often  of  the 
greatest  service.  At  the  same  time,  it  is  not  readily 
combined  with  several  agents  with  which  it  may  be 
advantageously  administered,  as  quinine,  for  in- 
stance. Last  year  I  abstracted  lor  the  London 
Medical  Record  (April  20,  1875),  a  paper  by  Dr. 
DeW'itt  C.  Wade  on  this  agent,  which  ajipeared  in 
the  Peninsular  Jowmal  of  Medicine  (Detroit),  in 
February,  1875.  He  described  there  the  usefulness 
of  bromohydric  acid,  especially  in  obviating  the 
headache  which  is  produced  in  some  persons  by 
quinine.  From  what  he  said,  I  handed  over  his 
paper  to  the  dispenser  of  the  West  London  Hospi- 
tal, and  commenced  to  prescribe  the  new  remedial 
agent.  ...  I  will  therefore  briefly  relate  the 
conclusions  arrived  at  after  a  twelvemonths  expe- 
rience of  the  drug.  .  .  .  Dr.  Wade  states  that  it 
is  useful  in  the  treatment  of  fever.  It  would  seem 
the  acid  par  excellence  where  there  is  much  cerebral 
excitement  in  pyretic  affections,  but  of  this  I  have 
no  personal  experience.'  " 

Anaesthetic  Mixtures. — The  Vienna  mixtmre,  with 
which  eight  thousand  operations  have  been  performed 
without  an  accident,  consists  of  ether,  3  parts ;  chloro- 
form, 1  part.  Billroth's  favorite  anaesthetic  mixture 
is  chloroform,  3  parts  ;  ether,  1  part ;  alcohol,  1  part. 
An  EngKsh  mistiu-e,  known  as  the  A.  C.  E.  mixture, 
consists  of  alcohol,  1  i^art;  chloroform,  2  parts; 
ether,  3  parts. 

Owing  to  the  different  volatility  and  specific 
gravity  of  the  various  ansesthetic  liquids,  the  vapors 
have,  necessarily,  a  different  composition  from  that 
of  the  mixtures  themselves.  The  value  of  a  mixture 
must  therefore,  in  part,  be  determined  empirically. 
Some  experiments  have  been  made  in  the  mixing  of 
heart-stimulants  with  chloroform.  Sanford  mixed 
one  pound  of  chloroform  with  two  drachms  of  amyl 
nitrite.  Others  have  added  oil  of  turpentine  to  the 
chloroform.  The  objection  so  far  has  been  that  such 
mixtures  cause  a  headache. 

The  "Lady  Fever." — Dr.  J.  C.  Neal,  Archer, 
Fla.,  writes  :  "Dr.  Garrison's  account  of  the  'lady 
fever '  in  Arkansas,  moves  me  to  record  the  occur- 
rence of  the  name  as  used  in  this  section  of  Florida, 
by  the  blacks,  for  gonorrhoea  and  syphilis — the 
light  form  of  gonorrhoea  being  called,  usually,  '  run- 
ning range.'  The  first  stages  of  'lady  fever'  are 
larely  seen  by  medical  men,  for  not  until  there  is 
orchitis,  dysuria,  buboes,  or  ulceration,  do  the  ne- 


252 


THE  MEDICAL  EEOORD. 


groes  resort  to  the  doctor,  and  the  results  of  disease, 
dirt,  and  neglect  are  often  horrible  in  the  extreme. 
A  short  time  ago,  an  old  negro  came  to  me  with  a 
savage  conjunctivitis.  '  Uncle,'  said  I,  '  have  you  had 
the  lady  fever  lately? '  '  Why,  bless  you,  Mars  Doc- 
tor, you  done  knowed  dat,  who  tole  you  ? '  and  hfe 
uncovered  a  frightful  ulcer  in  the  left  groin,  em- 
bracing nearly  all  of  Scarpa's  triangle ;  and  the  old 
sinner  coolly  averred,  he  '  done  lifted,  dat  brung  it 
onto  me.'  The  colored  clergy  are  too  often  the  prop- 
agatoi-s  of  this  trouble.  In  fact  a  prominent  col- 
ored politician  once  remarked  :  '  Sinner  man  come 
to  my  house  when  I'se  gone ;  all  right,  but  I  don't 
want  no  black  preachers  to  fotch  lady  fever  to  kill 
me  out'  We  see  more  cases  of  syphilis  among  tlie 
blacks  than  all  other  diseases  combined,  and  with 
unbridled  passions,  unrestricted  intercourse,  bas- 
tardy no  disgrace,  and  '  lady  fever '  almost  epidemic, 
it  would  seem  almost  certain  that  the  blacks  will 
repeat  the  history  of  the  Sandwich  Islanders.  Al- 
ready we  see  a  greater  number  of  deaths  in  infancy 
than  prior  to  1865,  more  weakly  black  children,  and 
a  marked  increase  of  diseased  teeth  among  the 
younger  negroes — showing  a  tendency  to  retrograde 
physically.  In  most  of  these  cases  of  syphilis,  I 
have  found  small  doses  of  barium  chloride,  with 
decoction  of  stillingia,  especially  valuable,  being 
certain,  cheap,  and  safe,  qualities  that  recommend 
themselves  to  my  medical  confreres  in  the  South, 
where  such  cases  are  ao  frequent  as  to  be  a  burden 
of  expense  to  the  charitably  inclined." 

Do  Pet  AnimaijS  Commitnicate  Contagious  Dis- 
eases?— Dr.  William  Bunce,  of  Oberlin,  O.,  sends 
us  a  report  of  the  following  oases  in  support  of  the 
theory  :  "  Pet  Animals  may  be  the  Means  of  Spread- 
ing Fatal  Diseases."  On  May  1,  1881,  he  was  called 
to  see  a  boy  four  years  of  age,  of  German  parentage, 
and  one  of  sis  children  ;  he  was  found  to  have  diph- 
theria. On  the  following  day  the  youngest  daugh- 
ter, two  years  of  age,  presented  symptoms  of  the 
same  disease,  and  on  the  next  day  the  father  and 
two  more  children  were  attacked.  After  this  date 
all  the  other  members  of  the  family,  except  the 
oldest  boy,  contracted  the  disease.  A  thorough  ex- 
amination of  the  house  elicited  no  source  of  conta- 
gion, but  in  the  barn  a  cat  was  found  having  the 
charactei'istic  lesions  of  diphtheria.  On  inquiry, 
he  ascertained  that  this  cat  during  its  period  of 
sickness  had  been  plaved  with  bv  the  children.  On 
August  20,  1881,  he  'saw,  with 'his  son.  Dr.  W.  C. 
Bunce,  a  lady,  eighteen  years  of  age,  who  had  diph- 
theria of  a  very  severe  type,  which  terminated 
fatally  on  the  third  day.  In  a  short  time  the  dis- 
ease developed  in  the  mother  and  remaining  two 
daughters.  A  half -grown  cat  in  the  room  was  found 
to  have  well-marked  diphtheritic  membrane  in  its 
throat ;  it  was  also  ascertained  that  its  mother  and 
her  four  other  kittens  had  been  in  the  same  condi- 
tion. The  girls  had  endeavored  to  cure  the  cats  by 
removing  the  deposit,  in  this  way  exposing  them- 
selves to  the  contagious  influence  of  the  disease. 
After  the  recovery  of  these  cases,  and  the  removal 
of  the  diseased  animals,  the  spread  of  the  disease 
ceased.  Ifo  thinks  it  fair,  therefore,  to  conclude  that 
tlie  diseased  condition  of  the  cats  was  the  cause  of 
the  diphtheritic  manifestations  in  the  cases  reported. 
Mention  is  made  of  these  cases  as  they  are  of  im- 
portance in  the  consideration  of  comparative  medi- 
cine. 

Do  Southern  Hoos  Have  Tuioiiin.e  ? — An  investi- 
gation, which  seems  to  show  that  Southern  hogs  do 


not  have  trichinae,  was  made  by  Dr.  Jansen  T.  Payne 
last  summer.  His  report  was  submitted  to  the  Ameri- 
can Public  Health  Association  at  its  last  meeting. 
In  six  months  Dr.  Payne  examined  5,400  hogs,  find- 
ing only  22  infected  with  the  parasite  in  question. 

The  infected  animals  were  reported  as  having  been 
received  from  the  following  places :  St.  Louis,  18 ; 
Louisville,  2 ;  and  from  the  West,  marked  "  un- 
known," 2  ;  making  a  total  of  infected  hogs,  22. 

Of  the  hogs  examined,  only  529  came  from  St. 
Louis  ;  most  of  them  came  fi-om  Louisiana  (2,473) 
and  Tennessee  (1,060). 

The  observations  lead  to  the  belief,  therefore,  that 
Southern-bred  hogs  are  free  from  trichina;.  Still, 
such  a  deduction  is  not  absolutely  safe.  If  the  fact 
were  really  proved,  it  would  be  one  of  great  advan- 
tage to  Southern  pork-raisers.  Even  as  it  is,  they 
can  profit  from  the  fact  that  Tennessee  and  Louisi- 
ana hogs  are  almost  entirely  free  from  disease. 

Incidentally,  some  other  facte  regarding  the  origin 
and  commuuicability  of  trichinosis  were  developed. 
Observations  seemed  to  show  that  hogs  infect  each 
other  when  enclosed  in  the  same  pen,  and  do  not 
depend  upon  the  rat  as  an  intermediate  host.  The 
parasite  is  passed  out  of  an  infected  animal  along 
with  undigested  food,  and  the  food  is  then  eaten 
by  a  sound  hog,  who  in  turn  becomes  infecftd. 

By  Dr.  Payne's  examinations  it  was  also  ascer- 
tained that  ail  the  hogs  infected  with  trichinie  were 
coi'n-fed  animals.  No  mast-fed  animal  was  found  to 
be  infected. — Journal  of  Cmnparative  Medicine. 

Ectropion  Successfiillt  Treated  bt  Transplan- 
tation OF  THE  Skin  from  the  Forearm. — Mr.  L. 
H.  Tosswill,  of  Exeter,  England,  reports  (British 
Medical  Journal)  the  case  of  a  boy,  aged  ten,  whose 
face  had  been  horribly  disfigured  by  a  burn.  He 
had  so  much  ectroi>ion  of  both  lids  of  the  left  eye, 
that  the  cornea  could  not  be  covered.  Two  large 
skin  grafts  were  made  from  the  arm  to  the  eyelids. 
They  grew,  and  the  ectropion,  of  the  upper  lid  was 
perfectly  cured.  That  of  rtie  lower  is  much  im- 
proved. Another  operation  will  doubtless  restore 
the  lids  comjiletely. 

A  few  similar  operations  have  been  done  in  this 
city. 

The  Dangers  of  NerveSteetcking. — Five  fatal 
cases  of  nerve-stretching  for  locomotor  ataxia  are 
reported.  One  by  Socin,  one  by  Langenbeck  (who 
originated  the  operation),  one  by  Billroth  and  Weiss, 
one  by  Berger,  and  one  by  Benedict.  In  these 
cases  it  apjieared  as  if  there  had  been  some  violence 
done  to  the  spinal  cord  and  medulla,  e.g.,  vomiting, 
singultus,  paralysis  of  bladder,  etc.  Dr.  Altliaus 
considers  it  an  unsafe  measure  when  there  are  car- 
diac or  respiratoi-y  diseases. 

The  Salicylates  in  Eheimatism. — A  discussion 
upon  the  value  of  the  salicylates,  salicin,  and  salicyUc 
acid  in  rheumatism,  in  Ijondon,  recently,  led  to  the 
production  of  statistics  which  Beemed  to  show  that 
the  drug  iucroased  the  j^ossibility  of  heart  compli- 
cations, and  that,  though  it  diminished  the  first  vio- 
lence of  the  disease,  it  left  obstinate  joints  after- 
ward. 

In  a  recent  letter  to  the  British  Medical  Journal, 
Dr.  Chas.  Orton  speaks  up  for  the  salicylates,  and 
calls  attention  in  particular  to  their  local  applica- 
tion. He  soaks  lint  in  a  solution  of  salicylate  of 
soda,  applies  it  to  the  affected  joints,  and  covers 
the  whole  with  oil-silk. 


Vol.  XXI.-No.  10. 
March  11.  1882. 


THE  MEDICAL  RECORD. 


253 


©rigiiml  Comimmicatious 


THE  PER:M.\NENT  EEilOYAL  OF  HAIE  BY 

ELECTEOLYSIS— REPOET  OF  CASES.* 

By  GEOEGE  HENEY  FOX,  A.M.,  M.D., 

CLINICAL   PBOFES-OP.    OF  DISEASES   OF    TDE  SKIS,    COLLEGE    OF    PUY- 

The  gi-owtli  of  hair  upon  the  female  face,  to  the 
treatment  of  which  I  again  invite  attention,  is  a  de- 
formity which  is  rery  frequently  observed.  Perhaps 
few  physicians  have  an  adequate  idea  of  its  preva- 
lence. In  nearly  every  "  museum  of  living  curiosi- 
ties "  a  bearded  woman  figures  as  one  of  the  chief 
attractions,  and  it  is  quite  probable  that  but  a  small 
proportion  of  bearded  women  are  willing  to  adver- 
tise their  misfortune  for  pecuniai-y  gain.  I  think 
there  are  at  least  a  half  dozen  of  this  class  on  ex- 
hibition throughout  the  city.  Of  the  number  of 
ladies  in  private  life,  who  endeavor,  by  artifice  of 
various  kinds,  to  conceal  the  unpleasant  fact  that 
they  have,  or  might  have  a  beard,  it  would  be  very 
difficult  to  form  an  estimate.  I  have  no  doubt  that 
there  are  hundreds  of  such  cases.  I  speak  now 
merely  of  those  who  might  raise  a  thick  and  long 
growth  of  hair  which  would  deserve  the  name  of 
beard.  Of  those  who  have  a  comjjaratively  moderate 
growth  upon  the  face,  and  particularly  upon  the 
chin,  the  number  is  beyond  computation.  tVe  note 
instances  of  this  hypertrichosis  on  every  hand,  in  the 
drawing-room,  ujjon  the  street,  or  wherever  ladies 
congi'egate,  and  could  we  but  know  the  secrets  of 
the  boiidoir  we  would  be  surj^rised  to  find  how  large 
a  percentage  of  our  female  acquaintances  resort 
occasionally,  if  not  habitually,  to  the  use  of  the  de- 
pilatory, the  razor,  or  the  tweezers. 

Frequently  the  opinion  and  advice  of  the  jihysi- 
cian  is  sought  respecting  this  abnormal  and  obnoxi- 
ous gi'owth — and  what  does  he  say?  In  all  prob- 
ability he  will  tell  the  patient  that  depilatories  are 
merely  palliative,  advise  her  to  pull  the  hairs  out  or 
to  let  them  alone,  and  declare  that  it  is  a  very  trifling 
matter,  and  perhaps  add  jocosely  that  it  is  not  likely 
to  cause  death.  Such  an  opinion  never  satisfies  the 
patient,  for  no  woman  ever  yet  derived  consolation 
from  the  fact  that  ugliness  is  not  fatal.  Further- 
more, the  opinion  is  not  sound.  This  almormal 
growth  of  hair  is  not  always  a  trifling  matter.  It 
may  not  kill  the  patient,  it  is  true,  but  it  is  certain 
to  occasion  great  annoyance.  It  is  very  apt  to  affect 
her  disposition,  and  to  injure  her  prospects  in  life, 
especially  if  she  be  young  and  unmarried  ;  and  it 
may  eventually  ruin  both  her  health  and  her  happi- 
ness by  producing  a  mental  disquietude  which  in 
many  instances  verges  on  melancholia.  The  fre- 
quent occurrence  of  facial  hairiness  among  insane 
women  has  been  observed  by  several  writers,  and 
although  in  such  cases  the  insanity  has  usually  pre- 
ceded the  abnormal  growth  of  hair,  I  have  no  doubt 
that  in  many  instances  the  mental  worry  caused  by 
slight  facial  hairiness  has  acted  as  an  exciting  cause, 
and  served  to  develop  an  insane  tendency.  Dr.  J.  C. 
White  mentions  the  case  of  a  lady  who  searched 
long  for  a  surgeon  who  would  flay  the  lower  part  of 
her  face,  and  thus  remove  the  obnoxious  growth.  I 
have  certainly  treated  one  or  two  females  who  were 
monomaniacs  on  the  subject  of  their  facial  hairiness. 


*  R-ail  hetore  the  llediCiu  ! 
ary  27,  1SS9. 


7  of  the  Countv  of  Kew  York,  Febru- 


even  when  this  has  been  Tery  slight,  and  the  most 
satisfactory  result  of  treatment  in  these  cases  has 
been  the  improvement  in  general  health  which  has 
followed  the  removal  of  the  hair,  which  served  to 
make  their  lives  unhappy.     (See  Case  I.) 

Of  the  advances  which  dermatology  has  made  in 
recent  years,  the  development  of  the  operation  for 
removal  of  hair  is  without  doubt  the  most  brilliant. 
In  the  Arch  ires  of  Dermatologi/,  five  years  ago,  my 
friend  Dr.  Duhring,  of  Philadelphia,  reijorted  the 
case  of  a  bearded  woman,  whom  many  of  you  have 
doubtless  seen  on  exhibition,  and  after  an  exhaustive 
description  and  discussion  of  interesting  points  con- 
cluded with  the  fellowing  paragrajih  :  "  In  regard 
to  the  question  which  was  asked  me  by  the  patient, 
whether  the  gi-owth  on  the  face  could  he  successfully 
and  jiermanently  removed  (and  I  need  not  add  that 
it  is  to  her  a  source  of  intense  mortification  and  dis- 
tress), I  would  say  that  the  only  justifiable  means  at 
our  command  is  palliative,  consisting  in  either  the 
daily  use  of  a  razor  or  in  the  employment  of  a  de- 
pilatory powder."  This  was  written  only  five  years 
ago,  and  represented  advanced  025inion  at  that  time. 
I  quote  it  simply  to  show  that  dermatology  in  Amer- 
ica is  not  a  mere  reflex  of  European  thought,  but 
that  it  is  alive  and  advancing. 

In  a  pajjer  read  before  the  Fifth  Annual  Meeting 
of  the  American  Dermatological  Association,  Dr. 
1  Heitzmann  mention  sd  the  case  of  a  lady  with  :> 
growth  of  hair  uj^on  chin  and  submaxillary  region, 
i  who  bad  consulted  the  prominent  dermatologists  in 
Yienna.  All  agreed  that  no  one  would  promise  a 
permanent  eradication  of  such  superfluous  hairs  but 
a  regular  charlatan.  In  the  light  of  what  has  been 
accomplished  by  several  in  this  country,  it  is  appar- 
ent that,  in  one  respect  at  least,  we  are  in  advance 
of  our  dermatological  brethren  abroad,  who,  as  Dr. 
Heitzmann  remarks,  do  not  know  anything  about 
permanent  and  safe  epilation. 

The  operation  for  the  permanent  removal  of  hairs 
by  electrolysis,  has  been  described  by  several  who 
have  written  on  the  subject,  and  the  descrijations 
differ  merely  in  a  few  non-essential  points.  The 
ojieration  is  a  simple  one,  which  any  physician  with 
a  steady  hand  and  keen  eye  can  readily  perform, 
although,  as  in  many  other  simi^le  025erations,  a 
peculiar  dexterity  is  required,  and  far  more  satisfac- 
toi-y  results  are  obtained  after  a  certain  amount  of 
experience.  An  ordinai-y  galvanic  battery  is  re- 
quired and  a  fine  needle,  which  is  to  be  attached  to 
ti  e  negative  cord.  The  number  of  cells  required 
for  the  operation  depends  upon  the  activity  of  the 
liatteiy,  the  delicacy  of  the  i^atient's  skin,  and  the 
strength  of  the  hairs  to  be  removed,  and  should  be 
deteraiined  in  each  case  by  the  effect  which  is 
produced.  I  commonly  use  from  ten  to  sixteen 
cells  of  a  zinc-carbon  battery,  or  a  cori'esiJonding 
number  of  a  chloride  of  silver  battery. 

Upon  the  style  of  needle  employed  depends,  in  a 
large  measure,  the  success  of  the  operation.  A  fine 
cambric  needle,  which  has  been  recommended,  may 
be  successfully  used,  but  on  account  of  its  stiffness 
it  is  more  difficult  to  introduce  it  into  the  follicle 
without  piercing  the  follicular  wall  than  the  hair- 
like flesible'st«el  broach  which  I  have  recommended 
and  invariably  use.  The  cambric  needle  being 
larger  is  also  productive  of  more  inflammatory  re- 
action, and  more  likely  to  leave  permanent  traces  of 
the  opei-ation.  Fonnerly  I  used  a  vei-y  fine  plati- 
num wire,  pointed  by  means  of  a  jeweller's  file,  but 
the  delicate  flexible  broach,  much  finer  than  those 
commonly  employed  by  dentists  in  extracting  nerves. 


254 


THE  MEDICAL  RECORD. 


is  far  superior  to  any  other  needle  which  I  have 
ever  seen,  and  is  almost  a  necessity  in  removing  the 
hairs  from  the  upper  lip  without  the  production  of 
a  scar.  The  needle  can  be  readily  attached  to  the 
end  of  the  battery  cord  by  a  few  turns  of  copijel'- 
wire  protected  by  an  inch  or  more  of  rubber  tubing, 
or  a  special  handle  may  be  made  for  the  purpose. 

Provided  with  battery  and  needle  the  next  thing 
is  to  get  the  patient  in  a  jiroper  chair  and  in  a 
proper  light.  A  high  reclining-chair  and  a  southerly 
bay-window  are  desirable,  but  the  main  point  is  to 
secure  sufficient  light  and  to  have  the  operator's 
eyes  upon  a  level  with  the  patient's  chin.  The 
needle  is  now  introduced  into 'the  follicle  by  the 
side  of  the  hair.  If  this  is  skilfully  done,  no  pain 
whatever  is  felt  by  the  patient.  The  sponge-cup  or 
sponge-tipped  positive  electrode  should  now  be 
used  to  complete  the  circuit.  This  may  be  applied 
to  the  skin  in  the  immediate  vicinity  of  the  hair  if 
but  a  few  cells  are  used,  but  it  is  usually  more  con- 
venient to  allow  the  patient  to  hold  the  positive 
electrode  in  one  hand,  and  when  the  needle  has  en- 
tered the  follicle,  to  ask  her  to  complete  the  cii'cuit 
by  applying  the  moistened  sponge  to  the  palm  of 
the  other  hand.  The  electrolytic  action  now  mani- 
fests itself  subjectively  in  the  form  of  a  .sharp  sting- 
ing sensation,  and  objectively  in  the  form  of  slight 
hyperiemia  around  the  needle.  In  a  few  seconds 
the  hyperiemia  will  give  place  to  a  blanching  of  the 
skin,  and  a  little  fi-oth  will  appear  at  the  mouth  of 
the  follicle.  If  the  hair  be  now  seized  with  a  pair 
of  forceps  and  the  gentlest  ti'action  exerted,  it  will 
be  found  to  be  loose  in  the  follicle  in  the  course  of 
from  ten  to  twenty  seconds,  provided  the  needle  has 
been  skilfully  introduced.  Before  withdrawing  the 
needle  the  patient  should  remove  her  hand  from 
the  sponge,  in  order  to  avoid  the  slight  shock  which 
would  otherwise  l)e  felt. 

In  a  paper  on  this  subject  which  I  read  before  the 
New  York  State  Medical  Society,  three  years  ago,*  I 
recommended  the  extraction  of  the  hair  before  intro- 
duction of  the  needle  where  the  follicles  were  of  large 
size.  Under  no  circumstances,  at  the  present  time, 
do  I  ever  remove  the  hair  until  it  is  loosened  by 
means  of  the  electrolysis.  In  the  paper  mentioned 
I  wrote  as  follows  : 

"  The  first  effect  of  the  operation  is  to  produce  a 
small  whitish  elevation  around  the  mouth  of  the  fol- 
licle— in  fact  an  iirticarial  wheal.  After  a  protracted 
sitting,  the  part  operated  upon  will  be  acutely  con- 
gested and  somewhat  swollen,  and  the  number  of 
hairs  operated  on  can  usually  be  determined  by 
gently  passing  the  finger  over  the  skin  and  counting 
the  number  of  small  lumps  resulting  from  peri-fol- 
licular  exudation.  On  t)ie  foUowingday  the  dilTused 
congestion  will  have  disappeartMl  and  left  a  number 
of  red  papules  or  small  pustules  at  the  mouths  of 
the  follicles." 

At  that  time  I  was  in  the  habit  of  using  a  much 
coarser  needle  than  I  do  at  present.  With  the 
finest  flexible  needle  it  is  extremely  rare  to  produce 
wheals  or  pustulation.  In  many  cases  the  effect  of 
the  operation  is  simply  to  leave  red  jjoints,  which 
soon  disappear. 

Tlie  operation  is  by  no  means  a  pleasant  one,  but 
rarely  does  a  patient  make  any  complaint  of  jjain. 
The  majority  say  it  is  not  as  unpleasant  as  having 
teeth  filled  in  a  dentist's  chair,  and  with  the  fine 
needle  tlie  painful  sensation  is  greatly  reduced.  At 
the  first  sitting  the  patient  is  often  nervous,  and 


>Ncw  YorkMnu 


,  RKcoitu,  Muroh  fj,  IS'; 


suffers  really  more  than  in  a  dozen  subsequent  opera- 
tions. "When  the  sitting  is  prolonged,  and  especi- 
ally in  a  jjoor  light,  the  removal  of  the  hair  is  very 
trying  to  the  eyes  of  the  operator.  At  certain  times 
I  know  that  I  have  suflered  quite  as  much  or  even 
more  than  tlie  patient.  The  use  of  a  lens  held  in 
the  hand  or  fixed  before  the  eye  has  been  suggested, 
but  for  my  part  I  find  one  of  no  value.  A  delicacy  of 
touch  and  steadiness  of  hand,  is  more  essential  in 
this  operation  than  an  unusual  keenness  of  vision. 

As  to  the  number  of  hairs  which  can  be  removed 
at  one  sitting,  I  would  say  that  from  thirty  to  fifty 
is  the  number  which  I  tisuaUy  expect  to  destroy  in 
an  ojieration  lasting  three-quarters  of  an  hour. 
Upon  the  neck  it  takes  much  longer  to  destroy  hairs 
than  upon  the  chin  or  cheeks.  I  have  removed  over 
two  hundred  hairs  at  one  sitting,  when  patients  from 
a  distance  were  anxious  to  leave  the  city ;  but  I 
deem  it  far  better  to  spare  one's  eyes  and  to  be  more 
thorough,  even  if  it  involves  a  greater  number  of 
sittings. 

If  the  operation  is  very  skilfully  performed,  it 
ought  not  to  leave  scars,  as  a  rule.  In  some  cases  it 
is  impossible  to  prevent  the  production  of  minute 
punctate  cicatrices,  which,  however,  can  only  be 
seen  on  close  inspection.  I  made  a  mistake  in  some 
of  my  earlier  cases  in  operating  upon  two  or  more 
coarse  hairs  very  close  together,  instead  of  taking 
one  here  and  there  at  short  distances  apart.  (See 
Case  XI.)  A  little  attention  to  this  hint  may  serve 
to  i^revent  the  production  of  slight  scarring  by  those 
who  may  attempt  the  operation.  Here  again  I  must 
refer  to  the  fine  needle,  for  its  use  greatly  lessens 
the  liability  to  the  production  of  scars. 

As  regards  the  immediate  success  of  the  operation, 
it  must  be  stated  that,  as  a  iiile,  a  certain  percentage 
of  hairs  will  return  and  demand  removal  a  second 
time.  I  used  to  expect  a  return  of  from  thirty  to 
fifty  per  cent,  of  the  hairs,  while  now  I  am  surprised 
if  from  five  to  ten  per  cent,  reapjjear.  In  one  case 
(XII.),  in  which  I  removed  over  fifty  hairs  with  un- 
usual care,  not  a  single  one  has  rettirned  after  an  in- 
terval of  three  months.  In  some  patients  the  growth 
of  hair  appeals  to  have  ceased,  for  some  unknown 
cause,  and  when  the  hairs  are  destroyed  the  cure  is 
eS'ected.  In  other  patients  the  fine  hairs  are  con- 
stantly growing  larger  and  darker,  and  after  the 
most  conspicuous  have  been  removed  a  new  gi-owth 
will  in  time  succeed,  and  appear,  perhaps,  like  a  re- 
turn of  those  jireviouslv  removed.  (See  Cases  III., 
.IV.,  VIII.) 

In  this  operation  for  the  ])ermanent  removal  of 
hair  the  question  arises  as  to  how  the  electricity  de- 
stroys the  papilla  from  which  the  hair  sju'ings.  Is 
it  by  thermic  or  by  electro-chemical  action  ?  A  re-  , 
cent  writer  on  the  subject  objects  to  the  use  of  the  , 
term  electrolysis  as  being  a  misnomer,  claims  that 
the  heat  generated  in  the  needle  by  the  ]iassage  of 
the  electricity  is  the  active  agent  in  the  destruction 
of  the  tissue,  and  suggests  for  the  operation  the 
name  of  akido-fjahiino-caxten/.  It  cannot  be  denied 
that  in  this  operation  the  temperature  of  the  needle 
is  slightly  raised  by  its  resistance  to  the  galvanii' 
current,  but  surely  not  to  such  a  degree  as  to  pro- 
duce a  caustic  efTect.  On  the  other  hand,  it  is  evi- 
dent, from  the  frothing  seen  at  the  mouth  of  the  fol- 
licle and  other  eflocts,  that  a  decomposition  of  the 
water  and  salts  contained  in  tlie  cutaneous  tissues  is 
taking  place  around  tlie  needle  and  causing  the  es- 
cape of  bubbles  of  hydrogen.  This  is  certainly  noth- 
ing more  nor  loss  tlian  electrolysis. 

In  conclusion,  I  would  like  to  r(>for  to  the  cause  of 


THE  MEDICAL  RECORD. 


255 


facial  hirsuties  in  females,  and  I  shall  speak  briefly 
on  this  point,  for  I  know  very  little  about  it.  I  have 
wondered  and  pondered  by  the  half-hour  while 
operating  on  cases,  and  endeavored  to  find  some 
characteristic  common  to  all  of  my  patients,  but  in 
vain.  Some  are  in  line  physical"  condition,  while 
others  are  debilitated.  Some  are  extremelv  nervous  ; 
some  are  not  so  in  the  slightest  degree.  "  Some  are 
stout  and  others  thin.  Some  are  of  dark  and  others 
of  light  complexion.  Some  are  maidens  from  twenty 
to  fifty  years  of  age  ;  while  of  others  who  are  mar- 
ried, some  have  children  and  some  have  none.  The 
somewhat  common  idea  that  the  growth  of  a  beard 
in  the  feuiLile  is  necessarily  associated  with  mascu- 
line traits  of  character  is  certainly  not  founded  upon 
fact,  for  most  of  my  patients  have"  presented  the  verv 
highest  type  of  feminine  refinement.  That  facial 
hirsuties  is  dependent  upon  a  malformation  or  imper- 
fect development  of  the  reproductive  organs,  as  some 
have  claimed,  is,  in  my  opinion,  doubtful.  Cer- 
tainly, an  intimate  relation  between  these  two  con- 
ditions has  not  been  satisfactorily  proven,  save  in  a 
few  exeei^tioual  cases. 

The  relation  of  facial  haii-iness  in  females  to  de- 
rangement of  the  nervous  system  is  a  subject  which 
has  already  commanded  attention,  but  lias  not  as  yet 
been  sufficiently  studied.     I  have  already  spoken  of 
the  depressed  mental  condition  esisting'in  manv  of 
my  patients,  and  which  I  believe  to  be  not  merelv  a 
result  of  the  disfiguring  growth  of  hair,  but  a  symp- 
tom of  general  nervous  disease,  upon  which  the  hir- 
suties in  all  probability  depends.    Excessive  gi'owth 
of  hair,  whether  in  the  male  or  female,  is  an  aberra- 
tion of  nutrition,  and  not  a  sign  of  excessive  vitality. 
The  Samsons  of  tlie  present  day  are  clean-limbed, 
and  usually  short-haired  specimens  of  the  human 
race,  and  in  our  highest  type  of  feminine  health  and 
beauty  tliere  is  but  a  moderate  gi-owth  of  hair-.    The 
lady  in  the  museum,  whose  luxuriant  tresses  trail 
upon  the  floor,  is  rarely,  if  ever,  well-developed,  and, 
like  her  bearded  sister,  furnishes  unmistakable  evi- 
dence of  perverted  nutrition. 
I       An  abnormal  growth  of  hair,  whether  it  be  in  re- 
'  spect  to  length  or  location,  indicates  an  abnormal 
.  condition  of  the  nervous  system.     Precisely  what 
I  this  condition  may  be,  and  how  it  may  be  remedied, 
'■  I  must  leave  for  others  to  determine.  ' 
'       In  the  following  report  of  cases,  I  have  selected 
twelve  of  those  in  which  the  growth   of  hair  was 
I  more  or  less  abundant,  and  which  will  serve  to  il- 
I  lustrate  some  of  the  difliculties  in  the  way  of  treat- 
:  ment,  as  well  as  its  success. 

Case  I. — Mrs. ,  aged  thirty-one,  married  at 

!  eighteen,  and  has  one  child.     Is  quite  stout  and  in 

I  fair  health.     Is  greatly  worried  by  a  growth  of  hair 

upon  chin  and  neck.     Seldom  goes  out  for  exercise, 

but  prefers  "to  sit  and  mope."     Her  sleep  is  often 

disturbed   by   the    thought   of   her   "misfortune." 

The  patient  is  almost  a  monomaniac  on  the  subject 

of  her  beard,  and  most  of  the  time  is  greatly  de- 

pressed  in  mind.     The  growth  of  hair  upon  extremi- 

j  ties  IS  abnormal.      The    facial   hirsuties   appeared 

1  about   two   years   ago.  and   pulling   the   hairs    out 

I  seemed   to   increase  the  growth.     As  a  proof  that 

I  pulling  makes  the  hairs  grow  stronger,  she  cites  the 

I  fact  that  the  hairs  on  the  right  extremity  of  upper 

Up,  which  she  could  pull  more  readily  than   on  the 

,  left   side,  are  now  much   more  developed   in    size. 

There  is  no  tendency  to  hirsuties  among  her  female 

relations. 

Appbed  for  treatment  in  March,  1S80.     During 
the  summer  I  removed  over  a  thousand  dark  hairs. 


leaving  an  abundant  growth  of  fine  pigmentless 
hairs,  which  were  scarcely  noticeable  at  the  distance 
of  a  few  feet.  At  her  urgent  request,  I  continued 
to  operate  on  these  and  removed  a  second  thousand 
or  more,  most  of  which  were  so  fine  as  to  constitute 
no  disfigurement  whatever,  but  their  removal  jiro- 
duced  a  marked  indirect  eflect  upon  her  health 
and  happiness.  In  this  case  about  twenty-five  hun- 
dred hairs  were  removed  by  count.  How  many 
of  these  reappeared  and  were  removed  a  second 
time  it  is  diflicult  to  say.  There  was,  evidently,  a 
constant  tendency  for  the  fine  downy  hairs  to  de- 
velop in  size  and  thickness,  and  at  times  I  despaired 
of  being  able  to  eflect  their  removal,  but  after 
eighteen  months  of  intermittent  treatment,  success 
crowned  my  efibrts,  and  her  chin  and  neck  appeared 
quite  smooth  and  natural.  In  January,  1882,  I  saw 
the  patient,  at  which  time  there  were  no  conspicuous 
hairs,  and  she  stated  that  she  considered  the  opera- 
tions to  have  been  perfectly  successful  and  that  the 
results  had  far  exceeded  her  anticipations. 

Case  II.— Miss    ,  aged    twenty-four ;   a    tall 

blonde,  in  good  health.  Apjjlied  for  treatment  in  Oc- 
tolier,  1879,  on  account  of  a  gi-owth  of  light  hairs  on 
both  sides  of  chin,  about  an  inch  in  length.  She  had 
consulted  the  eminent  dermatologist  of  London,  Prof. 
Erasmus  Wilson,  and  stated  that  .she  had  been  ad- 
vised by  him  not  to  touch  the  hairs,  and  informed 
that  absolutely  nothing  could  be  done  in  her  case. 
Her  extremities  were  quite  hairy,  and  the  hair  of 
her  head  was  thick  and  long.  The  hair  on  her  chin 
had  mostly  grown  during  the  previous  year,  and  af- 
ter a  severe  fever.  In  this  case  I  removed  three 
hundred  hairs,  operating  upon  the  left  side  of  chin 
by  electrolysis,  and  upon  the  right  side  by  the 
method  suggested  for  the  mechanical  destruction 
of  the  follicle,  consisting  in  the  introduction  and 
rapid  twisting  of  a  barbed  needle.  In  April,  1880, 
the  patient  returned  to  the  city,  and  I  found  that 
nearly  all  of  the  hairs  upon  the'  right  side  had  re- 
■  turned,  wliile  there  was  a  perceptible  diminution  of 
the  number  upon  the  left  side  of  chin  where  the 
electrolysis  had  been  employed.  In  Ajjril  I  re- 
moved one  hundred  and  fifty,  and  in  June  one  hun- 
dred hairs  of  a  finer  growth  than  those  first  operated 
upon,  which  left  the  face  quite  free. 

Case  III. — Miss ,  a  young  lady,  aged  twenty- 
six  ;  tall  and  of  fair  complexion ;  in  good  health, 
though  delicate  in  appearance  and  inheriting  a  ten- 
dency to  pulmonary  disease.  Applied  for  treatment 
in  December,  1879,  on  account  of  hairs  growing  on 
either  side  of  chin,  which  had  appeared  within  three 
months.  There  was  a  very  light  moustache  on  up- 
per lip,  though  scarcely  more  than  is  commonly  seen. 
In  two  operations  I  removed  sixty  Iiairs  from  right 
side,  and  thirty-five  from  left  side  of  chin. 

In  May,  1880,  about  ten  of  the  long  dark  hairs, 
previously  operated  on,  appeared  to  have  returned. 
Removed  twenty-five  from  either  .side  of  chin,  most 
of  them  being  fine  and  light-colored. 

In  October,  the  patient  reported  that  she  had 
been  free  from  the  capillary  growth  during  the  early 
part  of  the  summer,  but  during  past  two  months  a 
few  fine  hairs  on  either  side  of  chin  had  rapidly  in- 
creased in  size.  These  were  removed,  and  as  I  "have 
recently  been  informed  by  a  member  of  her  family, 
there  has  been  no  subsequent  appearance  of  the 
hairs. 

Case  n^.— Miss ,  aged  thirty-two,  tall,  ofblonde 

complexion,  and  lymphatic  temperament  ;  health 
good.  Applied  fortreatment  in  June,  1880,  on  account 
of  long  curling  hairs  on  sides  of  chin  and  a  mole  on 


356 


THE  MEDICAL  RECOKD. 


neck.  She  had  been  in  the  habit  of  pulling  them 
every  three  weeks.  There  was  no  hirsuties  of  other 
portions  of  her  body,  nor  were  any  female  relatives 
affected  similarly.  Her  hair,  a  look  of  which  turned 
gray  at  sixteen,  appeared  quite  gray  m  front,  while 
the  back  hair  was  of  a  natural  brown  hue.  Upon 
her  legs  a  singular  condition  had  existed  for  two  or 
three  years.  The  hair  upon  the  tibial  region,  in- 
stead of  being  normal  or  in  excess,  had  almost  en- 
tirely disappeared,  and  the  existence  of  many  folli- 
cles, either  inflamed  or  distended  by  an  accumulation 
of  epidermic  cells,  showed  plainly  that  the  loss  of 
hair  was  the  result  of  the  atteetion  which  is  known 
as  lichen  pilaris.  The  hair  upon  her  chin  had  been 
growing  for  five  years  or  more. 

In  June  and  July  I  removed  one  hundred  and 
sixty  hairs. 

In  November  I  removed  eighty,  much  hner  than 
those  first  operated  upon. 

In  June,  1881,  there  were  but  seven  to  be  [re- 
moved. 

In  January,  1882,  I  removed  twenty-five,  which 
were  evidently  of  recent  development,  and  not  a  re- 
turn of  those  previously  operated  upon. 

Case  V.— Miss  ,  a  maiden  lady,  aged  forty- 
six  :  tall,  thin,  and  of  dark  complexion  ;  health  poor. 
Applied  for  treatment  in  July,  1880,  on  account  of 
numerous  line  dark  hairs  upon  either  side  of  chin. 
She  had  been  in  tlie  habit  of  cutting  them  close  or 
pulling  them  out,  and  at  the  time  of  her  first  visit 
they  were  about  half  an  inch  in  length.  There  was 
no  excessive  growth  of  hair  on  other  portions  of  the 
body.  The  hairs  on  chin  had  begun,  to  grow  at 
eighteen  years  of  age,  and  she  stated  that  a  sister 
and  two  paternal  aunts  suffered  in  very  much  the 
same  wav.  During  the  week  in  which  she  remained 
in  the  city  I  removed  five  hundred  of  the  largest 
hairs  in  six  operations. 

In  September  she  returned  to  the  city  with  appa- 
rently as  luxuriant  a  growth  as  before,  and  no  indi- 
cation, at  first  glance,  of  any  having  been  removed.. 
Close  inspection,  however,  showed  a  few  red  points, 
especially  on  ujiper  lip,  where  hairs  had  evidently 
been  destroyed.  I  now  removed  six  hundred  in  four 
operations,  including  many  finer  hairs,  and  used  a 
stronger  current  and  far  more  care  in  operating  than 
I  did  at  first. 

In  November  the  number  of  hairs  was  evidently 
decreased,  and  I  removed  less  than  a  hundred. 

In  June,  1881,  there  were  but  a  few  conspicuous 
hairs.  I  removed  one  hundred  more,  however,  most 
of  them  being  very  fine. 

In  October  there  were  but  seven  dark  hairs,  which 
I  removed  with  twenty-five  downy  ones,  which  ap- 
peared as  though  they  might  develop  and  become 
conspicuous.  A  few  niinute  cicatrices  were  visible 
upon  close  inspection.  The  patient  has  since  writ- 
ten to  me  as  follows  : 

"  The  result  of  the  operation  is  very  satisfactory. 
There  are  no  hairs  perceptible  on  lip  or  chin,  and 
the  few  scars  are  not  notice.ible." 

Case  VI.— Mrs. ,  a  married  lady,  aged  twenty- 
five  ;  quite  stout,  of  dark  complexion,  and  in  fair 
health.  Applied  for  treatment,  in  August,  lS8(),_on 
account  of  long,  dark,  curling  hairs  upon  either  side 
of  chin,  for  which  she  had  been  recently  applying  a 
depilatory.  She  had  a  luxuriant  growth  of  hair 
upon  the'head,  and  said  that  no  female  relative  was 
affected  with  liirsnties.  The  growth  of  hair  upon 
her  face  was  first  noticed  at  eighteen  years  of  age. 
Slie  began  to  pull  out  the  hairs  three  years  ago  at 
long  intervals,  but  more  frequently  of  late.      She 


thinks  that  the  epilation  increased  the  growth,  but 
not  so  much  as  did  the  depilatory  powder  which  she 
used. 

In  twelve  sittings,  extending  through  a  year,  I  re- 
moved four  hundred  and  fifty  hairs,  one-half  of  them 
being  quite  fine  and  evincing  a  marked  tendency  to 
develop  in  size.  After  a  six  months'  interval  the 
patient  writes  that  the  operations  have  proved  satis- 
factory, although  the  growth  has  not  been  entirely 
removed,  and  a  little  more  must  be  done  to  make  a 
complete  cure. 

Case  VII.— Miss ,  a  maiden  lady  of  forty-six ; 

small,  thin,  and  dark ;  in  fair  health,  although  of 
delicate  appearance.  Applied  for  treatment  m  Oc- 
tober, 1880,  on  account  of  dark,  curling  hairs  on 
sides  of  chin,  and  dark  hairs  at  either  end  of  upper 
lip.  The  growth  first  appeared  on  lip  fifteen  years 
ago.  This  had  been  treated  by  applications  of  sul- 
phuric acid,  which  had  lessened  the  growth  of  hair 
in  the  centre  of  the  lip,  and  given  it  a  whiter  ap- 
pearance than  the  rest  of  the  face.  The  hair  first 
appeared  on  chin  three  years  ago.  Her  mother  had 
four  or  five  hairy  moles  on  her  chin. 

In  October  I  removed  one  hundred  and  twenty- 
five  hairs. 

In  the  following  June,  1881,  the  patient  returned 
to  the  city  and  I  removed  seventy-five  hairs.  It 
must  not  be  inferred  that  over  one-half  of  the  hairs 
upon  which  I  first  operated  had  returned,  as  in  this 
second  operation  I  removed  many  fine  hairs  which 
had  been  left. 

In  November  there  were  but  one  or  two  hairs  at 
all  conspicuous.  These  I  removed,  with  a  few  more 
fine  ones,  and  the  patient  returned  to  her  home  well 
pleased  with  tlie  results  of  treatment. 

Case  VIII.— Miss  ,  aged  about  thirty  ;  tall, 

dark,  and  of  extremely  nervous  temperament ;  health 
good.  Applied  for  treatment,  in  January,  1881,  for 
a  slight  growth  of  hair  mostly  on  right  side  of  chin, 
which  had  appeared  during  the  preceding  year. 
She  had  always  noticed  a  tendency  to  a  slight  ex- 
cess of  hair  vipon  extremities,  although  upon  the 
scalp  her  hair  was  rather  thin. 

At  two  operations,  in  January  and  February,  I  re- 
moved thirty-two  hairs  from  chin  and  left  cheek. 
In  June  there  were  but  five  hairs  to  remove. 
In  February,  1882,  I  removed  twenty-seven  fine 
hairs,  which  were  evidently  a  recent  development 
and  not  a  return  of  those  previously  operated  upon. 

Case  IX. — Mrs. ,  a   married   lady,   of  about 

forty-five,  with  no  children;  tall,  thin,  and  of  dark 
complexion  ;  health  poor  ;  applied  for  treatment  in 
March,  1881,  on  account  of  a  few  fine  and  long  hairs 
on  chin,  and  a  fibrous  mole  on  right  cheek,  from  whi<  h 
a  few  hairs  sprung.  She  liad  first  noticed  the  growth 
of  hail-  about  three  years  before  and  had  resorted  to 
depilatories  and  epilation.  In  March  I  removed 
forty-five  hairs  from  the  chin  and  inserted  the  needle 
at  several  points  around  the  base  of  the  mole,  which 
was  of  the  size  of  a  split  pea.  In  June,  there  was 
scarcely  a  trace  of  the  mole  and  no  hair  on  chin,  save 
a  few  very  fine  ones  which  I  removed.  I  have  heard 
through  h'iends  of  the  patient  since  that  the  grov  tli 
of  hair  was  permanently  removed. 

Case   X.— Mrs. ,   a   young    married   lady  ot 

twenty-eight ;  of  rather  weak  constitution,  but  in  fair 
health.  Apiilied  fortreatment  in  .-Vpril,  1880,  with  an 
abundant  growth  of  fine,  soft  hair  on  cliceks.  chin,  ami 
neck,  which,  if  allowed  to  grow,  would  undoubtedly 
have  produced  a  fine,  thick,  soft  beard.  The  upper 
lip  was  free  from  an  excess  of  hair,  and  there  was  r,<i 
tendency  to  hursuties  on  other  parts  of  the  body. 


I 


THE  MEDICAL  RECORD. 


257 


The  growth  of  hair  began  at  the  age  of  fourteen,  and 
there  had  been  no  perceptible  increase  during  the 
past  three  or  fonr  years.  For  nine  years  she  had 
been  in  the  habit  of  pulling  out  the  hairs  at  intervals 
of  three  days,  and  necessarily  devoting  a  liberal 
amount  of  her  time  to  this  procedure.  Attempts 
had  been  made  to  destroy  the  hairs  by  hypodermic 
injections  of  carbolic  acid,  but  with  no  result  save 
the  production  of  a  few  disfiguring  scars.  The  pa- 
tient stated  that  her  mother  had  a  remarkably  fair 
comiilexion,  and  that  no  female  relative  suffered 
from  hir.sTities. 

During  the  months  of  May  and  June  I  operated 
daily,  and  sometimes  twice  a  day  upon  the  patient's 
face,  and  removed  upward  of  live  thousand  hairs.  I 
operated  rajjidly — too  rapidly,  as  the  sequel  proved 
— and  remove<J  from  one  to  two  hundi'ed  hairs  at  a 
sitting. 

In  October,  1881,  the  j^atient  came  again  to  New 
York,  and  at  first  glance  I  could  not  see  that  very 
much  had  been  accomplished.  She  exjiressed  her 
opinion,  nevertheless,  that  the  operations  of  the  pre- 
vious year  had  j^roven  quite  satisfactory,  inasmuch 
as  they  had  lessened  the  growth  of  hair  decidedly. 
I  accordingly  resumed  the  treatment,  and  with  the 
assistance  of  Dr.  W.  S.  Conovei-,  removed  aboiit  one 
thousand  hairs.  This  left  the  face  much  smoother 
and  more  free  from  hair  than  after  the  first  series  of 
operations. 

CiSE  XI. — Miss ,  aged  thirty-five ;  of  dark  com- 
plexion, and  in  fair  health  ;  a  teacher  by  occupation. 
Applied  for  treatment  in  December,  1879,  with  a  thick 
and  strong  gi-owth  of  black  hairs  on  cheeks,  lip,  chin, 
and  neck.  Indeed  she  would  have  had  as  perfect  a 
beard  as  almost  any  of  the  women  on  exlubition  if 
she  had  allowed  the  hair  to  gi'ow,  but  for  over  fifteen 
years  she  had  been  using  both  a  dej^ilatory  and  the 
tweezers.  Yonv  hours  at  a  time  she  was  in  the  habit 
of  devoting  to  tJie  painful  operation  of  removing 
the  hair.  Neither  her  mother  nor  any  one  of  four 
sisters  manifested  any  tendency  to  hirsuties,  and  the 
patient  herself  did  not,  except  on  face. 

During  the  first  six  months  of  treatment  I  re- 
moved, with  the  assistance  of  Dr.  Conover,  over 
twenty-seven  hundred  hairs.  During  the  following 
year  about  twenty-three  hundred  were  removed  by 
Dr.  Conover  and  myself,  making  five  thousand  hairs 
in  all. 

The  patient  is  still  under  occasional  treatment  for 
the  growth  of  hair  \ipon  the  upper  lip,  from  which 
would  grow  a  strong  moustache.  The  removal  of 
this  is  very  tedious,  since  with  a  view  to  the  preven- 
tion of  even  minute  scars,  she  only  allows  a  dozen 
or  more  isolated  hairs  to  grow  at  one  time  upon  the 
lip.  The  left  side  of  her  face,  exclusive  of  the  upper 
lip,  is,  and  has  been  for  the  past  eight  months,  per- 
fectly free  from  the  objectionable  growth.  Upon 
the  right  side  the  hairs  were  removed  with  less  care 
at  first,  and  some  fine  ones  have  been  lately  removed. 
There  have  been  many  minute  cicatrices  left  by  the 
needle,  but  they  are  of  little  account,  and  the  result 
of  the  prolonged  ti-eatment  has  been  most  satisfac- 
tory both  to  myself  and  to  the  patient. 

Case  XII. — Mrs. ,   a   large,    handsome  lady, 

aged  twenty-five,  and  apparently  in  perfect  health  ; 
married  four  years  and  no  children.  Her  skin  was 
unusually  fine  and  delicate,  and  with  the  exception 
of  fifty-seven  hairs  gi-owing  upon  her  neck  and  a 
single  small  mole  upon  right  side  of  chin,  there  was 
no  tendency  to  an  abnormal  growth  of  hair  upon 
face  or  other  portion  of  body. 

This  patient's  skin  seemed  unusually  sensitive,  and 


as  an  exceiJtion  to  the  rule,  she  complained  of  the 
pain  produced  by  the  operation.  •  Small  wheals,  like 
mosquito-bites,  were  produced  at  the  points  where 
the  needle  was  inserted. 

These  fifty-seven  hairs  were  removed  in  Novem- 
ber, 1881.  Two  months  later  she  wrote  me  in  ac- 
cordance with  my  request  and  stated  that  the  red 
marks  caused  by  the  needle  still  lingered,  "  but  so 
surely  did  the  instrument  do  its  work  that  the  ob- 
jectionable hairs  seem  to  be  i^ermanently  eradicated, 
not  one  having  reappeared.  The  mole  on  the  chin 
has  entirely  gone." 


death   after  oy.akioto:\iy,  due  to 
preli:mixaey  t.ypping. 

By  LAWSON  TAIT,  F.E.C.S., 

BIRMINGHAM,  E.N'GLAXD. 

Ix  the  last  series  of  one  hundred  operations  which 
I  have  iJerformed  for  the  removal  of  ovarian  cys- 
toma, there  have  been  three  deaths,  and  in  all  of 
these  cases  the  patients  had  been  previously  tapped. 
The  deaths  were  all  of  the  same  kind,  and  were  due 
to  the  same  cause — heart-clot ;  and  they  would,  I 
feel  sure,  most  certainly  not  have  occurred  but  for 
the  tapping.  "With  such  an  experience,  I  think  it 
quite  time  that  a  strong  opinion  was  pronounced 
against  the  i^ractice  of  tajiping  ovarian  tumors  in  all 
cases  where  removal  of  the  disease  is  possible. 

I  propose  to  allude  particulr.rly  to  only  one  of 
these  cases,  and  to  give  it  without  any  details,  such 
as  might  lead  to  its  identification,  for  I  do  not  desire 
to  convey  an  impression  that  I  blame  the  gentleman 
who  performed  the  tajipings.  He  was  but  carrying 
out  the  principle  which  until  lately  governed  our 
practice  in  such  cases :  to  palliate  and  stave  ofl"  the 
major  operation  as  long  as  possible.  Whilst  the 
mortality  of  ovariotomy  with  the  clamp  was  ticet^tp-live 
per  cent,  this  was  the  correct  thing  to  do,  but  now  that 
the  mortality  is  only  three  or  four  per  cent.,  especially 
when  the  whole  of  that  very  small  death-rate  seems 
to  be  due  entirely  to  conditions  produced  by  delaying 
the  operation,  we  must  reverse  our  practice  and  per- 
form ovariotomy  in  an  early  stage  of  the  disease. 
If  my  operations  were  confined  to  cases  which  had 
never  been  taj^ped,  I  think  I  should  have  no  mortal- 
ity at  all,  or,  at  any  rate,  less  than  one  per  cent. 

The  case  in  question  was  one  in  which  neither  the 
age  of  the  patient  nor  the  character  of  the  tumor 
were  such  as  to  warrant  an  unfavorable  prognosis, 
but  I  told  my  friend  who  sent  me  the  case  that  she 
would  probably  die  of  heart-clot  in  thirty  or  forty 
hours  after  the  operation,  because  she  had  been 
tapped  a  great  many  times.  On  the  day  of  the  oper- 
ation she  was  of  immense  girth,  yet  sixty  pints  of 
lluid  had  been  taken  from  her  only  a  few  days  be- 
fore. 

The  fluid  was  intensely  albuminous,  that  is  to  say, 
it  was  made  viscid  by  a  large  amount  of  one  or  more 
of  those  mysterious  inconstant  coagulable  suhstaucts 
found  in  ovarian  and  ascitic  fluid.  I  have  made  pro- 
longed researches  on  the  nature  of  these  substances, 
and  so  far  I  have  found  no  two  exactly  alike,  and 
therefore  I  look  upon  it  as  hopeless  to  expect  that 
we  shall  ever  be  able  to  reduce  them  to  order  or  to 
a  satisfactory  nomenclature.  It  is  perfectly  cer- 
tain that  the  abstraction  of  these  albuminous  sub- 
stances in  large  quantities  dej^rives  the  blood  of 
some  very  important  item  of  its  constitution,  and 
it  is  no  less  certain  that  when  the  blood  has  been 
robbed  of  these  substances  the  rest  of  its  constitu- 


258 


THE  MEDICAL  RECORD. 


ents,  or  some  of  them,  have  a  tendency  to  coagulate 
in  a  most  unusual  way.  The  patient  of  whose  case 
I  am  speaking  did  not  look  an;craic,  and  she  was 
not  very  much  emaciated,  but  within  three  years  she 
had  had  at  least  seventy  gallons  of  fluid,  with  about 
eight  per  cent,  of  solid  matter  in  it,  removed  by  tap- 
ping. 

Unfortunately  the  result  of  the  operation  fulfilled 
my  prediction.  In  a  few  hours  the  swelling  of  her 
legs,  the  difficulty  in  breathing,  the  slight  delirium, 
the  rapid  rising  of  the  pulse  and  its  speedy  dis- 
appearance from  the  extremities,  showed  me  that 
my  previous  experiences  were  being  i-epeated.  From 
the  point  of  ligature  in  the  stump  a  firm,  colorless 
clot  began  to  grow.  It  gradually  occupied  the  whole 
venous  system,  finishing  its  work  in  thirty-six 
hours.  Such  an  ending  I  have  never  seen  in  any 
case  in  which  there  had  been  no  repeated  jirevious 
tapping. 

I  conclude  from  this  and  from  the  fact  that  all  the 
three  deaths  in  my  last  hundred  cases  have  been  of 
exactly  the  same  kind,  that  ovarian  tumors  should 
never  be  tapped  until  it  has  been  ascertained  that 
they  cannot  be  removed. 

If  a  patient  is  once  tapped  she  insists  on  its  re- 
petition, as  long  as  she  gets  a  few  weeks'  relief  from 
it,  whereas,  if  she  had  the  tumor  removed  in  an 
early  stage,  she  would  have  permanent  relief  with- 
out risk.  The  first  tapping  is  therefore  the  step  that 
is  to  be  avoided,  for  not  only  is  it  risky  in  itself — far 
more  risky,  I  believe,  than  the  removal  of  an  un- 
tapped ovarian  tumor — but  it  complicates  the  sub- 
sequent operation  in  a  ve^y  fatal  manner. 


ILLUSTRATn^E  C.\SES  OF  DISE.ISE  OF 
THE  EYE  -JlRISING  FEOM  AFFECTIONS 
OF  THE  TEETH. 


Bx  EDWAKD  T.  ELY,  M.D., 


OpnTHALMIO   SCRGE 


It  is  a  familiar  fact  that  serious  disease  of  the  eye 
may  be  caused  through  affections  of  the  fifth  nerve 
in  its  distribution  to  distant  parts.  The  following 
four  cases  (from  the  practice  of  Dr.  Rocsa  and  my- 
self) are  offered  in  illustration  of  the  subject,  because 
they  were  very  carefully  observed,  and  because  in 
each  one  the  relation  of  cause  and  effect  seems  un- 
mistakable. In  all  the  affection  of  the  eye  appeared 
to  arise  from  irritation  about  the  teeth. 

Case  I. — Paresis  of  Orbicularis  Ahiscle — Irregular 
Spasm  of  Ciliari/  Muscle  —  Monocular  J)iplopia.  — 
jNIale,  aged  twenty-sis.  Complains  that  vision  of 
right  eye  has  suddenly  become  blurred,  and  that  he 
sees  double  with  that  eye.  No  pain  or  redness. 
Pupil  small  and  movable.  Fundus  normal.  Has 
jiaresis  of  right  orbicularis ;  lids  cannot  be  com- 
pletely closed,  and  eye  is  very  watery.  V.  =  s"i,  and 
with  +  ,V  c.  180'  =  5o-  A  careful  examination  of 
the  teeth  shows  nothing  abnormal. 

Patient  was  ordered  to  take  mcrcui-y  and  iodide  of 
potash,  which  he  did  for  some  time  without  benefit. 
One  night  he  was  seized  with  severe  pain  in  one  of 
his  upper  molar  teeth.  The  next  day  the  tooth  was 
extracted,  and  an  abscess  wliich  had  formed  about 
its  root  was  evacuated.  Paresis  of  orbicularis  muscle, 
diplooia  and  astigmatism  disappeared  immediately, 
and  V.  became  i"  without  any  glass.  There  was  no 
doubt  aV>out  the  astigmatism  in  this  case,  as  the 
vision  was  subjected  to  the  most  careful  te-sts. 

Case   II. — /'an^sis  of  Kif/ht  Internal   llechix  and 


Ciliari/  Micsctes. — Male,  aged  thirty-one.  December 
15,  1880,  comiilains  of  blurring  and  "  confusion  "  of 
vision  of  right  eye  of  a  week's  duration.  No  redness 
or  pain.  Size  and  movements  of  pupil  normal.  Fun- 
dus normal.  Y.  =  jr,  with  -t-  -,},:.  Slight  paresis  of 
right  internal  rectus  muscle.  Slight  paresis  of  ac- 
commodation, requiring  +  -,\-  to  restore  normal 
range. 

Root  of  first  molar  tooth  of  upper  jaw,  right  side, 
is  denuded,  roughened,  and  sensitive.  Patient  was 
referred  to  a  dentist,  and  was  also  treated  with  mer- 
cury and  iodide  of  potash  (there  being  a  syphilitic 
history),  and  by  electricity.  Part  of  the  root  of  the 
tooth  was  removed  and  the  remainder  filled.  The 
nerve  of  the  tooth  was  found  "dead,"  and  the  alve- 
olar process  absorbed,  but  there  was  extensive  sup- 
puration in  the  adjacent  parts.  The  ocular  paresis 
recovered  immediately  when  the  condition  of  the 
tooth  was  corrected  (in  tire  latter  part  of  January), 
the  other  treatment  having  been  abandoned  for 
some  time  previously. 

Case  III. — Partial  Paresis  of  Tliird  Xerre. — Fe- 
male, aged  forty.  June  3,  1881,  complains  of  con- 
fused feeling  in  right  eye,  which  she  cannot  de- 
scribe. Says  it  began  with  burning  pain  in  the  right 
ear  and  the  right  side  of  the  head. 

No  redness  of  eye.  Pupil  dilated  and  immovable, 
and  accommodation  partially  paralyzed.  Opacities 
of  both  lenses.  Teeth  on  right  side  are  decayed  and 
tender,  and  gums  are  in  an  unhealthful  condition. 
Advised  to  consult  a  dentist. 

June  9th. — Paresis  of  thii'd  nerve  disappeared  en- 
tirely after  extraction  of  one  tooth. 

Case  IV.  —  Inflammation  of  Conjunctiva  and 
Scle)-a  (?). — Male,  aged  thirty-three.  January  20, 
1882,  complains  of  painful  inflammation  of  left  eye, 
which  he  has  had  for  three  weeks.  Has  had  "  neu- 
ralgia "  of  left  side  of  face,  most  of  the  time,  for  the 
past  month. 

There  is  a  patch  of  inflammation  involving  con- 
junctiva, subconjunctival  tissue,  and  apparently  the 
sclerotic,  at  the  lower  and  outer  quadrant  of  the  globe. 
It  is  about  ten  millimetres  broad,  and  extends  from 
the  edge  of  the  cornea  to  the  retrotar.5al  fold.  Its 
appearances  are  those  of  the  affection  ordinarily 
called  episcleritis.  There  is  lachrymation  and  local- 
ized ciliary  tenderness.  The  pupil  is  small,  but 
movable.  Yision  and  accommodation  normal.  Fun- 
dus normal.  Between  first  and  second  canine  teeth 
of  upper  jaw,  left  side,  is  a  small  ulcerated  patch  on 
the  gum.  Space  between  the  teeth  is  very  tender 
upon  pressure  with  probe. 

Patient  was  advised  to  consult  a  dentist,  who  found 
an  exposed  nerve  in  one  of  the  canine  teeth  just  re- 
ferred to.  An  application  was  made  to  devitalize 
the  nerve,  and  the  facial  neuralgia  disappeared  at 
once.  Tlie  ocular  inflammation  disappeared  com- 
pletely within  forty-eight  hours.  No  local  treatment 
for  the  eye  was  employed. 

20  East  TllIRTreTir  Strket,  Febniory,  1S8-J. 


Tkeatmrst  of  Pn"ei;moxia  by  the  Inhal.\tion  of 
Etheu. — Dr.  Samuel  W.  Francis.  Newport,  P.  I., 
reports  the  successful  treatment  of  an  acute  case  of 
pneumonia  by  the  inhalation  of  sulphuric  ether. 
He  says  that  "  if  seen  early,  diiring  the  first  stage, 
by  inhaling  ether  for  thirty  minutes,  every  six  hours, 
many  severe  and  protracted  cases  of  sickness  would 
be  arrested."  Dr.  Francis  recommended  inhalation 
of  .sulphuric  ether  for  bronchitis  in  1868  (see  J. 
Solis  Cohen's  work). 


THE   MEDICAL  RECORD. 


259 


SOME  REMAEKS   ON  ANTISEPTIC   MEDI- 
CATION. 
By  J.  r.  CORRIGAN,   M.D., 


Many  of  my  professional  brethren  in  New  York  have 
lately  given  attention  to  the  system  of  antiseptic 
medication  introduced  by  Dr.  Doolat,  of  Paris.  The 
successful  residts  of  this  system  in  Europe,  and  more 
especially  iu  France  and  the  French  colonies,  where 
it  is  better  known,  have  already  been  sufficiently 
extended  and  marked  to  justly  claim  the  examina- 
tion of  our  .\merican  con/rires. 

In  this  city  the  treatment  has  been  successful  in 
several  cases  that  had  resisted  all  other  medication, 
reports  of  which,  I  trust,  will  be  laid  before  the 
readers  of  the  Medical  Eecokd  at  a  later  2ieriod.  I 
beg  leave  now  to  present  to  them,  for  a  thorough 
investigation  in  practice,  a  short,  though  imperfect 
sketch  of  this  antiseptic  treatment,  in  the  hope  and 
belief  that  by  its  means  we  shall  be  able  to  control 
or  cure  some  diseases  that  now  apparently  defy 
medical  skill. 

Modern  scientific  investigations  have  tended,  with 
increasing  force,  to  pi'ove  that  diseases  are  caused 
by  the  introduction  into  the  system  of  minute  germs, 
which,  finding  themselves  in  a  fluid — the  blood — 
suitable  to  their  development,  rapidly  increase  in 
strength  and  numbers. 

j\.s  far  back  as  18-16,  Dumas,  in  his  admirable 
"  Lessons  to  the  Faculty,"  had  expressed  the  thought 
that  malarial  fevers  could  be  caused  only  by  the 
penetration  into  the  human  economy  of  some  plant 
or  part  of  plant  developed  in  the  infected  locality. 

Other  observers  followed  with  similar  deductions, 
and  af  terw.ird  came  the  great  Pasteur,  whose  experi- 
ments and  demonstrations  before  the  Academies  of 
Medicine  and  of  Sciences,  in  Paris,  develoj^ed  and 
established  the  certainty  of  the  propagation  of  dis- 
ease by  living  germs.  This  was  shown  in  malignant 
pustule,  in  which  he  succeeded  in  isolating  the 
germs,  developing  them,  and  j^rodueing  the  disease 
at  will  in  animals  by  inoculating  them  with  these 
germs. 

It  remained,  then,  to  find  a  germicide,  which 
could  be  introduced  into  the  system,  which  would 
not  be  essentially  changed  by  the  living  tissues,  nor 
be  injurious  to  them,  retaining,  at  the  same  time, 
its  power  of  killing  these  germs  wherever  met. 

It  is  known,  from  the  experiments  of  Dr.  Calvert, 
that  a  solution  of  the  salts  of  mercury  prevents  all 
animal  fermentation,  that  a  solution  of  the  salts  of 
quinine  prevents  all  vegetable  fermentation,  and 
finally,  that  a  solution  of  carbolic  or  phenic  acid 
prevents  both.  The  salts  of  quinine,  however,  though 
readily  soluble  in  the  acids  of  the  stomach,  begin  to 
lose  their  virtues  the  moment  they  are  introduced 
into  the  alkaline  blood,  and  consequently  do  not 
meet  the  requirements  of  an  efficient  germicide. 

The  development  of  germs  in  the  living  system  is 
as  properly  called  a  fermentation  as  the  similar  pro- 
cess occurring  in  the  wine-vat  in  the  formation  of 
wine.  In  the  latter  case,  as  soon  as  the  fermentation 
begins,  the  temperature  rises.  Shortly  thereafter 
myriads  of  minute  living  beings,  the  sole  cause  of 
fermentation,  attack  the  saccharine  matter,  decom- 
pose it,  and  appropriate  to  themselves  a  portion, 
sending  another  into  the  atmosphere  under  the  form 
of  carlxjnic  acid,  and  finally  leaving  there  a  new 
substance — alcohol — which,  mingling  with  the  re- 
mainder of  the  fermented  matter,  constitutes  wine. 


If  the  vat  is  subjected  to  a  temperature  of  about 
sixty-five  to  eighty-five  degrees  F.,  the  fermentation 
is  very  active.  If,  on  the  contrary,  it  is  exposed  to 
a  current  of  cool  air,  or  if  it  is  refrigerated  by  being 
placed  in  cold  water,  the  intensity  of  the  fermenta- 
tion is  proportionately  diminished.  If,  however,  at 
the  outset,  carbolic  acid  is  added  to  the  grape-juice, 
fermentation  will  not  take  place.  This  results  solely 
from  the  fact  that  the  acid  kills  the  germs  that  would 
otherwise  cause  the  fermentative  transformations. 

Studying  the  same  process  in  the  human  organ- 
ism, in  zymotic  diseases,  we  find  that  the  fermenti- 
tial  microbes,  after  their  introduction  into  the  circu- 
lation, will  then  seek  the  elements  of  their  nurture, 
and,  in  order  to  aj^iJi-opriate  them,  will  subject  the 
blood  to  a  transformation  similar  to  that  caused  in 
the  juice  of  the  grape.  The  easier  the  action  of  fer- 
mentation, the  greater  is  the  heat  and  the  more  in- 
tense the  malady. 

The  analogy  iu  this,  however,  is  not  complete,  in- 
somuch as  that  in  the  wine-vat  the  microbes  only 
find  inert  matter,  whereas  in  the  organism  they  have 
to  contend  against  the  vitality  of  the  globules, 
which  are,  in  themselves,  a  sort  of  living  beings. 
The  greater  their  vitality  and  resisting  power,  the 
lesser  are  the  fermentation  and  sickness. 

There  is,  therefore,  a  vast  distinction  to  be  made 
as  regards  germs  in  ordinary  fermentation  of  inor- 
ganic matter,  and  those  in  fermentation  in  living 
organi.sms.  It  is  evident  that  doses  of  antiseptics 
harmless  to  the  former  may  have  very  great  efiect 
against  the  latter. 

iSTotwithstanding  this  reservation,  the  analogy  be- 
tween the  two  orders  of  fermentation  is  striking.  It 
is  evident  that,  in  zymotic  diseases,  the  sooner  tl  e 
ferment-destroying  substances  are  administered  in 
full  doses,  the  sooner  will  be  arrested  the  propaga- 
tion of  the  germs,  and  the  better  protection  afforded 
to  the  integrity  of  the  globules.  It  must  not  be  for- 
gotten that  these  germs  develop  in  proportion  to 
the  lower  degree  of  vitality  of  the  blood. 

Phenic  acid  is  the  basis  and  most  important  con- 
stituent of  all  tlie  remedies  introduced  by  Dr.  De- 
clat.  The  term  phenic  is  here  used  instead  of  the 
more  usual  one  of  carbolic  acid,  because  it  is  the 
term  employed  by  Dr.  Dfclat  in  his  numerous  works, 
and  to  distinguish  it  from  the  carbolic  treatment  of 
Lister,  which  originated  several  years  later,  and  is 
different  from  the  former  in  many  important  ele- 
ments. 

Previous  to  the  year  1861,  carbolic  or  phenic  acid 
had  not  been  made  available  as  a  medicine,  properly 
speaking,  that  is  to  say  as  a  remedy  against  disease, 
particularly  of  the  internal  organs.  This  was  due 
mainly  to  its  impurity,  even  of  the  best  specimens 
ordinarily  sold,  to  the  association  with  it  of  numer- 
ous dangerous  bodies,  volatile  essences,  crystalliz- 
able  and  non-crystallizable  substances,  creasote, 
cresilic  acid,  rosauiline,  etc.,  which  prevented  its 
administration  in  doi-es  sufficiently  large  to  be  effec- 
tive and  at  the  same  time  free  from  danger.  It  is  not 
necessary  to  recall  the  accidents  that  have  arisen  from 
the  use  of  this  character.  It  can,  however,  be  ob- 
tained in  a  chemically  pure  state  by  i^irocess  es  given  by 
Dr.  Dtclat  in  his  work,  "  Traitc  de  I'Acide  Phtnique 
appliquee  it  la  Medecine,"  first  ijublished  in  Paris  in 
1865.  After  describing  the  process  of  extracting 
the  acid  from  bituminous  coal,  he  adds :  "  The 
phenic  acid  is  then  rectified  by  distillation  after 
treating  it  with  five  per  cent,  of  caustic  potash.  At 
first  a  mixture  of  water  and  acid  passes  over,  then 
the  acid  alone  in  a  state  of  comparative  purity.     A 


260 


THE  MEDICAL  RECORD. 


second,  and,  if  necessary,  a  third  distillation  purifies 
it  completely.  It  then  sublimes  in  handsome,  rhom- 
boidal,  silky  needles." 

The  pure  acid  crystallizes  always  in  long,  needle- 
shaped  crystals,  never  in  masses.  It  has  no  action 
on  litmus  paper.  It  is  soluble  in  distilled  water  in 
the  proportion  of  six  per  cent. .  A  specimen  which 
does  not  respond  to  these  tests  is  not  chemically 
pure.  In  its  pure  state  it  changes  readily  on  expo- 
sure to  moisture,  air,  and  light.  This  change  can  be 
prevented  by  combining  it,  atom  for  atom,  with 
symp  or  glycerine. 

When  taken  internally  in  either  of  these  combina- 
tions, it  resumes  its  nascent  condition  so  soon  as  the 
processes  of  digestion  and  absorption  free  it  from 
its  combination.  Being  then  readily  diffusible,  it 
permeates  the  system,  performing  its  germicidal 
work  on  the  way,  and  passes  off  principally  by  the 
lungs  and  skin,  but  a  slight  amount  being  eliminated 
by  the  kidneys. 

In  addition  to  its  principal  effect  as  a  germicide, 
there  are  two  minor  effects  that  claim  attention. 
One  is  that  it  has  a  tendency  to  cause  constipation. 
The  second  is  that,  to  a  very  slight  degree",  it  di- 
minishes the  fluidity  of  the  blood.  In  many  cases, 
especially  those  of  chronic  diseases,  these  effects  may 
not  be  oljjectionable. 

In  all  acute  diseases,  however,  from  simple  bron- 
chitis to  yellow  fever,  there  is  a  rise  of  temperature 
depending  on  a  fermentative  action  more  or  less  ex- 
tended, and  corresponding  alteration  in  the  blood. 
This  change  shows  itself  most  markedly  by  a  dimin- 
ished fluidity  of  the  blood,  tending  toward  conges- 
tion of  various  organs,  especially  of  the  brain  and 
lungs. 

To  counteract  this  result  of  febrile  action  and  the 
similar  tendency  of  phenic  acid,  it  is  necessary  to 
add  to  the  latter  some  agent  which  facilitates  the 
circulation  by  keeping  the  blood  fluid,  and  at  the 
same  time  stimulates  the  nervous  system.  Ammonia 
in  its  chemically  pui'e  and  gaseous  state  meets  these 
requirements,  and  .should  therefore  be  associated 
with  the  phenic  acid,  making  an  ammoniacal  phenic 
acid.  It  can  be  made  by  passing  a  current  of  am- 
moniacal gas,  very  dry,  upon  rectified,  jKire,  and 
very  white  phenic  acid  contained  in  any  vessel.  The 
operation  is  continued  until  saturation.  The  matter 
is  made  suflicieiitly  hot  in  order  to  liquefy  the  mass, 
and  the  liquefaction  may  be  acceterated,  if  that  is 
necessary,  by  heating  the  vessel  during  the  passage 
of  the  current  of  gas. 

In  chronic  diseases,  the  germs  may  remain  a  long 
time  in  a  latent  state,  awaiting  conditions  favorable 
to  their  development.  This  is  the  case  both  with 
hereditary  diseases,  as  tuberculoses,  and  with  ac- 
quired maladies,  as  rheumatism,  diseases  of  the  skin, 
lupus,  etc.  It  has  been  found  by  experience  that 
the  addition  of  sulphur  to  phenic  acid  is  useful  in 
many  of  tliese  diseases.  Tliis  combination  can  be 
made  as  follows  :  After  the  first  preparation  above 
alluded  to  is  made,  tliat  is  to  say,  after  the  phenic 
acid  is  completely  saturated  with  ammoniacal  gas, 
let  a  current  of  sulphydric  acid  penetrate  into  this 
preparation,  the  said  acid  being  equally  dry,  and  with 
the  exclusion  of  the  air.  This  produces  an  ammo- 
niacal sulpho  phenic  acid. 

The  proper  dose  of  absolutely  pure  phenic  acid 
for  internal  use,  in  an  adult,  is  twenty-five  to  fifty 
centigrammes,  aboiit  four  to  eight  grains  daily,  to 
be  increased  as  needed  to  one  or  two  grammes,  about 
fifteen  to  tliirty  grains  a  day.  This  gives  doses  of 
from  two  to  ton  tablispoonfuls  a  day,  of  the  syrup 


or  glycerine  combination  as  generally  used.  They 
may  be  taken  pure  or  mixed  with  water,  and  pref- 
erably half  an  hour  before  or  some  hours  after  a 
meal.  The  doses  for  children  are  proportionately 
smaller,  as  in  general  medication. 

In  zymotic  diseases,  in  those  tei-rible  emergencies 
which  arise  sometimes  from  poisoning  by  animals, 
from  dissection  wounds,  in  congestive  chills  and  in 
similar  dangers,  the  most  direct  and  logical  course 
of  arresting  the  fermentative  jorocess  is  by  the  im- 
mediate introduction  into  the  circulation  of  an  effi- 
cient antiseptic  liquid.  In  1861,  Dr.  DOclat  had 
begun  his  system  of  the  internal  administration  of 
phenic  acid  in  the  Infirmary  of  the  Brothers  of  St. 
Jean  de  Dieu,  of  Paris.  In  1863  he  solved  the  jirob- 
lem  as  to  its  hypodermic  employment.  It  was  there 
that  the  eminent  surgeon  Maissonneuve  saw  its  ap- 
plication and  results,  and  adopted  it  in  his  clinical 
school  of  La  Pitifi,  and  in  the  Hospital  of  the  Hotel- 
Dieu. 

At  that  period  the  majority  of  physicians  were 
firm  in  the  conviction  that  the  subcutaneous  cellular 
tissue  could  not  admit  more  than  thirty  drops  of 
any  solution  whatever  at  one  time  and  place.  Con- 
sequently, as  phenic  acid,  though  really  an  alcohol, 
is  somewhat  caustic,  it  seemed  tliat  in  that  quality 
there  dwelt  a  material  impossibility. 

To  overcome  this  it  became  necessary  to  deter- 
mine two  questions  :  first,  in  what  strength  the  solu- 
tions would  no  longer  be  jjaintul  or  injurious,  and 
second,  what  quantity  of  liquid  the  same  tissue 
would  admit  without  inconvenience. 

After  numerous  experiments  ufjon  animals  and 
also  on  his  own  person,  he  ascertained  that  the  sub- 
cutaneous cellular  tissue  would  easily  admit,  in  favor- 
able parts  of  the  body,  as  many  as  a  hundred  drops 
of  a  solution  containing  two  per  cent,  (two  grains)  of 
pure  phenic  acid. 

Two  to  three  injections  a  day,  sometimes  only  one, 
will  often  be  followed  by  more  marked  results  than 
when  fifteen  grains  liave  been  given  by  the  mouth. 

There  is  sometimes,  though  rarely,  as  an  imme- 
diate effect  of  the  hypodermic  injection  of  phenic 
acid,  a  temporary  intoxication,  passing  off  in  a  few 
moments.  No  dangerous  results  are  known  to  have 
ever  occurred  where  the  remedies  used  were  jnne, 
the  syringe  clean,  and  the  injection  properly  made. 

The  parts  most  suitable  for  hypodermic  medica- 
tion are  the  inner  sides  of  the  arms  and  thighs,  and 
the  front  of  the  chest  and  abdomen.  The  latter, 
however,  is  the  place  of  election.  The  needle  should 
be  exceedingly  fine,  and  have  a  flat,  bevelled  end, 
so  that  the  irritation  from  the  puncture  should  be 
as  slight  as  possible.  It  should  i]enetrate  far 
enough  to  reach  the  cellular  tissue.  Sometimes  a 
small,  hard  mass  may  remain,  occasionally  tender, 
especially  in  stout  patients,  but  the  minor  elVects 
disappear  in  a  few  days. 

To  sum  up  the  indications  for  the  emjiloyment  of 
phenic  acid  and  its  combinations  :  in  slight  sick- 
ness, in  malaria,  and  in  many  clironic  diseases  the 
preparation  of  pure  phenic  acid  should  bo  used. 

Whenever  fever  is  present,  as  in  zymotic  diseases, 
the  combination  with  ammonia  is  indicated,  either 
alone  or  alternately  with  the  simple  acid. 

The  use  of  the  combination  with  sulphur  has  al- 
ready been  referred  to. 

Hypodermic  injections  of  the  various  preparations 
should  be  resorted  to  where  a  more  rapid  and  thor- 
ough effect  is  needed,  whether  in  adults  or  children. 
In  many  cases  both  metliods  should  be  used. 

For  external  use  the  acid  may  be  mixed  with  gly- 


THE  MEDICAL  RECORD. 


261 


cerine  and  water,  the  acid  being  in  the  proportion  of 
ten  per  cent.,  and  applied  locally  in  diseases  of  the 
throat,  etc.  This  preparation  mavbe  added  to  ene- 
mas, using  fifteen  to  forty-five  grains  for  this  pur- 
pose, may  be  mixed  with  equal  jjarts  of  oil  and  well 
shaken  with  it.  forming  a  very  pleasant  and  useful 
application  in  burns,  etc.,  or  may  be  further  diluted 
with  water  in  the  proportion  of  one  part  to  twenty 
or  fifty  of  water,  and  thus  employed  for  gargles,  for 
washing  inflamed  surfaces,  for  vaginal  injections,  etc. 

For  inhalations,  the  dry  emanations  or  water  so- 
lutions in  form  of  spray  should  be  used,  the  latter 
not  stronger  than  one-half  to  one  per  cent,  of  acid. 
There  seem  to  be  no  counter-indications  to  the  use 
of  phenic  acid,  nor  does  it  interfere  with  any  coinci- 
dent medication. 

The  very  numerous  cases  given  in  foreign  publi- 
cations of  the  good  eflects  of  these  remedies,  at- 
tested by  many  physicians,  encourage  the  hope  that 
by  their  use  a  great  advance  may  be  made  in  the 
practice  of  medicine.  It  is  most  resijectfully  sug- 
gested that  the  medical  profession  examine  into  the 
truth  of  the  system,  and  report  results,  whether 
good  or  bad,  that  can  be  clearly  ti-aced  to  the  action 
of  chemically  pure  phenic  acid. 


Hc^orts  of  Cjospitals. 


BEIiLEVUE  HOSPITAL,  NEW  YORK. 

CEBEBKAL   EMBOLISM   ON   THE  EIGHT   SIDE. 

Four  cases  related  by  Dr.  Janeway,  at  his  clinics 
this  winter,  illustrate  how  little  reliance  can  prac- 
tically be  placed  in  some  of  the  general  rules  laid 
down  as  aiding  in  diagnosis.  The  statement  is  made, 
and  based  on  careful  analysis,  that  cerebral  embol- 
ism occurs  more  often  on  the  left  side  than  on  the 
right.  Biit  Dr.  .Janeway  presented  three  brains  in 
which  the  emboli  were  in  the  right  Sylvian  artei-y, 
and  with  the  histories  of  these  cases  gave  the  histoi-y 
of  another,  in  which  the  diagnosis  of  the  same  lesion 
was  unquestionable. 

During  the  period  in  which  these  cases  came  to 
him  he  had  but  one  case  of  left  cerebral  embolism. 

Teakly  stjiptom  of  aneurism  op  the  aokta. 

Dr.  Janeway  refers  to  three  cases,  in  his  experi- 
ence, of  aneurism  of  the  arch  of  the  aorta,  in  which 
the  first  symptom  attracting  attention  was  cervico- 
brachial  neuralgia. 

One  of  the  visiting  physicians  insists  upon  the 
importance  of  the  rale  that  two  doses  of  oj^ium 
should  never  be  given  with  a  shorter  interval  than 
one  hour  and  a  half  or  two  hours,  and  says  that  he 
has  seen,  in  several  cases  in  which  this  rule  has  been 
disregarded  by  others,  disastrous  results  from  the 
sudden  and  apparently  cumulative  action  of  the 
drug. 

OOZING   FBOM   LEECH-BITES. 

The  application  of  a  small  piece  of  blotting-paper 
to  leech-bites  is,  in  some  divisiions  of  the  hospital, 
a  favorite  method  of  stopping  the  bleeding,  and  one 
which  often  gives  surprisingly  satisfactory  results. 

THE  treatment  OF  PNEUMONIA  AT  BELLEVUE. 

The  motive  of  the  general  treatment  of  pneumonia 
at  Bellevue  Hospital  is  to  sustain  the  powers  and 
stimulate  the  functions  of  the  patient  till  the  com- 
paratively brief  and  self-limited  disease  shall  have 
spent  itself.  '■ 


The  pulse  is  taken,  rather  than  the  temperature, 
as  the  guage  which  best  indicates  the  capacity  for 
resistance,  and  an  increase  in  its  rapidity  and  dimi- 
nution in  its  force  are  understood  as  a  call  for 
stimulants.  The  forms  of  stimulation  used  are  to 
some  extent  subject  to  differences  of  opinion  on 
the  part  of  the  visiting  physicians,  but  all  are  agreed 
as  to  the  value  of  whiskey,  and  there  is  almost  as 
much  unanimity  in  their  regard  for  the  carbonate  of 
ammonium.  Digitalis  is  much  used  ;  but  it  is  ob- 
jected to  by  some,  jiartly  because  experience  seems 
to  indicate  that  in  some  cases,  when  the  crisis  of  the 
disease  has  passed,  patients  are  left,  after  its  use, 
in  a  condition  less  favorable  for  recovery,  and  partly 
from  the  theoretical  consideration  that  this  drug  is 
not  general  enough  in  its  action.  Camphor  has  been 
employed  by  some  as  a  diffusible  stimulant. 

The  general  treatment  of  imeumonia  is  then  by 
simply  stimulation.  In  special  conditions,  how- 
ever, more  is  done.  TMieu  the  patient  is  first  seen, 
if  he  is  suffering  from  considerable  pain,  a  few  doses 
of  morphia  are  recommended. 

If  the  disease  is  seen  at  its  outset,  and  if  the  out- 
set is  violent  in  character,  one  at  least  of  the  leading 
physicians  on  the  visiting  staff  believes  in  the  good 
effect  of  a  few  doses  of  aconite,  but  its  use  is  not 
general  in  the  hospital  The  spirit  of  Mindererus, 
sweet  spirit  of  nitre,  calomel,  and  Dover's  powder, 
are  used  by  some  in  the  first  stage  of  the  disease. 
Quinine  is  occasionally  called  upon  to  bring  down 
the  temperature  when  it  rises  to  a  serious  height. 
One  of  the  visiting  physicians  makes  a  special  point 
of  the  importance  of  watching  the  kidneys  and  see- 
ing that  they  perform  theii-  duty  well. 

The  appearance  of  cedema  of  the  lungs  finds  all 
agreed  upon  the  necessity  of  crowding  the  stimu- 
lants. But  beyond  this  there  are  some  differences 
of  practice.  They  would  be  included  in  the  use  of 
dry  cups,  the  hot  pack,  oxygen,  and,  in  the  few  cases 
which  are  entirely  suitable  for  it,  bleeding. 

INCONTINENCE   OF   URINE   IN    CHELDEEN. 

The  combination  of  ergot,  belladonna,  and  iodide 
of  iron,  proves  more  useful  for  incontinence  of  urine 
in  children  than  either  of  the  drugs  alone,  or  than 
any  other  combination  which  has  been  tried. 


The  Origin  of  Vacoikia  is  yet  a  disputed  ques- 
tion. The  old  opinion,  that  it  was  a  modified  small- 
pox, has  of  late  been  given  up  by  many,  especially 
in  view  of  Chauveau's  experiments.  Dr  C.  K.  Drys- 
dale  has  recently  written  a  note  to  the  Britiiih  Med- 
ical Journal  on  the  matter.    He  concludes  by  saying  : 

"  For  my  own  part,  I  have  paid  a  good  deal  of  at- 
tention to  the  evidence  on  this  most  curious  and 
important  matter ;  and,  from  formerly  having  been 
of  Mr.  Fleming's  opinion,  I  have  become  convinced 
by  personal  conversations  with  Mr.  Ceely,  Mr.  Bad- 
aock,  and  Mr.  Green,  of  Birmingham,  that  vaccinia 
is  merely  '  mitigated  small-pox.'  Mr.  Badcock  told 
me,  a  few  months  ago  (November,  1881),  that  he  had 
succeeded  in  raising  a  vesicle  on  cows  thirty  times 
out  of  four  hundred  experiments  ;  while,  it  must  be 
remembered,  Chauveau  never  raised  a  vesicle  in  any 
of  his.  I  am,  therefore,  still  of  the  old  faith  in  this 
matter  :  but  think  the  time  has  come  for  making 
careful  fresh  experiments,  in  which,  I  trust,  Professor 
Fleming  will  assist  us  in  arriving  at  some  definite 
conclusions.  Theory  (Pasteur's)  is  on  the  side  of 
Badcock,  since  it  is  only  on  this  theory  that  we  can 
account  for  vaccinia  for  preventing  small-pox." 


262 


THE  MEDICAL  RECORD. 


pr00rc03  flf  iHctilcal  Science. 


ExPERniENTAL  Ubjsmia. — A  recent  work,  published' 
by  MM.  Feltz  and  Ritter  (Paris,  18S1),  summarizes 
the  results  of  researches  which  the  authors  have 
carried  on  for  the  last  fifteen  years,  and  is  analyzed 
by  M.  Lerebouillet  in  the  GazpAle  Hebdomadaire, 
October  21,  18S1.  Says  M.  Lerebouillet:  "The  an- 
tecedents of  the  patient,  progress  of  the  symptoms, 
and  their  well-marked  character,  allow  a  prac- 
titioner to  quickly  establish  the  diagnosis  of  ur:e- 
mia,  of  which  he  only  partially  understands  the 
meaning,  and  much  less  tlie  method  of  treatment." 
He  knows,  it  is  true,  that  bleeding  in  large  or  re- 
peated quantities  has  some  chance  of  arresting 
the  most  terrible  complications  ;  he  has  often  seen 
it  stated  that  drastics  and  diaphoretics  some- 
times succeed.  But  is  it  very  rational  to  bleed  an 
albuminuric  individual  who  has  already  long  since 
arrived  at  a  state  of  extreme  debility ;  is  it  of  use 
to  purge  him?  These  unemic  symptoms  are  not 
due  to  acidity  of  the  urine,  nor  to  the  introduction 
into  the  veins  of  urinary  organic  matters.  On  the 
contrary,  it  is  claimed  that  the  poisonous  salts  of 
the  urine  are  the  salts  of  potash.  If  clinical  ob- 
servation should  confirm  these  experiments  made 
on  animals,  and  if  it  be  demonstrated  that  uriemia 
is  nothing  more  than  poisoning  by  salts  of  potash 
accumulated  in  the  blood  or  fixed  in  excess  in  the 
tissues,  a  new  era  will  certainly  have  been  reached, 
and  the  physician  will  have  comparatively  little  diffi- 
culty in  initiating  therapeutic  measures  to  antago- 
nize the  potash  salt.  —  British  Medical  Journal, 
November  12,  1881. 

High  Local  Temper atubes. — Mr.  William  Squire, 
in   reviewing  the  very  interesting  snViject  of  high 
temperatures  in  non-fatal  cases,  asks  that  those  who 
have  lately  furnished  printed  records  of  extraordi- 
nary readings,  shotild  re-examine  their  patients  in  the 
liglit  of  our  jn-esent  information,  and  furnish  such 
explanation  as  each  case  afiords.     He  therefore  calls 
attention  to  the   following   points  :   During  scarlet 
fever  a  temperature  in  recto  has  been  105',  while  it 
was  only  95°   on  the  skin  of  the  abdomen.     In  the 
axilla  an  accurate  surface  thermometer  has  marked 
103'  on  the  thoracic  side  and  98    on  the  brachial, 
in  a  case  of  acute  pulmonary  congestion.    In  another, 
where   a  man   had   some   obscure    aflection  of  the 
cervical  sympathetic,  the  temperature  was  found  i° 
higher  on  the  left  temple  than  on  the  right.     The 
range  in  health,  at  various  times  in  the  day,  will 
vary  between  92°  and  9(5%  but  the  range  between  the 
two  sides  at  the  same  time  is  rarely  so  much  as  half 
a  degree.    In  conclusion,  Mr.  Squire  suggests  that  a 
definite  value  will  be  given  to  future  records  of  high 
tempei-ature,  provided  allusion  is  made  to  the  in- 
dications of  increased  combustion,  as  evidenced  by 
the  high  color  or  specific  gravity  of  the  urino.    Fur- 
ther, records  of  the  associated  pulse  and  tempera- 
ture, respiration,  condition  of  mouth  and  tongue, 
and  combined  observations  on  the  temperature  at 
various  parts   of  the   liody,    statements   as   to   the 
presence  or  absence  of  hysteria,  or  any  desire  to 
induce  deception,  aa  by  the  use  of  hot- water  bottles, 
etc.,  are   required   to   give   such   cases   a  scientific 
standing.      A  full  history  of  the  case   previous   to 
and  after  the  high  temperatui'n  would  also  assist  in 
making  generalizations  adapted  to  exjilain  the  appa- 
rent paradoxes. — Lnncul,  December  10, 1881. 


CEsTKUS  LABva;  IN  THE  NosTEiLS — The  following 
unique  case  is  reported   by  Kirschman  :   A  peasant 
woman,  aged  fifty  years,  was  seized  with  a  ^-iolent 
fit  of  sneezing,  lasting  a  half-hour.     This  was  fol- 
lowed by  epistaxis,  which  continued  almost  without 
interraption  for  three  days,  finally  requiring  her  ad- 
mission into  the  hospital.     Here  the   hemorrhage 
was  found  to  proceed  from  the  left  nostril  only.  The 
left  half  of  the  face  was  enormously  swollen.     At- 
tempts to  introduce  a  Bellocq's    sound  were  I'en- 
dered  futile  by  an  obstacle  in  the  nostril,  aa  well  as 
by  the  intense  pain  to  which  they  gave  rise  ;  injec- 
tions of    diluted    liquor  ferri    sesquichlorati  were 
consequently  ordered.     After  the  first  injection  the 
patient  stated  that  she  felt  something  moving  around 
in  the  nose  and  in  a  few  moments  a  worm  fell  out, 
followed  shortly  after  by  a  second  and  a  third.     Af- 
ter a  short  interval  a  clump  of  twenty  or  more  worms 
was  evacuated,  together  with  an  ichorous  and  fetid 
mass,  which  jjroved  on  examination  to  be  the  greater 
part  of  the  cartilaginous  septum.     The  hemorrhage 
now  ceased  and  the  swelling  began  to  diminish. 
On  the  following  days  more  worms  were  expelled, 
amounting  in  all  to  seventy-nine  living  specimens. 
In  a  short  while  the  patient  recovered  completely. 
Each  of  the  worms  was  two  centimetres  long,  and 
one-fourth  centimetre  wide,  and  was  recognized  as 
belonging  to  the  class  of  QSstrus  ovis,  the  gadfly  of 
the  sheeiJ.     This  fly  deposits  its  eggs  in  the  nos- 
trils of  the  sheep,  whence  the  growing  larviie  crawl 
into  the  frontal  sinus,  there  causing  ulceration  and 
frequently  gangrene  of  the  mucous  membrane,  the 
affected  animals  in  the  latter  event  perishing.     The 
symptoms  are  constant  sneezing  and  a  discharge  of 
mucus  from  the  nostrils,  together  with  a  tossing  of 
the  head  from  side  to  side,  thereby  offering  consider- 
able resemblance  to   the  staggei-s,   which  is,  how- 
ever, _a  much  more  serious  disease. —  Wiener  med. 
Wochenschrift,  December  3,  1881. 

SnioN  ON  Laege  Doses  of  Belladonna  in  TVhoop- 
ING- Cough. — In  the  Hi'ipitnl  des  Enftmts  Malades, 
of  Paris,  M.  Simon  makes  frequent  use  of  liella- 
donna  in  various  forms  ;  less  often  of  the  neutral 
sulphate  of  atropia.  He  cites  a  case  of  whooping- 
cough  in  a  child  of  three  and  one-half  year.s,  where 
he  gave  during  the  first  day  the  ainusually  large  dose 
of  thirty  drops  of  the  tincture  of  belladonna  ;  on 
the  next  day,  forty  drojis ;  and  on  the  following, 
sixty  drops,  continuing  this  latter  amount  for  ten 
days,  during  which  time  the  medicine  was  borne 
very  well  and  the  attack  greatly  moderated.  The 
same  good  fortune  attended  him  in  prescribing  a 
similar  amount  for  a  second  child,  four  years  old. 
In  a  third  instance,  a  child  three  and  one-half  years 
old  received  between  forty  and  fifty  drops  per  day. 
In  a  young  girl  of  thirteen  the  dosage  was  at  first 
ten,  and  finally  twenty  drops,  the  amount  being  less 
well  borne  by  the  older  children.  Under  the  age 
of  two  he  very  rarely  uses  belladonna,  but  if  he  were 
called  upon  to  prescribe  it  for  an  infant  one  year 
old,  the  dose  would  be  from  one  to  five  drops.  Bel- 
ladonna is  much  preferred  to  atropia. — Gazette  des 
Hopil<titx,  January  5,  1882. 

OiiD  ON  THE  Diagnosis  of  Myxoedema. — At  an 
adjourned  meeting  of  the  London  Clinical  Society, 
held  January  13,  1882.  Dr.  Ord  enumerated  the 
chief  data  by  which  he  would  distinguish  myxci'deraa 
fi'om  other  aflfections,  and  especially  nephritis,  with 
which  some  observers  have  sought  to  connect  it. 
Clinically,  he  found  it  more  common  in  women  than 
I  in  men.     Albuminuria  did  not  occur  in  the  early 


THE  MEDICAL  RECORD. 


263 


stages,  and  sometimes  was  aljsent  in  the  later.  The 
textures  of  the  skin  were  thickened  ;  the  hair  was 
scanty  and  ill-nourished ;  perspiration  was  absent. 
The  thyroid  gland  was  increased  in  size.  Bodily 
temperature  low.  Speech,  thought,  and  movements 
were  sluggish,  but  still  were  performed  with  a  good 
degree  of  completeness.  There  was  no  loss  or  ex- 
aggeration of  the  patella  reflex.  The  patient,  as  the 
disease  advanced,  became  unreasoning,  suspicious, 
and  perhaps  finally  demented.  Death  was  some- 
times introduced  by  debility  and  urx-mia.  The 
pathological  conditions  thus  far  noted  had  been,  in 
the  first  place,  swelling  of  the  connective  tissues 
throughout  the  body,  these  substances  being  im- 
iisually  rich  in  nuclei  and  mucin.  The  elastic  tis- 
sues shared  in  the  overgrowth.  Concurrently  there 
was  atrojjhy  of  the  heart,  liver,  kidneys,  central 
nervous  organs,  hair-bulbs,  sebaceous  and  sudo- 
riferons  glands. — Medical  Pr-ess  ami  Circular,  Jan- 
uary 18,  1882. 

Ho-w  THE  FiBBrMous  Clot  op  an  Axeurism  is 
Formed. — The  old  and  long-accepted  view  that 
laminated  aneurismal  clots  are  formed  by  a  re- 
tarded blood-current  depositing  its  fibrin  in  suc- 
cessive layer.s,  and  the  later  theory  of  Broca,  by 
■which  clots  were  classified  as  vital,  active,  or  fibiin- 
ous,  in  contradistinction  from  those  that  were 
passive  or  mechanical-,  have  been  re-examined  by 
Dr.  H.  D.  Schmidt,  of  New  Orleans,  with  special 
reference  to  a  ease  of  fusiform  aneurism  of  the  femo- 
ral. He  had  been  much  struck  on  previous  occa- 
sions with  the  irregularity  in  the  disposition  of  the 
fibrinous  layers,  diS'ering  as  they  did  much  from 
types  that  have  been  described.  In  this  present 
instance  he  found  abundant  evidence  to  prove  that 
the  original  fibrinous  deposit,  which  measured  only 
two  and  one-fonrth  inches  in  diameter,  had  been 
separated  from  the  waU  of  the  vessel,  allowing  the 
blood  to  pass  behind  it.  The  laminpe  also  were  not 
concentric  but  imbricated  as  a  rule,  and  it  was 
plain  that  the  blood-current  wave  had  swept  in  dif- 
ferent directions  at  dififerent  times.  The  apjjear- 
ances  called  to  raind  the  arrangement  in  the  corol- 
lary petals  of  a  flower  like  the  rose,  rather  than  the 
coatings  of  an  onion,  which  has  been  the  object  so 
often  selected  for  comparison.  The  cause  of  these 
peculiar  deposits  he  traces  to  various  conditions, 
and  even  to  the  position  of  the  patient. 

When  fibrin  is  deposited  between  the  clot  and  the 
sac,  ridges  and  columns  are  formed,  which  at  first 
are  rectangular  to  the  sac,  but  subsequently  are 
pressed  down  by  the  onward  current  of  the  blood, 
which  in  passing  deposits  another  series.  The 
blood-corpuscles  ai-e  thought  to  be  active  agents  in 
the  organization  of  the  thrombus.  Each  change  in 
the  form  of  the  tumor  necessitates  a  change  in  the 
manner  in  which  the  filjrin  is  deposited. — Annah 
of  Anatomy  and  Siirgert/,  February,  1882. 

Thompson  oy  Lithotritt  at  a  SrsroLE  Sitting.^ 
Sh-  Henry  Thompson,  in  summarizing  some  of  his 
views,  expressed  in  a  lecture  delivered  at  University 
College  Hospital,  makes  the  following  statements  : 
Lithotritv  completed  at  a  single  sitting,  is,  in  ex- 
perienced hands,  an  o))eration  unequalled  in  its 
safety  for  the  )5atient.  It  appears  also  to  ))roduce 
less  subsequent  persistent  irritation  of  the  bladder 
than  the  operation  by  several  sittings.  No  new 
form  of  instrument  is  required  by  this  operation. 
The  value  of  the  proceeding  lies  altogether  in  the 
removal  of  all  foreign  matter  from  the  bladder  at 
once,  so  that  nothing  remains  to  excite  inflamma- 


tion in  an  organ  already  irritated  by  the  process, 
and  the  less  in-itating  the  operation  has  been  the 
more  certain  and  more  speedy  will  be  the  recovery. 
It  should  be  employed  by  beginners  only  for  calculi 
of  moderate  size,  when  bard.  If  calculi  are  large  as 
well  as  hard,  a  young  surgeon  will  succeed  more 
safely  by  lithotomy.  In  friable  phosphatic  calculi, 
size  offers  a  much  less  serioiis  difficulty.  Lithotrity 
at  a  single  sitting  for  a  hard  calculus,  upward  of 
one  ounce  in  weight,  and  a  fortiori  when  double 
that  weight,  certainly  demands  an  experienced  oper- 
ator.—  The  Lancet,  January  1-1,  1882. 

Poisoning  by  Dctsoisia. — Dr.  Berner  has  observed 
in  his  own  person  symptoms  of  poisoning  due  to 
instilling  a  one  per  cent,  solution  of  duboisia  into 
his  own  eye.  About  two  minutes  after  the  02)era- 
tion  all  objects  appeared  misty,  small,  and  distant. 
At  the  same  time  he  felt  vertigo  in  turning  round. 
In  the  opposite  eye,  which  had  not  been  treated, 
the  pupil  was  dilated  to  the  maximum ;  there  was 
absolute  loss  of  accommodation,  .ind  sjiarks  of 
fire  appeared  before  him.  Headache  was  absent, 
but  he  experienced  a  sensation  of  coolness  in  the 
face  and  temples,  and  a  constant  desire  to  be  mov- 
ing. The  intellectual  functions  were  also  disturbed, 
and  he  became  somnolent.  At  first  there  was  buz- 
zing in  the  ears,  then  failure  in  hearing.  The  voices 
of  those  about  him  seemed  like  distant  whispers. 
The  mucous  membrane  of  the  mouth  and  throat 
were  dry  ;  deglutition  became  painful  and  difiicult. 
The  embarrassments  of  s])eech  he  regarded  as  partly 
due  to  the  cerebral  condition,  and  partly  to  paraly- 
sis of  the  tongue.  The  arch  of  the  palate  also  was 
paralyzed.  Pulse  was  88,  full  and  strong;  respira- 
tion superficial  and  accelerated.  Partial  and  slight 
paresis  of  the  muscles  of  chest  and  extremities  was 
thought  to  be  present.  .\t  first  the  fingers  and 
nails  were  pale  and  cold,  later  they  were  red  and 
hot.  The  walk  was  unsteady,  as  of  a  drunken  man. 
These  symptoms  disappeared  in  about  four  hours, 
without  anv  special  treatment. — Annales  d'Hi/giene 
Piiblique;  VAbeille  Mtdicak,  January  9,  1882. 

Kesults  of  Foreign  Bodies  KEMAiNrxG  in  the 
Eye. — Prof.  Leber,  of  Gottingen,  claims  that  inflam- 
mation and  suppuration  following  the  accidental 
lodgment  of  foreign  bodies  in  the  eyes  are  not  due 
to  the  foreign  body  jyer  se,  but  either  to  septic  mat- 
ter carried  in  with  the  foreign  body  and  undergoing 
decomposition,  etc.,  or  some  chemical  change  in  the 
body  itself.  In  corroboration  of  these  ideas  he  cites 
instances  from  antiseptic  animal  experimentation, 
where  bits  of  clean  glass,  gold,  etc.,  have  remained 
in  the  different  chambers  of  the  eye  for  a  longer  or 
shorter  period,  and  yet  caused  no  inflammation, 
whereas  similar  but  non-antiseptic  experiments  have 
resulted  in  suppuration,  atrophy  of  the  retina,  cloudi- 
ness of  the  cornea,  hemon-liages  into  the  anterior 
chamber,  and,  finally,  total  loss  of  eyesight.  He 
concludes  that  similar  results  follow  like  experi- 
ments upon  the  human  eye,  and  instances  one  case 
where  a  clean  piece  of  iron  jienetrated  to  the  ciliary 
region  through  the  cornea  and  lens,  the  result  being 
a  corneal  cicatrix  und  traumatic  cataract.  But  no 
inflammation  ensued  until  months  had  elapsed,  and 
chemical  changes  in  the  iron  initiated  the  morbid 
processes,  resulting  in  destraction  of  the  organ. 
Subsequently,  when  enucleation  was  performed,  the 
iron  was  found  in  a  corroded  condition,  the  cornea 
clouded,  the  lens  absorbed,  the  vitreous  fluid  all 
gone,  while  the  retina  was  detached  and  atrophied. 
— British  Medical  Journal,  December  21,  1881. 


264 


THE  MEDICAL  KECORD. 


The  Medical  Record: 

"31  iDfeklg  Journal  of  fllebiciut  anb  Suvgerj) 


GEORGE  F.  SHRADY,  A.M.,  M.D.,  Editor. 


PUBLISnED   By 
frm.  WOOD  ic  CO.,  No.  27  Great  Jones  St.,  N.  Y. 

New  York,  March  11,  1882. 

EXPEEBIENTAL  STUDIES   REGARDING 
THE   NATURE   OF   DIPHTHERIA. 
Dks.  Wood  and  Formad  laave  continued  their  re- 
searches into  the  pathology  of  diphtheria,  and  have 
presented  the  results  ot  their  work  in  a  recent  sup- 
plement to  the  National  Board  of  Health  Bulletin. 

We  present  a  brief  review  of  their  report,  which 
contains  matter  of  the  highest  interest. 

In  a  bibliograi^hical  introduction  the  authors 
quote  nine  observers  who  sujij^ort,  more  or  less 
strongly,  the  bacterial  origin  of  diphtheria.  The 
same  number  of  persons  is  cited  as  opposing  this 
view. 

In  their  experiments  the  authors  worked  with  two 
kinds  of  material.  One  was  the  membranes  from 
cases  of  mild  sporadic  diphtheria  occurring  in  Phil- 
adelphia ;  the  other  was  from  cases  of  ei^idemic 
and  malignant  diphtheria  that  had  occurred  in  Lud- 
dington,  Michigan. 

The  pathology  of  diphtheria  is  discussed,  and  the 
authors  take  the  gi-ound,  now  so  generally  held,  that 
croup  and  diphtheria  are  identical,  pathologically. 

A  description  is  given  of  the  appearance  and  nat- 
ural history  of  the  micrococci  found  in  diphtlieria. 
These  in  fresh  membrane  are  of  one  kind  only.  If 
rod-bacteria  are  seen,  it  is  an  evidence  of  putrefac- 
tion. The  organisms  are  at  first  minute,  round 
bodies,  averaging  in  size  .. snTr,,  of  an  inch,  and  in- 
festing the  white  blood-cells  and  epithelium,  which 
they  tend  to  destroy.  In  the  course  of  twenty-four 
hours  they  grow  a  little  larger,  elongating  till  they 
look  like  small  rod-bacteria,  forming  occasionally 
chains  or  dumb-bell  shapes,  but  in  largo  part  exist- 
ing as  colonies  or  zoiiglcra  masses.  They  have  ap- 
jjarently  only  a  trembling  or  vibratilo  movement. 

These  micrococci  are  always  found  in  diphtlieritic 
membrane,  and,  as  our  aiithors  believe,  are  always 
to  be  seen  in  the  blood  of  cases  of  malignant  diph- 
theria. 


They  are  morphologically  identical  with  the  mi- 
crococci found  in  the  scrajiings  from  a  furred  tongue, 
as  well  as  in  other  non-infective  organic  matter. 
They  are  not  found  in  the  blood  of  healthy  persons. 
But  the  micrococci  of  malignant  diphtheria  have 
this  important  distinguishing  peculiarity  :  they  can 
be  cultivated  to  the  tenth  generation,  gradually  los- 
ing meanwhile  their  poisonous  properties.  Oidi- 
nary  mici'ococci  can  only  be  cultivated  for  four  or 
five  generations,  becoming  gradually  more  sluggish 
and  inactive.  The  difi'erence  between  the  poisonous 
and  nou-poisonous  micrococcus  is,  therefore,  one 
not  of  form,  but  of  vital  activity,  or,  so  to  speak,  of 
fighting  capacity.  This  is,  perhajis,  the  most  impor- 
tant conclusion  reached  by  our  investigators,  for  we 
can  at  once  infer  that  the  poisonous  may  be  easily 
developed  out  of  non-poisonous  organisms. 

Many  inoculation  experiments  were  made  upon 
rabbits.  These  animals  generally  died.  When  mem- 
brane from  mild  cases  of  diphtheria  was  inoculated, 
there  was,  as  a  rule,  local  inflammation,  cheesy  de- 
posit, and  general  tuberculosis.  When  the  more 
virulent  material  was  used,'  there  was  local  ulcer- 
ation, false  membrane,  septic  fever,  and  death,  with 
micrococci  in  the  blood  and  membranes,  and  some- 
times in  the  organs. 

The  authors  think  that  in  these  latter  cases  diph- 
theria was  really  inoculated  in  the  rabbits.  They 
review  the  objections  made  to  such  a  conclusion  by 
Curtis  and  Satterthwaite.  These  latter  experimenters 
produced  death  in  rabbits  by  inoculating  foul  tongue- 
scrapings  and  i^utrid  Cohn's  fluid.  The  lesions  and 
symiJtoms  were  similar  to  those  produced  by  inocu- 
lating diphtheritic  membrane.  Hence,  they  say,  the 
death  was  from  no  specific  dii)htheritic  poison. 

To  this  Wood  and  Formad  say  that  the  deaths 
in  rabbits  inoculated  with  tongue-scrapings  and 
Cohn's  fluid  resulted  from  a  tuberculous  infection, 
and  resembled  the  deaths  produced  by  them  with 
non-malignant  membrane.  Or  else  the  "  scrapings" 
had  themselves  acquired  a  septic  malignancy  which 
was  really  diphtheritic.  This  latter  is,  of  course, 
simply  admitting  that  diphtheria  is  itself  not  the 
specific  disease  supposed,  but  only  a  gangrenous 
septicaemia. 

Still,  as  the  evidence  now  stands,  it  may  lie  as- 
sumed, provisionally,  that  diphtheria  was  really  pro- 
duced in  the  rabbits. 

This  assumption,  it  will  be  seen,  involves  a  good 
deal.  For,  if  these  rabbits  really  suffered  from  diph- 
theria, there  is  a  solid  basis  for  studying  the  question 
as  to  what  share  the  micrococci  had  in  producing  it. 

This  part  of  the  inquiry  can  be  followed  up  in 
three  ways  :  Fir^t,  by  studying  the  influence  of  fil- 
tration upon  the  diphtheritic  poison ;  si\'on(L  by 
studying  the  action  of  the  isolated  micrococci  as 
they  are  to  bo  obtained  from  urine ;  third,  by  study- 
ing the  action  of  micrococci  raised  in  culture-cham- 
bei's  entirely  away  from  tlio  original  poison. 


THE  MEDICAL  RECORD. 


265 


Regarding  the  first  point,  the  authors  are  content 
with  citing  the  conclusive  experiments  of  Curtis  and 
Satterthwaite.  These  gentlemen  showed  that  the 
infectious  princii:)Ie  of  diphtheria,  putrid  Cokn's 
fluid,  and  the  like,  is  solid  and  particulate. 

As  to  the  second  question,  Letzerich  has  found 
that  if  the  clear  urine  of  a  patient  suifering  fi-om 
diphtheria  be  run  through  filter  papers,  and  these  be 
then  washed  and  dried,  the  paper  is  full  of  micro- 
cocci alone,  and  is  as  poisonous  as  diphtheritic  mem- 
brane. Drs.  Wood  and  Formad  repeated  Letzerich's 
experiments,  except  that  they  did  not  wash  the  filters. 
They  found  that  the  dried  paper  was  even  more 
poisonous  than  diphtheritic  membrane  itself. 

This  confirmation  of  Letzerich  is  certainly  most 
important,  and  our  experimenters  are  justified  in  lay- 
ing great  stress  upon  it.  In  their  opinion  it  proves 
that  the  micrococci  are  either  themselves  the  poison, 
or  carry  it,  or  by  their  gi-owth  develop  it. 

The  last  point,  as  to  whether  the  cultivated  or- 
ganisms could  produce  diphtheria  in  rabbits  we 
have  already  referred  to.  The  experiments  were 
hai'dly  conclusive,  being  not  sufliciently  numerous, 
but  they  tended  to  show  that  inoculations  of  the 
second  culture  of  malignant  organisms  would  pro- 
duce the  disease,  that  with  higher  cultures  the  poison 
disappeared,  and  that  cultures  of  micrococci  from 
mild  cases  were  harmless. 

It  seemed  also  apparent,  from  other  experiments, 
that  the  diphtheritic  micrococcus  gradually  lost  its 
vitality  upon  exposure  to  air. 

In  conclusion,  it  will  be  seen  that  the  above  ex- 
periments show,  if  anything,  a  very  close  connection 
between  diphtheria  and  certain  septic  diseases,  such 
as  hospital  gangrene  and  anthrax.  In  the  latter 
diseases  the  same  micrococci  are  found  in  the 
blood  as  in  diphtheria.  The  baci/lus  anthracis  has 
some  features  of  resemblance  to  the  micrococcus  of 
diphtheria,  both  in  appearance  and  life  history. 

That  dijohtheria  and  various  septic  diseases  are 
only  different  manifestations  of  the  same  afl'ection 
seems,  therefore,  not  improbable. 

But  until  this  identity  is  established  and  it  is 
proved  that  rabbits  can  be  inoculated  with  true 
diphtheria,  we  cannot  say  that  micrococci  are  the 
actual  germs  of  the  disease. 


DE.4.FNESS   IN   SCHOOL-CHTLDREN. 

At  the  request  of  the  Commissioner  of  Education, 
Dr.  Samuel  Sexton  has  made  some  investigations 
regarding  the  prevalence  of  deafness  among  school- 
children, its  causes  and  prevention.  The  results  of 
his  work  are  published  in  the  form  of  a  circular  by 
the  bureau  in  question. 

Dr.  Sexton  examined  five  hundred  and  seventy  pu- 
pils in  the  public  and  parochial  schools  of  this  city. 
In  seventy- six  jjersons.  or  about  thirteen  per  cent., 
there  was  greatly  diminished  hearing  in  one  or  both 
ears.     In  only  one  case  had  any  deafness  been  sus- 


pected previously  either  by  teacher  or  pupil.  The 
test  used  was  generally  the  teacher's  voice,  the  pupil 
being  placed  about  twelve  feet  away. 

The  inference  from  the  above  facts  is  that  there 
is  a  wide  prevalence  of  impaired  hearing  among 
school- children,  that  this  fact  is  not  recognized  by 
the  teachers,  and  that,  consequently,  the  children 
sufier  in  various  ways.  No  one  at  all  acquainted 
mth  aural  diseases  will  be  sui-prised  at  or  doubt  this 
conclusion.  One  of  the  immediate  remedies  for 
the  trouble  is  to  seat  the  children  who  are  deaf 
nearer  the  teacher,  and  also  to  institute  a  careful 
examination  of  the  pupils  as  to  deafness  at  the  be- 
ginning of  each  term. 

The  existence  of  deafness  or  defective  hearing  of 
any  kind  among  teachers  also  is  a  matter  deserving 
attention,  and  is  referred  to  by  Dr.  Sexton.  Much 
injury  and  injustice  may  be  done  by  a  teacher  whose 
sense  of  hearing  is  not  normally  acute.  An  exami- 
nation of  teachers  as  to  this  point  is  wiselv  recom- 
mended. 

A  number  of  hints  are  given  regarding  aural  hv- 
giene,  especially  as  it  concerns  the  young  and  their 
relations  to  the  school-room.  The  dangers  from 
taking  cold,  from  dental  irritation,  from  out-door 
bathing,  mouth-breathing,  boxing  the  ears,  and 
from  the  constant  din  of  street  noises,  are  dis- 
cussed. 

The  essential  jjoint  in  Dr.  Sexton's  pami^hlet — 
viz.,  that  there  are  many  unrecognized  cases  of 
deafness  in  the  schools,  and  that  these  ought  to  be 
looked  out  for — is  one  of  real  importance,  and  the 
Commissioner  of  Education  has  done  a  wise  thing 
in  bringing  it  to  the  attention  of  our  educators. 
We  draw  therefrom  another  argument  for  the  pres- 
ence of  the  doctor  in  the  school-room. 


THE    CH.VRm   OKGANIZ.'lTION    SOCLETT. 

With  the  best  of  intentions  on  the  part  of  the  most 
trustworthy  charitable  organizations,  there  is  no  ab- 
solute guarantee  against  fraud.  Recent  investiga- 
tions have  proven  that  apparently  deserving  and 
respectable  persons  have  been  beneficiaries  of  sev- 
eral societies  at  once,  adajjting  their  religious 
creed  to  the  emergencies  of  the  moment.  The  same 
system  prevails  in  our  dispensaries  and  hospitals, 
as  every  one  connected  with  these  institutions  very 
well  knows. 

The  main  cause  of  this  evil  appears  to  be  a  lack  of 
proper  system  in  general  charity  organizations  which 
shall  enable  each  society  to  protect  itself  against 
frauds  and  so-called  "  repeaters,"  and  at  the  same 
time  directly  and  eiHciently  aid  the  common  cause. 
A  movement  in  this  dii'ection,  we  are  glad  to  learn,  is 
now  being  made  by  the  Charity  Organization  Society 
of  the  City  of  New  York,  a  newly  established  asso- 
ciation, having  for  its  main  object  the  systematic 
intercommunication  between  the  various  churches 
and  charitable  agencies  in  the  city,  thus  checking 


266 


THE  MEDICAL  RECORD. 


the  evils  of  the  overlapping  of  relief  to  professional 
paupers,  and  giving  proper  directions  to  snch  as  are 
entitled  to  help  from  particular  charities.  Also  to 
aid,  in  a  strictly  advisory  capacity,  every  effort  to  re- 
press mendicity  by  the  prosecution  of  impostors, 
and  in  every  other  way  protect  and  advance  the  in- 
terests of  the  deserving  poor.  The  society  will  not 
dispense  alms  in  any  form,  but  will  be  what  has 
so  long  been  needed,  a  central  bureau  of  information 
concerning  all  matters  connected  with  charity  or- 
ganizations of  eveiy  kind.  The  step  has  not  been 
taken  unadvisedly,  nor  does  it  appear  that  anything 
is  lacking  in  the  system  of  management  of  the  so- 
ciety to  make  it  in  every  respect  what  it  should  be. 
Too  much  credit  cannot  be  given  to  Miss  Jane  S. 
Lowell  for  her  zeal  and  perseverance  in  laying  the 
broad  foundation  for  its  efficient  working.  Her 
large  experience  in  charity  organization  as  one  of 
the  commissioners  of  the  State  Board  of  Charities, 
has  thus  been  utilized  in  a  direct  and  practical  man- 
ner, and  we  have  i-eason  to  expect  the  best  results. 
The  management  of  the  society  is  vested  in  a  coun- 
cil comjiosed  of  representative  men,  the  Mayor  and 
heads  of  departments  being  members  ex-officio, 
while  Dr.  S.  Oakley  Vander  Poel  has  the  honor  of 
being  its  first  pi-esident. 

We  echo  the  sentiment  of  the  medical  profession 
when  we  wish  the  society  success.  The  realization 
of  the  result  will  tend  to  remedy  many  of  the  flag- 
rant abuses  of  medical  charity,  of  which  physicians 
know  so  much  and  from  which  they  have  so  long 
suffered. 


ADVANCING   THE   STANDARD. 

There  is  no  doubting  the  fact  that  the  standard  of 
qualifications  for  graduation  in  the  medical  schools 
of  this  city  has  materially  advanced  within  the  jiast 
few  years. 

The  system  of  examination  is  more  rigid  than  at 
any  time  heretofore,  and  great  pains  are  taken  to 
prevent  the  graduation  of  unqualified  persons. 
Written  examinations  are  the  rule,  the  questions 
given  are  selected  with  remarkable  cai-e,  and  a  given 
standard  is  strictly  enforced  by  a  direct  vote  of  the 
faculty  on  the  papers  of  eacli  candidate.  It  is  prac- 
tically conceded  that  the  time  has  como,  with  the 
New  York  schools  at  least,  when  a  high  standard  of 
qualifications  for  graduates  must  be  guaranteed,  oth- 
erwise the  prestige  of  New  York  as  a  medical  cen- 
tre will  not  be  maintained.  The  active  competition 
for  places  in  our  hospitals  is  snch,  and  the  require- 
ments for  admission  to  intei-ueshii)  are  so  rigidlv 
enforced,  that  no  New  York  school  can  afford  to  be 
distanced  by  its  generous  rival.  The  same  holds 
true  with  reference  to  army  and  navy  positions. 
The  three  medical  schools  of  this  city  ai-o  about  on 
a  par  regarding  standards  for  graduation,  and  we 
venture  to  s.vy  tliat  the  candidates  who  pass  through 


their  respective  examinations  will  be  immeasurably 
better  fitted  for  the  practice  of  their  future  calling 
than  those  who  gi-aduated  with  honors  a  quarter  of 
a  century  ago. 

Certainly  progress  is  being  made  in  the  right  di- 
rection. 


THE   SEPARATE    SE-WEBAOE   SYSTEM. 

Kesolutions  recently  adopted  by  the  State  Board 
of  Health,  relating  to  the  condition  of  sewers  in 
large  cities,  call  attention,  in  a  very  direct  manner, 
to  a  very  important  subject.  It  is  well  known  that 
most  of  the  sewerage  system  in  large  cities  is  based 
on  a  so-called  mixed  principle — the  surface-drain- 
age, rain  wash,  and  house-sewerage  emptying  into 
a  common  receptacle.  With  a  capacity  equal  to  the 
most  pressing  emergencies  of  the  heaviest  storms, 
the  large  sewers  are,  on  ordinary  occasions,  in  the 
condition  of  spacious  caves,  along  the  floors  of  which 
slowly  courses  a  stream  of  concentrated  filth.  The 
damp  walls  of  these  caverns,  aided  by  the  attend- 
ing conditions  of  heat  and  dampness,  favor  the 
formation  of  bacteria,  and  thus  tend  directly  to  the 
spread  of  the  numerous  zymotic  diseases  which  are 
so  commonly  associated  with  sewer  systems  in  gen- 
eral. Of  course,  we  do  not  pretend  to  say  that  there 
is  anything  particularly  new  in  this,  but  merely  re- 
fer to  it  by  way  of  showing  the  reasons  for  the  re- 
commendation by  the  Health  Board  of  the  so-called 
"  separate  system  "  of  sewerage.  We  have  always 
believed  in  its  principle,  and  are  glad  to  know  that 
the  Health  Board  has,  in  a  formal  and  public  manner, 
given  it  its  sanction.  The  iitility  of  the  measure  has 
been  strikingly  exemplified  in  the  case  of  Memphis, 
which  has  been  transformed  from  a  pest-hole  to  a 
comparatively  healthy  city  ;  and  the  same  might  be 
proven  doubtless  regarding  other  cities  not  a  hun- 
dred miles  awav. 


THE  PAT  OF  THE  LATE  PRESIDENT  S  SrRGEONS. 

Of  late  there  have  been  many  rumors  as  to  the 
amoiint  of  so-called  pay  which  will  be  tendered  to 
the  surgeons  in  attendance  upon  the  late  President. 
We  have  reason  to  believe  that  no  amount  has  as 
yet  been  settled  iipon  by  the  committee  having  the 
matter  in  charge.  The  surgeons  have  not  presented 
any  bills,  nor  is  it  at  all  likely  that  they  will.  Such 
services  as  were  rendered  by  them  should  be  re- 
warded by  honoraria  from  the  Government.  There 
is  a  disposition  to  do  so  on  the  part  of  Congress,  as 
manifested  in  the  cases  of  Surgeon-General  Barnes 
and  Surgeon  Woodward,  both  of  whom  will  doubt- 
less be  advanced  in  rank,  and  will  receive  in  addi- 
tion the  formal  thanks  of  both  Houses.  This  is  as 
it  should  be,  and  the  action  will  be  indorsed  by  the 
medical  profession  and  the  entire  people.  To  the 
other  gentlemen  the  nation  cannot  be  too  liberal. 
The  case  was  a  j)eculiarly  responsible  one  from  first 
to  last,  and  virtually  commanded  the  undivided  at- 


THE   MEDICAL  RECORD. 


267 


tention  of  all  connected  with  it.  It  is  safe  to  say 
that  nowhere  in  history  has  an  instance  been  known 
in  which  there  was  more  devotion  shown  to  any  pa- 
tient, and  more  care  taken  to  minister  to  his  press- 
ing needs,  than  in  that  of  the  late  President. 

The  committee  cannot  err  on  the  side  of  liberality 
to  all  concerned,  and  in  any  case  of  doubt  as  to  the 
amounts  to  be  recommended  should  be  free  to  seek 
advice  from  different  representative  medical  men 
throughout  the  country.  If  any  of  the  figures  lately 
published  apportioning  sums  to  each  of  the  attend- 
ants are  true,  they  are  much  below  the  average  of 
what  they  should  be.  The  nation  certainly  is  gener- 
ously inclined  toward  the  surgeons,  and  the  commit- 
tee in  Congress  will,  it  is  to  be  hoped,  interpret  the 
sentiment  accordinglv. 


THE   HaailC    CKISIS   IN    FEVKRS. 

M.  Hatem,  whose  name  is  familiar  as  a  contributor 
to  the  physiology  and  pathology  of  the  blood,  has 
recently  announced  some  new  discoveries  in  this 
direction. 

The  termination  of  all  acute  fevers  is  accompanied, 
he  says,  by  a  profound  modification  in  the  constitu- 
tion of  the  blood.  This  has,  in  its  constancy,  time 
of  appearance,  intensity,  and  ephemeral  duration, 
every  characteristic  of  a  true  crisis,  as  that  word  is 
understood  at  the  present  day. 

The  phenomenon  in  question  consists  of  a  sud- 
den and  rapid  increase  in  the  number  of  hajmato- 
blasts,  followed  by  an  almost  equally  sudden  decline 
in  this  number,  and  subsequent  increase  in  the 
red-blood  globules. 

In  the  normal  state,  according  to  Hayem,  there  is 
about  one  hiematoblast  to  twenty  red-blood  glob- 
ules. In  fevers  this  ratio  changes,  the  proportion- 
ate number  of  hjematoblasts  becoming  somewhat 
greater. 

At  the  time  when  the  thermic  crisis  sets  in,  the 
hiematoblasts  begin  to  increase  very  rapidly,  and 
within  eighteen  hours  their  number  has  doubled. 
The  increase  then  becomes  slower,  and  within  a  clay 
or  two  has  ceased.  The  curve  of  this  h:emic  crisis 
is,  therefore,  a  very  sharji  one. 

During  fevers  there  is  a  less  active  renovation, 
or  less  comjdete  supply  of  red-blood  globules  than 
in  health.  At  the  crisis  there  is  a  sudden  pouring 
into  the  blood  of  the  hasmatoblasts.  In  a  few  days 
this  increase  stops,  but  meanwhile  the  red-blood 
globules  have  increased,  until,  as  convalescence  pro- 
gresses, the  normal  ratio  is  obtained.  It  is  noted, 
however,  that  these  new  red  globules  are  defective  in 
hsemoglobin,  and  that  there  is  consequently  a  slight 
aniemia,  despite  the  numerical  richness  of  the  blood 
in  globules.  The  normal  condition  of  the  blood  is 
not  brought  about  \mtil  the  end  of  convalescence. 

M.  Hayem  asserts  his  views  regarding  the  above- 
described  phenomena  with  much  positiveness,  and 
there  is  no  esi>ecial  reason  to  doubt  the  facts  that  he 


gives.  His  statements  as  to  the  existence  of  a  post- 
febrile anaemia  tell  us  nothing  new.  In  fact,  his  so- 
called  "  ha^mic  crisis  "  is  chiefly,  if  genuine,  a  thing  of 
theoretical  interest.  Nevertheless,  a  knowledge  of 
its  possible  existence  may  be  of  value,  as  sening  to 
enforce  attention  to  the  fact  that  the  blood  is,  in 
fevers,  a  diseased  tissue,  and  should  be  watched  by 
the  physician. 


Ucrilcn)0  (inti  ttoticcs  of  fJooks. 


Sensation  and  Pain.      By  Chakles  Fatette  Tay- 

LOK.     12mo.     New  York :  G.  P.  Putnam's  Sons; 

1881. 
This  little  monogi-aph  is  the  embodiment  of  a  lec- 
ture delivered  by  the  author  before  the  New  York 
Academv  of  Sciences,  as  one  of  the  public  course 
for  1880-81. 

The  subject  is  treated  in  as  clear  a  manner  as  the 
present  advanced,  though  still  unsatisfactory,  state 
of  psychological  science  permits,  and  the  conclu.sions 
drawn  are  logical. 

Several  of  the  phenomena  of  what  science  is 
pleased  to  call  iniagination,  for  lack  of  a  more  defi- 
nite term,  are  forcibly  illustrated  by  appropriate 
anecdote,  and  the  author  has  shown  how  it  is  quite 
possible  for  the  pretensions  of  charlatanry  to  induce 
false  beliefs  of  apparently  wonderful  cures  in  the 
minds  of  susceptible  and  unobseri-ing  individuals. 

Optom-Smoking.  By  H.  H.  Kane,  M.D. 
The  author  of  this  little  volume  very  ably  dis-- 
cusses  the  origin  and  spread  of  opium-smoking  in 
America ;  its  efl'ect  on  the  difl'erent  systems  and 
organs ;  and  explains  how  all  the  symptoms  hereto- 
fore considered  dangerous  and  distressing,  may  now 
be  easily  and  effectually  met. 

Aids  to  Rational  TnEKAPErTics.  By  J.  Milnek 
Fothekgill,  M.D.,  M.E.C.P.  New  "York  :  G.  P. 
Putnam's  Sons.  1882. 
The  book  abounds  in  common-sense  prescriptions. 
It  is  perhaps  unfortunate  that  most  of  them  call  for 
rather  unpalatable  and  bulky  mixtures.  The  ad- 
vantage of  elegant  and  compact  prescriptions,  when 
not  incompatible  with  efficiency,  cannot  be  too 
strongly  impressed  upon  the  minds  of  students. 

Nekvous  Diseases  :  Their  Description  and  Treat- 
ment. A  Manual  for  Students  and  Practitioners 
of  Medicine.  By  Allan  McLane  Hamilton,  M.D. 
Second  Edition,  Revised  and  Enlarged.  With 
Seventy-two  Illustrations.  Philadelphia  :  Henrv 
C.  Lea's  Son  A:  Co.     Pp.  578.     1881. 

The  present  edition  of  this  work  has  been  consid- 
erably remodelled  and  enlarged.  New  illu.strations 
have  also  been  added.  The  author  introduces  his 
subject  with  some  concise  and  useful  directions  re- 
garding the  modes  of  examining  the  jiatient,  mak- 
ing autopsies,  and  preserving  and  studying  the  ner- 
vous tissues.  A  chapter  on  instruments  for  diagTiosis 
and  treatment  follows,  which  is  not  very  complete, 
though  perhaps  sufficiently  so  for  practical  pur- 
poses. 'The  author  does  not  give  a  correct  account 
of  the  i:)resent  condition  of  cerebral  theimcmetry. 
Ai-midon's  experiments  are  not  referred  to,  nor  the 


268 


THE  MEDICAL  RECORD. 


later  ones  of  Bert,  Franck,  and  Lombard,  which 
throw  so  much  doubt  over  the  value  of  this  msthod 
of  investigation.  The  description  of  electrical  ap- 
paratus aud  of  the  mode  of  application  of  that  agent 
is  very  meagre. 

The  different  diseases  of  the  nervous  system  are 
then  taken  up  in  the  usual  order.  It  is,  we  believe, 
a  mistake  not  to  recognize  functional  diseases  as 
such  by  distinctly  classifying  them.  There  is  no 
evidence  that  such  diseases  as  hysteria,-  catalepsy, 
l^aralysis  agitans,  chorea,  etc.,  are,  in  any  proper 
sense,  spinal  diseases.  However,  Dr.  Hamilton's 
classification  is  convenient,  and  is,  perhaps,  as  good 
as  any. 

The  author  treats  of  the  different  subjects  con- 
cisely, as  is  necessary,  yet  for  the  most  part  all  that 
is  practically  needed  is  given.  A  gi-eater  familiarity 
with  the  microscope  and  with  pathological  appear- 
ances is  shown  than  is  usually  the  case  with  .Ameri- 
can authors.  There  are  frequent  citations  of  illus- 
trative cases  also,  which  make  a  valuable  feature  of 
the  book.  Considerable  original  matter  is  intro- 
duced. The  author  refers  to  his  introduction  of 
nitro-glycerine,  and  he  still  commends  it  in  epilep- 
sy and  otlier  conditions.  He  also  continues  to  speak 
well  of  nitrous  oxide  in  melancholia  and  cerebral 
anaemia,  though  we  are  left  in  doubt  of  the  perma- 
nence of  the  good  effects. 

The  author  has  aimed  to  present  the  subject  of 
nervous  diseases  in  a  clear  and  compact  manner,  for 
the  benefit  of  those  who  have  not  time  or  patience 
to  grapple  with  moi'e  formidable  treatises.  We 
thiok  he  has  succeeded,  and  that  his  book  will  prove 
to  be  a  very  useful  one. 

liEOTUBES  ON  Electriiiity  (Dynamic  and  Franklinic) 
in  its  Relations  to  Medicine  and  Surgery.  Bv  A. 
D.  EocK\vELL,  A.M.,  M.D.  New  York :  William 
Wood  &  Co.     Second  Edition.     1881. 

This  is  a  series  of  six  lectures,  which  present  very 
clearly  as  much  as  can  be  given  in  such  space. 

The  author  speaks  rather  too  confidently  of  the 
brilliant  results  of  electrical  treatment.  He  is  also 
somewhat  premature  in  formulating  so  fully  the  value 
of  static  electricity.  The  book  is,  in  the  main,  how- 
ever, a  very  well  condensed  and  trustworthy  manual. 

Frozen  Sections  op  .*.  Child.  By  Thomas  Dwight, 
M.D.,  Instructor  in  Topographical  Anatomy  and 
Histology  in  Harvard  University,  etc.  With  Fif- 
teen Drawings  from  Nature  by  H.  P.  Qdinct, 
M.D.     New  York  :  AVilliam  Wood  &  Co.     1881. 

This  is  a  series  of  fifteen  plates,  reproducing  an  equal 
number  of  drawings  made  from  freshly  prepared 
transver.se  sections  through  the  frozen  body  of  a 
girl,  aged  three.  The  plates  are  of  life-size,  and  are 
accompanied  by  careful  explanatory  notes,  which  call 
attention  to  many  obscure  but  interesting  points  in 
topographical  anatomy.  Tlie  work  is  almost  unique, 
treating  of  human  anatomy  as  seen  at  an  age  much 
earlier  than  that  of  the  subjects  usually  selected. 
Tliis  fact  does  not,  however,  militate  against  its 
usefulness,  since  all  deviations  from  adult  anatomy 
are  carefullv  indicated.  The  preface  contains  practi- 
cal suggestions  concerning  the  iireparation  of  frozen 
sections,  for  the  value  of  which  the  author's  largo 
experience  is  a  sufficient  guarantee.  The  book  is 
provided  with  a  good  index,  and  is  printed  in  beau- 
tifully clear  typo  upon  excellent  pajier.  It  deserves 
to  be  welcomed  as  a  valuable  contribution  to  the  de- 
partment of  medical  science  of  which  it  treats. 


Ifleport0  0f  Societieg. 


MATERIA  MEDICA  SOCIETY. 

Staled  Meeting,  Thursday,  January  26,  1882. 
Dr.  Henry  G.  Pifpakd,  President,  in  the  Chaib. 
The  paper  for  the  evening,  entitled 

MERCURY    AND    OTHER    REMEDIES     IN    THE    TREATMENT 
OF   SYPHILIS, 

was  read  by  Dr.  G.  H.  Fox.  The  author  proposed  to 
present  certain  views  regarding  the  treatment  of 
syphilis,  which  had  resulted  from  his  study  and  ex- 
perience. He  did  not  present  them  as  novel  and 
original.  They  were  simjily  his  own  opinions  on 
points  of  interest  and  practical  importance,  and  he 
offered  them  for  whatever  they  might  be  worth.  He 
commenced  with  mercury,  and  embodied  his  re- 
marks in  the  form  of  propositions  : 

Fir!<t. — In  the  treatment  of  syphilis  mercury  is 
naturally  the  most  valuable  curative  agent  of  which 
we  have  any  knowledge.  The  positive  results  which 
follow  its  employment  are  such  as  to  convince  any 
competent  observer  as  to  its  efficacy. 

Second. — Mercury  is  an  overrated  remedy.  The 
fact  that  a  remedy  will  do  much  is  no  sign  that  it 
will  accomplish  evei-ything  that  may  be  desired  of 
it.  It  will  lessen  the  manifestations  and  shorten  the 
natural  course  of  syphilis  in  most  cases,  but  it  wiU 
not  always  produce  a  speedy  and  beneficial  effect,  as 
most  physicians  are  inclined  to  believe.  Some  of 
the  worst  cases  of  syi^hilis  in  my  practice  have  oc- 
curred in  patients  to  whom  I  gave  mercury  for  one 
or  two  years. 

Third.  —  If  the  profession  generally  were  more 
strongly  impressed  with  the  great  value  of  hygienic 
measures  in  the  treatment  of  syphilis,  and  were  less 
inclined  to  confide  solely  in  the  specific  action  of 
mercury,  I  am  convinced  that  patients  would  receive 
a  far  greater  amount  of  benefit.  Remedial  agents 
often  acquire  a  fictitious  value  by  reason  of  the  fact 
that  patients  improve  during  tlieir  administration. 
We  know  that  meroury  is  not  inert,  and  have  ample 
proof  that  it  can  and  does  accomplish  a  great  deal. 
The  imiirovement  which  takes  place  in  our  syphi- 
litic patients  when  treated  is  not  wholly  the  effect 
of  mercury.  It  is  due  in  great  measure  to  the  vis 
medicatrix. 

Fourth. — Mercury  is  not  essential  to  the  enre  of 
syphilis.  This  disease,  like  other  erythemas,  tends 
to  run  its  course.  It  may  be  severe,  and,  in  that 
instance,  terminates  fatally.  In  the  majority  of  cases, 
it  is  a  far  less  malignant  disease  than  it  is  supposed 
to  be.  If  the  patient  is  of  sound  constitution  and 
the  infection  is  mild,  it  usually  runs  its  course  with- 
out injuring  the  health  of  the  patient.  It  may  be 
said  that  such  patients  will  sufTer  more  from  severe 
lesions  in  later  years.  I  believe  that  these  patients 
are  as  thoroughly  cured  as  though  they  had  taken 
mercury.  I  have  seen  hale  men  of  advanced  years 
who  have  hail  syphilis  in  their  younger  days  and 
have  received  no  specific  ti'eatment.  so  that  I  can- 
not believe  that  mercury  is  essential  to  the  cure  of 
the  disease. 

Fifth. — The  internal  administration  of  mercury  is 
preferable  to  the  inunction,  vapor-baths,  etc.,  in 
every  case  for  the  cure  of  constitutional  disease.  A 
Romewliat  extended  trial  of  mercurial  inunction  has 
led  me  to  abandon  it.     It  is  but  just  for  me  to  say 


THE  MEDICAL  RECORD. 


269 


that  my  experience  with  the  vapor-baths  and  hypo- 
dermic injections  has  been  very  limited.  They  'pos- 
sess no  advantages  over  the  method  of  internal 
treatment  which  I  can  recommend,  nor  can  they 
claim  the  merit  of  simplicity. 

Si.rt/i.  — Tlie  dose  of  mercury  usually  given  to 
syphilitic  patients  is  unnecessarily  large.  From  the 
time  when  the  heuefpcial  efl'ect  of  mercury  was  esti- 
mated by  the  pints  of  saliva  which  dribbled  from 
the  patient's  mouth,  there  has  been  a  sudden  ten- 
dency toward  diminution  of  the  dosage  of  this  drug. 
I  believe  that  in  the  vast  majority  of  cases  the  very 
best  eifects  on  syphilis  may  be  obtained  by  the  em- 
ployment of  doses  which  will  not  incur  the  slightest 
danger  of  salivation.  I  have  no  faith  in  the  admin- 
istration of  doses  upon  the  homoeopathic  principle. 
The  daily  dose  of  one-half  to  one  gi-ain  of  the  bin- 
iodide  wiU  do  more  good  than  two  to  three  grains. 
Regarding  the  choice  between  metallic  mercury  and 
the  numerous  .salts,  I  am  not  prepared  to  speak. 
The  protiodide  given  in  the  form  of  trituration  will 
not  cause  gastric  disturbance.  In  the  late  stages  of 
syjihilis,  I  have  followed  the  custom  of  changing 
from  the  green  to  tlie  red  iodide.  In  my  own  ex- 
perience, I  have  never  observed  any  benefits  result 
from  the  combination  of  various  salts,  as  recom- 
mended by  Bumstead,  or  by  the  frequent  change 
from  one  preparation  to  another. 

Seventh. — The  duration  of  mercurial  treatment 
should  vary  according  to  the  character  of  the  case. 
There  are  cases  of  mild  and  cases  of  severe  syphilis. 
Mild  syphilis  does  not  demand  mercurial  treatment. 

I  do  protest  against  treating  all  cases  of  syjihilis 
upon  a  routine  jjlan.  Many  wi'iters  on  syphilis  lay 
down  the  absolute  rule  that  the  disease  must  be 
treated  during  a  certain  specified  number  of  months 
or  years,  without  even  hinting  that,  for  varioiis  rea- 
sons, one  patient  may  not  require  as  much  treatment 
as  another.  In  our  text-books  of  the  present  day 
the  description  of  syphilis  rarely  corresponds  with 
the  average  case  in  ijractice,  but  it  is  the  description 
of  the  superior  and  comparatively  uncommon  forms 
of  the  disease.  The  question  is  not  what  the  disease 
is  capable  of  doing,  but  what  it  is  likely  to  do. 
There  ai-e  cases  of  syphilis  which  demand  two, 
three,  or,  perhaps,  five  years  of  treatment.  But  it 
seems  to  me  to  Vie  utterly  impossible  to  fix  a  certain 
time  as  the  duration  of  treatment  for  all  cases. 
When  the  early  symptoms  are  slight  and  disappear 
under  treatment,  I  deem  it  quite  necessary  to  con- 
tinue the  use  of  mercury  for  two  or  three  years  to 
entirely  eradicate  the  disease  and  prevent  subse- 
quent manifestations.  Late  lesions  of  .syphilis  fre- 
quently do  occur  after  prolonged  administration  of 
mercury.  My  own  practice  is  to  give  mercury  in 
every  case  during  the  existence  of  any  symi^tom  of 
the  disease,  whether  it  occurs  early  or  late.  In  the 
early  period  I  continue  the  use  of  mercury  for  six 
months  after  the  last  symptom  has  yielded.  I  then 
stop  the  administration  of  the  drug  and  await  fur- 
ther developments.  If  the  symptoms  reappear,  I 
resort  again  to  the  xise  of  merciiry,  and  continue  for 
perliaps  two  or  three  months  after  the  disappear- 
ance of  the  latest  symptoms.  In  late  syphilis  I  give 
mercury  to  subdue  any  growing  symptom  and  then 
stop. 

lODIKE    AND   ITS   COUPOUKDS. 

Iodine  has  been  strongly  recommended  as  an  anti- 
syphilitic  remedy  by  vai-ious  writers.  The  drug  is 
rarely  er.ployed,  and  appears  to  me  to  have  fallen 
into  disuse.     In  oral  lesions  I  have  obtained  such 


satisfactory  results  from  the  use  of  iodine  that  I  am 
inclined  to  believe  that  in  such  cases  where  mercury 
l)roduces  little  etl'ect,  iodine  would  be  advantageous. 
It  is  the  ju-evalent  belief  among  authoritative  writ- 
ers that  the  iodide  of  potassium  has  no  actual  cura- 
tive effect  in  the  treatment  of  syphilis,  but  merely  a 
power  to  cause  the  disajipearance  of  certain  symp- 
toms, and  furthermore,  that  it  has  little  or  no  value 
in  the  early  stages  of  the  disease.  I  believe  that  in 
the  earlier  stages  of  syphilis,  iodide  of  potassium  is 
an  invaluable  therapeutic  agent.  In  many  cases  of 
chancre  characterized  by  massive  induration  I  gave 
the  iodide  of  potassium,  and  apparently  with  the  ef- 
fect of  reducing  its  size.  In  the  stage  of  efflorescence 
I  must  admit  that  the  drug  has  little  or  no  effect 
u]!on  the  cutaneous  manifestations.  Still,  as  the 
drug  causes  an  increase  in  the  number  of  blood-cor- 
puscles, it  has  the  same  right  as  mercury  to  be 
ranked  as  a  tonic.  In  ulceration  of  the  tongue  and 
mucous  patches  I  have  seen  good  results  following 
the  iodide  of  potassium,  when  mercury  had  been 
given  for  several  weeks  with  no  effect.  In  the  cure 
of  cephalalgia  and  arthritic  pains  associated  with  tiie 
tirst  outbreak  of  svphilis,  the  iodide  of  pota.'sium 
displays  its  remarkable  power.  Of  the  great  value 
of  the  drug  in  late  .syphilis  I  need  not  speak.  Its 
power  is  often  exerted  in  a  most  brilliant  manner 
when  its  administration  is  preceded  by  a  course  of 
mercurials.  I  can  recall  cases  of  syphilitic  orchitis- 
where  the  drug  has  been  seen  to  have  little  effect, 
but  on  resuming  the  iodide  of  potassium  after  a 
course  of  mercury,  the  swelling  of  the  testicle  was 
lessened  with  surjirising  rapidity.  The  iodide  is. 
best  prescribed  in  an  aqueous  solution,  a  cubic  centi- 
metre containing  one  grain  of  the  drug.  Iodide  of 
liotassium  is  a  remedy  which  no  i>atient  ought  to  be 
compelled  to  take  for  a  great  length  of  time.  It 
does  its  work  quickly  or  not  at  all.  When  unneces- 
sarily continued  it  is  sure  to  do  harm.  It  is  un- 
doubtedly ti-ue  that  a  tive-gramme  dose  will  eonjetimes 
accomplish  a  result  when  four  grammes  will  produce 
no  effect.  For  every  case  of  syphilis  which  I  have 
seen  benefited  by  immense  doses  of  the  iodide  I 
have  seen  at  least  two  cases  in  which  large  doses 
have  done  harm.  Several  physicians  have  told  me 
of  cases  of  syphilis  in  which  the  symptoms  were 
frightful  to  an  extreme  degree,  and  could  only  be 
kept  in  abeyance  by  the  continuous  administration 
of  immense  doses  of  iodide  of  potassium.  I  cannot, 
from  my  o-mi  experience  believe  that  there  are  such 
cases,  and  I  am  sure  that  in  some  instances  the 
symptoms  of  iodism  have  been  mistaken  for  the  ef- 
fects of  syphilis.  I  do  not  deny  the  value  of  large 
doses  of  the  iodide  of  potassium  in  certain  cases, 
but  I  protest  against  the  continuance  of  large  doses 
in  chronic  syphilis. 

Where  there  is  dyscrasia  and  a  weakened  state 
of  the  digestive  organs,  I  have  gi'eat  faith  in  the 
iodide  of  starch.  Iron  is  a  remedy  which  in  the 
treatment  of  syphilis  is  of  very  gi'eat  value.  It  de- 
serves to  be  ranked  with  mercury  and  the  iodide  of 
potassium.  Its  power  to  combat  the  ana-mia  which 
is  invariably  present  in  the  early  stage  of  syphilis 
renders  it  a  most  invaluable  adjunct  of  mercury. 

I  should  prescribe  it  for  a  patient  presenting  the 
chancre  or  initial  lesion,  and  give  it  as  routine  in 
the  secondary  lesions.  It  tends  in  a  slight  degree 
to  lessen  the  probability  of  sulisequent  manifesta- 
tions. In  the  weakened  state  of  the  system  associ- 
ated with  late  syphilis,  the  value  of  iron  is  too  well 
known  to  require  mention,  but  in  the  early  stage  of 
the  disease  its  value  seems  to  be  unknown  or  unap- 


»70 


THE  MEDICAL  RECORD. 


predated.  I  should  employ  the  tincture  of  chloride 
of  iron  in  daily  doses  of  ten  to  fifteen  drops.  Cod- 
liver  oil  is  a  remedy  which  is  not  infrequently  of 
service  in  the  treatment  of  syphilis.  When  an  indi- 
vidual with  a  strumous  diathesis  is  affected  by  this 
disease,  its  symptoms  are  apt  to  be  severe  and  pro- 
longed, and  amenability  to  mercurial  treatment  is 
greatly  lessened.  Jn  these  cases  the  use  of  cod-liver 
oil,  alone  or  in  connection  with  ii-on,  is  likely  to  be 
productive  of  good  results.  In  late  .syphilis  of  an 
ulcerative  type,  I  have  repeatedly  seen  mercury  fail 
to  do  good  at  first,  while  after  the  administration  of 
oil  for  a  month  or  two,  it  has  accomplished  all  the 
good  that  could  be  expected  from  its  use.  Of  the 
vegetable  remedies  in  the  treatment  of  syphilis  I 
am  not  prepared  to  speak  at  the  present  time.  In 
regard  to  hygienic  measures,  I  would  remind  you  that, 
in  many  of  our  cases,  over-indulgenc-e  in  alcoholic 
drinks,  improper  food,  and  lack  of  out-door  exercise 
have  produced  a  condition  of  mind  and  body  which 
complicates  syjihilis,  and  for  which  mercury  is  not 
a  specific.  Teachers  of  medicine  impress  upon  the 
mind  of  the  pupil  the  necessity  of  treating  the  dis- 
ease and  not  its  symptoms.  I  would  impress  upon 
the  mind  of  every  physician  the  duty  of  treating  the 
patient  and  not  simply  his  disease. 

The  discussion  was  opened  by  Dn.  Sturgis,  who 
spoke  as  follows  :  The  wi'iter  says  that  he  thinks 
mercury  is  the  best  thing  to  be  given  under  the  cir- 
cumstances, but  many  cases  will  get  on  perfectly 
well  without  it.  We  will  grant  that,  but  I  think 
the  danger  of  not  giving  it  is  the  risk  that  is  run  for 
the  future.  I  do  not  think  we  can  predict  positively 
whether  the  case  will  turn  out  well  or  ill,  no  matter 
whether  mercury  be  discontinued  or  not,  and  I 
think  the  physician  or  surgeon  runs  a  risk  in  de- 
priving his  patient  of  mercury.  With  regard  to 
the  question  of  routine  treatment,  I  do  not  suppose 
that  any  surgeon  follows  it  alisolutely  in  the  adminis- 
tration of  mercury.  It  is  merely  giving  the  best 
thing  that  can  be  used.  Various  forms  of  mercury 
and  the  manner  in  which  they  can  be  given  often 
constitute  a  very  important  feature  in  the  treatment 
of  the  case.  I  agree  with  the  gentleman  in  think- 
ing that  any  form  of  mei-cury  is  perfectly  admissible 
in  treating  syphilis.  There  are  certain  ])re|)arations, 
however,  which  I  do  not  think  are  of  benefit.  There 
are  others  which  I  think  will  work  very  much  bet- 
ter than  the  forms  spoken  of.  The  protiodide, 
although  a  very  excellent  drug,  I  think  is  very 
much  more  apt  to  produce  disturbance  than  other 
mild  preparations  of  mercury,  among  these  notably 
blue  mass,  with  or  without  sulphate  of  iron,  which 
acts  as  a  tonic  and  which  I  think  also  prevents  the 
ill  effects  of  mercury  either  on  the  mucous  mem- 
branes or  other  parts.  With  regard  to  the  inunc- 
tion method,  I  am  i-ather  surprised  at  the  conclu- 
sion that  the  reader  has  arrived  at,  because,  of  all 
the  methods  of  giving  mercury,  the  inunction,  apart 
from  its  disagreeable  qualities  of  uncleanliness,  is 
certainly  the  most  effective  way  and  jiroductive  of 
the  least  ill  results.  The  hypodermic  method  is 
oi)en  to  objections ;  the  principal  ones  in  jirivate 
practice  are  the  tendency  which  it  has  to  produce 
ab.scesses  and  the  discomfort  which  it  generally  pro- 
duces to  the  patient  himself.  As  regards  the  iodide 
of  potassium,  I  do  not  believe  in  its  efficacy  in  the 
earlier  stages.  I  do  not  believe  that  its  action  is 
really  what  we  would  call  at  all  curative.  The 
reader  spoke  of  massive  indurations  disap))pariug 
under  its  use.  UndouV)tedly  they  will ;  but  during 
(the  initial  stage  and  during  the  period  of  eruption 


of  the  skin  and  mucous  membranes,  in  cases  where 
the  induration  disappeared,  it  was  vei-y  apt  to  re-  i 
turn.  I  believe  that  the  effect  of  iodine  throughout  I 
the  whole  coxirse  of  the  disease  is  purely  evanescent 
and  temporary.  The  later  stages  of  the  disease  re- 
quire mercury  for  their  thorough  cure  and  thorough 
disappearance  of  symptoms.  Where  headaches  oc- 
cur large  doses  of  iodide  of  .potassium  will  some- 
times produce  a  quick  result.  But  I  have  noticed 
where  the  iodide  has  been  used,  the  effect  is  lost 
much  more  quickly  than  if  a  small  dose  of  mercury 
be  at  once  commenced  and  continued  until  the 
symptoms  are  permanently  and  definitely  relieved.  J 
I  believe  that  preparations  of  iodine  are  of  most  use,  I 
principally  for  the  relief  of  symptoms,  in  cases  where  ( 
ulcerations  have  occurred.  I  consider  that  the 
action  of  iodide  of  potassium  has  been  vastly  over- 
rated, and,  although  I. think  it  is  an  excellent  assist- 
ance, I  do  not  by  any  means  regard  it  as  the 
essential  point  in  the  treatment  of  the  disease.  With 
regard  to  tonics,  etc.,  the  remarks  were  imdoubtedly 
well  made.  The  syruj)  and  the  various  other  prepa- 
rations of  the  iodide  of  iron  are  exceedingly  good ; 
the  syrup  is  the  one  form  that  I  prefer  to  others.  I 
like  that  better  than  the  tincture  of  the  chloride  of 
iron,  although  the  latter  is  a  good  preparation. 
The  iodide  of  starch  and  the  iodide  of  sodium  have 
rather  disappointed  me ;  I  do  not  think  they  are  of 
very  much  sei"vice.  I  have  never  been  satisfied  with 
the  results  that  I  liave  been  able  to  produce  with 
the  iodide  of  starch.  Within  the  last  year  I  have 
practically  given  up  the  use  of  it.  As  regards  the 
combined  use  of  mercury  and  the  iodide  of  potas-  ft 
slum,  I  think  the  effect  which  he  thought  was  ^pro-  \\ 
duced  by  the  iodide  was  really  produced  by  the  ' ' 
mercury.  Iodine  seems  to  produce  solution  of  the 
mercury  and  render  it  very  much  more  active.  We 
find  if  after  a  course  of  mercui-y  iodine  be  u.sed,  the 
effects  of  mercurialism  are  noticed  in  the  slight 
ptyalism  and  diaiThoea,  where  mercury  alone  has 
produced  no  such  result.  In  the  case  sjioken  of,  I 
am  inclined  to  lielieve  that  the  result  occurred  fi-om 
the  mercury  and  not  from  the  iodide  of  potassium. 
In  syphilis  you  will  often  find  jjatients  who  do  not 
seemn^to  respond  to  the  use  of  mercury.  It  pro- 
duce.saio  results  either  physiologically  or  toxically. 

If  purgatives  or  tonics  be  given  while  mercury  is 
suspended,  you  will  find  the  absorptive  power  very 
easily  increased.  I  belief  that  if  the  use  of  mercury 
be  abandoned  in  the  treatment  of  syphOis.  it  wonUl 
be  bad  for  both  surgeon  and  patient.  The  latter 
would  be  very  much  more  likely  to  show  evil  results 
of  thejdisease  than  where  the  proper  course  of  mer- 
cury is  given,  and  where  it  is  properly  administered 
during  the  course  of  the  disease.  In  the  treatment 
of  syphilis  and  in  the  intermittent  way  of  giviuir 
mercury,  I  fully  agree  with  the  reader  of  tho  piqier. 

Dr.  Johnson  :  The  reader  drew  a  parallel  between 
syphilis  and  scarlet  fever.  I  have  always  understood 
tliat  certainly  there  were  cases  of  syphilis  tliat  were 
mild,  and  cases  that  were  severe,  but  I  have  always 
supposed  that  the  mildness  or  severity  of  the  case 
depended  entirely  uiK)n  the  constitiition  of  tlie  indi- 
vidual ;who  was  afflicted  with  it,  while  in  scarlet 
fever,  measles,  small-pox,  and  other  exanthematous 
diseases,  where  we  have  mildness  or  severity  of  dis- 
ease, it  is  generally  attributed  not  so  much  to  the 
condition  of  the  patient,  although  that  not  infre- 
quently modifies  it  to  a  very  great  extent,  but  more 
generally  to  climatic  infiuencea  or  sanitary  .surround- 
ings. Thus,  for  instance,  we  are  now  in  the  mid.st 
of  an  epidemic  of  scarlet  fever  which  in  a  gieat  num- 


THE  MEDICAL  RECORD. 


271 


ber  of  instances  is  exceedingly  severe,  even  in  families 
who  are  in  the  midst  of  good  hygienic  surroundings. 
I  should  like  to  know  what  the  reader  of  the  paper 
means  by  his  mild  and  benignant  disease,  whether 
he  wishes  to  consider  the  jiarallel  drawn  as  original, 
and  whether  syi^hilis  is  a  disease  which  is  subject  to 
the  like  laws  and  manifestations  with  other  exanthe- 
matous  diseases.  AVith  regard  to  the  point  which 
was  made  by  Dr.  Sturgis  on  the  use  of  mercury  and 
iodide  of  potassium,  the  iodide  of  jjotassium  render- 
ing the  mercury  more  evident,  I  would  say  a  few 
words — I  think  there  can  be  no  doubt  that  the  iodide 
of  potassium  renders  the  mercury  which  has  re- 
mained inactive  in  the  system  for  a  time  much  more 
active.  It  certainly  acts  in  an  analogous  manner  in 
the  case  of  lead.  The  iodide  of  potassium  is  not  in- 
frequently used  as  a  remedy  in  lead-poisoning ;  very 
often  when  its  use  is  first  begun,  and  the  system  is 
brought  under  its  influence,  the  .symptoms  of  jioi- 
soning  are  increased.  No  doubt  by  its  prolonged 
use  it  helps  to  eliminate  the  lead  from  the  sy.stem  ; 
but  the  flrst  stage  in  that  process  of  elimination  is 
marked  by  an  increase  in  the  activity  of  the  lead  and 
an  increase  in  the  poisonous  symptoms. 

Dr.  O.iSTLE :  I  agree  with  Dr.  Fox  in  the  state- 
ment he  made  regarding  the  different  ways  in  which 
different  persons  are  afl'ected  by  the  disease.  I  have 
seen  quite  a  number  of  cases  that  were  quite  mild. 
These  I  treated  with  mercui-y,  more  because  I  be- 
lieved that  my  duty  required  that  I  should  give  it, 
with  a  view  to  jjrevent  subsequent  developments,  than 
because  their  condition  [at  the  time  required  active 
medication.  In  such  cases  I  have  combined  it,  as 
in  others  that  were  more  severe,  with  the  use  of 
tonics,  and  as  thorough  attention  as  I  could  secure 
to  the  hygiene  of  the  patient,  which  I  consider  in 
the  treatment  of  syphilis  to  be  quite  as  important 
as  specific  medication.  I  believe,  as  the  writer  of 
the  paper  does,  that  the  natural  tendency  of  the 
system  to  recover  fi'om  the  effects  of  the  poison  is 
great  enough  to  be  of  service  in  its  treatment,  and 
that  this  power  of  recuperation  differs  greatly  in  dif- 
ferent persons.  In  using  the  iodide  of  potassium, 
as  I  have  done,  sometimes  in  combination  with  the 
mercury,  sometimes  by  itself,  most  commonly  in  the 
later  stages  of  the  disease,  I  have  had  two  i^oints  in 
view,  viz.,  the  influence  of  iodine  in  producing  the 
absorption  of  such  pathological  deposits  as  were 
about  to  take  place  in  a  disease  of  tliis  character, 
and  also  in  relieving  the  pains  which  are  liable  to 
occur  in  the  later  stages  of  the  malady.  I  believe 
that  it  is  only  in  this  way  that  the  iodide  of  potassium, 
or  any  of  the  iodides,  can  produce  any  specific  effect. 
As  soon  as  the  iodine  is  eliminated  from  the  system 
its  eflect  ordinarily  ceases,  and  to  secure  it  the 
iodide  must  be  continued  for  some  time." 

Dii.  Smith  :  Some  of  the  important  facts  in  the 
paper  have  already  referred  to  what  had  occurred 
to  me,  and  although  not  in  the  line  of  treating  miich 
syphilis,  I  have  to  see  it  all  the  time  in  primary, 
secondary,  or  tertiary  form.  Young  men  are  thus 
taught  very  frequently  that  mercurials  and  the 
iodides  are  specifics  in  the  treatment  of  syphilis,  and 
not  sufficient  stress  is  laid  by  teachers  upon  the  im- 
portance of  resorting  to  other  means  of  aiding  those 
remedies.  I  do  not  refer  now  to  the  use  of  other 
means  to  the  exclusion  of  mercurials  and  iodides, 
but  to  using  other  remedies  as  aids  to  mercury  and 
the  iodides — the  very  jioint  that  Dr.  Fox  brought  out 
so  prominently.  I  am  satisfied  that  in  many  cases  I 
have  seen  mercury  produce  very  little  effect  upon 
the  advance  of  syphilis,  but  after  the  administra- 


tion of  tonics,  the  surrounding  of  the  patient  with 
good  hygiene,  and  improvement  of  the  general  con- 
dition, particularly  of  the  digestive  assimilative 
powers,  the  merciiry  has  produced  much  more  de- 
cided results.  1  am  not  so  .sure  but  that  Dr.  Fox  made 
a  very  important  point,  to  which  two  of  the  gentle- 
men in  referring  to  it  did  not  seem  to  assent.  I  con- 
fess that  I  am  not  inclined  to  feel  that  the  eflecte  of 
giving  large  doses  of  iodides  are  evanescent.  I  ques- 
tion very  much  whether  it  would  be  safe  to  recom- 
mend the  administration  of  iodide  of  potassiiim  in 
increasing  doses  until  you  get  certain  effects  in 
order  to  control  the  tertiary  forms  of  syphilis.  I 
speak  upon  it  because  in  using  the  iodide  of  potas- 
sium in  the  case  of  a  lady  who  was  past  sixty,  and 
who  had  led  me  to  believe,  and  the  opinion  was  con- 
firmed by  other  observers,  that  there  was  a  syphil- 
itic taint,  the  iodide  of  potassium  produced  at  first 
a  veiy  good  effect  upon  her  but  finally  developed  a 
permanent  difficulty  in  the  way  of  throat  and  nasal 
ti-oubles  which  never  disappeared.  That  led  me  to 
study  the  subject,  and  I  Vielieve  that  I  have  seen 
permanent  results  from  the  continued  use  of  iodide 
of  potassium,  which  I  was  inclined  to  disbelieve  be- 
fore. The  winding  up  of  this  paper  seemed  to  me 
again  to  be  most  practical  and  excellent,  and  that  is 
that  we  should  remember  the  i^atient  as  well  as  the 
disease,  more  decidedly  the  patient  than  the  dis- 
ease. 

Dr.  Mobkow  :  My  plan  of  the  treatment  of  sy- 
philis has  been  the  orthodox  one  of  giving  mercury 
and  iodide  of  potassium  in  all  stages  of  the  disease, 
of  coiirse  with  proper  discrimination.  But  I  treated 
quite  a  number  of  cases  without  mercury,  and  I  can 
only  state  that  I  have  not  been  able  to  observe  any 
difference  Iietween  the  evolution  of  the  secondary 
symptoms  in  these  cases  and  those  of  other  cases 
that  I  was  treating  at  the  same  time  with  merciiry. 
Tliese  cases  that  I  refer  to  may  have  been  exception- 
ally mild.  In  one  of  them  I  had  to  resort  to  mer- 
cury because  there  was  an  iritis  developed  which  I 
did  not  think  could  be  controlled  by  any  other 
plan  of  treatment.  But  I  have  no  faith  in  the  ab- 
solute curative  jjower  of  mercury  over  syphilis.  I 
believe  that  it  may  suppress  certain  manifestations 
of  the  disease,  but  I  do  not  think  it  can  eradicate 
the  poison  or  correct  the  diathesis.  It  is  a  matter 
of  interest  to  note  the  fact  that  twenty-five  to  thirty 
years  ago  the  ]ilan  of  treatment  recommended  for 
the  cure  of  syphilis  was  to  give  mercury  for  a  few 
months — perhajis  six  to  twelve  months — that  was 
thought  to  cure  the  disease.  But  later  on  this  treat- 
ment was  extended  from  eighteen  months  to  two 
years.  Now,  I  think  the  best  syphilogi-aphers  are 
of  the  oi^inion  that  a  mercurial  course  ought  to  be 
continued  for  at  least  four  years,  even  if  there  be  no 
manifestation  of  the  disease  at  that  time,  simply 
with  a  view  of  protecting  the  individual  from  subse- 
quent manifestations,  sometimes  occurring  ten  to 
twenty  years  later.  *I  think  that  the  change  which 
has  taken  )dace  in  the  treatment  of  the  disease  is  an 
evidence  of  a  growing  lack  of  faith  in  the  curative 
properties  of  mercury. 

In  regard  to  the  use  of  iodide  of  potassium,  I  have, 
of  course,  given  it  in  what  I  considered  sensible 
dosee,  but  have  never  given  it  in  those  enormous 
doses  of  700  grains  per  day  and  upward,  and  should 
be  very  much  inclined  to  doubt  the  propriety  of 
doing  so.  I  think  there  are  many  cases  of  syphilis 
which  would  get  along  just  as  well  without  any  treat- 
ment, except  a  simple  tonic  one,  as  they  will  under 
the  influence  of  mercury  and  iodide  of  potassium. 


272 


THE   MEDICAL  RECORD. 


Dr.  Bronson  :  I  would  express  my  concurrence 
folly  with  the  views  of  that  radical  paper.  I  think 
it  is  high  time  that  something  be  said  to  combat  the 
dicta  of  Foamier  with  regard  to  tlia  routine  treat- 
ment of  all  cases  of  syphilis.  I  think  there  is  suflj- 
cieut  authority  on  the  other  side  which  would  justify 
us  in  regarding  some  cases  as  not  requiring  mercu- 
rial treatment  to  any  great  extent.  For  my  own 
part,  I  would  not  feel  justified  in  neglecting  mer- 
curial treatment  in  any  case.  Certainly,  there  is  no 
remedy  for  the  treatment  of  syphilis  that  can  com- 
pare in  efficacy  with  that  of  mercury,  and  I  would 
consider  it  my  duty  in  every  case  to  begin  treatment 
with  that  drug.  I  do  not,  however,  by  any  means 
feel  that  I  am  required  to  jjursue  this  treatment  for 
four  yeai's,  or  for  any  long  period,  if  on  the  develop- 
ment of  the  case  it  proves  to  be  a  mild  one,  and  is 
not  likely  to  materially  damage  the  patient's  health. 
With  regard  to  the  form  of  the  mercurial,  the  sanc- 
tion of  the  profession  is  that  the  one  should  be 
chosen  which  is  most  easily  assimilated.  I  think 
that  the  principle  in  giving  the  iodides  is  to  facili- 
tate the  absorption  of  mercurials,  thus  enabling  us 
to  accomplish  with  small  doses  what  formerly  we 
could  only  do  with  large  ones.  It  seems  to  me 
that  the  most  scientific  plan  of  giving  mercury  would 
be  the  hypodermic  injection,  for  the  reason  that  we 
know  precisely  the  amount  of  mercury  given.  In 
this  way  the  proportion  eliminated  by  the  kidneys 
corresponds  more  nearly  to  the  amoimt  given  than 
when  it  is  administered  in  any  other  form.  It  would 
seem  as  though  we  could  anticipate  the  most  uni- 
form results  when  given  in  this  way.  The  inconve- 
nience of  the  method,  however,  is  an  objection  to 
such  use,  and  I  have  almost  entirely  given  it  up 
myself  for  this  reason.  I  think  that  of  all  the  reme- 
dies the  bichloride  is  the  most  reliable.  We  can 
accomplish,  perhaps,  nearly  the  same  thing  by 
means  of  tritui'ations,  as  a  trituration  of  calomel 
with  sugar.  It  seems  to  me  that  in  very  many  in- 
stances the  enormous  doses  of  the  iodides  which 
have  been  given  were  necessitated  from  the  fact 
that  the  remedy  was  administered  continuously. 
Very  frequently,  with  a  dose  of  twenty  grains  three 
times  a  day,  and  intermitted  to  be  recommenced 
after  five  days,  we  can  continue  a  much  smaller  dose 
than  if  the  same  dose  was  continued  without  remis- 
sion. There  is  no  question  that  in  many  cases  of 
nervous  syphilis  the  iodide  of  potassium  is  required 
in  very  large  doses,  but  these  will  have  to  be  very 
much  larger  if  the  remedy  is  given  continuously. 

Dk.  PiPFAKD  closed  the  discussion.  He  said  : 
The  paper  is  exceedingly  interesting  and  exceed- 
ingly important.  But  there  are  between  thirty  and 
forty  different  propositions,  some  of  which  I  agree 
with  thorouglily,  and  some  of  which  I  dissent  from 
most  radically.  Tliere  are  three  points,  however, 
that,  from  a  pharmaceutical  point  of  view,  I  think 
attention  should  be  paid  to.  Vr.  Fox  sijoko  of  the 
benefits  he  derived  from  the  use  of  iodine  alone  in 
syphilis,  and  mentioned  in  tliat  coniiei-tion  that  he 
was  in  the  habit  of  giving  Lugol's  solution.  There 
is  more  iodide  of  potassium  in  that  than  iodine.  In 
speaking  of  the  use  of  iodine,  he  did  not  refer  to  the 
iodide  of  starch  at  that  time,  but  bro\ight  it  in  af- 
terward. The  iodide  of  starcli  is  iodine  pure  and 
simple,  not  combined  with  starch,  but  a  simple 
mixture.  In  the  third  iilace,  he  spoke  of  the  solu- 
tion of  iodide  of  ])otassium  in  water.  In  giving  a 
cubic  cent,  of  that  solution,  we  would  not  give  a 
gramme  of  the  iodide  of  potassium,  but  less.  If  you 
mix  them,  you  will  find  that  by  adding  1(10  grammes 


of  the  iodide  of  potassium  to  100  c.c.  of  water  you 
will  get,  not  100  c.c,  but,  because  of  the  swelling  of 
the  solution,  you  wiU  have  a  larger  volume  of  fluid. 
Moreover,  the  solution  turns  red  after  a  time.  It 
may  be  kept  thoroughly  well  by  using  some  sub- 
stance as  a  preservative  ;  for  instance,  the  carbo- 
nate of  potassium,  and  ordinarily  commercial  iodide 
of  potassium  of  the  shops  will  keep  longer  in  a 
saturated  solution  than  tlie  chemically  pure  iodide 
of  potassium. 

Dh.  Stubois  hereupon  asked  if  the  keeping  of  the 
iodide  did  not  depend  upon  its  being  shut  out  from 
the  sunlight.  He  said  that  the  commercial  medi- 
cinal iodide  is  worth  just  one-fourth  the  chemically 
pure. 

In  conclusion,  Dr.  Pippard  called  the  attention  of 
the  society  to  a  preparation  of  carbolic  acid  which 
had  been  jirepared  by  Mr.  Milhau,  of  this  city.  As 
a  rule,  carbolic  acid  became  discolored,  but  this 
preparation  would,  it  was  stated,  not  change  color. 

Dr.  Piffard  was  further  assured  that  the  best 
grades,  so  far,  of  pure  carbolic  acid  yield  only  about 
one-fourth  of  their  weight  of  this  preparation.  It 
certainly  was  beautiful  in  appearance,  being  the  only 
sample  of  carbolic  acid  that  he  had  ever  seen  that 
showed  the  crystalline  formation  as  handsomely  as 
this. 

Dr.  Stdrgis  remarked  that  he  had  seen  samples 
of  Merck's  carbolic  acid,  showing  very  nearly  as 
handsome  crystals  and  as  free  from  fluid  as  that 
passed  around. 

The  society  then  adjourned. 


NEW  YORK  ACADEilY  OF  JIEDICINE. 

Slated  Mveting,  March  2,  1882. 

FoRDTCE  Barker,  M.D.,  LL.D.,  President,  in  the 
Chalr. 

Dr.  F.  a.  Castle  read  a  paper,  entitled 

SOJIE  PRACTICAli  SrOGESTIGNS  IN  THE  TREATMENT  OF 
THOSE  DISEASES  OF  WOMEN  WHICH  EVERY  PHYSICIAN 
MAY   BE   CALLED    UPON   TO    CONSIDER. 

The  speaker  began  with  the  practical  statement 
that  a  thorough  knowledge  of  the  jiatient,  such  as 
pertained  to  derangements  of  other  portions  of  the 
body  than  the  uterus  and  its  appendages,  heredi- 
tary tendencies,  etc.,  was  necessary  to  a  proper 
appreciation  of  the  real  affection  for  which  she 
should  be  treated. 

Most  physicians  in  general  practice  had  met  with 
women,  between  forty  and  fifty  years  of  age,  who 
suffered  from  two  to  four  years  with  peculiar 

DISTURBANCES    OF    THE    NERVOCS    SYSTEM     COINCIDENT 
WaTH   THE    MENOPAUSE, 

and  yet  it  was  a  remarkable  fact  that,  of  English 
authors,  Lawson  Tait  and  Kobert  Barnes  were 
the  only  writers  in  the  special  dejiartrnpnt  of  dis- 
eases of  women  who  had  given  nnuh  information 
concerning  this  class  of  cases  and  their  nuvnagemeut. 
The  result  had  been  that  the  treatment  consisted 
largely  in  the  encouragement  that  "  these  symptoms 
will  disajjpear  when  the  menoi>au.se  has  been  fully 
established  and  tiie  system  luis  become  accustomed 
toltho  great  change."  Attention  was  directed  to 
one  of  the  numerous  phenomena  manifested  at  the 
change  of  life — namely,  "  frequent  attacks  of  fufh- 
ings,  or  heats,"  as  Ringer  describes  them,  starting 
from  various  parts,  as  the  face,  epigastrium,  etc., 


THE  MEDICAL  KECORD. 


273 


thence  spreading  over  the  greater  part  of  the  body. 
"Sometimes,  although  the  patient  feels  deeply 
flushed,  the  skin  remains  natural.  The  sensation 
of  heat  may  be  so  urgent  that  the  patient  opens  her 
clothes  or  removes  the  gi'eater  part  of  the  bed-cov- 
ering, and  even  throws  open  the  window  in  the 
coldest  weather."  "These  heats  may  last  a  few 
minutes,  an  hour,  or  more,  and  may  be  rejieated  a 
number  of  times  a  day.  They  are  generally  followed 
by  perspiration,  often  profuse ;  at  other  times  the 
skin  remains  dry,  and  they  are  accompanied  l>y 
great  throbbing  throughout  the  whole  body,  fol- 
lowed by  prostration.  In  many  cases  palpitation  or 
'  Hutterings  at  the  heart,'  occur  on  the  .slightest  ex- 
citement, or  even  without  ajiparent  cause.", 

For  the  relief  of  these  symptoms  drastic  purga- 
tives, frequent  removals  from  home  at  short  inter- 
vals, frequent  small  bleedings,  bromide  of  potash, 
and  nitrate  of  amyl  had  been  recommended.  The 
bromide  of  potassium  was,  perhaps,  the  remedy 
most  commonly  used,  but  he  had  not  seen  much 
benefit  follow  its  administration.  He  had  used 
amyl  nitrite  with  benefit  occasionally.  The  remedy 
which  had  given  him  the  best  results  was  arsenic, 
Fowler's  solution,  three  to  five  drops  three  or  four 
times  a  day,  used  with  the  customai-y  precautions 
concerning  its  administration,  and  continued  for  a 
long  time.  In  his  experience  the  patients  had  been 
either  relieved  entirely  or  the  severity  of  the  attacks 
had  been  materially  lessened. 

Dr.  C.istle  next  directed  attention  to  the  subject 
of 

UTERINE  DISPLACEMENTS, 

and  spoke,  first,  of  over-distention  of  the  abdomen 
with  flatus  as  one  of  the  causes  of  prolapsus  uteri 
and  other  forms  of  uterine  malposition. 

For  some  time  he  had  been  led  to  regard  this  fac- 
tor as  an  important  one  in  the  etiology  of  prolapsus, 
and,  in  the  treatment  of  this  form  of  displacement 
particularly,  he  regarded  it  as  essential  to  resort  to 
measures  calculated  to  correct  indigestion  and  keep 
the  alimentary  canal  free  from  flatulence,  as  well  as 
to  use  mechanical  supports  for  the  uterus.  He  had 
not  seen  any  mention  made  of  this  etiological  factor 
in  any  of  the  books  on  uterine  diseases. 

With  regard  to  retroflexion  or  retroversion  and 
fixation  of  the  fundus  to  the  anterior  wall  of  the  rec- 
tum by  adhesion  and  interference  with  the  function 
of  the  bowel,  he  had  noticed  one  symptom  of  which 
he  had  not  seen  any  mention  made,  namely,  hemor- 
rhage not  due  to  hemorrhoid^3.  He  had  been  in  the 
hibit  of  treating  such  cases  by  a  modification  of  Dr. 
Campbell's  pneumatic  method,  and,  in  addition  to 
distending  the  vagina,  had  at  the  same  time  dis- 
tended the  rectum  with  air.  His  results  had  been, 
by  the  use  of  the  combined  vaginal  and  rectal  dis- 
tention, that  defecation  had  been  rendered  more 
satisfactory,  and  the  hemorrhage  had  been  dimin- 
ished in  severity.  It  was  not  to  be  expected  that 
retroversion  of  the  uterus  would  be  cured  by  this 
method. 

The  next  topic  to  which  Dr.  Castle  directed  atten- 
tion was 

AN   ANTEVEESION   PESSART, 

which  consisted  in  a  modified  Albert  H.  Smith  re- 
.troversion  instrument,  and  had  answered  the  indi- 
cations as  weU  as  any  mechanical  appliance  he  had 
ever  tried. 

The  method  he  employed  for  changing  the  shape 
of  hard-rubber  pessaries  was  then  demonstrated, 
and  consisted  in  oiling  the  instrument  thoroughly 


with  sweet-oil,  heating  it  in  the  flame  of  a  spirit- 
lamp,  bending  it  into  the  desired  shape,  and,  while 
held  in  that  position,  dipping  it  into  cold  water, 
when  it  promptly  became  inflexible. 

In  this  instance  the  modification  was  somewhat 
like  the  "  doiible  horse-shoe  "  anteversion  pessary  of 
Gelirung,  made  by  bending  a  single-lever  Hodge  in- 
strument upon  itself,  as  the  antever.sion  pessary 
produced  from  the  ordinary  Albert  H.  Smith  retro- 
version pessary — one  of  a  little  more  than  the  usual 
length  served  the  best  purpose — was  like  the  "cradle- 
pessary."  To  prevent  it  from  twisting  and  becoming 
displaced,  it  should  be  compressed  somewhat  later- 
ally at  the  angles  where  it  was  bent  upon  itself. 

"The  theories  with  reference  to  the  action  of  pes- 
saries were  discussed  briefly. 

Attention  was  then  directed  to  the  dangers  and 
the  benefits  following  the  use  of 

VAGIN.AIi   DOUCHES 

of  hot  water.  To  jjrevent  entrance  of  water  into  the 
uterus  the  central  ajjerture  in  the  nozzle  of  the 
syringe  should  be  i)lugged,  and  further  safety  was 
secured  by  bending  the  nozzle  and  plugging  the 
holes  on  the  convex  surface.  Dr.  Castle  endorsed 
all  that  Dr.  Emmet  had  claimed  for  the  efficacy  of 
this  measure  in  the  treatment  of  pelvic  diseases. 
He  doubted  the  special  etiieacy  of  medicated  vaginal 
injections,  but  believed  that  the  benefit  to  be  de- 
rived from  the  use  of  the  hot  water  could  be  in- 
creased by  the  addition  of  common  salt.  His 
method  of  using  the  vaginal  douche  was  to  have  the 
patient  resort  to  it  while  taking  a  hip-bath. 

The  discussion  was  opened  by  Dr.  H.  T.  Hanks, 
who  regarded  the  points  referred  to  by  the  author 
of  the  paper  as  of  practical  importance,  and  he  had 
been  esjiecially  interested  in  what  had  been  said 
concerning  the  troublesome  class  of  cases  seen  in 
connection  with  the  occurrence  of  the  menopause. 
He  also  thought  that  many  could  bear  testimony 
to  the  truth  of  the  statement  made  by  Dr.  Castle, 
concerning  flatulence  as  one  of  the  causes  of  uterine 
displacement,  particularly  prolapsus.  At  least,  pro- 
lapsus was  very  commonly  complicated  with  consti- 
pation, flatulence,  and  indigestion,  and  the  former 
■was  very  much  aggravated  by  the  latter. 

With  reference  to  retroversion,  with  fixation  and 
the  occurrence  of  hemorrhage  as  a  symptom,  he 
thought  it  might  be  true  during  the  first  three 
months,  but,  when  the  condition  became  chronic, 
hemorrhage  from  the  bowel  did  not  occur  ;  it  was 
present  only  during  the  iuflammmatory  stage  of  the 
retroversion,  with  cellulitis. 

With  regard  to  anteversion  pessaries,  he  bad  not 
yet  found  one  which  acted  satisfactorily.  He  had 
not  yet  found  Gehrung's  instrument  in  the  position 
in  which  it  was  introduced,  and  he  had  had  occasion 
to  remove  more  than  twenty  of  them.  He  could  say 
the  same  of  Di\  Thomas'  latest  anteversion  instru- 
ment, and  he  had  removed  three  within  the  last 
week.  The  instrument  kept  the  uterus  up,  but  Dr. 
Hanks  thought  that  it  did  not  do  it  in  the  best  way. 
He  had  found  the  short  anteversion  pessaries, 
which  simply  passed  up  in  front  of  the  uterus,  of 
little  use,  and,  in  the  vast  majority  of  cases,  the  so- 
called  short  anteversion  pessaries  did  much  harm 
when  left  undisturbed  for  two  weeks.  From  a  long 
pxperience  at  the  Demilt  Disj^ensary,  and  a  some- 
what shorter  one  at  the  Woman's  Hospital,  as  well 
as  from  his  private  practice,  he  was  cer/ain  that  he 
could  treat  successfully  all  cases  of  anteversion 
without  pessaries,  except  when  it  was  accompanied 


274= 


THE  MEDICAL  RECORD. 


by  prolapsus  in  the  first  degree.  When  that  condi- 
tion existed,  he  had  been  well  pleased  with  the  use 
of  Thomas'  liinrfe  sudille-pessari/,  and  believed  that 
others  would  And  it  eilectual.  The  pessary  to  which 
he  referred  was  an  Albert  H.  Smith  pessary,  with  a 
second  jjiece  for  the  cervix  to  rest  upon,  hinged  at' 
its  wide  extremity.  This  instrument  rai.ses  the 
uterus  from  the  floor  of  the  vagina,  and  at  the  same 
time  corrects  the  anteversion. 

Dr.  Pauij  F.  JMunde  referred  to  certain  cases  of 
nervous  disturbance  occurring  during  the  change 
of  life,  and  thouglit  that  while  the  symptoms  might 
be  manifold  there  was  danger  of  attributing  too  lit- 
tle to  them  on  one  hand  and  too  much  on  the 
othei\     The  extremes  should  be  avoided. 

Concerning  dyspepsia  and  flatulence  as  a  cause  of 
prolapsus  uteri,  he  thought  that  the  jirimary  cause 
existed  in  malnutrition,  and  consequent  relaxation 
of  tissues,  and  although  the  flatulence  might  aid  in 
producing  the  displacement  and  aggravated  the 
condition,  the  author  of  the  paper  had  laid  more 
stress  upon  it,  perhaps,  as  a  causative  agent  than  he 
would  be  willing  to  do. 

With  reference  to  hemorrhage,  with  ulceration  of 
the  rectum,  as  a  symptom  in  retroversions  with  fix- 
ation, the  statement  was  rather  new  to  him,  and  he 
would  take  pleasure  in  making  investigations  in 
that  direction. 

He  thought  Dr.  Castle  had  overlooked  the  fact,  in 
speaking  of  the  treatment  by  vaginal  and  rectal  dis- 
tention with  air,  that  the  rectum  itself,  in  very  many 
cases,  was  also  bound  down,  and  would  prevent  the 
uterus  from  being  lifted  forward,  and  therefore  the 
method  would  fail  in  a  large  proportion  of  instances. 

The  cradle-pessary,  shown  by  Dr.  Castle,  Schnet- 
ter  devised  by  elongating  a  ring,  and  bending  it 
upon  itself,  and  he  had  found  it  useful  in  cases  of 
cystocele,  and  also  anteversion,  especially  when  its 
branches  were  flared  outward.  The  trouble  with 
all  anteversion  pessai-ies,  however,  was  that  they 
pressed  too  deeply  into  the  wall  of  the  vagina,  and, 
sooner  or  later,  were  sure  to  do  damage. 

He  was  ready  to  take  back  what  he  had  said  in 
his  book  on  the  "  Minor  Surgical  Gynecology  "  con- 
cerning the  value  of  Gehrung's  anteversion  j^essary. 
In  addition,  he  had  found  that  the  instrument  some- 
times overdid  the  work  and  ivlroverted  the  uterus. 

He  was  pleased  with  the  latest  moditication  of 
anteflexion  pessary  which  Dr.  Thomas  had  given, 
namely,  the  open  cup  with  a  hinge.  He  had  modi- 
fied it  by  sinking  the  hinge,  so  as  to  lessen  the  lia- 
bility to  do  injury  to  the  soft  parts.  There  were, 
however,  two  objections  to  the  instrument:  (1)  it 
may  produce  erosion  of  the  anterior  wall  of  the 
vagina  by  pressure  ;  and  (2)  it  was  liable  to  be- 
come foul  from  concealment  of  the  discharges  where 
they  could  not  be  reached  by  any  cleansing  injec- 
tions. 

Dr.  IMundf:  then  referred  to  the  plugging  of  the 
central  hole  in  the  nozzle  of  the  .syringe  used  for 
vaginal  injections  or  douches,  to  which  attention 
had  long  ago  been  directed,  and  also  to  the  absorb- 
ing power  of  the  vagina  which  he  believed  existed, 
although  not  equal  to  that  pos.ses.sod  by  the  rectum. 

Dn.  T.  .\.  Emmkt  tlious;ht  that  a  great  deal  of  the 
difficulty  encountered  with  reference  to  the  dis- 
placements, and  the  use  of  pessaries,  existed  in  the 
lack  of  correct  diagnosis  at  the  beginning.  A  great 
deal  of  ingenuity  had  been  wasteil.  from  the  fact 
that  there  was  not  a  proper  appreciation  alwaj's  of 
exactly  what  it  was  desirable  to  accomplish. 

He  did  not  regard  anteversion  of  the  uterus  as  a 


malposition,  and,  so  long  as  the  view  was  held  that 
it  was  a  malposition,  just  so  long  practitioners 
would  be  misled  concerning  it. 

One  of  the  commonest  errors  made  was  negect- 
ing  to  examine  by  the  rectum,  in  order  to  discover 
whether  or  not  inflammation  exists  behind  the 
uterus  in  the  uterosacral  ligaments.  A  small 
amount  of  inflammation  existing  there  would  pro- 
duce those  symptoms  which  were  commonly  recog- 
nized as  belonging  to  displacement  of  the  uterus 
forward.  Now,  with  inflammation  behind  the  uterus, 
if  an  attempt  was  made  to  correct  the  anteversion 
by  the  use  of  a  pessary,  disappointment  would  surely 
follow. 

Another  important  point  to  be  determined  was, 
whether  or  not  the  irritation  was  due  to  the  dis- 
placement, if  one  existed.  The  first  impulse,  nearly 
always,  if  prolapsus,  or  anteversion,  or  retroversion 
was  present,  was  to  correct  the  position  of  the 
uterus,  and  in  his  experience  he  had  found  it  one 
of  the  commonest  errors  to  attempt  to  force  the 
uterus  into  (lie  position  which,  as  it  was  thought, 
it  should  occupy,  without  making  a  complete  diag- 
nosis. In  such  cases  the  use  of  a  pessary  did  a 
great  deal  of  harm.  When  the  utero-sacral  liga- 
ments wei-e  inflamed  the  symptoms  could  be  relieved 
by  lifting  the  uterus  a  trifle,  just  enough  to  relieve 
the  vessels,  and  sometimes  that  could  be  done  by 
means  of  Gehrung's  pessary,  or  a  small  india-rubber 
disc,  or  packing  the  vagina  with  cotton,  so  as  to 
restore  the  circulation.  He  thought  that  the  import- 
ance of  supplementing  a  vaginal  by  a  rectal  exami- 
nation could  not  be  too  strongly  stated,  for  a  con- 
dition of  affairs  could  be  recognized  by  the  latter 
which  it  was  impossible  to  determine  by  the  former 
alone.  It  mattered  but  little  what  the  pessary  was, 
so  long  as  the  object  to  be  attained  was  properly 
appreciated. 

With  regard  to  vaginal  injections,  he  would 
simply  say  that  the  woman  who  would  not  take 
them  lying  down  should  be  prohibited  from  using 
them.  The  horizontal  posture  was  as  necessary  to 
the  emptying  of  the  vessels  as  it  was  to  the  emptying 
of  the  varicose  vessels  of  a  lower  extremity,  and 
should  be  insisted  upon.  He  always  directed  the 
patient  to  pass  the  nozzle  of  the  syringe  toward  the 
well  side,  and  as  a  rule,  that  precaution  woidd  avoid 
throwing  water  into  the  utenas. 

Dk.  W.  T.  LrsK  said  that  the  inflammation  of  the 
utero-sacral  ligaments  referred  to  by  Dr.  Emmet 
was  an  exceedingly  important  question.  About  ten 
years  ago,  Schultze  wrote,  and  insisted  Tipon  the 
fact,  that  anteversion  of  the  uterus  gave  rise  to  no 
bad  symptoms,  unless  there  was  au  inflammatory 
deposit  in  these  ligaments,  and  for  the  relief  of  that 
condition  invented  the  cradle-pessary  shown  by  Dr. 
Castle.  Dr.  Lusk  had  nearly  discarded  Gehrung's 
pessary.  Perliaps,  if  it  could  be  closely  watched,  it 
rnight  be  able  to  do  much  good,  but  in  hospital 
practice  he  had  always  found  it  displaced  soon  after 
it  had  been  inserted.  He  had  found  the  pes.sary 
exhibited  l>y  Dr.  Castle  to  be  a  very  satisfactory  in- 
strument, but,  like  all  anteversion  pessaries,  it  must 
bo  removed  from  time  to  time,  else  damage  would 
be  done  to  the  anterior  vaginal  wall. 

In  estimating  the  liability  of  the  vaginiil  douche 
to  produce  serious  symptoms,  ho  thouclit  nnotlier 
source  of  bearinpr-down  pains,  .such  as  follow  the  en- 
trance of  water  into  the  iiterine  cavity,  sliould  not 
be  lost  sisrht  of.  and  that  was  excessive  stretching 
of  the  vagina.  In  a  certain  number  of  well-authrn 
ticated  cases,  the  vaginal  injections  employed  after 


i 


THE   MEDICAL  RECORD. 


275 


Kiwiscli's  method  for  the  induction  of  premature 
labor,  had  been  followed  by  local  peritonitis,  due, 
as  was  believed,  to  over-stretching  of  the  vagina. 

The  Pkesidest  remarked  that  he  had  been  in- 
terested for  many  years  in  the  study  of  the  func- 
tional disturbances  incident  to  cessation  of  menstru- 
ation, and,  according  to  his  experience,  laxatives  and 
j)urgatives  wei'e  useful  in  a  certain  class  of  cases 
and  injurious  in  another.  He  regarded  them  as  ex- 
tremely useful  where  there  was  a  tendency  at  the 
climacteric  period  to  plethora,  to  become  stout, 
and  the  patients  suffered  from  palpitation  and  a 
feeling  of  pressure  in  the  head,  etc.  In  those  cases 
he  ordered  the  i^iatient  to  take  a  saline  laxative  daily, 
for  a  few  days,  at  the  time  corresponding  to  that  at 
which  menstruation  usually  occurred.  But  there 
was  another  class — that  in  which  the  patient  suffered 
from  cold  feet  and  extremities,  face  flushed  perhaps, 
tendency  to  vertigo,  had  shortness  of  breath  on  ex- 
ercise, sense  of  depression,  etc. — in  which  purgatives 
and  saline  laxatives  would  be  the  worst  treatment, 
hut,  on  the  other  hand,  marked  benefit  followed  the 
use  of  the  bromide  of  potassium,  eight  or  ten  grains, 
three  times  a  day,  combined  with  iron — preferably 
the  lactate.  With  reference  to  arsenic,  there  was 
no  remedy  more  efficient  in  cases  in  which  a  nerve- 
tonic  was  needed,  and  in  which  the  sense  of  dei^res- 
.sion  and  exhaustion  were  i^rominent  symptoms.  It 
was  a  remedy  which  he  had  used  and  recommended 
for  many  years,  and  with  very  satisfactory  results. 
He  had  found  it  almost  a  specific  in  the  class  of 
cases  in  which  there  was  a  small  loss  of  blood  daily, 
perhajjs  not  more  than  a  teaspoonful,  but  sometimes 
prolonged  for  weeks,  and  accompanied  by  great  de- 
pression, though  not  the  cause  of  it. 

The  President  did  not  think  that  flatulence  ever 
gave  rise  to  anteversion  of  the  uterus.  In  his  early 
practice,  when  he  had  charge  of  a  large  clinic  for 
diseases  of  women,  and  subsequently  when  in  charge 
of  a  large  hospital  pi-actice,  he  had  not  seen  it  as  a 
cause  of  displacement  in  that  class  of  patients,  al- 
though he  had  w'atched  for  it  in  private  practice 
amohg  those  in  good  circumstances  and  had  met 
with  it  and  made  it  a  special  indication  for  treat- 
ment. 

As  was  well  known,  he  was  not  an  enthusiastic  ad- 
vocate of  pessaries,  and  his  conviction  was  that 
displacements  had  i-eceived  more  attention  than  cer- 
tain general  pathological  conditions  which  were  of 
infinitely  greater  importance,  and,  when  removed, 
the  uterus  would  of  itself  recover  its  position  per- 
fectly. He  believed  that  it  was  a  mistake  very  com- 
monly made  to  regard  the  uterus  as  an  organ  which 
occupied  a  positive  fixed  situation  ;  for  it  is  con- 
stantly changed  by  the  condition  of  the  intestines, 
the  bladder,  position  of  the  patient,  etc.,  and  the 
changes  in  position  during  utero-gestation  are  very 
marked.  "When,  therefore,  the  attempt  was  made 
to  treat  it  as  though  it  should  occupy  a  fixed  posi- 
tion, a  mistake  was  very  liable  to  be  made,  inasmuch 
as  its  normal  and  physiological  changes  in  position 
were  extensive.  He  had  found  retroflexion,  due  to 
flatulence,  veiy  frequently,  and  had  for  many  years 
made  use  of  measures  intended  especially  to  correct 
that  condition,  .such  as  combinations  of  nitric  acid 
and  nux  vomica,  with  carminatives,  perhaps  with 
morphia,  and  with  salicine,  in  ten  or  fifteen  grain 
doses,  when  malarial  poisoning  manifested  itself. 
When  the  displacement  was  associated  with  hemor- 
rhoids, he  gave  such  agents  as  stimulated  the  he- 
patic function,  as  well  as  kept  the  intestines  far  from 
accumulation  of  gases.  With  reference  to  Gehrung's 


pessary,  he  had  removed  a  hundred  or  more  within 
a  few  years,  and  had  used  it  in  one  or  two  patientp. 
For  eystocele  in  old  ladies,  he  had  employed  it  with 
benefit,  when  the  financial  condition  of  the  patient 
was  such  as  permitted  him  to  give  the  pessary  the 
attention  which  it  really  lequircd. 

Dk.  Castle,  in  closing  the  discussion,  said  he  in- 
tended to  be  understood  as  saying  that  the  treat- 
ment of  retro-displacements,  by  means  of  inflating 
the  vagina  and  rectum,  would  be  of  service  only 
where  the  rectum  was  not  bound  down. 

W"ith  regard  to  hemorrhage  from  the  bowel  in 
cases  of  retroversion  with  fixation,  he  had  seen  it 
without  hicmorrhoids,  and  his  explanation  was  flat 
it  was  due  to' an  abrasion  of  the  mucous  membrane, 
produced  by  the  passage  of  hardened  fa-ces  through 
the  narrowed  canal. 

The  Academy  then  adjourned. 


MEDICAL  SOCIETY   OF   THE  COUNTY  OF 
NEW  YOEK. 

Staled  Meeiivg,  February  27,  1882. 
De.  F.  E.  Stuegis,  Pbesidest,  in  the  Chaie. 

THE  peemasent  EEMOVAL  OE  SUPEBELrOrS  haie. 

Dr.  Geokge  H.  Fox  read  a  paper  on  the  above  sub- 
ject.    [See  p.  2.53.] 

The  paper  being  open  for  discussion,  De.  C. 
Heitzmann  said  that,  at  the  meeting  of  the  Ameri- 
can Dermatological  Association,  in  1860,  he  gave  an 
account  of  a  series  of  experiments  which  he  had 
made  upon  the  face  of  woman  in  order  to  peima- 
nently  remove  superfluous  haiis,  all  of  which,  as 
well  as  experiments  made  by  others,  proved  to  be 
failures.  His  attention  at  that  time  was  drawn  to 
a  new  method  which  a  few  years  before  had  been 
brought  forward  by  Dr.  Hardaway,  of  St.  Louis, 
who,  although  not  the  first  to  suggest  the  plan,  that 
being  done  liy  Dr.  Michel,  of  St.  Louis,  was  the 
first  to  try  the  method  upon  the  face  of  a  living  pa- 
tient. Dr.  Heitzmann  had  since  then  resorted  to 
thi» method  and  could  corroborate  all  that  Dr.  Fox 
had  said  concerning  its  success.  Drs.  Michael  and 
Hardaway  were  to  be  congratulated  for  the  opera- 
tion, but  Dr.  Fox  was  entitled  to  special  credit  for 
having  animated  it  and  kept  its  practicaliility  before 
the  profession.  With  regard  to  the  avoidance  of  large 
needles,  mentioned  by  Dr.  Fox,  becau.se  they  were 
likely  to  leave  scars.  Dr.  Heitzmann  had  not  had  ex- 
actly the  same  experience.  He  had  usually  employed 
what  might  be  called  large  needles,  and  had  not 
produced  scars,  except  in  one  case,  and  in  that  they 
were  very  slight.  He  was  of  the  opinion  that  the 
skin  of  some  persons  was  more  prone  to  leave  scars 
than  that  of  others,  irrespective  of  the  size  of  the 
needles.  But  the  scars  were  usually  so  insignificant 
that  they  were  not  detected  except  upon  close  in- 
si^ection. 

With  regard  to  the  precise  agent  which  did  the 
work,  the  thermic  action  or  the  electric  current, 
he  based  his  opinion  that  it  was  the  heat  and  not 
the  electrolytic  process,-  upon  a  series  of  experi- 
ments made  several  years  ago  with  reference  to  life 
in  cartilage,  and  he  did  not  .see  why  we  should  as- 
sume it  was  the  action  of  electricity  when  its  exist- 
ence was  not  established.  That  heat  was  present 
and  aided  in  destroying  the  hair  he  believed  ;  but 
what  else  occurred  to  aid  the  loosening  of  the  hair, 
besides  the  thermic  action,  he  did  not  know. 

Db.  Geoege  M.  Beaed's  interest  and  experience 


376 


THE  MEDICAL  RECORD. 


concerning  this  subject  were  rather  historic  than 
otherwise.  Some  years  ago  he  made  a  number  of 
experiments  and  was  considerably  pleased  with  the 
results.  He  did  not  use  so  small  a  needle  as  the 
one  recommended  by  Dr.  Fox,  but  the  ordinary  glov-. 
ers'  needle.  He  was  annoyed,  however,  by  the  re- 
turn of  the  hairs  after  he  had  supposed  that  they 
were  destroyed.  He  had  fotind  that  the  practical 
difficulty  of  applying  the  method,  on  account  of  the 
pain,  was  of  no  special  consequence,  for  the  most 
nei-vous  soon  became  accustomed  to  it.  and  bore 
whatever  there  was  with  the  greatest  courage. 

With  reference  to  whether  the  destroying  agent 
was  thermic  action  or  the  electric_  current,  he 
thought  there  could  be  really  no  qiiestion.  The 
action  was  a  chemical  one.  To  be  sure  there  was, 
incidentally,  a  thermic  action,  and  so  was  thermic  ac- 
tion generated  whenever  electricity  was  made  to  go 
through  any  substance,  and  the  greater  the  resist- 
ance the  more  intense  the  heat.  In  alV  electrolytic 
operations,  heat  was  developed — slight  when  a 
small  needle  was  used — but  it  was  an  incident.  The 
main  action  was  chemical  decompo.sition,  and  it  was 
through  chemical  effects  that  the  results  were  ob- 
tained. He  admitted  that  some  results  could  be 
obtained  by  the  use  of  heat,  but  in  the  present 
instance  he  thought  it  impossible  to  get  heat  into 
the  follicle  as  well  as  electricity  could  be  sent  there. 

With  reference  to  the  relation  which  the  hairy 
growths,  referred  to  in  the  paper,  had  to  the  ner- 
vous system,  he  felt  that  Voltaire's  saying  was  espe- 
cially applicable  :  -'The  more  we  know  the  less  we 
ai-e  sure."  Probably  the  condition  was  due  to  some 
modification  of  nutrition,  the  exact  nature  of  which 
was  still  unknown. 

Dr.  p.  a.  Morrow  had  seen  some  vei-y  satisfactory 
results  obtained  by  the  method,  but  he'had  not  had 
any  personal  experience  in  its  application. 

Dr.  a.  Jacob:  remarked,  with  regard  to  pulling 
out  the  hairs  during  the  operation,  that  perhaps  the 
plan  he  had  followed  in  a  few  instances  might  prove 
acceptable.  He  does  not  pull  the  hair  out,  but 
leaves  it  as  an  indicator  whether  or  not  the  effect 
has  been  sufficient  to  destroy  it.  If  sufficient,  the 
hair  will  be  gone  when  the  patient  returns  ;  if  in- 
efficient, it  will  remain,  and  the  next  application 
will  suffice  to  make  its  destruction  complete.  With 
regard  to  the  hyper;emic  condition  at  the  insertion 
point,  he  had  not  seen  it.  He  had  observed  imme- 
diate aniemia.  It  was  true  that  reaction  came  on 
afterward,  and,  subsequently,  the  localized  small 
swellings.  Occasionally  there  was  a  little  tinge  of 
color  when  the  current  was  ai:)plied,  but  the  imme- 
diate effect  certainly  was  the  production  of  anicmia. 

Dr.  W.  Gill  Wylie,  as  bearing  ujjon  the  possible 
relation  between  hairy  growths  on  the  face  and  ab- 
normal development  of  the  female  genitals,  in- 
stanced the  .serotal-like  development  of  the  labia 
observed  in  women  who  had  an  excessive  amount  of 
hair  upon  the  face. 

A  member  referred  to  the  fact  that  he  had,  to  a 
considerable  extent,  been  successful  in  permanentlv 
removing  single  hairs,  here  and  there,  hj  pullinjj; 
the  hair  out  and  immediately  plunging  into  the  fol- 
licle a  needle,  the  tip  of  which  had  been  dipped  in 
a  solution  of  some  caustic. 


A  1\I.VMM0TH  HYDROPATFnO  INSTITUTE   PrOI"O.SED. — 

A  number  of  gentlemen  of  this  city  propose  to  raise 
the  sum  of  .SIOO.OOO,  and  erect  an  "  Institute  "  of 
hydropathy  here. 


CONSULTATION  ^ATTH  lEKEGULAES. 

To  THE  Editor  of  The  ilEDic.\L  Recobd. 

Sir  :  The  action  of  the  State  Medical  Society  in 
adopting  sundi-y  amendments  to  its  code  of  ethics 
is  farther  reaching,  perhaps,  than  was  at  first  ex- 
pected by  even  the  most  eager  aspirants  for  homoeo- 
pathic windfalls,  and  entails,  moreover,  a  somewhat 
difficult  question  to  be  discussed  between  the  respec- 
tive advocates  of  medical  "  State  rights  "  and  national 
jiu'isdiction,  as  exemplified  in  the  American  Medical 
Association.  That  the  new  rule  concerning  consul- 
tations is  virtually  an  ordinance  of  secession  fi'om 
the  national  organization  must  be  evident  to  every 
one  conversant  with  the  perennial  Ann  Arbor  con- 
tention ;  and  St.  Paul  (meaning  the  city  of  Minne- 
sota, not  the  polemic  epistolist  of  that  name)  will 
doubtless  re-echo  with  the  invective  eloquence  of 
Chicago,  fulminated  more  in  anger  than  in  sorrow 
against  the  "erring  sister"  who  has  out-Michigan- 
dered  Michigan.  For  if  it  Vie  an  unpardonable  sin 
in  the  latter  Strife  merely  to  lecture  on  the  mechan- 
ism of  labor  before  a  class  containing  any  immature 
believers  in  homceoiJathy,  what  shall  be  said  of  an 
official  instigation  to  conciliate  consultation  fees,  not 
only  from  matured  and  hardened  Hahnemannian 
heretics,  but  from  all  "legally  qualified  practition- 
ers of  medicine  " — a  phrase  which  includes  gradu- 
ates from  homicopathic,  eclectic,  and  other  irregular 
schools  which  the  Legislature,  in  its  collective  wis- 
dom, has  seen  fit  to  charter;  all  the  persons  to 
whom  an  irregular  county  society  is  alleged  to  have 
dispensed  licenses  at  .?10  a  piece  in  1874  ;  nay,  all 
persons  who  have  "practised  medicine  and  surgery 
for  ten  years  last  past,"  under  any  pretence  whatso- 
ever? 

But  attractive  as  may  be  the  pecuniary  prospect 
thus  graciously  opened  to  the  yearning  New  Yorker, 
the  bud  of  promise  is  not  without  its  possible  thorn. 
Suppose  some  less  enlightened  county  society  than 
that  of  the  city  of  New  York  should  be  so  lost  to  a 
proper  sense  of  allegiance  to  Albany  as  still  to  wish 
for  its  representation  in  the  American  Medical  Asso- 
ciation. Its  right  to  send  delegates  to  this  body 
depends  upon  its  affiliation  with  its  State  Society ; 
but  in  the  present  instance  the  latter  itself  becomes 
irrepresentable  by  refusing  to  conform  with  the  na- 
tional code.  What  action  will  be  taken  by  such 
minor  societies  remains  to  be  seen  ;  it  is,  howevei', 
probable  that  outside  of  the  metropolis  there  are 
many  physicians  too  obtuse  to  perceive  wherein  the 
retention  of  the  adjective  "  homoeoimthic,"  after  the 
abandonment  of  its  etymon  "  'o^lntns  ttiiSos,"  indicates 
an  advancement  imra  ignorance  or  charlat.mism  to 
rational  medicine.  The  fact  that  a  few  practitioners 
who  use  this  adjective  for  private  ad  ctqitandiim 
ends  are  willing  to  admit  in  professional  confidence 
that  they  practise  without  regard  to  the  precepts 
which  it  implies,  argues  rather  for  their  intelligence 
than  for  their  integrity ;  but  even  scant  familiarity 
with  the  recent  publications  of  the  honuiopathic 
school  will  show  that,  as  a  school,  it  still  adheres  to 
the  Hahnemannian  dogmata,  that  "the  totality  of 
the  symptoms  constitutes  the  disease,"  that  such  to- 
tality of  symptoms  is  only  to  be  cured  by  a  drug 
capable  of  producing  a  similar  totality  of  symptoms, 
and  that  tlie  efficacy  of  the  appropriate  remedy  is 


THE  MEDICAL  RECORD. 


a?  7 


enhanced  by  its  "dynamization"  ati  infinitum.  In 
a  work  bearing  the  imprint  of  1882,  and  emanating 
from  a  homosopathic  medical  college,  I  find  gravely 
recorded  the  cure  of  a  case  of  mania  by  one  dose  of 
the  four-thousandth  potency  of  belladonna,  and  am 
farther  informed  that  lUium  tigrinum  is  the  proper 
medicine  for  hysteria  and  uterine  disjslacemeuts, 
with  much  other  similarly  instructive  matter. 

Aside  from  the  incongruity  of  clinical  conference 
between  a  regular  college  professor  and  a  practi- 
tioner whom  none  of  our  colleges  recognizes  as  fit 
even  to  give  a  student's  certificate,  it  is  manifest 
that  in  a  majority  of  instances  no  agreement  as  to 
treatment  could  be  reached  through  the  farcical 
form  of  consultation.  But,  to  meet  this  difticulty, 
it  is  ingeniously  provided  that  the  consulting  jiliy- 
sician  may  continue  his  visits  as  often  as  may  be 
deemed  necessary  "by  him."  There  is,  however, 
another  side  to  the  shield  thus  suspended.  It  is 
within  the  verge  of  possibility  that  some  patient 
under  the  care  of  an  expert  gynecologist  may  be 
persuaded  by  her  homoeopathic  friends  to  desire 
the  consultant  oiiiniou  of  an  inflnitesimalist  who 
insists  that  her  adherent  retroflexion  must  be  treated 
with  the  hundredth  dilution  of  lilium  ;  or  an  oph- 
thalmologist may  have  to  succumb  to  a  consultant 
who  will  instruct  him  that  presbyopia  is  to  be  re- 
lieved by  an  attenuation  of  drosera,  and  keratitis 
cured  by  the  internal  administration  of  diluted 
chalk  ;  or  a  genito-urinary  surgeon  may  be  told  by 
his  casual  medical  mentor  that  an  urinary  fistula  is 
to  be  healed  with  the  millionth  of  a  grain  of  sulphur. 
Clearly,  if  our  disinterested  brethren  are  bound  to 
meet  all  "legally  qualified  "  practitioners  when  they 
themselves  are  called  as  consultants,  they  are  equally 
bound  by  the  same  amendment  to  ignore  .sectarian 
distinctions  when  the  positions  are  reversed.  Granted 
that  the  instances  are  extreme,  and  that  there  are 
among  the  miscalled  homoeopathists  some  sensible 
men,  who  know  and  utilize  the  scientific  advances 
in  surgery  and  medicine,  it  is  certain  that  the  pic- 
ture is  not  overdrawn  as  regards  many,  if  not  most, 
of  the  homu?opathic  fraternity  in  this  country  ;  and 
it  is  equally  certain  that  from  this  ultra-Hahneman- 
uian  faction  will  arise  the  noisiest  howl  of  jubilation 
over  the  quasi-oflicial  surrender  of  the  regular  pro- 
fession. 

The  subject  is  important  enough  to  call  for  a 
more  general  expression  of  opinion  than  is  implied 
in  a  vote  at  a  meeting  of  the  State  Society,  and  it  is 
to  be  hoped  that  the  various  county  societies  will 
take  it  into  early  consideration.  The  simjjle  title 
of  physician  seems  to  me  to  be  the  only  one  deserv- 
ing recognition  ;  he  who  jn-efixes  to  it  a  qualifying 
adjective  jirofesses  to  be  more,  or  less,  than  a  physi- 
cian, and  thereby  voluntarily  withdraws  from  fellow- 
ship with  those  who  will  not  be  fettered  by  the 
dictation  of  any  therapeutic  "  school." 

I  am,  sii',  yours,  etc., 

A.  L.  Careoll. 

New  Bbightox,  Febni;iiy  15.  ISSJ. 


The  Cocnti  Hcspital  at  Denver,  Col.,  which 
was  at  first  captured  by  the  homc^opaths.  has  now 
been  turned  over  to  the  re.gular  school.  It  will  be 
utilized  for  the  necessities  of  the  sick,  and  of  the 
local  medical  college. 

The  Colorado  Medical  Journal  has  ceased  to  l)e 
published,  owing  to  the  unfortunate  demise  of  its 
accomplished  editor,  Dr.  William  H.  Warn. 


tlcu)  Jn0tnmrcnta. 


A  NEW  OBSTETRIC  FOECEPS  FOK  OPER- 
ATION AT  THE  SUPEEIOE  STEAIT. 
By  W.  H.  GEAINGEE,  M.D., 

BOSTON,   MASS. 

In  bringing  before  the  notice  of  the  medical  pro- 
fession a  new  midwifeay  forcejis,  1  feel  as  though  I 
were  treading  on  rather  dangerous  ground.  Perhaps 
in  no  other  department  of  medicine  or  surgery  has 
any  single  instmment  undergone  so  many  additions, 
alterations,  and  modifications,  as  the  one  devised  by 
Dr.  Paul  Chamberlain,  in  the  middle  of  the  seven- 
teenth century.  Many  of  these  imi^rovements  have 
stood  the  test  of  time,  while  others,  and  by  far  the 
greater  number,  have  been  relegated  to  the  realms 
of  oblivion  ;  and  it  would  seem  as  though  the  field 
had  been  so  completely  covered  that  but  little  re- 
mained to  be  desired.  This  may,  indeed,  be  true  so 
far  as  the  delivery  of  the  head  when  in  the  jjelvio 
cavity,  or  when  it  has  reached  the  inferior  strait. 
Modern  skill  has  shown  how  readily  such  an  opera- 
tion can  be  jjerformed,  but  when  the  head  has  simply 
engaged  at  the  brim,  it  then  becomes  a  matter  of 
grave  concern  even  in  the  hands  of  the  most  experi- 
enced obstetrician. 

It  is  not  in  the  i^rovince  of  this  jjaper  to  discuss 
the  relative  merits  of  turning,  or  the  resort  to  instru- 
mental delivery  when  the  head  is  above  the  brim ; 
such  a  subject  is  fully  treated  of  in  the  text-books 
on  midwifery. 

I  have  ever  looked  upon  the  application  and  proper 
use  of  the  forceps  at  the  superior  strait  as  being  one 
of  the  most  difficult  operations  in  midwifery,  owing 
to  the  obstacles  ofl'ered  by  the  sacral  curve  and  the 
resistance  of  the  perineum  and  soft  parts.  In  the 
various  instruments  constructed  for  this  purpose, 
although  the  anatomy  of  the  pelvis  has  been  con- 
sidered, and  the  pelvic  curve  added  to  allow  of  their 
proper  adjustment,  their  action,  from  a  purely  me- 
chanical standpoint,  has  been  sadly  ignored. 

In  order  to  fully  appreciate  the  diflieulties  that 
await  the  operator,  I  will  invite  attention  for  a  mo- 
ment to  the  relation  of  the  fetal  head  to  the  mater- 
nal pelvis  at  the  commencement  of  labor.  For  the 
purpose  of  illustration,  we  will  take  the  most  com- 
mon of  all  vertex  presentations,  the  left  occipito- 
iliac  anterior.  The  uterine  contractions  transmitttd 
through  the  spine  to  the  head  causes  the  chin  to  be- 
come flexed  on  the  chest,  producing  what  is  known 
as  the  stage  of  flexion  in  the  phenomena  of  labor. 
In  this  position  the  occipito-bregmatic  diameter  cor- 
resijonds  to  the  left  oblique  (C'azeau)  of  the  superior 
strait,  and  the  biparietal  to  the  right  oblique,  and 
it  is  to  this  latter  diameter  more  particularly  that  I 
wish  to  call  attention. 

Contrary  to  the  views  taught  by  Naegele,  the  head 
does  not  enter  the  brim  with  a  biparietal  obliquity, 
but  in  reality  in  the  direct  axis  of  the  superior  strait, 
as  has  been  conclusively  shown  by  Mathews  Duncan 
and  Leishman.  This  eiTor  on  the  part  of  the  great 
German  teacher  is  partly  owing  to  the  fact  that  the 
j  i^elvis  is  inclined  at  an  angle  of  .sixty  degrees  to  the 
horizon,  a  proposition  which  was  not  demonstrated 
until  some  years  after  he  wrote  his  essay.  It  is 
during  the  "stage  of  de.scent  that  the  unscientific 
principle  of  the  forceps  as  at  present  constructed 
becomes  aijparent,  and  I  think  I  can  prove  conclu- 


278 


THE  MEDICAL  RECORD. 


sively  that  the  tractile  force  applied  by  the  operator 
is  meohanicallv  wrong. 

If  we  examine  the  pelvis  we  shall  observe  that 
it  is  a  curved  canal,  the  posterior  wall  of  which  forms 
a  much  larger  segment  of  a  circle  than  the  anterior  ;• 
consequently  the  head  in  its  passage  from  the  supe- 
rior to  the  inferior  strait  must  follow  this  curve,  and 
the  left  or  posterior  parietal  protuberance,  traver.sing 
a  larger  space,  has  to  travel  more  rapidly  than  the 
right  or  anterior,  in  order  to  preserve  its  parallelism 
to  that  portion  of  the  pelvis  to  which  it  is  in  relation. 

Now,  what  is  the  action  of  the  long  forceps?  The 
head  having  been  seized  between  its  blades,  the  line 
of  traction  must  necessarily  be  forward  of  the  axis 
of  the  superior  strait,  as  the  coccyx  and  perineum 
prevent  the  handles  from  being  carried  sufficiently 
back,  and  most  of  the  force  is  expended  on  the  sym- 
physis pubes,  which  seems  to  act  as  a  fulcrum,  and, 
despite  the  ill-directed  efforts  of  the  operator, 
causes  the  posterior  portion  of  the  head  to  traverse 
the  whole  face  of  the  sacrum,  while  the  anterior 
travels  over  a  much  smaller  space.  That  this  as- 
sumption is  correct  can  be  very  easily  proved  by 
feeling  for  the  right  ear,  which  will  be  found  about 
the  centre  of  the  symphysis  pubes,  wherein,  if  this  mo- 
tion of  rotation  were  not  executed,  the  finger  would 
come  in  contact  with  it  beneath  the  arch  of  the 
pubes.  It  can  be  seen  at  once  that  this  rotary  move- 
ment is  entirely  independent  of  the  operator — in 
fact  I  might  with  justice  assert  that  it  is  performed 
in  opposition  to  his  traction.  This  fact  being  clearly 
demonstrable,  it  is  obvious  at  a  glance  that  the  object 
to  be  aimed  at  must  be  to  depress  the  distal  ends  of 
tlie  blades,  and  with  them  the  posterior  portion  of 
the  child's  head,  so  as  to  imitate  nature  and  relieve 
the  bladder  and  soft  parts  of  the  mother  covering 
the  symphysis  from  injurious  pressure.  It  is  very 
true  that  in  the  directions  laid  down  in  our  text- 
books we  are  instructed  to  make  backward  and 
downward  traction  in  the  axis  of  the  superior  strait, 
but  I  contend  that,  with  the  forceps  as  at  present 
constructed,  it  is  a  mechanical  impossibility. 

This  difficulty  struck  me  very  forcibly  some  nine 
years  ago,  in  a  case  where  the  head  was  arrested  at 
the  brim,  owing  to  a  slight  contraction  of  the  con- 
jugate diameter.  After  repeated  attempts  to  bring 
it  down,  I  passed  the  midtile  and  fore  finger  of  my 
left  hand  along  the  shanks  of  the  forceps,  as  high  up 
as  I  could  reach ;  making  pressure  downward  and 
backward,  at  the  same  time  elevating  the  handles,  I 
succeeded  in  delivering,  but  at  the  expense  of  a  pair 
of  very  sore  fingers.  This  plan  of  procedure  is 
almost  identical  with  that  so  ably  advocated  by  Dr. 
A.  Smith,  of  Philadelphia,  in  his  admirable  ai'ticle 
on  axis  traction.  I  made  drawings  at  that  time  of  a 
forceps  similar  in  principle,  but  differing  slightly  in 
construction,  to  tlie  one  here  shown,  the  difterence 
consisting  in  using  two  rods  instead  of  one. 

The  instrument  from  which  the  accompanying 
engraving  has  been  copied  is  tlie  one  devised  by  the 
late  Professor  Elliott,  of  Now  York,  with  my  im- 
provement attached,  and  was  made  by  Codman  & 
Shurtleff,  from  models  furnished  by  me. 

About  two  and  one-half  inches  from  the  lock  you 
will  notice  a  small  flange  springing  from  the  upper 
shank  and  slightly  overlapping  the  under  one.  This 
is  sufficiently  long  to  permit  a  uniform  bearing  when 
the  handles  are  separated  by  the  size  of  the  head  at 
full  terra.  In  the  centre  of  the  flange  is  a  small 
arched  piece  of  steel,  to  allow  the  attachment  of  the 
rod.  Tlio  distance  from  the  concave  edge  of  one 
blade  to  a  point  on  the  ojiposite  one  is  ,\  inch  nar- 


rower than  across  the  convex  or  posterior  edges, 
that  is,  iV  narrower  than  usiially  made.  I  consideied 
this  necessary  to  prevent  the  instvumeni  from  slip- 
ping, as  the  force  applied  differs  radically  from  that 
exerted  in  using  the  com- 
mon forceps.  In  the  latter 
the  traction  is  made  in  the 
long  axis  of  the  instrument. 
By  examining  the  engi'aving 
it  will  be  seen  that  when 
the  handle  of  the  rod  is  ele- 
vated, the  ijower  applied  is 
almost  in  a  line  drawn  from 
the  concave  to  the  convex 
poi-tion  of  the  blades.  The 
contraction  is  not  so  great 
as  to  caiise  undue  pressure 
on  the  head.  The  flange  on 
the  shank  will  not  offer  any 
hinderance  to  its  introduc- 
tion, as  the  second  blade  is 
usually  found  to  be  slightly 
everted  when  the  blades  are 
not  quite  jjarallel. 

The  manner  of  using  it  is 
simply  this:  The  forceps 
having  been  properly  ad- 
justed and  locked,  the  in- 
dex finger  of  the  left  hand 
is  carried  along  the  shank 
of  the  upper  blade  until  the 
little  arch  is  felt.  The  rod  is 
then  seized  by  the  right  hand 
and  held  almost  perpendic- 
ularly, when  the  hooked  ex- 
tremity will  be  found  to  fasten  very  readily.  There  is 
not  the  slightest  danger  of  the  rod  slipping  out,  as  the 
force  used  is  in  a  direction  contrary  to  that  by  which 
it  can  be  extracted.  The  rod  being  in  position,  the 
forceps  are  held  in  the  right  hand,  while  the  left 
grasps  the  handle  of  the  rod.  !Make  steady  and  uni- 
form pressure  downward  and  backward  in  the  axis 
of  the  superior  strait  with  the  left  hand  and  rod,  at 
the  same  moment  making  counter  force  with  the 
right  hand  on  the  handles  of  the  forceps  in  a  direc- 
tion upward  and  slightly  forward.  The  movement 
will  cause  the  distal  ends  of  the  instrument  to  be 
depressed,  and  with  it  the  posterior  portion  of  the 
child's  head.  As  the  head  clears  the  brim  and  de- 
scends into  the  pelvic  cavity,  the  traction  must  be 
changed  to  downward  and  somewhat  forward,  until 
the  floor  of  the  pelvis  is  reached,  when  the  delivery 
may  be  effected  as  with  the  ordinary  forceps. 

in  the  operation  just  described,  it  will  lie  observed 
that  all  pressure  is  taken  off'  the  bladder,  and  the 
rod  is  made  to  play  the  jiart  of  a  fiilcrum,  which  the 
posterior  face  of  the  symphysis  pubis  is  compelled 
to  enact  during  deliveiw  with  the  long  forceps. 

The  objection  may  be  raised  that  the  rod  would  be 
a  very  formidable  instrument  in  the  hands  of  the 
unskilful.  My  answer  is  that  such  pex-sons  are  not 
competent  to  perform  intelligently  so  difficult  an 
operation,  and  this  argument  should  not  militate 
against  its  usefulness.  The  rod  being  detached,  the 
instrument  becomes  an  ordinary  forceps,  and  can  be 
used  for  delivery  at  the  inferior  strait. 

The  improvements  as  described  are  the  result  of 
several  years'  careful  observation  in  operative  mid- 
wifery, and  in  presenting  the  insti-ument  to  the  pro- 
fession, I  do  so  in  the  hope  that  it  will  receive  a 
fair  and  imivK-tial  trial  before  it  is  either  accepted 
or  condemned. 


THE  MEDICAL  RECORD. 


279 


ARMY   NEWS. 

Official  List  of  CJianges  of  Staiiotut  and  Duties  of  Offi- 
cers of  the  Medical  Department,  United  States  Army, 
from  Febrvary  26,  1882,  to  March  4,  1882. 

Pope,  Benj.  F.,  Capt.  and  Asst.  Siirgeon.  Ee- 
lieved  from  duty  in  Department  of  Dakota,  and  to 
report  in  person  to  the  Surgeon-General  for  dntv  in 
Ins  office.     S.  O.  42,  A.  G.  O.,  February  21,  1882. 

CoMEGYS,  E.  T.,  Capt.  and  Asst.  Surgeon.  As- 
signed to  duty  at  Fort  Stanton,  N.  M.,  relieving 
Asst.  Surgeon  Newton.  S.  O.  40,  Department  of 
tlie  Missouri,  February  21,  1882. 

Spexcer,  Wm.  G.,  Capt.  and  Asst.  Surgeon.  l!e- 
lieved  from  duty  in  Department  of  the  Columbia,  to 
proceed  to  New  York  City,  and,  on  arrival,  report 
bv  letter  to  the  Surgeon-General.  S.  O.  46,  A.  G.  O., 
February  27,  1882. 

Powell,  J.  L.,  First  Lieut,  and  Asst.  Surgeon, 
Fort  Stockton,  Tex.  Granted  leave  of  absence  for 
oue  month.  S.  O.  19,  Department  of  Texas,  Feb- 
ruary 24,  1882. 

Newton,  R.  C,  First  Lieut,  and  Asst.  Surgeon. 
When  I'elieved  by  Asst.  Surgeon  Comegys  to  pro- 
ceed to  Fort  Cummings,  N.  M.,  and  report  to  the 
commanding  officer  for  duty.  S.  O.  40,  C.  S.,  De- 
partment of  the  Missouri. 

Fban'tz,  John  H.,  Major  and  Surgeon.  Died  at 
Baltimore,  Md.,  March  2,  1882. 


iHciiral  Sterns   aiiti  Hcius 


Vaccination  afteb  Small-Pox. — Dr.  C.  T.  Arm- 
strong, of  Corunna,  Mich.,  writes:  "I  had  small- 
pox in  1856,  treated  by  Professor  Sagar,  of  Michigan 
Univei'sity.  A  few  days  since  I  was  vaccinated  by 
Dr.  H.  B.  Shank,  of  Lansing,  and  have  as  nice  a 
vaccine-pock  as  one  would  care  to  see.  I  have 
treated  many  cases  of  small-pox  in  hospital  and 
camp,  also  in  private  practice,  without  taking  the 
disease." 

A  New  System  of  Surgical  Mechanics. — The 
"Transactions  of  the  American  Medical  Association 
for  1881  "  contain  a  very  concise  and  weU-iUustrated 
paper  on  the  above  subject,  read  before  the  surgical 
section  by  Dr.  Charles  F.  Stillman,  of  this  city. 

Dr.  Stillman,  while  connected  with  St.  Francis 
Hospital,  noticed  that  the  professional  ai-mamenta- 
rium  contained  no  instrument  which  would  permit 
constant  local  extension  of  a  joint,  and  also  allow 
fixation  at  any  angle,  or  motion  if  desired. 

He  thereupon  constructed  a  splint  possessing 
these  properties,  and  the  description  of  its  various 
adaptations  to  the  jiarts  of  the  body  and  the  principles 
governing  its  ajjplication  constitute  the  paper  in 
question.  His  exi>lanations  of  the  necessity  of  local 
extension  and  the  production  of  true  physiological 
rest  thereby,  are  novel  and  conclusive,  and  it  cer- 
tainly is  not  without  foundation  that  his  claims  lor 
an  extended  use  of  a  local  extension  system  are 
brought  forward. 

C0M:stENfEMi;N-T  OF  THE  MeDICAL  DePARTJIENT  OF 
THE    U.NIVERSITY    OF   THE    ClTI   OF    NeW   YoRK. — The 

forty-first  annual  commencement  of  the  Medical 
Department  of  the  University  of  the  City  of  New- 
York  was  held  Tuesday  evening,  March  7th,  in  the 
Academy  of  Music,  in  the  presence  of  a  large  audi- 


encei  Gilmore's  orchestra  furnished  the  music- 
The  graduates  filled  more  than  half  of  the  parquet 
spaoe,  numbering  213  in  all.  Two  large  candelabra 
were  on  the  stage,  and  beside  them  two  enormous 
vases  filled  with  flowers.  Professor  Alfred  C.  Post, 
M.D.,  LL.D.,  presided  as  Acting  Chancellor  of  the 
Medical  Department  of  the  University. 

The  Mott  gold  and  silver  medals,  for  the  best  and 
second  best  anatomical  or  anatomico-surgical  prep- 
arations, were  awarded  to  T.  J.  McGillicuddy,  of 
Maine,  and  R.  G.  Bindrim,  of  New  Y'ork,  and  a  third 
one  of  bronze,  for  the  best  book  of  recorded  cases 
of  surgical  clinics,  to  Emil  Heuel,  of  New  York.  Of 
the  faculty  jirizes,  the  first  of  ii^SOO,  for  the  candi- 
date whose  general  scholastic  standing  was  the  high- 
est, was  awarded  to  Frederick  Tuttle  Rogers,  A  B.; 
the  second,  of  .S300,  for  the  candidate  passing  the 
best  competitive  examination  in  the  seven  depart- 
ments, to  Felix  Peter  Shillock  ;  the  third,  of  .§200, 
for  the  next  best  candidate  in  the  same  deiJartments, 
to  Herbert  Bruce  Maclntire. 

John  Culver  Beekman  delivered  the  valedictory 
address,  and  the  Rev.  Richard  S.  Storrs,  of  Brook- 
lyn, an  exordium  to  the  graduates. 

American  Yetekinabt  College,  N.  Y'. — The  annual 
commencement  of  the  American  Veterinary  College 
took  place  on  Monday  evening  at  Chickering  Hall. 

Transactions  of  the  American  Medical  Associa- 
tion.— Volume  XXXII.  of  the  "Transactions  of  the 
American  Medical  Association  "  has  been  sent  to 
members,  in  the  care  of  the  librarian  of  the  New 
York  Academy  of  Medicine. 

Interesting  Letters  from  Drs.  S.  Sexton  and  F. 
A.  Burrall  have  been  unavoidably  crowded  out  of 
the  present  issue. 

Db.  Reuben  A.  Vakce,  of  Cincinnati,  Ohio,  has 
been  elected  Professor  of  Operative  Surgery  and 
Clinical  Surgery  in  Medical  Department  of  Wooster 
University,  Cleveland,  Ohio. 

The  Ninth  Annual  Report  of  the  New  York 
DiET-KircHEN  for  1881,  gives  an  account  of  an  insti- 
tution which  most  helpfully  supplements  the  work 
of  the  physician  among  the  poor.  The  society  has 
three  kitchens  in  connection  with  the  large  city  dis- 
pensaries. It  furnishes,  on  j^rescription  of  a  physi- 
cian, well-cooked  nutritious  food  to  such  persons  as 
are  unable  to  buy  proper  food  for  themselves. 

The  society  also  will  furnish  the  articles  needed 
for  infant  diet,  as  suggested  in  the  report  of  Dr. 
Jacobi  to  the  State  Medical  Society. 

The  Medical  Stttdent's  Pbimeb. — "What  place  is 
this  ?  This  is  the  Pathological  Society.  How  does 
one  know  it  is  the  Pathological  Society  ?  You  know 
it  by  the  specimens  and  the  smells. 

What  does  that  gentleman  say  ?  He  says  he  has 
made  a  post-mortem.  All  the  gentlemen  make  post- 
mortems. They  would  rather  make  a  post-mortem 
than  go  to  a  party. 

What  is  that  on  a  plate  ?  That  is  a  tumor.  It  is 
a  very  large  tumor.  It  weighs  one  hundred  and 
twelve  pounds.  The  patient  weighed  eighty-eight 
pounds.  Was  the  tumor  removed  from  the  patient? 
No,  the  patient  was  removed  from  the  tumor.  Did 
they  save  the  jiatient?  No,  but  they  saved  the 
tumor. 

What  is  this  in  the  bottle?  It  is  a  tapeworm. 
It  is  a  long  tapeworm  ;  it  is  three-quarters  of  a  mile 
long.  Is  that  much  for  a  tapeworm  ?  It  is  indeed 
much  for  a  tapeworm,  but  not  much  for  the  Patho- 
logical Society. 


280 


THE  MEDICAL  RECORD. 


,  Peofessok  Polk's  Lectdre. — By  an  oversight  Pro- 
fessor Polk  did  not  have  an  oj^portunity  of  reading  the 
proof  of  his  recent  lecture,  and  of  making  such  cor- 
rections as  he  might  have  thought  desirable.  It  was 
taken,  however,  as  delivered  in  the  lecture  room,  and^ 
as  an  extemporaneous  efl'ort,  is  beyond  criticism. 

A  Sanitaky  Coxvention  was  held  at  Ann  Arbor, 
Mich.,  under  the  auspices  of  the  State  Board  of 
Health,  February  28  to  March  1,  1881. 

Medical  Supervision  of  Schools.  —  A  bill  has 
been  introduced  into  the  Ohio  Legislature  which 
aims  to  secure  a  medical  supervision  of  schools.  It 
authorizes  the  local  Health  Boards  to  take  chai-ge 
of  the  matter  and  appoint  some  physician,  not  on 
the  board,  who  shall  make  sanitary  inspections  and 
see  to  the  proper  carrying  out  of  hygienic  rules. 

M.\larial  HE^nPLEciA. — Di\  George  A.  CoUamore 
reports  what  he  considers  an  authentic  case  of  this 
rare  affection  in  the  Oltio  Medk((l  Journal.  The  pa- 
tient was  a  boy,  aged  eight,  who  was  suddenly  taken 
with  a  fit  on  December  9th.  This  was  almost  im- 
mediately followed  by  complete  hemiplegia  of  the 
left  side,  including  the  face.  Sensation  and  vision 
on  that  side  were  completely  lost,  and  the  eyes  were 
deviated  to  the  left.  The  head  would  shake  for 
hours  at  a  time.  Speech  was  not  affected.  He  had 
a  high  fever.  He  continued  in  this  condition  for 
three  days,  when  the  symptoms  nearly  all  dis- 
appeared. Twenty-four  hours  later  he  had  a  chill 
followed  by  fever.  Two  days  later  he  had  a  slight 
fever.     The  patient  recovered  rapidly  under  quinia. 

Malaria  in  Rhode  Island. — This  State  had  been 
free  from  malaria  for  the  past  fifty  years  until  the 
summer  of  1880.  At  this  time  an  endemic  of  inter- 
mittent fever  occurred  at  Nayatt.  During  the  2)ast 
summer  Dr.  C.  V.  Chapin  tried  to  estimate  the 
amount  of  the  disease  in  the  city  of  Providence. 
He  obtained  rej^orts  of  about  three  hundred  cases. 

The  Tkeatiiest  op  Whooping-cough  by  mustard- 
plasters  to  the  spine  at  night,  with  cold  sponging  in 
the  morning,  is  highly  commended  in  a  Lancet  an- 
notation. 

The  UNrvERsrnr  of  Pennsylvania  has  lately  ac- 
quired, by  act  of  Councils,  a  large  piece  of  land  ad- 
joining its  property  in  West  Philadelphia.  Dr. 
Pepper  also  states  that  within  the  past  eleven 
months  the  sum  of  826-5,000  has  been  donated. 

Borax  in  Surgery.  —The  fact  that  borax  is  a 
powerful  germicide,  and  yet  is  without  poisonous 
properties  to  the  individual,  is  clean  and  odoi-less 
and  convenient,  has  not  been  so  widely  recognized 
as  it  should  bo,  according  to  the  Philadelphia  ^M^- 
cal  Times.  Surgeons  are  strongly  recommended  to 
use  it  more  extensively  as  a  substitute  for  carbolic 
spray  or  the  now  popular  iodoform. 

Borax,  we  understand,  has  been  given  quite  an 
extensive  trial  in  some  of  the  New  York  hospitals. 
It  gives  very  fair  results,  but  none  that  are  at  all 
extraordinary. 

The  Vivisection  Question  in  the  German  Par- 
liament.— .\  petition  was  presented  to  the  German 
Parliament  some  time  ago,  asking  for  the  restriction 
or  abolition  of  vivisection.  The  matter  was  referred 
to  a  committee,  which,  through  its  chairman.  Prof 
Hiiter,  of  Greifswald,  has  recently  reported  against 
the  petition.  The  report  was  accompanied  with  a 
motion  that,  considering  (1)  that,  in  the  interest  of 
science,  vivisection  appears  to  be  indispensable  in 
teaching  institutions  ;  (2)  that  changes  in  the  penal 


statutes  in  the  direction  desired  by  the  petitioners 
have  not  been  shown  to  be  necessary  ;  (3)  that  the 
petitioners  have  the  opportunity  of  laying  their 
complaints  of  any  abuses  fin  regard  to  vivisection 
before  the  local  authorities  who  have  the  regulation 
of  the  teaching  institutions — the  house  passes  to  the 
order  of  the  day.  Two  of  the  members  of  the  com- 
mission had  exj^ressed  themselves  as  unfavorable  to 
vivisection,  and  had  proposed  that  all  experiments 
on  animals  attended  with  suffering,  unless  they 
served  liigbly  important  scientific  purposes,  should 
be  punished  with  a  fine  of  six  hundred  marks  (£30), 
or  a  corresponding  term  of  imprisonment.  In  the 
discussion  in  the  House,  Herr  von  Minnigerode  pro- 
posed as  an  amendment  that  the  petitions  should 
be  refeiTed  for  consideration  to  the  Imperial  Chan- 
cellor. Professor  Virchow  denied  the  correctness 
of  the  statement  made  by  the  petitioners,  that  ex- 
periments were  performed  in  the  universities  to  a 
great  extent  by  students.  He  proceeded  to  show 
that  vivisection  was  indispensable  to  the  progress  of 
medical  science.  The  Minister  of  Public  Instruc- 
tion endorsed  the  report,  and  the  motion  of  the 
committee  was  carried  by  a  large  majority. 

A  Simple  Means  of  Detecting  Trichtnj.. — Ac- 
cording to  John  Phin,  the  i^arts  of  an  animal  that 
shoidd  first  be  examined,  are  the  diaphragm,  ten- 
derloin, and  muscles  about  the  head  and  throat. 
In  a  ham,  the  most  likely  place  is  that  part  at  which 
the  muscle  ends  in  a  tendon.  Cut  oft'  a  thin  slice 
with  a  very  sharp  knife,  or  with  a  pair  of  scissors 
curved  on  the  flat.  T)iis  thin  section  should  then 
be  soaked  for  some  minutes  in  acetic  acid,  spread 
out  on  a  thin  piece  of  glass,  and  covered  with 
another  similar  piece.  These  two  slips  are  then 
pressed  together.  A  compressorium,  by  means  of 
which  the  plates  of  glass  are  forced  together  by  a 
lever  and  screw,  answers  admirably.  But  better  still 
he  finds  the  trichinoscope,  which  is  a  compres- 
sorium holding  the  two  glass  slips,  but  fitted  with  a 
simple  microscope  on  a  sliding  frame,  which  per- 
mits the  exajnination  of  the  specimen  in  each  part. 

His  plan  is  as  follows :  a  thin  piece  of  flesh,  moist- 
ened with  a  mixture  of  equal  parts  of  acetic  acid  and 
glycerine,  is  placed  on  the  lower  plate  and  spread 
by  means  of  needles  fixed  in  wooden  handles.  The 
upper  plate  is  then  brought  down  on  the  lower  one, 
and  the  screw  is  turned  into  the  slot  in  which  it 
fits.  By  turning  the  nut  any  degree  of  pressure 
may  be  brought  to  bear  on  the  flesh,  which  thus  is 
rehdered  so  thin  and  transparent  that  any  trichinaj 
present  will  be  readily  brought  into  view 

Increased  Sickness  in  New  Yomc. — There  is  said 
to  have  been  an  increased  amount  of  sickness  in  this 
city  during  the  past  winter.  Dispensaries  and  hos- 
pitals have  been  more  crowded. 

The  following  table  shows  that  there  has  been  an 
actual  increase  of  patients  in  the  city  institutions. 

At  Bellevue  Hospital : 

ISSi.  ISSl.  Incroiisc. 

December 651  525  126 

January 638  500  138 

February 579  484  95 

At  the  Charity  Hospital  on  BIackwelJ"s  Island  : 

December '. 935  615  320 

Januarv 1,01-4  576  438 

February 997  575  422 

At  the  Homteopathic  Hospital  on  the  Island  : 

December 404  292  112 

January 440  288  152 

Februarv 573  262  311 


Vol.  XXI.-No.  11. 
March  18,  1883. 


THE  MEDICAL  RECORD. 


S81 


©rtginol  Communications. 


ON  THE  LOCAL  TEEATINFENT  OF  CIE- 
CL^ISCKIBED  GAXGIIENOUS  INFLASI- 
MATIOXS  OF  THE  SIQN  AND  CEL- 
LUL.AR  TISSUE,  COMMONLY  KNOWN 
AS  CAEBUNCLES  AND  FURUNCLES.* 
By  ALFRED  C.  POST,  M.D.,  LL.D., 

SEW   YORK. 

As  there  is  considerable  diversity  of  opinion  among 
surgeons  as  to  the  local  treatment  of  these  tronble- 
some,  painful,  and  often  dangerous  affections,  I  have 
thought  it  expedient  to  present  to  the  society  my 
views  on  the  subject,  in  the  hope  of  eliciting  discus- 
sion which  may  tend  to  harmonize  our  sentiments 
and  improve  our  jiractice,  and  thus  to  alleviate  and 
abbreviate  the  suffei-inga  of  our  patients,  and,  in 
some  instances,  to  lescue  them  from  imminent  dan- 
ger to  their  lives.  I  do  not  propose  to  consider,  on 
the  present  oc<!asion,  the  constitutional  treatment 
of  these  affections,  not  because  I  regard  such  treat- 
ment as  unimportant,  but  because  there  is  less  di- 
versity of  opinion  on  the  subject,  and  because  it  is 
more  difficult  to  lay  down  any  precise  rules  as  to  the 
best  means  of  counteracting  the  various  morbid  con- 
ditions of  the  system  which  are  influential  in  caus- 
ing and  maintaining  the  local  manifestations  of  the 
disease  which  we  are  considering. 

As  to  the  local  treatment  of  carbuncles  and  fur- 
tmoles,  the  leading  measures  which  are  recommended 
by  surgeons  may  be  referred  to  four  distinct  classes  : 

I.  The  sedative,  or  mothing  trentmeni,  consistiiirf  in 
the  rippUciUion  of  emollients,  poultices,  or  fomentations 
to  the  inflamed  parts. — This  method  recommends 
itself  to  timid  patients,  because  it  inflicts  no  pain 
and  excites  no  apprehension  of  suffering  beyond 
that  which,  in  its  natural  course,  is  occasioned  by 
the  disease.  But  the  method  appears  to  me  to  be 
faulty  in  these  respects :  that  it  does  very  little  to 
relieve  the  suffering  of  the  patient ;  that  it  does  not 
abridge  the  duration  of  the  disease  ;  that  it  does 
not  limit  the  destruction  of  the  tissues  which  are  in- 
volved ;  and  that  it  does  not  diminish  the  danger  of 
septic  absorption,  and  contamination  of  the  lilood. 
Under  this  inefficient  treatment  the  patient  often 
suffers  prolonged  agony  for  days  and  weeks,  his 
health  is  often  seriously  undermined,  and  a  fatal  re- 
sult sometimes  follows. 

II.  Tlie  treatment  hy  free  incision  through  the  u-hole 
breadth  and  thickness  of  the  affected  parts. — This  is 
the  method  which  I  have  employed  in  nearly  every 
case  of  the  disease  which  has  come  under  my  care 
after  the  intlammatoiT  symptoms  have  reached  their 
height,  and  the  process  of  disorganization  has  com- 
menced. In  snch  cases  I  have  divided  the  inflamed 
parts  throughout  their  whole  extent  by  a  p rucial  or 
stellate  incision,  and  have  interposed  between  the 

I  edges  of  the  wounds  lint  smeared  with  a  liniment 
I  composed  of  two  parts  of  ung.  resin  and  one  part  of 
I  ol.  terebinth.  The  effect  of  this  treatment  has  been 
mvariably  to  an-est  the  progress  of  the  disease, 
almost  immediately  to  relieve  the  sufferings  of  the 
patient,  to  quiet  the  constitutional  disturbance,  to 
hasten  the  suppuration  of  the  sloughs,  and  to  pro- 
mote healthy  granulation.  I  have  never  known  an 
instance  in  which  the  treatment  by  free  incision 

*  Head  before  the  New  York  Surgical  Society,  February  38,  1882. 


and  stimulating  dressings  was  followed  by  an  aggra- 
vation of  the  constitutional  si  niptcms,  or  by  a  de- 
teriorated condition  ol  the  local  disease. 

I  will  briefly  allude  to  three  or  four  cases  illus- 
trating the  beneficial  results  of  this  mode  of  treat- 
ment. 

A  number  of  years  since  I  was  called  to  see  a 
l)liysician  of  this  city,  who  had  been  suffering  for  a 
number  of  days  from  a  large  carbuncle  on  the  back 
of  his  neck,  which  had  been  exceedingly  painful, 
and  which  had  almost  entirely  deprived  him  of 
sleep.  He  had  been  attended  by  one  of  our  most 
eminent  surgeons,  who  had  treated  him  by  consti- 
tutional remedies  and  by  emollient  applications.  I 
advised  free  crucial  incisions,  and  the  surgeon  in 
attendance  assented  to  the  change  of  treatment,  and 
carried  it  out  in  a  most  thorough  manner,  extending 
his  incisions  at  each  point  into  healthy  tissues.  The 
pain  was  almost  immediately  relieved ;  the  patient 
had  a  quiet  sleep,  followed  by  a  marked  improve- 
ment in  his  constitutional  condition.  The  progress 
of  the  disease  was  at  once  arrested,  the  sloughs  soon 
liegan  to  separate,  and  the  rejiarative  process  went 
on  without  interrui^tion  until  cicatrization  was  com- 
plete. 

About  the  same  time  I  was  called  to  see  another 
member  of  our  profession,  a  hospital  surgeon,  who 
had  suffered  for  several  days  from  the  very  painful 
and  dangerous  disease  known  as  facial  carbuncle, 
and  by  some  designated,  improperly,  as  I  think,  by 
the  name  of  malignant  pustule.  The  disease  in- 
volved one  side  of  the  upper  lip.  I  made  an  inci- 
sion through  the  vermilion  border,  dividing  the 
inllauied  parts  throughout  their  whole  extent.  The 
incision  was  followed  by  immediate  relief  of  pain, 
and  the  patient  i-apidly  recovered. 

In  the  summer  of  1872  I  was  called  to  see  an 
elderly  gentleman,  father-in-law  of  two  well-known 
members  of  our  profession,  at  his  country  seat  on 
the  banks  of  the  Hudson,  above  the  Highlands.  He 
was  suffering  from  a  number  of  carbuncles  on  dif- 
ferent parts  of  his  body.  One  of  them,  on  the  side 
of  the  thorax,  was  of  an  irregular  shape  and  of  enor- 
mous size.  The  patient  had  been  treated  by  ap- 
propriate constitutional  remedies  and  by  emollient 
applications,  but  the  disease  was  extending  and  the 
general  health  was  much  impaired.  I  divided  the, 
largest  carbuncle  by  deep  stellate  incisions,  extend- 
ing to  its  most  remote  boundaries,  and  the  smaller 
carbuncles  by  crucial  incisions.  The  usual  stimu- 
lating dressings  were  applied.  The  progress  of  the 
difease  was  at  once  arrested.  The  sloughs  were 
gradually  thrown  off,  and  granulation  and  cicatriza- 
tion soon  followed.  I  have  a  strong  conviction  that 
the  disease  would  have  been  fatal  if  the  incisions 
had  not  been  made. 

I  will  finish  the  recital  of  cases  under  this  head 
by  abrief  account  of  an  extremely  complicated  case,  in 
which  free  incisions  were  followed  by  a  marked  im- 
provement in  the  condition  of  the  inflamed  parts, 
but  a  fatal  result  from  blood-poisoning  and  multiple 

j  abscesses  occurred  after  the  lapse  of  more  than  six 

I  weeks. 

j       On  December  11,  1880,  I  was  called  in  consulta- 

I  tion  to  see  a  gentleman  about  forty- five  years  of  age, 
who  was  suffering  from  a  very  large  carbuncle  on 
the  back  of  his  neck.  His  general  health  was  much 
impaired,  and  he  was  passing  enormous  quantities 
of  urine,  heavily  loaded  with  sugar.  I  made  a  free 
crucial  incision  through  the  carbuncle,  washed  the 
incised    parts   freely  with    carbolic   acid,  1    to   40, 

I  and  applied  the  usual  stimulating  dressings.     The 


382 


THE  MEDICAL  RECORD. 


sloughs  gradually  separated,  and  the  base  of  the 
sore  was  tillej  with  granulations,  but,  notwithstand- 
ing the  use  of  api>ropriate  constitutional  remedies, 
the  diabetes  continued,  abscesses  formed  in  differ- 
ent parts  of  his  body,  one,  of  enormous  size,  in- 
volving the  deep  cellular  layers  of  one  of  his  thighs, 
and  death  from  exhaustion  took  place  near  the  end 
of  January,  1881. 

III.  —  Trejilment  by  the  potential  or  actual  cautery. — 
Many  surgeons  have  treated  carbuncles  by  the  ap- 
plication of  caustic  potassa  to  the  centre  of  the  in- 
flamed part.  The  api^lication  is  made  thoroughly 
so  as  to  destroy  the  skm  to  the  extent  of  one-fourth 
to  one-third  of  the  part  involved  in  the  disease.  It 
should  also  penetrate  the  diseased  mass  through 
nearly  its  entire  thickness.  This  method  was  rec- 
ommended by  Dr.  Physick  in  America,  and  by  Mr. 
Higginbottom  and  Mr.  Pritchard  in  England.  Very 
favorable  accounts  are  given  of  the  results  of  this 
method.  I  have  no  personal  experience  of  the  treat- 
ment of  carbuncle  by  caustic  potassa,  but  I  liave 
made  use  of  nitric  acid  in  one  instance  with  marked 
benefit.  About  sixteen  years  ago  I  had  a  painful 
inflammatoi-y  swelling  on  the  outer  jjart  of  my  right 
leg  ;  the  swelling  was  circumscribed  and  indurated, 
and  the  integument  involved  was  of  a  livid  red  color. 
The  swelling  had  continued  more  than  a  week,  daily 
increasing  in  circumference,  in  induration,  and  in 
painfulness,  and  it  was  beginning  to  interfere  with 
locomotion.  In  this  condition  I  applied  to  the  sur- 
face a  piece  of  bibulous  paper,  covering  about  half 
the  extent  of  the  inflamed  surface,  and  moistened 
with  fummg  nitric  acid.  After  the  burning  sensa- 
tion occasioned  by  the  application  had  subsided,  a 
sensation  of  relief  was  afl'orded.  The  progress  of 
the  inflammation  was  arrested,  the  separation  of  the 
eschar  was  followed  by  a  very  slight  amount  of  sup- 
puration, and  the  sore  rapidly  healed.  I  felt  satis- 
fied that  the  application  of  the  escharotio  had  saved 
me  from  prolonged  suffering,  and  probably  from  a 
tedious  confinement. 

From  repeated  personal  experience,  I  am  inclined 
to  regard  the  actual  cautery  as  a  very  valuable  abor- 
tive remedy  in  the  treatment  of  carbuncle  in  its 
early  stages,  before  actual  disorganization  has  oc- 
curred to  any  considerable  extent.  In  the  spring  of 
1879,  I  had  a  circumscribed  indurated  inflammatory 
swelling  over  the  right  natis,  continuing  a  number 
of  diys,  gradually  increasing  in  size  until  its  cir- 
cumference had  equalled  that  of  the  butt  end  of  a 
hen's  egg,  and  it  had  become  so  painful  as  to  be  an 
occasion  of  great  annoyance.  While  the  parts  were 
in  this  condition,  I  requested  my  friend  Dr.  Hinton 
to  apply  the  actual  cautery  to  the  middle  of  the  in- 
flamed part.  The  cautery  used  for  this  purpose 
was  Thorp's  multiple  cautery,  presenting  six  points 
about  the  size  of  a  small  knitting-needle.  This  was 
h  :ated  to  a  red  heat  and  plunged  into  the  inflamed 
part  so  as  extend  through  the  skin  into  the  sub- 
jacent tissue.  Tliore  was  a  momentary  acute  pain  ; 
this  rapidly  subsided,  and  was  followed  by  sensible 
relief  of  the  pain  which  provinnsly  existed.  The 
next  day  the  swelling  and  hardness  had  diminislied, 
and  from  that  time  there  was  ])rogre8sive  improve- 
ment until,  witliin  three  or  four  weeks,  the  parts 
wore  restored  to  a  sound  condition.  There  was  no 
destruction  of  the  cellular  tissue,  and  no  proper 
suppuration,  only  a  slight  discharge  of  bloody  serum. 
Within  loss  than  a  week  after  the  application  of  the 
cautery  I  rode  in  the  cars  to  Philadelphia,  and  re- 
turned the  next  day,  suffering  very  slight  inconveni- 
ence from  the  journey.     In  the  cour.se  of  the  spring 


and  summer  I  had  four  other  attacks  similar  in 
their  leading  features  to  the  first,  and  they  were  all 
treated  substantially  in  the  same  manner,  only  one 
application  of  the  cautery  having  been  made  after 
each  attack.  Within  about  a  week  after  the'  appli- 
cation following  the  second  attack,  I  started  on  a 
journey  of  two  thousand  miles,  and  scarcely  suffered 
any  pain  from  the  long-continued  sitting  posture. 
During  none  of  these  attacks  did  I  remain  in  the 
house  for  a  single  day,  or  abstain  from  any  of  my 
ordinary  avocations.  I  have  a  strong  conviction, 
from  what  I  have  seen  of  similar  attacks  in  patients 
whom  I  have  attended,  that  the  heroic  treatment 
which  I  adopted  saved  me  from  protracted  suffering 
and  from  the  loss  of  much  valuable  time. 

From  my  personal  experience  I  have  been  so 
fully  convinced  of  the  benefit  of  this  abortive  mode 
of  treatment  that  I  have  been  anxious  to  make  far- 
ther proof  of  its  efiicacy  in  appropriate  cases.  But 
I  have  not  had  the  opportunity  of  testing  the  treat- 
ment in  any  well  marked  case  of  the  early  stage  of 
carbuncle  in  a  clearly  defined  form.  But  during 
the  last  summer,  in  my  service  at  the  Presbyterian  ■ 
Hospital,  I  had  two  cases  of  circumscribed  indurated 
inflammation  of  an  obstinate  character,  bearing 
some  relation  to  carbuncle.  And  in  both  of  these 
cases  I  applied  the  actual  cautery  with  marked 
beneflt.  I  will  present  these  cases  as  they  appear 
on  the  hospital  records,  as  furnished  by  Dr.  W.  K. 
Simpson,  who  was  House  Surgeon  at  the  time  of 
their  occurrence. 

C!.\SE  I. — L.  Sweeny,  aged  fifteen  years,  admitted 
August  17,  1881.  About  two  months  before  her  ad- 
mission, a  painful  swelling  occurred  at  the  upper 
part  of  the  left  thigh,  with  slight  stiflhess  of  the  leg 
in  walking,  with  swelling  in  the  neck,  and  pain  in 
the  axilla.  The  swelling  of  the  thigh  had  gradually 
increased  until  the  time  of  her  admission,  and  there 
had  been  at  times  cramps  in  the  left  leg. 

At  the  time  of  her  admission  there  was  a  circum- 
scribed, hard  red  painfid  swelling  of  the  left  thigh 
in  .Scarpa's  space,  with  enlargement  of  the  corre- 
sponding inguinal  glands.  There  were  also  enlarged 
glands  in  the  right  axilla. 

Treatment. — Flaxseed  poultices  were  directed  to 
be  applied  to  the  inflammatory  swelling,  and  sul- 
phite of  calcium  was  dii'ected  to  be  given  internally 
in  doses  of  one-fourth  of  a  grain  three  times  a  day. 

August  27th. — The  swelling  and  induration  con- 
tinue, the  pain  has  not  been  relieved,  and  no  sup- 
puration has  occurred  but  at  a  minute  point.  I  had 
the  patient  etherized,  and  applied  a  thermal  cauteiT 
at  a  number  of  points,  penetrating  the  skin  and  the 
indurated  tissues  beneath.  Lint  moistened  with  a 
saturated  solution  of  bicarb,  sodte  was  directed  to 
be  ai)plied  over  the  surface. 

August  2Sth. — The  inflammatory  symptoms  are 
notably  alleviated. 

October  1st. — The  sores  made  by  the  cautery 
have  all  healed,  and  the  swelling,  redness,  and  in- 
duration have  been  very  much  reduced.  General 
health  is  rapidly  improving. 

November  Ist. — There  are  scarcely  any  remains  of 
induration  in  Scarpa's  space.  The  inguinal  glands 
are  reduced  in  size,  but  are  still  somewhat  enlarged. 
The  patient  walks  without  pain. 

Discharged  cured. 

C.vsE  II.— John  Dunn,  aged  twenty-eight,  carpen- 
ter. Admitted  August  30,  1881.  Two  years  before 
his  admission  he  had  an  inflammatory  swelling  of  the 
right  leg  near  the  knee.  The  inflammation  was  of  an 
obstinate  character,  and  led  to  anchylosis  of  the  joint. 


THE  MEDICAL  RECORD. 


283 


At  the  time  of  his  admission  he  had  a  circum- 
scribed inflammatoiy  swelling,  with  considerable 
induration,  about  six  or  seven  centimetres  in  diam- 
eter, involving  the  skin  and  cellular  tissue  of  inner 
side  of  the  right  thigh,  more  than  a  hand's  breadth 
sbove  the  knee.  It  was  quite  painful  and  tender  on 
pressure.  It  had  existed  for  several  months,  and 
had  resisted  domestic  treatment.  There  was  no 
fluctuation,  but  there  were  two  small  ulcerated  spots 
near  the  centre.  I  ordered  absolute  rest  and  hot 
poultices,  to  be  renewed  once  in  two  hours,  ano- 
dynes at  night,  to  relieve  pain  and  to  secure  .sleep. 

September  1st. — No  relief  having  been  afforded,  I 
applied  the  thermal  cautery  at  nine  points,  and 
directed  the  surface  to  be  covered  with  lint  moist- 
ened with  a  saturated  solution  of  sodif  bicarb. 

September  3d.— There  is  a  slight  purulent  dis- 
charge from  the  cauterized  points.  The  pain  is  re- 
lieved, and  there  is  a  decrease  of  the  swelling. 

September  6th.— The  swelling  has  nearly  sub- 
sided. There  is  a  slight  discharge  from  the  sores, 
which  are  now  dressed  with  carbolic  acid  1  to  40 

September  Kith. — The  swelling  and  induration 
have  disappeared.  The  discharge  has  ceased.  The 
patient  is  free  from  pain,  and  is  able  to  walk  with- 
out inconvenience. 

Discharged  cured. 

C.tsE  III. — Hypodermic  injection  of  dilute  carbolic 
acid  at  a  number  of  points  around  the  circumference 
of  the  swelling,  and  directed  toward  its  centre. 
This  method  of  treatment  was  highly  recommended 
by  a  Spanish  surgeon,  Dr.  Muiioz.  He  used  the 
following  formula : 

Carbolic  acid 5  parts. 

Alcohol 10     " 

Distilled  water 100     " 

He  used  these  injections  daily,  and  reported  that 
there  was  in  each  case  immediate  improvement,  fol- 
lowed by  a  complete  cure  within  a  few  days  (see 
Medical  Record,  September  10,  1881,  p.  308).  I 
have  made  but  a  single  trial  of  this  mode  of  treat- 
ment, and  that  was  in  a  case  where  the  disease  was 
too  far  advanced  to  afford  a  fair  test  of  its  efficacy. 
I  give  the  following  details  of  the  case  as  furnished 
by  the  records  of  the  Presbyterian  Hospital : 

Dancan  Phillips,  aged  forty-one,  admitted  Sep- 
tember 30,  1881.  Ten  days  before  his  admission  a 
swelling  occurred  on  the  back  of  his  neck,  which 
was  painful  and  tender  on  pressure,  and  increasing 
rapidly  in  size.  On  admission  a  large  carbuncle 
was  found  with  several  openings,  which  gave  issue 
to  pus  and  disintegrated  tissue.  I  ordered  hy])o- 
dermic  injections  of  carbolic  acid,  1  to  40,  into  the 
base  of  the  swelling.  These  injections  gave  pain, 
and  were  not  rejieated. 

October  Ist. — The  patient  came  under  the  care  of 
Dr.  Shrady.  He  had  at  that  time  a  temperature  of 
104°  r.  Poultices  were  applied,  and  the  patient  was 
directed  to  take  sulph.  quinirc,  gr.  ij.,  every  two 
hours,  and  four  ounces  of  brandy  during  the  day. 

October  4th. — Patient  feeble,  discbarge  profuse. 
_  October  10th. — Disclmrcce  still  very  profuse  ;  quan- 
tity of  quinine  and  stimulants  increased. 

October  1.5th. — Base  of  carbuncle  8  by  .5  inches  in 
diameter.  This  afternoon  a  severe  arterial  hemor- 
rhage occurred,  and  the  patient  seemed  to  be  sink- 
ing. Temperature  fell  to  97°.  Ice  was  freely  ap- 
plied to  the  swelling,  and  hot  applications  to  the 
body.  Hypodermic  injections  of  brandy  were  freely 
administered. 


October  16th. — No  return  of  hemorrhage.  Patient 
has  rallied  from  extreme  depression.  Carbuncle 
thoroughly  carbolized,  and  dressings  not  disturbed. 

October  18th.  —  General  condition  improving. 
Sore  granulating.  Same  general  treatment,  with  ad- 
dition of  beef  peptone,  Z  ij.,  ter  in  die.  Sore  dressed 
with  balsam  of  Peru  covered  by  a  layer  of  carbolized 
gauze. 

December  1st. — General  condition  has  steadily 
improved.  The  sairface  of  the  Fore  has  been  daily 
strapped,  and  is  now  reduced  to  a  small,  healthy 
ulcer. 

Discharged  cured. 

The  trial  of  hyi^odermic  injections  of  carbolic  acid 
in  this  case  was  so  imperfect,  and  it  was  made  at  so 
advanced  a  stage  of  the  disease,  that  no  fair  infer- 
ence can  be  dedaiced  from  it  as  to  the  utility  of  the 
practice.  I  feel  disposed  to  give  the  treatment  a 
fair  trial  when  a  favorable  opportunity  shall  j^resent 
itself. 

Carbolic  acid  has  been  used  in  a  different  way  in 
the  treatment  of  furancles,  as  reported  by  C"  B. 
Cleborne,  M.D.,  Surgeon  U.  S.  Navy,  in  the  Ameri- 
cnn  Jounial  of  Medical  Sciences.  He  made  a  free  in- 
cision as  soon  as  fluctuation  could  be  detected, 
pressed  out  the  matter,  and  then  swabbed  the  sur- 
face of  the  cavity  with  strong  carbolic  acid,  after 
which  he  applied  cold  water  dressings.  This  treat- 
ment was  followed  by  a  very  rapid  cure.  (See  Medi- 
cal Kecoed,  January  15,  18G9,  p.  515.) 


THE  TREATMENT  OF  SC AELATIN.\.  * 
By  DANIEL  LEWIS,  M.D., 

KEW   YORK. 

In  The  Medicai.  Eecoed  of  February  3,  1877,  may  be 
found  a  brief  report  of  thirteen  cases  of  scarlatina, 
treated  by  infusion  of  digitalis,  in  which  I  offered 
my  reasons  for  recommending  its  general  use.  The 
present  paper  is  based  upon  the  histories  of  one  hun- 
dred and  fifty  cases,  which  succeeded  the  thirteen 
previously  reported,  and  they,  being  the  product  of 
two  pretty  severe  epidemics  which  have  visited  this 
city  during  the  past  three  years,  are  believed  to  be 
sufficient  grounds  for  reliable  dediictions. 

My  attention  was  first  called  to  this  use  of  digi- 
talis by  Professor  Bartholow's  clinical  lecture  on 
"  Physiological  Antagonism  as  Apjilied  to  the  Treat- 
ment of  the  Febrile  State,"!  and  his  theory  was 
based  upon  the  physiological  action  of  the  drug, 
concerning  which  nearly  all  writers  are  now  agreed, 
viz. : 

First. — Digitalis  causes  contraction  of  the  arte- 
rioles, and  consequent  diminished  blood-supply.  Ex- 
udation is  thereby  checked  or  prevented. 

Second. — The  pulse  is  reduced  in  frequency,  and 
the  arterial  blood-pressure  raised. 

J  bird. — Doses  sufficiently  large  to  slow  the  action' 
of  the  heart  will  reduce  temperature. 

In  the  rapid  pulse  and  high  temperature  of  .scarla- 
tina, the  low  arterial  tension  and  embarrassed  secre- 
tion by  the  kidneys,  are  to  be  found  all  the  indica- 
tions for  the  use  of  this  remedy,  and  Professor  Bar- 
tholow  declares  "  that,  in  a  considerable  experience 
in  the  treatment  of  scarlet  fever,  digitalis  has  been 
uniformly  successful." 

For  present  purposes  we  may  divide  scarlatina- 
into  two  classes  : 

•  Read  before  the  Medical  Society  of  the  State  of  Now  York,  Feb- 
mnry  8.  18S2. 
t  American  Clinical  Lectures,  vol.  li..  No.  1. 


284 


THE  MEDICAL  RECOED. 


First. — Malignant  scarlet  fever,  in  which  the  at- 
tack is  so  sudden  and  overwhelming  that  the  patient 
dies  before  the  etlects  of  any  drug  can  be  obtained. 

Second. — AU  cases  usually  classed  as  scarlatina 
simplex  and  scarlatina  anginosa,  in  which  the  chief 
dangers  are  the  pyrexia  and  consequent  tissue  de- 
generation, and  the  catan-h,  or  parenchymatous 
nsphritis,  by  which  elimination  by  the  kidneys  is 
diminished  or  arrested. 

Digitalis  meets  both  these  indications  by  lessen- 
ing the  blood-supply  to  the  tissues,  by  increasing 
the  amount  of  water  in  the  urine,  and  by  its  direct 
action  on  the  Malpigbian  tufts. 

While  most  writers  admit  this  effect  of  the  drug 
on  the  circulation  of  the  kidneys,  there  is  abundant 
evidence  that  the  tendency  to  exudation  in  all  f/hmd- 
ular  tissue  is  reduced  to  the  minimum  by  its  use. 

The  most  reliable  preparation  for  these  cases  is 
the  infusion  of  the  best  English  leaves.  Dr.  Bar- 
tholow  says  a  reliable  tincture  may  be  used,  but 
in  cases  where  I  have  employed  it  the  results  were 
not  satisfactory. 

It  does  not  appear  to  be  as  readily  eliminated  as 
the  infusion,  and  unpleasant  effects  will  often  fol- 
low, and  its  administration  be  interfered  with,  while 
we  may  give  the  infusion  for  weeks,  without  depress- 
ing the  circulation  beyond  the  desired  limits.  I 
would  suggest  also  that,  in  ordering  the  infusion, 
you  send  to  a  reliable  pharmacist,  unless  you  are 
willing  to  receive  as  a  substitute  a  diluted  fluid  ex- 
tract, or  some  equally  uncertain  jireparation. 

We  should  commence  the  administration  of  this 
remedy  at  the  earliest  possible  stage  of  the  disease, 
before  those  tissue  changes  occur  which  it  is  intend- 
ed to  prevent  as  well  as  cure. 

To  a  child  five  years  old,  a  teaspoonful  every  four 
hours  is  a  safe  and  usually  efficient  dose.  Should 
the  pulse  and  temperature  he  unaffected  by  it,  more 
can  be  given,  but  its  effects  carefully  noted  and  the 
dose  redviced  whenever  the  desired  effects  are  pro- 
duced. I  continue  to  give  it  two  or  three  times  a 
day  until  the  end  of  the  third  week,  unless  the  pulse 
becomes  less  frequent  than  it  should  be. 

The  following  table  contains  pulse  and  tempera- 
ture (axillary)  of  a  few  cases  treated  on  this  plan. 


AOE. 

r>AT9. 

Years. 

1st. 

2a. 

3d. 

4th. 

5th. 

(ith. 

Tth. 

8th. 

9th. 

10th 

Temp. 

lOSf" 

1(13° 

inoi" 

1011° 

101*° 

100° 

!W° 

-.a.  j 

PulBC. 

IXll 

I'.'ll 

1111 

ISO 

'■,       i 

Tennp. 

VK' 

lll_"  ■ 

l,i.ji„ 

l(l(lj» 

1004° 

■'■■■  i 

Pulse. 

Mil 

1  .'i 

l-JI 

70 

<)       ' 

'I'emp. 

III";  ■ 

ii:.  i 

11  1 

H)1;J° 

101° 

•Ic-  1 

Pulso. 

r:ii 

in 

j.-ai 

11(1 

1       1 

Temp. 

1U5° 

lUH" 

lUii" 

loop 

100° 

!(!>f° 

'■■■  1 

I'ulst* 

3....| 

Temp. 
Piil5e» 
Temp. 

105° 

1014° 

101J° 

101J° 

1001° 

100° 

Mr 

»      i 

103i° 

10Rt° 

104° 

10H° 

101° 

iont° 

"•••I 

Pulse. 

mo 

1-10 

110 

110 

00^ 

.       J  I'i'cmp. 

lUKf" 

lU4f° 

100° 

1051° 

104}° 

104i°  death 

'■■•I 

Piilfie. 

IW 

1,.    ( 

Temp. 

104}- 

101i° 

1001° 

100}° 

1m-  j 

Pulse. 

1411 

Kill 

.V..-- 

Tcmp.l05» 

11 «» 

10'.>^» 

lo:j}° 

lllOii° 

lOlli" 

I0IH° 

on»° 

I'nlw.   KiU 

140 

13U 

124 

'lO 

no 

*No 

breco 

rdcd. 

It  will  be  ob!;prved  from  this  table  that  in  nearly 
all  cases,  a  decided  fall  in  pulso  and  tcniporaturo  oc- 
curred within  twenty-four  hours  after  the  digitalis 
treatment  was  commenced. 

The  first  day,  in  the  table,  refers  to  the  beginning 
of  treatment,  some  of  the  patients  having  been  sick 


one  day  before  I  was  called  to  attend  them.  Such 
was  the  fact  with  the  fatal  case  recorded,  which  was 
of  a  very  malignant  type,  from  the  onset  of  the  dis- 
ease. On  the  fourth  day,  in  the  last  history,  it  will 
be  noticed  there  was  a  decided  rise  in  pul.se  and 
temperature,  and,  although  the  patient  was  only 
five  years  old,  a  dessertsjjoonful  ot  the  infusion  was 
given  every  four  hours  till  the  following  morning, 
and  with  the  most  gratifying  result. 

In  all  cases  the  following  prescription  has  been 
ordered  for  the  throat : 

6 .    Potass  chlorat 4.0 

Tr.  ferri  chlorid 8.0 

Glyoerinas 30.0 

Aquae q.  s.  ad.  2.50.0 

M.  Sig. — Teaspoonful  every  half  hour. 

If  exudation  occur  in  the  fauces  the  same  mixture 
is  also  to  be  used  with  Davidson's  Atomizer  No.  55, 
every  twenty  minutes.  A  warm  sponge-bath  should 
be  given  more  or  less  frequently  according  to  the 
degree  of  fever,  and  inunctions  of  olive-oil  over  the 
entire  body,  at  least  twice  daily.  The  oiling  should 
be  continued  until  desquamation  is  complete. 

A  milk  diet  should  be  strictly  enforced,  especially 
on  account  of  its  diuretic  effect. 

The  results  of  this  plan,  in  my  one  hundred  and 
fifty  cases,  have  been  quite  satisfactory.  Seventeen 
proved  fatal,  only  two  of  whom  died  of  ne)ihvitis. 

The  mortality  from  scarlatina  in  New  York  City 
during  the  past  year  was  nearly  twenty-lLiee  per 
cent.,  while  in  my  cases,  you  will  notice,  it  was  less 
than  eleven  per  cent. 

There  were  only  two  cases  of  otitis,  both  of  which 
were  mild  and  made  a  good  recovery. 

In  the  entire  number  there  was  no  case  of  suppu- 
ration of  cervical  or  other  glands. 

Dr.  r.  A.  Thomas,  of  New  York,  informs  me  that 
he  has  employed  the  same  treatment  in  fifty  cases 
with  excellent  results. 

In  the  epidemic  of  the  present  season  I  am  pur- 
suing the  same  plan,  and  have  not  the  slightest 
hesitation  in  recommending  it  to  the  profession. 


The  Htoienic  Value  of  tke  Electric  Light. — 
The  French  scientific  journal  La  j\'atiire  summarizes 
a  communication  from  Dr.  Javal,  who  believes  that 
the  electric  light  is  absolutely  without  danger  to 
the  sight,  in  conse(iuence  of  the  amount  of  division 
which  can  now  be  obtained  in  it.  U Union  Midi- 
cale  also  reminds  its  readers  that  similar  researches 
of  great  interest  from  a  scholastic  point  of  view 
were  published  in  that  journal  in  May  and  July,  1881 ; 
including  the  researches  of  Dr.  Cohn  of  Breslau, 
who  found  that  the  electric  light  increases  sixfold, 
as  compared  with  daylight,  the  perception  of  yellow, 
and  doubles  the  perception  of  green  and  blue.  The 
observations  of  Dr.  Blasius  and  Dr.  Hoppe,  in  a  dis- 
cussion which  took  place  at  a  meeting  of  the  Bruns- 
wick Society  of  Natural  Sciences,  are  aL-io  note- 
worthy. These  scientists  have  shown  that  ilhuin'na- 
tion  by  the  electric  light  deserved  preference  over 
all  other  methods  in  use,  for  the  following  reasons  : 
1.  It  does  not  pollute  the  air  with  deleterious  pasea 
or  other  unhealthy  products.  '2.  It  induces  a  greater 
visual  unity  than  with  daylight  or  gaslight.  The 
conclusion  adopted  by  tlie  meeting  was,  that  "the 
hygienic  qualities  of  the  electric  light  have  not  liith- 
erto  been  appraised  at  their  real  value."' — lirilish 
Medical  Journal. 


THE  MEDICAL  RECORD. 


285 


CASES  ILLUSTRATING  TKEATjMENT  OF 
COXSraiPTION  BY  A  SYSTEMATIC  GEN- 
EK.AJL  AND  LOCAL  ANTISEPTIC  THER- 
APY. 

By  J.  HILGAKD  TYNDALE,  M.D., 

NEW  TORE. 

Evert  iatUvidual,  strumous  or  otlierwi.se,  has  his 
own  standard  of  physiological  well-being.  When- 
ever the  general  condition  and  nutrition  of  a  person 
is  dragged  below  this  physiological  line,  pulmonaiy 
consumption  may  be  developed,  either  as  a  sequel 
to  an  acute  pulmonary  trouble,  or  be  a  sluggish  pro- 
cess from  the  beginning,  aggravated  from  time  ,to 
time  by  fiesh  catarrhs  of  the  pulmonary  or  gastric 
mucous  membrane. 

Actual  destruction  of  lung-tissue  takes  place  ft  cm 
the  moment  of  the  advent  of  bacteria,  which  usher 
in  local  putrefaction,  to  be  in  turn  followed  by  gen- 
eral septicfemia. 

We  have,  therefore,  in  a  fully-developed  case  of 
consumption  :  iirst,  a  local  putrefaction  caused  by 
the  presence  of  bacteria  and  their  rapid  prolifera- 
tion ;  second,  a  general  septicemia  caused  by  ab- 
sorption of  septic  material,  on  the  one  hand  (aseptic 
fever  of  Volkmann).  and  general  ttibereulosis,  so- 
callei  acute  tuberculosis,  on  the  other,  whenever 
bacteria  find  in  the  lowered  nutrition  of  the  patient 
a  favorable  field  for  acclimatization  and  develop- 
ment. 

It  results  fi-om  the  above  that  the  possibility  of  a 
cure  lies  in  the  resisting  power  of  the  patient  as  op- 
posad  to  the  destructive  agencies  of  local  putrefac- 
tion and  general  septiciemia. 

Any  trsatment,  therefore,  which  aims  at  success 
has  to  depend  in  large  measure  upon  the  assimila- 
tive powers  of  the  patient,  primarily  U230U  his  diges- 
tive capacity,  and  this,  of  course,  is  again  dependent 
upon  the  state  of  his  circulation  and  nervous  system. 
We  may  with  considerable  precision  approximate 
the  extent  and  dangers  of  the  local  process  in  the 
lung,  and  also  of  the  general  septicaemia,  but  the 
sum  total  of  the  patient's  functional  capacities  can 
onlv  be  determined  by  actual  trial 

To  mv  mind  it  has  long  been  clear  that  what  should 
primarily  be  done  is  to  counteract  by  all  means  in 
our  power  local  putrefaction  and  general  septicajmia, 
and  to  depend  upon  the  patient's  functions  to  assert 
themselves,  while  we  help  to  increase  the  resistance 
of  the  organism  by  combating  septic  influences. 
Keeping  this  general  plan  in  mind,  it  would  seem 
*  rational,  therefore : 

First. — To  combat  general  septicfemia. 
Second. — To  combat  local  putrefaction. 
Third. — To  allow    digestion   and   assimilation   a 
chance  to  re-establish  themselves  ;  to  make  blood 
wherewith  to  baptize  the  starving  tissues. 

To  this  end  the  receptacle  of  all  food,  the  stom- 
ach, should  be  left  free  from  medicinal  substances 
altogether,  or,  at  least,  until  such  time  as  we  have 
succeeded  in  limiting  the  disease,  and  see  a  chance 
to  save  a  goodly  portion  of  the  affected  lung.  The 
loss  of  an  extensive  section  of  lung  is  not  inconsis- 
tent with  life  and  very  reasonable  health. 

It  is  upon  these  broad  principles  that  I  have  based 
my  "  systematic  general  and  local  antiseptic  treat- 
ment of  pulmonary  consumption."  In  this  method 
reliance  is  not  placed  upon  one  feature,  such  as  in- 
halation, nor  upon  one  route  of  administration  of 
remedies,  nor  upon  any  one  antiseptic  remedy.  I 
have  allowed  the  system  to  evolve  itself  out  of  a 
sound  basis,  and  endeavored  to  improve  and  perfect 


it  by  the  experience  which  came  from  close  obsei  va- 
tion  of  cases  treated.  The  system  itself  consist!-  if 
seven  counts,  each  one  the  link  of  a  perfect  chain, 
not  one  of  which  can  stand  alone.  These  "  counts  ' 
will  be  published  hereafter. 

If  now  a  few  of  my  cases  are  published,  with  the 
results  thus  far  attained,  it  is  my  wish  not  to  be  con- 
sidered premature.  The  sole  reason  why  it  is  done 
at  this  time  is  to  draw  the  attention  of  the  profes- 
sion to  the  system,  and  to  ask  that  it  be  given  a  fair 
trial,  in  private  as  well  as  in  hospital  practice,  for 
which  purpose  the  details  are  at  disposal. 

Let  me  add,  that  any  system  or  method  intended 
to  yield  better  results  than  any  former  line  of  treat- 
ment must  be  conducted  with  extreme  care.  It  is 
essential  that  there  be  an  absolute  and  comijlete 
control  of  all  details.  The  two  great  factors  in  the 
treatment  of  such  a  chronic  disorder  as  23ulmonary 
consumjition  are  individualization  and  strict  attention 
to  derail. 

Case  I. — H.  B ,   aged  thirty-two ;  tanner  by 

trade  ;  no  hereditary  vulnerability.  Directed  to  me 
by  Dr.  Pinner.  Limited  cavity  of  right  a-pex  ;  con- 
solidation surrounding  it.  Infiltration  of  left  apex. 
Great  weakness ;  loss  of  appetite.  Diagnosis  :  Ca- 
tarrho-fibroid  phthisis,  with  bronchifctatic  cavity. 
Treatment :  HyiJodermic  injection  of  three  per  cent, 
carbolic  acid  solution,  for  general  septicnsmia  ;  in- 
trapulmonary  injections  of  carbolic  acid  solution 
(first  two  and  then  three  percent.,  Tit  30)  ;  no  medi- 
cine by  stomach.  First  intrapulmonary  injection 
called  forth  a  slight  jileurisy,  readily  reduced.  Frc  m 
October  31,  1881,  to  February  7th  of  this  year,  seven- 
teen intrapulmonary  injections  given.  Begins  now 
with  continuous  inhalation  of  antiseptics  (pure  car- 
bolic acid  and  eucalyptol  alternated).  Eesult  thus 
far  :  Constant  gain  in  strength  and  weight ;  diges- 
tion normal  ;  no  dulness  anywhere  ;  vesicular  mur- 
mur in  left  lung ;  cavity  of  right  apex  shrinking 
with  consolidation  supplanted  by  vesicular  miirmur. 

Case  II. — Anna  M ,  aged  twenty-three ;  mother 

died  of  consumption,;  single ;  marked  emaciation ; 
slight  fever  ;  night-sweats ;  muco-purnlent  expecto- 
ration. Diagnosis :  Chronic  catarrh  of  left  lung 
from  apex  to  third  rib  ;  scattered  rales  over  right 
apex.  Treatment :  General  antisepsis  ;  hypodermic 
injection  of  three  per  cent,  carbolic  acid.  Local  : 
Inhalation  of  pure  carViolic  acid  through  oro-nasal 
respirator  ;  iron  and  nux  vomica  internally  ;  occa- 
sional counter-irritation.  Treatmfnt  commenced 
October  18,  1881.  Inhaled  from  three  to  six  hours 
per  day.  Present  condition :  General  condition 
established  on  a  firm  basis  ;  right  lung  clear  :  no 
dulness  over  left,  and  sparse,  dry  crackles,  with 
scarcely  any  expectoration.  Able  to  resume  work 
as  chambermaid. 

Case  III. — Elizabeth   H ,  aged  thirty-eight ; 

married  ;  hereditary  vulnerability  ;  greatly  emacia- 
ted ;  digestive  functions  shiggish ;  sick  for  ten 
months,  during  which  time  two  hemorrhages.  Tem- 
perature, 104°F.,  evenings.  Diagnosis:  Medium-sized 
cavity  of  right  apex ;  moist  rales  over  whole  of  right 
lung ;  superficial  catarrh  of  left  apex.  Treatment : 
General  antisepsis  ;  hypodermic  injection  of  carbolic 
acid  (three  and  one-half  ])er  cent.),  and  occasional  qui- 
nine doses.  Locally  :  Intrapulmonary  injections  of 
three  per  cent,  carbolic  acid  ;  continuous  inhalation 
(six  to  eight  hours  a  day)  of  pure  carbolic  acid,  fol- 
lowed by  eucalyptol  and  creasote  with  oil  of  turjif  n- 
tine  I  lung  gymnastics  to  strengthen  heart  and  dia- 
phragm. Treatment  commenced  October  22,  1881. 
Present  condition :  Fever  absent  for  past  five  weeks  ; 


286 


THE  MEDICAL  RECORD. 


slow  but  certain  progress  in  general  condition  ;  left 
lung  clear;  respiration  somewhat  exaggerated; 
shrinking  of  cavity  of  right  side,  and  partial  re- 


n\<  k^  r7  \ 


turn  of  respiratory  murmur ;  expectoration  mu- 
cous, with  occiisional  globular  pus.  Patient  in 
bed  when  firdt  treated ;  now  able  to  take  short 
walks. 

Case  IV.— Frederick  G ,  aged  forty-four ;  mar- 
ried ;  ticket  agent  on  Elevated  Boad.     Sick  three 
years.      Diagnosis:    Slowly   progressive    catarrho- 
tibroid  phthisis,  involving  whole  of  left  lung.    Very 
excitable  nature.    Kapid  heart's  action.    Treotment, 
since  November  10,  1881 :    Local  anti.sep.sis ;  ejght  ; 
intrapulmonary  injections  up  to  date  (February  7th), 
same  as  others  ;  inhalation  at  night,  as  he  is  busy 
in    daytime ;    lung  gymnastics.     Improvement    to 
date  :  "Normal  action  of  hearty  no  weakness,  which  | 
kept  him  from  work  at  first ;  left  lung  clearing  up,   j 
after  two  attacks  of  subacute  catarrh  foUowiug  in- 
jections.    In  this  case  one  of  the  injections  caused  | 
emphysema  of  the  subcutaneous  connective  tissue 
over  loft  lung,  extending  up  the  neck,  which  disap- 
peared in  five  days. 

Case  V.— Adam  L ,  aged  forty-five  years  ;  jew- 
eller ;  married.  Diagnosis  :  Fibroid  phthisis  of  both 
lung-i,  largely  dependent  upon  long-continued  mal- 
nutrition and  sui>erficial  breathing  ;  digestive  func- 
tions much  retarded ;  frequent  asthmatic  attacks. 
First  seen  November  15,  1881.  Treatment :  Inhala- 
tion of  pure  carbolic  acid  from  four  to  five  hours  a 
day  ;  dry  cupping  every  fifth  day.  Systematic  lung 
gymnastics.  Improvement  up  to  date :  Digestive 
functions  normal ;  no  asthma  ;  can  walk  two  miles, 
as  against  two  blocks  formerly  ;  rales  over  both  lungs 
dryer  and  more  sparse,  vesicular  murmur  heard  above 
thorn  ;  had  discontinued  work  when  first  seen,  now 
works  all  day. 

Case    VI.— Maggie  McB ,  aged   twenty-three 

years  ;  single  ;  saleslady  ;  no  hereditary  taint.  Gen- 
eral aniomia;  uncertain  appetite  ;  kept  awake  nights 
by  coughing.  Diagnosis  (October  11,  1881)  :  Catar- 
rhal phthisis  of  left  lung  ;  r'des  bend  to  fourth  rib  ; 
no  cavitr.  Great  tendency  to  disturbances  of  gastric 
and  pulmonary  raucous  membranes.  Treatment : 
General  condition  :  Iron  and  occasional  hypodermic 
injection  of  two  per  cent,  carbolic  acid  solution. 
Local :    Continuous   inhalation    of   ethereal    tinct. 


iodine,  followed  by  oil  of  turpentine ;  lung  gym- 
nastics and  occasional  dry  cupping.  Resulted  in 
perfect  cure  after  two  months'  treatment. 

For  hypodermic  medication  I  use, 
of  course,  a  needle  of  the  usual  size. 
Of  three  per  cent,  solution  of  car- 
bolic acid  I  have  injected  from  three 
to  six  syringes  full  a  day.  At  prei  - 
ent  I  am  using  carbonate  of  quinine 
and  chloride  of  zinc. 

The  needle  for  "intrapulmonary 
injection"  is  two  and  one-half  inchf  8 
(6i  ctm.)  in  length,  a  little  stronger 
and  with  a  somewhat  larger  bore 
than  the  ordinaiy  hypodermic  ne(  - 
die. 

My  "  oro-nasal  antiseptic  respirt- 
tor,"  illustrated  by  the  accompany  - 
ing  woodcut,  is  manufactured  by 
Tiemann  &  Co.,  of  this  city.  Fig.  1 
shows  the  respirator  as  applied  to 
the  nose  and  mouth.  Fig.  2  pre- 
sents an  inside  view  of  the  sieve 
separating  the  facial  organs  from  a 
cup  with  a  readily  closing  lid,  into 
which  cup  the  antiseptic  remedy  is 
introduced  upon  fine  sponge,  lint, 
or  absorbent  cotton.  Fig.  3  is  a  ver- 
tical section  of  the  whole  respirator.  Fig.  4  shows 
the  buckle  attached  to  either  side. 

The  oro-nasal  respirator  of  the  pattern  here  shown 
is  made  of  thin  sheet-tin,  japanned  flesh-color  or 
black.  We  are  now  perfecting  the  respirator  by 
using  thin  brass,  thus  making  it  lighter  and  of  a 
semi-globular  shape. 

THE  ANATOMY  AND  HISTOLOGY  OF  CYST 

or  THE  PANCRK\S.* 

By  HENKY  J.  GARBIGUES,  A.M.  M.D , 

NEW  YORK. 

At  the  meeting  of  this  society  which  was  held 
December  14,  1881,  Dr.  Bozeman  presented  a  cyst 
he  had  removed  from  the  pancreas  of  a  living 
woman,  gave  the  clinical  history  of  the  case,  and 
described  the  operation. 

Pancreas  cvsts  are  so  rare  that  only  quite  few  are 
on  record,  and  nowhere  have  I  been  able  to  find  a 
full  anatomical  description  of  one,  nor  has  there 
ever  been  made  a  microscopical  examination  of  the 
elements  of  the  cyst  and  the  fluid,  so  far  as  I  know.  , 
It  seems,  therefore,  desirable  that  this  opportunity 
be  seized  to  give  as  full  particulars  about  this  rare 
case  as  possible,  and  no  place  seems  fitter  for  the 
record  than  the  Transactions  of  the  Pathological 
Society.  ,   ,, 

The  cyst  with  fluid  weighed  twenty  and  one-halt 
pounds ;  the  fluid  measured  two  and  one-hnlf  gal- 
lons It  lay  close  up  to  the  anterior  abdominal 
wall,  and  was  cut  off  from  the  tail  of  the  pancreas. 
It  was  a  monocyst  in  the  surgical  sense  of  the  word, 
but  on  several  jilacos  were  seen  secondary  cysts  as 
large  as  a  small  hen's  egg.  The  outer  surface  was 
of  a  light  bluish  gray  color  ;  the  inside  was  dark  red, 
and  in  some  places  greenish  brown.  Large  parti- 
tions, with  largo  holes,  were  seen  in  the  interior,  as 
remnants  of  walls  separating  different  cy.sts. 

On  the  inner  surface  was  found  an  opening  as  large 
as   a  dollar,  leading  into  a  canal  six  inches  long, 
which  rapidly  diminished  in  calibre,  the  first Jialf^ 
'Bead  before thu  New  York  PathologlcaJ  Society. 


THE  MEDICAL  RECORD. 


287 


mitting  a  finger,  the  second  half  a  probe,  and  ended 
blind  in  the  wall.  I  have  once  met  with  a  similar 
canal  in  an  ovarian  cyst,  which  I  demonstrated 
before  this  society  a  year  ago. 

The  wall  of  the  main  cyst  was  mostly  thin,  measur- 
ing only  two  or  three  millimetres  in  thickness.  The 
outer  surface  was  smooth  and  hard,  and  it  was  only 
with  difficulty  that  soTue  flat  peritoneal  endothelial 
cells  were  scraped  oft".  Tlie  inner  surface,  on  the 
contrary,  was  velvety,  and,  by  scraping,  whole  pieces 
of  epithelium  were  obtained,  the  single  cells  of  which 
were  very  long,  narrow,  and  columnar.  I  measured 
a  couple  of  them,  and  found  them  thirty-two  micro- 
millimetres  long  and  eight  micromillimetres  wide. 
The  upper  end  was  rounded;  the  lower  formeda 
thin  root,  near  which  was  seen  a  nucleus.  In  the 
upper  part  were  seen  some  tine  fat  granules. 

Scrapings  from  the  beginning  of  the  above-men- 
tioned canal  showed  only  pigmented  Bennett's  cor- 
puscles, i.e.,  changed  epithelial  cells  (see  Garrigues: 
.  "Diagnosis  of  Ovarian  Cysts  by  Means  of  the  Con- 
tents," in  American  Journal  of  Ohst-'lric.i,  January, 
1882,  p.  181,  as  we  find  them  so  commonly  in  ovarian 
cysts,  some  red  blood-coriinscles,  and  fine  granules. 
A  snip  removed  from  the  inner  surface  of  a 
secondary  cyst  showed  a  beautiful  regular  polygonal 
epithelium,  exactly  like  an  ovarian  cyst. 

I  hardened  a  piece  of  the  cyst  with  a  secondary 
cyst  in  a  one-fourth  per  cent,  solution  of  chromic 
acid,  which,  later,  was  replaced  by  alcohol,  and  ob- 
tained good  cuts,  of  which  one  lies  under  the  micro- 
scope before  us. 

The  wall  is  composed  of  fibrous  connective  tissue, 
which,  in  the  outermost  and  innermost  part,  eon- 
tains  many  round  cells,  while  the  intermediate  part 
contains  very  few  of  them  ;  especially  near  the  epi- 
thelium the  tissue  is  choke  full  of  them. 

The  inner  surface  shows  the  formation  of  second- 
ary cysts,  exactly  as  we  find  it  in  ovarian  cysts. 
For  the  convenience  of  the  members,  I  have  made 
rough  diagrams  of  different  places  of  the  same  cut, 
and  by  them  it  will  be  seen  how  at  first  there  are 
only  broad  and  shallow  depressions,  separated  by 
low  and  broad  hills ;  nest  the  bays  become  long, 
narrow  creeks,  separated  by  more  pointed  jjromon- 
tories ;  finally  the  outer  opening  is  blocked  up  by 
epithelial  cells,  and  the  connective  tissue  prolonga- 
tions grow  together.  Thus,  a  closed  pouch  lined 
with  epithelium  and  surrounded  with  connective  tis- 
sue is  formed,  and  the  same  process  is  repeated 
over  it. 

The  single  cells  of  which  the  epithelitim  is  com- 
posed are  goblet-shaped,  with  a  nucleus  at  the  lower 
end. 

The  /fluid  found  in  the  main  cyst  was  yellowish 
gray,  viscid,  had  a  specific  gravity  of  1020,  and  acid 
reaction.  No  spontaneous  coagulation  took  place 
in  it,  but  by  boiling  it  precipitated  much  solid  mat- 
ter. The  microscope  revealed — 1st,  innumerable 
bodies,  which  looked  as  if  they  were  composed  of  a 
few  short  threads,  and  which,  by  examining  a  second- 
ary cyst,  were  found  to  be  the  remnants  of  the 
bodies  of  the  epithelial  cells  ;  2d,  innumerable  very 
small  nuclei,  with  dark  granules ;  3d,  pigmented 
large  Bennett's  corpuscles ;  4th,  epithelial  flakes  in 
a  semi-dissolved  condition,  including  similar  bodies. 
From  a  secondary  cyst  was  first  taken  fluid  which 
was  like  raw  albumen,  but  from  the  bottom  came  a 
thick  brownish  gray  fluid,  which  was  full  of  colum- 
nar epithelial  cells  and  pigmented  Bennett's  cor- 
puscles, exactly  as  seen  in  many  secondary  cysts  of 
ovarian  cvsts. 


The  fluid  from  the  main  cyst  looked  macroscopi- 
cally  entirely  like  the  fluid  from  the  most  ccrcmon 
kind  of  myxoid  ovarian  cysts,  but  urder  the  micro- 
scope it  difl'ered  from  it  by  the  presence  of  the 
tli-eady  bodies  and  the  uniform  size  of  the  nuclei. 
Besides  that,  it  difl'ered  from  ovarian  fluid  by  its 
acid  reaction.  This  reaction  is  veiy  puzzlirp,  for 
the  pancreas  juice  is  alkaline.  I  can  only  explain  it 
by  an  endosmosis  from  the  stomach.  How  near  the 
relations  were  between  the  latter  organ  and  the  tu- 
mor appears  from  the  clinical  fact  that  on  the  fif- 
teenth day  after  the  operation  the  patient  vomited 
six  or  eight  ounces  of  pus. 

I  have  searched  some  of  the  chief  works  on  mor- 
bid anatomy,  in  order  to  find  parallel  cases.  lioki- 
tansky  (Sydenham  Society,  London,  1849,  vol.  ii., 
p.  179)  mentions  very  briefly  serous  cysts  of  the 
pancreas,  which,  he  says,  must  be  distinguished 
from  dilatations  of  the  ducts  and  their  teiminations, 
which  put  on  a  similar  appfarance.  It  is  evident 
that  he  did  not  know  of  any  large  cyst  in  this  locality. 
Cruveilhier  does  not  mention  pancreas  cysts  at  ail 
in  his  atlas.  Virchow,  in  his  voluminous  sjiecial 
work  on  tumors  ("Pathologie  des  Tumeurs,  traduit 
par  Aronsohn,"  Paris.  1867,  vol.  i.,  p.  273,  fig.  48), 
reiiresents  a  case  of  "very  considerable  "  dilatation, 
partly  cystiform,  of  the  pancreatic  duct,  due  to  ob- 
literation of  the  orifice  by  a  tumor  in  the  duodenum, 
but  as  no  dimensions  are  given  it  is  more  than 
doubtful  if  really  a  large  cystic  tumor  was  formed. 
Lebert  ("Traite  d'Anatomie  Pathologique,"  Paris, 
1857,  vol.  i.,  p.  238,  etc.)  is  the  only  author  in  whom  I 
have  found  detailed  descriptions  of  pancreatic  cysts. 
He  mentions  (p.  279)  a  specimen  found  in'  St. 
Bartholomew's  Museum  in  London,  in  which  there 
was  a  cyst  measuring  more  than  one  inch  in  diame- 
ter, and  situated  on  the  end  of  the  Virsungian  duct, 
which  was  obliterated  by  calcareous  matter.  Further, 
he  mentions  the  case  of  Gould,  of  Boston,  in  which  at 
an  autopsy  the  whole  pancreas  was  found  changed  to 
a  cyst  containing  from  three  hundred  and  fifty  to  four 
hundred  grammes  of  a  sero-sanguinolent  fluid.  Le- 
bert speaks  further  with  doubt  of  Storck's  case,  who 
found  .the  pancreas  weighing  thirteen  pounds  and 
changed  into  a  sac  filled  with  blood.  Finally,  he 
mentions  a  .specimen  found  in  the  museum  of  Stras- 
bourg, in  which  a  cyst  as  large  as  the  head  of  a  four 
years'  child  occupies  the  body  and  the  tail  of  the 
pancreas,  while  the  head  of  the  gland  seems  to  have 
remained  healthy.  It  has  fibrous,  whity.  veiy  re- 
sistant walls,  three  millimetres  thick.  This  latter 
specimen  seems  to  have  much  in  common  with  the 
one  described  above.  Since  Dr.  Bozeman's  patient 
was  dismissed  cured,  it  is  impossible  to  say  any- 
thing about  the  condition  of  the  non-cystic  part  of 
the  pancreas. 

Since  it  is  the  first  time  a  description  of  the  his- 
tological structure  of  a  pancreas  cyst  is  given,  we 
have  no  others  to  compare  it  with,  no  standard  to 
measure  it  with.  We  find  in  our  case  a  striking 
likeness  of  the  secondary  cy.st  formation  with  that  of 
ovarian  cysts.  I  do  not  see  any  difficulty  in  explain- 
ing it.  The  Virsungian  duct  being  lined  with  co- 
lumnar epithelium,  and  an  obstruction  taking  place 
somewhere  in  its  course,  a  retention  cyst  is  formed, 
and  tlie  proliferation  which  has  just  been  described 
begins  on  the  inside. 

But,  if  in  the  course  of  time,  when  a  larger  num- 
ber of  well-observed  cases  are  at  hand,  it  should  be 
found  that  this  kind  of  cyst-formation  does  not  he- 
long  to  the  pancreas,  our  specimen  may  he  explained 
in  another  way.     It  is  possible  that  it  is  not  formed 


288 


THE  MEDICAL  RECORD. 


of  elements  belonging  to  the  pancreas  itself.  This 
whole  enormous  cyst  which  now  had  grown  together 
with  the  pancreas,  may  originally  have  formed  part 
of  the  rjf.rminal  epithelium  described  by  Waldeyer 
('•Eierstoek  und  Ei,"  p.  117,  Leipzig,  1870,  etc.), 
which  is  the  first  beginning  of  the  Wolffian  body  and 
Mailer's  duct,  in  other  words,  of  the  whole  uro-genital 
apparatus.  A  few  of  the  columnar  cells  of  which  it 
is  composed  may  not  have  been  used  for  building  up 
the  organs  we  have  just  mentioned,  and  may  have 
been  surrounded  by  connective  tissue  and  formed  a 
smill  cyst,  which  in  the  course  of  time  attained  so 
large  dimensions. 


progress  of  iHcDical  Science. 


iNOCDTiATION    OF     AnDHALS    -WITH  VeNEHEAL     MAT- 
TERS.— Dr.    Rebate!,    of   Lyons,    has   recently  heen 
making  a  series  of  experiments  on  animals  with  a 
view  to  test  anew  the  question  whether  or  not  they 
are  susceptible  to  any  of  the  several  venereal  dis- 
eases of  mvnkind.     These  experiments  have  either 
been  performed  under  his  immediate  supervision  or 
with  the  assistance  of  his  colleagues,  and  have  been 
controlled  and  varied  in  such  a  way  as  to  leave  no 
doubt  in  his  mind  that  there  is  but  one  way  in  which 
the  question  is  to  be  answered.     He  fii'st  took  some 
pus  from  a  patient  with  gonorrhoea,  and  inoculated 
it  vipon  the   mucous   membranes   of  the   eye,  the 
glans,  and  of  the  urethra,  even  injecting  some  of  the 
virus   into  .the  urethral  canal.     His  subjects  were 
dogs,  rabbits,  and  guinea-pigs.     No  trace  of  consecu- 
tive  inflammation   was   ever  seen.     Another  series 
of  experiments  was  performed  with  the  matter  from 
a  soft  chancre  ;  the  results  were  negative,  as  in  the 
former  case.     Finally  he   took   two   hard  chancres 
that  had  been  removed  in  the  operation  of  circum- 
cision ;  then,  making  slits  in  the  inguinal  folds  of  a 
bitch,  he  inserted  them,  sewing  up  the  openings. 
No  symptoms  of  infection  followed.     Into  the  jugu- 
lar vein  of  a  dog  he  next  injected  one  hundred  and 
fifty  gramme?  of  defibrinated  blood,  taken  from  a  pa- 
tient in  the  full  tide  of  secondary  syphilis.     No  ill 
symptoms  followed,  but  in  due  course  of  time  these 
two  animals  contributed  mutually  to  the  production 
of  a  litter  of  puppies,  twelve  in  number.     Nor  did 
these  young  manifest  any  congenital  disease  or,  in 
fact,   anvthing  but   the  most    exuberant    health. — 
L>/on  Medical,  January  8,  1882. 

SnDDBN  Death  during  Foroet)  Depbe.ssion  of 
THE  ToNOtiE. — The  following  case  was  reported  to 
the  SncieUide  Miulecine  el  de  ('kirurr/ie  de  Bordeaux  by 
Dr.  Moure  :  A  woman,  sixty  years  of  age,  complaining 
of  buzzing  in  the  ears  and  commencing  deafness, 
presented  lierself  for  treatment.  The  physician  sui-- 
mised  a  catarrhal  difficulty  and  obstruction  in  the 
Eustachian  tubes.  Wishing  to  specially  examine  tlie 
pharynx,  he  told  the  patient  to  o]>en  lier  mouth,  and 
as  tiie  tongue  interfered  with  his  exploration  he 
made  use  of  the  spatula.  He  had  just  commenced 
pressure  upon  the  tongue  when  the  patient  was 
taken  with  a  8uft')cative  attack.  Thinking  there  was 
spasm  of  the  glottis.  J)r.  Moure  began  artificial 
respiration.  Asphyxia  being  imminent,  however, 
tracheotomy  was  performed,  but  without  relief. 
Blood  poured  out  by  the  canula  and  moutli,  and  the 
patient  died.  The  reporter  was  of  opinion  that  the 
forced  dopreHsion  of  the  tongue  was  merely  the  oc- 


casion for  determining  a  spasm  of  the  glottis,  which 
would  have  been  insufficient  to  produce  death  in  a 
sound  and  vigorous  person  ;  but  in  this  particular 
instance  revived  an  old  cardiac  affection,  which 
either  set  up  an  acute  pulmonary  congestion  or  pul- 
monary apoplexy. — Moniteur  de  la  Foliclinique,Ja,jixi- 
ary  8,  1882. 

Successful    Transplantation    of    Humerus    to 
Beplace  a  Necrosed  Shaft.— The  following  case, 
reported  by  Dr.  MacEweu,  of  Glasgow,  instances  a 
novel  procedure  that  may  prove  of  some  practical 
utUity  to  surgeons :  William  Connell,  a  boy  three 
years  of  age,  entered  the  Koyal  Infirmary  in  Glas- 
gow, in  a  state  of  great  emaciation,  resulting  from 
necrosis  of  the  right  humerus.     This  bone  was  so 
extensively  necrotic  that  it  was,  in  great  part,  re- 
moved  (by   Liston's   forceps),    the  epiphyses   only 
remaining  behind.      There   was  little  evidence   of 
lieriosteuni,  fungous  granulationsalmobt  wholly  sup- 
plying its  place.     The  wound  subsequently  healed, 
the  patient's  health  was  greatly  improved,  but  the  * 
periosteum  had  only  developed  a  small  pointed  and 
delicate    bit  of  bone,   adherent   to   the  upper  ex- 
tremity, which,  in  its  totality,  only  measured  about 
one  and  three-fourths  inches  in  length.     As  the  con- 
dition was  not  materially  altered  during  the  fifteen 
months  following  the  operation,  it  was  decided  to 
transplant  the  bone,  and  accordingly  a  section  was 
taken  from  an  incurved  tibia,  cut  up  into  pieces, 
and  placed  in  conjunction  with  the  upper  extremity 
of  the  humerus.     An  attachment  subsequently  took 
place.     Pleased  with  this  result,  a  second  graft  was 
made,  in  this  instance  the  bone  being  cut  up  into 
somewhat  larger  pieces  than  at  first,  the  size  varying 
from  one-sixteenth  inch  in  diameter  to  one-fourth 
inch  ;  of  these  about  one-third,  and  the  larger  ones 
did  not  adhere,  but  escaped  by  the  open  wound.     As 
a  result  of  this  operation,  the  bone  now  measured 
four  inches  in  length.     The  third  graft  was  attached 
to  the  lower  extremity.     The  pieces  of  bone  in  this 
instance  were  made  still  smaller  than  in  the  other 
experiments.     The  result  was- a  success.     It  now  re- 
mained to  unite  the  confronting  extremities  of  the 
grafts,   which    was  successfully    done.     The   whole 
length  of  the  bone  was  now  six  inches,  only  half  an 
inch  less  in  length  than  its  fellow  on  the  opposite 
side.     All  the  movements  of  the  arm  are  now  com- 
plete.    MacEwen  adds,  in  his  conclusions,  that  each 
little  fragment  that  is  transplanted  should  contain 
in  it  all  the  elements  of  the  bone,  and  the  antiseptic 
method  should  be  adopted  to  ensui-e  success. — lieciit' 
I   de  Chirurgie,  January  10,  1882. 

Hepatic  Affections  in  their  Kelations  to  Dia- 
betes, and  New  Diagnostic  Symptoms  op  the  Lat- 
ter.— Congestion  of  tlie  liver,  according  to  M.  Le- 
corchC',  is  a  frequent,  if  not  a  constant  phenomenon 
in  diabetes,  and  is  due  to  the  increased  activity  of 
the  organ.  Hypertrophic  cirrhosis  of  the  liver  he 
has  often  observed  in  diabetes,  so  often  that  lie 
thinks  it  can  hardly  be  a  coincidence  merely,  and 
mav  be  traced  to  the  enormous  amount  of  fluid 
which  dialjetic  patients  consume.  It  has  but  a 
slight  connection  with  the  congestion  ju.st  men- 
tioned. At  the  meeting  of  the  Academio  de  Medi- 
cine, at  which  the  above  statements  were  made,  M. 
Magitot  gave  some  new  symptoms,  which  he  regards 
as  characteristic  of  this  disease.  According  to  him, 
an  examination  of  the  mouth  will  invariably  enable 
the  observer  to  detect  diabetes  when  jiresent.  It 
will  be  seen  that  there  is  a  disease  of  the  alveolar 
border,  called  alveolar  periostitis,  which  exists  dur- 


THE  MEDICAL  RECORD. 


289 


ing  the  whole  life-history  of  the  affection.  At 
first  the  teeth  deviate  from  theii'  proj^er  line  of  in- 
sertion, then  thev  become  loosened,  and  at  an  ad- 
vanced period  fall  out.  The  fatal  termination  may 
be  inaugurated  by  absorption  of  the  alveola,  or  gan- 
grene of  the  gum. — Moniteur  de  la  Polidiniqne,  Janii- 
ary  1,  1882. 

P.UiACIISrE.SIS  OF  THE  BlADDER  THKOrGH  THE  PeKI- 

XEUM  .A.ND  Prost.\te. — Mr.  Reginald  Harrison,  after 
justly  criticising  the  various  methods  of  relieving  a 
distended  bladder  in  old  men  with  enlarged  prostate, 
describes  a  means  of  relief  practised  by  himself  ujoon 
a  man  eighty-four  3'ears  of  age.  He  passed  a  trocar 
with  its  canula  through  the  i^erineum  and  gland  into 
the  bladder  so  as  to  reach  the  point  where  this  vis- 
cus  is  uncovered  by  peritoneum,  guiding  the  instru- 
ment by  the  left  forefinger  in  the  rectum.  He  then 
removed  the  trocar  and  secured  the  canula,  in  silu, 
by  means  of  tapes. 

The  advantages  he  claims  are :  More  complete 
drainage,  an<l,  therefore,  less  danger  from  pyelitis, 
cystitis,  etc.,  than  where  a  catheter  is  retained  in  the 
urethra;  a  short  "  low  lerd"  urethra  more  adapted 
to  the  new  relation  of  prostate  and  bladder ;  a  con- 
tinuous discharge  of  urine  at  night,  with  easy  com- 
mand over  the  same  during  the  day,  the  flow  being 
regulated  by  a  spring  clamp  titted  to  a  bit  of  rub- 
ber-tubing, which  latter  is  connected  with  the  canula. 
—British  Medical  Journal,  December  24,  1881. 

MoN'ocYsTic  Tdmob  Cont.uking  LiMPm  Fluid, 
Probably  of  Ovarian  Okigis. — M  a  meeting  of  the 
Philadelphia  Obstetrical  Society,  held  January  5, 
1882,  Dr.  B.  F.  Baer  presented  a  tumor  removed  liy 
Dr.  Wm.  Goodell  from  a  woman  forty  years  old. 
Its  history  revealed  sudden  growth,  with  ra])id 
emaciation  of  the  j^atient.  Laparotomy  disclosed  a 
monocyst  to  the  left  of  the  uterus,  with  the  Fallopian 
tube  stretched  across  its  surface.  It  contained  limpid 
fluid.  The  left  ovary  could  not  be  found  after  a  care- 
ful search,  either  in  its  normal  position  or  in  the 
cyst  wall.  The  question  of  ovarian  origin  is  an  in- 
teresting one,  as  certain  wi'iters  deny  that  ovarian 
cysts  are  ever  unilocular  or  ever  contain  limjjid 
fluid.  If  of  parovarian  origin  no  special  interest 
exists,  except  that  there  was  an  absence  of  the  ovary, 
and  the  tumor  grew  with  unusual  i-apidity.  At  the 
same  meeting  Dr.  Baer  related  a  case  where  un- 
doubted monoeysts  of  both  ovaries  were  removed  by 
Dr.  Goodell  from  a  woman  twenty-two  years  old. 
though  the  latter  was  inclined  to  believe  that  this 
tumor  had  its  origin  from  the  broad  ligament,  in 
which  opinion  he  was  sustained  by  Dr.  Drysdale, 
who  regarded  the  presence  of  the  limjiid  fluid  as 
proof  positive  that  such  was  its  origin. 

Diphtheria. — Dr.  Franklin  Staple.?,  of  Winona, 
Minn.,  after  an  extended  correspondence  with  phy- 
sicians in  most  of  the  counties  of  his  State,  has  pub- 
lished a  report  on  diphtheria,  in  which  he  classes 
the  disease  as  contagious  and  infectious,  and  demon- 
strates that  it  is  on  the  increase,  a  fact  due,  in  his 
opinion,  to  failure  on  the  part  of  physicians  in  rec- 
ognizing its  self-propagating  properties  ;  to  want  ot 
systematic  nursing  of  patients  suffering  from  the 
disease ;  to  incomplete  disinfection  of  premises  at- 
tacked ;  and  last  but  not  least,  to  the  frequent  inter- 
course of  convalescents  with  healthy  persons.  He 
maintains  that  strict  regulations,  rigidly  enforced, 
are  the  only  means  adequate  to  cut  short  its  career, 
and  since  individual  power  is  unable  to  cope  with 
it,  urges  that  every  city  and  town  should  devise  effi- 
cient  sanitary  laws,  and  let  them  be  enforced  by 


intelligent  medical   ofllcers,   who   shall   also   make 

it  thefr  duty  to  instruct  the  people  in  sanitary  rules. 
To  guard  against  contamination,  he  believes  that 
filth,  whether  from  dirty  rooms,  soiled  clothing,  de- 
fective drains  and  cesspools,  ill-ventilated  rooms, 
poisonous  inodorous  gases,  etc.,  should  be  re- 
garded as  conditions  which  invite  the  disease  :  that 
the  apartments  set  apart  for  the  patient  should 
be  divested  of  all  furniture,  carjjets,  curtains,  and 
fabrics  of  any  kind  not  alisolutely  required  ;  that 
discharges  from  the  nose,  mouth,  and  bowels,  should 
be  carefully  collected  and  destroyed,  and  that  all 
personal  clothing,  bed-linen,  etc.,  should  be  thor- 
oughly disinfected  before  being  sent  to  the  general 
wash.  In  case  of  death,  all  clothing  and  unimpor- 
tant articles  should  be  burnt,  the  body  should  be 
immediately  disinfected,  and  put  into  its  coffin,  which 
should  be  kept  permanently  closed.  There  should 
be  no  public  funeral.  He  prefers  disinfection  by 
chlorine  gas,  which  is  to  be  set  free  in  the  room'. 
Ventilation  for  a  number  of  hours  should  then  be 
insisted  upon.  Precautions  falling  short  of  these 
Dr.  Staples  considers  to  be  useless  in  preventing  the 
spread  of  the  infection. — Report  on  Biplitheria  to  the 
Min7iesota  Board  of  Health,  1881. 

Is  Salicylic  Actd  a  Specific  for  EHEUiiATisM  ? — 
Dr.  Lewis  Shaffer,  Physician  to  the  Devon  and  Ex- 
eter Hospitals,  commenting  ui:>on  the  value  of  salicy- 
lic acid  in  the  treatment  of  rheumatism,  is  un- 
willing to  admit  its  specific  properties.  But  Dr. 
Wm.  Strange,  of  the  Worcester  General  Infirmary, 
•HTiting  in  the  same  issue  of  the  journal,  after  an  ex- 
tended experience  with  this  drug,  is  confident  in  his 
statements  that  in  the  same  sense  as  quinine  acts  as 
a  specific  in  malaria,  or  mercury  and  iodide  of  potash 
in  syphilis,  so  salicylic  acid,  but  more  especially  its 
compound,  the  salicylate  of  soda,  acts  as  a  specific 
in  acute  articular  rheumatism,  by  neutralizing  the 
poisonous  elements  of  the  blood. — British  Medical 
Joui-nal,  December  24,  1881. 

Suppurative  P.abotitis  rs'  Puerperal  Fever. — 
The  interest  which  recent  events  have  attached  to 
suppurative  parotitis  has  induced  Dr.  W.  H.  Taylor, 
of  the  Cincinnati  Hospital,  to  report  the  fcllowing 

case  :    L.  S ,  aged  twenty-one,  primijoara,  had  a 

normal  delivery  on  April  23,  1881,  but  on  the  third 
day  following,  violent  headache,  vomiting,  and  ab- 
dominal pain  set  in.  while  the  lochial  discharges 
became  offensive  and  scanty.  Pulse,  104  ;  tempera- 
ture, 103.8°.  Ten  days  later,  the  temperature  had 
risen  to  105.2'.  On  the  thirteenth  day  a  i)ainful, 
red  and  indurated  swelling  appenred  below  and  be- 
hind the  left  ear.  On  the  nineteenth  a  purulent 
discharge  issued  from  the  left  auditory  canal,  and 
suppuration  occurred  on  the  middle  finger  of  the 
right  hand.  After  this  date  the  patient  improved, 
and  on  the  thirty-fifth  day  after  delivery  was  dis- 
charged cured.  Trousseau  and  Niemeyer  are  cited 
to  show  how  formidable  the  complication  is.  In 
a  clinic  by  Professor  Da  Costa  {Boston  Medical 
and  Surgical  Journal,  December  15th),  a  case  of 
typhus  was  shown  in  which  there  was  at  first  tume- 
faction of  the  parotid,  a  symptom  he  also  thought 
implied  considerable  severity  in  the  case.  How- 
ever, under  the  treatment  by  internal  applica- 
tion of  ice  it  gradually  became  smaller,  and  when 
suppuration  set  in  was  very  limited.  Dr.  Da  Costa 
regarded  it  as  a  vei-y  unusual  and  grave  symptom, 
indicating  a  septicemic  or  pyjemic  form  of  typhus 
fever.  He  had  met  it  more  frequently  in  typhoid  and 
typho-malarial  fevers. 


290 


THE  MEDICAL  RECOED. 


The  Medical  Record: 


51  llUtlfln  jloui-nal  of  iHebtcine  aub  Suigeig 


GEORGE  F.  SHRADY,  A.M.,  M.D.,  Editor. 


PUBLISHED   BY 
WM.  WOOD  &.  CO.,  No.  27  Great  Jones  SC,  N.  \'. 


New  York,  March  18,  1882. 

STATE    EXAMINATIONS    AND    THE    NEW 

MEDICAL  BILL. 
The  Committee  on  Legislation  of  the  State  Medical 
Society  have,  in  accordance  with  instructions  given 
at  the  recent  meeting  of  that  organization,  jiresented 
to  the  State  Legislature  an  amended  act  relating 
to  State  examinations,  and  a  new  bill  for  regulating 
the  practice  of  medicine.  The  full  texts  of  the  pro- 
posed laws  we  give  in  another  j)lace. 

The  amendment  offered  is  one  to  the  original  act 
passed  May  16,  1873,  relating  to  the  examination  of 
candidates  for  the  degree  of  doctor  of  medicine. 
That  act  provided  for  the  appointment  by  the  re- 
gents of  the  University  of  the  State  of  New  York  of 
one  or  more  boards  of  examiners  in  medicine,  each 
consisting  of  not  less  than  seven  members,  whose  duty 
it  was  to  test  the  qualifications  of  all  candidates  ap- 
pearing before  them  for  a  license  to  practise  medi- 
cine. Such  examinations  are  specifically  named, 
and  embrace  those  in  all  the  fundamental  In-anches 
of  medicine,  viz.  :  anatomy,  jjhysiology,  materia 
medica,  pathology,  histology,  clinical  medicine, 
chemistry,  surgery,  midwifei-y,  and  "  in  therapeu- 
tics, according  to  each  of  the  systems  of  jjractice 
represented  by  the  several  medical  societies  of  this 
State." 

The  latter  clause  was  altered  by  an  amendment 
passed  July  U(5,  1881  (Chap.  G79,  Laws  of  1881),  pro- 
viding for  an  examination  in  "  therapeutics  of  that 
one  of  the  .systems  of  i)ractice  represented  in  the 
several  incorporated  State  Medical  Societies  of  this 
State  which  the  candidate  may  olect." 

The  present  amendment  presented  by  tlie  Legis- 
lative Committee  of  the  State  Society,  and  endorsed 
by  the  said  society,  is  to  the  effect  tliat  all  such  ex- 
aminations, instead  of  being  voluntary,  as  heretofore, 
shall  be  compulsory,  and  the  reception  of  a  certifi- 
cate or  diploma  from  one  or  other  of  these  boards 
shall  be  necessary  for  a  license  to  practise  mcilicino 


on  the  part  of  all  future  graduates  from  our  medical 
colleges,  or  others  who  may  desire  to  join  the  profes- 
sion in  this  State.  In  other  word.s,  the  first  practical 
step  is  being  taken  toward  establishing  independent 
medical  examinations  by  the  State.  This  is  by  no 
means  a  new  idea.  Substantially,  the  same  plan  of  pro- 
cedure has  been  advocated  by  many  leading  medical 
men,  not  only  in  this  but  in  other  States  ;  and  nearly 
fifteen  years  ago  The  Medical  Kecord  earnestly  ad- 
vocated it  as  one  of  the  most  practical  means  of  ad- 
vancing the  standard  of  medical  education  and  of 
guaranteeing  in  all  cases  proper  qualifications  for 
practising  medicine.  A  careful  and  impartial  study 
of  the  subject  from  that  time  to  tlie  present  has  not 
changed  our  views  ;  in  fact,  we  are  more  than  ever 
in  favor  of  such  a  measure.  It  appears  to  us  to  be 
the  best  and  most  direct  way  of  settling  many  vexed 
questions  associated  with  the  possible  graduation  of 
incompetent  persons,  even  from  some  of  our  best 
schools. 

As  will  be  seen,  there  is  no  intention  of  depriving 
the  medical  colleges  of  their  rights  as  institutions  of 
learning,  or  of  their  privileges  of  gi-anting  degrees,  but 
simply  of  the  power  of  licensing  their  graduates  to 
practise  medicine.  This  was  formerly  the  case  in  this 
State,  and,  by  the  act  of  1827,  the  colleges  did  not 
carry  with  them  the  licensing  power.  It  is  hardly 
to  be  supposed  that  the  leading  schools  wiU  object 
to  this  restriction  when  the  princii^le  upon  which  it 
is  founded  is  so  obviously  in  favor  of  fixing  the 
requisite  qualifications  on  the  part  of  all  candidates 
for  a  license.  These  schools  have  everything  to 
gaiii  by  such  an  arrangement,  as  the  results  of 
their  teaching  will  be  strongly  contrasted  with  that 
of  the  lower  grade  colleges  by  the  large  majority 
of  their  graduates  who  must  necessarily  pass  these 
State  examinations. 

If  any  active  opposition  is  developed  against  the 
amendment  it  will  certainly  come  from  such  institu- 
tions as  feel  that  their  standards  of  qualifications  for 
graduation  are  not  what  they  should  be.  And  there 
is  no  disguising  the  fact  that  the  aim  of  compulsory 
State  examinations  is  essentually  in  the  direction  of 
proving  how  far  below  the  standard  are  many  of  the 
chartered  medical  schools  who  are  now  qualified  by 
law  to  confer  licences  uj^on  their  graduates.  It 
must  be  recollected  in  this  conuection  that  the 
graduates  from  the  law  scliools  of  this  State,  al- 
though duly  receiving  their  degi'ees,  are  subse- 
quently subjected  to  additional  examinations  before 
being  admitted  to  practise  at  the  bar.  It  has  been 
proven  that  the  graduates  from  the  better-class 
schools  are  almost  always  successful  before  these 
boards  of  examiners.  And  as  far  as  candidates  for 
medical  licenses  are  concerned,  it  does  not  appear 
that  any  argiiments  can  be  offered  against  the  prin- 
ciple of  such  examination,  except  such  ones  as 
weigh  in  the  direction  of  supposed  incompetency  of 
candidates. 


THE  MEDICAL  RECORD. 


291 


The  bill  for  regulating  the  pi-actice  of  medicine  is 
the  result  of  much  study,  based  ujjon  the  acknowl- 
edged defects  in  the  law  of  1880,  and  is  accordingly 
worded  with  great  care.  Proper  medical  registra- 
tion is  the  point  upon  which  all  its  main  provi- 
sions revolve.  Every  physician  by  its  proNisions 
is  expected  to  be  registered  in  the  County  Clerk's 
Office.  None  but  qualified  practitioners  can  be  so 
registered.  All  others  who  are  not  so  registered 
and  attempt  to  practise  medicine  are  declared  to 
be  guilty  of  misdemeanor,  while  those  who  register 
falsely  are  guilty  of  felony.  The  defects  in  the 
bill  of  1880  are  now  appai-ently  removed,  making 
it  no  longer  possible  for  the  quack  and  otherwise 
unqualified  practitioner  to  escape  conviction  and 
punishment  for  perjury.  As  is  well  known,  the 
law  of  1880  was  proven  to  be  defective,  in  that  the 
penalty  for  perjui-y  was  not  sufficiently  severe. 
Now,  however,  the  true  intent  of  the  clause  is  made 
sufficiently  explicit.  Nor  does  it  seeml.possible 
that  any  unqualified  person  or  quack  can  dodge 
the  responsibility  of  being  a  doctor  so  long  as  he  in 
any  manner  prescribes  for  the  sick.  The  defini- 
tion of  the  term  doctor  of  medicine,  or  prescriber 
for  ths  sick,  is  one  which  apjiarently  covers  every 
possible  contingency,  and  leaves  no  loophole  for  the 
escape  of  wilful  offenders. 

The  proposed  amendment  and  the  new  medical 
bUl  both  complement  each  other  and  with  a  few 
verbal  changes  can  be  made  pei-fectly  consistent  with 
the  idea  of  proper  regulation  for  the  practice  of 
medicine.  Both  amendment  and  medical  bill  will 
doubtless  receive  the  hearty  endorsement  of  the 
profession  of  the  State. 


THE  CHRONIC   CARBOLIC    ACID    POISONING   OF   SUKCxEONS. 

Pbopessor  Czern'Y,  of  Heidelberg,  in  discussing  the 
relative  value  and  danger  of  carbolic  acid  and  iodo- 
form makes  some  interesting  comments  on  the 
chronic  carbolic  acid  poisoning  of  surgeons. ? 

The  amount  of  carbolic  acid  taken  into  the  sys- 
tem by  the  surgeon  during  a  single  operation  may 
be,  as  he  shows,  very  great.  The  following  surpris- 
ing statement  is  made  by  Falkson.  In  the  twenty- 
four  hours  succeeding  a  two  and  a  half  hour  operation 
in  which  a  two  per  cent,  carbolic  acid  spray  was 
used,  he  excreted  by  the  urine  2.0655  grammes  of 
carbolic  acid.  Now  the  maximal  dose  of  carbolic 
acid  is  two  or  three  minims,  which  would  be  four- 
teen times  less  than  the  amount  thus  thrown  ofi'  by 
the  kidneys  alone.  It  is  well-known  that  the  drug 
is  excreted  by  the  skin  and  lungs  also. 

Professor  Czerny  says  that  the  history  of  the  sur- 
geon's sufferings  from  chronic  carbolic  acid  poison- 
ing has  yet  to  be  written.  He  gives,  however,  some 
of  the  symptomatology.  The  "carbolic  marasmus," 
as  he  calls  it,  begins  with  slight  headaches,  bronchial 
irritation,  languor,  and  diminished  apjietite.  When 
the  poisoning  is  of  long  standing  or  intense,  the 


cough  becomes  permanent,  there  are  heavy  dragging 
pains  in  the  region  of  the  kidneys,  the  legs  feel 
hea's'y,  there  is  a  sluggish  circulation  in  the  abdo- 
men, nausea,  especially  in  the  morning ;  cutaneous 
pruritus,  and  finally  insomnia,  which  latter  may  be 
due  in  part  to  the  formication  and  other  disagree- 
able sensations  in  the  hands.  The  blood  becomes 
impoverished  and  the  face  assumes  an  ansemic  ap- 
pearance. 

The  symptoms  are,  says  our  writer,  such  as  would 
come  under  the  head  of  what  is  now  described  as 
neurasthenia.  But  it  is  a  neurasthenia  which  will 
disappear  after  vigorous  walking  in  the  open  air  and 
a  few  days  absence'  from  the  clinic. 

The  symptoms  no  doubt  vai^y  with  the  idiosyn- 
cra.sy  of  the  individual,  and  it  would  be  a  matter  of 
much  interest  if  more  complete  data  regarding  this 
form  of  poisoning  were  accessible. 

Professor  Czemy  has  never  seen  any  structural 
change  result  from  the  constant  absorption  of  car- 
bolic acid. 

His  conclusion  is,  however,  that  phenol  is  not  a 
safe  thing  for  the  surgeon  to  use  constantly,  especi- 
ally according  to  the  method  of  Lister. 

In  comparing  it  with  iodoform  it  may  be  said  that 
the  iodoform  is  safer  for  the  surgeon,  the  phenol 
safer  for  the  patient.  There  is,  however,  no  great 
danger  to  the  patient  from  either  agent  if  it  be 
judiciously  used. 


MALARIA    AND   RICKETS. 

The  attempts  to  show  a  relationship  between  mala- 
ria and  the  various  diseases  of  the  body  have  in 
late  years  been  very  active.  Indeed,  there  are  few 
diseases  now,  from  leprosy  to  diabetes,  in  which  the 
particulate  poison  of  the  swamps  has  not  been 
thought  to  play  more  or  less  of  a  part.  It  is  indeed 
suggested  that  if  the  Principle  of  Evil  had  only 
chosen  to  embody  himself  in  the  bacillus  malarite 
he  would  have  found  an  immense  pleasure  in  the 
exercise  of  his  unblessed  activities. 

This  is  only  preliminary,  however,  to  some  account 
of  another  function  that  has  recently  been  attributed 
to  malaria,  ■(•iz.,  that  of  being  the  cause  of  rickets. 
Oppenheimer,  of  Heidelberg,  in  the  Archiv  fur 
klinische  Medicine,  has  ventured  to  defend  this  view, 
and  he  jiresents  arguments  which  are  certainly  in- 
genious and  interesting. 

The  ■writer  in  question  first  attacks  the  present 
views  of  the  cause  of  rickets.  He  asserts,  as  others 
have  done,  that  a  famine  diet  and  bad  hygiene  do  not 
by  any  means  always  bring  on  this  disease,  and  that 
too  much  attention  has  been  paid  to  the  osseous 
lesions,  which  are  after  all  only  secondary.  He 
states  that,  before  the  bones  are  affected,  the  pa- 
tients show  characteristic  symptoms.  Such,  for  ex- 
ample, is  a  certain  form  of  diarrhoea  which  appears 
on  fixed  days,  generally  in  the  morning,  and  with  a 
periodicity  generally  like  that  of  tertian  ague.     At 


292 


THE  MEDICAL  RECORD. 


the  same  time  the  abdomen  becomes  tumefied,  and 
the  spleen  invariably  enlarges.  These  symptoms 
may  be  absent,  and  the  disease  announce  itself  by 
other  crises,  also  periodical.  Thus  the  child  at  night' 
has  attacks  in  which  he  cries  for  hours,  the  spleen 
is  enlarged,  tlie  temperature  rises  but  falls  again 
toward  morning  with  profuse  sweating  of  the  head. 

Professor  Ojipenheimer  contends  that  when  rick- 
ets has  reached  the  stage  of  marasmus,  the  appear- 
ance of  the  patient  resembles  closely  that  of  an 
adult  with  malarial  marasmus.  And  he  puts  side  by 
side  the  descriptions  of  the  two  conditions  as  por- 
trayed by  classic  authors. 

As  i-egards  the  osseous  lesions  found  in  rickets 
alone,  our  author  reasons  in  the  following  ingenious 
manner :  The  medulla  of  bones  is  undoubtedly  af- 
fected in  malarial  poisoning  of  adults,  as  has  been 
shown  by  the  investigations  of  Arnstein,  Browicz, 
Heuck,  and  others.  This  medulla  has  an  equally 
undeniable  function  in  the  manufacture  of  red  blood- 
corpuscles,  and  perhaps  in  metabolism.  But  such 
function  is  comparatively  inactive  in  the  adult,  while 
it  is  very  active  in  infancy  and  early  childhood.  A 
poison,  therefore,  which  might  have  little  eflect 
upon  an  adult  medulla  would  be  very  injurious  to 
the  bones  of  infants. 

A  final  argument  is  drawn  from  the  geographical 
distributian  of  rachitis.  It  is  shown  by  Hirsch  that 
this  disease  is  extremely  rare  in  countries  where 
paludal  fevers  are  unknown,  as  upon  the  elevated 
plateaus  of  Europe,  and  in  the  north  of  Scandinavia. 


THE   DEATH   OF    A    PRIZE-FIGHTEK. 

A  SHORT  time  ago  a  notice  was  published  that  John 
J.  Dwyer,  the  prize-fighter  and  ex-heavy-weight 
champion  of  America,  died  of  consJimption  at  St. 
Peter's  Hospital,  Brooklyn.  He  was  only  thu-ty-six 
years  old.  For  twelve  years  he  had  been  a  promi- 
nent member  of  the  ring,  and  less  than  three  years 
ago  he  easily  won  the  championship  of  America. 
He  possessed  naturally  a  powerful  j;)hysique,  which 
he  had  assiduously  cultivated  from  boyhood.  Since 
leaving  the  ring,  in  1879,  he  led  a  temperate  life  as 
a  clerk. 

We  do  not  give  the  above  items  to  commemorate 
the  career  of  Mr.  Dwyer,  but  to  extract  the  lesson 
which  may  he  found  in  it. 

The  cultivation  of  a  powerful  muscular  develop- 
ment does  not  of  itself  ensure  health  and  long  life. 
It  may  even  entail  a  certain  danger.  The  man  who 
makes  an  athlete  of  himself  must  continue  one,  or 
else  drop  his  exercise  with  slowness  and  caution. 
Our  ex-pulilist  accepted  a  sedentary  occupation 
after  he  had  cultivated  his  lungs  to  perhaps  double 
the  capacity  needed  in  such  an  employment.  A  dis- 
used organ  degenerates,  and  becomes  liable  to  dis- 
ease. The  robust  chest  of  the  country  youth  may 
be  a  source  of  danger  to  him  if  he  adopts  life  in  a 


city  office.  A  fine  physical  development  does  not 
necessarily  ensure  a  long  life.  Robustness  is  only  a 
relative  term.  In  the  physical  education  of  youth, 
therefore,  we  should  aim  to  make  every  organ 
healthy — not  hypertrophied.  The  law  that  the  or- 
ganism must  be  adapted  to  its  environment  was  well 
illustrated  by  the  jirize-fighter,  who  was  attacked 
with  consumiition  eighteen  months  after  he  had  left 
the  ring  for  a  city  office. 


DRAWN   OB    tmDBAWN   POULTRY. 

The  question  whether  poultry  and  game  should  be 
"  drawn  "  or  not  when  prepared  for  market  has  been 
receiving  public  attention,  and  there  is  likely  to  be 
some  legislative  action  taken  about  it.  The  immense 
amount  of  poultry  sent  to  our  large  cities  for  con- 
sumption makes  the  subject  one  of  considerable  sani- 
tai-y  interest.  It  is  the  prevalent  custom  now  to  sell 
poultry  "undrawn."  The  highest  prices  are  generally 
paid  for  fowls  thus  prepared — or  unprepared.  Even 
those  sent  from  the  West  often,  as  we  are  informed, 
come  in  this  condition,  and  it  is  the  belief  of  some 
that  the  flesh  keeps  longer  so.  The  opening  of 
the  body  and  exposure  of  the  interior  to  air  offers 
naturally  an  opportunity  for  putrefactive  changes. 
At  the  same  time,  the  presence  of  undigested  food 
and  of  exorementitious  substances  in  the  animal 
would  seem  to  favor  decomposition.  It  is  well- 
known  that  the  viscera  are  the  first  parts  to  become 
putrid,  and  the  continual  osmosis  cannot  but  carry 
some  of  the  putrid  juices  to  neighboring  tissues. 

There  seems  to  be  no  definite  facts  as  to  which  will 
keep  longer  under  various  conditions,  the  drawn  or 
undrawn  fowl. 

The  ordinary  laws  regarding  putrefactive  changes, 
however,  certainly  lead  to  the  oiiinion  that  the  re- 
moval of  the  viscera  with  their  contents  would  be 
much  the  more  certain  way  of  insui-ing  the  freshness 
of  the  tissues.  There  would  be  no  question  at  all  as 
to  the  advisability  of  this  procedure  if  the  abdom- 
inal cavity  were  carefully  dried  and  the  incision 
sewed  up. 

The  Hotel-Keepers'  Association,  in  discussing 
this  subject,  came  to  a  similar  conclusion — that 
poultry  should  be  drayiTi — and  a  bill  to  enforce  such 
a  procedure  is  to  be  presented  to  the  State  Legis- 
latm-e. 


SHALL  PROPRIETARY  MEDICINES  ItE  TAXED  .■' 

A  DISCUSSION  in  the  public  press  as  to  whether  the 
stamp  tax  on  proprietary  medicines  should  be  abol. 
ished,  has  drawn  out  a  number  of  interesting  facts. 
We  are  informed  by  "  one  of  them  "  that  «flOO,000,- 
000  has  been  paid  to  the  press  of  this  country  alone 
for  advertising  these  preparations  during  the  past 
twenty  years.  As  the  business  has  vastly  inci-eased 
of  late,  it  would  bo  safe  to  estimate  that  four  or  five 


THE  MEDICAL  RECOED. 


293 


millions  of  dollars  are  now  paid  annually  for  the 
above  piu-pose. 

The  United  States  Government,  we  are  told  by 
the  same  authority,  has  received  836,000,000  from 
the  stamp  tax:  since  1861.  Its  annual  receipts  at 
present  must  therefore  amount  to  several  millions. 
The  manufacturers  themselves  make  only  the  jjitiable 
sum  of  a  million  or  so  per  year.  So,  at  least,  we  are 
told ;  but  it  seems  a  very  low  estimate.  At  any  rate 
these  manufacturers,  under  the  gi-inding  pressure  ol 
poverty,  are  trying  to  get  the  tax  abolished. 

To  this  we  must  oppose  a  most  earnest  protest. 
If  there  is  any  need  whatever  of  an  internal  revenue, 
proprietary  medicines  should  help  to  furnish  it. 
The  medical  profession  has  a  right  to  speak  strongly 
upon  this  point,  since  it  is  best  qualified  to  know 
the  true  value  of  these  preparations.  And  it  is,  we 
believe,  the  general  verdict  of  jihysicians  that  society 
would  really  lie  healthier  if  not  a  patent  medicine 
existed.  And  society  would  not  only  be  healthier 
but  richer.  The  assertion  that  the  i^oor  man  is 
supplied  with  medicine  cheaply  thi'ough  them  is  ar- 
rant nonsense.  For  most  patent  medicines  consist 
of  mixtures  which,  costing  fifteen  or  twenty  cents, 
are  sold  for  a  dollar.  Furthermore,  these  mixtures  do 
not  supply  the  needs  of  the  poor  man,  but  are  rather 
forced  upon  him  by  unlimited  advertising.  He  buys 
a  "polyform"  or  a  "  saintly  oil"  for  four  times  the 
price  of  an  ordinary  liniment  which  would  be  equally 
efficacious.  And  he  does  this,  not  because  the  oil  is 
good,  but  because  it  is  advertised.  The  patent  medi- 
cine trade  rests  upon  the  twin  foundation  of  preten- 
tious claims  on  one  side  and  credulous  misery  on 
the  other.  The  money  is  coined  out  of  the  public's 
ignorance  and  suflering.  If  success  in  its  manufac- 
ture can  be  lessened  by  a  heavy  tax,  such  should 
certainly  be  placed  upon  it. 

We  question  whether  the  enormous  consumjition 
of  ijatent  medicines  may  not  in  time  become  an  evil 
deserving  the  attention  of  the  sanitarian  and  the 
legislator.  That  more  money  is  i^ut  in  their  manu- 
facture every  year  is  manifest.  The  trade  has  al- 
ready, with  its  money,  stifled  the  conscience  of  the 
religious  press  which  gives  a  quasi-sanctification  to 
the  most  unholy  specifics.  Not  many  of  the  secular 
press  can  afford  to  take  the  independent  stand  which 
the  New  York  Herald  does.  Of  old,  Scribner's 
MontMij  defended  patent  mixtures  ;  and  now  the 
venerable  North  American  Rerieir  is  sandwiched  be- 
tween outrageous  panaceas.  The  presumably  un- 
shackled Puck,  which  some  time  ago  devoted  its  car- 
toon against  patent  medicines,  now  includes  an  at/- 
■vertising  cartoon  of  one  of  them  in  the  midst  of  its 
reading  matter.  That  there  is  a  moral  sense  of  the 
unfitness  of  such  things  is  shown  in  the  new  weekly 
edited  by  .Judge  Toui-gee,  Our  Continent.  This 
journal  in  its  prospectus  declares  that  it  will  receive 
no  patent  medicine  advertisements,  and  it  thereby 
deserves  well  of  our  profession. 


We  repeat  then,  that  society  would  be  better  with- 
out patent  medicines. 

If  some  are  not  bad  or  are  even  helpful,  yet,  as  a 
whole,  they  are  pernicious  and  are  simply  forced 
upon  the  people  by  unscrupulous  advertising.  Their 
manufacturers  deserve  no  consideration  or  relief. 


tlmcuja  antr  ttottce0  of  OooKs. 


A  Treatise  on  the  Disea.ses  op  the  Nebvous  Sys- 
tem. By  James  Koss,  M.D.  Illustrated  with 
Lithogi-aphs,  Photogi-aphs,  and  Two  Hundred 
and  Eightv  Woodcuts.  Two  Volumes.  New  York  • 
William  Wood  &  Co.     1881. 

This  is  a  work  in  two  volumes,  the  whole  embracing 
nearly  sixteen  hundred  pages.  It  evidently  aims  to 
be  systematic  and  complete,  if  not  actually  encyclo- 
pedic in  its  character. 

The  name  of  the  author  is  a  new  one  to  neurolo- 
gists, and  it  is  something  of  a  surprise  to  see  so  23re- 
tentious  a  work  from  an  unknown  source.  The  book, 
on  this  account,  will  not  escape  severe  scrutiny  and 
criticism. 

There  are  treatises  upon  the  diseases  of  the  ner- 
vous system  which,  like  that  of  Rosenthal,  are  es- 
sentially clinical.  The  present  work  is  as  nearly  the 
opposite  to  that  as  i^ossible.  The  prominent  fea- 
tures of  it  are  its  anatomical,  physiological,  and  path- 
ological discussions.  If  one  wished  to  get  an  idea 
of  what  are  the  latest  views  regarding  the  anatomy, 
histology,  and  iihysiology  of  the  nervous  system,  he 
could  hardly  find  a  more  complete  statement  in  any 
one  hand-book.  As  regards  the  clinical  and  thera- 
peutical jjortions,  they  are,  as  we  have  said,  not  so 
conspicuous.  Y'et  evei-y  disease  receives  due  no- 
tice. The  descriptions  are  succinct  and  clear.  The 
recommendations  for  treatment  show  a  wide  knowl- 
edge and  very  good  judgment.  There  is  a  lack  of 
evidence  of  any  great  practical  exiierience  with  ner- 
vous diseases,  yet  the  author  has  evidently  used 
his  opportunities  well. 

Dr.  Ross's  method .  of  treating  his  subject  is  a 
very  elaborate  one.  A  large  part  of  the  first  volume 
is  devoted  to  the  General  iPathology  of  the  Nervous 
System.  Under  this  head  are  given  chapters  on 
The  Structure  and  Function  of  the  Nervous  Svstem, 
General  Etiology,  General  Symptomatology,  JEsthe- 
sioneuroses,  Kinesioneuroses,  Trophoneuroses,  Gen- 
eral Morbid  Anatomy  and  Pathology,  General  Diag- 
nosis and  Prognosis,  General  Ti-eatment. 

Having  thus  devoted  nearly  three  hundred  pages 
to  general  pathology,  the  author  takes  up  special 
pathology,  beginning  with  diseases  of  the  periph- 
eral nerves.  Continuing  this  branch  of  his  subject, 
he  treats  of  the  sympathetic  system,  the  diseases  of 
the  spinal  cord,  of  the  brain,  and  of  the  brain  and 
cord.  Under  each  of  these  special  heads  there  is 
an  anatomical  and  physiological  introduction,  which 
is  quite  full. 

A  very  superficial  glance  at  the  author's  work 
shows  that  he  has  aimed  to  adopt  a  rigidly  scientific 
method  of  treating  the  subject  in  hand.  The  ques- 
tion will  occiir  if  he  has  not  been  too  much  so. 
The  part  on  general  pathology  is  well  enough  done, 
but  it  is  unnecessarily  long  and  should  be  cut 
down  to  a  skeleton.  The  author  presents  the  physi- 
ology of  the  nervous  system  very  well  and  fully' in- 


294 


THE  MEDICAL  RECORD. 


deed,  in  some  parts ;  in  others  he  is  not  complete, 
though  giving  all  that  is  necessary  for  clinical  pur- 
poses. He  Aows  a  little  immaturity  also  in  his  un- 
questioned acceptance  of  the  chemical  theories  of 
life,  and  of  Spencer's  time  and  space  hypothesis,' 
for  the  explanation  of  the  functions  of  the  cerebro- 
spinal and  cerebello-spinal  systems.  In  fact,  the 
handiwork  of  the  non-expert  betrays  itself  here  and 
there  throughout  the  volumes. 

Th«  work  is  profusely  and  beautifully  illustrated 
with  woodcuts,  lithographs,  and  photographs.  The 
latter  represent  cases  of  the  ai'thropatliies  of  ataxics, 
and  patients  with  pseudo-hypertrophic  paralysis. 
The  author  contributes  some  interesting  facts  re- 
garding the  mechanism  of  locomotion,  obtained  by 
studying  the  latter  cases. 

Taken  as  a  whole,  the  two  volumes  form  a  really 
valuable  addition  to  neurological  literature.  To  a 
person  who  is  setting  out  to  gain  some  special 
knowledge  of  the  nervous  system  they  will  prove 
particularly  helpfuil. 

In.sa.nity  and  its  Treatment.  Lectures  on  the 
Treatment  of  Insanity  and  Kindred  Nervous  Dis- 
eases. Bv  Samuel  Worcester,  M.D.  New  York 
and  PhOadelphia :  Boericke  &  Tafel.     1882. 

This  bo  3k  is  made  up  of  a  series  of  lectures  deliv- 
ered before  the  students  of  the  Boston  University 
School  of  Medicine,  a  homceopathic  institution.  We 
have  the  best  desire  to  say  nothing  against  this  book 
that  is  injust,  or  that  could  be  attributed  to  a  sec- 
tarian prejudice.  But  we  are  compelled  to  say  that 
we  have  never  seen  a  worse  treatise  on  insanity,  and 
we  cannot  imagine  how  a  worse  one  could  be  written. 
The  author  confesses  that  he  "  used  freely  the  ma- 
terials at  his  command,"  and  we  can  fully  confirm 
his  statement.  He  has  compiled  in  a  wholesale 
fashion  (and  thus  secured  some  valuable  extracts  in 
his  book).  But  he  does  not  seem  to  understand  his 
subject  except  in  a  superficial  way.  He  gives  no 
pathology  and  very  little  etiology.  His  therapeutics, 
even,  are  quoted,  and  form  a  ridiculous  jumble  of 
hypothetical  inanities. 

We  have  had  a  little  experience  in  using  homceo- 
pathic remedies  for  mental  diseases.  The  only  rem- 
edy with  which  we  have  obtained  any  good  results, 
however,  is  not  even  mentioned. 

The  book  is,  in  fact,  about  such  a  thing  as  a  not 
very  bright  student  might  get  up  for  his  graduating 
thesis.  There  is  no  cause  for  its  being,  and  it  is 
only  in  ju.stice  to  the  profession  that  we  condemn  it 
as  we  do.  We  know  notliing  about  Dr.  Worcester 
except  a  few  reports,  which  made  us  think  him  ca- 
pable of  better  things.  We  trust  that  he  has  such 
capabilities,  and  we  would  explain  his  present  fail- 
ure liy  supposing  that  he  has  been  entirely  deprived 
of  the  training  and  associations  which  help  to  make 
the  scientific  psychiatrist. 

Handbuch  der  Pharmaceutischen  Praxis.  Fiir 
Apotheker,  Arzte,  Droguisten  und  Medicinal-be- 
amte.  Bearbeitet  von  Dr.  Hermann  Haoer.  Er- 
giinzungsb'inde  i.-vii.  8vo,  pp.  112.  Berlin  :  Ver- 
lag  von  .Tiilius  Springer.  1881.  (Hand-book  of 
Pharmaceutical  Practice.  For  the  tJsG  of  Apothe- 
caries, Physicians,  Druggists,  and  Medical  Offici.als. 
Edited  by  Dr.  Hermann  Haqer.  ,  Supplementary 
volumes  i.-vii.) 

Thw  work  is  intended  as  a  supplement  to  Dr.  Ha- 
ger's  "  Handbook  of  Pharmaceutical  Practice,"  which 
appeared  several  years  ago,  and  was  designed,  as  its 
title  indicates,  for  the  use  of  physicians,  druggists, 


and  medical  officers.  The  new  publication  is  to  be 
recommended  as  containing  the  important  advances 
and  discoveries  made  in  the  field  of  jjractical  phar- 
macy during  the  last  half  decade,  especially  as  re- 
gards the  examination  of  foods  and  beverages,  a 
department  which  was  still  undeveloped  at  the  time 
the  Handbook  appeared.  These  supplementary 
volumes,  seven  in  number,  contain  numerous  wood- 
cuts, and  will  doubtless  be  welcome  both  to  those 
who  possess  Dr.  Hager's  earlier  work  and  those  who 
do  not. 

lUiUSTKATIONS    OF    DISSECTIONS.      By  GeOKGE   ViNBK 

Ellis,  Professor  of  Anatomy  University  College, 
London,  and  George  H.  Ford,   Esq.      Vol.   II., 
February.     8vo,  pp.  23(5.     Second  edition.     New 
York  :  WiUiam  Wood  &  Co.     1882. 
This  is  the  second  of  the  two  volumes  referred  lo- 
in one  of  the  recent  numbers  of  the  Record.     Its 
plates,    descriptions,    and     practical    remarks    are 
equally  good  with  those  of  the  first,  already  noticed. 
We  mention  again  that  the  plates  are  reduced  on  a 
uniform  scale  from  the  life-size  drawings  of  the  Eng- 
lish edition,  and  are  reproduced  in  fac-simile  es- 
pecially for  Wood's  Medical  Library. 

Human  Osteology  :  Comprising  a  Description  of  the 
Bones,  with   Delineations  of  Attachments  of  the 
Muscles,  the  General  Microscopic  of  Bone  and  its 
Development.     By  Luther  Holden,  Ex-President 
and  Member  of  the  Court  of  Examiners,  assisted 
by  James  Shuter,  F.E.C.S.,  M.A.,  M.B.   Cantab. 
8vo,  pp.  29(5.     Sixth  edition.   Philadelphia  :  Pres- 
ley  Blakiston.     1882. 
No  work  has  appeared  treating  any  special  depart- 
ment of  human  anatomy  that  has  a  more  deserved 
popularity  than  Holden's  "  Osteology."     That  it  is 
able  to  maintain  its  position  goes  without  the  saying 
As  its  title  indicates,  it  covers  the  whole  ground  of 
study  of  the  skeleton,  and,  aside  from  minute  and 
careful   descriptions   of  anatomical  conditions  and 
surgical  relations  of  the  bony  parts,  contains  admir- 
able outline   plates  illustrating  the  same.     In   the 
present  edition  a  few  brief  notes  on  comparative  os- 
teology have  been  added,  several  of  the  plates  have 
been  redrawn,  and  a  more  systematic  arrangement 
of  the  bones  has  been  made. 

The  Diagnosis  and  Tkeatsient  of  Diseases  of  the 

Eye.     Bv  Henry  W.   Williams,  A.M.,  M.D.     Pp. 

464.     Boston  :  Houghton,  Mifflin  i  Co.     1881. 
The  present  volume  is  an  expansion  of  the  author's 
previous  smaller  work  on  diseases  of  the  eye.     So 
much  is  now  added  that  it  is  virtually  a  new  treatise. 

There  is  no  preliminary  account  of  the  anatomy 
and  physiology  of  the  eye,  but  the  author  proceeds 
at  once  to  a  description  of  methods  of  examination, 
remedial  means,  and  traumatic  injuries.  He  then 
takes  up  the  diseases  of  the  different  structures  in 
order.  The  parts  devoted  to  pathology  are,  as  a 
rule,  brief,  and  there  is  no  discussion  of  theoretical 
questions.  Tliere  is  a  chapter  npon  color-blindness 
and  the  methods  of  testing  it. 

Regarding  the  lately  introduced  operation  of 
sclerotomy,  for  relief  of  tension,  Dr.  Williams  says 
that,  although  it  offers  a  fair  chance  of  success,  iri- 
dectomy is  most  to  be  relied  upon. 

The  new  operation  of  optico-ciliary  neurotomy 
justly  receives  warm  endorsement.  The  author's 
views  upon  glaucoma  are  already  quite  generally 
known,  and  need  not  be  discussed  here. 

Altogether,  we  find  very  little  to  criticise  in  this 
book  and  very  much  to  praise.     In  writing  it,  Dr. 


THE   MEDICAL  KECORD. 


295- 


Williams  has  most  admirably  fulfilled  one  of  the 
functions  of  the  specialist :  that  of  instructing  the 
general  practitioner.  He  tells  what  he  knows  easily 
and  simply,  using  no  mystifying  nomenclature  and 
entering  into  no  recondite  scientific  discussions. 
The  book  is  well  illustrated  with  cuts  and  colored 
lithographs.  It  contains  also  test-type  and  the  test 
lines  for  astigmatism. 

Fistula,  H.emorrhoids,  Painful  Ulcee,  Strictuee, 
Prolapsus,  and  other  Diseases  of  the  Rectum, 
THEIR  Diagnosis  and  Treatment.     By   William 
Allingham,  F.K.C.S.  Eng.,  etc.     Fourth  edition. 
8vo,  pp.  332.     Philadelphia  :   Presley  Blakiston. 
1882. 
The  fourth  edition  of  this  excellent  work  comes  to 
us  very  slightly  altered  from  the  previous  edition. 
Here  and  there  evidences  of  i-evision  are  apparent. 
No  important  additions  have  been  made,  save,  per- 
haps, an  index,  and  the  work  as  a  whole  has  not 
been  enlarged.     It  still  maintains  its  place  as  one  of 
the  best  works  written  upon  rectal  diseases. 

A  Manual  of  Dental  ANATosre,  Human  and  Com- 
parative.    By  Charles  S.   Tomes,  M.A.,  F.E.S. 
Second  edition.     12mo,  pp.  440.     Philadelphia : 
Presley  Blakiston.     1882. 
This  work,  which  has  now  advanced  to  its  second 
edition,    is   a   study  of  dental  anatomy,  pure  and 
simple.     The  whole  ground  is  very  thoroughly  cov- 
ered, not  only  in  regard  to  the  growth  and  structure 
of  teeth  themselves  in  man  and  other  members  of 
the    animal   kingdom,   but  in  regard  to  important 
anatomical  relations  of  these  parts  to  each  other  and 
the  functions  of  the  same. 

The  illustrations  are  admirable  and  instructive. 
The  work  cannot  fail  to  be  of  special  value  to  den- 
tists and  such  practitioners  who  are  interested  in  the 
study  of  comparative  anatomy. 

A  Manual  on  Diseases  of  the  Eye  and  Ear,  for  the 
U.se  of  Students  and  Practitioners.  By  W.  F. 
MiTTEN'DOKF,  M.D.,  Surgeon  to  the  New  York  Eye 
and  Ear  Infirmary  ;  Ophthalmic  Surgeon  to  Belle- 
vue  Hospital  Out-door  Department ;  Assistant  to 
the  Chair  of  Ophthalmology  and  Otology,  BeUevue 
Hospital  Medical  College.  Second  Edition.  8vo, 
pp.  429.    New  York  :  G.  P.  Putnam's  Sons.     1881. 

The  author  has  embodied  his  lectures  to  pupils  in 
the  two  departments  of  the  eye  and  ear,  and  fur- 
nished a  lai-ge  manual,  five-sixths  of  whose  pages  are 
devoted  to  the  former,  and  one-sixth  to  the  latter. 
While  we  cannot  agree  with  the  author  in  the  asser- 
tion of  the  long-felt  want  of  such  a  practical  manual, 
as  its  rnison  d'i'tre,  we  desire  to  recommend  it  to  the 
general  profession.  So  long  as  its  specialties  re- 
main linked  in  practice  by  usage,  the  union  of  these 
branches  under  one  cover  is  pardonable. 

Examined  analytically,  one  notices  a  marked  de- 
ficiency of  plates  ;  only  nine  woodcuts,  and  some  of 
these  inadecpiate  to  the  text,  comprise  the  number 
of  uncoloreil  plates.  Had  the  author  rejiroduced  some 
of  the  original  and  admirable  macroscopic  woodcuts 
from  Alt's  "Human  Eye,"  whose  book  is  in  his  biblio- 
graphical list ;  selected  less  exaggerated  colored 
plates  than  those  of  Sickel ;  and  secured  a  better 
execution  of  the  excerpts  from  Politzer's  "  Beleuch- 
tungsbilder  d.  Trommelfells,"  it  would  have  added 
largely  to  the  exposition  of  the  text.  This  is  hardly 
creditable  to  Politzer,  who  is  himself  an  accomplished 
artist  in  aural  work,  and  wont  to  make  his  own  il- 
lustrations in  water,  oil,  and  plaster. 

The  author  gives  clear   and   terse   definitions  of 


some  of  the  more  intricate  topics,  as  the  visuaJ 
angle,  conjugate  foci,  and  the  physiology  of  vision  ; 
pathology  of  squint,  secondary  deviation  in  squint, 
test  for  insuificiency  of  the  internal  rectus  muscle  ; 
while  farther  on  in  the  book  an  attempt  is  made  to 
elaborate  the  definition  with  more  or  less  confusion. 

The  author  finds  ten  varieties  of  conjunctivitis, 
and  thirty-three  of  cataract,  with  a  corresponding 
multiijlicity  of  titles.  This  must  be,  so  far  as  the 
study  of  cataract  is  concerned,  a  confusing  array  of 
names  and  lenses  for  the  elementary  student. 

Eight  pages  are  given  to  the  internal  ear,  five  to 
its  anatomy,  and  three  to  its  diseases.  We  wish  the' 
author  had  written  a  chapter  on  syphilitic  changes- 
in  the  ear.  The  pathological  importance  of  this- 
topic  is  equalled  only  by  its  acoustic  interest.  So 
intimately  associated  is  the  acquirement  of  music 
and  the  proper  jjerception  of  sound,  that  this  optic 
could  with  propriety  find  place  in  a  manual  ad- 
dressed to  "  students  and  practitioners."  But  the 
subject  has  received  merely  an  allusion.  A  chapter 
on  fissures  and  fractures  of  the  petrous  bone,  in  the- 
light  of  the  present  Literature,  would  have  added' 
very  much  to  the  book. 

We  look  in  vain  for  Siegle's  otoscope  as  a  means- 
of  diagnosis  of  intrinsic  thickening  and  vibratory 
power  of  the  membrana  tympani.  No  mention  is' 
made  of  the  audiphone,  dentaphone,  or  audinet  in- 
chronic,  non-suppurative  (fibrous)  catarrh  of  the 
middle  ear ;  and  we  presume  that  Dr.  Mittendorf's- 
views  of  the  doubtful  aid  of  these  sound-conductors 
corresj3ond  with  those  of  his  confreres. 

The  second  edition  is  free  from  the  too  frequent 
misuse  of  Latin  technical  names,  the  misspelling  of 
well  known  terms  and  pro2:)er  names,  and  the  care- 
lessness of  the  proof-reader,  which  were  noticeable 
in  the  first  issue. 

We  have  given  Dr.  Mittendorf's  manual  a  careful 
perusal,  and  desjiite  its  shortcomings  (and  what 
book  is  without  them  ?)  it  should  find  a  place  on 
every  practitioner's  shelf;  not  only  because  it  as- 
sumes to  comjirise  the  clinical  range  of  diseases  of 
the  eye  and  ear,  but  since  it  is  written  in  a  scientific 
spirit  by  an  instructor,  who  for  many  years  lias  been 
enthusiastic  in  his  work,  and  whose  work  is  a  large 
one. 

Lectures  on  Diseases  op  the  Bones  and  Joints. 
By  C.  Macnamara,  F.B.C  S.  Eng.,  etc.  Second 
edition.  12mo,  pp.  5.50.  London:  J.  it  A.  Church- 
ill.   1881. 

The  appearance  of  a  second  edition  of  Mr.  Macnama- 
ra's  work  in  so  short  a  time  after  the  fir.st  is  hardly  a 
.surprise.  The  work  is  one  which  is  so  well  tilled  with 
important  and  practical  facts  connected  with  the  sub- 
jects treated  of,  that  its  value  cannot  be  overesti- 
mated as  a  safe  guide  to  the  surgeon  and  a  valuable 
book  of  reference  for  the  pathologist  and  general 
practitioner.  The  author  takes  pains  to  base  his  as- 
sertions upon  actual  bedside  experience,  and  his 
illustrative  cases  are  studies  in  themselves.  He  has 
the  rare  faculty  of  bringing  out  the  salient  points  of 
a  disease  clinically  and  pathologically,  and  of  con- 
sistently following  their  indications  in  treatment. 
In  a  word,  the  reader  gains  a  thoroughly  practical 
knowledge  of  the  diseases  of  bone,  which  he  is  en- 
abled on  sound,  general  principles  to  intelligently 
apply  to  the  requirements  of  jiarticular  cases.  In 
the  present  edition  much  material  has  been  added 
refen'ing  to  diseases  of  joints,  -which  gives  the  vol- 
ume a  proportionate  value.  It  is  destined  to  be  a 
leading  work  on  the  subjects  of  which  it  treats. 


296 


THE  MEDICAL  RECORD. 


tlrport0  of  0ocirtie«. 


NEW  YORK  PATHOLOGICAL  SOCIETY. 

Slated  Meeting,  January  25,  1882. 

Dr.  Edward  C.  Sequin,  President,  in  the  Chair. 

Dr.  D.  Bryson  Delevan  presented,  on  behalf  of  a 
candidate,  a  specimen  consisting  of 

A  portion  op  the  scalp,  avixh  the  hair  attached, 

REMOVED   Br   MACHINERY. 

Dr.  Delevan  also  presented  a  siiecimen  of 

FIBROMA   OP   THE   TONSIL. 

It  was  removed  from  a  man,  aged  twenty-three, 
■who  was  in  the  third  stage  of  phthisis.  Thepatient 
was  not  aware  of  the  presence  of  the  tumor,  which 
was  discovered  while  examining  the  throat  for  tuber- 
cular ulceration.  It  was  situated  upon  the  surface 
of  the  left  tonsil,  about  three-eighths  of  an  inch  be- 
low its  upper  margin,  and  was  attached  by  a  distinct 
pedicle.  Its  surface  was  smooth,  polished,  and  of 
a  light  pink  color,  and  offered  a  marked  contrast 
with  the  surrounding  mucous  membrane.  The  parts 
in  the  neighborhood  of  the  tumor  were  congested, 
and  the  tonsillar  crypts  were  filled  with  the  yellow 
excretion  peculiar  to  them.  The  tumor  was  easily 
removed  by  means  of  a  small  ecraseur,  and  without 
hemorrhage.  Upon  microscopic  examination,  it  was 
found  to  be  covered  with  buccal  mucous  membrane, 
beneath  which,  and  near  the  periphery,  was  an 
abundant  growth  of  young  ceUs.  The  mass  of  the 
tumor  was  made  up  of  fibrous  tissue,  containing  a 
large  supply  of  blood-vessels,  particularly  numerous 
near  the  surface.  It  was  a  fibroma.  It  had  not 
given  rise  to  symptoms,  but  probably  was  of  rapid 
growth,  and,  if  it  had  been  allowed  to  remain, 
doubtless  would  have  soon  produced  irritation  suf- 
ficient to  have  attracted  attention  and  led  to  're- 
moval. 

The  tumors  one  might  expect  to  find  in  this 
region,  although  very  rare  of  any  kind  in  that  local- 
ity, were  adenomata,  perhaps  myxomata,  and  then 
fibromata. 

With  reference  to  the  absence  of  symptoms  pro- 
duced by  the  growth.  Dr.  Delevan  referred  to  a  case 
reported  by  Dr.  Clinton  Wagner,  in  which  a  tumor 
an  inch  in  length  by  three-fourths  of  an  inch  in 
width,  and  one  fourth  of  an  inch  in  thickness,  al- 
most completely  filled  one  side  of  the  phai-ynx  ;  and 
it  was  only  two  weeks  prior  to  its  removal  that  the 
patient  had  been  conscious  of  its  presence,  although 
it  evidently  was  congenital.  Microscopical  exami- 
nation determined  that  it  was  of  old  standing. 

A   PIECE    OP   OLA.SS   ENCYSTED   IN   THE   HAND. 

Dr.  Robert  Newman  presented  a  piece  of  window- 
glass,  one  and  one-eighth  inch  long,  five-sixteenths 
of  an  inch  wide  at  one  end,  and  ono-sixteentli  of  an 
inch  in  width  at  the  other  end.  It  was  removed 
from  between  the  third  and  fourth  metacarpal  bones 
of  the  thin,  spare  hand  of  a  young  Kirl,  who  thrust 
her  fist  through  a  window-pane.  Hhe  waslied  her 
hand,  which  was  cut  and  bled  a  little,  and  thought 
nothing  more  of  it,  After  a  time  a  slighthardnoss  was 
felt,  and  six  weeks  afterward  the  patient  presented 
herself  to  Dr.  Xowman,  who  detected  a  foreign  bodv, 
dissected  down  upon  it,  and  removed  the  specimen 
presented,  which  was  encysted  and  had  given  rise  to 


no  trouble.  After  it  was  extracted  the  wound  did 
not  heal  kindly,  and  he  was  obliged  to  destroy  the 
cyst  with  carbolic  acid,  when  recovery  began  to'  take 
place.  Three  weeks  had  elapsed,  and  yet  the  wound 
was  not  entirely  healed. 

The  President  referred  to  a  case  in  which  he  re- 
moved a  portion  of  a  narrow,  uniformly  shaped  tack 
(brad)  from  the  finger  of  a  soldier.  It  was  encysted, 
and  had  not  given  rise  to  any  symjjtoms  whatever. 

cabibs  of  oalvabitosi  and  abscess  of  brain  from 
a  non-penetraung  gun-shot  wound. 

Dr.  Geo.  L.  Peabody  presented  specimens  ac- 
companied with  the  following  histoi-y.  They  were 
removed  from  the  body  of  a  man,  twenty-eight  years 
of  age,  a  German  laborer,  who  was  shot  on  May  28, 
1881.  The  bullet,  which  was  lying  in  contact  with  the 
bone,  was  removed  at  the  Chambers  Street  Hosjiital 
soon  after  the  shooting.  The  wound  was  found  to 
be  non-penetrating,  and  the  patient  was  treated  as 
a  dispensary  case,  every  other  day.  He  suffered  a 
little  from  headache,  and  about  the  middle  of  June 
he  vomited  several  times,  and  his  headache  in- 
creased. On  June  18th,  he  was  sent  to  the  New 
York  Hospital.  On  admission  he  complained  of 
severe  headache,  he  was  drowsy  and  unwilling  to 
talk,  but  was  easily  aroused  and  answered  questions 
slowly  and  intelligently.  His  pulse  was  full  and 
strong,  his  temperature  was  97.4"  F.  There  was  no 
paralysis  at  any  time.  He  gradually  grew  more  and 
more  stupid,  became  comatose,  and  died  two  days 
after  admission. 

The  cahnrhim  presented,  exhil)ited  the  efiect  of 
the  bullet  wound  above  the  right  superciliary  ridge. 
In  that  situation  a  button  of  bone,  about  half  an 
inch  in  diameter,  had  been  almost  completely  de- 
tached from  the  outer  table  of  the  skull,  being 
united  to  it  by  a  narrow  isthmus  of  bone,  about  one- 
eighth  of  an  inch  wide.  On  the  inner  table  the 
separation  was  less  complete,  extending  only  over 
about  half  its  circumference.  The  bone  in  the 
neighborhood  of  this  button  was  porous,  the  process 
of  caries  having  distinctly  invaded  both  tables  of 
the  skull.  The  inner  surface  of  the  frontal  bone 
exhibited  several  small  osteophytes,  not  in  any  way 
connected  with  the  injury. 

The  lirnin,  also  presented,  showed  more  exten- 
sive injury.  The  dui-a,  pia,  and  brain  surface  be- 
neath the  site  of  the  injury  were  firmly  adlierent,  so 
that  on  gently  separating  the  dura  from  the  brain, 
a  small  fragment  of  gray  matter  came  with  it  from 
the  second  frontal  convolution.  This  was  followed 
by  the  oozing  of  pus  from  the  opening.  The 
brain  was  then  hardened  and  subsequently  opened 
as  shown,  disclosing  an  abscess-cavity  which  was 
ovoidal  in  shajie.  It  had  an  antero-posterior  long 
diameter  of  one  and  one-half  inch,  and  a  vertical 
short  diameter  of  one  and  one-eighth  inch.  It  was 
lined  by  a  thick  pyogenic  membrane,  so  caUed.  It 
conies  within  three-foiirths  of  an  inch  of  the  upper 
surface  of  the  frontal  lobe,  and  within  about  the 
same  distance  of  the  liase.  invading  the  gi'ay  matter 
only  to  a  slight  extent  in  the  second  frontal  convo- 
lution. It  was  separated  from  the  corj)Us  striatum 
by  about  one-fourth  of  an  inch. 

Dr.  Peabody  also  presented  a  specimen  of 

BlCUSrro     AORTIC    V.ALVE — DEATH     ITIOM     PACHYMENIN- 
OITIS   HEMORRHAGICA. 

The  ])atiGnt  was  a  young  man  of  twenty-two  years, 
who  was  found  in  a  condition  of  unconsciousness 
and  taken  to  the  Chambers  Street  Hospital.     It  was 


THE  MEDICAL  RECORD. 


297 


then  recognized  that  he  was  suffering  from  intra- 
cranial pressure.  He  died  a  few  hours  after  admis- 
sion, having  been  continuously  comatose  since  ad- 
mission.    Xo  previous  history  could  be  obtained. 

The  autopsi/  revealed  as  the  cause  of  death  an  ex- 
tensive meningeal  hemorrhage,  which  completely 
covered  the  right  central  hemisphere.  The  thickness 
of  the  hemorrhage  was  greatest  at  the  vertex,  where 
it  was  about  one-fourth  of  an  inch.  The  blood  was 
in  part  upon  the  pia  mater  and  in  part  within  the 
meshes  of  the  false  membrane,  which  could  be  seen 
upon  the  inner  surface  of  the  dura  mater  covering 
the  right  hemisjihere.  This  false  membrane  was 
made  of  connective  tissue,  and  seemed  to  be  dis- 
posed in  layers.  The  deeper  layers  were  quite  dis- 
tinctly jjigmented,  showing  that  there  had  been 
repeated  small  hemorrhages  from  time  to  time  be- 
fore the  final  copious  hemoiThage  that  killed  the 
patient. 

The  heart  was  normal  in  size ;  the  muscular  tissue 
was  brownish  in  color.  The  cavities  were  all  nor- 
mal in  size  and  in  the  thickness  of  their  walls.  The 
aorta  showed  the  lesion  of  endarteritis  deformans  to 
a  somewhat  unusu.al  degree,  considering  the  age  of 
the  patient,  and  the  aortic  valve  was  composed  of 
only  two  cusps.  They  were  about  equal  in  size,  and 
there  was  no  evidence,  beyond  a  very  slight  thick- 
ening, of  any  inflammatory  change  in  them.  There 
were  but  two  corpora  arantii,  one  situated  at  the 
middle  part  of  the  cusps.  There  were  quite  dis- 
tinctly tliree  sinuses  of  Valsalva,  and  two  coronary 
arteries.  From  the  normal  appearance  of  the  left 
ventricle  we  thought  we  might  justly  conclude,  even 
without  a  previous  history,  that  the  bicnsjiid  aortic 
valve  performed  its  function  as  well  as  a  normal  valve 
would  have  done. 

Dr.  Peabody  presented  a  second  specimen  of 

BICrsPID   AORTIC    VAXVE — DEATH    FEOM   rNErMOXIA. 

The  patient  was   C.  J ,  twenty-five   years   of 

age,  a  native  of  the  United  States,  married,  and  a 
dressmaker.  She  was  admitted  to  the  New  York 
Hospital  January  H,  1882.  She  was  too  ill  to  give 
her  history,  and  the  following  data  were  obtained 
from  her  friends : 

She  was  a  hard  drinker,  but  was  in  good  health 
until  a  week  ago,  when,  after  exposure  to  cold,  she 
was  suddenly  seized  by  a  chill  and  great  pain  all 
over  the  riglit  side  of  her  body.  At  this  time  she 
vomited  freely.  The  pain  was  greatly  aggravated 
by  motion,  by  coughing,  and  by  deep  insj^iration. 
She  had  taken  scarcely  any  food  during  the  past 
week,  and  was  very  nervous  and  hyperiesthetical. 
She  had  been  delirious  diu'ing  one  or  two  niglits, 
and  had  had  continuous  high  fever.  She  had  not 
been  able  to  bear  the  weight  of  a  poultice  over  the 
right  side,  and  had  used  various  applications  and 
numerous  drugs  internally.  On  admission,  her 
pulse  was  96  ;  respiration,  40  ;  temjjerature,  102.6 
F.  She  was  stout  and  well-nourished,  face  flushed. 
Urine.  1016,  acid,  albumen,  and  epithelial  casts.  A 
diagnosis  of  pneumonia  in  the  upper  part  of  the 
right  lung  was  made.  She  continued  delirious  for 
three  days,  with  temperature  continuously  elevated. 
During  this  time  her  heart  was  examined,  and  no 
murmurs  were  heard.  Notwithstanding  appropriate 
medication,  she  died,  ^^-ith  temi^erature  of  107.6  F., 
thi-ee  days  after  admission. 

Autopx;/  nine  hours  after  death.  There  was  gray 
hepatization  of  the  upper  lobe  of  the  right  lung,  aod 
very  extensive  fibrinous  exudation  over  the  lower 
lobe.     The  kidneys  were  in  condition  of  diffuse  in- 


flammation. The  other  organs,  excepting  the  heart, 
were  normal.  In  this,  as  in  the  heart  just  presented, 
the  aortic  valve  consisted  of  two  cusps.  They  were 
equal  in  size,  and  had  only  two  corpora  arantii, 
which  were  not  well  marked.  The  cusps  were 
slightly  thickened,  especially  along  their  free  bor- 
ders. There  were  two  coronary  arteries,  and  two- 
well-develojjed  sinuses  of  Valsalva,  at  the  middle 
of  one  of  which  was  a  partial  division  of  it  into  two. 
The  muscular  tissue  was  brownish,  and  the  cavity 
of  the  left  ventricle  was  slightly  dilated.  He  pre- 
sumed it  would  be  fair  to  infer  from  this  dilatation, 
though  it  was  hut  slight,  that  the  bicuspid  aortic 
valve  had  probably  not  at  all  times  been  comisetent. 

In  connection  with  these  heart  cases.  Dr.  Pea- 
body  had  looked  up  the  subject  in  the  reports  of 
the  London  Pathological  Society,  and  in  the  works 
of  several  authors  who  have  written  ujion  the  heart, 
such  as  Hayden,  Peacock,  Fothergill,  Walsh,  and 
others.  This  malformation  may  be  either  congeni- 
tal or  acquired.  As  a  congenital  anomaly  it  is  more 
uncommon  than  is  the  other  form  which  he  had  oc- 
casion to  illustrate  a  few  weeks  ago,  namely,  the 
presence  of  four  cusps  in  one  aortic  valve.  Ordi- 
narily the  bicuspid  aortic  valve  is  not  competent  to 
close  the  aortic  orifice  during  diastole  ;  and  many 
of  the  recorded  cases  in  which  this  malformation 
has  been  hereditary  have  been  sufferers  from  heart 
symptoms  from  birth,  and  have  died  in  infancy. 
From  the  very  slight  amount  of  inflammatory  thick- 
ening in  both  of  his  cases,  he  was  inclined  to  regard 
them  as  congenital  ;  and  may  say,  congenital  mal- 
formation of  this  kind  are  much  more  uncommon 
than  those  that  have  been  acq^iired. 

Dk.  WrLLABD  P.AJtKEK,  Jr.,  asked,  with  reference 
to  Dr.  Peabody's  first  specimen,  if  there  were  not 
symptoms  sufficiently  well-defined  to  have  warranted 
trephining. 

Dk.  PE.\BODr  thought  that  many  surgeons  would 
have  trephined  imder  the  same  circumstances. 

The  President  asked  Dr.  Peabody  if  he  noticed 
whether  there  was  any  peculiarity  in  the  distribu- 
tion of  the  flattening  of  the  convolutions  which  was 
indicative  of  the  seat  of  the  abscess. 

Dr.  Peabody  was  unable,  as  the  autopsy  was 
made  some  time  ago,  to  state  positively,  but  to  the 
best  of  his  recollection  the  flattening  of  the  convo- 
lutions was  only  local. 

The  President  remarked  that  that  was  an  impor- 
tant point.  He  thought  it  was  taught  that  the  ef- 
fects of  pressure  in  the  cerebrum  are  distributed 
quite  equally  throughout  the  mass.  At  the  last 
autopsy,  however,  of  tumor  of  the  brain  which  he 
made,  there  was  a  well-defined  limitation,  and  the 
signs  of  pressure  were  very  evident.  The  tumor 
was  an  inch  in  diameter,  situated  under  the  ascend- 
ing convolution  near  the  median  line,  and  the  ad- 
jacent convolutions  were  flattened  in  the  character- 
istic manner,  but  the  first  frontal  and  the  posterior 
l^art  of  the  second  and  the  third  convolutions  were 
perfectly  natural,  and  there  was  only  very  slight  flat- 
tening across  the  median  line.  On  clinical  grounds 
he  did  not  believe  in  transmission  of  pressure  in 
all  directions,  but  was  not  aware  of  any  post- mortem 
demonstration  of  it. 

About  a  year  ago  he  presented  a  similar  specimen 
due  to  necrcsis  of  the  orbital  plate  of  the  frontal 
bone,  from  an  orbital  abscess.  There  was  disease 
of  the  dura  mater  covering  the  orbital  plate,  afl'ec- 
tion  of  the  pia  mater,  arachnoid,  and  gray  matter, 
and  the  formation  of  an  abscess  in  the  frontal  IoIjc. 
The  patient  had  no  paralysis,  no  lesions  of  the  op- 


■298 


THE  MEDICAL  RECORD. 


■tic  nerves,  no  convulsions,  and  not  any  very  severe 
pain  until  a  short  time  before  death.  There  was 
slow  pulse,  Cheyne-Stokes  respiration,  and  gradually 
increasing  coma.  The  whole  of  the  white  centre  of 
the  frontal  lobe,  except  a  portion  near  the  convexity 
of  the  hemisphere,  was  destroyed  close  to  the  island 
of  Keil  and  the  head  of  the  nucleus  candatus.  The 
mass  of  white  substance  connecting  the  posterior 
part  of  the  third  frontal  convolution  and  the  ante- 
rior gyri  of  the  island  of  Eeil,  with  the  internal  cap- 
sule, were  uninjured.  (See  Medical  Eecord,  vol. 
xix.,  p.  247.) 

In  reply  to  a  question,  the  President  stated  that 
in  both  cases,  that  reported  by  Dr.  Peabody  and 
the  one  from  which  he  obtained  his  specimen,  the 
symptoms  were  so  dafinite  that  the  diagnosis  of 
abscess  was  reasonable  and  trephining  would  have 
been  justifiable. 

liABVA  OP  A    FLY  DEVELOPED   TJNDBR  THE   SKIN   OF    THE 
HUMAN   BODT. 

Dr.  W.  R.  Birdsall  described  a  specimen  sent  to 
him  by  Dr.  H.  M.  Bachelor,  stationed  about  two 
hundred  miles  from  Gaboon,  on  the  west  coast  of 
Africa.  The  specimen  spoiled  and  he  was  unable 
to  present  it.  A  trader.  Dr.  Bachelor  stated  in  his 
letter,  had  a  painful  swelling  upon  one  of  his  hands, 
which  he  poulticed  with  flaxseed  meal,  and  soon 
discovered  a  small  hole  between  the  middle  and  ring 
fingers,  from  which  a  peculiar  looking  worm  came, 
and  a  second  one  followed  on  the  next  day.  At  first 
it  was  thought  that  the  worms  were  from  the  flax- 
seed meal,  but  doubt  in  that  direction  was  dispelled 
by  the  fact  that  another  workman  had  a  swelling 
upon  the  leg  from  which  precisely  the  same  kind  of 
a  worm  was  extracted.  No  one  had  seen  the  animal 
prior  to  this  year.  Subsequently  it  was  learned 
that  this  worm  preys  upon  the  gorilla,  and  that  the 
Panwees,  a  tribe  that  follows  the  catching  of  these 
animals  and  selling  them  to  the  traders,  are  very 
commonly  troubled  with  these  worms,  which  are 
probably  the  larva  of  some  species  of  fly.  One  of 
the  specimens  sent  by  Dr.  Bachelor  was  about  one- 
fourth  of  an  inch  long,  one-eighth  of  an  inch  thick, 
and  the  other  was  about  twice  that  size. 

The  society  then  went  into  executive  session. 


NEW  YORK  SOCIETY   OP  GERMAN  PHY- 
SICIANS. 

Staled  Meeti7}(],  September  23,  1881. 
Dr.  E.  Gruknino,  PREsroENT,  in  the  Chair. 

SANOUINEOU.S   MOLE. 

Dr.  GARUionES  presented  a  specimen  of  bloody 
mole,  showing  the  formation  of  numerous  hemor- 
rhagic cysts.  The  patient  came  to  him  with  a  his- 
tory of  amenorrhoea  of  some  months'  standing.  Slie 
did  not  suppose  herself  to  be  pregnant.  In  March, 
1881,  however,  a  physician  had  told  her  that  she 
was  pregnant,  her  last  menstruation  having  ap- 
peared in  .January.  A  dirty-looking,  tari-y  discharge 
was  coming  away  from  the  uterus  when  Dr.  Gar- 
rigues  first  saw  her.  This  was  on  the  KHli  of  .\ugust 
of  the  same  year.  Only  local  treatment  was  em- 
ployed for  three  days.  On  the  fourth  day  she  was 
seized  with  severe  uterine  pains,  and  a  rounded 
mass  was  discovered  throvigh  tlie  patulous  os.  Very 
soon  the  specimen  jjresentod  was  discharged  in  its 
entirety.  It  was  found  to  be  a  bloody  mole,  or  so- 
called   ajwplectic   ovum.      Its   size   was   unusuallv 


large,  and  its  inner  surface  was  the  seat  of  numer- 
ous blood-filled  cysts,  varying  in  size  from  a  pea  to 
tliat  of  a  cherry.  No  trace  of  a  placental  site  or 
fetal  structure  was  visible.  The  patient  denied 
having  had  syphilis. 

INTERN.AL   STR.ANGULATION   OF   .SMALL   INTESTINE. 

Dr.  Wendt  jiresented  a  specimen  illustrating  the 
occurrence  of  internal  strangulation  from  the  pas- 
sage of  a  loop  of  small  intestine  through  an  open- 
ing in  a  false  mesentery,  which  px'oceeded  from  a 
redundant  sigmoid  flexure.  (See  Medical  Record, 
October  1,  1881.) 

Dr.  Jacobi  said  that  a  certain  amount  of  redun- 
dancy of  the  sigmoid  flexure  was  of  normal  occur- 
rence in  infancy,  but  that  the  joersistence  of  such  a 
condition  through  adult  life  was  quite  exceptional. 

Dr.  Wendt  thought  that  tlie  present  case  would 
have  been  a  very  favorable  one  for  an  early  opera- 
tion. No  doutit  a  laparotomy  would  have  been  suc- 
cessful before  the  advent  of  peritonitis,  as  the  stran- 
gulated loop  of  intestine  could  have  been  readily 
liberated.  The  only  practical  difficulty  in  the  way 
of  a  rapid  discovery  of  the  site  of  the  trouble,  lay 
in  the  existing  tympanitic  distention  of  the  gut, 
and  the  position  of  the  strangulation,  which  was 
low  down  in  the  pelvis. 

Dr.  Jacobi  did  not  regard  this  as  a  contra-indica- 
tion  to  the  performance  of  an  operation.  Similar 
conditions  obtained  in  almost  all  laparotomies  for 
strangulation.  The  distended  loops  of  intestine 
might  with  im])unity  be  removed  from  the  abdom- 
inal cavity,  and  replaced  after  liberation  of  the 
strangulated  gut. 

neuro-sarcoma  of  tibial  nerve. 

Dr.  Gerster  presented  a  specimen  of  sarcoma 
involving  the  tibial  nerve,  which  he  had  success- 
fully removed  from  a  patient's  leg  some  time  previ- 
ously. The  tumor  was  spindle-shaped,  and  meas- 
ured seven  inches  in  length.  The  diagnosis  had 
been  rendered  difficult  on  account  of  the  hidden 
position  of  the  growth,  and  its  gradual  evolution. 
Over  the  main  bulk  of  the  tumor,  bundles  of  uerve- 
fibres  were  seen  to  pass  in  a  longitudinal  direction. 
On  either  side  of  the  neoplasm  the  tibial  nerve  was 
found  to  be  diseased  to  the  distance  of  about  three 
inches.  The  age  of  the  male  patient  was  forty  years, 
and  his  recovery  after  the  ojjeration  was  satisfactory. 

epithelioma   of  the   si;pERioR    maxilla,  eye,   and 

NOSE. 

Dr.  Gerster  also  exhibited  a  specimen  of  epitheli- 
oma, removed  by  operation  from  a  man  aged  fifty 
years.  The  growth  was  extensive,  involving  the  eye- 
ball, witli  the  conjunctiva  and  lids,  as  well  as  a  por- 
tion of  tlie  nose  and  upper  jaw.  The  biilbus  oculi 
had  lost  its  "mobility,  owing  to  which  circumstance 
the  conclusion  appeared  justifiable  that  the  infra- 
orbital tissues  were  extensively  involved.  The 
prognosis,  therefore,  seemed  doubtful.  During  the 
progress  of  the  ojieration,  however,  it  was  ascer- 
tained that  the  posterior  portion  of  the  contents  of 
the  orbital  fossa  was  free  from  disease.  It  was 
thus  ])ossil)Ie  to  enucleate  the  eyeball  within 
liealthy  tissue,  which  materially  improved  the  pa- 
tient's chances  of  a  cure. 

RARE   DOUBLE   MONSTER. 

Dr.  Moeller  showed  a  double  monster  which  he 
had  delivered  after  veision  by  force})s.  at  about  the 
seventh  mouth  of  utero-gestation.     It  was  found  to 


THE  MEDICAL  RECORD. 


299 


belong  to  a  type  of  monstrosity  known  as  syncepha- 
lus  and  thoracopagus.  There  were  two  heads,  joined 
together  at  the  occipital  border,  and  one  thorax, 
with  a  supplementary  half  thorax.  The  common 
abdomen  had  a  large  cleft,  from  which  a  portion  of 
liver  and  some  intestines  i)rotruc.led.  Four  arms 
and  hands,  and  as  many  well-foi-med  lower  extremi- 
ties were  i^reseut.     A  spina-bifida  also  existed. 

SARCOMA   OF   THE   IIVEB. 

Dk.  Seibebt  read  the  histoiy  of  a  case  of  prol:>abIe 
primary  hepatic  sarcoma,  and  exhibited  some  gall- 
stones, of  which  over  a  hundred  had  been  found  in 
thfi  gall-bladder.  The  patient,  a  man  aged  fifty- 
two,  had  been  seriously  sick  only  about  three  months. 

Several  months  before  this  time  he  had  merely 
complained  of  vague  gastric  disturbances  and  loss 
of  api^etite,  whereas  previously  he  had  been  perfectly 
well.  A  tumefaction  over  the  hepatic  region  was 
readily  visible,  and  as  the  tumor  gi-ew  raj^idly,  a 
diagnosis  of  hepatic  sarcoma  was  made.  Death 
took  place  with  symi^toms  of  general  peritonitis. 
At  the  autopsy  the  gall-bladder  was  found  to  be 
surrounded  by  a  spongy,  dirty-looking  mass.  The 
neoplasm  had  attained  about  the  size  of  an  adult 
head,  and  a  sharp  boundary  line  sepai-ated  it  from 
the  surrounding  liver-substance,  which  was  intensely 
congested.  Microscopical  examination  showed  the 
questionable  mass  to  consist  principally  of  small 
round  lymphoid  corpuscles,  many  of  which  were  in  a 
condition  of  fatty  degeneration.  It  was  therefore 
concluded  that  the  growth  was  a  primary  lympho- 
sarcoma, and  not  a  hepatic  abscess.  No  other  tu- 
nlors  or  noteworthy  lesions  were  discoverable  in  the 
different  organs  of  the  body. 

AUTOMATIC   TRACHEAL   EETR ACTOR. 

Dr.  Caille  showed  the  above  instrument  and 
explained  its-  mode  of  application.  (See  Medical 
Eecoed,  December  24,  1881.) 

HYPER-PERISTALSIS   OF  THE   STOMACH. 

Dr.  L.angm.\ns  reported  a  case  of  abnormally  in- 
creased gastric  peristalsis,  in  a  i)atient  having  a 
dilated  stomach.  The  phenomenon  in  question  had 
been  recently  described  by  Kussmaul  in  Volkmann's 
Sammlinig  Kliniacher  Vorirdge.  The  patient  had 
been  for  a  long  period  suffering  from  dyspepsia, 
with  dilatation  of  the  stomach.  The  lesser  curvature 
of  the  stomach  extended  below  the  umbilicus.  A 
vermiform  contraction  of  the  stomach  occurred 
spontaneou.sly  at  certain  intervals,  and  was  accom- 
panied with  great  pain.  The  contraction  was  first 
visible  at  the  pylorus,  and  thence  extended  to  the 
cardiac  portion.  The  entire  phenomenon  lasted  only 
about  two  seconds.  By  tapping  the  abdomen,  a  vis- 
ible contraction  could  be  brought  on  at  will.  In- 
troduction of  the  oesophageal  sound  invariably 
excited  vomiting.  The  capacity  of  the  stomach  was 
about  five  quarts.  A  course  of  washing  out  of  the 
stomach,  carried  on  at  first  twice  daily,  was  soon 
followed  by  marked  relief. 

LAPAROTOMY    FOR   INTUSSUSCEPTION    OP   THE    COLON   EC 
A   CHILD. 

Dr.  H.  F.  Kctdlich  narrated  the  history  of  a  case 
of  intussusception,  in  which  laparotomy  was  per- 
formed, but  whicli  terminated  in  the  death  of  the 
patient.  The  latter  was  but  two  months  old,  and 
had  been  ^jerfectly  well  up  to  the  time  of  the  fatal 
illness.  The  onset  .of  the  disease  was  marked  by 
its  .suddeness,  occurring  at  night  on  the  21st  of  Seja- 


tember.  On  the  following  morning  the  discharge 
from  the  bowels  was  blood-stained,  and  later  on  the 
evacuations  consisted  exclusively  of  grumous  blood. 
There  was  also  a  constant  oozing  of  a  sanguinolent 
fluid  from  the  anus.  At  the  same  time  the  little 
girl  grew  rapidly  weaker.  The  invaginated  portion 
of  the  colon  was  felt  low  down  in  the  rectum,  but  all 
attempts  at  reducing  it  j^roved  unavailing.  Dr. 
Jacobi,  who  was  asked  to  see  the  case  in  coniBulta- 
tion,  advised  and  subsequently  performed  laparo- 
tomy as  a  last  resort.  The  operation  was  performed 
eighteen  hours  after  the  first  appearance  of  morbid 
symptoms,  and  the  infant  died  five  hours  after  its 
completion.  ■ 

At  the  autopsy,  the  colon  had  a  bluish  black  ap- 
pearance,  and  was  found  to  be  very  friable.  Gan- 
grene,if  not  actually  present,  was  certainly  imminent. 
The  reduction  of  the  invaginated  iiortion  had  been 
accomplished  only  on  exercising  considerable  force. 

Dr.  Jacobi  supplemented  the  above  history  by 
the  following  remarks  :  Palpation  and  percussion 
had  thrown  no  light  on  the  nature  and  seat  of  the 
affection,  which  was  only  made  otit  with  certainty 
by  rectal  exploration.  Copious  enemata  and  at- 
tempts at  manual  reduction  had  been  futile.  By 
the  use  of  a  .suitable  catheter,  a  reduction  en  masse 
was  obtained.  This  latter  was  made  evident  by  the 
fact,  that  during  its  performance  the  rectal  walls 
became  tense,  thin,  and  smooth.  He  had  made 
similar  observations  on  i^revious  occasions,  which 
clearly  showed  the  illusory  nature  of  such,  at  first 
sight  successful  reductions.  In  this  instance  a  hard, 
sausage-like  mass  was  distinctly  felt  in  the  left  iliac 
fossa,  after  the  intussusoei^ted  gut  had  been  jiushed 
upward  by  means  of  the  catheter. 

As  regards  the  ojjeration,  the  ordinary  incision  in 
the  median  line  was  practised,  in  the  space  between 
the  symphysis  and  umbilicus.  The  child's  bladder, 
however,  extended  so  high  up  above  the  symphysis 
pubis,  that  this  incision  opened  the  viscus.  When 
this  circumstance  became  ajiparent,  the  incision  was 
prolonged  upward  to  the  right  of  the  navel.  Loops 
of  intestine,  distended  with  gas,  at  once  protruded 
into  the  wound,  and  the  invaginated  colon  at  length 
came  in  view,  having  ab-eady  assumed  a  dusky  hue. 
By  means  of  forcible  massage  and  inversion,  the  in- 
vagination was  finally  reduced.  During  these  ma- 
nipulations, the  tumefied  serous  coat  of  the  intestine 
became  fissured  in  several  places.  In  order  to  re- 
turn the  coils  of  intestine  to  the  abdominal  cavity,  it 
became  necessary  to  repeatedly  puncture  them,  so 
as  to  permit  the  escape  o^  gas.  A  drainage-tube 
was  introduced  through  the  urethra  into  the  blad- 
der, and  the  wound  in  the  latter  organ  allowed  to 
remain  open.  The  child,  as  already  stated,  lived 
five  hours  after  the  operation.  Invaginations  were 
extremely  rare  in  infants  of  such  tender  age,  but 
were  more  frequently  seen  at  five  or  six  months. 
Finally,  allusion  was  made  to  a  similar  case,  which 
had  been  successfully  operated  upon  by  Dr.  Sands. 


Stated  Meeting,  October  28,  1881. 
De.  H.  Klotz,  President,  in  the  Chair. 

traumatic  paralysis  op  the  facial,  auditory,  and 
abdccens  nervt:s. 
Dr.  Seessel  exhibited  a  patient,  aged  forty-four, 
who,  in  consequence  of  a  violent  blow  upon  the 
right  side  of  the  face,  had  developed  a  jmralysis  in- 
volving the  facial,  auditory,  and  aViducens  nerves. 
Immediately  after  receiving  the  injury,  the  patient 


300 


THE   MEDICAL  RECORD. 


had  been  completely  bereft  of  consciousness  for 
about  ten  hours.  The  zygomatic  arch  had  been 
fractured,  and  blood  had  escaped  from  the  ear. 
One  week  after  receipt  of  the  injury  the  patient 
first  came  under,  his  observation,  and  the  above 
diagnosis  was  at  that  time  made  out.  Pain  had 
been  altogether  absent.  Dr.  Seessel  thought  that 
the  paralysis  must  be  a  peripheral  one,  and  for  the 
following  reasons :  All  the  branches  of  tlie  facial 
nerves  were  involved,  and  all  reflex  movements  were 
lost.  The  muscles  involved  were  ascertained  to  be 
undergoing  morbid  changes.  Trophic  disturbances 
were  also  unmistakably  jn-esent,  and  the  secretion 
of  sweat  was  diminished.  The  seat  of  the  lesion, 
which  must  consist  of  fracture  and  hemorrhage,  was 
located  at  the  entrance  of  the  facial  nerve  into  the 
ear.  The  prognosis  was  not  an  absolutely  bad  one, 
since  the  galvanic  excitability  of  the  muscles  was 
only  partially  lost. 

BESECnON    OP    SOPEKIOR    MAXILIiARY    NERVE    FOR    IN- 
TRACTABLE  NEURALGIA. 

Dr.  Gerster  showed  a  man,  aged  thirty-six,  upon 
whom  he  had  successfully  operated  for  intense  re- 
current neuralgia  of  the  second  branch  of  the  tri- 
geminus. The  choice  of  the  operative  method  was 
according  to  Langenbeck's  plan  of  temjjorary  ex- 
section  of  the  superior  maxilla.  The  indication  for 
its  performance  was  a  violent  paroxysmal  neuralgia, 
which  had  resisted  all  attempis  at  treatment.  In 
connection  with  the  previous  history  of  the  patient, 
it  might  be  mentioned  that  his  occupation  necessi- 
tated frequent  exposure  to  extremes  of  temperature. 

Eighteen  years  ago  the  patient  first  began  to 
suffer,  and  in  the  year  1877  the  paroxysms  became 
so  severe  that  he  sought  relief  by  an  operation,  per- 
formed by  Dr.  Mott.  In  view  of  the  fact  that  the 
attacks  of  pain  were  only  controlled  for  a  very  short 
period,  and  further,  that  no  cicatrix  was  now  visible, 
the  surgical  interference  had  very  probably  only 
consisted  in  section  of  the  nerve.  Dr.  Hassloch 
next  treated  him,  and  large  doses  of  salicylic  acid 
secured  temporary  remissions  of  the  attacks.  Qui- 
nine was  also  found  serviceable  in  a  large  dose  on 
one  occasion.  These  drugs,  in  conjunction  with 
morphine,  at  length  failed  to  give  him  relief,  and  he 
then  consulted  Dr.  Weir. 

Under  the  advice  of  the  latter,  aconitine  was 
given  in  doses  of  ^"-ij  of  a  grain  every  two  to  three 
hours  foi  one  week.  This  resulted  in  so  mai-ked 
and  app.irently  lasting  an^  improvement,  that  the  case 
was  published  in  1880  as  cured.  The  jjains,  how- 
ever, returned  after  some  months,  and  finally  the 
patient  applied  to  Dr.  Gerster  for  relief.  An  opera- 
tion being  consented  to,  this  was  done  in  the  fol- 
lowing way :  A  curved  incision,  extending  at  once 
to  the  bone,  was  carried  from  the  zygoma  to  the 
corresponding  nasul  orifice.  The  soft  parts,  includ- 
ing tlie  periosteum,  were  then  lifted  upward,  thus 
exposing,  after  section  of  the  massoter  muscle,  the 
pterygopalatine  fossa.  Tlie  superior  maxillary  bone 
was  next  sawed  through  in  the  direction  of  the  first 
incision.  Then  a  .second  deep  incision  was  made, 
beginning  at  the  inner  canthus  of  the  eye,  and  join- 
ing the  first  at  an  obtuse  angle.  The  nerve  thus 
being  exposed,  was  cut  at  the  infra-orbital  foramen. 
The  zygomatic  arch  was  now  severed  by  means  of  a 
saw,  and,  after  cutting  throus;h  the  bottom  of  the 
bony  orbit,  the  superior  maxilla  was  gently  lifted 
out,  its  only  connection  being  with  the  nose.  The 
nerve  was,  in  this  way,  extruded  from  the  infra-or- 


bital canal,  seized  with  a  i^air  of  forceps,  and  again 
cut  at  the  foramen  rotundum. 

Hemorrhage,  at  first  quite  profuse,  was  soon  con- 
trolled. The  jaw  was  replaced,  a  drainage-tube  was 
inserted  into  the  pterygo-palatine  fossa,  and  the  in- 
cisions closed  by  sutures.  The  disinfectant  wash 
employed  was  an  eight  per  cent,  solution  of  chloride 
of  zinc. 

The  patient  bore  the  operation  well.  There  were 
no  untoward  symptoms,  and  osseous  union  was 
comidete  after  six  weeks.  Langenbeck,  who  devised 
this  operative  method,  originally  intended  it  for  the 
removal  of  naso-phaiyngeal  growths.  But,  as  was 
shown  in  this  case,  it  might  be  readily  employed  for 
exsecting  the  superior  maxillary  neiTe.  The  prin- 
cipal advantage  of  this  plan  over  that  of  Carnochan, 
was  owing  to  the  circumstance  that  the  former  of- 
fered a  much  larger  field  for  accurate  inspection  and 
subsequent  surgical  interference. 

PrBRO-CTSTIC   TUMOR   OP  KIDNEY. 

Dr.  Garrigues  presented  a  specimen  of  tumor  of 
the  kidney,  removed  at  the  Woman's  Hosjiital  by 
Dr.  Thomas.  The  solid  portions  of  the  growth  were 
fibro-myxomatous.  (This  case  has  been  reported 
elsewhere  in  full.) 

Dr.  Welch  had  examined  the  neoplasm,  and  was 
disposed  to  regard  it  as  fibro-cystic,  and  not  myxo- 
matous. He  based  his  opinion  on  the  fact  that  the 
fluid  removed  from  the  smaller  cysts  showed  si:)on- 
taneous  coagulation. 

Dr.  Garrigues  remarked  that  no  clot  had  formed 
in  the  fluid  removed  from  the  principal  cysts,  as  late 
as  two  days  after  it  was  first  drawn. 

Dr.  NoEGiiERATH  believed  that  this  apparent  dis- 
crepancy might  be  accounted  for  by  a  recognition 
of  the  fact  that  the  fluid  fi'om  fibro-cystic  tumors 
would  coagulate  or  not,  accordingly  as  it  contained 
or  was  free  from  blood.  Probably  Dr.  Garrigues 
had  obtained  fluid  unmixed  with  blood,  whereas  Dr. 
Welch  had  examined  bloody  fluid. 

Dr.  Garrigues  was  positive  that  the  fluid  submit- 
ted to  him  for  examination  had  contained  blood, 
and  yet  a  clot  had  not  formed.  ISIoreover,  he  was 
of  oijinion  that  the  fluid  contained  in  fibro-cystic 
growths  showed  spontaneous  coagulation.  On  the 
other  hand  ovario-cystic  fluid  only  exceptionally  be- 
haved in  this  way. 

CONGENITAL   MALFORMATION   OF   CRANIUM. 

Dr.  Wettengel  presented  a  specimen,  which  con- 
sisted of  an  infant  twenty-four  hours  old.  It  was 
born  with  the  roof  of  the  cranium  completely  ab- 
sent. The  oocipal,  parietal,  and  frontal  bones  showed 
only  a  rudimentary  development.  There  was  a  cu- 
taneous pouch  containing  the  encejihalon.  The 
foetus  also  had  a  redundant  toe  on  the  right  foot. 

Dr.  Jacobi  remarked,  concerning  the  genesis  of 
such  malformations,  that  in  an  early  stage  of  em- 
bryonic development,  a  supervening  meningitis 
would  inhibit  the  further  growth  of  the  cranial 
bones.  Such  an  arrest  of  development  might  be 
either  comjdete  or  ])artial.  A  regressive  metamor- 
phosis of  already  existing  cerebral  structures  might 
also  take  ]dac€,  leading  finally  to  the  production  of 
anencoplialous  monsters. 

In  tliose  cases  where  the  rudimentary  cranium 
contained  no  brain-substance,  and  only  showed 
blood-vessels  and  connective  tissue,  the  malfoi"ma- 
tion  belonged  to  the  tyi)e  of  pseuden-cephalous 
monsters.  In  the  sjiecinien  just  presented,  a  sep- 
tum appeared  midway  between  two  lateral  halves  of 


THE  MEDICAL  RECORD. 


301 


the  mass  constituting  the  encephalon.  Two  sepa- 
rate cerebral  vesicles  must  therefore  have  existed, 
and  the  arrest  of  development  accordingly  must  have 
taken   place   at   about   the   third   month  of  utero- 


C05IPLETE   DIPHTHERITIC   CAST   OF   BLADDEB. 

Dr.  Jacobi  presented  a  specimen,  consisting  of  a 
diphtheritic  cast  of  the  entire  bladder.  It  was  re- 
moved from  the  body  of  a  man,  aged  sixty-sis,  who 
died  with  symptoms  of  septic  ulceration  of  the  blad- 
der. For  many  years  the  patient  had  suffered  from 
various  difficulties  in  passing  his  water.  Often  the 
urine  had  a  very  offensive  odor.  It  was  mixed  with 
blood,  and  also  contained  a  large  proportion  of  pus. 
Repeatedly,  almost  clear  blood  escaped  after  mic- 
turition. The  fetid  smell  was  improved  by  washing 
out  the  bladder.  Five  days  before  his  death,'  col- 
lapse oecun-ed,  and  a  catheter  being  introduced  into 
the  distended  bladder,  failed  to  remove  any  urine. 
Instead,  an  ichorous,  very  offensive  fluid  escaped. 
A  malignant  neoplasm  was  supposed  to  be  present, 
blocking  uj)  the  neck  of  the  bladder.  Attempts  to 
puncture  the  bladder  above  the  symphysis  proved 
fruitless,  and  the  jjatient  died. 

At  the  autopsy,  the  bladder  was  found  adherent 
to  neighboring  loops  of  small  intestine.  On  open- 
ing the  organ,  by  incision,  it  was  seen  to  be  paved 
with  a  complete  cast,  which  was  attached  to  the 
muscular  coat.  Tlie  latter  was  hypertrophied  in 
certain  places,  and  abnormally  thin  in  others.  It 
was  the  presence  of  this  vesical  coating  that  had 
prevented  the  passage  of  the  catheter. 

STRANGULATED    tJlIBILICAL    HERNIA — EX.SECTION    OF    A 
PIECE   OP   THE   TBANSVEKSE   COLON. 

Dr.  Gerster  gave  an  account  of  the  above  oper- 
ation, and  presented  as  a  specimen  the  excised  por- 
tion of  the  transverse  colon.  The  patient  was  a 
woman,  aged  sixty-six.  For  many  years  she  had 
suffered  no  discomfort  from  the  presence  of  an  um- 
bilical hernia  of  about  the  size  of  a  small  fist.  When 
seen  by  Dr.  Arcularius,  the  hernia  had  been  strangu- 
lated for  about  sixteen  hours.  Vomiting  was  severe, 
and  the  tumor  being  irreducible,  Dr.  Gerster  was 
asked  to  see  the  patient  in  consultation. 

It  was  decided  that  immediate  herniotomy  was 
necessary.  There  being  an  abundance  of  subcuta- 
neous fat,  an  incision  six  inches  long  l>ecame  neces- 
sary. After  incision  of  the  constricting  ring,  the 
liberated  gut  was  examined  and  found  to  show  signs 
of  gangrene,  although  ulceration  or  perforation  had 
not  yet  occurred.  Excision  of  the  affected  portion 
of  the  gut  was  at  once  undertaken.  The  excised 
piece  measured  twenty  centimetres.  A  double  series 
of  eighteen  catsut  ligatures  was  applied,  the  sutures 
being  made  according  to  the  plan  of  Lembert.  On 
removing  the  temporary  sutures,  some  intestinal  con- 
tents were  seen  to  ooze  out.  The  abdominal  cavity 
having  been  cleansed,  the  gut  was  returned.  Pre- 
viously, however,  it  became  necessary  to  apply  three 
longitudinal  sutures,  on  account  of  a  rent  produced 
by  the  tearing  of  one  stitch,  through  the  friable  in- 
testinal wall.  The  duration  of  the  operation  was 
one  and  one-half  hour.  The  patient  rallied  well 
immediately  after  the  surgical  interference,  but 
subsequently  died  in  collapse,  with  symptoms  of 
peritonitis.     An  autopsy  was  not  permitted. 

In  conclusion.  Dr.  Gerster  explained  the  circum- 
stances which  had  led  him  to  prefer  exsection  of  the 
gut  *o  the  establishment  of  an  artificial  anus. 

Db.  Meyer  remarked  that  the  prognosis  of  estab- 


lishing an  artificial  anus  would  have  been  less  un- 
favorable than  Dr.  Gerster  was  inclined  to  believe, 
and  for  this  reason,  in  his  opinion,  this  method  of 
procedure  should  have  been  selected. 

Dr.  Gerster  replied  that  the  attending  conditions 
were  far  more  more  unfavorable  in  umbilical  hernia 
than  in  ordinary  inguinal  hernia,  and  that  the  rec- 
ognition of  this  fact  had  been  one  reason  'why  he 
had  not  attempted  the  establishment  of  an  anus 
prajter-natuialis. 


NEW  YORK  SURGICAL  SOCIETY. 

Stated  Meeting,  January  10,  1882. 

Dr.  T.  M.  Maekoe,  Prkstdekt,  in  the  Chair. 

a  unique  case  of  fracture  of  the  sternum. 

Dr.  L.  A.  Sttmson  mentioned  a  case,  in  his  service 
in  Bellevue  Hospital,  of  fracture  of  the  sternum,  due 
to  a  fall  upon  the  shoulder,  bringing  the  clavicle 
against  the  upper  end  of  the  sternum  with  such  force 
as  to  carry  \\ith  it  a  .small  fragment  of  the  bene,  pro- 
duce a  displacement  of  the  inner  end  of  the  clavi- 
cle, and  give  rise  to  distinct  crei^itus.  There  was 
disphicement  of  the  inner  end  of  the  clavicle  up- 
ward nearly  half  an  inch,  and  the  first  rib  was  ex- 
jjosed  beneath  it.  There  was  distinct  crepitation, 
but  it  could  be  produced  only  by  pressure  against 
the  sternal  end  of  the  clavicle  downward  and  out- 
ward. Considenng  the  displacement,  ishich  was 
not  that  of  a  simple  dislocation  of  the  sternal  end  of 
the  clavicle  upward,  and  consielering  the  direction 
in  which  jwessure  caused  crepitus,  he  saw  no  in- 
terpretation of  the  condition  except  that  a  fracture 
had  occurred  running  obliquely  from  above  down- 
ward and  outward.  The  fragment  must  be  very 
small  because  the  function  of  the  steiTiocIeido  mas- 
toid muscle  was  not  interfered  with.  The  evidences 
of  fracture  were  localized  pain  below  the  sternal 
end  of  the  clavicle,  ecchymosis,  swelling  under  the 
clavicle,  exposure  of  the  first  rib  to  touch,  and  crep- 
itus produced  in  the  manner  descrilied.  Draw- 
ing the  shoulder  backward  produced  no  effect  what- 
ever upon  the  deformity.  Probably  the  fragment 
broken  off  did  not  include  the  entire  thickness  of 
the  bone. 

[Two  weeks  after  the  injury,  the  swelling  having 
subsided,  the  inner  end  of  the  clavicle  was  freely 
movable,  and,  while  it  was  drawn  upward  by  as.sist- 
ants,  crepitation  coiild  still  be  got  by  pressure  njion 
the  sternum  with  two  fingers,  one  near  the  median 
line  of  the  upper  end,  and  the  other  on  the  outer 
border  near  the  junction  of  the  first  rib.] 

HTDBOCELE,  of  SIX  months'  STANDING,  WITHOUT  TRANS- 
LUCENCy. 

Dr.  a.  C.  Po.st  narrated  a  case  as  follows  :  He  re- 
cently saw  a  patient  with  a  scrotal  tumor,  consider- 
ably larger  than  a  goose's  egg,  which  extended  so 
far  up  toward  the  groin  that  it  was  difficult  to  deter- 
mine whether  or  not  it  came  from  the  inguinal  canal. 
There  was  a  feeling  of  fluctuation,  but  he  was  un- 
able to  make  out  any  trsnslucency.  The  facts  that 
the  tumor  was  only  about  six  mouths'  standing,  and 
that  the  patient  had  no  knowledge  of  its  ever  having 
been  reducible,  also  that  when  it  first  attracted  at- 
tention it  was  of  nearly  the  same  size  as  then,  sug- 
gested to  him  the  propriety  of  making  an  explora- 
tive puncture.  He  found  the  investments  of  the  sac 
very  thick,  but  the  fluid  withdrawn  was  clear.  At 
first  he  had  a  little  hesitation  concerning  the  nature 


302 


THE  MEDICAL  RECORD. 


of  the  tumor  on  account  of  the  absence  of  translu- 
cency. 

FIBRO-SiBCOSIA   OP  THE  ISOHTOSI. 

Dr.  R.  F.  Weir  presented  a  specimen,  with  the 
following  history  :  It  was  removed  from  a  man  forty- 
eight  years  of  age,  and  without  hereditary  history. 
Two  or  three  years  ago  he  fell  down  stairs,  striking 
his  buttocks  quite  severely  upon  several  steps.  It 
was  not  until  about  eighteen  months  ago  that  he 
noticed  a  slight  tumor  upon  the  posterior  aspect  of 
the  thigh,  high  up,  but  it  did  not  increase  rapidly  m 
size,  nor  give  rise  to  much  inconvenience.  His  only 
complaint  had  been  of  pains,  varying  in  severity,  not 
very  acute,  along  the  posterior  portion  of  the  right 
thii-h,  none  in  the  cilf  of  the  leg,  and  none  in  the 
sole  of  the  foot.  The  tumor  presented  itself  about 
two  inches  below  the  tuberosity  of  the  right  ischium, 
movable  laterally,  not  up  and  down  ;  edges  indefi- 
nite, evidently  beneath  the  fascia  lata,  and,  so  far  as 
he  was  able  to  appreciate  its  size  by  palpation,  it  was 
supposed  to  be  about  twice  as  large  as  an  ordinai7 
hen's  egg.  An  attempt  to  render  the  limb  bloodless 
failed,  °and  the  ablation  of  the  tumor  with  some 
difficulty  was  accomplished  by  an  incision  nearly 
six  inches  in  length.  The  tumor,  when  removed, 
weighed  a  pound  and  measured  seven  inches  in  its 
longest  diameter.  ,   ,    ^  .,      ■  i  i.  u 

In  the  dissection  it  was  supposed  that  it  might  be 
blended  with  the  common  origin  of  the  muscles 
arising  from  the  ischium.  That  supposition,  how- 
ever, was  not  absolutely  correct,  although  the  ten- 
don of  the  semi-tendinosns  was  lost  in  the  mass,  but 
that  of  the  biceps  was  not  involved. 

Again  it  was  thought  that  it  might  be  one  of  those 
rare^tumors  arising  from  the  sciatic  nerve,  which  do 
not  always  give  rise  to  severe  pressure  effects  upon 
that  nerve.  In  fact,  however,  this  nerve  was  found 
npon  the  anterior  portion  of  the  tumor,  but  a  care- 
ful dissection  showed  that  it  was  entirely  separable 

from  it.  ...         11 

The  tumor,  in  reality,  had  its  origin  from  the  up- 
per portion  of  the  tuberosity  of  the  ischium  in  the 
ascending  r.-imus,  curving  somewhat  around  into  the 
sciatic  notch,  whence  it  was  detached  after  consider- 
able troublesome  dissection.  It  was  irregularly  lob- 
nlated  like  a  fatty  tumor,  and  dense,  and,  fi-om  a 
subsequent  microscopical  examination,  was  a  fibro- 
sarcoma. ,  ,  ^         .   ,  J .       , , 

Its  origin  was  unique,  and  seemed  to  point  directly 
to  the  traumatism  as  the  cause. 

EXOSTOSIS  IN   THE  POPniTEAI;  SrACE. 

Dr.  L.  S.  Pilcher  presented  a  tibia,  which  had, 
upon  the  inner  and  posterior  aspect,  near  its  head, 
two  projections.  The  upper  one  was  a  nipple-like 
process,  immediately  beneath  the  line  corresponding 
to  the  epiphyseal  junction.  Toward  the  fibular  side, 
still  posterior,  there  was  a  much  more  prominent 
process  of  bone,  which  extended  backward  and 
downward  to  the  distance  of  three  fourths  of  an  inch, 
like  the  spur  of  a  cock. 

It  seemed  to  be  one  of  those  cases  m  which  a  suc- 
cession of  bony  growths  had  been  observed,  reced- 
ing from  the  epiphyseal  line,  and  increasing  in  the 
extent  of  their  dnvelopment  according  to  the  dis- 
tance from  that  point. 

OONORKHOSA  OP  SIX  WEEKS'  ST AVDINO— ABSCESS  OP  THE 
PROSTATE— QANORENE  OF  THE  BT.ADDER— SUPPURA- 
TIVE INPI.AMMATION  OP  THE  KIDNEYS. 

Dii.  E.  Mason  presented  specimens  which  illus- 
trated rapid  and  extensive  disease  of  the  bladder, 


prostate,  and  kidneys,  supervening  upon  an  attack 
of  gonorrhoea.  They  were  accompanied  with  the 
following  history.  A  man,  thirty-two  years  of  age, 
entered  his  service  at  the  Koosevelt  Hospital  on  the 
6th  of  December,  1881,  with  thehistqfy  that  six  years 
before  he  had  an  attack  of  gonorrhcea,  again  three 
years  ago,  and  none  subsequently.  He  came  m  un- 
able to  pass  water.  His  bladder  was  distended  so 
as  to  reach  nearly  up  to  the  umbilicus.  Ihe  onJy 
instrument  which  the  house-surgeon  was  able  to 
introduce  was  a  flexible  catheter,  No.  4.  Iwo  or 
three  days  afterward  a  larger  size  flexible  rubber  in- 
strument could  be  introduced  easily,  and  the  urine 
drawn.  Finding  that  the  patient  suffered  no  appar- 
ent pain  upon  pressure  above  the  pubis,  but  was  ob- 
liged to  have  his  urine  drawn.  Dr.  Mason  Mamined 
with  reference  to  the  prostate  on  December  Idth, 
and  detected  that  the  right  side  was  very  much  en- 
larged, fluctuating,  and  tender.  Again  he  denied 
having  had  gonorrhoea  since  three  years  ago,  but  a 
few  days  afterward  he  confessed  having  had  gonor- 
rhoea about  six  weeks  pre't-iously,  and  that  lie  haa 
suffered  from  bladder  symptoms  three  weeks  before 
admission  to  the  hospital.  Two  days  afterward,  four 
ounces  of  offensive  pus  passed  by  the  urethra,  and 
on  the  next  dav  pus  passed  from  the  rectum,  ihe 
urine  was  so  offensive,  and  also  the  pus  discharged 
from  the  rectum  and  from  the  urethra,  that  it  was 
necessary  to  remove  the  patient  to  one  of  the  out- 
buildings ;  but  he  complained  of  no  pam,  sometimes 
passed  his  water  without  assistance,  at  other  times 
had  it  drawn  ;  sometimes  passuig  it  through  the 
urethra,  and  at  other  times  through  the  rectum.  On 
the  eighteenth  day  after  admission  he  became  deli- 
rious, and  died  on  the  following  day  comatose. 

The  autopsy  revealed  the  bladder  distended  above 
the  symphysis,  its  peritoneal  surface  covered  with 
considerable  recent  plastic  exudation,  its  walls  ne- 
crosed, its  mucous  membrane  destroyed  or  greenish 
and  gangi-enous  throughout,  with  occasional  irregular 
patches  of  exudation.  The  ureters  were  consider- 
ably dilated  and  filled  with  muco-pus.  The  kidneys 
were  consideraV)ly  increased  in  size,  the  pelves  were 
the  seat  of  suppurative  inflammation  ;  both  kidneys 
were  infiltrated  with  small  and  large  aggi'egations 
of  pus,  and  in  the  right  kidney  there  was  a  uniform 
infiltration  with  pus.  The  prostate  was  the  seat  of 
an  abscess  which  opened  into  the  rectum  and  into 
the  urethra.  .„     ...       ,    „  „, 

The  case  was  interesting  as  illustrating  how  ex- 
tensive disease  may  follow  rapidly  upon  gonorrhcea. 
The  patient  complained  only  a  very  little  of  pam. 
The  temperature  was  not  high,  except  once,  when  it 
reached  104°  F.  . 

In  reply  to  questions.  Dr.  Mason  said  it  was  the 
opinion  of  the  house  surgeons  that  the  catheter  had 
been  nse.l,  but  unsuccessfully,  before  the  patient 
was  admitted  to  the  hospital.  The  reason  why  he 
did  not  open  the  fluctuating  tumor,  which  he  felt 
per  rectum,  was  because  he  was  told  that  pus  dis- 
charged from  the  urethra.  He  had  opened  acute 
abscesses  through  the  perineum,  but  there  was  no 
tenderness  in  this  case  to  call  his  attention  m  that 
direction  :  and  besides,  he  supposed  that  the  escape 
of  pus  from  the  urethra  was  free.  ,  .  ,   ^ 

DiH  Weir  and  Sabin  refened  to  cases  whicli  ter- 
minated fatally  within  four  to  six  weeks  from  kidney 
complications  following  acute  gonorrhoea. 

FRACTirRE  OP  THE    ACROinON  PROCESS  OP  THE  SCAPUI-A. 

Dk  T.  T.  Sabine  presented  the  clavicle  and  scap- 
nbv  removed  from  a  dissecting-room  subject.    On 


THE  MEDICAL  RECORD. 


303 


the  scapula  there  was  a  separation  of  the  acromion 
process,  which  was  either  a  fracture  or  a  case  of  non- 
union of  the  epiphysis.  He  believed  that  it  was  a 
fracture,  (1)  because  the  fragment  was  too  large  to 
Ije  a  separated  epiphysis,  the  line  of  junction  be- 
tween the  spine  and  the  2Joint  of  separation  was 
farther  back  than  the  line  of  junction  between  the 
epiphysis  and  the  spine  of  the  bone  ;  (2)  because  the 
separation  was  greater  than  it  usually  is  when  there 
is  non-union  of  the  ejjiphysis.  Again,  it  almost  al- 
ways occurs,  not  invariably,  when  the  epiphysis  upon 
one  side  is  not  united  that  the  one  upon  the  opi^osite 
side  is  aJso  separated.  At  one  time  it  was  supposed 
that  such  was  invariably  the  case,  but  subsequent 
observations  had  proved  the  supposition  to  be  in- 
coi'rect.  In  this  instance  the  clavicle  and  scapula 
upon  the  opposite  side  were  perfectly  normal. 

DISLOCATION   OF   THE   KNEE. 

The  President  presented  a  specimen  of  disloca- 
tion of  the  knee,  which,  on  account  of  its  rather 
rare  occurrence,  he  regarded  as  worthy  of  special 
note.  The  man  fell  from  a  scaffold  fifteen  or  twenty 
feet  high,  and  received  a  compound  fracture  of  the 
skull,  together  with  a  dislocation  of  the  knee.  He 
was  brought  to  the  hospital  in  a  condition  of  par- 
tial insensibility.  The  almost  complete  ansesthesia 
produced  by  the  compound  fracture  of  the  skull 
enabled  him  to  make  a  careful  examination  of  the 
knee,  and  it  was  determined  that  there  was  com- 
plete separation  between  the  head  of  the  tibia  and 
the  condyles  of  the  femur,  the  tibia  riding  up  an 
inch  or  more  beyond  the  condyles. 

One  fact  in  connection  with  the  manipulation  of 
the  limb  for  the  reduction  of  the  dislocation  was  es- 
pecially interesting,  namely  :  it  was  impossible  to 
move  the  hones  a  particle  by  any  force  in  the  direc- 
tion of  extension  that  could  be  applied  with  the 
hands  alone,  but  at  the  same  time,  when  the  limb 
flexed,  the  contour  of  the  joint  was  restored  per- 
fectly. On  again  making  extension,  nothing  could 
prevent  the  bones  slipping  out  as  before. 

The  patient  lived  four  days  and  died  as  the  result 
of  the  compound  fracture  of  the  skull.     Dissection 
I       of  the  knee  revealed  the  following : 
I  "  The  displacement  is  such  that  the  whole  head  of 

[  the  tibia  is  behind  and  partly  above  the  posterior  sur- 
face of  the  femoral  condyles.  The  popliteal  space  is, 
of  course,  obliterated.  No  fracture  exists,  except  a 
small  crack  on  the  anterior  lip  of  the  tibia,  which 
separates  but  does  not  detach  a  small  fragment  of 
bone. 

"  Of  the  muscles,  the  outer  head  of  the  gastrocne- 
mius is  torn  almost  completely  across,  opposite  the 
prominence  of  the  outer  condyle.  A  few  fibres  only 
of  the  inner  head  are  ruptured.  The  pnpliteus  is, 
of  course,  entirely  torn  across.  The  plantaris  could 
not  be  easily  identified. 

"  Both  the  popliteal  artery  and  vein  are  uninjured, 
but  are  pushed  l:aek  and  somewhat  stretched  by  the 
head  of  the  tibia,  over  the  posterior  edge  of  which 
they  pass  at  a  considerable  angle.  The  sciatic 
nerve  is  uninjured,  but  the  peroneal,  at  about  half 
an  inch  from  the  point  at  which  it  leaves  the  sciatic, 
is  three-quarters  torn  across. 

"The  ligamentum  posticum  'Winslowi  is  torn 
nearly  transversely  across,  and  hangs  in  irregular 
Bhreds.  The  crucial  ligaments  are  both  torn  com- 
pletely across.  The  posterior  fibres  of  the  internal  [ 
lateral  ligament  are  ruptured,  the  anterior  two- 
thirds  of  the  ligament  being  intact.  Tiie  external  i 
lateral  ligament  is  torn  ofif  from  its  attachment  to 


the  femur  ovjer  almost  its  entire  breadth,  a  few 
fibres  only  of  its  auleiior  part  remainirg  intact, 
where  it  is  confounded  with  the  aponeurosis  of  the 
quadriceps  extensor. 

"All  the  tissues  are  so  infiltrated  with  blood  as  to 
make  their  distinct  identification  uncertain  and  diffi- 
cult. The  inner  inter-articular  cartilage  is  torn  into 
two  pieces,  the  posterior  half  icmainirgin  contact 
with  the  articular  surface  of  the  tibia.  The  outer 
one  is  intact." 

Dr.  Weir  referred  to  a  case  of  dislocaticn  of  the 
knee  which  he  saw  when  house  surgeon,  when  there 
was  rupture  of  the  middle  and  internal  coats  of  the 
artery.  Gangrene  supervened  and  amputation  was 
performed. 

The  society  then  proceeded  to  the  transaction  of 
miscellaneous  business. 


Corrcsponticucc. 


DR.    SKINNER'S    CASE    OF   RUPTURED 
PULMONARY  INFARCTION  (?). 

To  THE  Editor  of  The  Medical  Record. 
SiB :  In  the  number  of  The  Medical  Eecoed  for 
December  31,  ISSl,  which  has  just  reached  me,  I 
see  that  Dr.  Skinner  has  reported  what  seems  to 
him  a  unique  case  of  ruptured  pulmonary  infarction. 
I  must  be  allowed  to  enter  a  protest  against  the  case 
going  on  record  as  such.  Anyone  who  will  read 
over  the  clinical  history  of  the  case  (unfortunately 
it  is  not  given  very  fully),  and  then  the  account  of 
the  autopsy,  will,  I  am  sure,  be  convinced  that  we 
have  to  do  here,  not  with  pulmonary  infarction,  but 
with  an  aneurism  of  one  of  the  blood-vessels  of  the 
lungs,  probably  a  branch  of  the  pulmonary  artery. 

The  dry  cough,  the  absence  of  any  account  of 
dyspncea,  and  the  sudden  sharp  pain  in  the  chest, 
followed  by  bloody  expectoration,  are  certainly  all 
against  infarction  ;  while  a  history  of  syphilis,  the 
dry  cough,  and  the  sudden  mode  of  death  occurring 
in  a  man  well  enough  to  be  walking  about,  are  cer- 
j   tainly  in  favor  of  aneurif  m. 

I       In  considering  the  autoj/Sy,  the  chief  points  to 
j   note,   are  the   hypertrophy  of  the  right  ventricle, 
!   the  atheromatous  aorta,  the  enormous  quantity  of 
j   blood  in  the  pleural  cavity,  the  large  rent  extend- 
ing from  the  "  infarction "  to  the  surface  and  com- 
1   muiiicatwg  u-ith   the  pulmonary  artery,  and  finally, 
the  "  infarction  "  itself.      Of  the  latter  the   report 
I   says,  it  "  was  superior  and  posterior  to  the  artery, 
i   was   lamiiiafed,  and  was  contained,  in  part,  in  what 
I   seemed  to  be  a  fibrinous  sac.     It  was  about  three 
'   inches  in  diameter,  its  layers  were  concerjtric,  and 
;  its  central  parts  presented,  here  and  there,  a  gray- 
i  ish   or  yellowish   dense    inelastic   structure.     The 
strata  of  this  central  mass  were  so  arranged  as  to 
I   overlap  each  other,  and  seemed  to  have  been  depos- 
j   ited  at  irregular  intervals,  although  there  was  no 
fluid   material   between  these  layers.     They  v-ciild 
peel  or  break  off  from  the  mass  like  Ike  layers  taken 
from  a  rair  onion  or  cooked  beet.     At  the  periphery 
of  this  mass  adjacent  to  the  pulmonary  artery,  were 
three  or  four  coagula,  evidently  of  more  recent  de- 
posit and   growth.     They  were  almond-shaped,  fil- 
bert-size, and   disconnected  from  both  the  artery 
and  infarction  proper.     The  walls  of  the  pulmonary 
artery  at  this  point,  if  any  existed,  could  not  be  dis- 
tinguished, but  what  seemed  to  be  theii-  degenerate 


304 


THE  MEDICAL  RECORD. 


coats  or  the  remains  of  the  primary  focus  of  the 
infarction  was  present  in  the  form  of  a  brittle,  glis- 
tening, though  scarcely  calcareous  deposit  on  the 
proximal  (cardiac)  surface  of  the  infarction." 

I  have  taken  the  liberty  of  italicizing  those  por- 
tions of  tliis  description  which  seem  to  me  to  point 
with  particular  emphasis  to  the  fact  that  the  sup- 
posed infarction  was  an  aneurism  nearly  filled  with 
fibrinous  deposits,  and  the  picture  is  so  clear  and 
characteristic  that  an  analysis  on  my  part  of  the 
appearances  seems  superfluous.  The  fact  that  the 
right  ventricle  was  hypertrophied,  would  also  be  a 
factor  in  favor  of  aneurism  of  one  of  the  branches  of 
the  pulmonaiT  artery,  rather  than  of  one  of  the 
bronchial  vessels. 

If  we  accept  Oohnheim's  generally  adopted  theory 
of  hemorrhagic  infarction  taking  place  from  a  ve- 
nous reflux  into  the  area  previously  supplied  by  the 
plugged  artery,  or  Litten's,  that  it  is  due  to  a  col- 
lateral arterial  circulation  sufficient  to  fill  the  cajiil- 
laries,  but  too  feeble  to  maintain  a  circTilation  in 
them,  in  either  case  it  becomes  ajiparent  that  the 
blood-pressure  in  the  infarction  is  not  only  not  in- 
creased, but  even  below  the  normal.  How,  then,  I 
would  like  to  ask,  could  such  an  infarction  not  only 
rupture  itself,  but  also  tear  through  a  large  amount 
of  apparently  normal  lung-tissue  ?  That  the  blood 
found  in  a  hemorrhagic  infarction  is  not  due  to  a 
rupture  of  capillaries,  but  to  a  diapedesis  of  red 
blood-corpuscles,  is,  since  Cohnheim  published  his 
"  Untersuchungen  iiber  die  embolischen  Processe," 
a  generally  accepted  fact.  How  then  could  fibrine 
be  deposited  in  layers  in  an  infarction  ?  Such  a 
large  infarction,  too  (three  inches  in  diameter),  would 
be  almost  unheard  of  near  the  hilus,  for  it  is  a  rule 
that  infarctions  increase  in  frequency  and  size  the 
farther  away  from  the  hilus  thev  are  situated. 

I  think  that  any  one  who  will  go  over  the  case 
carefully  will  come  to  the  conclusion  that  I  have, 
namely,  that  the  patient  died  from  the  bursting  of 
an  aneurism  of  a  pulmonary  artery,  the  lilood  tear- 
ing through  the  lung  and  emptying  itself  into  the 
pleural  cavity,  and  also  that  the  rupture  of  a  hemor- 
rhagic infarction  is  an  impossibility. 
Very  truly  yours, 

Waltee  Menbelson, 

of  New  York. 

LSIFZIO,  GebUast,  Jaimarj'  25,  18S2. 


Hero  Jnstnintcnts. 


Vexesection. — Dr.  Dolan  (Medical  Press  and  Cir- 
cular, May  18,  1881)  comes  to  the  following  conclu- 
sions respecting  venesection  :  1st,  venesection  has 
no  direct  influence  over  external  or  internal  inflam- 
mation ;  2d,  it  is  useless  in  external  inflammations ; 
3d,  it  is  useful  in  those  internal  inflammations  which 
affect  the  cardiac  and  respiratory  functions ;  4th, 
local  bleeding  has  a  potent,  useful  effect  in  external 
inflammations ;  5th,  local  bleeding,  in  cases  of  inter- 
nal inflimmation  in  which  a  direct  capillary  circu- 
lation exists  between  the  .skin  and  the  part  affected, 
is  of  decided  benefit ;  Gth,  the  value  of  local  bleed- 
ing when  these  indications  are  not  present,  is  doubt- 
ful. In  the  opinion  of  the  therapeutical  editor  of 
the  Riivimo,  these  conclusions  certainly  affirm  what 
will  bo  accepted  by  all  reasoning  tlierajioiitists  as 
true,  and  they,  most  assui-edly,  are  destitute  alike 
of  the  provenesection  cant  and  its  opposite,  which 
have  alternately  been  prevalent  and  are  certainly 
about  e,|ually  pernicious  and  absurd. —  Chicaijo  Med. 
Review, 


A  DEMCE  FOR  L,\PvYNGOSCOPIC    PRAC- 
TICE. 
By  J.  M.  HAEKISON,  M.D., 


The  following  simple  contrivance  may  be  of  service 
to  medical  students,  and  even  to  some  phy.sicians,  in 
acquiring  dexterity  in  the  manipulation  of  the  laryn- 
goscope and  the  laryngeal  mirror.  In  the  descrip- 
tion, please  consider  that  I  am  talking  to  a  student. 


The  above  figure  represents  a  jiasteboard  bos,  four 
inches  square  and  two  and  one-quarter  inches  deep, 
with  a  partition  (5,  6,  7,  8)  placed  one  inch  (4,  8) 
from  the  back  (4,  1,  11)  of  the  box.  This  partition 
separates  a  posterior  chamber  (PC;  from  an  anterior 
chamber. 

Circular  holes  (13  and  12)  the  size  of  a  silver  half- 
dollar  are  cut  in  the  centre  of  the  front  end  of  the 
box  (2,  3,  10,  9),  and  also  in  the  centre  of  the  pai'- 
tition  (5,  6,  7,  8).  A  lid  fits  over  the  side  (1,  2, 
3,  4),  making  a  closed  chamber  (PC). 

On  the  top,  bottom,  and  sides  of  PC  are  pasted 
clippings  from  a  newspaper. 

Let  us  now  imagine  the  lips  of  our  patient  to  be 
at  13,  to  be  the  mouth,  12  to  be  the  passage 
from  the  mouth  to  the  pharynx,  and  let  tbe  upper 
portion  of  PC  represent  that  portion  of  the  pharynx, 
and  the  lower  portion  of  PC  be  the  region  of  the 
larynx. 

Here  you  have  a  patient  who  never  becomes  weary 
and  never  gnffs  ! 

Now  take  your  mirrors,  and  passing  one  through 
the  openings  13  and  12,  try  to  read  the  printing  on 
the  sides  of  PC. 

After  you  think  you  know  just  where  everything 
is  located,  take  a  wire  and  try  to  tmich  what  you  see. 
In  other  words,  make  local  apiilicalio<>s  to  the  phai-ynx 
and  larynx. 

Wiien  you  can  accomplish  this  with  ease,  run  a 
rubber  tube  through  the  bottom  of  the  posterior 
chamber,  and  breathe  into  PC  while  making  your  ex- 
aminations. 

Finally,  when  you  feel  sure  that  you  know  bow  to 


THE  MEDICAL  RECORD. 


305 


use  the  laryngoscope,  get  a  patient  who  has  the  pleas- 
ant peculiarity  of  always  gagging  just  at  the  moment 
when  you  flatter  yourself  that  you  see  something, 
and  you  will  realize  how  simple  and  easy  it  is  to  use 
this  means  of  making  a  diagnosis  of  pharyngeal  and 
laryngeal  troubles. 

Dkcember  15,  ISSl. 


ARMY  NEWS. 
Official  List  of  Changes  of  Stations  and  Duties  of  Offi- 
cers of  the  Medical  Department,  United  States  Army, 
from  March  5,  1882,  to  March  11,  1882. 

AiiEXASDEii,  li.  H.,  Major  and  Surgeon.  Now 
awaiting  orders,  to  report  iu  person  to  the  Command- 
ing General  Department  of  the  Missouri  for  assign- 
ment to  duty.     S.  O.  52,  A.  G.  O.,  March  6,  1882. 

Brown,  H.  E.,  Major  and  Surgeon.  Now  await- 
ing orders,  to  report  in  person  to  the  Commanding 
General  Department  of  the  South  for  assignment  to 
duty.     S.  0.  52,  C.  S.,  A.  G.  O. 

Dickson,  J.  M.,  Capt.  and  Asst.  Surgeon.  Now 
awaiting  orders,  to  report  in  person  to  the  Com- 
manding General  Department  of  the  East  for  assign- 
ment to  duty.     S.  O.  52,  C.  S.,  A.  G.  O. 

Lauderdale,  J.  V.,  Capt.  and  Asst.  Surgeon.  Re- 
lieved from  duty  in  the  Dej^artment  of  the  South, 
and  to  report  in  person  to  the  Commanding  General 
Department  of  Dakota  for  assignment  to  duty. 
S.  O.  52,  C.  S.,  A.  G.  O. 

FiNLisT,  J.  A.,  Capt.  and  Asst.  Surgeon.  At  expi- 
ration of  his  present  leave  of  absence,  to  be  relieved 
from  duty  in  the  Department  of  the  East  and  to  re- 
port in  person  to  the  Commanding  General  Depart- 
ment of  Texas  for  assignment  to  dutv.  S.  O.  52, 
C.  S.,  A.  G.  O. 

Gardner,  Edwin  F.,  Capt.  and  Asst.  Surgeon. 
ToTeport  in  person  to  the  President  of  the  Medical 
Examining  Board,  in  session  in  New  York  City,  for 
examination  for  promotion,  and  on  its  conclusion  to 
report  by  letter  to  the  Surgeon-General.  S.  O.  52, 
C.  S.,  A.  G.  O. 

Robinson,  S.  Q.,  Capt.  and  Asst.  Surgeon.  To  re- 
port in  person  to  the  President  of  the  Medical  Ex- 
amining Board,  in  session  in  New  York  City,  for 
examination  for  promotion,  and,  on  its  conclusion, 
to  report  by  letter  to  the  Surgeon- General.  S.  O. 
52,  C.  S.,  A.  G.  O. 


The  Specific  Character  of  Tubercdlosis,  as  lately 
claimed  by  Cohnheim,  is  alHrmed  by  M.  Toussaint, 
Professor  of  Comparative  Pliysiology  in  the  Veteri- 
nary School  at  Toulouse.  The  tuberculosis  induced 
by  placing  foreign  bodies  under  the  skin  is  "  false." 
The  tubercles  thus  formed,  though  morijhologically 
identical  with  true  tubercle,  are  pathologically  dis- 
tinct. Inoculation  of  the  false  tuberculous  matter 
does  not  cause  tuberculosis. 

The  true  tubercular  poison  is  rather  a  pathologi- 
cal than  anatomical  entity.  Its  inoculation  causes 
tuberculosis,  and  repeated  cultivations  of  it  increase 
its  virulence.  This  true  tuberculosis  occurs  in  man 
and  the  domestic  animals,  and  may  be  communi- 
cated by  food  as  well  as  by  blood  inoculation. 

These  views  are  confirmed  by  experiments  of  M. 
Hippolyte  Martin,  who  is  inclined  to  the  opinion 
that  the  active  tuberculous  principle  is  a  parasite. 

Small-Pox,  according  to  the  latest  reports,  is  de- 
creasing.    It  has  nearly  disappeared  from  Illinois. 


iJlctricftl  3tcm0  antr  tletps. 


Contagious  Disrasks  —  Weekly  Statement.  — 
Comparative  statement  of  cases  of  contagious  diseases 
reported  to  the  Sanitary  Bureau,  Health  Department, 
for  the  two  weeks  endiiig  March  11,  1882. 


& 

i, 

y 

=  .• 

i 

& 

Week  BndiBg 

1 

Is 

i 

■3 

1 

i 

1 

^ 

1 

1 

S 

a 

S 

March    4,  1883. 

2 

7 

329 

10 

197 

107 

44 

0 

March  11,  1883. 

7 

5 

205 

3 

191 

106 

36 

0 

An  Act  to  asiend  Chapter  746tOF  the  Laws  of  1872, 
entitled,  "  An  act  relating  to  the  examination  of  can- 
didates for  the  degree  of  Doctor  of  Medicine."  Sec- 
tion 1.  Section  one  .so  that  it  will  read  as  follows  : 
Section  1.  The  Regents  of  the  University  of  the 
State  of  New  I'ork  bhall  ai^point  one  or  more  boards 
of  examiners  in  medicine,  each  board  to  consist  of 
not  less  than  seven  members,  who  shall  have  been 
licensed  to  practise  phy.sic  and  surgery  in  this  State  ; 
and  all  jjersons  desiring  to  practise  physic  or  sur- 
gery after  the  passage  of  this  act,  must  submit  to 
the  examination  hereinafter  presciibed  and  obtain 
the  diploma  hereinafter  provided  before  entering 
upon  the  practice  of  physic  or  surgeiy  in  this  State. 

An  Act  to  Regulate  the  Licensing  of  Phtsicians 
and  Sukgeons.  The  peoj)le  of  the  State  of  New  York, 
represented  in  Senate  and  Assembly  do  enact  as 
follows : 

Section  1. — No  person  shall  practise  physic  or 
surgery  within  this  State  unless  he  is  twenty-one 
years  of  age  and  has  been  heretofore  legally  author- 
ized and  duly  qualified  so  to  do,  pursuant  to  the  firo- 
visions  of  Chapter  513  of  the  Laws  of  1880,  and 
Chapter  186  of  the  Laws  of  1881,  or  shall  be  here- 
after authorized  so  to  do  by  the  subsequent  sections 
of  this  act. 

Sec.  2. — Every  person  who  has  not  heretofore  been 
legally  authorized  and  duly  qualified  to  })ractise 
physic  or  surgery  as  aforesaid,  shall,  before  practis- 
ing physic  orsiu'gery  within  this  State,  be  examined 
as  prescribed  by  the  laws  of  this  State. 

Sec.  3. — To  entitle  any  person  to  practise  physic 
and  surgery  within  this  State,  excepting  such  as 
have  heretofore  lawfully  registered  in  pursuance  of 
the  provisions  of  Chapter  513  of  the  Laws  of  1880, 
and  Chajiter  186  of  the  Laws  of  1881,  he  or  she  shall, 
and  every  person  hereafter  complying  with  section 
2  of  this  act,  shall,  before  commencing  to  practise 
physic  and  surgery  register  in  the  Clerk's  office  of 
the  county  where  he  or  she  intends  to  practise  phy- 
sic and  surgery  in  a  book  to  be  kept  by  said  Clerk,  his 
or  her  name,  residence,  and  place  of  birth,  together 
with  the  date  of  the  diploma  as  conferred  by  the 
Regents  of  the  University  of  the  State  of  New  York, 
and  shall  subscribe  and  verify  by  oath  or  tifBrma- 
tion,  before  a  person  duly  qualified  to  administer 
oaths  under  the  laws  of  the  State,  an  affidavit  con- 
taining a  plain  statement  of  all  such  facts  as  afore- 
said, together  with  the  name  of  the  degree  conferred 
by  said  diploma,  and  the  fact  that  he  or  she  is  over 
twenty-one  yeai-s  of  age,  and  the  County  Clerk  shall 
receive  a  fee  of  twenty-five  cents  for  such  registra- 
tion, to  be  paid  by  the  person  so  registering. 


306 


THE  MEDICAL  RECORD. 


Seo.  4.— a  person  who  shall  wUfully  swear  falsely 
to  any  statement  contained  in  the  affidavit  required 
by  section  3  of  this  act,  shall  be  deemed  to  be  guilty 
of  and  subject  to  conviction  and  punishment  for  per- 
'ury ;  and  a  person  who  violates  any  of  the  othei: 
provisions  of  this  act,  or  who  shall  practise  physic  or 
surgery  under  cover  of  a  diploma  illegally  obtained, 
shall  be  deemed  to  be  guilty  of  a  misdemeanor,  and 
on  conviction  thereof,  shall  be  punished  by  a  fine 
of  not  less  than  §250,  nor  more  than  8500  for  the 
first  offence,  and  for  each  subsequent  offence  by  a 
fine  as  aforesaid,  and  by  imprisonment  for  not  less 
than  thirty  days,  nor  more  than  six  months.  The 
fine  when  collected  shall  be  paid  the  one  half  to  the 
person  or  corporation  making  the  complaint,  the 
other  half  into  the  County  Treasury. 

Sec.  5.— For  the  purposes  of  this  act  the  words 
"  i>ractis6  physic  and  surgery  "  shall  mean  to  prefix 
to  one's  name  the  word  "Doctor,"  or  the  abbrevia- 
tion "Dr.,"  meaning"  thereby  Doctor  of  Medicine,  or 
to  annex  the  letters  "  M.D."  thereto  or  to  suggest, 
recommend,  prescribe,  employ,  use  or  direct  for  the 
use  of  any  person,  any  drug,  medicine,  appliance, 
apparatus,  or  other  agency,  whether  material  or  im- 
miterial,  for  the  treatment,  cure,  relief,  or  palliation 
of  any  real  or  supposed  ailment  or  di.sease  of  the 
mindor  body,  or  for  the  treatment,  cure,  or  relief  of 
any  wound,  fracture,  or  other  bodily  injury,  or  any 
bodily  deformity.  ,    ,    „         , 

Seo.  6.— Nothing  in  this  act  contained  shall  apply 
to  commissioned  medical  officers  of  the  United  States 
Army  or  Navy,  or  of  the  United  States  Marine  Hos- 
pital Service,  or  to  members  of  the  House  Staff  of 
any  Hospital  during  their  terms  of  service. 

Seo.  7.— So  much  of  Chapter  513  of  the  Laws  of 
1880,  Chapter  186  of  the  Laws  ot  1881,  and  all  other 
acts  and  parts  of  acts  as  are  inconsistent  with  the 
provisions  of  this  act  are  hereby  repealed. 

Electrolysis  in  Enlarged  Prostate.— Dr.  A.  A. 
Hoehling,  Surgeon  U.  S.  Navy,  U.  S.  Naval  Dispen- 
sary, Washington,  D.  C,  writes :  "  I  would  like  to 
suggest  to  our  electro-therapeutists  the  trial  of  elec- 
trolysis in  enlarged  prostate.  This  is  such  a  com- 
mon condition  after  the  age  of  fifty,  and  so  difficult 
tq  relieve  with  our  present  modes  of  treatment,  that 
anything  which  holds  out  some  promise  ought  to 
have  a  judicious  trial.  In  order  that  such  trial  may 
begin  under  the  most  favorable  auspices,  I  publish 
this  suggestion  for  the  information  of  those  best 
qualified  to  make  it,  rather  than  undertake  it  with 
my  limited  experience  in  electro-therapeutics." 

Is  Castration  Warrantable  in  Spurious  Heb- 
MAPHR0DITIS.M  ?— Dr.  E.  P.  Bennett,  of  Danbury, 
Conn.,  sends  us  the  following  interesting  and  sug- 
gestive communication:  " There  perhaps  has  never 
been  a  true  case  of  hermaphroditism  found  in  the 
human  subject,  but  there  is  a  peculiar  deformity 
which,  among  the  ignorant,  is  considered  as  such. 
Two  cases  of  this  kind  have  occurred  in  my  own 
practice.  Both  children  wore  considered  females, 
and  baptized  as  such.  In  one  of  these  oases,  my 
son,  Dr.  William  0.  Bennett,  was  called  upon  to  visit 
a  sick  girl,  as  they  said,  and  during  his  visit  the 
mother  had  occasion  to  change  the  child's  diaper, 
and,  although  at  fir.Ht  sight  the  genitals  of  the  cliild 
appeared  as  those  of  a  female,  yet  from  some  pecu- 
liarity he  suspected  that  it  was  not  a  female.  We 
then'togother  visited  it,  and,  upon  examination, 
we  found  an  ununited  scrotum,  and  in  the  sulcus, 
between  the  two  halves,  was  tlio  opening  of  the 
urethra,  and  in  each  labia  was  found  a  testicle.}  The 


penis  was  about  the  size  of  asmaU  goose-quill,  with- 
out any  prepuce  and  unperforate.  The  second  case 
was  a  complete  duplicate  of  the  first.  Now,  I  do  not 
report  this  case  as  anything  strange,  as  most  works 
on  surgery  treat  of  them,  but  it  is  to  anotlier  aspect 
of  the  case  to  which  I  wish  to  call  the  attention  of 
the  profession,  and  seek  their  advice.  One  of  these 
mothers,  after  I  had  explained  the  case  to  her, 
wished  me  to  remove  the  testes,  and  for,  as  I  thought, 
good  and  substantial  reason.  She  said  to  me,  '  This 
child  can  never  develop  into  a  man  or  a  wornan.  He 
will  have  the  passions  of  a  man  without  being  able 
to  gratify  them  ;  therefore,  if  castrated  he  will  not 
have  this  to  contend  with.  Again,  the  removal 
of  the  testicles  will  prevent  the  growth  of  a  beard 
and  whiskers,  and  I  can  rear  it  as  a  female,  and 
the  deformity  will  never  be  discovered,  as  it  cer- 
tainly would  be  if  reared  as  a  boy,  as  he  would  al- 
ways' have  to  sit  down  to  urinate,  and  other  Httle 
boys  would  soon  discover  his  deformity,  and  call 
him  hermaphroditic,  to  his  shame  and  annoyance.' 
Now,  the  question  is  :  Would  not  this  have  been  the 
better  course  under  the  circumstances?  In  my 
opinion  it  would,  but  I  told  the  mother  I  did  not 
know  that  I  had  a  legal  right  to  do  so.  I  then  lost 
sight  of  the  case." 

The  Celebrated  Anatomist  Hirtl  was  once  busily 
engaged  in  dissecting  in  the  anatomical  rooms  of  the 
Vienna  Hospital.  A  guard  of  military  police  came 
into  the  neighboring  court  upon  which  the  windows 
of  Hvrtl's  rooms  looked.  They  began  to  go  through 
their  evolutions,  when  Hyrtl  threw  open  the  window 
in  a  rage  and  cried  out,  "  Withdraw,  you  slaves :  dis- 
turb not  with  your  fanfarade  the  quiet  of  the  dead." 

The  Jefferson  ]Medical  College  is  the  title  of 
the  last  new  college  in  Louisville,  Ky.  It  is  a  spring 
and  summer  school,  giving  a  complete  and  gradu- 
ating course.  The  Faculty  consists  of  teachers  from 
the  other  local  schools.  There  is  another  spring 
school  in  that  city— the  Kentucky  School  of  Medi- 
cine ;  five  colleges  in  all,  three  in  winter  and  two  in 
summer. 

WRrrER's  CR.\sn>.— Mr.  Wolff,  a  German  teacher  of 
writing,  has  gained  a  wide  continental  reputation 
for  his  treatment  of  writer's  cramp.  He  is  endorsed 
by  such  authorities  as  Nussbaum,  Bamberger,  Char- 
cot, and  others.  His  method  consists  in  methodical 
use  of  massage  and  gymnastics.  He  makes  his  pa- 
tients execute  definite  movements  many  times  a  day, 
and  in  addition  he  extends  the  spasmodic  muscles 
several  hundred  times  daily.  He  attains  success 
within  two  or  three  weeks,  if  at  all. 

Untntoxicatino  Wines.— Dr.  Norman  Kerr  de- 
scribes eight  varieties  of  pure  and  unintoxicating 
wines  which  have  been  recently  introduced  into 
England.  Among  these  are  "  Muscat,"  "  Lachryraie 
Christi,"  "  Bordeaux,"  and  "  Congress."  This  latter 
is  an  American  wine,  and  when  fermented  is  sold  as 
"American  port."  The  wines  in  question  have  a 
pleasant  flavor,  and  considerable  nutritive  and  hygi- 
enic value. 

The  Meteic  System  in  Commerce.— A  bill  has  been 
favorably  reported  from  the  "House  Committee  on 
Coinage!  Weights,  and  Measures,  providing  that  the 
ad  quantum  duties  upon  all  articles  imported  from 
foreign  countries  which  are  invoiced  according  to 
the  weights  and  measures  of  the  metric  .system  shaU 
bo  levied,  collected,  and  paid  at  rates  appropriate 
to  the  weights  and  measures  of  that  system. 


THE  MEDICAL  RECORD. 


307 


Santtart  Condition  of  the  ■White  House. — In  a 
report  on  the  sanitary  condition  of  the  White  House, 
Colonel  G.  E.  Waring  comes  to  several  conclusion.^, 
most  of  them  being  rather  theoretical  than  demon- 
strated. He  says  :  "  The  house  stands  on  the  sum- 
mit of  a  gently  sloping  hill,  of  which  the  soil  is  of 
an  extremely  porous  character.  It  is  beyond  ques- 
tion that  from  the  leakage  of  the  fountain  basin  and 
of  the  water-jjipes,  drains,  and  sewers,  by  which  the 
house  is  surrounded,  the  soil  under  the  building  is 
in  a  state  of  more  or  less  complete  saturation — a 
Liaturation  not  entirely  due  to  clear  water.  Some  of 
the  water-drains,  and  especially  the  main  sewer 
under  the  centre  of  the  building,  have  been  leaking 
foul  matter  for  many  years.  This  heavy,  saturated 
soil  bears  not  only  the  foundation  wall  of  the  build- 
ing, but  the  very  floor  itself  of  the  basement  story. 
It  is  recommended  as  a  most  important  sanitary 
measure  that  the  whole  structure  be  supported  on 
piers  and  groined  arches  of  the  best  construction  to 
secure  a  complete  circulation  between  the  ground 
and  the  building." 

Another  presumably  bad  element  is  said  to  be  the 
"Kidwell  Flats,"  whicli  are,  however,  below  and  at 
some  distance  from  the  White  House. 

Pkismatic  Mirbob  for  Khinoscopic  Examina- 
tion.— At  the  meeting  of  the  Socicte  deBiologie,  on 
the  8th  of  December,  M.  OeLlf-  presented  a  prismatic 
mirror  for  rhinoscopic  examination,  which  has  the 
advantage  of  presenting  the  image  in  the  true  pro- 
portions, and  not  distorted,  as  in  the  plain  mirror. 
It  is  also  extremely  easy  to  introduce,  and  gives  a 
very  distinct  and  well-detined  image. 

Professor  RoijLEt. — The  dignity  of  State  Chan- 
cellor has  been  conferred  by  the  Emperor  of  Austria 
on  Dr.  Alexander  Eollet,  Professor  of  Physiology  in 
the  Univcirsity  of  Gratz,  in  recognition  of  his  long 
services  in  the  cause  of  science. 

KoBERT  Bridges,  M.D.,  Emeritus  Professor  of 
Chemistry  in  the  Philadelphia  College  of  Pharmacy, 
and  one  of  its  trustees,  died  at  his  residence  in 
Philadelphia,  February  20,  1882,  near  the  close  of 
his  seventy-sixth  year. 

French  House-Surgeons  seem  to  be  particularly 
unfortunate.  The  interne  at  the  French  Foundling 
Hospital  recently  died  of  diphtheria,  and  the  interne 
of  the  Small-pox  Hospital  at  Xantes  died  from  small- 
pox, contracted  in  discharge  of  duty. 

A  Successful  Gastrotomt  was  recently  performed 
by  Mr.  Paul  Swain,  of  Plymouth,  England,  on  a 
woman  suffering  from  malignant  stricture  of  the 
oesophagus. 

The  Prizes  of  the  Paris  Academy  of  Sciences. — 
The  Paris  Academy  of  Sciences  has  conferred  on 
Prof.  Brown-Sequard  the  distinguished  honor  of  the 
Grand  Prix  Lecaze.  This  prize,  which  is  of  the 
value  of  10,000  francs,  is  only  given  in  recognition 
of  a  life-long  devotion  to  ijhy.siological  science  which 
has  resulted  in  important  discoveries.  The  pre- 
vious recipients  have  been  Chauveau,  Marey,  and 
Dai-este. 

The  Academy  has  also  given  the  Montyon  Prize 
to  Dr.  Berenger-Feraud  for  his  two  works,  entitled, 
"  The  Yellow  Fever  in  Martinique  "  and  "  The  Dis- 
eases of  Eurojieans  in  the  Antilles."  A  second  prize 
was  given  to  Dr.  Favre  for  his  researches  upon  Dal- 
tonism, and  a  third  prize  to  M.  Toussaint  for  his  ex- 
periments relative  to  preventive  inoculations. 

The  BrcSant  Prize  was  given  to  M.  L6on  Colin  for 


his  treatise  on  "Epidemic  Maladies."  The  Godard 
Prize  to  M.  Dubar  for  his  memoir  on  "  Tuberculous 
Affections  of  the  Mamma." 

The  Serres  Prize  was  given  to  M.  Edouard  van 
Beneden,  Professor  of  Physiology  in  the  University 
of  Liege,  for  his  work  on  "Embryology." 

The  Lallemand  Prize  to  Dr.  Luys  lor  his  treatise 
on  "Mental  Diseases." 

The  Physiological  Prize  to  M.  d'Arsonval  for  his 
researches  in  local  temperatures. 

It  is  noticeal^le  that  of  nine  prizes  given,  four  were 
bestowed  on  account  of  physiological  reseaiches. 

•  PicTORiAii  Averages  of  the  Phtsiognowt  or  Dis- 
ease.— Mr.  Francis  Gallon  and  Dr.  Mahomed  Lave 
for  some  time  been  engaged  in  making  composite 
pictures  of  different  diseases,  but  especially  of 
phthisis.  The  process  consists  ill  throwing  a  suc- 
cession of  images  of  portraits  of  different  persons 
on  the  same  sensitized  plate,  and  in  thus  obtaining 
a  pictorial  average.  Great  care  has  to  be  taken  in 
the  process. 

The  Detection  of  Lead  Bullets  by  the  Induc- 
tion Balance  has  been  attempted  again,  but  the  in- 
strument proved  to  be  a  failure. 

The  Gabfield  Memorial  Hospital. — A  bill  to 
incorporate  this  proposed  hospital  has  been  intio- 
duced  into  the  House  of  Eepresentatives,  but  it  un- 
expectedly met  with  some  opposition,  and  the  bill 
has  had  to  be  put  in  order  on  the  calendar.  It  will, 
therefore,  not  be  reached  for  a  long  time. 

Chronic  Tonsillitls. — Davis  A.  Hogue,  M.D., 
Houtzdale,  Pa.,  writes  :  "  I  have  successfully  treated 
several  children,  where  excision  was  impossible,  by 
the  use  of  a  prescription  from  the  clinic  of  the  late 
lamented  Prof.  James  Aitken  Meigs,  viz. :  If .  Chro- 
mic acid,  20  grs.  ;  aquiie,  1  oz.  M.  Sig. — Apply  to 
the  tonsils  by  means  of  a  camel's  hair  pencil.  I 
have  found  it  successful  even  when  the  thickening 
was  very  great." — Med.  Brief. 

The  Fourth  International  Congress  or  Hygiene 
will  meet  at  Geneva,  September  ith  to  September 
9,  1882. 

A  Recent  Investigation  of  the  State  Asylum  for 
Insane  Emigrants  on  Ward's  Island,  which  is  one 
of  the  institutions  under  the  supervision  of  the 
State  Commissioner  in  Lunacy,  revealed  a  very 
anomalous  condition  of  affairs.  It  seems  that  the 
investigation  was  the  result  of  an  intestine  disturb- 
ance, the  matron  intriguing  against  the  asylum  phy- 
sician, who  had  reprimanded  some  of  her  favorites 
for  neglect  of  duty.  In  this  instance,  fortunately, 
the  dictates  of  humanity  and  common  sense  tri- 
umphed over  the  political  inlfliences  which  have  so 
often  defeated  the  true  purposes  of  similar  investiga- 
tions ;  the  physician  was  sustained,  and  the  matron 
dismissed.  The  worst  feature  exposed  was  the  fact 
that  a  relative  of  one  of  the  officials  had  had  the  key 
of  the  female  wards,  paid  frequent  nightly  visits, 
and  that  this  privilege  culminated  in  the  adoption 
of  the  "increase  and  multiply"  principle  on  the 
part  of  several  of  the  irresponsible  patients.—  Jominil 
of  Neurology  and  Psychiatry. 

Death  op  Dr.  Joseph  Pancoast. — The  profession 
will  learn  with  regret  of  the  death  of  the  veteran  sur- 
geon Dr.  Pancoast.  He  died  of  pneumonia,  at  his 
residence  in  Philadelphia,  on  March  7th. 

He  was  bom  in  Burlington  County,  N.  J.,  in  1805. 
At  the  age  of  twenty-three  he  was  graduated  from 
the  medical  department  of  the  University  of  Penn- 


308 


THE  MEDICAL  RECORD. 


sylvania,  and  at  once  bagan  practice,  adopting  sur- 
gery as  his  specialty.  Tliree  years  later  lie  was 
teaching  practical  anatomy  and  surgery,  obtaining 
promineuce  by  publishing  an  annotated  edition  of 
Lobstein's  "  Treatise  on  the  Structure,  Functions, 
and  Diseases  of  the  Human  Sympathetic  Nerve," 
having  himself  translated  the  work  from  the  Latin. 
In  1831  the  Brookley  Hospital,  Philadelphia,  elected 
him  to  its  board  of  physicians,  and  he  was  soon 
called  to  the  medical  management  of  the  Children's 
Hospital  connected  with  that  institution.  In  1844 
he  puljlished  his  "Treatise  on  Operative  Surgery," 
a  work  which  soon  passed  to  a  third  edition,  when 
he  enlarged  and  revised  it.  In  nine  years  nearly  a 
half  million  copies  of  the  book  were  sold,  and  it  be- 
came an  accepted  authority.  Prior  to  the  publica- 
tion of  this  volunje  Dr.  Pancoast  had  been  elected 
Professor  of  Surgery  in  the  .Tetferson  Medical  Col- 
lege. In  1854  he  was  prevailed  upon  to  become  one 
of  the  active  sui-geons  of  the  Philadelj^hia  Hospital, 
a  position  he  filled  for  ten  years.  Previous  to  the 
acceptance  of  this  work  he  had  been  elected  Profes- 
sor of  Anatomy  in  Jetferson  Medical  College,  which 
post  he  retained,  in  conjunction  with  his  other 
duties,  until  1874. 

There  seemed  to  be  no  limit  to  his  capability  for 
hard  work.  During  his  constant  connection  with 
the  medical  schools  and  hospitals  of  Philadelphia 
he  gave  close  attention  to  an  extensive  private  jwac- 
tice  and  devoted  much  time  to  authorship.  Among 
his  published  volumes  were  his  revised  and  remod- 
elled edition  of  "  A  System  of  Anatomy  for  the  Use 
of  Students,"  by  Dr.  Caspar  Wistar  and  Professor 
W.  E.  Horner.  He  editorially  supervised  '•  Menec 
on  the  Great  Sympathetic  Nerve,"  and  the  "  Cerebro- 
spinal System  in  Man,"  by  the  same  author.  Sub- 
sequently he  brought  out  Quain's  "  Anatomical 
Plates."  His  contributions  became  marked  features 
of  prominent  medical  journals,  and  he  gave  to  the 
public  various  monographs,  both  pathological  and 
surgical,  and  made  known  many  original  operations 
in  the  department  of  plastic  surgery.  His  introduc- 
tory lectures  to  his  college  classes  were  prepared 
with  great  care.  A  number  of  them  were  collected 
and  published  as  "  Essays  and  Lectures."  Another 
similar  volume  was  called  "  Professional  Glimpses 
Abroad."  He  was  a  member  of  the  American  Philo- 
sophical Society,  of  the  Philadelphia  College  of 
Pharmacy,  and  many  scientific  institutions.  He 
was  also  i^rominent  in  the  Philadelphia  County 
Medical  Society  and  the  Medical  Society  of  Penn- 
sylvania. 

HxPEBTBOPinED  ToNSiLS  aro  treated  very  success- 
fully and  safely  with  the  galvano-cautery,  by  M. 
Krishaber,  who  reports  more  than  forty  cases.  The 
operation  is  without  pain. 

PERiAHfiFirTLs ? — Dr.  Geo.  A.Harding,  ofSaultSte. 
Marie,  Mich.,  sends  us  the  account  of  a  case  with 
the  history  of  an  iliac  abscess,  which  he  ascribes  to 
an  inflammation  of  the  connective  tissue  about  the 
rectum  (periarchitis).  The  patient  was  a  vigorous 
Irish  laborer,  aged  eighteen,  who  had  been  com- 
plaining of  severe  pains  in  the  back  for  several  days. 
He  had  otherwise  been  well.  Ho  was  suddenly 
taken  with  a  chill,  fever,  vomiting,  tymijanitis,  and 
pain  on  evacuation.  There  was  tympanitis,  swell- 
ing, and  tenilerno.ss  in  the  hypogastric  region,  but 
more  on  the  left  side.  By  using  a  hypo<lormic 
needle  at  this  point,  a  sero-puruleut  fl\iid  was  ob- 
tained. On  the  .same  day  he  drew  half  a  i)int  of  this 
fluid  from  the  region  referred  to  by  means  of  an 


aspirator.  The  next  day  the  symptoms  had  im- 
proved. The  aspirator  was  used  again.  The  suc- 
ceeding history  is  as  follows  :  On  December  4th, 
two  days  later,  "  Adhesions  having  formed  between 
the  walls  of  pus  sac  and  abdomen  at  the  point  of  in- 
troduction of  aspirator  needle,  I  used  a  trocar,  and 
through  its  canula  had  no  difhculty  in  completely 
emptying  the  sac  and  cleansing  the  cavity  with  a  tive 
per  cent,  solution  of  carbolic  acid.  December  6th. 
Repeated  ojjeration  with  trochar,  obtaining  a  much 
less  quantity  of  pus  and  less  otiensive.  Again,  Decem- 
ber 8th,  with  increased  improvement,  but  still  the  pus- 
sac  refilled,  and,  the  adhesions  having  extended  by 
the  irritation  of  the  rejaeated  operations,  I  deemed  it 
safe  now  to  enlarge  the  opening.  Accordingly,  on 
December  11th,  I  introduced  a  probe-pointed  bis- 
toury through  the  opening  made  by  the  trocar,  and, 
cutting  longitudinally  in  both  directions,  enlarged  it 
to  the  border  of  adhesions,  about  one-half  inch,  thus 
accomplishing,  what  was  so  much  needed,  constant 
drainage.  Then  pushing  a  tent  of  cloth,  carbolated, 
to  the  bottom  of  cavity,  fully  four  and  one-half 
inches,  I  again  left  it.  From  this  time  (he  only 
treatment  was  cleansing  cavity,  and  changing  tent 
daily,  till  December  29th,  when  the  external  opening 
was  cauterized  and  left  to  heal,  which  it  did,  the  pa- 
tient becoming  entirely  well.  Taking  eveiTthing 
into  consideration,  pressuie  on  bladder,  pain  caused 
in  vicinity  of  abscess  by  defecation,  position  of  tu- 
mor, and  the  direction  of  probe  (introduced  down- 
ward and  to  the  left),  together  with  depth  of  sac,  it 
goes  far  to  place  the  origin  in  the  cellular  tissue  ad- 
jacent to  the  upper  portion  of  the  rectum  (?).  I  was 
also  unable  to  trace  any  cause,  unless  it  was  an  in- 
jury unconsciously  received  while  plowing,  as  that  was 
heavy  work,  it  being  new  land,  for  a  boy  of  that  age. 

Vaccination  Pamphlets.  —  The  State  Board  of 
Health  of  New  Hampshire  has  adojited  the  excellent 
I^lau  of  circulating  a  small  i^aniphlet,  giving  briefly 
the  facts  about  vaccination  and  protection  from 
smaU-pos. 

CmCUMCLSION    AND    A    CONTRACTED    MEATUS. — It    IS 

stated  in  "  Holmes'  Surgery "  that  ninety-live  per 
cent,  of  young  male  adults  of  the  Jewish  race  have 
contracted  urinary  openings.  The  cause  of  this  is 
sup])osed  to  be  the  universal  practice  of  circumcision 
among  the  Jews.  A  contracted  meatus  is  of  fre- 
quent occurrence  among  Americans,  and  in  our  ex- 
perience, is  met  with  as  frequently  among  those  who 
have  a  long  prejiuce  as  among  those  who  have  been 
circumcised. — Northwestern  Lancet. 

A  Bill  to  Establish  Local  Boards  of  Health  in 
Wisconsin  is  before  the  Legislature. 

Major  John  H.  Frantz,  Surgeon  United  States 
Army,  died  suddenly  at  his  residence  in  Baltimore, 
March  2,  1882. 

OnLiGATORTf  Vaccination  of  infants  has  just  been 
adopted  by  the  Swiss  Government. 

The  Rentucky  State  Medical  Societt  will  hold 
its  next  annual  meeting  in  the  Academy  rooms  of 
the  Polytechnic  Society  of  Kentucky,  on  the  first 
Wednesday  in  April. 

The  Detroit  Clinic  announces  itself  as  the  only 
weekly  medical  journal  in  the  Northwest,  contains 
eight  pages  of  reading  matter,  and  is  a  promi.siug 
looking  periodical.  Edited  bv  Drs.  H.  O.  Walker  and 
O.  W.  Owen,  of  Detroit,  Mich. 


Vol.XXI.-No.  12. 
March  25,  1882. 


THE  MEDICAL  RECORD. 


309 


©rtgmol  Communications. 


ON    THE    VALUE    OP    lODOFOEM    AS    A 

DKESSIKG  FOR  WOUNDS. 

Br  H.  B.  SAXDS,  M.D., 

BURGEON  TO  THB   ROOSEVELl*  HOSPITAL.    N.  T. 

In'  Gerinanj,  during  the  past  year,  iodoform  has  been 
exteasiveJy  employed  in  the  treatment  of  operation- 
wounds;  and  perhaps  no  other  antiseptic  has  ever 
grown  so  rapidly  in  popular  favor.  Indeed,  so  man- 
ife.st  were  many  of  the  advantages  attending  its  em- 
ployment, that  it  seemed  likely  to  create  a  revolu- 
tion in  surgical  practice.  Quite  recently,  however, 
numerous  cases  of  poisoning  from  iodoform  have 
come  to  light ;  and  the  acclamation  with  which  it 
was  received  when  introduced  a  little  more  than  a 
year  ago,  may  possibly  soon  be  followed  by  an 
equally  emphatic  condemnation.  Ha\-ing  shared 
the  enthusiasm  in  favor  of  the  remedy,  and  having 
also  verified  the  danger  accompanying  its  use,  I  ven- 
ture to  briefly  record  the  results  of  my  experience, 
as  a  slight  contribution  to  the  knowledge  required 
to  enable  tis  to  estimate  the  real  value  of  iodoform 
as  a  surgical  dressing. 

The  chemical,  physiological,  antiseptic,  and  toxic 
properties  of  iodoform  have  been  minutely  investi- 
gated by  German  observers.  It  contains  ninety-six 
per  cent,  of  iodine,  is  easily  soluble  in  ether,  and 
in  both  the  fixed  and  essential  oils ;  while  alco- 
hol is  a  more  feeble  solvent,  and  water  dissolves 
only  a  trace  of  it.  When  in  solution,  it  undergoes 
gradual  decomposition,  evolving  iodine,  to  which 
its  antiseptic  pj'operties  are  believed  to  be  due. 
When,  therefore,  a  wounded  surface.is  covered  with 
iodoform,  a  kind  of  antiseptic  reservoir  is  established 
which,  constantly  and  slowly  giving  off  iodine  in  a 
nascent  state,  effectually  hinders  putrefactive  changes 
ia  the  wound.  The  development  of  bacteria  is  not 
always  entirely  prevented,  but  all  other  evidences  of 
putrefaction  are  absent,  and  the  wound  remains 
wholly  aseptic.  It  has  been  shown,  however,  that 
the  action  of  iodoform  -  owing  to  its  slight  solubility 
in  water  and  in  the  animal  fluids — although  con- 
stant, is  slow,  contr.isting,  in  this  respect,  with  the 
quick  and  energetic  action  of  carbolic  acid.  Con- 
sequently it  cannot  be  substituted  for  the  latter  in 
the  disinfection  of  instruments,  sponges,  or  the 
hands  of  the  operator.  Moreover,  in  the  case  of 
wounds  intended  to  be  closed,  with  the  view  of  ob- 
taining union  by  the  first  intention,  carbolic  acid, 
as  a  direct  application  to  the  cut  surfaces,  is  pref- 
erable to  iodoform,  both  for  the  reason  above  men- 
tioned, and  because  the  presence  of  the  powder  be- 
tween the  ojiposed  surfaces  interferes  with  primary 
adhesion. 

The  favorable  local  influence  of  iodoform,  when 
applied  to  open  wounds,  has  been  noticed  by  all 
Burgeons  who  have  employed  it.  The  wound  re- 
maias  free  from  pain,  the  discharge  is  thin  and 
scanty,  the  surrounding  integument  free  from  in- 
flammatory swelling,  and  the  formation  of  healthy 
granulations  goes  on  rapidly  and  without  interrup- 
tion. The  iodoform  disappearing  very  slowly,  in- 
j  frequent  dressings  are  sufficient ;  and  until  the  repar- 
ative process  is  far  advanced  no  change  of  treatment 
\  is  rendered  necessary.  When,  howevei-,  granulation 
;  is  well  established,  and  the  wound  has  contracted 
I  in  size,  other  applications  are  preferable  to  iodoform. 


which,  perhaps,  somewhat  retards  cicatrization.  In 
the  management  of  ordinary  open  wounds,  its  supe- 
riority to  carbolic  acid  depends  mainly  on  the  fact 
that  while  the  direct  contact  of  the  latter  causes  ir- 
ritation and  suppuration,  iodoform  has  an  opposite 
effect,  restraining  inflammation,  and  promoting  the 
work  of  repair. 

Iodoform  is  also  employed  with  advantage  in  cer- 
tain situations  where  the  use  of  caibolic  acid  would 
be  either  uncertain  or  dangerotis — after  operations 
on  the  rectum,  such  as  the  extirpation  of  cancerous 
growths,  the  difficulty  of  maintaining  an  aseptic  con- 
dition ofthe  wound  by  means  of  carbolic  acid  solutions 
is  often  insuperable,  while  a  few  ajiiilirations  of  iodo- 
form usTially  accomplishes  this  object  with  certainty 
and  ease.  Again,  after  operations  for  the  removal 
of  cancerous  tumors  of  the  tongue,  the  tonsils,  the 
jaws,  or  the  floor  of  the  mouth,  disinfection  of  the 
wound,  although  extremely  desirable,  cannot  be 
safely  obtained  by  carbolic  acid,  on  account  of  its 
poisonous  properties  ;  consequently  the  wound  often 
becomes  exceedingly  offensive,  and  the  i^atient  is 
exposed  to  the  double  risk  of  septica?mia  by  direct 
absorption  of  septic  products,  and  of  becoming  con- 
taminated by  inhaling  or  swallowing  the  putrescent 
fluid  so  abundantly  secreted.  In  these  cases  iodo- 
form has  been  used  with  signal  success.  The 
operation-wound  being  jduggrd  with  a  strip  of 
gauze,  impregnated  with  this  sulistance,  remains 
aseptic,  and  frequent  removal  of  the  dressing  is  un- 
necessary. Twelve  consecutive  amputations  of  the 
tongue  were  lately  treated  in  this  manner  in  Bill- 
roth's  clinique,  without  a  fatal  result.  Most  of 
these  operations  were  severe  and  extensive,  involv- 
ing a  removal  of  the  floor  of  the  mouth. 

Iodoform  has  long  been  known  as  a  vahiable 
remedy  when  applied  to  unhealthy  and  fetid  ulcers;, 
and  its  excellence  in  this  respect  has  been  confiimecl 
by  recent  observation.  I  have  repeatedly  employed 
it  during  the  past  six  months  with  the  happiest 
effect  in  this  class  of  cases,  and  have  been  surpiised 
to  notice  how  quickly  the  ulcers  became  inoffensive 
and  covered  with  florid,  healthy  granulations. 

In  treating  ojien  wounds  with  iodoform  I  have 
followed  the  u.sual  practice  of  covering  the  surface 
with  a  thin  layer  of  the  powder,  dustfd  from  a  pep- 
jier-box,  afterward  applying  a  layer  of  cheese-cloth, 
a  coat  of  absorbent  cotton,  a  piece  of  guttapercha 
tissue,  and  a  bandage.  In  operation-wounds  in- 
tended to  be  closed  with  the  object  of  obtaining 
imion  by  adhesion,  I  have  simply  washed  the  wound 
with  a  solution  of  carbolic  acid,  and  after  uniting 
the  edges  with  sutaires,  with  or  without  the  inserticn 
of  a  drainage-tube,  have  covered  the  surface  with 
half  a  dozen  layers  of  cheese-cloth,  lightly  dusted 
with  powdered  iodoform,  over  which  were  applied  a 
mass  of  salicylated  or  absorbent  cotton,  a  piece  of 
gutta-percha  tissue,  and  a  gauze  bandage.  The 
dressings  were  usually  renewed  on  the  second  or  the- 
third  day,  and  afterward  at  longer  or'shorter  intervals, 
according  to  circumstances.  As  a  rule,  the  results 
have  been  entirely  satisfactory,  extensive  amputa- 
tion-wounds uniting  almost  completely  by  the  first 
intention,  and  invariably  remaining  aseptic. 

Among  the  larger  operation-wounds  I  have  treated' 
with  iodofoi-m  during  the  past  few  months,  in  hos- 
pital and  in  private  practice,  are  cases  of  strangu- 
lated hernia,  trej^hining  for  fracture  of  the  skull, 
colotomy,  enterotomy,  castration,  ligature  of  the  ex- 
ternal carotid  for  aneurism  of  the  posterior  auricular 
artery,  perinephritic  abscess,  enucleation  of  suppu- 
rating inguinal  glands,  excision  ofthe  breast,  removal 


310 


THE  MEDICAL  RECORD. 


of  tumors  of  the  neck,  amputation  o£  the  leg,  and 
amputation  of  the  thigh.  Of  three  cases  of  the  lat- 
ter operation,  one  was  a  primary  amputation  for  in- 
jury, and  two  were  performed  for  disease.  Prompt 
recovery  from  these  operations  followed  in  every 
instance,  except  three.  One  was  a  case  of  lumbar 
colotomy,  which  will  be  described  hereafter.  Another 
was  a  ease  in  which  the  operation  of  castration  was 
followed  by  consecutive  hemorrhage,  rendering  it 
necessary  to  reopen  the  wound,  which  was  not 
quite  healed  when  the  patient  left  the  hospital. 
The  third  case,  still  in  jirogress,  was  that  of  a  woman 
from  whom  I  removed  a  large  myxomatous  tumor,  | 
situated  in  the  parotid  region.  Erysipelas  set  in  on 
the  fourth  day,  and  is  now  apparently  subsiding  on 
the  tenth  day. 

Besides  the  larger  operation-wounds,  I  have 
treated  with  iodoform  a  great  number  of  smaller 
wounds,  and  several  cases  of  compound  fracture, 
with  gratifying  success.  The  remedy  is  easily  ap- 
plied ;  its  antiseptic  action  is  efficient,  and  its  local 
action,  unlike  that  of  carbolic  acid,  is  sedative  and 
unirritating,  even  when  directly  in  contact  with  a 
raw  surface.  Moreover,  in  endeavoring  to  procure 
union  by  the  first  intention,  better  coaptation  can 
be  secured  by  the  even  pressure  of  the  cotton  pads, 
than  by  the  application  of  carbolized  gauze,  thereby 
favoring  the  chances  of  adhesion  of  the  cut  surfaces. 
I  know  of  no  other  antiseptic  dressing  which  is  at 
the  same  time  so  comfortable  and  so  etiioient,  and 
were  it  not  for  one  drawback,  I  believe  that  it  would 
soon  be  almost  universally  adopted. 

That  iodoform  possesses  poisonous  properties  has 
loQg  been  known  by  experimental  physiologists. 
Binz  and  Hogyes  have  shown  that  when  adminis- 
tered in  large  doses  to  dogs  or  cats,  it  causes  nar- 
cotism, and  destroys  life  by  paralysing  the  nerve- 
centres  of  respiration  and  circulation.  In  animals 
thus  destroyed,  the  heart,  liver,  and  kidneys  have 
been  found"  in  a  state  of  fatty  degeneration.  Simi- 
lar effec-ts  have  unfortunately  been  recently  observed 
in  the  human  subject,  as  the  result  of  absorption  of 
iodoform  by  wounded  surfaces.  It  is  remarkable 
that  for  some  time  after  its  introduction  into  general 
surgical  practice,  very  few  instances  of  its  injurious 
action  were  obsen-ed,  and  that  in  the  experience  of 
some  surgeons,  poisoning  is  extremely  rare.  Hoeft- 
miun  reports  that  out  of  a  thousand  cases  treated  by 
iodoform  in  the  hospital  in  Konigsberg,  only  two 
were  thus  affected,  both,  however,  terminating  fa- 
tally. With  other  observers,  bad  results  have  been 
more  frequent,  and  various  degrees  of  toxic  action 
hive  been  recorded.  Attention  having  been  di- 
rected to  the  dangers  attending  the  use  of  the 
remedy,  cases  are  rapidly  multiplying  to  prove  that 
it  cannot  be  freely  eraiiloyed  without  the  risk  of  fatal 
consequences. 

In  m;in,  as  in  animals,  poisonous  doses  of  iodo- 
form cause  rapid  and  feeble  heart-action,  coma,  and 
paralysis  of  the  organs  of  respiration.  Autopsies 
li we  demonstrated  in  such  cases  the  lesions  of  men- 
iui^itis  and  fatty  degeneration  of  the  heart,  liver,  and 
kidneys.  But  tlie  most  remarkable  manifestations  of 
piisoning  in  the  human  subject  are  due  to  perverted 
c'^r^bral  action,  taking  the  form  of  mental  derange- 
ment. Every  degree  of  intoxication  has  been  ob- 
served, froni  simple  exaggeration  of  nervous  ox- 
citibility  to  the  condition  of  acute  mania.  In  the 
li  filter  ca-ies  patients  are  restless  and  uncomfortable, 
complaining  of  headache,  loss  of  ajipetite,  wakeful- 
ness, and  the  constant  taste  of  iodoform.  Such  sym- 
tims  often,  but  not  always,  precede  those  which  are 


met  with  in  bad  cases,  which  are  nearly  identical  \*ith 
the  symptoms  of  delirium  tremens.  Profound  mental 
despondency,  inability  to  eat  or  sleep,  spectral  illu- 
sions, delirium  more  or  less  violent,  and  suicidal 
propensities,  are  the  most  frequent  manifestaticcs 
of  the  morbid  state.  Sometimes  the  patient  is  noisy 
and  abusive,  at  other  times  his  actions  are  stealthy  ! 
and  he  will  endeavor  to  run  from  his  bee  room  or 
jump  out  of  a  window  in  order  to  escape  from  a 
fancied  enemy.  From  such  a  condition  many  per- 
sons recover,  while  others  die,  often  suddenly,  from 
exhaustion  or  coma.  No  antidote  to  the  poison  has 
been  discovered,  and  the  only  ti;eatment  of  any  avail 
is  that  of  preventing  further  intoxication,  and  sup- 
porting the  patient's  vital  powers  by  alcoholic  stim- 
ulants until  the  crisis  is  past.  Opium  and  bromide 
of  potassium,  even  in  large  doses,  usually  fail  to  in- 
duce sleep,  while  chloral  hydrate  would  be  likely 
to  paralyze  the  heart,  already  enfeebled. 

I  have  observed  several  examples  of  the  lighter 
form  of  iodoform  poisoning  in  which  the  symptoms 
disappeared  almost  immediately  after  discontinuing 
the  use  of  the  drug. 

I  have  seen  also  two  cases  of  acute  mania,  due  to 
this  cause,  and,  until  the  second  case  occurred,  I 
failed  to  appreciate  the  nature  of  the  morbid  state, 
as  I  was  unaware  that  this  form  of  disease  could  be 
produced  by  iodoform. 

The  first  case  was  that  of  a  woman,  aged  thirty- 
sis,  on  whom  I  performed  lumbar  colotomy  at  the 
Roosevelt  Hospital  four  months  ago  for  the  relief  of 
intestinal  obstruction  dependent  on  cancerous  stric- 
ture of  the  rectum.  The  operation  was  unattended 
with  any  accident,  and  after  inserting  a  drainage- 
tube  at  each  angle  of  the  wound,  and  closing  it  with 
button-sutures,  an  iodoform  gauze  dressing  was  ap- 
plied. The  wound  failed  to  unite  in  its  deeper  part 
and  reopened  At  the  extremities.  Iodoform  was 
freely  applied  to  the  granulating  surfaces,  the  gauze 
dressing  being  continued.  The  mechanical  relief 
afforded  by  the  operation  was  satisfactory,  and  tlie 
patient  did  well  until  about  the  eighth  day,  when 
she  became  despondent,  somewhat  suUen,  and  wake- 
ful at  night.  She  was  suspected  of  being  addicted 
to  the  use  of  opium,  and  morphia  was  administered 
in  the  hope  of  controlling  the  nervous  symptoms. 
No  good  effect  followed  its  use.  Meanwhile  the  pa- 
tient slept  but  little,  refused  food,  began  to  lose 
flesh,  and  a  fortnight  after  the  operation  showed  un- 
mistakable signs  of  mania.  She  was  seen  putting 
her  fingers  in  the  wound,  and  immediately  afterw aid 
in  her  mouth.  She  became  melancholy  and  sus- 
picious, and  occasionally  violent  and  abusive,  at- 
tempting to  strike  the  nurse  or  the  physician.  After 
a  paroxysm  of  rage,  she  died  suddenly,  eighteen 
days  after  operation.  At  the  time  of  deatli  the  body 
was  greatly  emaciated.  During  her  fatal  illness  tbe 
pulse  was' accelerated,  but  the  temperature  never 
rose  above  100\ 

The  second  case  was  that  of  a  lady,  about  fifty 
years  of  age,  from  whom  I  removed  the  left  breast 
"and  axillarv  glands  for  carcinoma.  The  W(mnd  was 
closed  after  inserting  drainage-tubes  wliich  were  re- 
moved on  the  fifth  day.  l^foderate  suppuration  oc- 
curred, but  the  wound  healed  rapidly,  and  was 
nearly  closed  at  the  end  of  a  fortnight.  Dnriug  this 
period,  iodoformgauze  dressings  were  n]>plied.  being 
removed  every  day,  or  every  second  day,  according 
to  the  amount  of  discharge.  The  patient  was  a  wo- 
man of  nervous  temperament,  who  had  been  very 
apprehensive  regarding  the  danger  of  the  oiieratioB, 
but  who  hud  never  suffered  from  any  mental  dis- 


THE  MEDICAL  RECORD, 


311 


order.  On  the  fourth  day  she  began  to  be  restless 
and  hysterical,  and  required  opium  to  induce  sleep. 
A  few  days  later  she  became  very  despondent, 
thought  she  was  going  to  die,  and  insisted  on  mak- 
ing her  will.  On  the  tenth  day  the  evidences  of 
mania  were  very  plain,  delirium,  hallucinations,  fear 
of  those  around  her,  attempts  to  run  away,  sleepless- 
ness, and  absolute  aversion  to  food  being  among  the 
chief  symptoms.  Copious  sweatings  were  also  no- 
ticed, and  muscular  weakness,  except  during  pa- 
roxysms of  excitement.  Tlie  pulse  was  weak  and 
rapid,  varying  in  frequency  from  100  to  120.  The 
temperature  was  generally  normal,  and  never  ex- 
ceeded lOOF.  At  the  end  of  the  second  week,  the 
wound  being  nearly  healed,  the  use  of  iodoform  was 
discontinued,  and  from  that  time  the  patient  began 
to  improve,  her  recovery  being  complete  about  ten 
days  later. 

Besides  the  two  cases  just  described,  in  which  I 
think  there  can  be  no  doubt  as  to  the  poisonous 
effects  of  iodoform,  I  have  met  with  another  case 
which  was  marked  by  mild  maniacal  excitement, 
after  an  operation  for  necrosis  of  the  femur,  in 
which  iodoform  was  freely  and  repeatedly  applied 
to  an  open  wound.  But,  as  the  patient  had  previ- 
ously exhibited  signs  of  mental  derangement,  I  could 
not  with  certainty  determine  the  agency  of  iodoform 
in  causing  the  symptoms  observed  after  operation. 

Thus  far  it  has  not  been  ascertained  definitely 
what  amount  of  iodoform  is  necessary  to  cause  poi- 
soning, and  the  susceptibility  to  its  action  appears 
to  vary  greatly  in  different  ca.ses.  In  many  instances 
iodoform  has  been  freely  applied  to  extensive  open 
wounds  with  impunity,  two  or  three  ounces  having 
been  inserted  into  the  wound  immediately  after  an 
operation.  In  other  cases,  slight  nervous  symptoms 
have  followed  the  application  of  a  single  gramme, 
while  severe  attacks  of  mania  have  been  caused  by 
doses  of  half  an  ounce  and  upward.  In  many  of 
the  German  cases  an  excessive  amount  was  em- 
ployed, sometimes  amounting  to  five  or  six  ounces. 
The  toxic  effect  depends  much  upon  the  extent  of 
the  absorbing  surface,  and  a  fresh  wound  will  alj- 
sorb  more  rapidly  than  one  that  is  gi'anulating.  Old 
persons  are  especially  liable  to  suffar  from  iodoform 
poisoning,  while  such  is  not  the  case  with  children, 
as  far  as  can  be  inferred  from  the  limited  statistics 
thus  far  published.  The  subject  of  iodoform-poi- 
soning  is  one  of  deep  interest,  and  it  is  to  be  hoped 
that  surgeons  will  promptly  record  the  results  of 
their  investigations.  It  is  already  apparent  that  the 
sanguine  expectations  at  first  entertained  regarding 
the  value  of  this  anti.septic  cannot  be  fully  realized, 
and  that,  in  the  present  state  of  our  knowledge, 
iodoform  should  be  employed  with  great  caution,  and 
in  such  a  manner  that  it  can  be  readily  removed  from 
the  wound  in  case  the  symptoms  of  poisoning  shoTild 
supervene.  It  is  certainly  hazardous  to  fill  a  large 
fresh  wound  with  the  powder,  which  may  penetrate 
the  meshes  of  the  connective  tissue  so  that  it  can- 
not be  washed  oirt.  By  employing  it  in  the  mini- 
mum quantity  that  will  produce  the  desired  effect, 
and  by  learning,  perhaps,  to  recognize  beforehand 
the  class  of  cases  that  are  peculiarly  susceptible  to 
its  deleterious  influence,  we  may  yet  be  enabled  to 
use  with  safety  this  antiseptic,  which,  in  many  re- 
spects, is  the  most  valuable  that  has  ever  been  in- 
troduced into  surgical  practice. 

ChdjoiiIN,  the  new  drug  which  it  has  been  at- 
tempted to  introduce  as  an  antipyretic,  is  not  a  suc- 
cess. 


A    CONVENIENT    METHOD    OF    DOSAGE 
AND    ADMINISTRATION. 

The  Pkocess  of  makinq  Tablets  of  Simple  a>d 
CoMPOUKD  Powders,  inclddino  Tritobations, 
Hypodermics,  etc.* 

By  ROBERT  M.  FULLER,  M.D., 

NEW    YORK. 

Mr.  President  cmd  FeUoics  of  the  Materia  Medicn 
Society:  Pharmaceutical  chemists  have,  of  late  years, 
attained  a  great  advancement  in  the  production  and 
combination  of  medical  substances,  and  in  the  meth- 
ods of  dispensing  them.  All  methods,  of  whatever 
class,  should  be  properly  limited  to  that  field  -nhere 
they  would  be  found  of  the  most  practical  utility, 
and'  though  of  the  various  processes  used  in  phar- 
maceutical work  generally,  much  of  interest  might 
be  written,  it  is  simply  my  purpose  to  treat  only  of 
a  few  which  are  best  adapted  to  the  dispensing  of 
medicine  suitable  for  the  troche  or  tablet  in  an  un- 
coated  form. 

In  the  preparation  of  the  substance  for  the  troche, 
or  tablet,  the  pharmacist  usually  resorts  to  the  pro- 
cess of  cutting  the  paste,  or  of  compressing  dry  or 
moist  powder,  in  weighed  or  measiired  portions, 
with  dies  of  various  sizes  and  shapes.  The  cutting 
of  the  paste  has  been  found  to  be  generally  imprac- 
ticable for  pharmaceutical  piirposes,  but  the  process 
of  compression,  on  the  other  hand,  has  been  deserv- 
ing of  commendation  for  the  facility  it  affords  for 
the  preparation  of  medicines  in  a  convenient  and 
elegant  form. 

During  the  past  three  years,  however,  prominent 
pharmacists  have,  by  experience,  fully  demonstra- 
ted that  there  was  room  for  another  method  of 
securing  simplicity  and  palatability  in  the  prepara- 
tion and  administration  of  dose  medicine. 

The  method  in  question,  which  assures  the  same 
accurate  result  as  is  obtained  by  the  process  of  com- 
pression, was  the  outcome  of  a  long  scries  of  exi^eri- 
ments  made  in  tliis  line  as  early  as  1861,  and  before 
the  system  of  compression  was  generally  known  or 
adopted  in  this  country. 

The  .system  employed  in  this  simplified  method 
does  not  comprehend  merely  the  accurate  dosage 
and  agreeable  administration  of  medicines,  it  also 
embraces  their  preparation  in  large  quantities  with 
great  facility  by  simple  and  comparatively  inexpen- 
sive apparatus,  which  is  now  made  by  machinery 
with  great  exactnes.«  and  beauty  of  finish. 

It  is  this  particular  feature  which  especially  re- 
commends the  method  to  pharmacists  who  desiie 
to  secure  accuracy  of  result  by  .simple  and  readily 
available  apparatus.  The  basis  of  these  experiments, 
and  the  idea  which  insjjired  the  many  tests  made, 
was  a  belief  that  the  then  prevailing  domestic  cus- 
tom of  medicating  fragments  of  ordinary  loaf  cane- 
sugar  could  be  improved  by  the  substitution  there- 
for of  a  lozenge-shajied,  or  other  equally  convenient 
tablet  that  would  possess  similar  iJorosity  and  firm- 
ness. 

Such  a  tablet  was  finally  secured  by  moistening 
pulverized  cane-sugar  into  a  paste  of  suitable  con- 
sistence, with  the  aid  of  alcohol  or  water.  The  mass 
was  next  formed  into  any  shape  desired  by  a  mould 
and,  when  sufficiently  firm  to  allow  of  the  operation, 
was  removed,  and  allowed  to  dry  and  harden. 

Society,  February 


312 


THE  MEDICAL  RECORD, 


Thus  prepared,  the  tablet*  was  found  to  be  as 
thoroughly  absorbent  and  adaptable  to  medication 
by  saturation  as  were  the  cane-sugar  fragments  for- 
merly uaed.  Any  other  similar  inert  substance, 
whether  it  be  a  simple  or  compound  powder,  might 
have  been,  and  maybe  used  in  place  of  cane-sugar, 
if  desired.  Tests  made  to  determine  the  absorbent 
quality  of  this  tablet  blank  {or  saturate),  with  a  view 
of  ascertaiaiag  the  extent  of  its  utility,  demon- 
strated thit  a  large  number  of  standard  concentrated 
solutions,  or  liquids,  the  dose  of  which  was  small, 
could  readily  and  accurately  be  administered  in  this 
manner. 

The  tablets  may  be  made  of  auj  size  desired  by 
the  use  of  tablet-moulds  of  the  requisite  capacity. 
The  moulds  now  made  produce  tablets  varying  in 
siz3  from  one  half  grain  to  sixteen  grains.  Pipettes 
are  employed  in  the  medication  and  are  made  by 
Messrs.  CasweU,  Hazard  .t  Co.,  Dr.  E.  B.  Squibb, 
and  others,  in  improved  form  of  long  and  accui'ate 
register. 

The  field  to  which  the  tablet  blank  can  be  ap- 
plied has  been  found  to  embrace  a  large  number  of 
standard  and  extemporaneous  pharmaceutical  prep- 
arations, such  as  fluid  extracts,  tinctures,  and  other 
concentrated  solutions.  Among  this  class  are : 
Extr.  fl. — aconiti  radicis,  belladonnie  rad.,  gelsemii, 
ipecacnanhic,  nucis  vomicse,  veratri  viridis,  also 
tinct. — aconiti  radicis,  belladonnse,  cantharidis,  cai^- 
sici,  ignatiiic,  nucis  vomicae,  veratri  viridis  ;  etc. 

Having  secured  the  ijorous  tablet,  experiments 
were  next  instituted  to  ascertain  to  what  extent 
simple  and  compound  powders  could  be  similarly 
made,  with  alcohol  or  water,  into  a  porous  and  ad- 
hesive mass  that  might  be  moulded  in  the  same 
form. 

This  branch  of  inquiry  was  prompted  by  the 
evident  facility  with  which  certain  pharmaceutical 
substances  could  be  united,  and  their  cohesive  and 
adhesive  properties  utilized  for  the  object  in  view. 
The  idea  of  their  adaptability  for  this  purpose  was 
the  outgrowth  of  general  laboratory  practice  in 
pharmacy  and  chemistry  during  18(51-04,  at  which 
period  my  attention  was  drawn  particularly  to  the 
list  of  phtirmaceutical  agents  embraced  in  Part  iv. 
of  the  appendix  to  the  "  United  States  Disjiensatory  " 
of  185-1,  and  subsequent  editions.  Special  effort 
was  directed  toward  determining  the  possible  ex- 
tent to  which  these  agents  could  be  thus  employed. 
The  result  revealed  the  fact  that  a  wide  variety  of 
medicines  could  be  jirepared  for  moulding  in  this 
manner,  and  thus  there  was  opened  up  a  new  field 
for  the  practical  operation  of  this  jirocess.  The 
latter  was  employed  in  practice  thereafter,  as  occa- 
sion arose,  to  secure  certain  desirable  jiroparations 
that  could  not,  at  that  time,  be  procured  in  any  other 
way.  It  was  found  of  advantage  to  make  these 
tablets  in  such  a  manner,  and  of  sufficient  strength, 
to  allow  of  their  being  readily  subdivided  into  any 
required  number  of  do.ses.  By  this  means,  there 
was  secured  in  convenient  foi-m,  what  could  not  oth- 
erwise easily  have  been  obtained  short  of  an  ex- 
tensive variety  of  tablets  of  various  dose  capacity. 
Among  theiu  were  a  number  that  were  particularly 
useful  at  the  bedside,  or  in  cases  of  emergency. 

This  method  was  described  four  years  ago  in  a 
paper  I  then  had  the  honor  to  read  before  tlie  New 
York  4oa<ieD'iy  of  Medicine,  but  the  field  of  its  ap- 


•  Thin  In  tho  blnnk  fully  described  ni  the  "  tnbbt  Bntumto'"  in  the 
paper  on  "  l)o«e  Uinpi'nslnK  SimpUttod,"  publixhed  In  TuE  Meuical 
Recoud  of  Mftrch  fl,  IXiS. 


plication  was  merely  outlined.  Reference  was 
then  made  solely  to  the  extensive  utUity  of  sugar- 
ofmilk  in  the  preparation  of  blanks,  triturations, 
and  in  combination  with  various  substances  in  the 
form  of  soluble  tablets.  My  purjjose  this  even- 
ing is  to  demonstrate  with  specimens,  that  though 
sugar-of-milk  lias  always  been  found  of  extensive 
and  general  utility  in  tablet- making  by  this  method, 
still  the  i)rncess  is  not  by  any  means  solely  con- 
fined to  the  employment  of  this  substance  as  an 
indispensable  requisite  to  success.  On  the  con- 
trary, other  medicinal  substances  may  be  employed 
if  desired,  and  equally  satisfactory  results  attained 
therewith. 

Apparatus  of  a  simjjle  character  sufficed  for  the 
moulding  of  the  tablets,  and  there  w'as  employed 
in  this  branch  of  the  work  devices  that  were  easily 
constructed  by  any  one,  and  which  generally  speak- 
ing, were  modifications  of  the  simplest  style  of  com- 
pressing apparatus  now  in  use.  The  mechanism 
was  usually  of  glass,  although  metal  was  sometimes 
used.  It  consisted  of  a  tube  into  which  was  intro- 
duced one  or  two  perfectly  fitting  cylinders  as  re- 
quired. 

As  a  rule  the  process  was  to  hold  in  the  left  hand 
an  adjustable  cylinder,  which  had  been  inserted 
into  the  glass  tube.  The  paste  was  then  introduced 
with  a  spatula  in  the  02Jen  end  of  the  tube,  and  the 


cylinder  was  so  adjusted  by  hand,  or  with  the  aid  of 
a  screw  register,  that  only  so  much  of  tlie  jinste  as 
sufficed  to  contain  the  desired  amount  of  medicine, 
could  be  moulded  in  the  tube.  Tliis  amount  was 
accurately  determined  by  weight,  and  the  paste, 
after  hardening,  was  ]n-essed  out  in  a  tablet  of  per- 
fect shape.  Other  moulds  of  various  shapes  were 
employed  in  casting  a  similar  mass  in  otlier  forms  for 
special  tases.  Improvements  were  made  from  time  to 
time  in  tlie  tablet-making  apparatus,  and  ultimately 
there  was  produced  two  styles  of  apparatus,  the 
same  general  principle  governing  each,  but  leaving 
a  wide  margin  for  finish  as  regards  workmanship. 
These  styles  were  described  at  some  length  in  a 
previous  paper  on  tho  process  heretofore  published. 
They  comprised  the  adjustable  and  non-ndjustable 
moulds.  The  latter,  illustrated  as  above,  was  fully 
and  sTirticiontly  described  in  the  previous  pa)ier 
in  question,  and  can  be  made  in  various  sizes.  Tho 
adjustable  mould  is  tho  same  in  princijile,  with  the 
addition  of  any  device  for  accurate  adjustment. 
Those  moulds  are  generally  made  of  har<l  nibber. 
Glass  has  been  successfully  used  for  the  upper  plate. 


THE  MEDICAL  RECORD. 


31o 


and  other  hard  substances  may  be  employed  if  de- 
sired. Plates  have  been  made  of  metal"  contain- 
ing perforations  for  250  tablets;  of  hard  rubber, 
containing  50  or  100  holes,  which  is  the  number 
usually  employed ;  and  of  glass,  containing  50  per- 
forations. 

The  po'wders  found  in  the  appendix  which  coxild 
be  prepared  with  the  apparatus  in  the  manner 
described  embrace  triturations,  hypodermics,  and 
other  special  preparations.  The  triturations  were 
prepared  in  the  manner  elaborately  and  interestingly 
described  in  a  text-book,  used  in  connection  with 
my  earliest  experiments,  and  entitled  Mohr  .fc  Ked- 
wood's  "Practical  Pharmacy"  and  published  in 
London  in  1849.  Addi'ions  are  constantly  being 
made  to  the  list  as  experiments  demonstrate  the 
adaptability  of  other  substances  for  moulding  in  this 
form.  At  the  present  time  the  li.'-t  of  tablets  manu- 
factured by  prominent  pharmacists  include  a  large 
variety  of  trituration  tablets.  These  firms  now  reg- 
ularly use  triturations  for  tablets  made  with  a  special 
.  scale  which  permits  of  the  exact  amount  of  medicine 
desired  being  introduced  into  the  moulds.  To  be  of 
service,  hyjjodermic  tablets  should  be  so  prejjared 
that  they  wUl  become  readily  soluble.  This  desired 
solubility  may  generally  be  secured  liy  the  employ- 
ment of  one  or  two  suitably  selected  salts  for  a  basis. 
Preparations  combined  in  a  manner  to  thus  favor 
solubility  are  being  made  at  the  present  time 
by  Messrs.  Caswell,  Hazard  it  Co.,  of  salts  of  atro- 
pia,  morphia,  pUocarpia,  strychnia,  and  other  sub- 
stances. 

Eflforts  were  subsequently  directed  to  the  produc- 
tion of  pill-masses  and  troche  pastes  into  tablet 
form.  These  expei-iments  likewise  indicated  that 
by  modifying  the  adhesive  projjerties  of  both  the 
mass  and  paste,  either  coiild  be  adapted  to  the  pro- 
cess without  difficTilty,  and  that  the  tablets  could  be 
made  of  the  desired  density  or  porosity.  Fine  prepa- 
rations in  troche  form  have  recently  been  manufac- 
tured by  Messrs.  Fraser  fr  Co.  Among  them  is  a 
troche  of  pulvis.  conii  comp.,  to  which  is  added  a 
required  dose  of  codein.  Pill  masses  have  also  been 
prepared  in  a  very  satisfactoiy  manner  by  leading- 
pharmacists.  The  specimens  exhibited  in  con- 
nection with  this  jjaper  include  296  varieties  of 
preparation.  They  were  made  principally  by  phar- 
macists to  whom  had  been  explained  and  illustrated 
the  method  I  have  thus  described,  and  who  are  now 
familiar  with  all  its  essential  details,  as  well  as  with 
the  character  of  the  varioixs  styles  of  apparatus  em- 
ployed. 

The  experiments  in  their  progress  afforded  me  an 
interest  which  I  can  hardly  hope  to  transfer  to  any 
description  of  them,  either  orally  or  through  the 
medium  of  a  written  paper.  I  trust  that  they  may, 
however,  be  found  to  possess  sufficient  merit  in 
the  results  attained  to  pardon  the  imperfections  in 
the  method  of  presenting  them  to  your  attention, 
and  I  desire  to  thank  you  for  your  indulgence.  In 
closing,  I  cannot  permit  this  occasion  to  7-iass  with- 
out expressing  my  gratitude  to  my  friend,  Dr. 
H.  G.  Piffard,  and  also  to  Messrs.  Caswell,  Hazard 
&  Co.,  and  the  other  pharmacists,  with  whom  my 
relations  have  been  of  an  agrepable  nature,  since 
the  occasion  when  the  method  was  first  given  to 
the  profession,  at  the  solicitation  of  some  of  its 
m6mi)ers. 

The  appended  table  indicates  the  variety  of  sim- 
ple and  compound  pharmaceutical  substances,  shown 
in  specimens,  and  which  can  be  jirepared  by  phar- 
macists generally,  in  accordance  with  the  methods 


described.     The  tablets  marked  (*)  are  made  from 
the  triturations. 

TiBI.ETS. 


*.\cid  arsenious. 
"     gallic. 
"     tannic. 

*Aconitia. 

.\coniti  rad.  est.  fl. 
"        "      tinct. 

■"  Aloin. 

Animonii  muiiat. 

■^Autiinon.  ct  potass,  tartras. 

*Atropia  sulphas. 

*      "  "     (hypodermic). 

Belladonna  rad.  ext.  fl. 

Caffeina. 
*Cantharis. 
Oantharidis  tinct. 
Capsicum. 
Carbo  ligni. 
^Caulophyllin. 
Cerii  oxalas. 
*Codeia. 

*Oonii.  comp.  pulvis. 
^     "        "  '*      c.  codeia. 

*Digitalia. 
Ferri  et  quiniie  citr. 
'*      •'  strychnine  citras. 
*'    pyrophosphat. 
*Ferrum  reductum. 
Gelsei^il  ext.  fl. 
"'Gebemin. 
•^Helonin. 
*Hydrarg.  chl<irid.  corros. 

*  **  '•         mite. 

*  "         iodid.  rubrum. 

13(1  West  Fortt-secoxd  Street, 


*Hvdrarg.  iodid.  viride. 
Hydrargyii.  pU.  (U.  S.  P.) 
^Hydrargyrum  c.  creta. 
*Hyoscyamia. 
*Ipecacuanha. 
*Ipecacuanhffi  et  opii.    pulv. 

sacch. 
*Macrotin. 
*3Iorphiai  sulphas. 

*  "  "  (hypoder- 
mic). 

*Nux  vomica. 

*Opium. 

*Pilocarpia. 

*  "  (hypodermic). 
*Podophyllin. 

*'  comp.  pil. 

Potassii  chloras. 

Quinias  sulphas. 
"       bisulphas. 

*Santonmum. 

Sacch.  alb.  (absorbent  or  por- 
ous blanks). 

Sacch.   lactis.      (absorbent  or 
porous  blanks). 

Sodii  bicarbonas. 
boras. 

*Strychniae  sulphas. 

*         "  "        (hypoder- 

mic). 

*Veratria. 

Veratri  viridis  ext.  fl. 

*Zinci.  phosphidum. 


CASES     OF   MONOHYPOCHOXDKIA    .^'D 
MONOMANIA. 


By  GEORGE  M.  BEAED,  A.M.,  M.  D., 

VEVr  YOBK. 

The  philosophic  and  thorough  study  of  psychology 
along  theoretical  and  practical  lines — that  is,  by 
seeing  many  forms  of  mental  disorder,  light  and  se- 
!  vere,  comparing  them  with  themselves  and  with 
'  each  other,  and  reasoning  rightly  from  our  obser- 
vations— demonstrates  these  two  facts  which  are  of 
interest  and  of  importance  to  physicians  and  to  so- 
ciety : 

First. — That  there  is  a  very  large  and  increasing 
number  of  cases  of  mental  impairment  that  often 
pass  for  insanity,  but  are  not  insanity.  Many  per- 
sons who  are  mentally  sick,  whose  minds  are  dis- 
turbed through  cerebral  congestion  or  cerebral  ex- 
haustion, either  of  direct  or  of  reflex  origin,  all  the 
time  or  a  portion  of  the  time,  periodic  or  intermit- 
tent, are  called  liy  their  friends  insane,  are  some- 
times formally  diagnosticated  as  cases  of  insanitv  by 
physicians,  and,  rarely,  are  admitted  as  in.sane  to 
asylums.  By  any  just  theory,  definition,  or  concep- 
tion of  insanity  they  cannot  be  called  insane,  and 
are  not,  probably,  ever  to  be  insane — are  not  on  the 
road  toward  that  class  of  cerebral  disorder — but 
may,  on  the  contrary,  be  saved  from  insanity  by 
this  lighter  form  of  disease  which  is  mistaken  for 
it.  A  psychology  that  is  scientific  and  philosophic 
does  not,  therefore,  increase  the  amount  of  insanity 
in  society,  but  diminishes,  since  it  demonstrates  the 
existence  of  a  large  class  of  cerebral  disorders  in 
which  the  mind  is  disturbed  and  responsibility 
weakened,  without  being  seriously  enough  impaired 
to  be  called  insane,  either  in  a  medical  or  legal  sense. 


314 


THE  MEDICAL  RECORD. 


It  is  in  just  this  class  of  what  I  call  border-line  cases, 
in  which  the  offhand  diagnosis  of  insanity  is  impul- 
sively, or  sometimes  deliberately  made,  to  the  great 
misfortune  of  the  patients  and  their  friends,  since 
it  places  them  in  a  class  to  which  they  do  not  be: 
long,  giving  them  a  reputation  which  society  holds  as 
undesirable,  discourages  treatment,  and  gives  a  prog- 
nosis far  more  gloomy  than  is  required  by  the  facts. 
Although  I  call  these  border-line  cases,  since  they 
are,  or  appear  to  be,  on  the  border-line — on  the  no 
man's  laud  that  divides  the  sane  from  tlie  insane 
—yet   not  often   do   they  cross   the  border,   or   if 
they  do   make   incursions  into   the   realm   of  the 
crazy,  they   return    again;    but    more    frequently, 
—however  near  the  border  they  may  go— they  do 
not  actually  cross  it;  they  may  think  of   suicide, 
talk   of   it,"  perhaps   attempt    it,  but   they  do  not 
commit   it;   they  miy  think   of  murder,  but  they 
hurt  no  one ;  their  morbid  impulses  and  instincts 
never  reach   the    limits   of  irresponsibility,   or   if 
they  do,  they  do  not  pass  the  limit  when  it  is  be- 
yond their  power  to  control  their  environments; 
if  they  cannot  resist  when  under  temptation,  they 
can  at  least   deliver  them-telves  from  temptation  ; 
and  so  all  their  lives,  severe  as  their  sufferings  may 
be,  and  peculiar  and   grotesque  as  many  of  their 
symptoms  are  liable  to  be,  tliey  yet  do  not  abso- 
lutely lose  the  instinct  of  self-preservation,  or  the 
power  of  adapting  themselves  to  their  environment, 
nor  do  they  relapse  into  childhood,  nor  do  they  lose, 
to  a  great   degree,  their  rememberable  conscious- 
nsss.     In  short,  they  are  sane,  although  they  are 
sick  in  mind,  with  mental  responsibility  impaired, 
it  is  true,  but  not  sufficiently  impaired  to  class  them 
with  lunatics. 

Nervous  patients  of  this  class  are  exceedingly  in- 
teresting, scientifically ;  and  a  knowledge  of  their 
symptoms  and  the  philosophy  of  their  disease  is  of 
high  importance,  as  well  as  of  interest  to  themselves, 
to  the  i^rofession,  and  to  society. 

Second. — There  is  a  considerable  class—also  prob- 
ably somewhat  increasing— of  monomaniacs,  that  is, 
chronically  insane,  with  delusions  of  a  more  or  less 
limited  character,  who,  though  they  are  not,  usu- 
ally, thought  to  be  insane,  either  by  their  friends  or 
by  the  profession,  and  are  found  out  of,  far  more 
tiian  in,  asylums,  managing,  it  may  be,  important 
business  affairs,  in  places  of  not  a  little  responsi- 
bility, laborious,  successful,  happy,  and  useful  in 
society  in  many  relations,  are  yet  insane. 

Bv  any  just  "theory,  definition,  or  conception  of 
insanity ]^  their  mental  responsibility  is  seriously  im- 
paired "in  certain  directions — their  insanity  co-exists 
with  their  8anity--in  some  cases,  and  under  circum- 
stances that  arouse  the  disease,  they  may  develop 
symptoms  the  most  serious,  and  become  suicides, 
thieves,  or  murderers.  Insanity  of  this  kind  is  con- 
sistent with  almost  perfect  physical  liealth,  with 
brilliant  and  rare  intellectual  gifts,  and  with  great 
mental  activity  and  usefulness.  In  some  cases  this 
monomania  may  precede  full  mania ;  as  tlie  penum- 
bra precedes  the  shadow,  the  monomaniac  becomes 
the  maniac,  becomes  demented,  sinks  to  the  state 
wliero  both  friends  and  enemies,  the  profession  and 
the  laity  allow  that  he  is  insane.  More  often  these 
cases  remain  for  years,  and  oven  for  a  long  life, 
monomaniacs,  and  they  may  die  at  last,  not  of  the 
disease,  but— as  any  one  else  would  die— of  fever, 
pneumonia,  consumption,  or  of  any  acute  or  chronic 
disorder. 

IJetwoon  those  monomaniacs  and  maniacs  the  dif- 
ference is  one  of  degree  only;  the  distinctive  fact  of 


both  forms  of  insanity  being  irresponsibility  in 
some  particular  direction,  or  in  many  directions ; 
both  varieties — monomania  and  mania — are  forms  of 
partial  insanity,  as  all  insanity  is  partial  insanity  ; 
the  monomaniac  differing  from  the  maniac  as  the 
partial  eclipse,  a  slight  darkening  of  the  sky,  dif- 
fers from  a  total  eclipse  with  its  twilight  and 
chromosphere.* 

The  study  of  this  class  of  patients  is  of  interest  to 
society  and  to  the  profession,  for  the  two-fold  reason 
that  they  are  so  often  confounded  with  the  first 
class,  who  are  not  insane,  the  border-line  cases, 
and  because,  in  a  small  percentage  of  cases,  they 
commit  crimes  of  severity  and  come  into  court  and 
are  tried  for  such  crimes,  as  though  they  were  per- 
fectly responsible,  and  when  tried,  may  be  convicted 
unless,  perchance,  they  have  had  the  good  fortune 
to  be  admitted  to  insane  asylums. 

When  these  cases  enter  a  coui-t  they  become  a 
greater  terror  to  judges  and  juries  than  to  the  vic- 
tims of  their  crime.  During  the  past  century  this 
has  been,  amomg  English- speaking  people  especially, 
the  exciting  cause  of  a  measureless  quantity  of  ju- 
dicial nonexpertness  in  psychology. 

These  border-line  cases — cases  of  mm>o-Jii/pochon- 
dria — bear  to  cases  that  have  crossed  the  line,  the 
maniacs  and  monomaniacs,  somewhat  the  same 
relation  that  cases  of  neurasthenia  in  women  bear 
to  hvsteria  ;  and  the  study  of  feminine  neurasthenia 
and  "of  hysteria  is  a  valuable  preparative  to  the  study 
of  mono-hypochondria  and  monomania. 

Just  as  of  old  cases  now  known  to  be  illustrations 
of  neurasthenia,  classed,  studied,  diagnosed,  prog- 
nosed,  and  treated  as  such,  were  assigned  to  the 
realms  of  insanity,  or  ataxy,  or  general  paresis,  or 
spinal  congestion,"  or  cerebral  congestion,  or  cere- 
bral hemorrhage,  or  ataxy,  or  lateral  sclerosis,  or 
epilepsy,  just  so  these  cases  of  what  we  would  call 
mmio-h/pncJiondria,  with  special  and  limited  pha.«es 
of  morbid  fear,  mental  impairment  and  diminution 
of  responsibility,  may  have  been  classed  as  cranks, 
fools,  or  imbeciles,  men  who  are  not  insane,  any  m(  re 
than  they  are  neurasthenics,  or  hysterics,  or  epileptics, 
and  whose  symptoms— important,  interesting,  and 
instructive  as'  they  may  be — are  yet  never  to  lead,  as 
a  rule,  to  any  for"m  of"  insanity  ;  any  more  than  the 
cases  of  neurasthenia  are  to  go  on  to  epilepsy,  or  to 
any  grave  and  incurable  organic  disease  of  the 
nervous  system.  Yet  further  our  parallel  will  hold 
good,  and  it  may  be  claimed — and  observation  will 
establish  this  claim— that,  just  as  neurasthenia  saves, 
sometimes,  its  victims  from  the  graver  diseases 
which  it  so  well  .simulates,  and  for  which  it  has  been 
so  often  mistaken,  so  mono  hypochondria — this 
special,  limited,  and  comjiaratively  mild  form  of 
menial  impairment  with  slight  diminution  of  re- 
s]ionsibility--saves  its  victims  from  insanity,  with 
which  it  is  confounded,  the  lines  of  which  it  con- 
stantly threatens  to  cross,  without  ever  caiTying  its 
threat  into  execution. 

There  is  no  danger  of  making  too  clear  the  dif- 
ferential diagnoses  of  mono-hypochondria  and  mono- 
mania ;  for  in  the  best  current  psychological  litera- 
ture of  the  world— in  France  and  even  in  Germany, 
where  original  science  centres— cases  of  neurasthenia 
are  classed  as  cases  of  insanity,  referred  to  as  such, 
described  as  such,  and  their  prognosis  and  their 
treatment— if  they  have  any — are  based  on  this 
mistaken  diagnosis. 


•  In  mv  nrliclo  on  "The  0«  of  Gniee«n."  in  Journal  of  Norvou* 
DisfiiKO!!."  .Innnnry,  1888,  I  have  discussed,  more  in  detail,  the  subject 
of  partial  insanity. 


THE  MEDICAL  RECORD. 


315 


The  insane  may  have  morbid  fears,  but  morbid 
fears  are  not  necessarily  symptoms  of  insanity. 

Tliiis  Dr.  H.  Emminghaus  in  his  "  AUgemeine 
Psychopnthologie,"  page  Til,  speaks  of  agorophobia 
as  one  of  the  symptoms  of  insanity  as  described  by 
Westphal ;  Maudsley,  in  the  last  edition  of  "  The 
Pathology  of  Mind,"  follows  the  German  lead  in  this 
respect ;  also  Dr.  J.  Weiss  in  his  "  Compendium  der 
Psychiatrie,"  has  a  paper  on  fear,  as  one  of  the  symp- 
toms of  insanity  :  speaking — among  other  phases  of 
fear — of  panphobia.  At  a  meeting  of  the  Britisli 
Medical  Association  at  Cork,  in  1879,  Prof.  Ball 
of  Paris,  read  a  paper  on  claustraphobia — fear  of 
narrow,  closed  places,  the  opposite  of  agorophobia, 
fear  of  open  places — and  regarded  the  symi^tom  as 
indicative  of  insanity,  or  as  leading  to  it.  It  is  a 
fact  of  observation  that  fears  of  this  kind,  as  I  stated 
in  the  discussion  at  that  time,  and  many  other  forms 
of  fear  that  I  have  elsewhere  described  may  exist 
in  a  very  severe  form  indeed,  in  persons  who  are  not 
at  all  insane ;  who  may  do  business  and  acquire 
property  ;  they  may  be  very  hard  to  relieve,  and  yet 
not  be  in  any  sense  insane,  and  are  never  to  become 
insane. 

The  London  Lancet,  in  a  late  editorial,  speaks  of 
the  confusion  and  complexity  of  this  whole  subject 
of  insanity,  especially  in  morbid  fears,  to  which 
attention  has  been  directed  only  of  late.  The  edi- 
torial assumes  that  these  morbid  fears  are  phenomena 
of  insanity. 

jVf)  such  disease  as  mild  insanit;/. — No  one  can  be 
ft  little  crazy.  Insanity,  in  its  very  nature,  is  a  seri- 
ous disease,  and  he  who  is  not  seriously  sick  cannot 
be  insane.  All  insanity  is  p  .rtial  insanity.  There 
is,  indeed,  this  side  of  death  no  total  insanity,  but 
all  insanity,  though  it  be  partial,  is  serious  insanity. 
Mild  adjectives  before  insanity  are  contradictions. 
No  man  can  be  slightly  crazy,  as  no  one  can  have 
his  leg  a  little  broken.  A  fractured  thigh,  while  it 
lasts,  can  never  be  otherwise  than  a  serious  trouble, 
since  it  makes  it«  victim  a  physical  cripple  :  so  a  ' 
fractui-ed  mind,  while  it  lasts,  can  never  be  a  trifle, 
since  it  puts  its  victim  out  of  harmony  with  his 
environment  and  makes  him  a  mental  cripple.  i 

As  sprains   and  bruises  are  sometimes  mistaken   i 
for  broken  limbs,  so  mono-hypochondria  and  neu- 
rasthenia are  mistaken  for  insanity  ;  and  as  sprains   I 
and  bruises  may  be  even  more  obstinate  and  pro-   | 
tracted  in  their  course  than  fracture,  so  mono-hypo-   i 
chondria    and   neurasthenia    may,    in    some   cases, 
require  longer  treatment  than  the  far  graver  condi- 
tions of  monomania. 

The  recital  of  a  number  of  cases  of  mono-hypo- 
chondria, including  some  cases  of  general  neuras- 
thenia, on  the  one  hand,  and  those  of  monomania  on 
the  other,  g.ithered  from  mv  own  experience,  may 
help  to  make  clear  the  differential  diagnosis  here 
presented  better  than  extensive  abstract  reasoning. 

I  was  consulted  for  a  lady  of  great  eloquence  and 
persuasiveness,  who  had  over-worked  herself  in 
philosophical  and  religious  labors,  especially  in 
public  speaking,  which  she  took  up  suddenly,  and 
with  a  certain  dread,  under  the  inspiration  of  con- 
science and  without  previous  public  experience. 
This  unusual  exertion,  night  after  night  and  day 
after  day,  in  lines  of  labor  to  which  she  was  unac- 
customed, brought  her  into  a  state  of  profound 
bloodlessness  and  nerve-bankruptcy. 

The  feature  in  this  case  to  be  noted  is.  however, 
that  she  thought  and  talked  of  suicide,  and  lost,  or 
seemed  to  have  lost,  all  hope  both  of  this  world  and 
the  next,  and  it  was  feared— and  with  reason — that 


she  might  attempt  to  commit  suicide,  which,  I  be- 
lieve, she  did  not  do. 

I  was  able  to  keep  watch  of  this  case  afterward 
through  those  who  had  charge  of  her,  and  I  was 
cou^-inced  that,  while  she  was  near  the  border  line, 
she  did  not  cross  it.  Her  mental  responsibility  was 
impaired,  but  not  seriously.  She  could  not  have 
been  called  exactly  insane,  although  she  was,  per- 
haps, so  near  to  that  condition  as  one  could  well  le 
without  becoming  insane. 

I  saw  in  con.sultation,  not  long  ago,  a  lady  ■who 
was  a  sufferer  to  a  most  extraordinary  degree  from 
neuralgia,  and  who  was  at  the  same  time  atHicted 
with  many  neurasthenic  symptoms  ;  but  the  special 
feature  of  her  case  was  not  the  neuralgia  or  the  ntn- 
rasthenia  so  much  as  the  cerebral  disturbances  that 
appeared  in  the  morning  prior  to  a  neuralgic  attack. 
She  would  at  that  time,  for  a  few  hours  or  more,  be 
very  irritable,  ugly,  obstinate,  and  complaining,  was 
dissatisfied  with  every  thing  that  was  dene  for  her  : 
her  whole  moral  nature  seemed  changed  for  the 
time,  so  that  a  new  person  appeared  on  the  sc(ie. 
In  this  case  there  was  a  periodical  attack  of  men- 
tal impairment ;  a  loss  of  responsibility,  but  not 
a  serious  loss  ;  she  was  nervous,  but  not  insr-ne. 
She  was  not  mentally  herself  at  these  times,  but  she 
also  was  not  a  positive  hmatic. 

I  had  under  care  a  lady  with  all  the  phases  of 
neurasthenia  conceivable,  who  hss  anthiopcpliobia. 
or  fear  of  man.  in  a  tremendous  extreme.  She  is 
more  afraid  of  men,  she  says,  than  of  ■wild  animals. 
In  passing  up  and  down  the  street  she  would  raW  er 
meet  a  lion  than  a  human  being,  excejiting  only  her 
husband  and  her  parents  and  very  near  relatives. 

She  dreaded  terribly  to  ha^e  me  see  her;  and 
even  after  I  had  called  iipon  her  a  nr.mber  of  times, 
still  my  visits  were  annoying  to  her.  f.nd  were  fol- 
lowed by  exhaustion,  and  this  fact  became  a  very 
serious  one  in  undertaking  to  treat  her.  Many 
times  has  her  husband  called  upon  me  to  say  that 
his  wife  could  not  see  me  at  the  apjiointed  hour  ; 
that  there  must  be  delay  of  a  day  or  of  several  days, 
simply  because  she  had  not  the  courage  to  see  any 
one.  The  simple  presence  of  human  beings,  even 
although  they  did  not  speak  to  her  or  Icok  at  her, 
caused  her  great  distress  and  weakened  her.  In 
this  case  there  was  impniiment  of  mental  control, 
the  result  of  this  brain  bankruptcy,  which  .showed 
itself  in  this  fear  of  man  ;  but  by  any  theory,  defini- 
tion, or  conception  of  insanity,  she  was  not  insane. 
She  is  a  slave  to  her  environment,  but  in  a  degree 
she  can  control  her  environment.  She  might  be 
called  a  mono-hypochondriac,  but  cannot  and  would 
not  be,  and  is  not,  called  a  lunatic. 

I  had  recently  under  care  a  man  who  has  these 
symptoms  :  tremblirg  of  the  hands  and  feet,  trem- 
bling or  twitching  of  the  lips,  slowness  of  speech, 
difficulty  of  articulation,  impaired  memory,  diffi- 
culty and  slowness  of  mental  concentration,  dread 
of  going  upstairs,  and  uncertainty  of  gait  at  times. 
His  handwriting  is  so  affected  that  he  writes  like 
one  with  writers'  cramp,  very  slowly  and  tremblingly, 
and  in  writing  or  speaking  is,  or  was,  apt  to  use 
wrong  words  or  to  leave  out  words 

These  are  among  the  preliminary  symptoms  of  the 
general  or  progressive  paralysis  of  insanity,  and  very 
properly  belong  to  the  physical  and  mental  sympton  s 
of  that  disease:  but  this  man  is  not  insane.  His 
mental  responsibility  is  impaired,  but  not  seriously 
impaired  ;  he  cnn,  and  does,  attend  to  his  business, 
and  mingles  in  domestic  and  social  life.  Even  if  he 
should  develop  delusions  hereafter,  he  has  no  delu- 


316 


THE  MEDICAL  RECORD. 


sions  now ;  even  if  lie  should  subsequently  die  in 
the  insane  asylum,  he  is  not  insane  to-day. 

This  case  is  instructive  as  illustrating  the  position 
I  have  elsewhere  maintained,  that,  in  court,  the 
physical  symptoms  that  sometimes  accomijany  in- 
sanity should  not  be  referred  to  by  experts.  Insan- 
iti/is  a  mental  disease,  and  is  to  he  dinijnosticaled  by 
mental  si/mptoms.  Although  this  man  had  some  of 
the  physical  symptoms  that  accompany  general 
paralysis  of  the  insane,  he  yet  was  not  insane.  I 
have  seen  a  number  of  cases  of  this  kind. 

I  had,  at  different  times,  under  charge  two 
ladies  who  were  very  nervous  indeed,  and  were 
troubled  with  many  of  the  usual  symptoms  of  ner- 
vousness, such  as  sleeplessness,  constipation,  indi- 
gestion, aching  feet,  monophobia,  or  fear  of  being 
alone,  etc.  One  was  troubled  with  a  fear  of  going 
downstairs,  the  other  had  a  fear  of  society,  of  meet- 
ing people  ;  one  was  married,  the  other  unmarried  ; 
the  married  one  felt  that  she  had  never  really  loved 
her  husband.  In  the  case  of  one  there  had  been  a 
family  history  of  insanity,  and  other  nervous  dis- 
eases ;  the  other  also  had  a  very  nervous  mother. 

Both  of  these  persons  were  troubled  with  a  pecu- 
liar kind  of  delusion,  of  which  they  could  not  rid 
themselves,  namely,  that  gentlemen  whom  they  met 
on  the  cars  and  in  the  streets  were  looking  at  them 
and  watching  them,  and  understood  the  secrets  of 
their  persons,  their  peculiar  disease,  and  their  lives. 
One  of  those  persons  subsequently  developed 
other  symptoms  of  positive  insanity,  and  was  for  a 
time  taken  care  of  by  her  friends  ;  the  other  was 
certainly  not  insane,  but  was  almost  insane,  and 
might  become  so,  but  had  not  when  I  last  heard  ; 
and  the  other  had  recovered  sufficiently  to  attend  to 
important  duties.  These  are  border-line  cases — 
mono-hypochondriacs. 

I  was  at  one  time  consulted  by  a  man  in  middle 
life,  who  had  recently  married,  and  who,  instead  of 
being  made  happy,  was  made  miserable  by  his  mar- 
riage. 

The  symptoms  were  subjective,  not  objective.  He 
loved  his  wife  and  she  loved  him ;  he  loved  her  as 
much  after  as  before  marriage,  but  the  thought  and 
act  of  marriage  seemed  to  have  developed  in  him  a 
mono-hypochondria,  for  which  he  had  somewhat  of 
an  inherited  tendency,  and  which  was  of  such  a  na- 
ture that  he  regretted  his  marriage.  This  regret 
began  before  marriage,  on  the  approach  of  the  wed- 
ding. It  was  not  caused  by  anything  in  the  conduct 
of  his  companion,  or  of  any  human  being,  but  arose 
in  his  own  brain. 

He  went  as  far  as  one  could  go,  without  being 
positively  insane ;  he  could  reason  about  his 
symptoms  intelligently  and  scientifically  ;  he  was  of 
a  cool,  calm,  and  matter-of-fact,  i-ather  than  an 
imaginative  temperament ;  lie  analyzed  his  difficulty 
with  calmness,  but  nevertheless  it  was  a  real  diffi- 
culty, of  a  most  serious  character  to  him  and  to  his 
wife.  It  was  accompanied  by  other  symptoms  ;  he 
lost  sleep,  and  bore  on  his  face  the  impress  of  sor- 
row all  the  while  ho  was  living  with  his  wife. 

They  talked  over  the  troidile  with  frankness  and 
kindness,  but  frankness  and  kindness  did  not  cure 
or  relieve. 

I  gave  him  various  remedies,  which  helped  him 
somewhat,  and  saved  him  from  disease,  and  I  then 
advised  temporary  separation,  which  advice  was  fol- 
lowed, and  with  most  excellent  results. 

This  man  would  by  many  have  been  called  a  fool, 
and  a  diagnosis  of  that  kind  would  be  most  obvious, 
indeed  ;  but  ho  was  not  a  fool  any  more  than  is  a 


small-pox  patient.  He  was  really  and  seriously 
sick.  It  was  a  case  of  mono  hypochondria,  a  serious 
case  enough  for  that  disease,  but  not  serious  enough 
to  bring  it  into  the  catalogue  of  insanity.  It  is  jjos- 
sible,  and  even  probable,  that  this  terrible  experi- 
ence saved  him  from  something  worse ;  for  he  has 
been  growing  better  and  better,  and  the  last  time  I 
heard  from  him  he  was  perfectly  well ;  though  I 
question  if,  even  now,  there  might  not  be  a  relapse 
under  exciting  conditions. 

A  young  lady  has  the  following  history,  As  the 
result  of  a  fall  on  the  ice,  some  years  before,  she  had 
developed  quite  a  large  number  of  nervous  symp- 
toms ;  one  of  the  chief  of  which  was  a  desire  to  go 
abroad,  where  she  had  once  before  been ;  and  with 
this  morbid  desire — for  in  this  case  it  was  morbid — 
there  was  great  irritability  in  small  matters,  men- 
tal depression,  tendency  to  weep,  neurasthenic 
voice,  aching  eyes,  spinal  irritation,  some  uterine 
trouble,  retroversion  and  leucorrUcca ;  there  was 
also  fear  of  society,  which  was  an  annoyance  to  her- 
self and  to  her  family. 

This  was  one  of  those  cases  which  are  hard  to 
manage,  but  they  are  not  insanity  ;  there  was  mental 
impairment,  but  not  of  the  most  serious  character. 
She  got  better,  but  she  did  not  get  well,  nor  did  she 
become  insane,  and  I  believe  she  will  not  become 
insane. 

I  had  under  care  for  a  long  time  a  man  who  had 
been  in  the  profound  stages  of  melancholia,  with  the 
delusion  of  having  committed  the  irupardonable  sin. 
A  simple  hypochondriac  does  not  have  a  fixed  delu- 
sion of  this  kind.  He  gave  up  his  biisiness  and 
devoted  himself  to  getting  well ;  he  has  now  returntd 
to  business;  but  the  struggle  was  a  long  and  a  hard 
one.  One  of  the  symi:)toms  of  his  condition  was 
writing  exceedingly  long  letters  and  preparing  very 
long  documents.  This  is  one  of  the  symptoms  of 
insanity  when  it  occurs  in  a  person  who  does  net 
naturally  do  such  things.  As  he  improved  in  health, 
his  letters  became  shorter  and  shorter,  more  cohe- 
rent and  more  to  the  point. 

There  were  many  physical  symptoms  which  ac- 
companied this  condition  ;  he  was  troubled  with 
sleeplessness,  with  constipation  and  indigestion ; 
and  yet,  with  all  this  history  of  brain  disorder,  his 
mind  was  usually  clear  enough  all  through  to  trans- 
act business,  and  to  mingle  in  society  ;  and  had 
there  been  any  interests  involved,  tliere  would  have 
been  strong  opposition  to  the  view  that  he  had  betn 
at  any  time  insane  ;  although  there  is  no  question 
but  at  times  his  mental  responsibility  was  iminiired 
quite  seriously.  It  was  a  ca.se  of  mono-hypochondria 
deepening  at  times  into  insanity,  then  returning  to 
hypochondria,  thence  to  recovery. 

A  married  lady  consulted  me,  with  many  symp- 
toms, the  chief  of  which  was  what  I  call  niono}ihobia 
— fear  of  being  alone  joined  with  fear  of  travel- 
ling. Tliis  symptom  came  upon  her  suddenly,  al- 
most like  a  stroke  of  lightning,  at  the  Exposition 
at  CLiicago,  her  friends  having  left  her  for  a  few 
moments  alone  while  she  was  in  a  state  of  nervous 
depression. 

This  symptom — monophobia — is  common  enough, 
but  it  is  rarely  so  bad  as  in  the  case  of  this  lady ; 
she  must  have  not  only  a  amipnnion,  hut  companiuns 
— a  body  guard.  When  she  came  to  see  me  she  came 
with  her  mother  and  sister.  She  said  she  could  not 
come  alone,  or  even  with  her  husband  ;  for  he  might 
leave  her  alone  for  a  few  moments,  but  her  mother 
would  be  more  likely  to  stay  with  her,  and  this 
thought    gave  her  a  feeling  of    greater    security 


THE  MEDICAL  RECORD. 


317 


with  her  mother  and  sister  than  when  with  her  hus- 
band. 

Her  motlier  told  me  that  some  one  must  always 
be  with  her,  even  at  home  ;  if  she  even  suspects 
that  they  are  going  out  to  leave  her  alone  her 
countenance  will  change,  she  will  show  her  fear  at 
once,  in  her  face. 

This  lady  is  not  a  fool,  and  she  is  not  crazy  ;  she 
is  bright,  intelligent,  intellectual,  a  remarkably 
brilliant  conversationalist,  and  is  fully  able  to  com- 
prehend her  condition. 

As  a  girl,  she  was  lively,  not  melancholy ;  but  she 
came  of  a  nervous  family,  or  rather  from  a  family 
in  which  there  was  a  nervous  tendency ;  and  in  her 
case,  nervousness  takes  the  form  of  mono-hyi^oohon- 
dria — a  sjiecial  form  of  mental  impairment  which  is 
not  insanity,  and  is  not  likely  to  develojj  into  in- 
sanity. 

There  is  also  in  the  case  of  this  lady,  pantophobia 
— a  dread  or  fear  of  everything — she  has  a  dread  of 
assuming  responsibility  ;  for  example,  she  plays  the 
piano  well,  but  cannot  iJlay  in  public  if  announced 
beforehand. 

Morbid  impuheis. — Morbid  impulses  are  not  neces- 
sarily symptoms  of  insanity.  On  this  head  it  is 
proper  that  we  should  dwell  for  a  moment,  for  it 
seems  to  be  understood  among  neurologists  of  all 
countries  that  these  morbid  impulses  are  symptoms 
of  insanity ;  I  cannot  but  regard  it  as  an  error  that 
these  views  should  be  held  and  diffused  among 
society. 

True,  there  are  indeed  morbid  impulses  that  are 
serious  enough  to  indicate  seilous  mental  impair- 
ment, as  when  a  mother  is  forced  to  murder  her  be- 
loved and  favorite  child,  or  to  commit  suicide,  but 
there  are  vast  armies  of  morbid  impulses  that  are 
not  signs  of  lunacy  ;  the  more  mild  are  evidences 
of  mild,  not  serious  mental  impairment,  not  un- 
controllable enough  to  be  thought  signs  of  so  grave 
a  condition  as  insanity.  Pex'sons  who  are  thus 
affected  are  border-line  cases,  who  may,  or  may  not, 
ever  cross  the  border  ;  they  say  they  are  tempted  to 
kill  themselves,  at  different  times,  all  their  life  long, 
or  they  are  tempted  to  kill  others — their  husbands, 
their  wives,  their  children,  their  neighbors,  or 
their  friends  ;  but  as  "  barking  dogs  seldom  bite," 
they  never  do  any  harm  to  themselves  or  others ; 
they  are  not  mono-maniacs,  but  mono-hypochon- 
driacs. 

It  has  been  said,  and  it  will  again  be  said,  that 
persons  who  have  these  morbid  impulses  can  be  in- 
fluenced by  fear  of  punishment,  and  very  well  they 
may,  for  they  are  not  insane  ;  if  they  should  become 
insane,  the  fear  of  distant  punishment  would  have 
no  influence  over  them. 

I  had  under  my  care  the  wife  of  a  clergyman  of 
this  city  who  has  been  annoyed  with  this  morbid 
impulse — to  cut  herself  with  a  knife.  She  has  said 
to  me  that  she  hates  to  take  a  knife  in  her  hands, 
for  fear  she  may  cut  her  throat.  This  lady  is  ner- 
vous, but  she  is  not  insane  now,  whatever  may  be 
developed  hereafter ;  her  impulse  is  controllable. 
and  will  probably  remain  controllable. 

I  had  under  my  care  a  young  man  who  had  the 
following  symptoms :  fear  of  society,  which  kejjt 
him  fi'om  going  among  sti'angers ;  poor  memory, 
mental  depression,  and  a  morbid  fear  that  he  may 
say  or  do  some  foolish  thing  in  society ;  even  when 
alone  he  fancies  himself  in  society,  and  saying  fool- 
ish things  there  ;  he  talks  to  himself  in  the  street 
without  knowing  it ;  he  has  this  morbid  impulse, 
when  he  has  a  knife  in  his  hands  he  desires  to  cut 


himself ;  but  he  does  not  do  so,  and  is  not  likely  to. 
His  mental  capacity  is  impaired,  but  not  seriously 
enough  impaired  to  class  him  among  lunatics. 

There  is  a  case  of  a  once  well-known  clergyman, 
to  which  my  attention  has  been  called  by  my  friend. 
Dr.  Joseph  Parrish  This  clergyman  has  been 
obliged  to  give  up  his  pulpit  and  entirely  desist 
from  preaching,  because  of  in-esistible  attacks  ofpro- 
faniti/  that  come  upon  him.  He  would  be  writing  a 
sermon,  perhaps,  when  one  of  these  profane  im- 
pulses would  seize  him,  and  he  would  arise  from  his 
desk,  walk  up  and  down  the  room  shaking  his  lists, 
and  utter  in  rapid  succession  various  and  violent 
oaths,  after  the  manner  of  pirates  and  blackguards. 
The  attack  would  last — like  an  attack  of  neuralgia, 
sick  headache,  nervous  dyspepsia,  or  hay-fever — for 
a  limited  time,  then  the  storm  passed  over,  and  the 
air  was  once  more  clear,  until,  through  over-labor  or 
mental  effoi't,  a  new  excitement  was  aroused.  So 
severe  was  the  affliction,  and  so  great  his  dread  that 
an  attack  might  seize  him  in  public,  that  he  perma- 
nently abandoned  the  ministry. 

This  case  is  quite  well  known,  and  it  is  specially 
noticeable  from  this :  that  he  was  a  clergyman's  son, 
and  had  been  well  brought  up — certainly  was  not 
brought  up  to  swear. 

Is  this  accomi^lished  gentleman  and  able  clergy- 
man a  lunatic?  and  if  his  impulse  should  take  an- 
other form,  if  swearing  should  give  way  to  murder- 
ing, would  he  subject  himself  to  be  hanged  in  the 
presence  of  his  congregation  ? 

According  to  my  analysis  his  mental  resjaonsi- 
bility  is  impaired  ;  but  not  so  seriou.sly  impaired  as 
to  constitute  insanity  ;  for  although  the  impulse  to 
swear  is  as  irresistible  as  an  attack  of  inebriety,  of 
neuralgia,  or  sick  headache,  or  sleeplessness,  under 
a  special  exciting  cause,  such  as  mental  excitement 
or  over-work,  yet  he  still  has,  and,  as  I  believe,  al- 
ways has  had  it  in  his  power  to  control  these  excit- 
ing causes,  and  this  fact  alone  saves  him  from  abso- 
lute insanity.  He  is  on  the  border,  but  not  over  the 
border,  and  may  never  cross  it. 


Baltiiiobe  Medk'.a^l  Colleges,  etc. — The  com- 
mencements of  the  Baltimore  schools  took  place  on 
the  1st  and  7th  inst.  The  University  of  Maryland 
graduated  69  ;  the  College  of  Physicians  and  Sur- 
geons, 1.51 ;  the  Baltimore  Medical  College  (recently 
organized)  17,  including  one  female.  At  the  annual 
meeting  of  the  Alumni  Association  of  the  University 
the  oration  was  delivered  by  Professor  Eobert  Bar- 
tholow  (class  of  "52),  and  a  prize  of  fifty  dollars  was 
awarded  Dr.  Randolph  Winslow  for  an  essay  on 
"  Abnormalities  in  the  Circulation  in  Man."  A 
"Woman's  Medical  College,"  for  the  exclusive  educa- 
tion of  women,  has  lately  heen  incorporated,  with  a 
faculty  of  six,  all  gentlemen.  The  college  has 
already  been  located  in  a  central  position,  and  lec- 
tures will  commence  October  1st,  a  hospital  for 
women  and  children,  a  training  school  for  nurses, 
and  a  nurses'  directory,  similar  to  the  one  in  Bos- 
ton, will  be  carried  on  in  connection  with  it.  There 
is  much  di  cussion  now  as  to  the  permanent  site  of 
the  Johns  Hopkins  University,  whether  it  shall  re- 
main in  the  city  or  be  transferred  to  Clifton,  in  the 
suburbs,  as  .Johns  Hopkins  himself  designed.  An- 
other subject  of  interest  to  the  Maryland  profession, 
is  that  of  the  regulation  of  prostitution,  which  has 
been  brought  prominently  forward  through  the  in- 
fluence and  writings  of  Dr.  John  Morris. 


318 


THE  MEDICAL  RECOKD. 


A  CONTEIBUTION  AS  TO  THE  EFFICACY 
OF  ESEEINE  ESf  GLAUCOaiA  AND  AN- 
ALOGOUS AFFECTIONS. 

Br  CORNELIUS  WILLIAMS,  M.D., 

NEW   TORE. 

On  January  8,   1881,  L.  G ,  fifty  years  of  age, 

presented  himself  to  me  at  tlie  Ophthalmic  and 
Aural  Institute,  ailing  as  follows  :  The  conjunctiva 
of  the  right  eye  was  much  reddened,  the  vessels  dis- 
tended, no  unusual  secretion.  The  cornea  some- 
what hazy  ;  a  very  pronounced  zone  of  ciroumcorneal 
injection ;  iris  dull  and  lustreless,  with  here  and 
there  some  inflammatory  elevations  upon  its  sur- 
face ;  pupil  about  twice  the  size  of  the  other ;  does 
not  react  to  light ;  VI  -(- ;  media  so  opaque  as  to  allow 
only  the  larger  vessels  of  the  fundus  to  be  seen. 
The  patient  complained  of  great  pain,  preventing 
sleep  and  destroying  appetite. 

Diagnosis. — Iritis  plastica  ;  glaucoma  consecutiva. 
Patient  stated  that  the  eye  had  been  inflamed  for 
five  or  six  days,  and  that  a  lotion  obtained  from  a 
druggist  only  had  been  used. 

I  admitted  him  to  the  hospital,  and  ordered  six 
leeches  to  the  temple,  a  brisk  purgative  to  be  ad- 
ministered (the  man  was  of  full  habit),  and  instilled 
a  one  per  cent,  solution  of  eserine  into  the  eye,  and 
ordered  that  he  be  confined  to  bed  in  a  darkened 
room.  The  solution  of  eserine  I  dropped  into  the 
eye  at  once,  and  while  the  patient  was  yet  in  the  dis- 
pensary 1  noted  that  there  was  lessening  of  the  size 
of  the  pupil,  with  diminution  of  tension. 

On  the  9th  I  found  the  pupil  again  dilated.  Tl. 
Fai'ther  instillation  of  eserine,  and,  at  the  suggestion 
of  Dr.  Knapp,  occasional  instillation  of  atropine,  one 
per  cent.,  was  practised,  to  the  end  that  synechia 
might  be  prevented.  The  succeeding  five  days  were 
marked  by  increase  of  tension  at  night,  with  conse- 
quent pain  and  sleeplessness,  to  be  followed  by  de- 
cided diminution  of  tension  with  gTeater  ease  on  the 
morrow,  the  result  of  the  eserine.  The  use  of  the 
atropine  was,  after  the  first  day  or  two,  found  to  be 
unnecessary ;  for  while  it  probably  favored  increase 
of  tension,  it  became  evident  that  the  nocturnal 
glaucomatous  dilatation  of  the  pupil,  and  subsequent 
contraction  by  eserine,  would  effectually  prevent  ad- 
hesions. 

On  the  14th,  after  a  more  than  usually  restless 
night,  the  tension  again  increased  to  Tl  -f ,  and  did 
not  yield  to  several  instillations  of  eserine.  Dr. 
Knapp  thought  sclerotomy  would  have  to  be  done, 
unless  the  tension  could  be  speedily  reduced.  I 
ordered  chloral  hydrat.,  1.2.5,  potass,  bromid.,  1..50, 
and  eserine  to  be  instilled  every  four  hours. 

On  the  15th  I  found  T  +  only.  Patient  had  passed 
a  comfortable  night,  and  there  was  less  injection  of 
eyeball.  After  this  the  progress  toward  complete 
recovery,  though  very  slow,  was  steady  and  under 
daily  instillations  of  eserine,  and  occasional  draughts 
to  induce  sleep,  tlie  patient  was  so  far  well,  that 
at  the  end  of  three  weeks  he  wa&  discharged,  to  be- 
come an  out-patient.  At  time  of  discharge  the  con- 
dition of  the  eye  was  Tn.  ;  (conjunctiva  still  red,  and 
some  circumcornoal  redness,  with  bluish  lustre  of 
sclerotic  ;  ])upil  normal  in  size,  but  reacts  a  little 
more  slowly  than  the  other ;  media  clear ;  optic  disc 
redder  than  its  fellow ;  choroidal  congestion ;  no 
limitation  of  visual  field  (I  regret  that  I  have  no 
record  of  the  examination  of  the  field  at  the  time  of 
his  entrance,  though  I  think  there  was  no  decided 
limitation)  ;    no    excavation ;    vision,    iili-      Patient 


says  he  sees  nearly  as  well  as  ever.  The  patient 
continued  to  report  frequently  at  the  dispensary. 
The  circumcorneal  congestion  very  gradually  faded, 
until  at  the  end  of  six  weeks  all  that  remained  was 
the  dark  bluish  discoloration  of  the  upper  part  of 
the  sclerotic. 

rNJTJKY  vmn  much  KaatOPHTHALMOS — DISLOCATION  OF 
LENS  INTO  VITREOUS — CONSECOTm!  GLAUCOMA. 

On  December  28,  1880,  Mrs.  A.  McG ,  fifty- 
two  years  of  age,  was  sent  to  me  by  my  colleague. 
Dr.  Wallach,  at  Mt.  Sinai  Hospital.  A  few  days  be- 
fore, while  cutting  wood,  a  piece  flew  up  and  struck 
the  left  eye,  destroying  its  vision  in  a  few  moments. 
On  examination  I  found  some  contusion  of  lids,  con- 
gestion of  conjunctiva,  circumcorneal  injection  ;  cor- 
nea clear ;  anterior  chamber  seemed  to  be  entirely 
filled  with  dai'k  blood  ;  Tn.  ;  mobility  unimpaired ; 
no  perception  of  light.  Ordered  atropine,  0.06  to 
15.00,  to  be  dropped  into  the  eye  three  times  a  day, 
and  bandage. 

January  4,  1881. — Patient  came  again.  Has  had 
considerable  pain  ;  circumcorneal  injection  increas- 
ed ;  no  change  in  condition  of  anterior  chamber  ; 
T2.  Ordered  eserine,  0.015  to  2.00,  to  be  dropped 
into  the  eye  four  times  a  day  ;  bandage.  Stopped 
atropine.  Four  compound  cathartic  pills  to  be 
taken  at  bedtime. 

January  0th. — Condition  of  eye  much  improved. 
The  blood  in  anterior  chamber  has  lieen  now  so  far 
absorbed  that  the  ii-is  is  visible ;  the  pupillary  area 
is,  however,  entirely  occluded ;  less  circumcorneal 
injection.  Continued  eserine ;  Tn.  ;  no  pain.  The 
pills  produced  free  purgation. 

January  7th. — Eye  still  clearing  up.  Pupillary 
space  in  part  free,  and  it  is  found  that  the  lens  is  dislo- 
cated into  the  vitreous.  Clots  of  blood  float  to  and 
fro  through  the  pupil,  with  the  movements  of  the  eye, 
like  pieces  of  flotsam.  Tn. ;  circumcorneal  injection 
disappearing.  Can  discern  motions  of  the  hand, 
though  the  background  cannot  yet  be  illuminated. 
Eserine  to  be  continued. 

Januai-y  11th. — There  now  seems  to  bo  no  iritis. 
The  grosser  details  of  the  fundus  can  be  made  out 
with  the  ophthalmoscope,  and  with  the  aid  of  a  lens 
patient  can  count  fingers  at  five  feet.  Tn.  :  clots  of 
'  blood  still  float  about  within  the  eye.  Ordered  to 
use  eserine  every  other  day — one  or  two  drops  ;  to 
report  from  time  to  time. 

I  saw  the  patient  at  intervals  of  a  week,  for  a 
couple  of  months.  There  was  no  return  of  the  glau- 
comatous symptoms  ;  the  eye  became  clearer,  but 
vision  remained  about  the  same.  I  cautioned  her 
as  to  the  danger  that  she  was  constantly  exposed  to, 
and  told  her  to  come  at  once  upon  the  supervention 
of  any  disagreeable  feeling  in  either  eye. 

ACUTE  GLAUCOMA  IN  A  MYOPIC  EYE. 

On  November  19,  1881,  Louis  Suleger,  aged 
thirty -two,  (iernian  druggist,  myopic  \,  came  to  me  at 
the  Ophthalmic  and  Aural  Institute  with  the  follow- 
ing condition  of  the  left  eye  :  Conjunctiva  moderately 
injected ;  some  haziness  of  cornea  ;  pupil  dilated  to 
about  twice  its  natural  size,  slightly  movable  under 
oblique  light  ;  Tl  -f  ;  diftuso  opacity  of  the  vitreous  ; 
no  details  of  the  fundus  can  be  made  out  by 
ophthalmoscopic  examination,  except  the  outlines  of 
the  larger  vessels  ;  can  count  fingers  at  throe  feet ; 
visual  field  much  narrowed,  almost  absent  on  nasal 
side.  (This  examination  was  made  in  the  dark 
room  bj'  artificial  light.) 

Patient  states  that  his  eye  had  been  painful  with 


THE  MEDICAL  EECOED. 


319 


failing  vision  for  six  clays.  Dr.  Knapp  saw  this 
patient,  and  in  his  opinion  the  tension  was  T2.  I 
immediately  put  several  drops  of  a  solution  of  eser- 
ine,  one  per  cent.,  into  his  eye,  whioh  I  rejjeated 
several  times  in  the  course  of  the  hour  that  he  re- 
mained at  the  dispensary  ;  ordered  that  four  leeches 
be  applied  to  the  temple,  and  prescribed  a  calomel 
and  podophyllin  purge,  to  be  followed  in  the  morn- 
ing by  a  saline  draught ;  also  that  eserine,  one  per 
cent.,  be  dropped  into  the  eye  four  times  a  day,  pa- 
tient to  lie  in  bed  in  a  dark  room.  There  was  a  slight 
diminution  of  tension  before  patient  left  the  hospital. 
November  21. — Patient  reported  again.  He  had 
applied  the  leeches  and  taken  the  purge  as  directed, 
but  had  failed  to  remain  quiet  as  ordered,  and  had 
lost  the  prescription  for  the  eserine.  The  media 
are  now  entirely  clear  ;  not  a  trace  of  opacity  in 
vitreous  :  fund^is  in  every  detail  to  be  seen  withoiit 
any  difficulty  ;  pupil  very  slightly  dilated  :  no  jiain  ; 
visual  field  much  larger,  but  still  markedly  con- 
tracted. (Examined  by  daylight.)  The  barest 
perceptible  increase  in  tension.  I  instiled  eserine 
again  :  ordered  the  patient  to  keep  quiet,  and  gave 
a  new  prescription  for  the  solution,  to  be  used  once 
a  day  ;  to  keep  the  bowels  open,  aod  to  report  again 
in  a  few  days,  or  at  once  upon  suijervention  of  any 
disagreeable  symptom. 

In  this  patient  there  was  also  no  excavation  of  the 
optic  nerve.  He  has  large  posterior  staphyloma  in 
both  eyes,  and,  undoubtedly,  if  I  had  an  opportun- 
ity of  proving  it,  I  would  have  found  some  increase 
of  his  myopia  in  the  eye  which  had  been  ali'ected 
with  glaucoma.  The  patient  would  not,  however, 
remain  in  the  hospital,  and  has  not  rej^orted  since, 
though  I  have  wi'itten  to  him,  and  I  regret  that  I 
cannot  rejjort  as  to  his  present  condition.  I  may 
say  the  same  of  the  other  cases  reported.  I  have 
used  eserine  in  other  affections  of  the  eye  than 
those  that  were  glaucomatous — notably  in  a  case  of 
diff"use  opacity  of  the  vitreous  withoiat.  as  it  subse- 
quently appeared,  any  gi-o.ss  lesion  of  the  choroid — 
with  very  marked  benefit.  I  have  now  under  treat- 
ment the  case  of  a  child  with  congenital  hydroph- 
thalmus  and  opaque  corneie  where  eserine  has 
been  used  for  six  months,  part  of  the  time  with 
atropine,  alternately.  In  this  case  there  has  cer- 
tainly been  improvement.  The  opacity  is  less, 
clearing  up  at  the  periphei-y.  The  eyes,  which 
wei'e  at  first  hard  with  a  very  deep  anterior  cham- 
ber, are  now  of  normal  tension,  anterior  chamber 
not  so  deep.  There  is  now  certainly  jjerception  of 
light,  which,  in  the  beginning,  was  not  to  be  de- 
monstrated. It  is,  however,  natural  that  as  the 
child  grows  older,  the  corneal  opacity  disaj^peariug, 
such  percipient  elements  of  the  retina  as  remain 
intact  will  be  called  into  functional  activity. 

In  a  case  of  congenital  irideremia,  which  I  have 
observed  for  several  years,  there  are  several  ciliary 
staphylomata,  and,  undoubtedly,  a  remittent  glau- 
coma. I  and  others  have  seen  the  patient  when 
there  was  decided  increase  of  tension,  and  she  de- 
scribes attacks  which  have  all  the  chief  signs  of 
glaucoma,  colored  rings,  great  pain,  with  almost 
total  blindness,  etc.  In  this  case  I  have  used  eser- 
ine by  instillation  into  the  eye,  with  the  positive 
effect  of  reduciuK  the  tension  to  the  normal. 

It  is  without  di5ubt  that  in  any  case  of  glaucoma, 
as  in  all  severe  diseases  of  the  eye,  general  treat- 
ment of  the  patient  is  of  the  very  highest  import- 
ance ;  and  further,  it  may  be  assumed  as  a  postu- 
late, that  the  same  is  too  frequently  ignored,  even 
flagrantly  neglected. 


.-  What  I  claim  in  the  foregoing  cases  of  glaucoma, 
treated  by  eserine  and  generally  is  not  that  the  eserine 
alone  did  the  work,  but  that  eserine  was  the  deter- 
mining and,  most  essential  factor  in  the  treatment — 
without  it  the  patients  would  not  have  been  re- 
lieved ;  without  the  adjuncts  used  they  may  not,  or 
possibly  could  not,  have  been  cured. 

In  the  latter  two  cases  mentioned  above  I  hojje  to 
have  something  to  say  more  at  length  at  a  future 
time,  and  also  as  to  the  etiology  of  the  disease 
glaucoma. 

About  the  pathogenesis  of  glaucoma  and  its  patho- 
logical environment,  very  much  has  been  written  of 
an  imaginative  character  that  in  the  light  of  riper 
experience,  has  not  stood  the  test  of  applied  inves- 
tigation. Theories,  perhaps  a  little  fanciful  and 
fine  drawn,  would  not  be  objectionable  if  borne  out 
by  facts  demonstrable  to  others,  or  not  borne  down 
by  other  facts  more  pertinent  and  convincing  hav- 
ing an  opposite  bearing. 

In  general  terms,  if  it  be  stated  that  there  is  an 
inflammatory  disease  of  the  choroid,  or  more 
broadly,  of  the  uveal  tract,  more  or  less  acute  in  its 
nature,  attended  by  transudation  of  fluid  in  exces- 
sive quantities  within  the  eye,  which  excess  of  fluid 
for  its  removal  is  operated  upon  according  to  the 
same  laws  which  govern  the  removal  of  pathological 
transudations  in  other  closed  spaces  of  the  body,  as 
was  its  transudation  in  the  first  place,  and  that  the 
subsequent  correlated  lahenomena,  or  lesions,  are 
strictly  mechanical  and  nutritive  in  their  essence, 
the  disease  glaucoma  will  have  been  defined. 

2-3  P.iRK  Atexue. 


Urports  of  hospitals. 


HOSPITAL  OF  THE  UNR^ESITY  OF  PENN- 
SYLVANLi,  PHILADELPHIA,  PA. 

Seuvice  of  WILLIAM  GOODELL,  M.D., 

PROFESSOR  OF   CLINICAL   GTNECOLOGT. 

(Repoi-ted  by  G0T  Hinsdale.  M.D.) 
UEINAET   CAICULI   IN   THE   FEMALE. 

Gektleiien  :  The  first  case  which  I  bring  before  you 
to-day  is  one  of  stone  in  the  bladder.  I  intended 
operating  last  Saturday,  but  her  catamenia  very  in- 
opportunely came  on.  Now,  it  is  always  a  good 
rule  to  adopt  not  to  perform  any  operation  on  the 
pelvic  organs  just  before,  or  during  the  monthly 
flirx,  for  there  is  a  greater  vulnerability  at  that  time 
than  during  the  intermenstrual  period. 

Stone  in  the  bladder  is  of  rare  occurrence  in 
women,  because,  as  I  said  to  my  class  yesterday,  in 
the  didactic  course,  calculi  easily  escape  through 
the  female  urethra,  owing  to  its  compamtive  short- 
ness and  large  bore.  As  a  rule,  stones  found  in  the 
female  bladder  are  not  formed  in  the  kidney.  All 
such  calculi,  after  escaping  from  the  ureter,  are 
generally  swept  out  at  the  next  micturition.  The 
stones  that  you  will  find  are  generally  foreign 
bodies,  which  have  been  introduced  from  prurient 
motives,  and  have  afterward  become  encrusted  with 
urine  salts.  The  nucleus  is  very  often  a  hair-pin.  or 
perhaps  a  slate-pencil,  which  has  been  passed  into 
the  urethra,  and  has  slipped  away  from  the  fingers. 

This  is  an  exceedingly  interesting  case,  because 
the  history  points  to  the  fact  that  the  stone  has  had 
for  its  nucleus  some  foreign  body.  The  woman, 
some  five  or  six  years  ago,  had  a  labor  followed  by 


320 


THE  MEDICAL  RECORD. 


pelvic  cellulitis  ;  there  has  probably  been  an  abscess, 
which  opened  a  way  of  communication  between  the 
rectum  and  the  bladder.  That  is  the  only  way  in 
which  I  can  account  for  some  symptoms  presented 
in  the  case.  The  patient  passes  from  her  bladder 
gas  with  a  characteristic  fecal  smell,  and  not  only 
this,  but  tomato  and  pear  seeds,  and  occasionally 
fecil  matter.  Around  these  foreign  particles  cal- 
culi may  i-eadily  form.  There  is  also  in  this  case 
the  usual  history  of  severe  cystitis,  there  being 
great  frequency  and  distress  in  making  water. 
Sometimes  she  passes  blood  and  pus,  and  often  she 
is  fairly  doubled  up  with  urinary  tenesmus. 

I  have  introduced  the  uterine  probe  into  the 
bladder  ;  there  is  a  very  audible  click  as  the  instru- 
ment comes  in  contact  with  some  foreign  body. 
Those  of  you  who  are  near  by  can  hear  it.  There 
would  be  a  louder  sound  if  I  had  used  a  larger  in- 
strument. Dr.  McOall,  the  attending  physician,  has 
also  obtained  the  same  sound,  and  on  that  account 
sent  her  to  me.  As  I  strike  the  stone  it  has  a  queer 
metallic  feel,  as  if  it  were  either  a  very  hard  stone, 
or  a  jiiece  of  metal. 

How  shall  we  remove  it  ?  Shall  we,  as  gynecol- 
ogists, crush  that  stone,  or  shall  we  endeavor  to  re- 
move it  through  the  urethra  ?  The  rule  to  guide  us 
is  this  :  If  the  stone  be  larger  than  the  girth  of  the 
index  finger,  do  not  attempt  to  remove  it  through 
the  urethra  ;  an  incurable  incontinence  of  urine  will 
be  likely  to  follow  if  you  try  to  remove  too  large  a 
stone  in  this  way  ;  in  such  a  case  it  is  far  better  to 
cut  for  it.  If,  however,  the  stone  be  of  moderate  di- 
mensions, you  can  dilate  the  urethra  to  the  size  of 
your  index  finger,  and  remove  it  with  a  delicate  pair 
of  forceps.  The  operation  of  vaginal  lithotomy  is  so 
easy,  and  siich  a  safe  one,  tliat,  in  the  majority  of 
cases,  it  would  be  better  to  resort  to  it  than  to  at- 
tempt to  crush.  If  you  feel  that  you  have  the  requi- 
site skill  to  attempt  this  operation,  very  well.  I5ut 
it  is  a  difficult  matter  if  the  stone  be  very  hard,  or  of 
large  size.  Let  me  estimate  its  size  and  determine 
its  form  with  my  finger. 

I  take  this  uterine  dilator,  which  serves  so  many 
good  purposes,  and  pass  it  into  the  urethra.  These 
bladders  with  cystitis  are  dreadfully,  dreadfully  sen- 
sitive. It  gives  as  much  pain  to  touch  them  as  it 
would  to  pinch  an  exposed  nerve.  If  we  decide  to 
cut,  in  this  case,  how  shall  we  proceed  to  the  opera- 
tion ?  We  should  first  pass  a  sharply  curved  sound 
into  the  bladder,  and  push  down  the  ba.se  of  that 
organ  at  a  point  just  beyond  its  neck  ;  then,  with  a 
pair  of  scissors,  a  hole  is  cut  throiigh  the  anterior 
wall  of  the  vagina,  into  the  liladder,  uijon  the  tip  of 
the  sound.  The  hole  should  be  made  directly  in  the 
median  line,  and,  with  the  scis.sors,  the  incision  is  to 
be  carried  directly  upward  toward  the  cervix  uteri. 
By  following  this  course  we  .shall  avoid  any  injui-y  to 
the  neck  of  the  bladder  or  the  ureters.  After  re- 
moving the  stone,  the  edges  of  the  wound  are 
brought  together  with  silver  sutures,  and  treated 
in  precisely  the  same  manner  as  after  tlie  opera- 
tion for  vesico-vaginal  fistula.  In  cases  complicated 
with  cystitis,  as  in  the  present  instance,  it  is  lietter 
to  keep  the  incision  open  for  a  time,  until  the  irrita- 
tion caused  by  the  foreign  body  lias  been  relieved. 

A  few  years  ago  a  very  interesting  case  was 
brought  to  nio  for  operation.  The  subject  was  a 
hysterical  girl,  who  for  a  long  jteriod  could  not  jiass 
her  water,  the  physician  in  attendance  being  com- 
pelled to  use  a  catheter  several  times  a  day.  The 
silver  eatlieter  finally  became  worn  out,  and  on  one 
occasion,  while  in  the  bladder,  a  piece  broke  off ;  it 


could  not  be  removed  through  the  urethi'a,  and  the 
physician,  very  properly,  decided  to  cut.  In  doing 
the  operation,  however,  he  tut  the  neck  of  the  blad- 
der, and  subsequently  found  that  he  could  not  close 
up  the  wound.  He  then  brought  her  to  me,  and  I 
did  the  ordinary  operation  for  vesico-vaginal  fistula, 
but  her  health  was  very  poor  at  the  time,  and  every 
stitch  cut  out.  I  sent  her  home,  put  her  on  iron 
and  good  food,  and  after  her  strength  returned  I 
repeated  the  operation,  with  entire  success. 

While  talking  with  you  I  have  been  slowly 
stretching  open  the  urethra.  The  dilatation  must 
be  slow  to  do  no  harm.  I  now  coax  in  my  little 
finger,  which  has  been  well  oiled.  We  have  here  an 
unusually  small  urethra,  and  it  is  extremely  diftionlt 
to  make  any  progress.  In  fact.  Dr.  McCall  says 
that  the  urethra  was  so  small  that  he  could  hardly 
get  a  probe  in.  He  has  been  gradually  dilating  it 
for  several  days  before  bringing  the  patient  here.  I 
was  looking  at  the  little  rubber  bags  which  we  use 
in  labor  cases  to  dilate  the  cervix,  to  see  if  any  of 
them  could  be  introduced  into  the  urethra,  but  they 
are  too  large. 

This  woman's  urethra  is  so  unjielding  that  the 
pressure  on  my  little  finger  makes  it  numb  ;  but  I 
finally  reach  the  neck  of  the  bladder.  I  have  never 
bad  such  difiiculty  in  getting  into  the  bladder  before. 
I  can  just  touch  the  stone  ;  in  fact,  I  think  there 
are  two  of  them.  I  now  introduce  my  index  finger 
slowly,  and,  by  placing  a  finger  of  my  other  hand  in 
the  vagina,  I  lift  uj3  the  whole  tioor  and  fundus  of 
the  bladder.  I  can  readily  outline  two  stones.  I 
feel  them  perfectly  :  the  smallest  stones  will  rarely 
escape  detection  by  this  double  manipulation. 
Should  an  oiieration  through  this  vaginal  wall  be 
needed,  we  have  very  much  less  important  struc- 
tures to  cut  than  in  doing  lithotomy  in  the  male.  I  can 
feel  how  large  this  stone  is,  and  I  shall  try  to  grasp 
it  in  its  shortest  diameter.  I  introduce  these  fenes- 
trated forceps.  You  see  I  am  getting  it  out  precisely 
as  I  deliver  a  head  in  labor.  You  can  all  see  it  now 
emerging  from  the  urethra.  Let  me  see  if,  in  ex- 
tracting the  stone,  I  have  done  any  mischief  here. 
There  seems  to  be  only  a  little  bleeding  from  the 
upper  margin  of  the  meatus.  Now  I  shall  go  for 
the  other  stone.  Let  me  see  if  I  can  catch  it  end- 
wise. It  is  very  plainly  much  smaller  than  the 
other  one.  These  are  very  pretty  stones,  very 
smooth  and  very  hard  ones.  I  shall  put  them  on  a 
plate,  and  pass  them  around  for  your  inspection. 
We  must  now  see  if  there  are  any  blood-clots  re- 
maining in  the  bladder.  If  there  are,  they  must  be 
washed  out.  I  shall  now  pass  the  sound  gently 
here  and  there  in  the  bladder,  to  find,  if  possible, 
the  fistulous  opening  which  must  exist,  but  I  do  not 
succeed  in  hitting  it,  and  it  will  not  be  wise  to 
worry  the  bladder  by  a  prohmged  examination. 

How  shall  we  relieve  this  woman  of  cystitis  ?  It 
will  undoulitedly  be  relieved,  not  only  by  the  re- 
moval of  the  calculi,  but  by  the  overstretching  of 
the  walls  of  the  urethra.  The  latter  is  one  of  the 
best  means  we  possess  for  relieving  this  most  dis- 
tressing afi'ection. 

As  the  mucous  lining  of  the  bladder  has  un- 
doubtedly been  irritated  by  the  means  resorted  to 
for  remo\'ing  the  stones,  I  shall  give  this  woman  a 
mixture  containing  belladonna,  soda,  and  sweet 
spirit  of  nitre,  and  shall  also  prescribe  a  rectal  siip- 
pository  containing  one  grain  of  the  aqueous  ex- 
ti-act  of  opium,  to  be  used  at  bedtime.  She  will 
come  to  see  us  occasionally,  and  we  shall  keep  her 
under  observation  until  she  is  well. 


THE   MEDICAL  RECORD. 


321 


|)rogre00  of  iHetJtcal  Science. 


VALrE  OF  LiTHOLAPAXY. — Dr.  Van  Biiren,  of  New 
York,  in  giving  his  experience  of  the  operation  de- 
vised by  Dr.  Bigelow,  of  Boston,  says  that  he  has 
been  greatly  pleased  with  its  results.  The  bladder 
has  Vieen  found  amply  able  to  endure  the  prolonged 
operation,  and  he  believes  that  Ih'r/e/on^'s  operaliim 
will  add  honor  to  American  surgery.  In  thirty- 
four  cases  that  have  been  under  his  immediate 
supervision,  alone  or  in  conjunction  with  Drs. 
Keyes  and  Stimson,  since  January  1,  1879,  no 
stone  has  been  found  that  could  not  be  seized 
and  crushed  by  the  lithotrite,  and  the  bladder  each 
time  freed  from  the  fragments  at  one  sitting.  Of 
these  3J:  cases,  33  resulted  satisfactorily,  and  in 
the  one  fatal  result  an  autopsy  revealed  diseased 
kidneys  of  long  standing.  In  one  case,  of  a  man 
sixty-five  years  of  age,  urates  to  the  amount  of  1,06."> 
grains  were  washed  out  in  seventy-tive  minutes,  and 
the  patient  was  convalescent  within  a  week.  In 
another  case,  where  the  patient  was  sixty-five  years  of 
age  and  had  an  enlarged  prostate,  465  gi'ains  of  plios- 
phatie  depiosit  were  removed  in  sixty-five  minutes.  ' 
but  thoiigh  there  was  hemorrhage  from  the  enlarged  i 
gland,  no  chill  or  any  unfavorable  sequela  was  ex- 
perienced. Dr.  Van  Buren  believes  that  one  great 
advantage  of  this  operation  lies  in  the  fact  that  the 
bladder,  relieved  of  the  stone,  is  left  at  rest  and  free 
from  irritation.  In  a  small  proportion  of  cases  the 
catheter  was  required,  but  then  only  for  a  day  or  two. 
In  a  few,  where  chronic  cystitis  had  existed  previous 
to  the  operation,  the  deposit  appeared  at  intervals, 
but  judicious  treatment  checked  the  tendency.  In 
very  young  patients.  Dr.  Van  Buren  adheres  to  the 
older  views,  and  prefers  cutting,  because  the  ure- 
thra has  a  small  calibre.  In  some  thirty  or  forty 
cases  of  lithotomy  in  the  young,  he  has  had  a  favor- 
able result  in  every  instance. — Medical  Xea-s,  Janu- 
ary 14,  1882. 

Extra-Uterine  Pregnancy. — Dr.  Wm.  Goodell 
has  reported  the  case  of  a  patient  which  he  saw  in 
consultation  during  the  eighth  month  of  pi'egnancy. 
As  the  health  was  failing  rapidly,  he  performed 
laparotomy.  Upon  opening  the  perineum  a  cyst, 
containing  a  macerated  foitus,  was  disclosed.  The 
placenta  was  still  adherent.  The  fcetus  was  removed 
and  the  placenta  easily  stripped  from  its  bed.  No 
hemorrhage  followed.  Up  to  the  fifteenth  day  after 
the  ojieration  the  patient  did  well.  The  wound  had 
healed,  the  stitches  had  been  taken  out,  and  the 
drainage-tube  was  about  to  be  removed  when  con- 
vulsions suddenly  were  develojied  and  the  patient 
died  in  thirty-six  hours.  An  autopsy  revealed  dis- 
seise of  the  kidneys,  and  complete  disappearance  of 
the  cvst-wall.  No  connection  between  kidney  trouble 
and  the  abnormal  gestation  could  be  made  out. 

A  Dome  Trocar-Catheter. — Dr.  Fitch,  of  Hali- 
fax, Nova  Scotia,  has  devised  a  new  instrument 
called  the  dome  trocar-catheter,  for  tapping  the 
bladder  through  an  enlarged  prostate.  It  consists 
of  a  common  catheter  (No.  11  American)  running  in 
a  cauula  that  terminates  in  a  sharp  point,  the  canula 
being  fitted  with  a  piston  and  a  thumb-screw  at  the 
proximal  extremity,  so  that  advantage  can  be  taken 
of  the  one  or  the  other  at  the  will  of  the  operator. 
A  protuberance  near  the  cutting-point  of  the  canula   i 


protects  the  soft  parts.  To  tap  the  bladder  through 
the  prostate,  the  instrament,  arranged  as  a  catheter, 
is  introduced  by  the  urethra  until  resistance  is  felt 
at  the  enlarged  gland,  when  the  canula  is  thrust 
forward  by  means  of  the  piston  and  held  in  place 
by  the  thumb-screw,  and  the  instrument  is  then 
pushed  on  into  the  bladder,  when  it  is  reversed, 
and  the  urine  is  drawn  off  by  the  catheter.  A  small 
opening  at  the  extreme  end  of  the  catheter  allows 
urine  to  enter  the  instrument,  thereby  showing 
when  the  catheter  has  entered  the  bladder.  This 
little  instrument.  Dr.  Fitch  believes,  will  be  found 
useful  both  in  tapping  the  bladder  aliove  the  pubes 
thvougli  the  rectum,  or  even  in  tapping  ovarian 
cysts  throuijh  the  vagina. — Neu^  Yoi-k  Medical  Jour- 
nal, FebiTiary,  1882. 

Soluble  Compressed  Pellets  for  Hypodermic 
Use. — Dr.  Wilson,  Ophthalmic  and  Aural  Surgeon 
to  St.  Mary's  Hospital,  Philadelphia,  suggests  a 
new  method  of  putting  up  drugs  for  hypodermic 
use.  Solutions,  he  claims,  if  kejit  for  any  length  of 
time,  are  jirone  to  undergo  change  and  always  be- 
come inert.  Many  things  have  been  advised  to 
prevent  such  results,  but  in  vain.  In  ophthalmic 
surgery,  especially,  he  claims  that  serious  inflam- 
mation has  followed  the  use  of  the  ordinary  hypo- 
dermic solutions.  So  universal  is  this,  that  solu- 
tions are  less  used  than  formerly.  The  jjractice  oi 
making  them  extemporaneously  has,  therefore,  beer 
advised  by  Professor  Bartholow,  whose  name  is  inti- 
mately connected  with  hypodermic  medication  :  but 
this  practice  is  slow,  and  when  doses  below  one-third 
grain  are  required,  accuracy  must  be  impossible. 
Some  form  of  pre25aring  drugs  where  I'onvenience, 
accuracy  of  dose,  and  action,  are  combined,  is,  there- 
fore demanded,  and  Dr.  Wilson  claims  such  for  his 
compressed  pellet.s.  The  drugs  are  made  up  with 
sulphate  of  soda  simply,  which  acts  as  a  disinte- 
grator, and,  in  contact  with  water,  dissolves,  leavirg 
the  drug  in  a  finely  divided  condition.  The  ad- 
vantages he  claims  for  these  pellets  over  any  other 
form  of  hyijodermic  medication  are  :  Their  conve- 
nient size,  their  durability,  precision  in  do.'age,  cei'- 
tainty  and  quickness  of  action,  and  adaptability 
for  internal  administration,  especially  in  ophthalmic 
medication. —  Transactions  of  the  American  Medical 
Association,  1881. 

Bromide  OF  Ar!5Enic  IN  Diabetes. — Clemens  recom- 
mends the  liquor  arsenic,  bromat.  very  hi<?lily  in  the 
treatment  of  diabetes  insipidus  and  mellitus.  The 
dose  to  commence  with  is  one  drop  in  a  goWet  of  wa- 
ter, three  times  a  day.  This  quantity  should  be  grad- 
ually increased  to  three  drops  given  as  many  times 
daily.  As  soon  as  an  appreciable  diminution  is  noted 
in  the  amount  of  sugar  excreted,  which  usually  oc- 
curs within  two  weeks  from  the  inception  of  treat- 
ment, the  dose  should  be  gradually  reduced  to  the 
original,  and  this  should  be  kept  up  for  as  long  a 
time  as  may  be  thought  necessary.  No  harm  results 
from  continumg  the  use  of  the  remedy  for  months 
or  even  years.  The  diet  should  be  that  ordinarily 
recommended  for  diabetics,  and  the  patients,  more- 
over, should  be  out  in  the  open  air  as  much  as  pos- 
sible. CThe  author  neglects  mentioning  the  for- 
mula of  his  preparation,  which  he  introduced  in 
1859,  and  described  in  the  "Deutsche  Clinik  "  of  the 
same  year.  It  is  known  as  "  Liquor  arsenic,  bromat. 
Clementio,"  and  is  a  perfectly  colorless  and  tran- 
sparent fluid,  without  color  or  taste,  which  may  be 
obtained  from  Felix  Alfermann,  Berlin). — AVyevieine 
Med.  i'e-Htral-Zeilung,  Jan.  14,  1882. 


332 


THE  MEDICAL  RECORD. 


The  Medical  Recoto: 

^  lUcckln  Souvnal  of  illcbicine  anb  Surgerg 


!>EORGE  F.  SHRADY,  A.M.,  M.D.,  Editor. 


PnBLISnED   BY 
win.  WOOD  &  CO.,  No.  27  Oreat  Joneff  St.,  IV.  Y. 


New  York,  March  25,  1882. 


POSTGRADUATE    COUBSES. 

The  large  majority  of  graduates  from  our  medical 
colleges  leturn  to  tlieir  homes  and  at  once  prepare 
for  the  active  practice  of  their  profession.  In  most 
instances  the  reasons  for  this  are  twofold.  In  the 
first  place,  there  is  a  want  of  funds  and  a  pressing 
necessity  for  earning  a  living  in  the  shortest 
possible  period  ;  and  secondly,  there  are  few  oppor- 
tunities for  post-graduate  instiuction  aside  from  an 
appointment  as  interne  in  one  of  the  hospitals.  Of 
course  the  young  graduate  may  go  abroad  and 
continue  the  study  of  any  branch  of  medicine  or  sur- 
gery he  may  choose,  but  very  few,  comparatively 
speaking,  are  pecuniarily  able  to  do  this.  The  am- 
bitious man  will  continue  his  studies  on  his  own 
account,  it  is  true,  and  wiU  make  the  best  of  the 
chance  clinical  opportunities  which  his  scant  ])rac- 
tice  may  afford  :  but  that  he  is  far  from  being  satis- 
fled  with  his  efforts  is  evinced  by  the  large  percent- 
age of  practising  physicians  who  come  yearly  to 
this  and  other  medical  centres  for  the  sake  of  pro- 
fessional improvement.  In  some  of  the  medical 
schools  there  are,  during  each  term,  as  many  as  fif- 
teen to  twenty  per  cent,  of  medical  practitioners 
in  the  class.  These  gentlemen,  after  struggling 
along  as  best  they  could,  have  become  acipiainted 
with  their  deficiencies;  they  are  brought  by  liard  ex- 
perience to  appreciate  what  kind  of  knowledge  they 
require,  and,  often  at  great  sacriflce,  come  to  the 
fountain-heads  to  be  sujjplied.  There  is  hardly  a 
progressive  medical  man  away  from  the  centres  who 
does  not  at  some  time  or  other  hope  for  an  oppor- 
tunity to  live  over  the  general  experiences  of  his 
more  active  student  life  ;  to  study  disease  in  the 
hospital  ward  ;  to  perfect  himself  in  diagno<is  ;  to 
make  sure  of  physical  signs  ;  to  brush  up  on  his  sur- 
gical anatomy  ;  to  look  through  his  microscope  over 
the  shoulder  of  the  pathologist ;  to  witness  opera- 
tions by  the  hospital  surgeons — in  fact,  to  be  moro 


or  less  directly  in  communication  with  the  advanced 
thinkers  and  workers  of  his  day. 

As  a  rule,  such  gentlemen  who  visit  the  lai'ger 
cities  are  earnest  men,  faithful  workers,  and  deter- 
mined students.  No  one  must  doubt  that  they  are 
not  willing  to  do  to  the  uttermost  whatever  can  be 
done  to  render  their  stay  from  business  and  home  as 
profitable  as  possible.  In  this  connection  it  becomes 
our  medical  teachers  to  ask  themselves  the  question 
whether  or  no  the  facilities  which  are  afforded  these 
willing  and  ambitious  workers  are  what  they  should 
be.  We  think  it  must  be  answered  in  the  negative. 
It  is  true  that  there  are  occasionally  given  special 
courses  of  instruction  in  different  V)ranches,  but 
these  generally  are  little  more  than  spasmodic  efforts 
and  so  far  as  meeting  the  general  demand  for  post- 
graduate instruction  practically  amount  to  nothing. 
There  is  nothing  left  for  the  medica,l  man  but  at- 
tendance upon  someone  of  the  medical  colleges, 
and  the  taking  of  what  he  needs  fi-om  the  general 
course.  Comparatively  speaking,  he  obtains  very 
little.  He  does  not  expect  to  go  over  the  fundamen- 
tal branches  as  a  student,  and  consequently,  precious 
time  is  lost,  which  by  some  proper  system  of  study 
might  be  thoroughly  utilized.  He  may  visit  the 
college  clinics,  the  hosjiital  wards,  or  occasionally 
listen  to  a  didactic  lecture,  but  in  all  this  he  neces- 
sarily feels  that  he  is  treated  more  as  a  first-course 
student  than  a  man  whose  serious  business  it  is  to 
perfect  himself  in  the  higher  branches  of  his  calling. 
All  this  seems  to  our  mind  to  prove  the  necessity 
for  the  better  development  of  post-graduate  courses. 
Instead  of  the  latter  being  mei'ely  supplementary  to 
the  ordinary  college  coui'se,  as  at  jjresent,  they 
should  be  entirely  distinct  and  independent,  and 
every  effort  should  be  made  to  systematize  the  ad- 
vanced studies  belonging  to  such  a  course,  in  a  man- 
ner to  properly  economize  the  time  of  stay  in  the 
city  and  to  thoroughly  utilize  the  numerous  oppor- 
tunities for  clinical  instruction  which  abound  in  the 
great  cities.  Indeed,  there  is  no  reason  why  special 
advanced  schools  should  not  be  created  for  the 
puri^ose.  We  are  sure,  if  properly  managed,  that 
they  would  be  thoroughly  successful. 


BIKTHS   AND   DE.iTHS   IN    NEW   YORli   CITY. 

The  attention  of  the  profession  deserves  to  be  called 
to  the  very  complete  summary  of  liirths,  marriages, 
and  deaths  occurring  in  this  city,  compiled  by  Dr. 
John  T.  Nagle,  of  the  City  Board  of  Health. 

New  York  City  contained,  in  1880,  a  population  of 
1,206,577  inhabitants,  of  whom  727,743  were  native 
born.  The  average  number  of  persons  contained  in 
each  house  is  16.62.  In  contrast  to  this,  the  aver- 
age number  of  persons  in  each  house  iu  London  is 
7.8.  The  houses  in  London,  however,  are  closer  to- 
gether, since  there  are  42  i)ersons  to  the  acre  in  that 
city,  and  48.47  in  New  York. 

The  number  of  deaths  iu  this  city,  in  1880,  was 


THE   MEDICAL  RECORD. 


323 


31,937,  giving  a  death-rate  of  26.47  to  every  1,000 
inhabitants.  This  shows  a  diminished  mortality 
compared  with  the  first  half  of  the  preceding  de- 
cade, when  the  rate  was  over  28  per  thousand. 

Some  especially  interesting  facts  are  given  regard- 
ing the  deaths  from  pulmonary  diseases  in  this  city. 
The  deaths  since  180i  were  1,036,355.  Of  this 
number,  14.76  per  cent,  were  from  phthisis.  The 
per  cent,  of  deaths  from  phthisis  in  1880  was  14.73, 
and  for  the  decade  preceding  about  the  same  propor- 
tion. Thus  there  has  been  hardly  any  appi-eciable 
decrease  in  the  proportionate  number  of  deaths 
from  this  disease  in  late  years,  although  the  soil  has 
been  made  drier  by  extensive  sewers  and  drains. 
On  the  other  hand,  there  has  been  a  veiy  decided 
increase  in  the  jiroportionate  number  of  deaths  from 
pneumonia  and  bronchitis.  Thus  in  the  jjeriod 
from  1804  to  1842,  inclusive,  the  proportion  of 
deaths  from  pneumonia  and  bronchitis  to  the  deaths 
from  phthisis  was  33.81.  For  the  period  from  1843 
to  1880  the  proportion  was  66.29.  For  the  whole 
period  from  18W  to  1880  the  proportion  was  59.16. 
This  very  remarkable  increase  in  the  mortality  from 
pneumonia  and  bronchitis  is  a  fact  of  great  import- 
ance to  physicians  and  sanitarians.  The  ratio  of 
deaths  from  pneumonia  to  that  from  bronchitis  is 
about  as  five  to  two.  Most  of  the  deaths  from 
phthisis  were  among  adults. 

On  the  other  hand,  nearly  one-half  of  the  deaths 
from  pneumonia  were  among  children.  A  shghtlv 
less  number  of  deaths  proportionately  from  bron- 
chitis occurred  in  this  class.  The  facts  given  regard- 
ing deaths  from  diarrhcea  are  quite  generallv  known, 
and  we  need  not  refer  to  them  now. 

In  1880  there  were  1,419  deaths  attributed  to 
Bright's  disease.  It  is  a  curious  fact  that  a  very 
large  proportion  (396)  occurred  among  the  Irish, 
who  number  198,595.  There  were  only  360  deaths 
from  this  cause  among  the  native-born,  who  number 
727,743.  Cancers  caused  659  deaths.  The  most  fi-e- 
quent  form  of  the  disease  was  cancers  of  the  liver 
(151)  and  of  the  uterus  (151).  After  this  in  frequency 
come  cancers  of  the  stomach  (144),  and  then  cancers 
of  the  breast  (92 1. 

Nearly  one-third  of  the  deaths  during  1880  (9,572) 
were  from  zymotic  diseases.  Childi-en  suffered  by 
far  the  most  from  this  class,  the  total  mortalitv 
among  those  under  five  years  of  age  being  7,388. 
The  number  of  deaths  in  1880  from  croup  was  910  ; 
from  small- pos,  31 ;  from  cerebro-spinal  fever,  170  : 
from  suicide,  152. 

Considerably  over  one-half  (17,810)  of  the  total 
deaths  occurred  in  tenement-houses.  The  mortality 
in  children  living  in  such  houses  is,  as  is  well-known, 
very  great.  The  percentage  for  those  under  five 
years  of  age  was  56.69  ;  among  the  same  class  living 
in  private  dwellings,  the  percentage  was  only  39.79. 
Nevertheless,  as  we  have  previously  maintained,  ten- 
ement-houses are  not  any  more  fatal  to  children  than 


to  adults.  The  percentage  of  deaths  to  the  total 
mortality  was,  in  tenement-houses,  55.91 ;  in  private 
dwellings,  23.63. 

The  number  of  births  occurring  in  the  year  1880 
was  27,536,  which  gives  an  excess  in  deaths  of  4,201. 
This  would  have  a  very  dark  look,  were  it  not  that 
New  York  has  so  large  a  floating  population  and 
such  a  constant  influx  of  new-comers. 


ANTI-VACCTSM   AGAIN. 

Ix  the  cui-rent  number  of  the  North  American  Re- 
view; Dr.  Henry  A.  Martin  contributes  an  article  on 
anti-vaccism,  it  being  intended  as  a  reply  to  Mr. 
Bergh.  Dr.  Martin's  article  is  characterized  by  a 
tremendous  earnestness  that  makes  it  interesting 
and  effective.  He  has  represented  the  profession 
well  in  his  present  defence  of  its  position  regarding 
vaccination. 

The  charges  against  vaccination  are  two  :  (1)  that 
it  does  not  protect ;  (2)  that  it  introduces  disease 
and  impairs  the  vigor  of  the  system.  These  two 
l^oints  are  discussed  sejjarately  by  Dr.  Martin. 
With  regard  to  the  first,  he  does  not  attempt  to 
fortify  his  position  by  statistics,  but  simply  gives 
references.  The  evil  possibilities  of  small-pox  are 
portrayed,  however,  by  comparing  the  epidemic  of 
that  disease  in  Boston  in  1721  and  in  1872.  At  the 
former  period  over  half  the  population  were  struck 
down.  The  epidemic  of  1872  was  exceptionally  ma- 
lignant, and  it  no  doubt  would,  if  unchecked,  have 
afl'ected  an  equal  proportion  of  the  population.  In 
other  words,  it  is  all  but  certain  that  without  vac- 
cination there  would  have  been  100,000  cases  of 
small-pox  in  Boston,  and  50,000  deaths  from  it. 

A.  word  is  said  in  favor  of  "  those  twin  scourges 
of  humanity,  physic  and  physicians"  (Bergh).  It 
is  the  habit  of  the  less  decent  anti-vaccinators  to 
charge  physicians  with  encouraging  the  practice 
from  self-interest,  for  the  sake  of  the  fees  obtained. 
Dr.  Martin  states  (and  this  is  not  generally  known) 
that  the  medical  i^rofession,  when  they  first  unani- 
mously adopted  vaccination,  more  than  seventy 
years  ago,  did  so  at  a  great  pecuniary  loss.  Small- 
pox cases  brought  them,  before  Jenner's  time,  their 
greatest  fees  and  widest  reputation.  Indeed,  many 
of  the  eminent  physicians  of  the  last  century  were 
so  largely  by  reason  of  their  reputed  skill  in  treat- 
ing small-pox. 

As  regards  the  question  whether  disease  is  ever 
introduced  into  the  body  by  vaccination,  Dr.  Mar- 
tin adopts  the  general  opinion  of  the  profession, 
that  in, extremely  rare  cases  syphilis  may  be  inocu- 
lated when  humanized  virus  is  used.  Also  that  with 
this  latter  virus  a  form  of  erysipelas,  generally 
slight,  but  in  rare  instances  fatal,  may  follow.  He 
thinks,  however,  that  these  two  sequelae  may  be 
done  away  with  by  using  jmre  animal  virus.  We 
can  hardly  agree  with  this  latter  conclusion,  since 
cases  of  erysipelas  undoubtedly  occur,  not  so  very 


32-t 


THE  MEDICAL  RECOED. 


rarely,  after  the  use  of  the  bovine  virus  supplied  now 
in  this  city.  It  is  Dr.  Martin's  opinion,  however, 
that  such  results  indicate  an  impure  viras. 

As  regards  the  effect  upon  the  subsequent  general 
health,  there  is  no  evidence  whatever  that  the  vac- 
cine virus  affects  it  in  any  way.  Vaccinated  calves, 
after  their  pocks  have  healed,  are  said  to  be  excep- 
tionally healthy  and  to  fatten  easily. 

Dr.  Martin  concludes  his  article  by  reviewing  the 
facts  in  his  own  experience.  As  the  result  of  ex- 
ceptionally large  opportunities  of  observation  dur- 
ing a  professional  career  of  forty  years,  he  says  :  "I 
have  never  known  among  those  whom  I  have  vac- 
cinated a  single  case  of  small-pox  in  any  form  or 
modification,  except  a  certain  limited  number  into 
whose  system  the  germ  of  the  disease  had  entered 
before  the  time  of  vaccination.  I  have  never  seen 
or  sus2)ected  in  my  own  practice  one  such  case  as 
Mr.  Bergh  asserts  to  exi^t  by  millions.  I  have  never 
had  a  patient  die  in  any  way  that  could  be  directly 
or  indirectly  attributed  to  vaccination.  I  have  never 
had  the  slightest  reason  to  even  suspect,  in  a  single 
instance,  that  vaccination  had  in  any  way  impaired 
or  deteriorated  human  vitality,  but  have  seen  several 
cases  in  which,  besides  preventing  small-pox,  it  was 
the  means  of  carrying  off  certain  trivial  ailments,  and 
of  improving  the  general  health  of  the  patient."  He 
concludes  :  "  I  have  heard  of  a  school  that  is  not 

"  *  Any  school 
But  that  where  blind  and  naked  ignorance 
Delivers  brawling  judgments,  unashamed. 
On  all  things  all  day  long.' 

Is  Mr.  Bergh,  perhaps,  one  of  its  recent  graduates  ?  " 


THE   TOXIC    EFFECTS   OP   IODOFORM. 

Hakdly  has  the  announcement  been  made  that  iodo- 
form is  a  valuable  antiseptic  application  to  operation- 
wounds  when  cases  are  reported  proving  its  i)ositive 
toxic  effects.  The  paper  of  Professor  Sands  in  the 
present  issue  gives  some  very  interesting  facts  in  this 
direction,  and  helps  to  corroborate  a  similar  experi- 
ence on  the  part  of  several  German  surgeons.  It 
seems  to  be  settled  that,  contrary  to  what  was  at 
first  supposed,  iodofoi-m  has  positive  toxic  proper- 
ties, and  that  it  is  quite  necessaiy  to  use  it  with 
becoming  caution.  The  cases  related  by  our  con- 
tributor are  striking  and  instructive,  and  his  com- 
ments on  them  are  deserving  the  most  careful 
consideration  of  all  who  have  been  inclined  to  make 
a  free  use  of  the  drug  upon  freshly  cut  surfaces. 
The  warning  is  timely,  and  will  be  heeded  accord- 
ingly. Under  certain  circumstances  iodoform  is  a 
most  effective  antiseptic  application,  and  tlie  great 
pity  is  that  it  lias  associated  with  it  such  a  serious 
drawback.  It  is  quite  evident  that  cases  should  be 
selected  with  reference  to  certain  wound  conditions, 
and  then  the  drug  should  be  employed  only  in  rea- 
sonable quantity.  It  appears  to  he  safer  when  it  is 
applied  to  open  granulating  surfaces  than  to  frosh 


wounds.  In  fact,  for  more  reasons  than  one,  it  does 
not  seem  to  be  applicable  to  wounds  which  are 
subsequently  closed  as  on  such  in  which  union  by 
first  intention  is  looked  for.  Then  again,  idiosyn- 
crasy appears  to  influence  its  toxic  effects,  as  shown 
when  very  small  quantities  have  been  used  with  bad 
results.  Thus  far  comparatively  few  cases  of  poi- 
soning have  been  reported.  They  are  sufiticient  in 
number,  however,  to  be  significant. 

Some  time  ago,  Oberliinder  (Deutsche  Zeitschri/t 
far  praktisrhe  Medecin,  xxxvii.,  433)  observed  two 
cases  of  poisoning  caused  by  iodoform  administered 
internally.  In  one  case  •1'2  grammes  were  given  in 
eighty  days.  The  symptoms  were  vertigo,  prostra- 
tion, nausea,  and  vomiting ;  later,  emotional  ex- 
citement alternating  with  somnolence,  spasm  of  the 
facial  muscles  and  irregular  respiration.  In  the 
second  case,  similar  symptoms  followed  the  use  of 
5  grammes,  taken  within  a  period  of  seven  days. 
Both  patients  recovered. 

In  Billroth's  clinic, Mikuliez  (Langenbeck's  Archiv., 
vol.  i.,  1881)  met  with  several  cases  of  acute  intoxi- 
cation of  a  mild  character,  and  two  chronic  cases 
that  ended  fatally.  Case  1  was  a  child,  aged  nine,  in 
which  a  cold  abscess  of  the  thigh  was  opened,  scraped, 
and  filled  with  40  grammes  of  iodoform.  Bad  symp- 
toms appeared  on  the  twentieth  day — death  on 
twenty-eighth.  Case  2  was  a  child  of  five  years  of 
age,  in  which  resection  of  hip  had  been  performed, 
the  wound  was  filled  with  120  grammes  of  iodoform  ; 
symptoms  of  meningitis  appeared  on  the  twentieth 
day,  and  death  on  the  twenty -fifth  day.  The  autopsy 
showed  no  lesions. 

Henij  (Deutsche  Med.  Wochenschrift,  1881,  No.  84), 
reports  two  fatal  cases  (1),  a  man,  fifty-seven  years 
of  age,  intemperate ;  (2),  a  woman  aged  sixty-three 
years,  weakly.  Both  operations  were  for  caries.  In 
No.  1,  150  to  200  grammes  were  used ;  two  days  la- 
ter cerebral  symptoms  appeared,  and  death  occurred 
six  days  after  operation.  The  symptoms  were  not 
those  of  mania,  viz.:  headache,  drowsiness  followed 
by  coma,  rapid  pulse,  and  paralysis  of  sphincter.  In 
cose  2,  same  symptoms,  on  ninth  day,  after  employ- 
ment of  100  to  150  grammes ;  death  sixteen  days 
after  oi)eration.  Autopsy  showed  fatty  degeneration 
of  heart,  cloudy  swelling  of  liver  and  kidneys. 

Schede,  of  Hamburg  {Cenlralblalt  fur  Chiritrgie, 
January  21,  1882),  gives  fatal  case  of  a  child,  aged 
nine  years.  The  operation  was  for  resection  of  hip. 
The  wound  was  filled  with  iodoform  ;  three  weeks 
later  cerebral  excitement  was  followed  by  coma,  and 
death  after  four  days'  illness.  Tiie  autopsy  was 
negative. 

Hoeftmann  (Centrnlhlatt,  etc.,  February  18,  1882  >, 
out  of  one  thousand  cases,  had  two  of  poisoning, 
both  fatal.  Case  1  was  extensive  wound  after  extir- 
pation of  recurrent  mammary  cancer  :  the  quantity 
of  iodoform  used  was  35  grammes.  Mania  occurred 
on  the  third  dav  and  death  on  the  ninth  dav.     There 


THE  MEDICAL  RECORD. 


325 


was  no  autopsy.  Case  2  was  one  of  ovariotomv, 
20  grammes  applied  ;  mania  occurred  on  the  second 
day  and  death  on  the  third  day. 

Koenig  [Centralblatl,  etc.,  February  18  and  25, 
1882)  reports  thirty-two  cases ;  fifteen  of  slight  in- 
toxication, sis  severe,  seven  fatal  (all  adults) ;  and 
four  cases  of  children,  two  fatal ;  smallest  quantity 
used  in  fatal  cases,  10  to  15  grammes. 

It  is  quite  important  that  other  surgeons  should 
report  cases  which  have  suffered  from  the  poisonous 
effects  of  the  antiseptic,  in  order  that  the  indica- 
tions for  its  emi^loyment  may  he  clearly  marked  out, 
and  its  e-vil  effects  guarded  against.  It  is  certainly 
an  efficient  antisejjtic  in  proper  cases,  and  should 
not  be  discarded  without  further  trial. 


THE   REPOET   OF   THE   SENATE   COimTTTEE   rPOX   IXSAXE 
ASTIiUM   MANAGESDIEXT. 

The  committee  appointed  by  the  State  Senate  two 
years  ago  to  investigate  insane  asylum  management 
in  this  State  has  made  its  report. 

It  'is  very  gratifying  to  find  that,  as  a  result  of 
their  two  years'  study  of  the  subject,  conclusions 
are  reached  which  directly  contradict  the  report  of 
the  previous  committee,  and  which  affirm  nearly  all 
the  points  claimed  in  the  Kecord  and  elsewhere 
against  asylum  management  in  this  State. 

The  report,  which  is  a  brief  but  lucid  document, 
contains  a  number  of  propositions  regarding  the 
general  and  special  i^roblems  of  insanity.  Most  of 
these  are  not  new  to  medical  men,  but  it  is  an  evi- 
dence of  progress  that  they  are  understood  and  an- 
nounced by  a  committee  of  laymen. 

The  increase  of  insanity  is  referred  to,  and  its  dis- 
proportionate increase  is  accepted  as  a  fact.  It  is 
stated  also  that  there  is  a  disproportionate  increase 
among  the  pauper  insane,  and  also  of  the  "  border- 
land cases  "  and  of  the  slightly  or  partially  insane. 
The  prospects  of  ever  curing  any  large  per  cent,  of 
the  insane  are  thought  to  be  poor.  Efforts  should 
be  directed,  therefore,  rather  toward  preventing  it. 

The  defects  of  our  State  asylums  are  then  re- 
hearsed. The  lack  of  humanity  and  of  economy 
are  said  to  be  the  especial  defects  in  their  man- 
agement. The  insane  are  not  sufficiently  pro- 
vided with  employment,  amusement,  or  freedom. 
The  superintendents  are  rigidly  conservative,  and 
refuse  to  appropriate  the  more  recent  methods  of 
caring  for  their  patients.  The  money  expended  in 
building  the  asylums  cannot,  of  course,  be  replaced  ; 
but  it  is  recommended  that  for  the  future  more  eco- 
nomical buildings  be  constructed,  and  that,  so  far 
as  possible,  the  chronic  insane  be  cared  for  sepa- 
rately. 

The  establishment  of  small  local  asylums  at- 
tached to  the  county  jail  or  poor-house  was  not 
recommended,  since  what  would  be  gained  in  ex- 
pense at  first  would  be  lost  afterward. 

The  most  important  jjart  of  the  committee's  re- 


port was  the  emphatic  recommendation  for  the  es- 
tablishment of  a  State  Lunacy  Commission.  This 
commission  "  should  be  given  ample  powers  to  look 
after  the  interests  of  the  State  in  the  matter  of  ex- 
penditure and  to  protect  the  patient  in  the  matter 
of  physical  care,  with  full  powers  to  redress  all 
grievances  and  I'emedy  whatever  wrong  they  may 
discover. 

Viewing  the  report  as  a  whole,  we  can  make  very 
little  criticism  of  it,  except  that  it  lacks  somewhat 
in  detail,  and  that  its  view  of  the  increase  and  in- 
curability of  insanity  is  i^resented  in  only  its  darkest 
light.  It  would  have  been  well,  also,  if  the  commit- 
tee had  presented  the  problem  of  the  State  care  of 
the  insane  in  the  definite  form  suggested  by  Dr. 
Dana  in  a  paper  read  recently  before  the  National 
Association  for  the  Protection  of  the  Insane.  Ac- 
cording to  this,  our  legislators  should  bear  in  mind 
that  there  is  and  will  be  in  this  State  one  insane 
person  to  four  hundred  or  three  hundred  and  fifty 
sane,  and  three-foui'ths  of  these  need  to  be  provided 
for  in  public  institutions. 


ON   THE   rSELESSNESS   OF   SOME   OF   OrR    ORDINARY 
DISINFECTANTS. 

Some  time  ago,  in  commenting  on  certain  contribu- 
tions to  the  subject  of  disinfectants,  we  called  atten- 
tion to  the  inaccuracy  and  incompleteness  of  the 
present  knowledge  regarding  them.  This,  as  we 
then  averred,  is  a  matter  for  regret ;  for,  whatever 
position  micro-organisms  finally  take  in  our  path- 
ology, the  usefulness  of  disinfectants  will  not  be 
questioned,  and  it  is  of  the  highest  importance  that 
theu'  exact  power  be  known. 

In  an  official  volume  just  issued  by  Dr.  Struck, 
Chief  of  the  Sanitaiy  Department  of  Germany,  Dr. 
K.  Koch  has  published  the  results  of  his  studies 
ujjon  disinfectants,  and  has  contributed  to  the  sub- 
ject much  that  is  new. 

Koch  used,  in  order  to  test  the  value  of  a  disin- 
fectant, the  micro-  organisms  of  splenic  fever.  Sple- 
nic fever  is  a  septic  disease  of  a  low  specific  charac- 
ter. Its  organisms  exist  in  the  form  'of  minute, 
round  spores  or  micrococci,  which  afterward  develop 
under  favorable  conditions  into  slightly  larger,  rod- 
shaped  bodies  or  bacilli.  It  was  found,  though  this 
indeed  was  already  known,  that  the  spores  had  a 
much  greater  vital  resistance  than  the  bacilli. 

Two  per  cent,  solutions  of  carbolic  acid,  after 
three  days'  contact,  only  hindered  the  develoi:)ment 
of  the  spores,  but  even  five  per  cent,  solutions  did 
not  kill  them.  On  the  other  band,  one  per  cent, 
solutions  killed  the  bacilli  within  a  few  minutes. 
Furthermore,  one  part  of  carbolic  acid  in  1,000  parts 
of  beef-broth  prevented  the  further  development  of 
bacilli. 

These  are  important  facts,  since  they  show  a 
source  of  eiTor  in  former  exjieriments.  It  has  been 
stated  by   Endemann,   Sternberg,  and   others  that 


326 


THE  MEDICAL  RECORD. 


carbolic  acid  solutions  of  about  two  per  cent, 
strength  destroy  the  activity  of  low  organisms.  But 
this,  if  Koch's  experiments  are  correct,  evidently 
cannot  apply  to  all  organisms,  or  to  every  life-form 
of  the  same  organism. 

The  many  surgeons  whose  favorite  application  has 
been  carbolized  oil  will  be  surprised  at  Koch's  asser- 
tion that  "  carbolic  acid  dissolved  in  oil  or  alcohol 
has  not  the  slightest  disinfecting  power  " — meaning, 
it  is  presumed,  upon  splenic  fever  and  allied  septic 
organisms. 

Koch  tested  the  power  of  sulphuric  acid,  chloride 
of  zinc,  boras,  white  vitriol,  and  other  substances. 
He  found  them  absolutely  incapable,  in  any  ordinary 
solution,  of  killing  the  spores.  Such  substances  as 
arsenic,  quinine,  and  perchloride  of  iron  would,  in 
one  or  two  per  cent,  solution,  kill  the  organisms  in 
the  course  of  six  or  ten  days,  but  were,  on  the  whole, 
quite  feeble  disinfectants. 

On  the  other  hand  a  few  substances  only  were 
found  to  be  very  active.  Thus,  two  per  cent,  solu- 
tions of  bromine,  iodine,  and  chlorine,  and  of  corro- 
sive sublimate  (the  last  being  the  best)  killed  the 
spores  within  a  day.  The  power  of  these  latter  sub- 
stances to  prevent  the  activity  and  development  oi 
the  bacilli'  was  found  to  be  very  remarkable.  Thus, 
one  part  of  sublimate  in  500,000  of  water  would  com- 
pletely check  the  activity  of  the  organisms.  Certain 
volatile  oils,  such  as  thymol  and  terebinthene,  were 
also  efficient  in  dilutions  of  1  to  80,000  and  1  to  70,000. 
As  the  result  of  his  experiments,  Koch  came  to 
the  conclusion  that  only  bromine,  chlorine,  iodin 
sublimate,  and  the  few  oils  of  the  class  referred  to 
were  of  value  as  disinfecting  agents. 


HOSPITAL   EXAMINATIONS. 

The  season  for  hospital  examinations  has  commenced 
and  numerous  candidates  are  presenting  themselves 
for  interneship.  Competition  for  these  positions  is  so 
active  that  a  high  standard  of  qualification  is  guar- 
anteed to  such  as  successfully  pass  the  boards.  In 
not  a  few  of  our  hospitals  the  standard  is  equal  to 
that  of  entrance  to  the  medical  staff  of  the  army 
and  navy,  and,  in  fact,  several  who  have  failed  in 
obtaining  appointments  in  the  metropolitan  hospi- 
tals have  successfuly  passed  the  ordeal  of  one  or 
other  of  the  Government  examinations.  It  is  not  a 
little  surprising  to  find  how  well  up  in  the  funda- 
mental lirauches  are  the  majority  of  candidates  who 
present  themselves  for  the  hospital  examinations. 
There  is  not  room  for  all  the  good  men  who  qualify 
for  them.  With  the  op))ortunity  of  making  selec- 
tions from  the  best,  it  is  no  wonder  that  the  gentle- 
men who  compose  the  house  staff  of  our  larger 
hospitals  are  such  as  the  colleges  and  the  profession 
may  be  proud  of.  The  examination  for  these  posi- 
tions are  strictly  impartial,  and  the  successful  can- 
didates are  generally  quite  e(iually  apportioned  from 
the  three  loading  schools. 


tEleports  of  Societies;. 

NEW  YORK  PATHOLOGICAL  SOCIETY. 

Slated  Meeting,  February  8,  1882. 

Dk.  George  L.  Peabody,  VicePsesident,  in  the 

Chair. 

Dr.  Tauszkt  presented  a  specimen  of 
lacerated  bladder, 

which  he  had  obtained  through  the  courtesy  of  Dr. 
Waterman,  Deputy  Coroner.  It  was  accompanied 
bv  the  following  history  : 

'Wm.  McG ,  thirty-two  years  old,  Irish,  single, 

was  brought  to  St.  Vincent's  Hospital  Februai^  26, 
1881.  He  had  been  to  the  Northern  Dispensary,  and 
there  a  rupture  of  the  bladder  was  diagnosed.  On 
admission  to  the  hospital  the  patient  could  not 
give  a  correct  history  of  his  case,  but  thought  he  was 
injured  in  the  abdomen  by  some  one  falling  on  him 
while  he  lay  intoxicated  in  a  saloon.  He  complained 
of  retention  of  urine.  A  catheter  was  used,  and  a 
quantity  of  bloody  urine  drawn  off.  It  was  neces- 
sary to  use  the  catheter  eveiy  six  hours  to  relieve 
his  distress ;  but  after  a  few  days  the  urine  began  to 
assume  its  natural  color,  yet  on  standing  for  some 
time  would  show  a  deposit  of  blood.  The  amount 
drawn  each  time  was  considerable.  The  instrument, 
a  silver  cather,  had  to  be  introduced  up  to  the  rings 
before  the  urine  could  be  drawn,  which  at  the  time 
was  noticed  by  the  physician  in  charge  as  very  pe- 
culiar, and  even  then  it'  required  some  manipulation 
after  the  instrument  had  passed  the  normal  distance, 
until  the  instrument  would  suddenly  pass  farther  and 
the  urine  would  flow.  The  man  died  of  asthenia 
March  3,  1881,  at  3  p.m. 

Aiitopi^y,  performed  at  the  hospital  March  4,  1881. 
Body  well  nourished.  Intestines  sbghtly  injected, 
and  only  very  slightly  roughened  on  the  surface  of 
the  transverse  colon.  Peritoneum  slightly  thickened 
and  only  slight  injection  of  vessels.  There  was  con- 
siderable fluid  in  the  peritoneal  cavity,  with  an  am- 
moniacal  smell,  but  not  markedly  so  ;  there  was  also 
infiltration  in  the  tissues  in  tlie  neighborhood  of 
Poupart's  ligament,  especially  in  the  lower  portion 
of  both  recti  abdominalis  muscles,  which  had  a 
sloughy  appearance.  The  bladder  was  about  two 
inchesin  diameter,  contracted,  and  its  surface  was 
corrugated.  It  had  a  marked  bluish  color,  verging 
upon  a  gangi'euoTis  ajipearance.  There  was  a  hori- 
zontal rupture  of  the  walls  of  the  organ,  commencing 
a  little  to  the  right  of  the  fundus  and  passing  to  the 
left  nearly  to  the  neck  ;  the  edges  of  the  rupture  ap- 
peared not  of  recent  origin,  and  at  various  portions 
the  internal  and  outer  edges  had  cicatrized;  but  ia 
the  course  of  the  rupture  the  mucosa  of  the  bladder 
had  an  inverted  appearance,  inversion  taking  place 
toward  the  body  of  the  bladder.  Upon  and  under- 
neath the  meml)rane  lining  the  bladder  were  a  large 
number  of  small  cvsts  filled  with  Idoody  serum. 

Dr.  Tauszky  remarked  that  the  fact  that  the  i';>^ 
tient  had  onlv  a  circumscribed  peritonitis  whiU' 
under  the  treatment  of  Dr.  Stephen  Smith,  with  an 
extensive  laceration  of  the  bladder  from  February 
26th  to  March  3d.  and  the  tendency  of  the  rui)tiiro 
to  heal,  seem  to  show  the  correctnes.s  of  the  view 
first  enunciated  by  Prof.  Simon,  of  Heidelberg,  that 
liealthy  urine  does  not  prevent  the  healing  or  union 
of  incised  or  other  wounds  with  which  it  comes  iii 


THE  MEDICAL  RECOED. 


327 


contact.  This  fact  he  had  seen  corroborated  in  the 
New  York  Woman's  Hospital,  where,  on  account  of 
otherwise  incurable  cases  of  cystitis,  artificial  vesico- 
vaginal listulaj  are  made,  and,  as  Dr.  Emmet  ex- 
presses it,  do  what  we  may  these  artificial  vesico- 
vaginal fistulas  will  usually  close  in  about  ten  days. 
Another  important  question  in  connection  with  this 
case  is  whether  laparotomy  and  the  sewing  up  of  the 
bladder  at  the  time  the  diagnosis  was  made  would 
not  have  saved  the  patient's  life. 

Dr.  .J.  C.  Peters  remarked  that  in  the  third  vol- 
ume of  the  "  Transactions  of  the  Society  "  were  re- 
ported by  Dr.  Erskine  Mason  and  others  a  large 
number  of  oases  of  rupture  of  the  bladder. 

Db.  Wteth  presented  a  patient  on  whom  he  had 
performed 

EXSECnON   OF   THE   ANKLE-JOINT. 

About  thirteen  years  ago  the  young  lady  sustained 
an  injury  of  the  ankle-joint  which  was  followed  by 
suppurative  arthritis  and  necrosis  of  the  bones  en- 
tering into  its  formation.  She  had  been  unable  to 
walk  on  that  limb  ever  since.  She  was  brought  to 
him  by  Dr.  J.  G.  Wallach  for  operation,  which  was 
performed  in  the  latter  part  of  June,  1881.  Parallel 
perpendicular  incisions  were  made  on  either  side  of 
the  joint  down  to  the  malleoli,  and  then  out  upon 
the  tarsus  for  two  inches.  The  periosteum  was 
raised,  and  about  three-fourths  of  an  inch  of  the  fib- 
ula and  tibia,  and  the  upper  part  of  the  astragalus 
were  removed  by  means  of  a  delicate  chisel.  The 
remainder  of  the  astragalus  was  then  brought  in  con- 
tact with  the  ends  of  the  bones  of  the  leg,  drainage- 
tubes  were  inserted,  and  the  woimd  closed  by  silver- 
wire  sutures.  The  patient  was  now  able  to  walk 
with  ease ;  the  joint  admitted  of  flexion  and  ex- 
tension and  lateral  motion.  There  being  slight 
shortening  of  the  limb,  a  high-soled  shoe  was  worn 
on  the  foot  of  that  side.  The  patient's  appearance 
was  in  marked  contrast  with  what  it  was  before  the 
operation  ;  then  she  was  jiale  and  thin,  now  she  was 
rosy  and  healthy.  The  patient  also  had  a  rare  mur- 
mur, which  Dr.  Janeway  considered  to  result  from 
a  communication  between  the  aorta  and  pulmonary 
artery,  possibly  through  a  previoias  ductus  arteriosus; 
it  was  possible,  however,  that  the  murmur  produced 
was  caused  by  a  communication  between  the  innomi- 
nate vein  and  the  aorta.  In  eonseciuence  the  patient 
sometimes  suffered  fi'om  syncope. 

EEMOVAl   OF   BONY   TUMOR   OP   TIPPER   JAW  THROUGH 
THE   MOUTH — VALUE   OF   MORPHIA-NAKCOSLS,  ETC. 

Dr.  Geo.  F.  Sheadt  presented  a  specimen  of  os- 
teoma of  upper  jaw,  which  he  removed  by  operation 
througli  the  mouth.  The  jjatient,  a  female,  aged 
about  thirty-nine  years,  was  sent  to  Dr.  Shrady  in 
June  last  by  Dr.  Frederic  J.  Starr,  a  dentist  of  this 
city.  For  three  years  previously  a  tumor  had  Ijeen 
growing  on  the  left  side  of  the  upper  jaw,  appar- 
ently having  its  origin  in  the  root  of  the  first  molar. 
When  she  presented  herself  for  operation,  the 
growth  involved  the  entire  alveolar  margin  of  that 
side,  from  the  internal  aspect  of  the  canine  fossa  in 
front,  to  the  maxillary  tuberosity  behind,  includ- 
ing the  latter  in  an  expanded  knob  of  osseous  tis- 
sue. Internally  it  extended  nearly  to  the  median 
line  of  the  roof  of  the  mouth  and  hard  palate.  Ex- 
ternally its  projection  (most  m.oi-ked  in  the  neigh- 
borhood of  the  first  molar)  extended  beyond  the  per- 
pendicular plane  of  the  malar  bone,  while  its  upper 
limit  corresponded  with  the  horizontal  plane  of  the 
lower  border  of  the  malar  process  of  the  superior 


maxillai-y.  There  wae  marked  deformity  of  the  face, 
consisting  of  a  protrusion  of  the  corner  of  the  mouth, 
a  flattening  of  the  naso-labial  fold,  and  a  marked 
jirominence  of  the  cheek.  The  projection  from  the 
maxillary  tuberosity  extended  so  far  downward  as 
to  impinge  upon  the  contiguous  margin  of  the  lower 
jaw  and  interfere  with  easy  deglutition,  while  the 
contractions  of  the  masseter  muscle  over  the  promi- 
nence were  at  times  quite  painful.  The  diagnosis 
of  osteoma  of  the  jaw  was  made  without  difficulty. 

The  oi)eration  was  performed  at  the  St.  Francis 
Hospital,  in  the  presence  of,  and  with  the  assistance  of 
Prof.  Howe,  Drs.  D.  W.  GoodwiUie,  Satterthwaite, 
F.  J.  Starr,  and  members  of  the  House  Staff'.  An 
hypodermic  injection  of  ten  minims  of  Magendie's 
solution  was  administered  previous  to  etherization, 
in  order  to  enable  the  patient,  while  under  the  in- 
fluence of  morphia-narcosis,  to  clear  her  mouth  of 
blood  during  the  operation. 

A  gag  was  then  introduced  on  the  right  side  of  the 
mouth,  and  the  left  cheek  firmly  retracted.  The  peri- 
osteum was  carefully  sejiarated  from  the  external  as- 
pect of  the  tumor  as  far  back  as  the  pterygomaxillary 
fissure,  and  a  corresponding  &aip  raised  from  the  roof 
of  the  mouth  and  palatal  bone.  A  horizontal  section 
of  the  external  surface  of  the  tumor  was  made  with  a 
metacarjial  saw,  high  up  underneath  the  malar  pro- 
cess, extending  backward  to  include  the  correspond- 
ing portion  of  the  maxillary  process.  The  bony  roof 
of  the  mouth,  just  external  to  the  median  line,  was 
sawn  through,  and  finally  Goodwillie's  saw,  which 
is  provided  with  a  bracketed  shank  to  receive  the 
cheek,  was  inserted  behind  the  maxillary  tuberosity 
in  the  pterygo-maxillary  fissure,  and  carried  upward 
to  the  horizontal  level  of  the  attachment  of  the 
tumor.  The  blade  was  then  adjusted  flatwise,  and 
the  remaining  attachment  of  the  growth  was  sawn 
through  horizontally  from  behind  forward. 

The  hemorrhage  was  quite  profuse,  especially 
during  the  time  of  separating  the  deeper  and  jios- 
terior  portions  of  the  tumor,  but  was  promi^tly  con- 
trolled by  pressure.  The  patient,  during  the  opera- 
tion, readily  responded  to  directions  to  .spit  out  the 
blood  which  accumulated  in  her  mouth.  In  the 
latter  part  of  the  operation  the  patient's  head  was 
hung  backward  over  the  edge  of  the  table,  thus  ef- 
fectually preventing  the  entrance  of  blood  into  the 
trachea.  The  periosteal  flaps  were  suitably  trimmed, 
and  their  edges  stitched  together  to  form  a  new 
gum.  Nearly  the  entire  wound  united  by  first  in- 
tention, and  within  one  week  the  patient  was  able 
to  leave  the  hospital.  Six  weeks  afterward  the  parts 
commenced  to  solidify,  by  the  deposit  of  new  bone, 
and  three  months  subsequently  the  side  of  the  jaw 
and  bony  roof  of  the  mouth  were  so  perfectly  and 
symetrically  reproduced,  that  the  dentist.  Dr.  Starr, 
was  enable  to  make  for  her  a  set  of  teeth,  which,  ac- 
cording to  his  account,  she  is  now  wearing  with 
"  comfort  and  satisfaction."  The  tumor  was  homoge- 
neous throughout,  was  composed  of  condensed  bony 
tissue,  and  in  its  thickest  portion  was  eburnaceous  in 
character.  Its  focus  of  origin  appeared  to  be  in  the 
neighborhood  of  the  fang  of  the  first  molar,  where 
the  bony  condensation  was  most  marked,  and  the 
eburnaceous  character  most  pronounced. 

The  interesting  features  of  the  case  were  :  1st,  the 
character  and  situation  of  the  tumoi',  osteomata  of 
that  size  growing  from  the  upper  jaw  being  very 
seldom  met  with  ;  2d,  the  possibility  of  removing 
these  growths  through  the  mouth  without  section  of 
the  cheek,  and  without  preliminary  tracheotomy ; 
3d,  the  advantage  of  morphia-narcosis  in  all  opera- 


338 


THE  MEDICAL  RECORD. 


tions  about  the  mouth  attended  with  much  hemor- 
rhage ;  4th,  the  utility  of  the  backward  hanging  of 
the  head  (Rose's  position)  in  preventing  the  entrance 
of  blood  into  the  trachea ;  5th,  the  readiness  with 
which  bone  is  reproduced  after  similar  operations, 
and  the  great  utility  of  Goodwillie's  saw  in  making 
difficult  sections  of  bony  parts  deep  in  the  mouth. 
Without  this  instrument  the  performance  of  the 
operation,  in  the  manner  indicated,  would  have 
been  scarcely  possible. 

Dr.  Wm.  H.  Dbaper  presented  a  specimen  of 

ISTESTINAI,  OBSTRUCTION. 

The  interesting  features  of  which  were  with  regard 
to  its  clinical  histoiy.  First,  the  patient,  a  clergy- 
man, was  vigorous  and  of  great  activity  up  to  the 
day  of  liis  illness,  complaining  only  of  very  slight 
indigestion ;  second,  he  had  no  jiaiu,  and  comjilained 
only  of  a  vague,  indescribable  feeling  of  discomfort 
in  the  abdominal  region  (vomiting  occurred  later)  ; 
tfiird,  in  corroboration  of  the  views  entertained, 
rather  by  English  authorities  than  by  others,  was 
the  paucity  of  urine,  which  suggested  the  probability 
of  intestinal  obstruction  high  np  in  the  small  intes- 
tine. That  view  was  strengthened  by  the  fact  that 
at  first  there  was  no  considerable  distention  of  the 
bosvels,  they  being  flaccid  and  easily  manipulated. 
No  considerable  distention  occurred  until  after  the 
sixth  day  of  his  illness,  and  it  was  probable  that  by 
that  time  the  obstruction  had  made  considerable  of 
its  descent.  Had  the  subject  been  young  it  was 
probable  the  surgeons  would  have  advised  laparot- 
omy :  but  the  manifest  degeneration  of  the  patient's 
tissues,  afterward  jjroven  by  microscopical  examina- 
tion, and  the  great  obscurity  with  regai-d  to  the 
nature  and  seat  of  the  obstruction,  he  thought  jiistly 
deterred  the  surgeons  from  operative  interference. 
He  believed  the  view  entertained  with  respect  to  the 
nature  of  the  obstruction  by  most  of  the  physicians 
and  surgeons  was,  that  it  was  due  to  a  malignant 
growth  with  fecal  accumulation.  But  the  autopsy 
revealed  that  it  was  due  to  a  gall-stone. 

Dr.  John  A.  Wteth  said  it  was  a  question  of 
imj5ortance  in  such  cases  to  determine  whether,  or 
at  what  time,  an  operation  was  .justittable.  This 
was  one  of  the  cases  in  which  he  thought  delay  was 
dangerous,  as  the  result  proved.  He  had  had  a  case 
which  was  just  recovering  in  which  delay  was  at- 
tended with  success.  A  gentlemen  about  sixty  years 
of  age,  of  sendentary  habits,  had  an  obstruction 
seemingly  in  the  riglit  iliac  fossa.  Pour  days  had 
elapsed  without  any  movement  of  the  bowels,  previ- 
ous to  his  seeing  him,  and  there  was  e\'idently  a  great 
deal  of  gas  in  the  abdominal  cavity  above  this  jjoint, 
an  injection  produced  no  apparent  elVect.  Drs. 
Sands  and  .Taneway  were  called  in  consultation  as  to 
the  propriety  of  an  operation,  and  it  being  deemed 
proper.  Dr.  Wyeth  considering  that  it  was  danger- 
ous to  delay,  the  time  for  its  performance  was  set 
for  the  next  day.  That  night,  however,  a  hvpoder- 
mic  injection  of  fifteen  minims  of  Magendie's  solu- 
tion of  morphia  was  administered,  the  patient  was 
placed  on  his  right  side  with  a  downward  slope  of 
the  shoulders  of  thirty  or  forty  degrees,  and  nine 
pints  of  warm  water  were  slowly  injected  into  the 
colon.  Being  unable  to  stand  the  distention  any 
longer,  twenty-four  minutes  after  the  injection  was 
made  the  patient  got  up  and  passed  aViout  four  pints 
of  the  water  from  the  lower  pai-t  of  tlio  colon,  but  it 
contained  no  fecal  matter.  After  twelve  hours 
another  discharge  from  the  bowels  took  place,  com- 
posed of  about  a  pint  of  very  feculent  cofifee-ground 


matter,  and  from  that  time  the  obstruction  was  re- 
lieved. There  had  been  no  stercoraceous  vomiting 
at  aU,  else  he  would  have  operated  before  the  time 
appointed.  * 

Dr.  Peters  referred  to  the  fact  that  the  acetate  of 
lead  had  been  reported  by  good  authorities,  first  in 
Thurgood's  "IMateria  Medica,"  as  acting  favorably 
for  the  relief  of  intestinal  obsti-uction. 

Dr.  Peabodt  remarked  that  in  Thudicum's  work 
on  "  Gall-stones,"  were  related  several  cases  in  which 
recovery  from  intestinal  obstruction  took  place,  with 
the  passage  per  rectum  of  the  calculus,  it  being  in 
one  instance  much  larger  than  the  present  specimen. 

Dk.  Peabody  presented 

THE   heart,    KIDNETS,    BLADDER,    AND   PENIS 

removed  from  the  body  of  a  man  aged  thirty-four, 
who  died  of  pneumonia,  after  three  days'  Oluess. 
There  was  nothing  unusual  in  the  course  of  the 
pneumonia.  Nothing  told  by  the  patient  would 
lead  to  the  susjjicion  of  Bright's  disease  ;  but  there 
was  a  history  of  intemperance.  The  urine  contained 
albumen  and  casts,  and,  although  not  deficient  in 
quantity,  it  was  of  low  specific  gravity.  At  the  au- 
topsy there  was  found  to  be  a  slight  lesion  of  the 
aortic  valves,  the  cusps  being  quite  distinctly  adher- 
ent. The  kidneys  were  in  a  state  of  chronic  diffuse 
nephritis,  the  right  one  being  far  the  most  atrophied. 
Hydronephrosis  was  also  well  marked  in  the  right 
kidney.  Prom  that  organ  arose  two  ureters,  one 
from  the  ordinai-y  situation,  about  the  middle  of  the 
kidney,  the  other  from  its  lower  extremity.  The 
two  ureters  proceeded  side  by  side  to  the  bladder, 
and  entered  the  viscus  at  the  same  point.  One, 
of  them,  however,  became  largely  dilated  before 
entering  the  bladder,  forming  a  sack,  the  tissues  of 
which  resembled  very  much  those  of  the  bladder 
itself ;  that  is,  it  was  lined  by  a  mucous  membrane, 
and  its  walls  were  composed  of  muscular  fibres.  The 
bladder  was  markedly  hyi^ertrophied,  although 
there  was  no  stricture  of  the  urethra,  a  fact  which 
seemed  to  him  at  first  remarkable.  It  probably 
could  be  accounted  for  by  the  fact  that  the  bladder 
had,  as  it  were,  to  expel  a  double  amount  of  urine, 
although  the  patient  passed  only  a  normal  quantify ; 
that  is,  all  the  urine  secreted  had  to  be  expelled  by 
the  Tirethra,  part  of  it  having  been  ])re\nously  ex- 
pelled in  an  upward  direction  into  the  dilated  ui'eter, 
and  having  again  subsequently  entered  the  bladder 
after  the  contraction  of  that  viscus  had  subsided. 
The  condition  of  double  ureter,  he  believed,  was  not 
of  very  infrequent  occurrence.  He  found  an  exam- 
ple of  it  at  the  autopsy  on  an  infant  recently. 
Db.  Gerster  presented  a  specimen  of 

MALIGNANT   LTMPHO-S.\RrOMATA    OF   THE   NECK. 

The  patient  from  whom  it  was  removed  was  a  man, 
thirty-three  years  of  age,  who  for  some  time  had  a 
bad  tooth,  but  refused  to  have  it  removed.  Caries 
of  the  alveolar  process  followed,  and  in  the  course 
of  time  the  glands  in  the  submaxillary  region  of  the 
same  side  took  on  inflainmation,  but  did  not  siippu- 
rate.  .\fter  six  months,  without  any  known  cause, 
they  began  to  grow  rapidly,  and  three  months  later 
he  presented  liiniself  at  the  German  Dispensary, 
when  it  was  found  that  the  tumor  had  become  as 
large  as  one's  fist.  It  was  immovaVde,  atta<hed  to 
the  cervical  vertebr.^'  on  the  right  side,  and  appar- 
ently involved  all  the  important  organs  of  the  neck 
on  that  side.  The  patient  was  vei-y  anxious  to  have 
it  removed,  so  as  to  free  him  from  great  pain  and 
difficulty  of  breathing.      He  was    promised   little 


THE  MEDICAL  RECORD. 


329 


hope  from  the  operation,  whioli  would  be  a  difficult 
one,  but  it  was  undertaken.  The  attachments  of  the 
tumor  were  found  to  be  very  close  indeed,  and  for- 
midable hemorrhage  was  encoivntered.  The  method 
pur:>ued  in  this  case,  as  in  all  similar  cases,  was  that 
advised  b_y  the  elder  Langenbeck  :  expose  the  large 
vessels  leading  to  the  tumor,  and  pass  ligatures 
ready  to  tie  tliem  iu  case  hemorrhage  demand  it. 
A  dense  fibrous  mass,  which  occupied  the  position 
of  the  internal  jugular,  but  thought  by  Dr.  Shrady 
and  others  present  not  to  be  it,  was  ligated  and  di- 
vided, and  afterward  found  to  be  that  vessel  in  an 
obliterated  condition.  Two  hoiirs  elapsed  before  the 
bifurcation  of  the  common  carotid  was  reached,  and 
the  patient's  state  by  this  time  being  such  as  not  to 
admit  of  completing  the  removal  of  the  tumor  by  care- 
ful and  clean  dissection,  it  was  broken  away  by  main 
force  from  its  underlying  base,  and  the  remaining 
parts  were  removed,  as  far  as  possible,  by  the  scoop. 
Had  the  patient's  condition  permitted,  he  would  have 
ligated  and  severed  the  carotid  ai-tery,  and  cut  the 
pneumogastric  nerve,  and  removed  the  whole  mass. 
Death  took  place  thirty-eight  hovus  after  the  opera- 
■  tion,  and  was  due  to  shock  and  loss  of  blood. 

Dr.  Gerster  also  gave  the  history  of  nine  addi- 
tional cases  of  this  disease,  which  had  come  under 
his  observation  during  the  jjast  thi'ee  years,  particu- 
larly with  reference  to  the  treatment.  Seven  of 
them  were  treated  by  the  internal  administration, 
and  injections  into  the  tumor  of  Fowler's  solution 
of  arsenic  before  operative  measures  were  resorted 
to.  A  perfect  cure  from  this  method  was  obsei'ved 
in  but  one  case. 

In  the  second  case  the  patient  was  a  German 
woman,  aged  fifty-seven,  who  had  a  solitaiy  tumor 
of  irregular  shape,  and  about  the  si^e  of  one's  fist, 
situatad  on  the  left  side  of  the  neck.  In  the  course 
of  nine  months  about  fifty  sittings  were  had,  com- 
mencing with  one  drop  three  times  a  week,  and  in- 
creasing the  quantity  to  four,  from  four  to  five,  such 
injections  being  made  at  one  sitting  into  different 
portions  of  the  tumor.  The  lymphatic  elements,  of 
which  the  tumor  was  composed,  one  by  one  necrosed, 
and  were  removed  through  the  skin,  as  many  as 
twenty-five  incisions  being  made  altogether  for  their 
removal,  with  that  of  pus.  The  tumor  had  disap- 
peai'ed,  but  of  course  the  neck  remained  badly 
scarred. 

The  third  case  was  that  of  a  girl,  aged  eighteen, 
who  had  three  tumors,  as  large  as  a  turkey's  egg, 
on  the  right  side  of  the  neck,  also  enormous  tonsils, 
which  were  at  once  removed.  The  treatment  was 
continued  fourteen  months,  but  by  injections  only 
half  a  year.  The  tiimors  diminished  to  about  one- 
third  their  former  size,  due,  it  was  thought,  to  the 
systemic  rather  than  to  the  local  effects  of  the  drug. 
What  remained  of  the  tumor  seemed  to  consist  prin- 
cipally of  the  dense,  massive  cicatricial  capsules  of 
the  glands. 

Case  IV. — A  Dane,  aged  twenty-one,  very  florid, 
strongly  built.  Large  tumor  on  right  side  of  neck, 
tho  causation  of  which  was  not  known.  Treatment 
by  injections  and  increasing  internal  doses  of  Fow- 
ler's solution  for  three  months  at  the  German  Dis- 
peasary.  Four  incisions  were  made,  evacuating 
much  pus  and  some  solid  necrosed  glandular  tissue. 
Partial  cure. 

Case  V. — F.  C -,  mechanic,  aged  twenty-eight, 

a  cachectic-looking  individual,  whose  skin  was 
marked  in  many  places  with  pigmented  nipvi,  had  a 
soft,  almost  fluctuating  tumor  on  the  right  side  of 
the  neck,  reaching  from  the  mastoid  process  down 


to  the  sternum.  The  axillary  and  inguinal  glands 
on  both  sides  were  also  markedly  larger  than  nor- 
mal. An  operation  being  out  of  question.  Fowler's 
solution  was  exhibited  internally  and  locally.  Ca- 
chexia was  combated  by  a  suitable  dietetic  tieat- 
nient.  After  about  two  ^^eeks  of  treatment,  the 
tumor  became  still  more  enlarged  and  painful,  caus- 
ing fever  and  dyspnoea,  but  after  the  evacuation  of 
a  large  quantity  of  pus  from  the  deeper  parts  of  the 
swelling  by  incision,  it  shrunk  to  about  half  its  for- 
mer size.  The  patient  becoming  aware  of  a  chance 
to  return  to  Germany,  the  opportunity  of  complet- 
ing this  case  was  unfortunately  lost.  Tieatment  Lad 
lasted  for  five  months. 

Ca.se  VI. — A  powerful,  healthy  mechanic,  aged 
twenty-two,  pi-esented  himself  with  a  \\ell-defiLfd, 
freely  movable  tumor,  occupying  the  right  side  of 
his  neck,  which  had  its  origin  in  a  glandular  inflam- 
matoiy  svi'elling  caused  by  a  carious  tooth.  The 
tumor  was  very  hard,  smooth,  painless,  but  Ltd 
gi'own  rapidly,  wherefore  an  immediate  operatic  n 
for  its  removal  was  proposed  to  but  declined  by  the 
IJatient.  A  year  later  he  had  himself  admitttd  to 
the  German  Hospital,  and  j-re^ented  a  sad  example 
of  physical  decline.  The  original  tumor  had  en- 
larged so  as  to  fill  up  both  the  upper  and  lower 
triangles  of  the  neck  ;  general  intume.'cence  of  the 
cervical,  axillary,  the  inguinal  and  mesenteiic 
glands,  was  ascertained;  the  patient  was  in  a  state 
of  grave  cachexia,  feverish,  and  had  lost  all  appetite. 
A  systemic  treatment  of  the  disorder  by  interni.l 
administrations  of  Fowler's  solution,  iron,  and  qui- 
nine was  attempted,  but  the  patient's  state  wtnt 
from  bad  to  worse,  and  he  died  at  his  home  two 
years  after  the  incipiency  of  his  illness. 

The  second  group  of  cases  observed  contained 
those  in  which  operative  measures  were  resorted  to. 
The  first  case  belonging  to  this  class  was  dis-posed 
of  in  the  beginning  of  this  report.  In  that  case  no 
treatment  with  Fowler's  solution  was  employed.  In 
two  of  the  operative  cases,  however,  the  arsenical 
treatment  being  resorted  to,  quite  different  results 
were  obtained  therefrom.  One  case  showed  a 
marked  temporary  benefit,  the  other  most  undoubted 
aggravation  of  the  trouble. 

Case  VII. — Mrs.  H ,  a  very  ansemic  German 

woman,  aged  twenty-six,  had  borne  in  rapid  succes- 
sion five  children.  A  very  large,  soft  tumor,  con- 
sisting of  many  glandular  segments,  occupied  the 
right  side  of  her  neck  ;  causation  was  not  ascer- 
tained. The  usual  treatment  with  injections  and  tl  e 
internal  administration  of  Fowler's  sohrtion  was  in- 
stituted, and  in  the  course  of  four  months  five  glan- 
dular bodies,  presenting  a  cheesy  appearance,  were 
extracted  from  abscesses  after  incision,  and  the  pa- 
tient's condition  seemed  to  be  materially  improved. 
After  a  four  weeks'  pause,  the  remaining  parts  of  the 
swelling  again  commenced  to  enlarge,  and  there- 
upon excision  was  practised.  An  incision  extend- 
ing from  the  mastoid  process  to  the  jugular  fossa 
exposed  the  tumor,  which  had  to  be  dissected  away 
very  carefully  by  the  use  of  the  knife  and  scissors 
throughout  its  whole  extent.  The  internal  jugular 
vein  was  found  involved,  and  an  inch  and  a  half  of 
its  length  had  to  be  removed.  By  accident,  the 
pneumogastric  nerve  was  grasped  by  an  artery  for- 
ceps during  the  time  of  dissecting  away  the  jugular 
vein,  but  the  colleagues  supervising  the  ana'sthesia 
did  not  notice  any  unusual  change  in  pulse  or  re s- 
jjiratinn  during  these  three  or  four  minutes.  The 
operation  lasted  almost  three  hours,  but  the  patient 
recovered  well,  and  the  extensive  wound,  at  the  bot- 


330 


THE  MEDICAL  RECORD. 


torn  of  wbicli  a  large  portion  of  the  carotid  lay  ex- 
posed, healed  by  first  intention,  except  at  the  places 
where  drainage-tubes  had  been  inserted.  Neverthe- 
less, sis  months  after  the  operation  the  disease  be- 
came generalized,  the  spleen  had  become  enormously, 
intumescent,  likewise  the  mesenteric  glands,  which 
produced  marked  obstruction  of  the  transverse  co- 
lon. The  patient  died  of  cachexia  one  year  and  a 
half  after  the  removal  of  the  tumor. 

Case  VIII. — Wm.  R -,  a  German  grocer  boy, 

aged  seventeen,  exhibited  a  movable  tumor  of  the 
size  of  a  hen's  egg,  placed  in  the  right  upper  cervical 
triangle.  Causation  from  a  carious  tooth.  Here, 
also,  Fowler's  solution  was  injected  four  times,  caus- 
ing, however,  a  more  rapid  growth  of  the  swelling 
without  fever,  and  the  involvement  of  numerous 
neighboring  glands.  A  very  clean  and  thorough 
dissection  of  the  new-growth,  including  its  capsular 
envelope,  was  accomplished.  The  jugular  vein  and 
carotid  lay  exposed  to  the  extent  of  two  inches. 
The  wound  healed  kindly,  and  principally  by  first 
intention,  and  yet  a  relapse  became  apparent  two 
months  afterward,  involving  some  glands  lying  above 
the  clavicle.  These  were  again  removed,  but  before 
the  wound  had  cicatrized,  the  corresponding  glands 
on  the  other  side  of  the  neck,  and  likewise  the  axil- 
lary and  inguinal  glands,  became  degenerated,  and 
the  boy  is  now  in  a  dying  condition. 

In  the  remaining  two  cases  no  treatment  with  ar- 
senic was  resorted  to  for  different  reasons. 

Case  IX. — Miss  B ,  a  very  anajmic,  rachitic 

shop-girl  of  eighteen  years,  observed  three  discrete 
tumors,  of  the  size  of  a  pigeon's  egg,  in  her  right 
submaxillary  region,  caused  by  the  presence  of  some 
foul  teeth,  which  were  growing  rapidly  and  disfig- 
ured her  considei-ably ;  wherefore  she  declined  the 
arsenical  treatment,  and  accordingly  was  operated 
on.  Dissection  was  difficult,  as  usual  where  the 
rule  is  adhered  to,  to  remove  both  the  glandular 
swellings  and  their  dense,  vascular  capsules.  The 
recovery  was  prompt,  and  no  relapse  had  appeared 
so  far — almost  three  years  after  the  operation. 

This  good  result  seems  to  indicate  that  all  indo- 
lent, painless,  but  rapidly  growing  swellings  of  the 
cervical  glands,  be  they  caused  by  the  presence  of 
carious  teeth  or  some  other  circumstance,  ought  to 
be  removed  without  delay,  and  thoroughly — that  is, 
together  with  their  capsular  envelopes. 

Case  X. — R.  S ,  laborer,  fifty-seven   years   of 

age,  noticed  a  glandular  swelling  in  his  right  sub- 
maxillary region,  when  suffering  from  an  ulcerated 
tooth,  which  did  not  inconvenience  him  much  after 
the  removal  of  the  tooth,  but  commenced  to  grow 
rapidly  six  months  after  without  a  known  cause. 
The  tumor  had  the  size  of  a  small  orange,  and  was 
closely  adherent  to  the  inner  aspect  of  the  ramus  of 
the  jaw.  It  was  removed  in  January,  18H1,  together 
with  a  lamella  of  the  adherent  bone.  In  August  of 
the  same  year  a  relapse  necessitated  the  removal  of 
the  right  half  of  the  lower  jaw,  together  with  the 
right  side  of  the  floor  of  the  oral  cavity  and  a  por- 
tion of  the  right  side  of  the  tongue.  The  tong>ie 
was  sutured  to  the  remaining  parts  of  the  buccal 
mucous  lining,  the  wound  was  treated  with  an  eight 
per  cent,  solution  of  chloride  of  zinc,  and  closed  by 
cutaneous  sutures,  and  healed  rapidly ;  but  three 
months  after  the  operation  another  relapse  took 
place,  occupying  the  sphono-maxillary  fossa,  and 
forbidding  further  operative  measures.  The  patient 
is  now  in  a  state  of  imbecility,  and  rapidly  approach- 
ing death. 
Experience  gathered  in  the  foregoing  ten  cases 


seems  to  point,  in  a  majority  of  instances,  to  the 
fact  that  the  beginnings  of  this  terrible  diteaEe  are 
developed  by  inflammatory  processes;  though  of 
course  the  cause  remains  unexplained,  why  the  in- 
flamed glands  do  not  .show  the  usual  course  leading 
to  resolution  or  suppuration  and  consequent  heal- 
ing, but  develop  into  an  illness  leading,  in  most  in- 
stances, to  sure  death. 

Further,  we  see  that  in  a  number  of  cases  the 
coml)ined  external  and  internal  arsenical  treatment 
is  capable  of  producing  considerable,  if  not  radical 
and  lasting  benefit ;  but  that  sometimes  it  will  ag- 
gravate the  disease  consideraldy.  Then,  again,  we 
see  that  early  and  thorough  operative  measures  do 
promise  favorable  results,  and  that  operations,  how- 
ever extensive  and  seemingly  radical,  will  give  but 
poor  satisfaction  in  well-developed  and  extensive 
cases.  Finally,  it  could  be  seen  that  the  technical 
difficulties  of  the  more  extensive  operations  for  these 
tumors  were  so  great  that,  although  most  of  the  pa- 
tients did  recover  remarkably  well  from  the  effects 
of  the  bloody  measures,  surgeons  who  refused  to  in- 
terfere in  similar  cases  seemed  to  be  justified  in 
their  course  by  the  preponderatingly  unsatisfactory 
results. 

Dr.  TadszivT  remarked  that  in  1873  he  saw  a  case 
of  this  kind  which  was  being  treated  by  the  arseni- 
cal method.  It  was  commenced  with  one  drop,  and 
increased  up  to  ten.  After  the  sixth  week  the  tu- 
mor entirely  disappeared,  but  about  five  months 
later  a  relapse  occurred.  The  same  treatment  was 
again  resorted  to,  with  similar  good  results,  and  he 
then  lost  sight  of  the  patient. 

Dr.  Wteth  remarked  that  Dr.  Frank  H.  Hamil- 
ton reported  a  favorable  result  from  the  arsenical 
method  in  a  case  published  recently  in  the  Medical 
Gazette. 

Dr.  Parker  had  had  three  cases  within  the  last 
three  months,  all  on  the  left  side  of  the  neck.  In 
one  very  severe  case,  in  which  an  operation  was  ad- 
vised by  Dr.  Willard  Parker,  Sr.,  the  tumor  was  re- 
moved with  the  assistance  of  Dr.  Stimson.  The  pa- 
tient finally  died.  In  the  ca.se  of  a  robust  young 
man,  on  whom  an  operation  was  refused  to  be  per- 
formed at  the  New  York  Hospital,  he  removed  a 
very  large  tumor,  necessitating  an  incision  from  ihe 
ear  down  to  the  sternum.  No  relapse  had  occurred, 
and  the  patient  was  robust  and  healthy.  It  was  a 
little  singular  that,  in  most  cases,  it  seemed  the 
tumor  occurred  on  the  left  side. 

Dr.  SEaum  asked  what  was  the  object  of  the  ar- 
senical injection,  whether  to  prodiice  a  local  irrita- 
tive effect,  or  an  effect  upon  the  constitution. 

Dr.  Gerstek  replied  that  the  ol)jert  which  Bill- 
roth, who  introduced  this  mode  of  treatment,  had 
in  view  was  to  produce  both  these  effects — namely, 
by  injections  to  destroy  the  growth  as  far  as  possi- 
ble, and  administered  by  the  stomach  to  get  the 
constitutional  effects  which  might  tend  to  produce 
molecular  destruction  of  the  now  tissue  formation. 

Dr.  Seiuiin  said  tliat  in  order  to  get  the  constitu- 
tional effects  larger  doses  of  Fowler's  soluticui  would 
have  to  be  given  than  what  he  understood  was  given 
in  these  cases,  viz.,  four  or  Ave  drops.  Four  minims 
produ(«d  no  offc(-t  at  all  scarcely  upon  the  system 
in  cases  of  chorea,  while  fifteen  to  twenty  minims 
were  borne  well. 

Dr.  Oerster  said  the  amount  given  intemnlly 
was  much  more  than  four  or  five  drops  ;  thirty,  and 
even  forty  minims  were  given  three  times  a  day  to 
some  of  the  patients  without  any  ill  effects. 

Dr.  B.  Rodmson  said  that  in  a  case  of  tumor  of 


THE   MEDICAL  RECORD. 


331 


the  neck  in  a  child  at  St.  Luke's  Hospital  this  mode 
of  treatment  bad  arrested  further  growth  during  the 
time  of  his  serrice ;  it  then  passed  from  under  his 
observation. 

Dr.  B.  Kobinson  presented  a  specimen  of 

PERICABDITIS  H^aiOKRHAGICA. 

It  was  removed  from  the  body  of  a  woman,  aged 
forty  years,  admitted  to  Charity  Hospital.  Januaiy 
29,  1882,  Dr.  Robinson  saw  her,  and  found  her  in 
the  dorsal  decubitus  with  blue  lips  and  respiration 
laborious  and  frequent.  Physical  examination  re- 
vealed flatness  over  the  left  side  of  the  chest  ante- 
riorly, laterally,  and  posteriorly.  There  was  oedema 
in  the  left  axilla,  the  veins  of  the  neck  were  turgid, 
and  those  on  the  surface  of  the  thorax  were  abnor- 
mally marked.  On  auscultation  some  moist  bron- 
chial rales  of  large  size  were  heard  over  the  chest 
anteriorly.  The  ajiex  of  the  heart  could  not  be  felt. 
The  organ  was  pushed  upward  and  toward  the  ax- 
illa. There  was  a  considerable  area  of  diffuse  pul- 
sation. .  A  loud  rasping  bruit  preceded  the  first 
sound,  was  appai-ently  endocardial,  and  heard  with 
great  intensity  over  the  entire  length  of  the  sternum, 
and  in  the  second  and  third  intercostal  spaces  on 
the  left  side.  It  was  not  propagated  into  the  left 
a>:illa,  nor  heard  over  the  back,  at  which  place  res- 
piratory murmur  was  also  absent.  About  twenty 
ounces  of  straw-colored  fluid  were  removed  from 
the  left  pleiu-al  cavity  by  Dr.  C.  H.  French,  House 
Physician,  and  the  patient  was  temporarily  relieved. 
The  murmur  persisted  after  removal  of  the  fluid. 

The  autopsv  was  made  by  Dr.  IMaxwell,  twenty- 
eight  hours  a^ter  death. 
Head. — Not  examined. 

T/iorar. — Left  }3leural  cavity  nearly  filled  with  a 
reddish  yellow  effusion.  Upon  right  side  a  few 
slight  adhesions.  The  left  lung,  lower  lobe,  and 
lower  portion  of  the  upper  compressed,  contained 
no  air,  smooth,  yellow,  and  shining.  Few  fibrous 
nodules  in  upper  lobe  as  well.  Right  lung  oedema- 
tous,  bronchi  contains  a  yellowish  brown  muco-pus. 
Pei-icardium. — Distended  with  fluid,  measures  six 
and  three-foiirth  inches  base,  and  vertical.  Fluid  is 
thin  and  yellowish  brown.  Both  visceral  and  parie- 
tal layers  of  pericardium  are  shaggy  from  a  layer  of 
fihroiis  exudation,  a  line  in  thickness,  and  this  ex- 
udation is  almost  everywhere  of  a  yellowish  color, 
save  round  base  of  heart,  where  it  is  hemorrhagic 
and  grouped  in  spots. 

Heart. — Heart  weighs  fifteen  ounces.     Right  cavi- 
ties  are   distended   with   dark   soft  coagula.     Left 
cavities  are  empty,  dark,  and  dry.     Both  tricuspid 
and  mitral  orifices  are  larger  than  normal,  but  no 
evidences  of  disease  of  valves  ;  aortic  valves  normal. 
Aorta  shows  a  few  patches  of  endarteritis. 
Peritoneal  cst.vity  contains  no  fluid. 
Liver. — Weighs  five  and  one-half  poiinds,  consid- 
erable  thickening   of    capsule,    old    perihepatitis. 
Surface  markedly  lobulated,  of  yellow  color.     Gall- 
bladder is  contracted  and   thin   over  large  biliary 
calculi,*  one  of  these  has  produced  ulceration  and 
perforation  in  two  places  of  its  walls.    Upon  section 
there  is  old  chronic  hepatitis.     In  other  places  the 
acini  are  larger,  of  yellow,  brownish  white  color, 
whose  borders  are  marked  by  a  lemon  yellow  zone. 
Spleen. — Enlarged,  softened. 
_  A'lV^ne^s.— Chronic  diffuse  nephritis  with  conges- 
tion. 

Dr.  Robinson  asked  whether,  since  there  was  no 
disease  of  the  valves  of  the  heart  or  endocardium, 
the  bruit  might  not  have  been  due  to  coarctation  of 


the  heart  orifices  due  to  pressure  of  fluid  in  the 
pericardium.  It  was  well  known  that  diagnosis  was 
sometimes  made  of  organic  disease  of  the  heait 
from  the  jiresence  of  a  muimur  due  to  temporary 
dilatation  of  the  orifice  of  the  hetrt,  which  alter  a 
time  disappeared  and  left  no  symptoms  whatever. 

De.  Petees  said  that  fome  vears  ago  the  late  Dr. 
Swett  and  the  ■whole  hous-e  staff  of  the  New  Yoik 
Hospital  diagnosed  valvular  disease  of  the  heart 
from  the  presence  of  a  murmur  in  a  patient  who 
had  pericarditis,  but  that  murmur  afterward  disaji- 
peared.  He  had  seen  a  few  cases  of  the  kind  since, 
but  could  give  no  exjdanaticn  for  them. 

The  society  then  went  into  executive  session. 


NEW  yOEE  NErEOLOGJCAL  SOCIETY. 

Stated  3(eethin,  Murrh  1,  lfc82. 
Dr.  T.  a.  McBbide,  Pke-sieekt,  in  ihe  Chaie. 
Dk.  W.  T.  BiBDSAtL  read  the  paper  of  the  evening, 
which  was  entitled 

A    CONTRIBUTION    TO   THE    PATHOLOGICAL    ANATOMY    OF 
LEAD-POISONIKG. 

The  speaker  said  that  cases  of  lead-paralysis  in 
which  ft  postmoitem  was  obtained  were  so  rare, 
and  the  pathology  of  the  disease  was  so  unsettled, 
that  he  ventured  to  offer  the  present  contribution 
to  the  subject. 

The  clinical  history  of  a  patient  suffering  with 
lead-palsy  was  then  given.  The  disease  Lad  lasted 
over  two  years,  snd  showed  itself  with  no  unusual 
symptoms.  (The  facts  regarding  the  paialvsis  are 
given  in  the  discussion.)  The  patient  finally  died. 
A  post-mortem  was  obtained,  but  under  stich  difficul- 
ties that  it  was  not  so  comjilete  as  could  be  wished. 
The  muscles  were  not  examined,  but  they  were 
not  atrophieel. 

There  was  no  change  of  importance  in  the  brain 
or  its  membranes. 

The  changes  were  most  marked  in  the  spinal 
cord,  from  the  elecussation  of  the  pyramitls  to  tUe 
middle  of  the  cervical  enlargement.  Below  this 
point  they  gradually  became  less  decided.  The 
changes  in  this  section  were  gieatest  in  the  gray 
matter  about  4  ctm.  below  the  decussation  of  the 
pyramids.  At  this  part  for  a  elistance  of  2  ctm. 
hardening  elid  not  take  place  well.  Here  there 
was  increased  vascularity.  Many  lymphoid  cells 
were  also  present.  The  cells  of  the  anterior  horns 
were  remarkably  large.  The  only  approach  to  a 
pathological  change  in  them  was  in  the  upper  cer- 
vical region.  Here  the  outer  of  the  two  cell-groups 
of  the  anterior  horns  seemed  to  be  affected,  the 
cells  being  small  and  indistinct.  The  largest  cells, 
in  most  cases,  were  normally  developed.  There 
were  no  positive  changes  in  the  fibres  of  the  an- 
terior roots,  although  in  some  cases  there  was  an 
abnormal  vascularity,  and  lymphoiel  bodies  were 
seen  lying  between  the  fibres  to  a  greater  extent 
than  usual.  As  regards  the  white  columns,  there 
was  some  thickening  of  the  septa  near  the  gray  mat- 
ter, and  some  spots  of  sclerosis  in  the  nntero-lateral 
columns.  There  was  also  a  very  slight  appearance 
of  sclerosis  in  the  columns  of  Goll.  On  the  whole, 
the  speaker  was  inclined  to  consider  the  changes 
those  of  a  very  mild  grade  of  myelitis. 

A  summary  of  the  literature  ujjon  the  subject  of 
the  pathological  anatomy  of  lead-poisoning  was 
then  given.  The  observations  anel  views  of  Ber- 
nardt,  Vulpian,  Friedlander,  Zenker,  Monokau, 
Morritz,  Seguin,  BromweU,  and  others  were  given. 


332 


THE  MEDICAL  RECORD. 


The  paper  being  open  for  discussion,  Dr.  E.  C. 
Spitzka,  in  response  to  a  question,  was  told  that  the 
paralysis  was  bilateral,  that  it  aflfected  the  upper 
extensors  of  the  fingers  chiefly,  biit  also  the  index 
finger  and  the  thumb.  The  deltoid  was  not  para' 
lyzed.  The  right  side  was  rather  the  more  affected. 
The  atrophy  of  the  cell-groups  was  quite  symmetri- 
cil.  The  cells  of  the  anterior  horns  were  not  smaller 
in  size  than  normal,  but  the  large  cells  seemed  to 
be  fewer  in  number,  while  the  number  of  small  cells 
was  apparently  increased.  There  were  certainly 
manv  healthy  cells,  and  Dr.  Birdsall  could  not  say 
positively  that  there  was  atroj^hy  as  regards  the 
columns  of  GoU.  There  was  an  increased  vascular- 
ity of  that  part.  This  increased  vascularity,  and  an 
increase  in  the  lymphoid  elements  were  about  the 
only  changes  observable. 

Dr.  Spitzka  said  that  the  localization  of  the 
atrophy  interested  him  as  a  possible  confirmation  of 
a  view  previously  advanced  by  himself,  that  the  cell- 
groups  of  the  outer  part  of  the  anterior  horn.s  inner- 
vated the  extensoi's  of  the  arm,  and  those  of  the  inner 
part  the  flexors.  Some  of  the  reasons  for  this  view, 
based  on  comparative  anatomy,  were  given. 

Dr.  M.  Pptnam-Jacobi  discussed  the  question  of 
the  mode  of  action  of  the  lead.  It  seemed  to  her  a 
fact  of  very  great  interest  that  the  three  metals,  lead, 
silver,  and  mercui-y  had  the  common  effect,  in  cer- 
tain cases,  of  producing  paralysis  and  other  indica- 
tions of  a  direct  impairment  in  the  nutrition  of  the 
nervous  tissue.  This  was  particularly  the  case  with 
lead,  in  the  use  of  which,  so  far  as  she  knew,  no 
symptoms  of  excitement  were  ever  ob.served,  and  in 
which  almost  all  the  pathological  changes  might  be 
interpreted  as  due  to  interference  with  nutrition. 
The  vascularity  of  the  nerve-centres  and  cell-gi-oups, 
described  by  Dr.  Birdsall,  might  indicate  a  defective 
nutrition,  since  it  showed,  perhaps,  a  slackening  of 
the  blood-cuiTent.  This  question  whether  the  action 
of  the  three  metals  mentioned  was  not  jjrimarily 
upon  the  nutrition,  seemed  of  much  importance  in 
view  of  their  extensive  use  medicinally. 

The  speaker  asked  whether  there  were  any  micro- 
scopical changes  noted  in  the  muscles  of  the  intes- 
tinal walls  ;  such  as  might  explain  the  colic  in  lead- 
poisoning. 

Dk.  Biudsall  said  that  no  examination  had  been 
made  by  himself  and  he  knew  of  no  records  of  any. 
Dr.  Birdsall  exhibited  microscopic  sections  of  the 
cord. 

Db.  Spitzka,  after  examining  them,  said  that  they 
did  not,  in  liis  opinion,  show  the  existence  of  myelitis. 
He  thought  the  columns  of  GoU  were  quite  normal. 

Dr.  Birdsall.,  in  reply,  reiterated  his  opinion  that 
there  were,  probably,  slight  inflammatory  changes. 
Ho  had  at  first  been  in  doubt,  but  more  careful  exami- 
nation convinced  him  that  the  cord  was  not  normal. 
There  was  a  spot  of  softening  in  the  cord,  and  this, 
he  admitted,  was  very  likely  po.st-mortem.  But  .some 
previous  pathological  change  was  the  primary  cause. 
As  regards  the  question  whether  the  lesion  in  lead- 
paralysis  was  primarily  in  the  cord  or  in  the  muscles, 
he  acknowie  Iged  that  there  were  many  cases  which 
seemed  to  show  that  the  muscles  were  chiefly  and 
first  affected.  Still  ho  believed  that  the  opposite 
view  was  not  without  support,  and  was,  on  the  whole, 
the  more  reasonable  one. 

Db.  Spitzka  referred  to  the  experiments  of  Dr. 
J.  T.  Mason  on  frogs.  Ho  had  fed  these  upon  lead, 
and  produced  paralysis,  though  not  the  typical 
one  seen  in  man.  The  nerve-cells  were  not  found 
to  be  affected  in  these  animals. 


MATERIA  MEDICA  SOCIETY. 

Stated  Meeting,  Thursday,  February  23,  1882. 

Dr.  Hbnrt  G.  Piffard  in  the  Chaik. 

The  paper  of  the  evening  was  read  by  Dk.  Eobekt 
M.  Fuller,  on 

THE  PROCESS  OF  MAKING  TABLETS  OF  SIMPLE  AND 
COMPOtlNB  PO^VDER6,  DJCLUDING  TRITtrRATlONS,  HY- 
PODERinCS,    ETC. 

The  discussion  was  opened  by  Dr.  Fabnham,  who 
said  that  he  fully  appreciated  the  value  of  Dr.  Ful- 
ler's preparations  for  dosage  and  administration. 
He  obtained  just  as  good  results  with  the  tablets  of 
aconite,  for  instance,  which  contain  one  minim,  as 
with  a  good  quality  of  Flemming's  tincture,  and  also 
with  other  preparations  that  he  had  had  any  expe- 
rience with,  fie  regarded  it  as  a  very  convenient 
method  for  carrying  about  doses  in  a  solid  form, 
which  would  be  very  difficult  to  cany  safely  and 
pleasantly  in  a  liquid  form. 

Dr.  Fox  said  he  had  used  the  tablets  prepared 
according  to  Dr.  Fuller's  process  for  the  past  two 
years,  and  felt  greatly  indebted  to  Dr.  Fuller  for 
having  devised  the  jjlan. 

Dr.  Castle  remarked  that  he  had  had  some  expe- 
rience in  making  and  using  the  tablets  proposed  by 
Dr.  Fuller,  from  which  he  derived  a  great  deal  of  satis- 
faction. He  was  pleased  not  only  with  their  porta- 
bility, but  also  with  the  facility  afforded  in  dispens- 
ing. Even  where  the  tablet  represented  a  greater 
amount  than  he  cared  to  give,  he  would  break  it  up 
and  dissolve  it  in  water  and  use  the  solution.  Be 
had  taken  occasion  to  show  his  apparatus,  and,  so 
far  as  he  was  able,  to  describe  the  methods  to  a 
number  of  physicians  who  had  called  upon  him, 
mostly  living  outside  of  the  city.  Some  of  them 
had  undertaken  to  use  them  in  the  country,  and,  f  o 
far  as  he  heard  from  them,  had  all  been  pleased. 
They  felt  themselves  under  obligation  to  him  for 
telling  them  of  it,  and  to  Dr.  Fuller  for  having  de- 
vised the  plan. 

De.  Webster  said  his  experience  in  the  use  of 
Dr.  Fuller's  tablets  had  been  very  small  indeed. 
Not  long  ago  an  agent  of  "Wyelh  Brothers  left  a 
quantity  of  their  preparations  at  his  office,  and  called 
his  attention  to  the  special  advantages  afforded  by 
one  kind  of  tablet,  viz.,  the  tablets  of  morphine  in- 
tended for  hypodermic  injection,  and  put  up  in 
little  bottles,  which  were  made  to  fit  all  hypodermic 
instrument  cases.  They  were  said  not  to  spoil,  as 
Magendie's  solution  does,  and  needed  only  to  be  dis- 
solved in  a  little  water.  Accordingly,  a  day  or  two 
afterward  he  (Dr.  Webster)  was  called  to  a  case 
where  there  was  excessive  pain  in  the  eye.  He  pro- 
ceeded to  try  one  of  the  morphine  tablets,  but  found 
very  great  difficulty  in  dissolving  it  in  water.  He 
poured  out  half  a  teaspoonful  of  water,  put  the  tab- 
let in  and  let  it  stay  a  little  while,  but  it  showed  no 
tendency  to  dissolve.  He  tried  to  crush  it  »'ith  his 
finger ;  it  was  so  hard  that  it  would  not  crush. 
After  manipulating  with  it  for  some  eight  or  ttn 
minutes,  he  finally  succeeded  in  dissolving  it.  Dr. 
Webster  thought  that  if  all  the  tablets  behaved  in 
that  way,  they  would  not  be  very  advantageous  for 
hypodermic  injection.  He  had  no  doubt  that  they 
would  be  excellent  for  swallowing,  because  then  it 
mattered  little  how  long  it  takes  t<y  dissolve.  It 
may  have  been  that  these  tablets  had  become  harder 
than  they  were  intended  to  be,  and  ho  hoped  that 
those  of  Dr.  Fuller  would  prove  extremely  soluble. 


THE  MEDICAL  RECORD, 


333 


He  also  took  some  Wyeth  tablets  of  pepsin  and  pan- 
creatin  for  indigestion,  and  was  sorry  to  state  tliat 
they^^did  not  relieve  him  very  much. 

Dr.  Purdy  had  extensively  nsed  the  tablet  tritu- 
rates of  l)r.  Fuller  intended  to  be  swallowed,  and 
employed  thorn  wherever  the  remedies  conld  be  ob- 
tained in  that  shape  in  preference  to  the  gelatin- 
coated  or  ordinary  jull.  He  was  very  much  better 
satisfied  with  their  effects.  He  did  not  find  that 
theyjpassed  through  undissolved,  as  a  large  number 
of  the  other  pills  do.  The  trouble  was  in  keepiog 
tliem  from  breaking  up. 

Dr.  ^Iobrow  being  called  upon,  suggested  that 
as  Dr.  Piffard  had  a  large  experience  with,  and  was 
an  enthusiastic  advocate  of  all  the  preparations  of 
Dr.  Fuller,  the  society  would  like  to  hear  from 
him.  ) 

Dr.  Piffard  thereupon  remarked  that  Dr.  Web- 
ster had  not  got  clearly  in  his  mind  the  idea  of  Dr. 
Fuller's  preparations.  The  Wyeth  preparations  are 
compi'essed  powders,  and  are  comparatively  insol- 
uble, while  the.se  jireparations  of  Dr.  Fuller  are 
porous  masses.  Dr.  Piffard  had  seen  the  Wyeth 
hypodermic  tablets,  and  was  glad  to  find  them  la- 
beled soluble  on  the  bottle,  because  he  would  not 
s  ispect  that  they  possessed  that  projierty  from  any  ex- 
perience that  he  had  had  with  them.  Whether  these 
tablets  of  Dr.  Fuller  will  prove  sufficiently  soluble 
for  hypodermic  injection  can  only  be  determined  by 
experiment.  But  they  will  prove  many  times  more 
soluble  than  the  Wyeth  taVilets.  Dr.  Piffard  stated 
that  he  found  the  blank  tablets  made  chiefly  with 
the  sugar  of  milk  very  convenient.  When  he  desired 
ti  give  a  placebo,  for  example,  he  would  give  a  suffi- 
cient number  of  these  blank  tablets,  instead  of  wi'it- 
ing  a  iiseless  prescription  making  up  one  dollar  or 
a  dollar  and  a  half  worth  of  medicine.  The  tritura- 
tions mide  in  the  taVilet  form  he  had  found  exceed- 
ingly useful  as  a  convenient  method  of  dosage,  be- 
lieving that  the  pharmaceutical  preparation  known 
a?  trituration  is,  for  many  substances,  the  most 
desirable  that  can  be  employed.  He  had  no  expe- 
rience with  the  troches.  All  physicians  who  at  all 
dispensed  their  own  medicines  would  find  them  the 
mist  convenient  and  economical  form  of  ready  made 
medicine  in  the  market,  because  they  are  furnished 
at  prices  considerably  under  that  of  gelatin  and 
shgarcoated  pills.  On  the  whole,  he  regarded  this 
Bdethod  of  preparation  as  being  one  of  the  greatest 
advances  in  practical  pharmacy  that  has  been  made 
of  late  years. 

Dr.  Webster  was  still  under  the  impression  that 
these  {Dr.  Fuller's)  were  called  comiiressed  tablets. 

Dr.  Piffard  explained  that  the  vital  difference 
between  the  tablets  of  Wyeth  Brothers  and  those  of 
Dr.  Fuller  lay  in  the  fact  that  the  former  being 
compressed,  lose  all  their  porosity,  whereas  the  lat- 
ter were  very  porous. 

Dr.  Farnham  stated  that  his  experience  with  the 
hypodermics  was  different  from  Dr.  Webster's.  He 
dissolved  in  ten  minims  of  water  a  tablet  (Dr.  Ful- 
ler's) containing  t  gi-.  of  morphia  and  ,4,,  gr.  of  atro- 
pia,  and  got  the  full  effect  of  the  drug. 

Dr.  Castle  stated  his  experience  with  the  Wyeth 
tablets,  of  which  a  samijle  box  was  sent  to  him  by 
Wyeth  a  short  time  ago.  He  found  that  some  of 
them  dissolved  comparatively  readily.  None  of 
them  dissolved  of  themselves,  but  he  had  to  use  the 
free  end  of  his  sjringe  or  the  bottom  of  a  little  bot- 
tle, which  served  as  a  convenient  pestle,  for  grind- 
ing them  up.  There  wei-e  still  tablets  in  the  lot  which 
would  not   dissolve   by   any   amount   of  gi-inding. 


After  a  long  trituration  there  was  still  left  a  sedi- 
ment in  the  bottom  of  the  spoon,  which  he  did  not 
feel  justified  in  injecting  into  the  connective  tisste 
of  his  patient.  He  did  not  know  whether  that  sedi- 
ment reijreseilted  any  of  the  active  element  of  the 
tablet,  or  whether  it  was  a  simple  inert  substance. 
He  also  had  his  attention  called  to  another  point  in 
his  experenee  with  these  Wyeth  tablets.  They  aie 
made  with  sodic  sulphate  as  a  basis.  He  had  no- 
ticed of  late  that  the  samples  he  had  in  his  instru- 
ment box  had  all,  with  one  exception,  absorbed 
moisture,  so  that  the  tablets  became  three  or  four 
times  as  thick  as  they  were  when  he  first  got  them. 
Whether  this  is  calculated  to  injure  the  properties 
of  the  tablet  or  not,  he  could  not  say.  His  experi- 
ence with  the  insolubility  of  certain  drugs  and  the 
tendency  to  absorb  moisture  had  led  him  to  aban- 
don them  in  injections. 

Dr.  Farnham  wished  to  know  how  to  get  over  the 
difficulty  of  making  the  tablets  when  the  active 
principle  is  volatile. 

Dr.  Piffard  informed  him  that  the  difficulty  could 
not  be  overcome.  The  tablets  of  Dr.  Fuller  weie 
not  adapted  to  the  administering  of  every  medicine, 
but  to  a  good  many.  Kearly  six  hundred  prepaia- 
tions,  mostly  with  the  sugar-of-milk  as  a  basis,  have 
thus  far  been  prepared.  Pharmacists  have  dis- 
pensed, so  far,  over  two  thousand  pounds,  averaging 
three  thousand  tablets  to  the  pound. 

The  attention  of  the  society  was  next  called  by  Dn. 
Piffard  to  certain  preparations  of  Messrs.  Mcln- 
tyre  k  Embury,  known  as  dialysates.  They  are, 
briefly,  prepared  as  follows  :  A  vessel  of  water  being 
taken,  into  that  is  placed  a  smaller  vessel  called  a 
"hoop,"  which  has  at  the  bottom  some  parchment 
paper.  The  fluid  preparation  of  the  drug,  having 
been  made  first  in  this  inner  vessel,  that  is  bunk  a 
short  distance  into  the  water  in  the  outer  vessel. 
After  it  has  stood  there  a  time,  it  is  found  that  the 
crystalline  and  crystalloid  principles  contained  in 
the  drug  will  have  left  the  inner  vessel  and  gone 
into  the  outer,  while  the  colloid  principles  will  have 
remained  in  the  inner  vessel.  When  that  process 
has  gone  on  a  sufficient  length  of  time  the  contents 
of  the  inner  vessel  are  discarded,  and  the  contents 
of  the  outer  vessel,  after  jiroper  standardization, 
constitute  the  dialysate. 

Dr.  Lewls  asked  if  dialyzed  iron  was  prepared  in 
the  same  way,  to  which  the  President  replied  in  tl  e 
negative.  Dialyzed  iron  would  not  pass  through 
the  membrane.  They  label  it  dialyzed,  perhaps 
for  the  same  reason  that  they  label  the  hypodermic 
tablets  soluble.  The  method  of  preparation  is  sci- 
entific and  calculated  to  give  good  results.  The 
process  is  only  applicable  in  cases  where  the  active 
principles  are  crystalloids.  It  seems  to  be  for  a 
large  line  of  drugs  fa.r  in  advance  of  the  fluid  ex- 
tracts. 

Dr.  Castle  remarked  that  it  did  not  render  the 
drugs  liable  to  the  change  that  may  take  place  in 
the  active  principles  due  to  thermal  and  chemical 
influences.  In  getting  the  active  principles  of  the 
drug,  it  had  been  heretofore  necessary  to  subject 
them  to  certain  chemical  processes  in  order  to  ren- 
der certain  parts  soluble,  or  to  form  salts.  The';e 
is  no  chemical  change  involved  in  this  process.  It 
is  simply  the  property  of  certain  substances  to  pass 
through  an  animal  membrane,  and  of  certain  other 
substances  not  to  pass  through. 

Some  reference  having  been  made  to  Keith's  so- 
called  resinoids.  Dr.  Pili'ard  remarked  that  some 
of  the  drugs  brought  forward  by  him  could  proba- 


334 


THE  MEDICAL  RECORD. 


bly  be  prepared  to  better  advantage  by  the  process 
of  dialysis.  Thus,  for  instance,  the  Inidrat^tin  of 
Keith  is  not  a  resinoid,  scientifically  speaking,  but 
a  mixture  of  various  substances,  including  the  alka- 
loids, hydrastia  (white),  berberina,  and  xanthopue- 
cina  (both  yellow),  which  would  pass  through  the 
dialyzar,  and  are  prob.ibly  tlie  efficient  principles 
contained  in  the  plant  hydrastis  canadensis. 

Dr.  Cistle,  in  conclusion,  called  the  attention  of 
the  society  to  an  apparatus  he  had  made,  which  was 
intended  to  facilitate  grinding,  and  to  be  used  in 
preparing  the  material  of  Dr.  Fuller's  tablets,  and 
also  for  making  triturations. 

Tde  society  then  went  into  executive  session. 


IOWA   STATE   IVIEDICAL   SOCIETY. 
The  thirtieth  annual  session  of  the  Iowa  Stat*  Medi- 
cal  Society  was   held   at   Des   Moines,   beginning 
January  25,  1882,  at  10  a.m. 

The  officers  present  were  :  President,  T.  J.  Cald- 
well, Adell ;  First  Vice-President,  D.  Scofteld,  Wash- 
ington ;  Secrelari/,  J.  F.  Kennedy,  Des  Moines ;  As- 
sistant Sici-etnry,'h.  C.  Swift,  Des  Moines ;  Treasurer, 
G.  R.  Skinner,  Cedar  Rapids. 

The  attendance,  even  at  the  opening  session,  was 
unusually  large. 

At  2  P.M.  The  President  delivered  the  annual  ad- 

The  people,  he  said,  need  more  light  upon  sanitary 
matters,  and  too  many  are  criminally  apathetic  con- 
cerning the  knowledge  they  now  have  on  such  mat- 
ters. 

The  President  recommended  for  the  improvement 
and  interest  of  the  sessions,  in  a  literary  and  profes- 
sional point  of  view,  the  adoption  of  the  plan  sug- 
gested by  Bowditch  in  an  address  before  the  Ameri- 
can Medical  Association. 

Dr.  a.  Reynolds,  of  Independence,  Superinten- 
dent of  the  Insane  Hospital,  read  a  paper  on  the 
"  Plea  of  Insanity."  He  said,  among  other  things, 
that  no  theory  relating  to  the  insane  is  more  erro- 
neous than  that  they  are  utterly  irresponsible.  He 
believed  there  was  no  such  thing  as  the  so-called 
moral  insanity,  pure  and  simple,  unattended  by  in- 
tellectual capacity.  In  referring  to  Guiteau,  he  said 
that,  sane  or  insane,  he  is  responsible  in  law,  and 
that  neither  the  cause  of  humanity,  nor  the  higher 
law,  nor  justice  nor  mercy  can  be  subserved  by  giv- 
ing him  the  benefit  of  a  doubt.  This  sentiment  was 
heartilv  cheered  by  the  members. 

Dr.  J.  A.  Blanchard  read  quite  an  interesting 
paper  upon  "  Inversion  of  the  Uterus."  He  gave  a 
case  occurring  in  his  practice  of  six  weeks'  standing 
successfully  reduced. 

Following  this,  Dr.  J.  Willi.oison,  of  Ottumwa, 
read  a  p  iper  entitled  "  Disappointments  of  Country 
Physicians  in  the  Practice  of  Gynecology."  The 
piper  was  listened  to  with  interest,  ami  a  lively  dis- 
cussion was  indulged  in  regarding  some  facts  stated 
in  this  and  the  pipor  road  by  Dr.  Blanchard. 
EvEMiNo  Session. 
At  the  evening  .session,  Dr.  R.  J.  Farqitharson, 
of  Dr<  Moines,  read  a  paper  on  "  A  Small-Pox  Hos- 
pital." 

Second  Day  —Morning  Session. 


Dr.  Ij.  C.  Swii'T,  of  Des  Moines,  read  a  paper  on 
"Pyelitis  Occurring  during  the  Puprpcral  State." 
Dr.  B.  M(;Cmier,  of  Dubucpie,  presented  a  paper 


prepared  by  Dr.  Wm.  Watson,  of  Dubuque,  on  "  The 
Diseases  Incident  to  Military  Prisons,  and  the  In- 
fluences  by  which  they  are  Modified."  The  paper 
gave  the  results  of  his  observations  while  Post  Sur- 
geon at  Rock  Island,  arid  in  charge  of  the  Confed- 
erate prisoners  during  tne  late  war. 

Dr.  G.  W.  Beggs,  of  Iowa  City,  read  a  paper  'de- 
tailing his  practice  in  the  care  of  the  newly -bom  in- 
fant. He  emphasized  most  particularly  the  import- 
ance of  ^Tapping  the  babe,  as  soon  as  it  was  taken 
from  the  mother,  tightly  in  a  soft  blanket  without 
washing,  and  letting  it  remain  in  that  position  for 
ten  or  twelve  hours. 

Second  Day — .Afternoon  Session. 

Society  convened  at  2  p.m.;  President  in  the  chair. 

Dr.  C."  M.  Habby,  of  Iowa  City,  read  a  paper  on 
"Operative  Procedures  in  Comeal  Lesions."  Dn. 
J.  R.  GoRRELD.  of  Newton,  also  read  a  paper,  en- 
titled "Life:  What  is  It?" 

Dr.  E.  H.  Hazen,  of  Davenport,  followed  with  a 
paper  on  "  Local  Treatment  of  the  Mucous  Mem- 
branes," expressing  most  confidence  and  better  re- 
sults from  local  treatment  by  proper  douches  and 
dry,  medicated  inhalations,  conjoined  with  constitu- 
tional remedies  when  indicated. 

Second  Day — Evening  Session. 

The  evening  was  given  to  the  lecture  on  "Micro- 
scopy." Dr.  J.  J.  M.  Angear,  of  Fort  Madison,  had 
on  exhibition  quite  a  number  of  microscopes,  and 
gave  an  interesting  address  upon  microscopy,  and 
demonstrated  the  wonderful  power  and  the  hidden 
beauties  of  nature  as  revealed  by  the  microscope. 

Dr.  Mcintosh,  of  Chicago,  who  was  present,  ren- 
dered valuable  assistance  and  furnished  some  strik- 
ing and  brilliant  exhibitions  of  the  power  of  the 
solar  microscope. 

Third  Day— Morning  Session. 

Thomas  Dunn  English,  M.D.,  LL.D.,  the  poet, 
class  of '39,  University  of  Pennsylvania,  was  intro- 
duced and  elected  a  member  of  the  society  by  invita- 
tion. 

Dr.  MoCmjre,  of  Mount  Pleas.ant,  and  Dr.  w.  F. 
Peck,  Davenport,  presented  papers  in  memory  of 
the  late  Dr.  John  C.  Hughes,  and  Dr.  W.  H.  Ward, 
of  Des  IMoines,  one  in  memory  of  Dr.  C.  W.  Davis,  of 
Indianola. 

Dr.  C.  M.  DRUJiEiiAK,  of  Panora,  read  a  voluntary 
paper  detailing  -  case  of  "Fracture  of  tlie  Skull." 

All  the  above-named  papers  were  received  by  the 
society,  and,  after  discussion,  were  referred  to  the 
Coraniitteo  on  Publication. 

The  following  officers  were  elected  for  the  ensuing 
vear:  Pi-ctWch/,  D.  Scoticld,  Washington;  First  Vice- 
'President,  S.  E.  Robinson,  West  Union ;  Second  Vice- 
President,  H.  L.  Getz,  IMarshal :  Secretory,  J.  F. 
Kennedy,  Des  IMoines  Assistant  Sea-etary,  D.  Mo- 
Crea,  (Jouncil  Bluffs;  Treasurer,  G.  B.  Skinner, 
Cedar  Rapids. 

Council  Blufl's  was  selected  as  the  next  place  of 
meeting,  and  the  time,  third  Wednesday  in  May, 
18S3.  ,  ,      ,        , 

Tliis  session  was  one  of  harmonv  and  hard  worK, 

and  the  character  of  the  papers  refd  was  above  the 

average  in  ability  and  interest.    The  attendance  was 

large,  and  neaily  fifty  new  members  were  added  to 

I  the  list. 


_1 


THE  MEDICAL  RECORD. 


335 


Corre0p0ntimc<. 


chloroform  and  the  nitrite  of 
a:\iyl. 


To  TUB  Edit 


Medical  Record. 


Sib  :  The  importance  of  the  subject,  and  a  desire  to 
correct  two  errors  in  a  recent  statement  concerning 
the  nitrite  of  amyl,  must  be  my  excuse  for  again  ask- 
iig  a  place  in  vour  columns.  In  the  article  on 
antesthetics,  by  Jo.seph  Lister,  Esq.,  revised  by  J. 
C.  Reeve,  M.D.,  in  Packard's  "Holmes'  System  of 
Surgery,"  it  is  stated  that :  "  Nitrite  of  amyl  has  i-e- 
ceived  the  highest  commendation  as  a  means  of 
combating  chloroform  narcosis.  Its  ailini/islralion 
being  hy  inhnhitioit  of  the  vapor,  it  can  only  be  re- 
sorted to  in  some  cases.  Recoveries  have  unques- 
tionably followed  its  use,  but  whether  as  a  sequence 
or  consequence  is  not  so  clear,  and  further  observa- 
tions are  needed.  It  must  be  remembered  that, 
although  nitrite  of  amyl  is  a  most  effective  remedy 
iu  one  form  of  cardiac  disease,  its  brilliant  .service  is 
not  due  \o  its  action  on  the  heart,  but  ujion  the 
peripheral  arterioles,  spasm  of  whicli  it  relaxes,  and 
that  its  action  in  lowering  the  blood-pressure  is  not 
favorable  to  its  use  in  clilorofoi~ni  accidents." 

My  experiment  on  a  kitten,*  made  in  187C,  showed 
that  the  hypodermic  injection  of  five  drops  of  nitrite 
of  amyl,  after  complete  auiesthesia  and  abolition  of 
reflex  action,  with  suspended  respiration  and  a  ilut- 
tering  heart,  was  promptly  followed  by  reaction  of 
the  pupils  to  light,  resumption  of  respiration,  and 
improved  cardiac  action,  with  ultimate  recovery  ;  so 
that  the  administration  of  this  agent  need  not  be 
limited  to  inhalation  of  the  rapor,  but  it  may  be  given 
hypodermically.    Again,  although  "  its  brilliant  ser- 
vice is  not  due  to  its  action  on  the  heart,"  the  result 
is  similar,  since,  by  the  r/s  a  fronte  effect  produced 
■when  the  arterioles  are  relaxed,  the  cardiac  current 
is  drawn  into  the  enlarged  vessels,  and  stasis  is  pre- 
vented.    Further,  the  statement  that  "  its  action  in 
lowering  the  blood-jiressure  is  not  favorable  to  its 
use  in  chloroform  accidents"  does  not  seem  to  be 
borne  out  by  clinical  experience.      Dr.   James  L. 
Minor,  of  Rapidan,  Ya.,t  reports  a  case  in  which  a 
patient  who  had  locomotor  ataxia  passed  suddenly 
from  a    condition    of   usual    health   into    collapse. 
There   was  general  p  illor,    with   complete    uncon- 
sciousness, and  the  arterial  beat  was  imperceptible 
at  the  radial   pulse,  but  faintly  recognized  at  the 
femoral   pulse.     Here  was  evidently  a  lowering  of 
the  blood-pressure  similar  to  that  which  occurs  in 
chloroform  syncope.     The  ordinary  method  of  in- 
haling a  few  drops  of  nitrite  of  amyl  was  tried  in 
vain,  and  then  three  minims  were  injected  hypoder- 
mically.    In  a  few  moments  the  heart  responded, 
and  the  pulse  was  recognized  in  the  radial  artery. 
In  about  half  an  hour  the  effects  of  the  medicine 
seemed  to  disappear,  when  five  minims  were  injectipd, 
with  the  result  of  producing  more  vigorous  action 
than  before.     The  patient  lasted  for  nearly  twenty- 
four  hours,  during  which  time  amyl  nitrite  was  fre- 
quently administered.     As  much  as  fifteen  minims 
were  given  at  one  of  the  doses  when  the  "  /ntlse  hr.- 
came  incompiressible."     "  So  long  as  the  vita!  ]ioTers 
were  able  to  respond,  the  administration  of  tlie  med- 
icine was  followed  by  reaction  which  seemed  mar- 

vember,  1876. 


vellous."  I  have  a  record  of  nine  cases,  in  all  of 
which  impending  death  from  chloroform  seems  to 
have  been  averted  by  the  nitrite  of  amyl.  In  some 
of  them  the  evidence  is  absolutely  conclusive  in  its 
favor.  It  would  be  unfortunate  if  a  full  trial  of  it 
should  be  prevented  by  incomplete  infoimation  as 
to  the  methods  of  employing  it,  or  hypothetical  ob- 
jections as  to  its  mode  of  action. 

Respectfully, 

F.  A.  BCKRALL,  M.D. 

4S  West  Sevestee.nth  Street. 


THE  QUESTION  OF  TASTING  MEDICINES 
INTRODFCED  INTO  THE  VAGINA  AND 
THE  EAR. 

To  THE  Editor  of  The  Medical  Recobd. 
Dear  Sik  :  In  reporting  the  discusbion  of  Dr.  Fos- 
ter's paper  at  the  December  meeting  of  the  Materia 
Medica  Society,  the  Recoud  of  February  25th  states 
that  "  Dr.  Sexton  related  a  case  in  which,  on  iodo- 
form application,  a  peculiar  sensation  ]  ass-ed  from 
the  right  ovarian  region  to  the  ear,  an  indefinite 
taste,  not  of  iodoform,  being  experienced  at  the  same 
time." 

If  my  memory  serves  me,  what  I  did  say  on 
that  occasion  was  this,  alluding  to  a  case  under  the 
treatment  of  a  ])hysician  for  a  diseased  condition 
in  which  the  right  ovary  had  been  the  seat  of 
much  pain  for  over  a  year,  that  whenever  the  ova- 
rian pains  were  experienced  by  the  patient,  severe 
pains  were  at  the  same  time  felt  iu  the  right  ear, 
and  that  the  otalgia  thus  set  up  in  the  ear  was 
associated  with  other  nervous  phenomena,  one  of 
which  was  the  sensation  of  something  crawling  along 
the  neck  on  the  affected  side,  and  on  the  back  of 
the  shoulder.  There  was  diiring  the  attacks  a  sen- 
sation, slightly  painful,  which  seemed  to  be  propa- 
gated from  the  ovarian  region  in  the  direction  of  the 
ear.  The  otalgia,  moreover,  was  only  present  when 
the  disturbance  in  the  ovarian  region  suffered  an 
exacerbation.  I  found  on  examination  that  the 
right  ear  was  entirely  free  of  any  inflammation  what- 
ever ;  that  there  was  no  local  cause  that  could  give 
rise  to  the  pains. 

This  case  was  pointed  out  as  illustrative  of  the  in- 
timate nervous  relationship  existing  between  regions 
remote  from  each  other,  as  the  ovary  and  the  ear. 
I  also  stated  that  I  had  frequently  seen  instances 
where  patients  exjierienced  excitation  of  the  sense 
of  taste  on  application  of  remedies  to  the  ear  ;  that 
even  the  introduction  of  a  silver  probe  into  the  ex- 
ternal auditory  canal  was  often  sufficient  to  give  rise 
to  the  same  phenomenon. 

From  observations  of  this  kind  it  seems  that  we 
are  warranted  in  believing  that  the  taste  in  the 
mouth  in  the  cases  cited  by  Dr.  Foster  could  be  ex- 
plained by  nervous  transmission  rather  than  by  the 
absorption  of  the  iodoform  and  its  passage  to  the 
mouth  through  the  circulation.  And  inasmuch  as 
the  odor  of  the  drug  usually  pervades  the  air  when 
used,  the  patient  cannot,  of  course,  always  differen- 
tiate as  between  the  action  on  the  senses  of  olfac- 
tion and  taste. 

Believe  me,  yours  sincerely, 

Samuel  Sexton. 

— ■ ^  >  ^ 

RraiovAii  OF  THE  Utekus. — The  patient  from  whom 
Sir  William  McCormac  recently  removed  the  entire 
uterus,  on  account  of  cancer,  is  said  to  be  convales- 
cent. 


336 


THE  MEDICAL  RECORD. 


IODOFORM    IN    SUPPURATION    OF    THE 
IMIDDLE  EAR. 

To  THE  EnrTOR  OF  The  Medical  Record. 

Dear  Sib  :  In  the  report  of  the  jiroceedings  of  the 
Materia  Medica  Society  contained  in  the  Record 
of  February  25th,  the  opinions  of  some  of  the  mem- 
bers as  to  the  action  of  iodoform  in  suppuration  of 
the  middle  ear  are  so  at  variance  with  what  I  have 
myself  observed,  that  I  feel  prompted  to  state 
briefly  my  own  experience  with  this  drug. 

In  some  cases  of  clironic  suppuration  of  the  mid- 
dle ear  I  have  found  iodoform  to  be  one  of  the 
most  useful  remedies.  In  the  greater  proportion 
of  thesa  cases  I  am  unable  to  state  any  exact  indica- 
tions for  its  use,  but  can  merely  say  tliat  it  acts  very 
bjaeflcially  where  all  other  applications  seem  to  be 
InefBcient  or  harmful.  For  instance,  I  have  now 
before  me  the  record  of  a  gentleman,  aged  sixty-six, 
who  has  had  a  perforation  of  the  left  drumhead  and 
an  intermittent  discharge  from  the  middle  ear  since 
childhood.  When  first  seen  by  me  the  discharge 
had  lasted  for  six  weeks.  He  was  treated  with  a 
variety  of  remedies  for  several  months  with  no  ap- 
parent benefit.  The  sujapuration  then  ceased  at 
once  after  an  ajiplication  of  iodoform.  The  dis- 
chai'ge  has  recurred  several  times  since  and  has  been 
always  so  promptly  checked  by  the  same  remedy — 
usually  by  a  single  application — that  I  think  the 
remedy  may  fairly  have  the  credit  of  the  cure. 

A  class  of  chronic  cases  in  which  I  have  used  iodo- 
form with  great  satisfaction  are  those  characterized 
by  considerable  sensitiveness  of  the  parts,  unhealthy- 
looking  ^granulations,  and  a  tenacious  whitish  secre- 
tion which  tends  to  adhere  to  the  underlying  surface 
in  the  form  of  a  tough  membrane. 

Iodoform  acts  well  also  in  some  cases  of  acute  sup- 
puration, and  I  think  it  will  occasionally  be  found 
preferable  to  caustics  for  some  forms  of  granulations. 
On  the  other  hand,  I  have  known  it  to  do  positive 
harm.  In  one  case  the  suppiirating  surface  was  al- 
most completely  closed  by  cicatrical  tissue,  and  there 
w.is  simply  a  moderate  thin  discharge,  coming  appar- 
ently from  the  upper  part  of  the  tympanum.  A  very 
small  quantity  of  iodoform  was  applied,  and  the  next 
day  there  was  extensive  destruction  of  the  new  tissue, 
a  thick  purulent  discharge,  vertigo,  staggering,  nau- 
sea, and  general  prostration,  lasting  three  orfourdays. 
My  method  of  using  iodoform  in  the  ear  is  to 
have  it  very  finely  powered  and  to  apply  it  (with 
Andrews'  powder  blower)  in  the  form  of  a  rather 
thin  film.  I  do  not  know  that  there  is  any  special 
advantage  in  applying  it  in  such  excess  as  is  often 
used.  When  used  in  the  latter  way  it  sometimes 
causes  temporary  throbbing  and  tinnitus,  and  it 
sometimes  forms  crusts  with  the  discharge,  which 
may  prove  irritating.  I  have  not  found  its  odor  any 
hindrance  whatever. 

I  think  iodoform  is  very  useful  also  in  some  cases 
of  trachoma  and  the  attendant  corneal  disease.  I  pre- 
fer to  mix  it  with  vaseline,  spread  it  thickly  on  the 
inner  surface  of  the  lid,  and  by  means  of  the  lid  to 
rub  it  well  over  the  cornea  for  a  few  seconds. 

In  a  recent  number  of  Tins  Medip.^i,  REconn  will 
be  found  an  article  by  Dr.  F.  H.  Rankin  on  this 
same  subject.  Edw.\bd  T.  Ei.t. 


The  Commencement  of  the  UsnT.n.siTV  of  Prnn- 
SYiiVANiA  Medical  Department  took  place  March  Loth. 
There  were  122  graduates  in  ratdicine,  and  11  in 
dentistry.  Professor  James  Ty^on  delivered  the 
valedictory  address. 


ARMY  NEWS. 

(yfftdnl  Linl  of  Changes  of  Stations  and  Duties  of  Offi- 
cers of  the  Medical  Department,  United  States  Army, 
from  March  11,  1882,  to  March  18,  1882. 

Brown,  H.  E.,  Major  and  Surgeon.  Ha^^ng  re- 
ported at  these  Headquarters,  will  proceed  to  Jack- 
son Barracks,  La„  and  report  to  the  Commanding 
Oflicer  for  dutv.  S.  O.  32.  Department  of  the  South. 
March  U,  1882. 

Porter,  Joseph  Y.,  Major  and  Surgeon.  Granted 
leave  of  absence  for  one  month,  with  permission  to 
apply  for  an  extension  of  one  month.  S.  O.  32,  C.  S. 
Department  of  the  South. 

The  following  named  officers  of  the  Medical  De- 
partment will  report  in  person  to  the  President  of 
the  Medical  Examining  Board,  in  session  in  New 
York  City,  for  examination  for  promotion,  and  on  its 
conclusion,  return  to  their  stations  : 

Captain  Wm.  H.  King,  Assistant-Surgeon,  Fort 
McHenry,  Md. 

Captain  H.  S.  Turrill,  Assistant-Surgeon,  Madison 
Barracks,  N.  Y. 

Captain  W.  Reed,  Assistant-Surgeon,  Washington 
Barracks,  D.C. 

Captain  H.  S.  Kilbourne,  Assistant-Surgeon,  Fort 
Porter,  N.  Y. 

Captain  M.  W.  Wood,  Assistant-Surgeon,  Fort 
Brady,  Mich. 

Captain  R.  W.  Shufeldt,  Assistant-Surgeon,  Wash- 
ington, D.C. 

Captain  H.  O.  Perley,  Assistant-Surgeon,  Fort 
Columbus,  K  Y.  H. 

Captain  H.  G.  Burton,  Assistant-Surgeon,  Fort 
Hamilton,  N.  Y.  H. 

Captain  L.  M.  Maus,  Assistant-Surgeon,  at  expi- 
ration of  his  present  leave  of  absence,  and  then  to 
return  to  his  proper  station,  David's  Island,  N.  1'. 

Captains  Wm.  H.  Corbusier  and  Wm.  B.  Davis, 
Assistant-Surgeons,  at  the  expiration  of  their  pres- 
ent leave  of  absence,  and  upon  conclusion  of  their 
examination,  to  report  by  letter  to  the  Surgeon- 
General.     S.  O.  58.     A.  G.  O.,  March  13,  1882. 


iHeiical  Jtema  antj  Utxos, 


OoNTAOIOrS  DlBEASES  —  WeEKI/T  Statkkk.nt.  — 
Oomparative  statement  of  cases  of  contagious  diseases 
reported  to  the  Sanitary  Bureau,  Health  Department, 
for  the  two  weeks  endijag  March  18,  1882. 


i 

i 

^ 

1,-| 

i 

Week  HndiBg 

1 
1 

y 

11 

a 

1 

i 

March  11,  1883. 

7 

5 

304 

3 

191 

108 

36 

0 

March  18,  1882. 

8 

9 

342 

2 

166 

110 

36 

0 

CojnrENrE>rENT  at  Bellevfe  HosrrrAT.  MEniOAL 
CoiitEOE  occurred  March  ICth  at  Chicl;ering  Hnll. 
A  class  of  1(1.'?  was  graduated.  The  dijilomas  were 
conferred  upon  the  class  bv  Professor  Isaac  E.  Tay- 
lor, M.D.,  President  of  the  Faculty.  Dr.  J.  S.  Bil- 
lings made  the  address  to  the  graduates. 

James  W.  McKean,  M.D.,  of  Iowa,  delivered  the 
valedictory  address. 


Vol.  XXI-No.  13. 

_April  1,  1882. 


THE  MEDICAL  RECOED. 


337 


©ritjimil  Communicatlcrns. 


obliqttity  of  the  pel\18  and  its 
tkeat:mext  ;  or,  saceo-llhibae  cur- 
vature.* 

By  CHAS.  F.  STILL.AIAN,  M.D., 

NEW   YOllK. 

The  subject  of  obliquity  of  the  pelvis,  or,  as  I  prefer 
to  call  it,  sacro-lumbar  curTature,  has  not  received 
from  .surgeons  the  attention  that  its  frequency  ami 
importance  demands.  Very  little  has  been  written 
upon  it,  and  these  disconnected  paragraphs  have 
usually  appeared  under  the  descriptions  of  diseases 
to  which  the  curvature  is  sometimes  secondary. 

It  is  in  reality  a  curvature  of  the  spine,  and  I 
claim  that  it  can  be  as  distinctly  classified  and  de- 
scribed as  such  with  as  much  reason  as  can  lateral 
rotary  curvature.  The  appended  division  of  lateral 
curvature  mto  (1)  lateral  rotary,  (2)  sacro-lumbar 
IS,  therefore,  proposed  for  consideration  ;  and  while 
I  am  not  in  favor  of  increasing  the  number  of  names 
which  encumber  our  surgical  nomenclature,  obli- 
quity of  the  pelvis  is  so  distinctivelv  spinal  curva- 
ture that  it  should  be  given  a  name  expressinr^  its 
position. 

It  may,  perhaps,  be  said  that  it  is  improper  to  in- 
clude a  sacro-lumbar  twist  among  the  curvatures  of 
the  spine,  that  it  really  should  he  classified  amono- 
abnormal  conditions  of  the  lower  extremity.  ° 

To  this  the  answer  would  be  returned  that  the 
spine  IS  supposed  to  extend  to  the  tip  of  the  coccvx 
and  therefore  includes  the  sacrum,  and  that  the  s'a- 
crum  IS  united  to  the  remainder  of  the  pelvis  in  such 
a  manner  as  to  make  it  practicallv  one  piece,  and 
that  a  twist  of  the  pelvis  upon  the  last  lumbar  ver- 
tebr.T  IS  anatomically  analogous  to  the  twisting  of 
the  last  lumbar  vertebrie  upon  the  fourth,  or  the 
fourth  upon  the  third. 

If  only  the  muscles  governing  the  movements  of 
the  thigh  upon  the  pelvis  were  involved,  we  might 
then  refuse  to  call  this  deformity  a  spinal  curvature, 
but  besides  these,  the  muscles  connecting  the  thi^li 
With  the  spine,  notably  the  psoas  muscles  and  tho^se 
connecting  the  pelvis  with  the  spine  and  lower  rib 
are  required  to  produce  the  curvature. 

Lateral  rotary  curvature  is  caused  mainly  bv  the 
action  of  the  latissimus  dorsi,  which  has  its  insertion 
in  the  humerus,  just  as  the  psoas  in  sacro-lumbar 
curvature  has  its  insertion  in  the  femur. 

The  two  curvatures  are  analogous,  but  while  thev 
may  coexist  m  the  samo  person,  there  is  one  svmp- 
tom  of  sacro-lumbar  curvature  which  sei-ves  to  dis- 
tinguish it,  and  that  is  limping ;  for  while  lateral 
rotary  curvature  may  exist  without  this  feature, 
sacro-lumbar  curvature  cannot ;  and  while  lateral  ro- 
tary curvature  destroys  the  parallelism  of  the  trans- 
verse plane  of  the  chest  with  the  transverse  plane  of 
the  pelvis,  sacro-lumbar  curvature  destrovs  the  par- 
allelism of  the  transverse  plane  of  the  pelvis  with 
the  transverse  plane  of  the  chest. 

They  are  both,  however,  included  in  the  general 
term  of  lateral  cm-vature  of  the  spine. 

Some  may  think  it  strange  that  as  coequal  varie- 
ties of  lateral  curvature,  the  curvatures,  cervical, 
dorsal,  and  lumbar— as  they  are  usuaUy  called,  be- 


cause  of  the  location  of  the  greatest  curve,  as  it  may 
happen  to  be— are  not  included. 

This  is  not  done  because  they  are  varieties  of  lat- 
eral rotary  curvature,  the  same  nnisclea  being  in- 
volved whether  the  main  curve  be  cervical,  dorsal, 
or  lumbar  ;  this  not  being  the  case  with  sacro-lumbar 
curvature,  in  which  the  pelvis  becomes  tilted  and 
twisted  by  an  entirely  different  set  of  muscles. 

The  erect  position  of  the  body  depends  upon  the 
tone  of  its  muscles.  These  are  divided  into  two  set? 
which  act  against  each  other  and 
serve  to  keeji  the  body  in  equi- 
librium, ready  to  move  either 
reflexly  or  voluntarily  u]ion  the 
slightest  provocation.  This  bal- 
ance is  lost  during  sleep  and 
periods  of  unconsciousness,  for 
then  the  body  is  limp,  and  if  un- 
supported, tends  to. fall.  We  are 
unconscious  of  etlbrt  in  produc- 
ing this  balance,  but  the  merest 
injury  to  one  of  the  inferior  ex 
tremities  serves  to  throw  oui 
weight  upon  the  sound  limb  and 
produce  distortion. 

"When  erect,  the  transverse 
axes  of  the  shoulders  and  pelvis 
should  be  parallel  and  also  the 
axes  of  the  limbs,  the  latter  be- 
ing at  right  angles  to  the  for- 
mer, see  Fig.  1. 

If  the  weight  be  sustained  on 
one  limb,  the  latter  angles  be- 
come acute  or  obtuse  instead  of 
ii?ht  angles. 

For   pur250ses  of  rest   nature 
has  allowed  man  to  assume  a  position  which  tends 
to   the   production    of   lateral   curvature.      If    the 
weight    of    the   body  is   received    upon   one    foot, 
see  Figs.  2   and  3,  the  opposite   side   of  the   pel- 


vis is  higher  and  a  sweeping  curve  is  noticed 
from  the  head  to  the  coccyx,  the  opposite  shoulder 
being  the  higher.  The  transverse  axis  of  the 
pelvis  thus  forms  an  obtuse  angle  with  the  verti- 
cal axis  of  the  leg,  and  the  transverse  axes  of  both 
pelvis  and  shoulders  are  deflected  from  the  horizon- 
tal and  from  their  parallelism  with  each  other.  We 
have  in  this  condition  of  rest,  sacro-lumbar  cnrva- 


338 


THE  MEDICAL  RECORD. 


ture  and  lateral  rotaij  combined.  But  when  tliis 
position  is  changed  for  the  erect  one,  the  parallelism 
of  the  shoulders  and  pelvis  is  reassumed  and  the 
axes  of  the  legs  become  at  right  angles  to  the  axes 
of  the  pelvis.  That  sacro-lumbar  curvature  is  in-, 
eluded  in  the  lateral  curvature  or  this  position  of 
rest,  may  be  proved  by  assuming  that  position  of 
rest  and'taking  a  step  or  a  succession  of  steps  with 
the  limb  fixed  on  the  pelvis  at  the  obtuse  angle 
assumed.  If  the  limb  be  carried  in  this  fixed  posi- 
tion, the  steps  cannot  be  taken  irithmil  decided  limp- 
ing, aad  if  the  body  be  balanced  upon  the  opposite 
limb  the  fixation  being  still  continued,  the  foot  of 
the  fixed  side  will  be  raised  from  the  floor. 

Frequent  and  prolonged  standing  in  this  position 
is  a  fruitful  cause  of  the  lateral  rotary  curvature 
which  is  so  often  observed  about  the  age  of  puberty, 
and  would  be  a  source  of  sacro-lumbar  curvature  as 
well,  were  it  not  that  the  limbs  support  the  pelvis 
upon  two  very  movable  ball-and-socket  joints,  and 
that  the  tendency  to  parallelism  between  the  limbs 
prevents  the  curvature  occurring  involuntarily. 
Then,  too,  the  reception  of  the  weight  of  the  body 
upon  the  sacrum,  midway  between  the  movable  sup- 
ports, tends  to  equalize  the  angles  and  prevent  the 
curvature.  When  standing  in  the  positiion  of  rest, 
the  foot  being  the  fixed  point,  the  psoas  and  iliacus 
muscles  curve  the  lumbar  portion  of  the  spine  and 
tilt  the  pelvis  forward,  and  from  the  obliquity  of 
their  insertion  into  the  inner  and  back  part  of  the 
thigh  that  side  of  the  pelvis  is  drawn  backward 
behind  the  proper  plane,  the  pelvis  thus  being 
twisted  on  the  last  lumbar  vertebra,  this  upon  the 
fourth,  the  fourth  upon  the  third,  the  third  on  the 
second,  the  second  on  the  first,  and  finally  the  fii-st 
on  the  last  dorsal,  these  corresponding  to  the  points 
of  origin  of  the  psoas  muscles.  In  addition,  a  con- 
traction of  the  quadratus  lumborum  of  the  same  side 
is  present.  It  must  be  borne  in  mind,  in  order 
to  explain  this  association  of  muscular  force  fully, 
that  the  nerve-supply  of  the  quadratus  lumborum 
and  the  psoas  muscles  is  derived  from  the  same  source, 
the  anterior  branches  of  the  lumbar  nerves,  and  that 
the  Uiaous  is  supplied  by  the  anterior  crural,  and 
that  when  one  of  these  muscles  is  found  to  be  con- 
tractured  or  inefficient,  the  others  are  usually  asso- 
ciated with  it.  I,  for  convenience,  therefore,  shall 
refer  to  them  as  the  psoas  group.  Instead  of  stand- 
ing in  the  position  of  rest,  if  the  patient  lie  upon  the 
back  and  the  thorax  be  taken  as  the  fixed  point,  the 
psoas  group  flex  the  thigh  upon  the  pelvis  and  rotate 
the  femur  outward. 

It  will  readily  be  seen,  therefore,  that  if  these 
muscles  become  contractured  and  thereby  shortened, 
the  distance  between  their  origin  and  insertion  will 
be  decreased,  the  lumbar  vertebrss  wiU  eune  forward 
and  be  deflected  toward  the  opposite  side,  when  the 
erect  position  is  assumed,  and  the  corresponding 
side  of  the  pelvis  will  be  twisted  and  seem  appar- 
ently higher,  producing  the  diagnostic  distortion  of 
sacro-lumbar  curvattire ;  and  conversely,  if  the  patient 
assume  the  horizontal  position,  the  knees  being 
flexed,  the  sacro-lumbar  curve  disappears,  only  to 
reappear  if  the  knee  be  brojight  down  to  the  hori- 
zontal plane. 

It  will  be  seen,  therefore,  that  a  certain  degree  of 
flexion  of  the  thigh  on  the  pelvis  is  produced  by  the 
contraction  of  tliese  muscles,  and  that  this  flexion 
cannot  be  reduced  by  voluntary  effort  upon  the  part 
of  the  ))atient.  How,  then,  shall  we  reduce  this  cur- 
vature ?  Firxt  onercome  the  flexion  find  nhdiiftiim  or 
ndduction  and  then  pnraUelize  the  shoulders  and  2>''iris. 


To  do  this  requires  antagonism  of  the  entire  psoas 
group.  Let  us  see,  first,  whether  the  iceight  if  the 
limb  would  be  itself  sufficient  to  affect  this  an- 
tagonism. 

If,  by  suspension,  the  shoulders  and  pelvis  paral- 
lelize and  the  heels  are  on  the  same  plane,  we  can 
consider  the  group  antagonized  by  the  weight  of 
the  limb  alone,  and  we  can  keep  this  antagonism 
constant  by  means  of  a  brace  for  that  purj^ose,  which 
is  now  exhibited  to  you.  It  consists,  as  you  see, 
of  two  well-fitting  segments,  one  for  the  pelvis  and 
the  other  for  the  thorax,  connected  posteriorly  by  an 
extension-rod,  provided  with  joints  for  lateral  and 
rotary  motion. 

Appropriate  shoulder-  and  hip-straps  are  used  to 
fix  the  segments  immovable  upon  the  pelvis  and 
thorax,  and  elastic  cords  are  provided  to  connect  the 
segments  on  the  side  opposite  the  contracture. 

This  brace,  as  you  see,  allows  all  necessary  motion 
of  the  back,  secures  all  possible  stretching  apart  of 
the  segments,  thus  imprisoning  symmetrical  ex- 
tension to  the  same  extent  as  does  the  plaster 
jacket,  and  yet  allows  any  degi-ee  of  elastic  power 
to  be  applied  necessary  to  parallelize  the  pelvis  and 
shoulders.  It  is  light,  comfortable,  and  above  all, 
effective  for  the  purposes  intended. 

If  the  contraction  of  the  psoas  group  be  so  marked 
that  the  resulting  cun-ature  cannot  be  reduced  by 
the  weight  of  the  limb,  a 
stretching  appliance  should 
be  used,  by  which  a  consid- 
erable degree  of  forcible  re- 
dui-tion  may  be  secured.  It 
should  be  attached  above 
to  the  trunk  and  below  to 
the  thigh,  and  is  provided 
with  a  double  motion  at  the 
hip,  so  that  abduction,  ad- 
duction, fiexion,  and  exten- 
sion may  all  be  allowed  and 
secured  at  any  angle.  Its 
superior  attachment  should 
rest  firmly  against  the  back 
as  high  as  the  eleventh  dor- 
sal vertebra,  so  as  to  cover 
the  origin  of  the  psoas  mus- 
cle. This  should  be  made 
F,n.  4.  very  firm,  to  keep  the  pelvis 

and  spine  from  rotating  up- 
on each  other,  to  hold  them  as  one  piece,  so  that 
when  the  limb  is  powerfully  extended  on  the  trunk, 
the  lumbar  vertebrae  will  not  curve.  The  inferior  at- 
tachment is  simply  a  firm  band  which  encircles  the 
thigh  just  below  the  hip-joint,  in  the  zone  of  inser- 


tion of  the  psoas  and  iliacus.  It  will  readily  be 
seen,  if  the  instrument  be  properly  applied,  while 
the  patient  be  in  sitting  posture  (for  then  the  lum- 
bar curve  disappears)  and  the  patient  then  reclines, 
any  attempt  to  force  the  limb  down  to  its  proper 


THE  MEDICAL  RECORD. 


339 


position  must  stretch  the  psoas  group,  wliicli  ex- 
tension can  he  secured  bv  the  instrument,  see  Figs. 
i  and  5. 

The  amount  of  the  flexion  which  is  reduced  on 
the  first  trial  depends  upon  the  duration  and  nature 
of  the  case.  The  instrument  should  then  be  clamjied 
to  secure  the  stretching  already  accomplished  and 
avoid  the  recontraction  which  would  otherwise  en- 
sue. And  on  the  nest  occasion,  if  one  be  necessary, 
the  process  is  begun  where  the  surgeon  ceased  at 
the  previous  operation,  and  more  reduction  of  the 
contraction  is  obtained  and  secured  in  the  same 
manner,  and  the  process  is  repeated  until  the  con- 
traction of  the  psoas  group  is  overcome.  The  brace 
for  parallelizing  the  pelvis  is  then  worn  until  the 
muscular  power  of  the  two  sides  of  the  body  be- 
comes eijualized,  and  the  cure  becomes  complete. 

Instead  of  using  a  stretching  aj^pliance,  tenotomy 
of  the  psoas  and  iliacus  may  be  resorted  to,  biit  the 
cases  in  which  it  might  be  necessaiy,  may  be  com- 
prised under  the  following  heads  : 

First. — When  the  curvature  is  of  long  standing 
and  accompanied  by  absorptive  changes  in  the  ar- 
ticular surface  of  the  vertebra'.  The  muscles  of  the 
contractured  side  exceed  those  of  the  relaxed  side 
in  power,  and  the  latter,  from  the  jjrolonged  stretch- 
ing they  have  undergone,  have  lost  contractile  power 
to  some  degree.  Here  tenotomy  might  be  followed 
by  an  equalization  of  power  and  consequent  sym- 
metry, not  to  be  obtained  by  any  other  method,  par- 
ticularly if  it  be  followed  by  symmetrical  extension 
of  the  lumbar  vertebne. 

SecoiuL — When  the  curvature  is  of  long  standing 
and  bilateral.  Tenotomy  of  the  psoas  and  iliacus 
muscles — although,  so  far  as  I  am  aware,  it  has  never 
been  practised — would  probalily  be  followed  by  a 
symmetrical  reduction  of  the  double  curvature,  and 
these  conditions  would  jH'obably  be  benefited  by  the 
operation,  but  in  other  parts  of  the  body,  tenotomies 
are  often  followed  by  a  lapsing  into  the  original  state 
for  which  the  opei'ation  was  performed,  and  the  rea- 
son for  this  is  physiological. 

If  the  tendon  of  a  muscle  be  divided,  the  contrac- 
tility of  that  muscle  causes  it  to  retract  and  a  conse- 
quent atrophy  takes  place,  and  when  the  tendon, 
permanently  lengthened  as  it  becomes  by  the 
new  structure  which  unites  the  separated  extremi- 
ties, again  performs  its  functions,  there  is  less  mus- 
cular structure  than  before  to  govern  it,  and  un- 
less the  operation  has  permanently  equalized  the 
strength  of  the  antagonistic  muscles,  distortion  will 
ensue. 

In  all  cases,  tenotomy  permanently  weakens  the 
muscle,  and  is  therefore  to  be  used  only  when  it 
is  deemed  necessary  to  weaken  a  muscle  instead 
of  strengthening  it.  In  most  cases,  we  prefer  to 
strengthen  the  weakened  muscle  and  make  it  equal 
in  power  to  the  stronger  one,  instead  of  diminishing 
the  stronger  by  tenotomy  to  make  it  equal  in  power 
to  the  weaker  ;  or,  in  other  words,  we  prefer,  wher- 
ever practicable,  to  stretch  the  stronger  muscle, 
and  thus  relax  the  weaker,  which  is  appropriately 
treated  and  assisted  until  it  equals  its  fellow  in 
strength,  when,  of  course,  distortion  becomes  im- 
possible. I  take  the  ground,  therefore,  that  me- 
chanical means  should  all  be  exhausted  before  te- 
notomy is  resorted  to. 

Sacro-lumViar  curvature  is  found  with  any  abnor- 
mal condition  accompanied  by  an  inequality  of 
length  in  the  lower  limbs,  and  in  general  with  any 
condition  in  which  the  movements  of  locomotion 
are  not  performed  with  the  same  action  on  both 


sides.  It  does  not  appear  to  be  a  primary  curva- 
ture, except  in  the  sense  that  club-foot  is  a  primary 
disorder,  although  consequent  upon  muscular  ineffi- 
ciency, or  in  the  sense  that  lateral  rotary  curvature 
is  primary,  although  consequent  upon  inefficiency  of 
certain  muscles  of  the  trunk.  It  is  essentially  sec- 
ondary, and  I  am  not  aware  of  a  single  recorded 
instance  of  this  deformity  in  which  it  has  occurred 
without  association  with  some  process  to  which  it 
was  either  secondary  or  compensatory. 

There  is  a  parahitic  form  of  this  curvatiire  which 
is  found  when  the  muscles  of  one  lower  limb  become 
partially  or  wholly  paralyzed. 

If  the  psoas  group  of  the  deficient  side  is  also 
affected,  the  curvature  is  produced  on  the  opposite 
side,  causing  apparent  lengthening. 

If  the  psoas  group  of  the  deficient  side  is  not  af- 
fected, the  curvature  is  produced  on  the  same  side, 
causing  apparent  shortening. 

The  latter  might  easily  be  mistaken  for  hip  dis- 
ease but  may  be  difl'erentiated  by  its  history,  the 
absence  of  pain,  and  in  its  early  stages  by  suspen- 
sion, which  proiiuces  a  parallelism  between  the 
shoulders  and  pelvis,  and  equalization  of  length  in 
the  limbs,  which  are  not  necessarily  either  inverted 
or  everted  except  at  will. 

The  so-called  infantile  paralysis  is  especially 
productive  of  this  form  of  cur\'ature,  and  it  usually 
involves  the  psoas  group  of 
the  same  side,  so  that  apparent 
lengthening  is  present,  the  limb 
lieing  dragged  behind  its  fellow. 
The  cases  are  rare  in  which  the 
curvature  occurs  on  the  same 
side,  but  I  wish  to  present  such 
a  one  to  your  notice  to-night. 
Previous  to  January,  187(>,  he 
was  a  healthy  boy  without  lame- 
ness, but  at  that  time,  when 
nine  years  old,  he  was  taken  sick 
with  diphtheria  of  a  very  severe 
form,  a  sister  dying  of  the  same 
disease  at  the  time,  and  when 
convalescence  commenced  it 
was  found  that  his  left  limb 
was  wasted  and  diminished  in 
power.  Each  joint,  however, 
was  normally  mobile,  and  as  he 
began  to  go  about,  the  psoas 
group  of  the  affected  side  con- 
tracted and  proiluced  an  aj)- 
parent  shortening,  for  which 
he  was  advised  to  wear  a  high- 
heeled  shoe,  which  simply  served  to  increase  the 
deformity,  so  that  when  he  first  came  under  ob- 
servation in  August,  1880,  four  and  a  half  years  after 
tlie  commencement,  he  was  deformed  to  the  extent 
shown  in  Fig.  G. 

The  movements  of  all  the  joints  were  normal  and 
the  affected  thigh  measured  three  and  a  half  inches 
less  in  circumference  than  its  fellow,  the  leg  tw'o 
inches  less,  and  there  was  an  apparent  shortening  of 
two  inches  in  the  limb  itself  as  compared  with  the 
other.  Suspension  in  this  case,  even  after  four  and  a 
half  years  of  existence,  produced  a  parallelization  of 
the  planes  of  the  pelvis  and  shoTilders  and  a  parallel- 
ization and  right  angulation  of  the  limbs  also,  the  feet 
being  on  the  same  plane,  so  that  by  using  a  brace 
which  secured  the  stretch  produced  by  the  suspen- 
sion, and  yet  allowing  motion  and  elastic  tension  on 
the  side  opposite  the  deformity,  the  result  shown  in 
Fig.  7  was  produced. 


340 


THE  MEDICAL  KECORD. 


It  is  but  rarely  in  these  paralytic  cases  that  the 
deficient  nerve-tone  can  be  restored,  and  it  has  been 
only  partially  so  in  this  ease,  the  thigh  at  the  pres- 
ent time  being  somewhat  less  in  circumference  than 
the  other,  and  the  leg  also  somewhat  less,  and  as  the 
patient  is  suspended  you  wiU  see  that  there  is  now  an 
actual  shortening  of  about  one- 
fourth  inch,  the  result  of  the  de- 
ficient nutrition  of  the  limb  com- 
pared with  its  fellow  diiring  the 
six  years  that  the  trouble  had  ex- 
isted, and  which  has  occurred 
during  his  years  of  growth. 

The  difference  between  an  ac- 
tual shortening  of  one-fourth  inch, 
and  an  apparent  shortening  of  two 
inches, which  formerly  existed,  and 
which  would  return  were  so  high- 
heeled  a  shoe  again  employed, 
suggests  the  use  of  suspension  in 
aU  cases  of  apparent  or  real  short- 
ening of  a  limb,  to  see  just  how 
much  actual  shortening  exists  and 
to  indicate  the  amount  of  thicken- 
ing the  sole  should  receive,  for  if 
it  receive  more  than  the  exact 
difference  in  length  between  the 
limbs,  it  serves  to  jjroduce  and 
constantly  increase  a  saoro-lum- 
bar  curvature  of  that  side. 
It  is  now,  to  a  gi'eat  extent,  the  custom  to  order 
high-heeled  shoes  for  all  forms  of  real  and  apparent 
shortening  of  limbs. 

The  majority  of  such  cases  add  a  little  thickness 
each  year  to  the  shoes  until  they  walk  on  several 
inches  of  sole  more  than  is  proper,  this  being  ren- 
dered necessary  by  the  increase  in  the  sacro-lumbar 
curvature.  This  curvature  should  be  reduced  first, 
by  which  all  apj>arent  shortening  is  relieved  and 
tlien,  if  actual  shortening  is  found  to  exist,  an  accu- 
rate measurement  should  be  made  of  this,  and  the 
sole  and  heel  of  the  shoe  increased  corres]5ondingly; 
but  if  only  an  apparent  shortening  existed,  the  high 
shoe  would  be  worse  than  useless,  and  its  use  should 
be  avoided  unless  fixation  of  one  of  the  joints  is 
present.  The  treatment  of  the  paralytic  form  of 
sacro-lumbar  curvature  is  then  directed  to  parallel- 
izing the  pelvis  and  shoulders  and  restoring  the 
right  angles  of  the  limbs,  the  treatment  of  the  jjaral- 
ysis  itself  coming  more  ijrojjerly  in  the  sphere  of 
the  electrician. 

By  appropriately  treating  the  curvature  we  re- 
duce the  limping  to  a  minimum,  but  limping  will 
not  be  entirely  relieved  until  the  two  limbs  corre- 
spond in  muscular  power. 

Sacro-lumbar  curvature  is  also  often  met  with 
as  a  temporary  condition,  assumed  to  prevent  the 
weight  of  the  body  from  being  borne  upon  an  injured 
limb.  The  psoas  groiip  of  the  opposite  side  con- 
tracts, and  an  apparent  lengthening  of  the  affected 
limb  produced,  which  allows  the  weight  to  be  borne 
mainly  on  the  sound  limb. 

This  form  of  curvature,  which  for  convenience  we 
will  designate  as  the  spasmo{/ic  form  of  sacro-lumbar 
eiu'vature,  is  temi)orary,  and  may  be  either  voluntaiy 
or  involuntary.  It  attends  any  attempts  at  locomo- 
tion, during  wliicli  the  affected  limb  is  prevented 
from  bearing  its  share  of  the  weight  of  the  body. 
Its  treatment  is,  of  course,  dei)endent  upon  the  con- 
dition which  accompanies  it,  and  treatment  directed 
to  that  condition  relieves  the  curvatui-e. 

To  render  certain  the  diagnosis  of  tliis  variety. 


it  is  only  necessary  to  suspend  the  patient,  when  it 
will  be  found  that  the  normal  axes  and  angles  of  the 
limbs  and  trunk  are  restored. 

Sacro-lumbar  curvature  is  also  found  associated 
with  ankylosis  of  the  joints  of  the  lower  extremity, 
and  also  as  an  accompaniment  of  club-foot  if  the  in- 
equality of  power  in  the  two  legs  be  marked,  and 
with  other  morbid  conditions. 

When  occurring  with  ankylosis  of  the  knee,  if  the 
joint  be  fixed  at  such  an  angle  as  to  make  it  shorter 
than  its  fellow  in  a  direct  line  from  heel  to  hip,  so 
that  the  foot  in  taking  a  step  causes  the  body  to 
dip  to  that  side,  the  contraction  of  the  psoas  group 
takes  place  on  the  opposite  side ;  and  if  the  knee  be 
fixed  in  a  straight  position,  so  that  the  leg  is  longer 
than  its  fellow  during  the  stepping  process,  the  con- 
traction takes  place  on  the  same  side.  The  curva- 
ture in  this  case  is  purely  compensatory,  and  if  not 
of  too  long  standing,  is  relieved  by  restoring  the 
normal  mobility  of  the  joints,  and  the  same  rules  of 
treatment  apply  equally  well  to  ankylosis  of  the 
ankle  and  joints  of  the  feet.  When  occurring  with 
fixation  of  the  hip-joint,  sacro-lumbar  cuiTature  is 
essentially  secondary,  and  is  of  sufiicient  importance 
to  merit  a  careful  description. 

Sacro-lumbar  currnlure,  due  to  Jlcatiou,  of  hip- 
joint. — The  kind  and  degi-ee  of  this  curvatuie  de- 
pends upon  the  angle  at  which  the  thigh  is  fixed 
on  the  pelvis,  these  angles  being  described  at  length 


by  Barwell  in  his  last  work  upon  joints,  under  the 
designation  of  hip  disease.  If  tlie  femur  is  united 
to  the  pelvis  at  an  acute  angle,  we  have  a  contrac- 
tion of  the  psoas  gi'oup  of  the  affected  side.  See 
Figs.  S,  <). 

If  the  fenuir  is  united  to  the  pelvis  at  an  obtuse 
angle,  we  have  a  contraction  of  the  psoas  group  of 
the  opposite  side.     See  Figs.  2  and  10. 

If  the  sacro-lumbar  curvature  be  associated  with 
a  fixation  of  the  hip-joint,  we  must  first  overcome 
this  fixation  befm-e  tlie  curvature  can  be  reduced. 

We  have  already  noted  tlie  ])arallelism  between 
the  axes  of  the  jiolvis  and  shouhlers,  and  between  the 
axes  of  the  limbs,  and  so  long  as  the  weight  of 
the  body  is  borne  by  the  limbs,  the  latter  tend  to 
produce  this  parallelism  between  themselves  with- 
out regard  to  the  angles  they  make  with  the  axis  of 
the  pelvis. 


THE  MEDICAL  RECORD. 


341 


If  the  eiirvature  be  primary  to  clianges  in  the 
angles  of  the  limbs,  its  reduction  is  followed  by 
changing  of  the  femoro-pelvic  angles  from  obtuse  or 
acute  to  right  angles,  and  anteriorly  from  a  state  of 
flexion,  the  limb  is  placed  in  line  with  the  vertical 
axis  of  the  trunli.     See  Fig.  1. 

The  obtuse  angle,  as  we  have  seen,  is  associated 
with  apparent  lengthening,  and  the  acute  with  ap- 
parent shortening,  while  flexion  exists  with  both. 
But  if  the  thigh  be  fixed  either  spasmodically  or  by 
ankylosis  upon  the  pehis,  this  miist  first  be  relieved, 
or  parallelization  of  the  pelvis  would  be  followed  by 
greater  distortion. 

Fi.ratinn  of  the  hip  irilJt  jie.non  and  ahdiidion  (see 
Fig.  10),  is  most  often  found  in  the  acute  stage  of  hip 
disease,  when  the  capsule  of  the  joint  is  distended, 
the  affected  limb  being  fixed  at  an  obtuse  angle 
'  with  the  pelvis.  Now,  when  the  patient  stands  the 
other  limb  parallelizes  itself  without  altering  the 
angle  its  fellow  has  assumed  with  the  pelvis,  and 


the  psoas  group  of  the  ojiposite  side  contract  to 
assist  the  parallelizing,  and  thus  produce  a  sacro- 
lumbar  curvature  of  the  side  opjiosite  to  the  affected 
joint,  so  that  we  have  the  phenomena  of  the  affected 
hip  fixed  by  the  muscles  immediately  about  it,  with 
prolonged  stretching  of  the  psoas  group  of  the  same 
side  in  resijonse  to  the  extra  contraction  which  the 
psoas  group  of  the  oi^posite  side  has  made  in  order 
to  keep  the  pelvis  and  sound  limb  at  an  acute  angle, 
and,  as  a  consequence,  apparent  lengthening  of  the 
affected  side.'  '■"!'_-' 

It  will  thus  be  seen  tnat  fixation  of  the  hip-joint 
does  not  necessarily  involve  contraction  of  the  ijsoas 
group  of  the  same  side,  and  this  feature  must  be 
borne  in  mind,  that  the  group  of  muscles  producing 
sacro-lumbar  curvature  is  not  to  be  considered  as 
the  group  which  serves  to  fix  the  hip-joint  immov- 
ably. 

If  we  were  to  attempt  to  reduce  this  curvature 
without  first  reducing  the  fixation  at  the  hip,  the 
Jjosition  of  the  affected  limb,  if  the  .shoulders  and 
hips  were  parallelized,  and  the  sound  limb  placed 
at  right  angles,  would  be  thrown  out  as  shown  in 
Fig.  11. 

The  rule  then  should  be  observed  when  spasmodic 
or  ankyloid  fixation  of  the  joint  exists,  not  to  at- 
tempt the  reduction  of  the  curvature  until  the 
natural  i-elations  of  the  joint  to  the  pelvis  are  re- 


stored. After  this  is  accomplished,  the  curvature 
itself  should  be  treated  as  previously  indicated.  The 
case  I  take  pleasure  in  jiresenting  to  you  is  an  in- 
stance of  fixation  of  the  joint  at  an  obtuse  angle  as 
a  result  of  gonorrheal  rheumatism.  You  will  notice 
that  suspension  is  followed  by  greater  distortion, 
and  that  very  little,  if  any,  motion  exists  in  the  hiij- 
joint  itself.  You  will  also  notice  that  the  contrac- 
tion of  the  muscles  about  the  affected  side  is  asso- 
ciated with  contraction  of  the  psoas  group  of  the 
opposite  side.  You  will  also  notice  that  when  he 
assumes  the  sujiine  position,  any  forcible  reduc- 
tion is  attended  Tvith  great  pain  and  resistance  on 
the  part  of  the  jiatient.  The  treatment  indicated  in 
this  case,  is  to  reduce  the  fixation  by  brisme  force,  or 
some  of  the  operations  practised  upon  the  joint,  and 
then  by  an  apj^ropriate  splint,  such  as  has  already 
been  shown  to  you,  to  prevent  recontraction,  and  allow 
passive  motion  when  necessary,  so  that  refisation 
does  not  take  place.  The  hip  is  very  firmly  fijed,  as 
you  will  see,  and  the  muscles  about  it,  notably  the 
tensor  vagin;e  femoris  and  the  adductors,  are  tense 
and  contracted,  and  serve  to  fix  the  limb  in  a  flexed 
as  well  as  abducted  position. 

Suspension  of  this  patient,  and  parallelization  of 
the  shoulders  and  pelvis  throws  the  limb  out  at  an 
angle  of  much  distortion,  and  we  mtist  restore  the 
mobility  of  the  joint  be- 
fore the  sacro  -  lumbar 
curvature  of  the  oppo- 
site side  can  be  relieved. 
With  the  co-operation  of . 
Dr.  George  F.  Shrady, 
this  patient  was  operated 
upon  by  brisement  forcf , 
Dr.  James  F.  Green  and 
myself  assisting.  He  was 
under  ether  about  one 
and  one-half  hour,  but 
the  ankylosis  was  so  firm, 
even  after  he  had  been 
kept  recumbent  and  poul- 
ticed over  the  hip  for 
three  weeks  previous, 
that  only  a  limited  range 
of  movement  was  pro- 
duced, and  this  only  by 
almost  dangerous  appli- 
cation of  force,  but  no 
bad  symptoms  followed. 

A  diagram  made  from  a  sketch  taken  before  the 
operation  (see  Fig.  12)  and  a  glance  at  the  subject 
who  is  before  you  shows  that  the  position  of  the 
limb  is  improved,  and  at  the  next  attempt  we 
hope  to  complete  the  operation.  This  case  presents 
a  good  instance  in  favor  of  my  assertion  that  the 
sacro-lumbar  curvature  cannot  be  reduced  without 
2ireviously  overcoming  the  ankylosis,  and  is  also  a 
striking  instance  of  the  fact  that  fixation  of  the  hijj 
at  an  obtuse  angle  with  flexion  produces  apparent 
lengthening  of  the  limb. 

Fixation  of  the  hip  ii-ith  Jtexion  and  adduction,  see 
Fig.  6,  is  most  often  found  as  the  result  of  the  acute 
stage  of  hip  disease.  When  this  condition  presents 
itself,  the  axis  of  the  femur  forms  an  acute  angle 
with  the  transverse  axis  of  the  pelvis,  and  when  the 
])atient  stands  and  the  limbs  jjarallelize,  a  contrac- 
tion of  the  psoas  group  of  the  affected  side  is  forced 
to  take  place  thereby,  and  produces  sacro-lumbar 
curvature  with  apjiarent  shortening  of  the  limb. 

In  hip  disease,  when  the  effusion  in  the  joint  hav- 
ing subsided  or  escaped,  and  the  fixation  of  the  hip 


342 


THE   MEDICAL  RECORD. 


at  the  obtuse  angle  has  disappeared,  and  the  muscles 
which  fixed  the  hip-joint  have  relaxed,  the  psoas 
group  of  that  size  is  suffered  again  to  contract.  But 
if  the  case  has  been  of  long  standing,  so  that  tlie 
limb  has  become  atrophied,  or  if  tenderness  exists 
about  the  joint  to  prevent  the  weight  of  the  body 
being  well  borne,  the  psoas  group  contracts  more 
than°on  the  sound  side,  and  we  have  apparent  short- 


The  thigh  rotates  inward,  and  as  the  parallelism 
of  the  limbs  must  be  maintained,  the  apparent 
shortening  becomes  permanent. 

Parallelization   of   the  pelvis  and  shoulders  and 
placin"'  the  sound  limb  at  right  angles  to  the  latter 
would'only  serve  to  create  the  distortion  shown  in 
Fie   13,  so  that  this  must  be  reduced  before  the  cur- 
vature can  be  overcome.     This  is  the  characteristic 
deformity  of  the  third  stage  of  hip  disease  and  is 
present  in  many  of  the  so-called  cured  cases,  and 
the  reason  for  this  seems  to  lie 
that  the  extension  sphnts  in 
use  are  not  directed  to  the  re- 
lief of  the  curvature.   We  must 
look  upon  the  hip  disease  as 
not  alone,  but  associated  with 
an    obliquity    of     the    pelvis 
which  is  as  important  to  be 
treated  when  found  as  is  the 
disease  itself,  in  order  to  ef- 
fect a   perfect   cure,    and  the 
hip-splints  in  use  do  not  fulfil 
the  indications  for  the  treat- 
ment  of   this   deformity,    be- 
cause they  do  not  eomViat  the 
contraction  of  the  psoas  group. 
In  fact,  sacro-lumbar  curva- 
ture does  not  seem  to  be  af- 
fected by  splints  constructed 
on  the  Davis  principle  or  its 
modilications,  except  so  far  as 
it  may  depend  upon  an  abnor- 
-•mal  condition  of  the  hip-joint. 
Fig.  I.3.  If  this  be  not  of  too  long  stand- 

ing, the  cure  of  the  hip-joint 
disease  is  followed  by  a  spontaneous  cure  of  the 
curvature,  but  such  splints  have  no  effect  upon  the 
curvature  /j;-*7/MtJv((/-  Their  power  is  exerted  on 
the  muscles  governing  the  hip-joint  itself,  and  we 
have  already  noted  as  a  phenomenon  that  the  psoas 
group  of  the  opposite  side  is  affected  during  the 
stage  of  lengthening  in  hip-joint  disease,  so  that  a 
splint  directed  alone  against  the  contraction  of  the 
hip  muscles  does  not  fulfil  the  indications.  To 
treat  this  form  of  sacro-lumbar  curvature,  wo  are 
required  to  reduce  to  mobility  the  fixation  of  the 
hip,  either  by  brisme  force  or  by  in-olonged  stretch- 
ing, and  then  to  parallelize  tlie  pelvis  and  shoulders 
by  the  use  of  the  brace  already  described. 

Asvmmetry,  which  is  much  more  common,  accord- 
ing to  the  statistics,  than  usually  suiiijosed,  is  at- 
tended by  sacro-lumbar  curvature,  unless  a  high 
shoe  1)0  worn  ^yhich  corresponds  to  the  actual  differ- 
ence in  length  between  the  limbs. 

In  conclusion,  the  limits  of  such  a  paper  do  not 
allow  me  to  dwell  at  sullicient  length  upon  many 
important  points  connected  with  this  subject.  It 
was  also  mvintention  when  this  paper  was  projected, 
to  take  up  the  study  of  lateral  rotary  curvature  as 
well,  and  I  bail  obtained  the  views  of  many  of  our 
leading  surgeons  witli  a  view  to  incorporate  them 
under  that  head,  but  for  want  of  sjiaco  I  have  been 
obliged  to  defer  the  consideration  of  that  subject 


until  some  future  time.  For  sacro-lumbar  curvature, 
however,  I  claim  a  more  important  place  than  has 
hitherto  been  accorded  to  it,  for  upon  the  treatment 
ol  this  curvature,  and  the  conditions  associated  with 
it,  depends  the  relief  of  that  annoying  symptom, 
limping,  of  which  so  much  exists  and  for  which  so 
little  is  done,  and  in  the  further  study  of  this  con- 
dition, gentlemen  of  the  society,  I  hope  for  your  co- 
operation. 


CARE  OF   THE  TEACHEA  AFTER  ITS  IN- 
CISION FOR  THE  RELIEF  OF  CROUP.* 
Br  LEWIS  S.  PILCHEK,  M.D., 

BROOKLYN.   N.   Y. 

DuKiNG  the  last  six  vears  I  have  had  occasion  to 
incise  the  trachea  for  the  relief  of  croup  m  thirty- 
three  instances,  in  thirteen  of  which  recovery  was 
secured  as  the  result  of  the  operation.     The  follow- 
ing case,  the  third  of  the  series,  of  date  March  3, 
1876,  exemplifies  some  of  the  more  important  of  the 
conditions  of  the  trachea  that  demand  consideration 
in  connection  with  an  operation  for  tracheal  mci.sion. 
The  patient,  Stanley  Herbert  Smith,  a  robust  boy  of 
two  and  a  half  years,  was  attacked  with  croup  on 
the  2d  of  March,  1876.     I  first  saw  him  twenty -four 
hours  after  the  beginning  of  the  attack,  when  he 
was  alrea<ly  insensible,   cyanosed,  having  extreme 
dyspnrea,  and  evidently  '"  art.iculo  worlis.     Assisted 
by  Dr.  F.  W.  Rockwell,  I  proceeded  at  once  to  in- 
cise the  trachea.     Distended  veins  in  the  track  of 
the  incision  gave  rise  to  such  free  hemorrhage  that 
the  incision  through  the  cricoid  and   first  ring  of 
the  trachea  had  to  be  made  through  a  pool  of  blood. 
Apparent  death  had  supervened  before  the  comple- 
tion of  the  operation.     The  canula^Fidler's  pattern 
—was   hastily   introduced,  and   efforts  at   artificial 
respiration    instituted.       Hypodermics    of    brandy 
were  also  administered.     Resuscitation  was  ai'com- 
plished,  and  within  half  an  hour  perfect  reaction  was 
secured.     By  the  third  day,  the  sui-faces  of  the  inci- 
sion and  the  adjacent  skin  were  covered  by  a  diph- 
theritic dei^osit. 

On  the  fifth  day  there  was  copious  expectoration 
of  membranous  shreds. 

On  the  seventh  day  trouble  began  to  be  experi- 
enced from  the  entrance  into  the  larynx  of  food 
when  swallowed.  ,.  ,  ,,      ...      , 

By  the  fourteenth  day  all  the  diphtheritic  de- 
posits had  heen  thrown  off,  exposing  sloughing  sur- 
faces. Nearly  all  food  taken  by  the  mouth  now 
seemed  to  enter  the  larynx.  At  the  close  of  the 
eighteenth  day  after  the  operation,  he  died  by 
asthenia,  having  been  free  from  any  symptoms  of 
pulnionarv  complication  throughout.  The  slougn- 
ino-  about  the  incision  was  found  to  have  destroyed 
the  anterior  half  of  the  thyroid  cartilage,  one 
lateral  half  of  the  cricoid,  and  the  anterior  portion 
of  the  three  upper  tracheal  rings.  In  addition, 
upon  the  anterior  wall  of  the  trachea,  about  halt 
way  down  to  its  bifurcation,  was  an  ulcer  which  had 
destroyed  i)oriions  of  four  tracheal  rings.  The 
tracheal  mucous  membrane  was  roughened  by  scat- 
tered remnants  of  diphtheritic  deposit  still  adherent ; 
the  bronchial  mucous  membrane,  as  far  as  the  thirct 
bifurcation,  was  congested,  but  beyond  that  point 
was  healthy  in  appearance. 

This  case  presents,  strongly  drawn,  three  ot  tne 
most  serious  conditions  of  tlie  trachea  winch  ma^ 

•  li.'nd  bcfc.vo  the  Now  York  Snrciinl  Society.  Jnnimry  9-1.  ISRi. 


THE  MEDICAL  RECORD. 


343 


be  present  after  its  section  for  relief  of  laryngeal 
stenosis,  viz.  :  deposit  of  diphtheritic  exudation 
npon  its  mucous  surface,  limited  ulceration  of  a 
portion  of  its  "(vall  from  pressure,  and  sloughing 
from  becoming  involved  in  dii^htheritic  gangrene 
of  the  wound  of  operation. 

From  the  record  of  the  post-mortem  appearances 
in  the  case,  it  will  be  seen  that  the  intratracheal 
exudate,  though  fragments  of  it  were  still  clinging 
to  portions  of  the  wall  of  the  tube  at  the  end  of 
eighteen  days,  had  never  extended  beyond  the 
larger  ramifications  ot  the  bronchi,  to  which  limita- 
tion is  due  the  complete  absence  of  obstructive 
symptoms  after  the  tracheal  section  had  been  made. 
A  similar  limitation  of  the  exudate  was  well  ex- 
emplified in  my  eighth  case,  that  of  a  boy,  Thomas 
Smith,  aged  five  years,  upon  whom  I  operated  May 
27,  1877.  The  incision  into  the  trachea  revealed 
its  interior  carpeted  with  a  dense,  closely  adherent 
membranous  exudate,  of  which  two  large  shreds 
were  separated  and  removed  at  the  time.  The 
wound  surfaces  and  the  adjacent  skin  became  cov- 
ered by  a  diphtheritic  exudate  by  the  third  day,  at- 
tended with  considerable  phlegmonous  inflammation 
of  the  deeper  tissues,  and  an  extended  erysipelatous 
areola  upon  the  skin  of  the  neck  and  chest. 
Trouble  from  the  entrance  of  the  food,  in  the  act  of 
swallowing,  into  the  air-duct  began  to  be  exjieri- 
eneed  on  the  fifth  day,  but  on  the  day  following  it 
became  possible  to  permanently  remove  the  canula, 
and  finally  a  complete  recovery  was  accomplished. 
Again,  in  my  tenth  case,  that  of  Thomas  Flanagan, 
aged  seventeen  months,  who  died  from  oedema  of  the 
lungs  at  the  end  of  thirty-two  hours  after  operation,  I 
was  able  to  determine  by  atrtopsy  the  existence  of  a 
thin  membranous  pellicle  extending  from  the  tiji  of 
the  epiglottis  to  the  bifurcation  of  the  trachea  only, 
investing  the  surface  thi-oughout. 

In  eleven  additional  cases,  of  those  in  which  the 
presence  of  a  membraniform  exudate  in  the  trachea 
was  determined  when  it  was  opened,  no  extension 
of  the  exudate  took  place  ;  of  these,  three  died 
from  diphtheritic  toxaemia,  at  periods  of  1^1,  22. 
and  -49  hours  respectively  after  the  opening  of 
the  trachea ;  two  died  fi'om  accidents  incident  to 
the  separation  and  discharge  of  the  tracheal  exu- 
date ;  one  died  on  the  fifth  day  fi-om  capUlary  bron- 
chitis, and  five  made  good  recoveries.  The  circum- 
stances attending  the  death  of  the  two  which  I  have 
reported  as  having  been  occasioned  by  accidents  in- 
cident to  the  sejiaration  and  discharge  of  the  tra- 
cheal exudate  were  painfully  instructive.  In  the 
first  case,  the  sixteenth  of  my  series,  of  date  Janu- 
ary 4,  1879.  a  robust  boy,  aged  nearly  five,  the  tra- 
chea had  been  incised  below  the  isthmus  ;  some 
membranous  shreds  were  expelled  at  the  time  of  the 
excision.  For  forty-eight  hours  the  case  progi'essed 
favorably,  with  the  expectoration  of  much  membran- 
ous debris  and  muco-pus ;  at  the  end  of  this  time 
sudden  and  marked  dyspncea  developed,  not  relieved 
by  cleansing  the  canula.  After  ten  hours  of  inetfec- 
tnal  struggle,  during  which  I  was  not  notified  of  his 
condition,  death  by  asphyxia  occurred.  When  I 
reached  the  child,  after  its  death,  I  found,  upon  re- 
moval of  the  canula,  a  tenacious  mass  of  membran- 
ous debris  and  mucus  in  the  trachea,  surrounding 
and  occluding  the  lower  end  of  the  canula,  which 
the  unaided  efforts  of  the  patient  had  been  unable  to 
expel,  but  which  could  have  been  easily  dislodged 
by  proper  assistance. 

In  the  second  case,  the  twenty-first  of  my  series, 
a  girl  aged  seven,  at  the  moment  of  the  section  of  I 


the  trachea  a  tubular  cast  of  its  interior,  an  inch  in 
length,  was  expelled.  For  three  days  she  did  well, 
with  moderate  expectoration,  containing  at  times 
membranous  shreds.  At  10  o'clock  of  the  evening 
of  the  third  day  I  saw  her,  when  she  had  a  pulse  of 
120,  and  an  unembarrassed  respiration  of  21  per 
minute.  Shortly  after  I  left  her,  as  I  afterward 
learned,  dyspncva  developed,  and  remained  unre- 
lieved and  intense  until  midnight,  when  death  took 
place.  Xo  post-mortem  was  made.  I  can  exjilain 
the  symptoms  only  on  the  hypothesis  of  the  detach- 
ment of  a  flake  of  the  exudate,  too  large  to  be  ex- 
pelled through  the  canula  without  assistance,  and 
by  which  the  lumen  of  the  trachea  was  blocked  up. 
Of  the  five  of  the  group  under  consideration  who 
made  good  recoveries,  three  progiessed  to  rapid 
convalescence,  without  serious  complications,  being 
able  to  disi^ense  with  the  canula  on  the  fourth  or 
fifth  day  in  each  instance.  In  a  fourth  case,  that  of 
a  girl,  aged  three,  Edith  Hannah,  the  copious  ex- 
pectoration of  membranous  shreds  and  viscid  mucus 
occasioned,  at  times,  much  trouble.  Troublesome 
dysphagia  and  albuminuria  supervened,  and  it  was 
not  until  the  thirteenth  day  that  the  canida  could  be 
dispensed  with,  but  after  that  date  the  convalescence 
was  rapid.  In  the  remaining  case,  a  girl  four  and 
one-half  years  of  age,  Constance  Hardcastle,  it  was 
not  until  the  twenty-eighth  day  that  it  was  possible 
to  permanently  remove  the  canula,  although  as  early 
as  the  sixteenth  day  it  was  kept  out  for  twelve 
hours,  at  the  end  of  which  time  a  gradually  increas- 
ing dyspncea  made  its  reintroduction  necessary.  On 
the  twenty-first  day  another  attempt  to  abolish  the 
canula  was  unsuccessful,  an  immediate  replacement 
being  necessary.  The  third  attempt,  after  the  ex- 
piration of  a  week,  was  successful,  and  without 
embarrassment. 

Of  the  whole  number  of  operations,  there  were 
four  cases  in  which,  after  temporary  relief,  a  fatal 
result  was  caused  by  the  extension  of  the  exudation 
to  the  smaller  bronchi.  The  period  after  oi^eration 
at  which  death  supervened  in  these  cases  was  quite 
uniform,  having  been  32  horus  in  three,  and  36 
hours  in  one  case. 

In  fifteen  cases,  less  than  half  the  whole  number, 
there  was  no  ajipreciable  extension  of  the  exudate 
to  the  ti-achea.  Of  these,  in  one  instance,  a  boy  of 
three  and  one-half  years,  sudden  death  by  syncope 
took  place  at  the  moment  of  the  fixation  of  the 
trachea  by  a  tenaculum  prior  to  its  section.  Chlo- 
roform was  being  administered  at  the  time,  and  I 
know  of  nothing  else  to  refer  the  death  to.  The 
child's  general  condition  was  good,  and  no  untoward 
complication  had  occuiTed  in  the  progress  of  the 
operation.  This  was  the  fourth  operation  of  the 
series,  of  date  November  26,  1876.  In  succeeding 
operations  ether  has  been  used  whenever  an  ames- 
thetic  has  been  employed. 

In  four  instances,  death  from  diphtheritic  toxje- 
mia  took  place,  at  periods  of  14,  22,  and  -48  hours, 
and  of  9  days  respectively.  In  the  latter  ease  the 
larynx  was  clear  so  that  the  canula  was  dispensed 
with  on  the  seventh  day.  The  immediate  caiise  of 
death  was  uraamia.  In  three  instances  death  was 
occasioned  by  capillaiy  bronchitis.  In  one  of  these, 
which  terminated  forty  hours  after  the  operation,  an 
autop.sy  showed  the  interior  of  the  larynx  to  be  com- 
pletely blocked  by  a  plug  of  exudate,  and  the  en- 
tire bronchial  mucous  membrane  inflamed,  and  the 
tubes,  down  to  the  smaller  bronchioles  filled  with 
muco-pus.  The  second  case  died  at  the  end  of 
fifty-nine  hours,  and  the  third  at  the  close  of  the  sev- 


34:4 


THE  MEDICAL  RECORD. 


enth  day.  This  latter  case  might,  perhaps,  be  justly 
included  among  the  recoveries  from  the  operation, 
for,  after  having  successfully  struggled  against  a 
copious  secretion  of  viscid  mucus  within  the  trachea 
and  bronchi,  which  demanded  continuous  watching 
and  assistance  for  its  removal,  duringthe  two  days 
immediately  following  the  operation,  it  had  pro- 
gressed favorably  until,  upon  the  fifth  day,  it  was 
able  to  dispense  with  the  canula.  During  the 
evening  of  tlie  sixth  day  it  was  subjected  to  an  un- 
fortunate exposure,  which  determined  a  capillary 
bronchitis  that  terminated  in  death  within  twenty- 
four  hours.  Excluding  this  case,  however,  there 
remain  seven  cases  of  recovery  out  of  the  fifteen  in 
whom  the  exudate  did  not  extend  to  the  trachea.  Of 
these,  five  progressed  without  serious  complicatiou 
to  early  convalescence,  being  able  to  dispense  with 
the  canula  after  3,  4,  4,  5,  and  6  days  respectively. 
Of  the  others,  one,  a  boy  of  six  years,  was  some- 
what distressed  by  the  copious  accumulation  of 
thick,  viscid  mucus  in  the  trachea  during  tlie  first 
forty-eight  hours,  but  this  subsided  so  that  he  was 
able  to  dispense  with  the  canula  at  the  close  of  the 
fifth  day. 

The  remaining  case  of  recovery  was  a  child  who 
had  already  been  the  subject  of  the  operation. 
The  croup  in  the  first  instance  arose  as  a  com- 
plication of  an  attack  of  measles,  and  the  V)oy  was 
insensible  and  hi  arliculo  mortis  at  the  time  of 
operation.  On  the  fourth  day  he  was  able  to  dis- 
pense \vith  the  canula.  Three  weeks  thereafter 
full  cicatrization  of  the  wound  having  been  ac- 
complished, an  acute  laryngitis  was  developed  as 
the  result  of  exposure,  wliich  again  necessitated 
section  of  the  trachea.  It  was  not  until  the  expira- 
tion of  sixteen  days  that  the  canula  could  be  finally 
dispensed  with.  I  had  no  reason  to  consider  that  in 
either  of  these  attacks  there  was  any  membranous 
exudation  present.  With  the  exception  of  these 
two  c  ises,  I  believe  that  the  exudate  was  in  all  cases 
of  diphtheritic   origin. 

Keviewing  the  iil  cases  of  diphtheritic  croup 
subjected  to  operation,  it  has  been  seen  that  11 
recovered  and  20  died ;  that  of  the  fatal  cases,  8 
succumbed  to  general  diphtheritic  toxiumia,  com- 
plete relief  to  lireathing  having  been  secured  by 
the  operation  during  tlie  remaining  hours  of  life, 
4  were  asphyxiated  by  extension  of  the  exudate  to 
the  smaller  bronchi  after  a  very  short  interval  of 
relief  by  the  operation,  4  died  from  capillary  bron- 
chitis, 1  from  pulaionary  ledema,  1  from  chloroform 
syncope,  and  2  from  accidental  asphyxia. 

Keflection  upon  the  conditions  which  these  cases 
have  presented  to  me  has  led  me  to  the  belief  tliat 
great  importance,  so  far  as  the  final  result  is  con- 
sidered, attaches  to  the  conditions  which  the  trachea 
presents  at  the  time  of  the  section,  or  wliich  may 
arise  within  it  afterward.  In  a  certain  proportion 
of  cases,  where  once  the  trachea  has  been  incised 
and  a  new  respiratory  orifice  has  been  secured,  tlie 
simplest  precautions  to  prevent  damage  from  extra- 
neous intliienees  will  alone  be  necessary  to  secure 
unimpeded  and  speedy  recovery.  In  another  group 
of  caseM  the  re.sult  of  the  tracheal  section  will  be  only 
to  alford  time  for  a  more  ext3uded,  and  certainly 
fatal  accumulation  of  exudate  in  the  air-passages. 
But  in  quite  a  large  number  of  cases  the  result, 
whether  in  recovery  or  death,  will  depend  upon  the 
thoroughness  with  which  special  conditions,  chiefly 
intra-tracheal,  are  appreciated,  and  the  skill-  witli 
which  they  are  treated.  While  there  is  no  casein 
which  it  would  be  justifiable  to  omit  any  precaution  or 


safeguard,  in  many  cases  the  ultimate  result  will 
depend  directly  upon  the  faithfulness  and  thorough- 
ness with  which  such  precautions  and  safeguards  are 
attended  to. 

The  presence  of  diphtheritic  exudate  within  the 
trachea,  below  the  point  of  incision,  constitutes  the 
source  of  danger  most  frequently  present,  and 
the  one  most  likely  to  become  urgent.  In  two  of  my 
cases  it  has  been  seen  that  death  was  due  directly 
to  obstniction  from  loosened  patches  of  exudate. 
In  the  majority  of  those  who  recovered,  alarming 
obstnictive  symptoms  occurred  at  some  time  in  their 
course  from  difticiilty  in  the  ejection  of  shreds  of 
exudate.  At  the  moment  of  incision  of  the  trachea 
it  frequently  occurs  that  more  or  less  extensive 
patches  of  membraniform  exudate  are  thrown  out 
from  the  trachea,  accompanied  by  much  muco-pus.  In 
other  cases  it  is  still  possible  to  secure  the  detach- 
ment and  expulsion  of  portions  of  the  exudate  at 
this  time  by  the  introduction  through  the  wound  of 
a  suitable  instniment,  as  a  proper  probang  or  a 
feather  or  forceps.  It  seems  to  me  to  be  of  impor- 
tance that,  in  all  cases  in  which  the  presence  of  a 
membraniform  exudate  in  the  trachea  below  the 
point  of  incision  is  found,  efibrt  should  be  made  to 
remove  it,  and  that  from  the  beginning  the  opera- 
tion should  be  planned  and  executed  with  this  in 
view. 

Cases  of  croup  have  been  too  generally  regarded 
by  the  tracheotomist  only  from  the  standpoint  of 
the  immediate  danger  of  suflbcation  that  was  immi- 
nent, the  establishment  of  a  new  respiratoi-y  orifice 
being  the  only  condition  to  be  met.  The  processes 
of  Chassaignac,  and  of  Saint  Germain,  the  numerous 
tracheotomes  devised,  the  •  general  delay  of  the 
operation  till  suffocation  appears  imminent ;  and  the 
frequent  advocacy  of  a  rapid  method  of  operating 
and  the  section  of  the  trachea  without  regard  to 
hemorrhage  are  based  upon  this  restricted  view. 
Thus  regarded,  the  section  of  the  trachea  becomes  a 
critical  moment,  and  the  immediate  introduction  of 
a  canula  of  supreme  importance.  If,  however, 
the  indications  for  treatment  presented  by  a  tracheal 
exudate  be  of  the  importance  that  I  have  attached 
to  them,  operative  methods  must  be  adopted  more 
suited  to  the  search  for  and  removal  from  the  trachea 
of  a  foreign  body,  which,  indeed,  the  exfoliating 
exudate  is. 

The  importance  of  operating  at  a  period  .suffi- 
ciently early  to  admit  of  delilieration  in  every  step 
of  the  oj^eration  is  necessarily  involved  in  these 
vie-ns,  as  well  as  the  staunching  of  all  hemorrhage 
before  the  incision  is  made  into  the  trachea.  The 
place  where  the  trachea  shall  be  opened,  also,  is  no 
longer  left  to  the  caprice  of  the  ojierator,  nor  even 
to  be  determined  by  the  anatomical  conditions  which 
make  one  point  easier  of  access  than  another,  but 
the  lowest  point  possible,  compatible  witli  tlie  ne- 
cessary after-cares,  is  required  for  the  fulfilment  of 
the  indications  which  have  been  elaborated.  This 
incision  sluuild  be  free,  and  its  lips  should  be  kept 
apart,  the  opening  being  drawn  up  to  the  surface  as 
much  as  possible,  to  admit  of  full  exploration  of  the 
interior  of  the  tube,  and  of  the  removal,  so  far  as 
possible,  of  all  substances  from  within  it.  Only 
after  this  has  been  accomplished  is  the  placing  of  a 
canula  in  the  trachea  in  order,  the  circumstances 
now  being  such  as  to  preclude  the  occurrence  of  any 
of  the  traditional  accidents  connected  with  this  part 
of  the  operation.  As  additional  illustration  of  the 
importance  of  these  operative  details,  the  following 
case  from  the  experience  of  my  lamented  fi-iend,  the 


THE  MEDICAL  RECORD. 


345 


late  Dr.  Giberson,  is  worthy  of  citation.  In  tiiiscase, 
the  patient  was  an  infant  of  nineteen  months,  if  I  re- 
member correctly.  In  the  course  of  t}ie  operation 
much  trouble  was  experienced  from  hemorrhage,  and 
the  child's  extremity  became  so  great  that  a  hasty  in- 
cision and  immediate  insertion  of  the  canula  was 
deemed  necessary.  Much  embarrassment  to  respira- 
tion continued  after  the  canula  was  in  place,  confined 
chiefly  to  expiration.  This  continued  unrelieved,  and 
■was  a  prominent  factor  in  determining  the  fatal  re- 
sult, which  took  place  in  about  twenty-four  hours. 
Post-mortem  examination  .showed,  occupying  the 
central  part  of  the  anterior  wall  of  the  trachea,  and 
extending  from  the  first  ring,  about  half-way  down 
to  the  bifurcation  of  the  trachea,  with  a  prolonga- 
tions till  farther  downward  of  less  size,  a  polypus- 
like mass  of  exudate,  the  upper  part  of  which  ad- 
hered with  some  firmness  to  the  wall  of  the  trachea, 
while  its  lower  part  was  loose,  so  that  it  could  have 
been  carried  liack  and  forth  in  the  respiratory  cur- 
rent. The  incision  had  been  made  through  the  first 
two  rings,  and  upon  the  lateral  aspect  of  the  trachea. 
The  canula  was  inserted  by  the  side  of  this  pseudo- 
polypus,  and  as  its  lower  end  did  not  reach  below 
the  mass,  this  had  been  the  source  of  the  trouble  in 
expiration  which  had  been  experienced,  its  free  ex- 
tremity having  been  carried  iip  against  the  inner 
opening  of  the  canula  by  every  expiratory  effort, 
partially  occluding  it,  while  it  was  floated  away 
again  at  each  inspiration. 

A  second  case,  again  illustrating  the  importance 
of  regarding  tracheotomy  for  crouj?  in  the  light  of 
an  operation  for  the  removal  of  a  foreign  body  from 
the  trachea,  occTirred  in  the  practice  of  my  friend, 
Dr.  Geo.  R.  Fowler.  In  this  case,  that  of  a  girl  aged 
three  and  one-half  years,  during  the  second  day  after 
the  operation  symptoms  of  tracheal  obstruction  de- 
veloped suddenly,  and  with  such  force  that  asphyxia 
was  imminent.  The  doctor  being  present,  removed 
the  canula,  to  more  perfectly  gain  access  to  the  in- 
terior of  the  trachea.  Having  introduced  a  pair  of 
curved  forceps  at  some  depth  into  the  trachea,  he 
succeeded  in  grasping  and  withdrawing  a  large, 
irregular  membranous  mass.  The  urgent  symptoms 
were  relieved  and  ultimate  recovery  was  seciired. 

I  am  satisfied  from  my  own  experience  that  few 
cases  will  be  met  with  in  which  the  opening  of  the 
trachea  below  the  thyroid  isthmus  will  not  be  per- 
fectly practicable  by  methods  of  operation  that  will 
fully  satisfy  the  indications  for  the  after-manage- 
ment of  the  trachea  that  have  been  dwelt  upon. 

The  two  conditions  that  most  seriously  compli- 
cate the  low  incision  are  the  greatly  varying  ar- 
rangement of  blood-vessels  in  the  pretracheal  s))aee 
and  the  embarrassing  mobility  of  the  mediastinal 
connective  tissue,  which  is  sucked  down  behind  the 
sternum  and  thrust  \\p  again  in  front  of  the  trachea 
to  such  an  extent  in  the  labored  respiratory  efforts 
when  once  this  space  has  been  exposed.  These  con- 
ditions become  especially  to  lie  dreaded  when  a  sur- 
geon is  required  to  operate  without  assi.stance.  Two 
devices  have  enaliled  me  to  become  nearly  indepen- 
dent of  assistants  in  the  performance  of  tracheotomy, 
while  at  the  same  time  they  have  gi'eatly  facilitated 
a  rapid  deliberation  in  all  its  steps.  The  first  is  tlie 
little  catch-forceps  known  as  the  haemostatic  forceps 
of  P^an.  By  them  it  is  possible,  not  only  to  control 
all  hemorrhage  with  facility,  and  without  loss  of 
time,  but  they  serve  as  automatic  retractors  when 
fixed  in  the  deeper  parts  of  the  incision,  and  caused 
to  fall  outward  upon  the  side  of  the  neck;  and 
when  fastened  in  the  fascia  that  immediately  envel- 


ops the  trachea,  they  serve  to  elevate  and  fix  it  for 
incision  and  exploration.  The  second  device  is  a 
retractor  for  the  tissues  at  the  lower  angle  of  the 
wound,  having  a  curved  portion  broad  enough  to 
confine  and  protect  the  tumultuously  moving  tissues 
at  that  point,  having  a  shaft  well  arched,  so  as  to 
clear  the  projecting  upper  border  of  the  sternum, 
and  terminating  in  a  sharp  double  hook,  which  is  to 
be  fixed  in  the  integument  over  the  sternum  after 
the  retractor  has  been  applied,  thus  holding  itself 
in  place,  somewhat  after  the  fashion  of  the  double 
hooks  of  the  anatomist.  It  is  possible  also  to  have 
a  detachable  handle  adapted  to  this,  to  be  used 
when  the  helj)  of  an  assistant  is  available. 

I  have  no  symjiathy  with  any  tendency  to  the  use- 
less multiplication  of  instrtiments,  nor  to  the  com- 
plication of  simjile  procedures,  and  yet  I  am  con- 
vinced that  the  surgery  of  the  trachea,  in  many 
instances,  would  be  made  more  certain,  more  facile, 
and  more  productive  of  good  results  if  the  special 
conditions  which  it  presents  were  more  carefully 
studied  and  met. 

In  continuing  the  consideration  of  the  treatment 
of  intra-tracheal  conditions,  the  question  of  the  use 
of  canulas  is  an  important  one.  The  necessities  of 
the  case  demand  that,  if  one  is  to  be  employed,  it 
shall  be  as  large  as  the  trachea  will  easily  admit, 
while,  on  the  other  hand,  the  larger  its  calibre,  the 
gi-eater  the  dangers  from  pressure  effects.  In  the 
recent  studies  of  Dr.  Bloch,  of  Copenhagen  (Annals 
of  Anatomii  and  Surgery,  January,  1882  :  Dr.  H.  J. 
Garrigues,  from  Hospitals  Tklende),  it  appeared 
that,  out  of  thirty  autopsies  upon  patients  who  had 
died  after  tracheotomy,  in  sixteen  the  trachea  had 
suffered  from  the  pressure  exerted  by  the  canula, 
the  seat  of  injury  being  the  anterior  or  the  posterior 
wall,  or,  most  commonly,  both  simultaneously,  and 
including  every  degree  of  effect,  from  .simple  ana'- 
mia  and  superficial  erosion  to  destruction  and  per- 
foration of  its  entire  thickness.  In  the  case  which 
I  detailed  at  the  beginning  of  this  pajier,  the  ex- 
treme degree  of  evil  effect  from  the  pressure  of  the 
canula  is  illustrated.  In  this  case  I  used  one  of 
the  bivalve  tubes  known  as  Frdler's  tubes,  a  kind  of 
tube  in  which  the  inner  tube  must  necessarily  be 
tightly  grasped  by  the  blades  of  the  outer  one  when 
the  former  is  in  place,  so  that  much  disturbance  to 
the  whole  apjjaratus  results  from  the  force  required 
to  remove  it,  producing  unavoidable  injury  to  the 
trachea  whenever  its  removal  is  required.  I  regard 
it  as  an  instrument  wholly  bad,  and  one  to  be  abso- 
lutely condemned.  In  this  case  the  prolongation  of 
the  period  during  which  the  canula  was  retained  to 
fourteen  days,  and  the  frequent  removal  of  the  inner 
tube  required  to  keep  it  clear  during  this  time, 
served  to  develop  the  full  extent  of  the  damage 
which  it  is  capable  of  producing. 

Still  another,  and  hitherto  undescribed  source  of 
injury  to  the  trachea  from  the  canula  was  demon- 
strated by  Dr.  Louis  Carrie,  in  a  thesis  for  the  doc- 
torate, before  the  FacTilty  of  Medicine,  Paris,  1879 
("Contribution  a  I'fitude  des  Causes  empechant 
I'ablation  definitive  de  la  Canule  apr&s  la  Trachfoto- 
mie  chezlesEnfants."  These  de  Paris.  Iso.  13.  1879). 
A  yoTing  child,  in  whom  for  some  cause  difficulty 
was  experienced  in  finally  taking  away  the  canida 
after  traoheotomy,  died  in  a  fit  of  suffocation  in- 
duced by  cauterization  of  a  reddish  prominence, 
seen  in  the  interior  of  the  trachea.  I''pon  autopsy 
it  was  found  that,  upon  the  posterior  wall  of  the 
trachea,  at  a  point  directly  opposite  to  where  the 
section  of  the  cartilaginous  rings  had  been  made, 


346 


THE  MEDICAL  RECOKD. 


where  the  canula  had  been  introduced,  there  existed 
a  reddish  prominence,  which,  projecting  into  the  in- 
terior of  the  air-tube,  diminished  notably  its  calibre, 
without,  however,  completely  obliterating  it.  This 
projection,  which  had  been  perceived  during  life,  at 
the  bottom  of  the  wound,  was  not  formed  by  a  mass 
of  exuberant  granulations,  as  had  been  thought,  but 
by  the  posterior  wall  of  the  trachea  itself,  which  had 
been  thrown  into  a  longitudinal  fold  involving  its 
whole  thickness,  a  folding  which  was  owing  to  the 
pushing  toward  each  other  of  the  posterior  extremi- 
ties of  the  rings  that  had  been  separated  in  front  to 
admit  the  canula.  The  same  folding  and  in-pushing 
of  the  posterior  wall  was  repeatedly  reproduced  ex- 
perimentally on  the  cadavers  of  children  by  M. 
Carrie,  and  the  final  conclu.'*ion  announced  in  the 
thesis,  based  on  this  case  and  upon  the  experiments, 
was  that  very  often  the  introduction  of  a  canula  into 
the  trachea  of  an  infant  produces  a  diminution  in 
the  transverse  diameter  of  the  posterior  wall ;  that 
this  posterior  wall  is  made  to  jn-oject  more  or  less 
markedly  into  the  interior  of  the  trachea,  and  that 
if  this  projection  persists  after  the  i-emoval  of  the 
canula,  and  the  cicatrization  of  the  wound,  a  perma- 
nent constriction  of  the  trachea  will  be  produced. 
It  should  be  noted  that  in  subjects  under  two  and 
one-half  years  of  age,  this  folding  of  the  posterior 
wall  was  not  observed. 

While  the  descriptions  of  this  observer  as  to  the 
changes  in  the  posterior  wall  of  the  trachea  may  be 
accepted  as  correct,  the  canula  has  perhaps  been 
assigned  too  prominent  a  role  in  relation  to  them, 
for  it  is  evident  that  the  separation  of  the  incised 
tracheal  I'ings  in  front  alone  causes  this  change  in 
the  structures  behind.  I  have  observed  this  pro- 
trusion forward  of  the  jiosterior  wall  of  the  trachea 
when  the  lips  of  the  tracheal  wound  were  widely 
drawn  apart,  and  in  one  instance  remember  to  have 
mistaken  it  for  a  mass  of  exudate,  ha-iang  grasped  it 
with  forcei)s  trying  to  remove  it.  By  whatever 
means  the  tracheal  wound  may  be  kept  dilated,  this 
forward  projection  of  the  posterior  wall  may  be  ex- 
pected to  occur  ;  and  as  soon  as  the  margins  of  the 
cut  rings  are  permitted  to  come  together  in  front, 
the  posterior  wall  may  be  expected  to  unfold,  and 
the  protrusion  to  be  efifaced,  unless  as  the  result  of 
some  irritation,  inflammatory  exudation  shall  have 
so  complicated  it  as  to  render  it  persistent.  The 
irritation  of  the  canula,  particularly  if  it  be  long  re- 
tained in  situ,  would  be  a  fruitful  source  of  the  con- 
ditions needed  to  make  tliis  source  of  obstruction 
persistent.  The  development  of  exuberant  granu- 
lations, forming  polypoid  excrescences,  projecting 
into  the  trachea  in  the  rare  instances  in  which  they 
are  intra-tracheal  in  their  origin,  may  likewise  be 
considered  as  the  results  of  ulceration  caused  by 
pressure  of  the  canula.  The  many  references  to  this 
subject,  and  its  frequent  discussion  in  recent  years, 
render  notliing  more  than  a  passing  allusion  to  it 
necessary  here,  especially  as  I  have  not  met  with 
this  condition  in  any  of  my  own  cases. 

In  no  case  of  my  own,  nor  indeed,  in  any  case  in 
the  practice  of  otliers  that  I  have  had  the  oppoi'tu- 
nity  of  observing,  has  tlie  recommendation  to  dis- 
pense entirely  with  a  canula,  and  attach  the  edges  of 
the  tracheal  incision  to  the  adjacent  edges  of  the  skin 
incision,  been  adopted,  but  as  I  have  considered  the 
subject,  so  great  have  the  disadvantag(>s  attending 
the  use  of  canulas  appeared  to  me  to  be,  that  I  feel 
impelled  to  practically  test  the  possibility  of  conduct- 
ing a  case  of  tracheotomy  without  their  use.  The 
possible  disadvantages  from  pressure-effects,  which 


have  been  referred  to,  I  know  can  be,  in  the  majority 
of  cases  obviated,  Imt  in  addition,  it  is  true  of  the 
canula  that  it  hides  the  wound  from  view,  and  often 
conceals  the  beginnings  of  processes  that  should  de- 
mand active  treatment  at  tbeir  outset ;  being  with 
difficulty  kejit  clean,  it  is  likely  to  harbor  putrefac- 
tive substances  that  may  act  as  poisons  to  the  adja- 
cent tissues ;  it  encroaches  much  upon  the  area  of 
the  new  aperture  which  has  been  made,  which  it  is 
imjjortant  to  preserve  as  free  as  possible  to  facili- 
tate the  discharge  of  intra-tracheal  accumulations  ; 
and  it  converts  a  short,  direct,  and  free  communica- 
tion with  the  interior  of  the  trachea  into  a  long, 
tortuous,  and  constiicted  one.  It  is  probable,  how- 
ever, that  in  many  cases  the  use  of  a  canula  in  some 
stage  of  their  progress  will  be  imperative.  I  pre- 
fer, myself,  as  superior  to  any  of  the  various  modi- 
fications which  have  been  proposed,  the  style  of 
canula  now  most  generally  used,  of  silver,  with 
movable  shield,  double  tubes,  curved  upon  a  quar- 
ter circle,  the  inner  tube  projecting  slightly  lieyond 
the  outer  one  below,  and  both  having  the  anterior 
portion  of  their  lower  extremity  cut  away  slightly, 
the  edges  being  well  rounded,  the  outer  tube  with- 
out fenestrum,  and,  for  use  for  children,  with  an  av- 
erage outside  diameter  of  between  seven  and  eight 
millimetres.  The  use  of  a  suitable  obtunder  slightly 
projecting  from  the  lower  aperture  will  facilitate 
its  re-introduction,  and  diminish  to  the  minimum 
the  dangers  of  excoriations  and  lacerations  from  such 
introduction  in  the  later  stages  of  the  treatment  of 
a  case. 

If  a  tube  is  to  be  inserted,  it  would  seem  advis- 
able, in  order  to  prevent  the  folding  in  of  the  pos- 
terior wall  of  the  trachea  and  possiVile  difficulty 
from  that  cause,  to  excise  a  portion  of  the  anterior 
wall  of  the  ti'aehea  to  diminish  the  amount  of  out- 
ward drawing  that  the  incised  tracheal  rings  should 
be  subjected  to  in  order  to  accommodate  the  canula. 
In  two  instances  I  have  done  this.  In  both  the 
patients  recovered,  and  in  both  early  suppression  of 
the  canula,  one  on  the  fourth  and  one  on  the  fifth  day, 
was  accomplished  without  difficulty. 

The  after-treatment  of  the  trachea,  whether  a 
canula  be  employed  or  not,  may  test  to  the  utmost 
the  patience  and  skill  and  tact  of  the  nurse.  That 
whatever  exudate  is  still  adherent  to  the  walls  of  the 
trachea  may  be  speedily  loosened  and  safely  re- 
moved ;  that  no  extension  of  inflammatory  trouble 
shall  be  awakened,  and  that  the  secretion  from  the 
tracheal  and  bronchial  mucous  membrane  may  be 
held  in  check  and  its  expulsion  facilitated,  is  the 
task  to  be  accomplished.  In  addition  to  the  use  of 
a  thin  layer  of  sponge,  previously  purified  from  any 
possibility  of  septic  taint,  moistened  in  hot  water 
and  continuoTisly  applied  over  the  mouth  of  the 
canula,  or  upon  the  incision,  I  have  derived  gi'eat 
benefit,  and  in  some  cases  believe  that  a  favorable 
result  was  secured  by  the  use,  as  circumstances 
seemed  to  require,  of  inhalations  and  instillations 
of  various  agents.  Steam,  alone,  carbolized  steam, 
vaporized  Peruvian  balsam  and  steam,  and  vapor- 
ized lime-water,  have  all  .seemed  to  be  attended  with 
benefit.  Instillations  of  warm  water  simply,  of 
chloride  of  sodium  and  water,  of  lime-water,  and  of 
dilute  lactic  ai'id  have  all  been  used  at  times.  The 
results  have  been  such  as  to  encourage  me  to  their 
use  with  still  greater  freedom  and  pertinacity  in 
all  cases  in  whicli  any  accumulation  of  membranous 
debris  and  tenacious  mucous  in  the  trachea  becomes 
apparent. 

In  concluding  these  reflections,  which  are  to  be 


THE  MEDICAL  RECORD. 


347 


considered  rather  in  the  light  of  suggestions  based 
chiefly  on  my  own  experience,  than  as  an  exhaus- 
tive consideration  of  the  subject,  I  would  summa- 
rize them  as  follows  : 

FirfL — The  proportion  of  cases  of  croup,  demand- 
ing incision  of  the  trachea  for  their  relief,  in  which  an 
intra-tracheal  exudate  will  be  found  present  is  so 
great  that  it  should  determine  the  method  of  ope- 
rating in  all  cases. 

Second. — This  method  should  include  the  arrest  of 
all  hemorrhage  before  the  opening  of  the  trachea,  and 
the  careful  exploration  and  cleansing  of  its  interior 
after  its  section. 

TJiird. — The  point  of  incision  should  be  as  low  as 
practicable.  Rarely  will  it  be  found  impracticable  to 
reach  the  trachea  and  open  it  below  the  thyroid 
isthmus. 

Fourth. — Serious  disadvantages  attend  the  use  of  a 
canula  of  any  kind.  Their  entire  supiiression  is  de- 
sirable. If  imperatively  demanded,  especial  care 
should  be  exercised  to  employ  one  which  shall  re- 
duce these  recognized  disadvantages  to  a  minimum, 
and  to  excise  from  the  edges  of  the  incised  tra- 
cheal rings  suffloient  of  their  substance  to  obviate 
any  tendency  to  the  production  of  any  infolding  of 
the  opposite  posterior  wall. 

Fifth. — Topical  apijlications  to  the  interior  of  the 
trachea  may,  in  many  cases,  be  important,  and  in 
some  essential  to  recoverv. 


INEFFECTIVE    VACCINE    VIRUS. 
By  H.  J.  GAREIGUES,  M.D., 

ETRTC   SUBGEON   TO   THE   NEW  YORE   MATERNITY    HOSPITAL.  N.  Y. 

Recently  a  baby,  in  the  reconvalescent  ward  of 
the  Maternity  Hospital  on  Blackwell's  Island,  was 
taken  with  small-pox.  The  child  was  immediately 
removed  to  the  Small-pox  Hospital,  and  all  the  in- 
mates of  the  Maternity  Hospital  vaccinated.  Among 
these  were  sixteen  babies  who  were  only  from  a  few 
hours  to  a  few  weeks  old.  The  vaccination  was 
carefully  executed  by  the  physicians  attached  to 
the  hospital,  as  I  am  satisfied  fi'om  my  examination 
of  at  least  one-half  of  these  vaccinated  children. 

Nevertheless  the  vaccination  failed  in  fourteen. 
or  in  87..5  per  cent.!  Fortunately,  no  other  cases  of 
small-pox  occurred,  but  this  was  not  due  to  the  pro- 
tection afibrded  by  the  vaccination.  We  might  as 
well  have  got  a  most  serious  ejjidemic,  so-called. 
Whenever  a  case  of  small-pox  occurs  it  is  the  first  san- 
itary rale  to  vaccinate  and  revaccinate  all  inmates  of 
the  house,  and  if  this  be  done  with  efficient  virus, 
apjilied  in  time,  it  is  an  almost  sure  preventive.  Dr. 
C.  Hansen,  the  late  chief  of  the  Royal  Vaccination 
Institute  of  Copenhagen  (Denmark),  has  reported 
a  striking  example  of  the  value  of  vaccination  under 
such  circumstances.  A  baby  nursed  for  five  days  a 
■wet-nurse  suftering  from  varioloid  who  had  almost 
confluent  pustules  in  the  face.  As  soon  as  the  nature 
of  the  disease  was  recognized,  the  nurse  was  removed, 
the  child  was  vaccinated,  and  the  vaccinia  ran  a 
perfectly  regular  course  so  as  to  lie  fully  developed 
on  the  eighth  day,  while  there  did  not  appear  any 
trace  of  small-pox  in  this  individual,  nor  in  any 
other  member  of  the  family,  who  all  were  revacci- 
nated  (Ugeskrift  for  Laeger,  1870,  vol.  ix.,  p.  382). 

The  virus  used  in  the  Maternity  Hospital  is  that 
furnished  by  the  Board  of  Health. "  But  I  have  been 
unable  to  find  any  difference  between  virus  obtained 
from  three  or  four  different  sources.  » 

In  my  private  practice  it  has  likewise  struck  me 


how  unreliable  the  virus  is  which  can  be  obtained 
here  in  the  city.  It  is  more  an  exception  than  a 
rule  that  the  first  vaccination  takes.  Within  a  year 
I  have  had  three  cases  in  which  I  vaccinated  three 
times  in  vain  before  finally  a  fourth  attempt  was 
siiccessful. 

The  fault  cannot  be  in  the  method,  for  I  scrape 
off  the  epidermis  entirely  from  a  square  measuring 
a  quarter  of  an  inch,  or  a  little  more,  and  rub  the 
virus  on  for  at  least  a  minute. 

If  often  vaccination  is  attempted  in  vain,  on  the 
other  hand  the  effect  is  sometimes  so  great  as  to  be- 
come dangerous.  I  have  seen  the  ulcer  cover  a 
surface  as  large  as  a  quarter,  surrounded  by  consider- 
able swelling  in  the  surrounding  tissues,  and  giving 
rise  to  high  fever.  I  have  also  heard  of  cases  in 
which  an  amputation  has  become  necessary,  and  of 
fatal  cases,  but  I  cannot  vouchsafe  the  reliability  of 
these  rejiorts. 

A  third  fault  in  the  l)ovine  vaccine  sold  here  in 
the  city  is  the  great  irregularity  as  to  the  time  in 
which  the  pustules  are  formed.  I  have  several 
times  seen  tliis  formation  begin  as  late  as  the  twelfth 
day,  while  in  the  Jennerian  vaccination  the  devel- 
opment follows  an  almost  mathematically  regular 
course. 

Finally,  a  process  takes  place  on  the  abraded 
surface,  which,  I  think,  is  only  due  to  the  mechan- 
ical injury,  or  an  irritation  produced  by  the  stuff 
which  is  rubbed  in.  After  ten  or  twelve  days, 
small  red  protuberances  rise  on  the  place  fi'om 
which  the  epidermis  was  removed,  and  which  has 
been  covered  with  a  scab  composed  of  dried  lymph, 
exuded  from  the  open  dymph-vessels,  and  combined 
with  the  substance  rubbed  on.  These  small  pro- 
tuberances grow  in  size,  coalesce,  and  form  a  small 
tumor,  much  like  half  a  raspberry  in  shajie  and 
color.  No  silver  line  appears  outside  of  the 
abraded  surface.  The  contents  is  only  a  clear 
lymph.  The  tumor  does  not  suppurate,  but  dries 
up,  forming  a  scab,  which  falls  off  without  leaving 
any  deep  cicatrix.  Once  I  inoculated  some  of  the 
fluid  on  two  babies.  In  one  a  similar  eruption  was 
produced,  in  the  other  no  effect  took  place,  and  on 
both  regular  vaccinia  was  produced  shortly  aftei-- 
ward  by  inoculation  of  humanized  cow-pox  virus 
from  another  child. 

This  kind  of  eruption  I  believe  to  be  very  com- 
mon, especially  after  revaccination,  and  it  is  scarcely 
necessary  to  point  out  the  great  danger  of  it.  Lay- 
men who  see  it  always  regard  it  as  vaccinia,  and, 
thinking  their  vaccination  has  "taken,"  they  pre- 
sume themselves  protected  against  small-pox. 

These  are  simple  facts,  gathered  on  a  limited 
field  of  observation.  I  have  not  the  time  nor  the 
opportunity  to  make  a  sjiecial  study  of  the  merits 
of  different  methods  of  vaccination,  but  I  have  seen 
enough  in  the  literature  on  the  subject  to  know  that 
at  least  some  of  the  above  observations  have  been 
made  on  a  large  scale  in  institutes  for  vaccination 
in  different  European  countries,  and  when  I  com- 
pare my  present  results  with  those  I  obtained  in  for- 
mer years,  when  I  either  vaccinated  from  arm  to 
arm  or  with  virus  taken  by  myself  in  a  tube  from 
one  patient  to  the  other,  I  cannot  help  regretting 
the  change. 

By  the  old-fashioned  vaccination,  as  introduced 
by  .Tenner,  effect  takes  place  with  very  few  excep- 
tions. I  have  never  had  to  rejieat  the  operation 
more  than  once  in  order  to  secure  vaccination  in 
those  in  whom  the  first  attempt  had  proved  a  fail- 
ure.    Non-humanized  lymph  fails  very  often,  and 


348 


THE  MEDICAL  RECORD. 


the  operation  has  sometimes  to  be  repeated  many 
times  before  it  brings  on  vaccinia. 

We  know  exactly  how  many  pustules  we  produce, 
or,  at  least,  we  know  the  maximum  number  which 
can  come  from  the  inoculation  with  a  lancet.  By . 
rubbing  the  virus  into  an  abraded  surface  we  have 
no  idea  what  we  are  doing. 

In  Jenuerian  vaccination  the  develojjment  is  en- 
tirely regular,  and  so  characteristic  that  whoever 
has  seen  a  true  vaccine  pustule  can  tell  when  he 
sees  another.  In  our  present  mode  we  get  conflu- 
ent irregular  pustules,  and  are  apt  to  be  misled  by 
false  vaccinia. 

"  But,"  say  the  advocates  of  non-humanized  virus, 
"  by  inoculating  the  lymi)h  from  one  person  to 
another  we  risk  to  tran.^mit  diseases."  Only  one 
disease  has  ever  been  proved  to  have  been  thus  trans- 
mitted, namely,  syphilis,  and  it  is  ea.sy  to  avoid  this 
serious  accident.  Even  the  Legislature  may  pro- 
tect the  population,  as  has  been  done  in  Denmark, 
where  it  is  forbidden  by  law  to  take  vaccine  virus 
from  a  child  younger  than  three  months  or  from  re- 
vaccinated  persons.  The  reason  of  the  former  deci- 
sion is  that  congenital  syphilis  almost  always  ap- 
pears before  that  period  ;  that  of  the  latter  is  too 
evident  to  need  any  explanation. 

ELASTIC  TENSION  THERAPEUTICALLY 
UTILIZED  IN  ADHESIVE  AND  ]\IEDL 
GATED  PLASTERS. 

By  M.  JOSIAH  ROBERTS,  M.D. 

Some  years  ago  I  was  so  fortunate  as  to  enjoy  many 
courtesies  at  the  hands  of  the  late  distinguished 
Professor  John  T.  Darby.  It  was  that  most  skilful 
surgeon  and  honorable  gentleman  who  first  directed 
my  attention  to  the  important  role  which  india-rubber 
played  in  practical  surgery.  Observation  in  this 
direction  having  thus  been  inaugurated,  the  mechan- 
ical principle  iipon  which  its  value  depended, 
namely,  elastic  tension,  soon  became  apparent.  It 
was  also  evident  that  this  elastic  tension  was  a  force 
that  could  be  exerted  in  any  direction,  and  devel- 
oped by  a  great  variety  of  substances.  Since  that 
time,  whenever  opportunity  1ms  been  afforded,  I 
have  made  use  of  elastic  tension  in  the  mechanical 
treatment  of  a  diver.sified  class  of  cases.  The  use- 
fulness of  this  mechanical  principle  is  so  manifold, 
that  I  am  astounded  it  has  not  received  moi'e  general 
recognition  by  the  medical  profession  as  one  of  the 
fundamental  principles  of  mechanical  therapeutics. 

In  a  paper  which  I  had  the  privilege  of  reading 
before  the  Medical  Society  of  the  County  of  New 
York,  *  attention  was  incidentally  called  to  the  bene- 
fits to  be  derived  from  the  use  of  elastic  adhesive 
and  elastic  medicated  jilasters  in  the  treatment  of 
chronic  articular  inflammations. 

It  is  my  purpose  now  to  make  some  specific  state- 
ments in  regard  to  the  above-named  plasters.  INIore 
than  three  years  ago  I  tried  to  convince  one  of  the 
principals  of  a  firm  engaged  in  the  manufacture  of 
adhesive  plasters  in  this  city  of  the  ])racticability 
of  spreading  various  omplastra  upon  strips  of  elastic 
webbing.  This,  however,  was  declared  to  be  impos- 
sible, owing  to  the  necessity  of  putting  great  tension 
upon  the  cloth  during  the  i)rocess  of  coating  it  with 
the  adhesive  mixture.  The  statement  of  this  gen- 
tleman was  but  a  temporary  damper  to  my  enthusi- 


•  EUwtic  Tonalon  and  Articular 
tlie  Mcotmnical  Treatment  of  Chri 
ary  2.),  1882. 


Motion   as   Thcrapoutic  Agents  in 
nic  Inllammatiun  of  Joint^,  Janu- 


asm,  for  shortly  afterward,  in  a  few  experiments 
conducted  in  my  office,  I  convinced  myself  of  the 
above  suggestion,  and  demonstrated  the  practical 
utility  of  elastic  adhesive  plaster  upon  some  jiatients 
then  under  treatment.  The  labor  and  inconvenience 
of  preparing  the  plaster  were  so  considerable,  that 
for  some  months  I  made  very  limited  use  of  it. 
Later,  Mr.  H.  R.  Spencer,  of  15-tth  Street,  near  Court- 
land  Avenue,  New  York,  succeeded  in  spreading  some 
adhesive  and  medicated  emplastra  upon  strips  of 
elastic  webbing  such  as  garters  are  made  of,  and 
which  can  be  had  in  any  well-regulated  dry-goods 
store.  This  proved  to  be  far  superior  to  any  made 
by  myself. 

The  reason  for  selecting  elastic  webbing  instead 
of  sheet-rubber,  such  as  is  used  for  dental  purjioses, 
or  the  solid  rublier  bandage,  is  that  it,  like  the  ordi- 
nary cloth  upon  which  plasters  are  spread,  is  porous 
and  readily  permits  of  the  evaporation  through  its 
meshes  of  the  insensible  perspiration  of  that  part  of 
the  body  to  which  it  is  applied. 

The  following  named  emplastra  are  those  which  I 
have  most  frequently  made  use  of,  and  are  applic- 
able in  a  great  variety  of  cases  : 

Kmplastriim  phimhi  (U.  S.),  on  account  of  its  non- 
irritating  properties,  and  also  from  the  fact  that  it 
may  be  applied  to  the  skin  for  weeks,  months,  or 
even  years,  without  the  absorption  of  lead  taking 
place,  is  most  serviceable  where  it  is  desirable  to 
exert  continuous  elastic  compression  for  the  purpose 
of  mechanically  aiding  the  absorption  of  inflamma- 
tory efl'usions,  or  preventing  the  occuiTence  of  the 
same  following  surgical  operations.  It  may  also  be 
used  as  a  strapping  applied  to  parts  requiring 
support.  Spread  upon  elastic  webbing  and  carefully 
applied  to  ledematous,  eczematous,  and  varicose 
limbs,  it  reta:ins  its  place  much  better  than  the  solid 
rubber  bandage,  and,  owing  to  its  elasticity,  is  far 
less  irksome  to  the  patient  wearing  it  than  any  non- 
elastic  strapping.  I  have  made  use  of  this  as  a 
retentive  and  corrective  agent  in  the  treatment  of 
club-foot,  and  with  excellent  results,  as  well  as  in 
overcoming  various  other  deformities  due  to  faulty 
muscular  action. 

Emplastrum  adkesivvm  (Emplastnim  resinse, 
U.  S.)  owes  its  greater  adhesiveness  to  the  addi- 
tion of  resin  to  ordinary  lead  plaster.  As  would 
naturally  be  .supposed,  this  plaster  is  useful  when 
great,  or  at  least  considerable,  tension  is  to  be 
exerted  upon  a  part,  as  its  superior  adhesiveness 
renders  it  less  liable  to  slip  when  applied  to  the 
skin.  I  have  used  it  with  signal  advantage  in  the 
treatment  of  fractures  for  overcoming  muscular 
spasm.  It  is  especially  applicable  in  those  cases  of 
fracture  in  which  a  fragment,  epiphysis,  tubercle,  or 
bony  prominence  is  likely  to  be  drawn  out  of  place 
by  muscular  action.  It  can  be  advantageously  used 
in  the  treatment  of  torticollis,  in  di.slocations — espe- 
cially those  of  the  shoulder,  and  as  a  temporary  dress- 
ing in  drop-wrist,  and  in  a  diversified  cla.ss  of  cases 
too  numerous  here  to  detail. 

Kmplitstruin  /•cllitilmnui  (V  S.),  owing  to  its  anal- 
gesic, antiKpasmodic.  and  absorbent  properties,  is 
pre-eminently  useful  in  combating  acute  local  inflam- 
mations. 

Spread  upon  elastic  webbing,  and  applied  about 
joints  in  cases  of  acute  synovitis,  or  other  acute 
articular,  or  periarticular  inflammations,  its  benefi- 
cial efl'ects  are  very  much  augmented,  owing  to  the 
elastic  circumferential  conipres.sion  which  is  contin- 
uously exerted.  I  have  also  made  noteworthy  use 
of  it  in  hydrocele  and  epididymitis. 


THE  MEDICAL  RECORD. 


349 


EmpUistrum  dconiti  (U.  S.),  locally  applied,  has  a 
sedative  effect  upon  the  terminal  nerve  filaments, 
and  will  be  found  serviceable  in  dealing  with  acute 
and  painful  articular  and  periarticular  inflamma- 
tions. 

Emplasiruin  (immoniaci  cum  ht/drnrgyri  (U.  S.)  is 
an  old  and  deservedly  well-known  lymphatic  stim- 
ulant. Spread  upon  elastic  webbing  its  value  is 
much  increased,  as  an  application  to  chronically  in- 
flamed joints.  I  might  add,  that  its  absorbent 
properties,  enhanced  by  the  mechanical  effects  of 
continuous  elastic  compression,  are  none  the  less 
apparent  in  the  treatment  of  syphilitic  nodes  and 
chronic  glandular  enlargements. 

The  most  magical  effects,  however,  which  I  have 
yet  obtained  in  the  use  of  elastic  medicated  plasters, 
have  been  with  the  following,  which  was  made  for 
me  and  spread  upon  elastic  webbing  by  Mr.  F. 
TBagoe,  pharmacist,  of  this  city,  in  accordance  with 
a  formula  which  I  furnished  him,  viz.:  Venice  tur- 
pentine, six  parts  ;  extract  of  belladonna,  two  parts  ; 
extract  of  aconite,  two  parts ;  magnesia,  sulHcient 
quantity  to  make  a  plaster  mass. 

The  therapeutic  effects  which  I  have  obtained  by 
the  use  of  this  elastic  plaster,  in  the  treatment  ot 
acute,  articular,  and  periarticular  inflammations, 
have  been  so  talismanic,  that  I  fear  the  credulity  of 
my  orthopedic  brethren  would  be  overtaxed  were  I 
to  detail  them.  The  wonderful  absorbent  effects  of 
turpentine,  which  I  have  for  several  years  so  fre- 
quently had  occasion  to  obseiTe,  were  what  led  me 
to  incorporate  it  in  an  elastic  plaster.  I  have  no 
doubt  but  that  other  of  the  terebinthinates  may  be 
found  equally  serviceable. 

The  above  enumerated  emplastra  may  be  spread 
upon  strips  of  elastic  webbing  varying  in  width 
from  three-eighths  of  an  inch  to  an  inch  and  a  hall 
or  two  inches,  according  to  the  necessities  of  the 
case.  The  amount  of  elastic  compression  which 
will  be  tolerated  in  a  given  case,  will,  as  a  rule,  de- 
pend upon  the  amount  of  inflammatory  effusion 
present ;  the  greater  the  effusion  and  the  more  re- 
cently it  has  taken  place,  the  more  tolerant  will  be 
the  patient  to  elastic  compression,  providing  the 
parts  below  are  previously  covered  with  a  firmly  and 
smoothly  applied  roller-bandage.  The  elastic  ban- 
dages are  most  conveniently  applied  in  the  form  of 
a  continuous  strip  rolled  \\\>  as  is  an  ordinary  band- 
age. To  avoid  unpleasant  experiences,  and  to  ob- 
tain the  maximum  amount  of  good  in  the  shortest 
space  of  time,  considerable  skill  and  mechanical 
tact  -will  be  requisite  in  the  apiilication  of  bandages, 
elastic  and  non-elastic. 

In  conclusion,  permit  me  to  say  that  it  is  hoped 
this  commTinication  will  sei-ve  to  stimulate  others  to 
make  use  of  elastic  adhesive  and  elastic  medicated 
plasters. 

With  a  view  to  making  a  subsequent  report  on 
this  subject,  I  earnestly  solicit  criticisms  from  those 
who  feel  inclined  to  use  elastic  emplastra,  or  in  any 
way  make  use  of  the  therapeutic  principles  involved 
therein. 

•1  West  Twenty-eighth  Street. 


A  Deb.\te  on  Nerve-stretohing,  recently,  extend- 
ed over  three  sessions  of  the  Berlin  Medical  Society. 
It  was  opened  by  Langenbeck,  who  w.as  followed  by 
Westphal,  Bardeleben,  Bernhardt,  Grael,  Eemak, 
Kiister,  Hahn.  and  others.  The  general  tone  of  the 
discussion  was  rather  unfavorable  to  nerve-stretch- 
ing, especially  in  tabes. 


|Jr00rea)5  of  iJlelitcal  Science. 


Re.sorcuie  versus  Qutnine  in  Malarial,  Affec- 
tion's.— Stillf's  experiences  with  resorcine  in  the 
treatment  of  intermittent  fever  have  not  been  very 
satisfactory.  Of  13  cases  in  which  this  drug  was  ad- 
ministered, in  5  the  result  was  favorable,  in  6  it 
was  only  palliative  ;  while  in  the  2  remaining  no 
effect  at  all  was  noticed.  These  last  two  classes 
were,  however,  promptly  cured  by  quinine.  The 
smallest  dose  of  resorcine  was  0.3  gramme,  given 
to  a  boy  of  three  years,  without  benefit ;  the  largest 
dose  was  four  grammes,  also  without  the  slightest  fa- 
vorable influence.  The  average  dose  should  be  about 
twice  as  large  as  that  of  quinine.  (The  administra- 
tion of  resorcine  in  quantities  greater  than  three 
grammes  has  produced  alarming  symptoms,  al- 
though StillC  states  that  nothing  of  a  serious  char- 
acter was  observed  in  his  cases).— Z>e/^'s  Memora- 
bilien,  January  10,  1882. 

HeATOn's    Ol'ER.iTION    FOR   THE    EaDICAL    Ci-EE   OF 

Hernia. — The  Heaton  method  consists,  as  is  w-ell 
known,  of  irrigating  the  inguinal  canal  and  rings 
with  a  preparation  of  white  oak  bark  in  solution. 
The  fluid  recommended  is  composed  of  white  oak 
bark  in  solid  extract,  fourteen  grains  in  amount,  to 
which  is  added  half  an  ounce  of  the  fluid  extract  of 
the  same  dmg.  The  two  are  then  gently  heated  to- 
gether. The  mixture  is  thick  and  muddy,  and  re- 
quires shaking  before  it  is  used. 

The  operation  is  thus  described  by  Dr.  George  W. 
Gay,  one  of  the  surgeons  of  the  Boston  City  Hospi- 
tal :  Having  reduced  the  hernia  and  if  possible  the 
sac,  an  instrument  resemViling  the  hypodermic 
syringe  is  charged,  and  then  thrust  directly  through 
the  skin  into  the  external  abdominal  ring,  the  point 
of  the  needle  then  being  carried  up  the  inguinal 
canal  in  front  of  the  spermatic  cord,  as  far  as  the  in- 
ternal ring.  The  fluid  is  deposited  slowly  while 
withdrawing  the  instrument,  the  point  of  which  is 
to  be  moved  about  in  all  directions,  in  order  that 
the  astringent  may  be  evenly  distributed  throughout 
the  canal.  A  compress  and  bandage  are  then  im- 
mediately applied,  and  they  should  be  worn  for  some 
weeks.  If  the  operation  prove  successful,  nothing 
further  is  required  to  be  done.  The  object  is  to  set 
up  a  moderate  inflammation,  for  anything  like  a 
severe  reaction  prolongs  convalescence  and  adds 
nothing  to  the  success  of  the  operation.  It  is  in- 
tended in  the  ojieration  to  bathe  the  fibrous  struc- 
tures in  contact  with  the  neck  of  the  sac,  but  in  many 
cases  it  is  by  no  means  certain  that  the  needle  does  not 
enter  the  perineum.  At  any  rate,  in  Dr.  Gay's  ex- 
perience (23  operations  in  15  ca?es)  peritonitis  has 
never  resulted.  Of  the  total  number,  a  cure  is  record- 
ed in  4,  relief  was  given  in  S,  and  there  were  3  failures. 

A  part  of  this  non-success  is  attributed  either  to  a 
lack  of  skill  or  experience  in  the  operator,  to  imper- 
fect after-treatment,  or  finally  the  unwillingness  of 
patients  to  undergo  the  secondary  operation  which 
is  often  necessary. 

Taking  inguinal  hernia  alone  as  a  test  for  the 
method,  it  is  thought  to  be  safe,  comparatively  easy  of 
performance,  and  attended  with  little  pain  or  danger. 
In  a  certain  number  of  cases  it  will  cure,  especially 
when  the  rings  are  small,  or  where,  as  in  children, 
nature  is  attempting  to  correct  the  vicious  condition 
of  the  part,  but  needs  a  little  assistance, — Bepi-int 
from  Boston  Medical  and  Surgical  Journal,  1882. 


350 


THE  MEDICAL  RECORD. 


The  Medical  Recokd: 


51  llltckln  Journal  of  fttcbicinc  anb  Suvgerj) 


GEORGE  F.  SHRADY,  A.M.,  M.D.,  Editor. 


PUBLISHED   BY 
Wn.  'WOOD  Sc  CO.,  No.  27  Creat  Jones  St.,  N.  Y. 

New  York,  April  1,  1882. 


THE  AMEKICAN   A]VIBUL.^CE   SYSTEM 
ABROAD. 

The  hospital  authorities  of  London  have  at  last  de- 
termined to  adopt  the  ambulance  system  of  hos- 
pital service.  The  earnest  and  well-timed  advocacy 
of  the  necessity  of  this  measure  by  Dr.  Benjamin 
Howard,  formerly  of  this  city,  has  been  the  princi- 
pal means  to  this  desirable  end.  His  exjjerience 
during  the  late  Confederate  war  gave  him  ample 
facilities  for  mastering  the  details  of  transportation, 
and  he  has  utilized  them  in  a  practical  manner  by 
constructing  an  ambulance  carriage  which  is  adapted 
to  all  possible  emergencies  of  street  accidents.  It  is 
modelled  after  the  American  ambulance,  as  used  in 
this  city,  and  is  claimed  to  be  an  improvement  on  the 
same.  Although,  practically  speaking,  this  does  not 
seem  possible,  the  London  carriage  is  considered  by 
the  hospital  authorities  to  be  the  perfection  of  con- 
struction, and  to  be  capable  of  answering  every  pur- 
pose. As  might  have  been  expected,  however,  there 
is  considerable  discussion  regarding  the  application 
of  the  system  to  the  needs  of  the  public  on  the  one 
hand  and  the  capabilities  of  the  hospitals  on  the  other. 
Fears  are  expressed  that  the  hospitals  will  be  over- 
crowded with  accident  cases,  and  that  the  extra  funds 
for  their  maintenance  may  not  be  forthcoming.  From 
an  American  point  of  view  this  seems  to  be  some- 
what absurd,  inasmuch  as  there  is  a  laudable  ambi- 
tion on  the  part  of  all  our  large  hospitals  of  obtain- 
ing all  the  acute  surgery  possible.  Indeed  the 
diflferent  ambtilanco  surgeons  manifest  almost  an 
inordinate  zeal  in  securing  and  hurrying  away  with 
all  the  wounded  within  tlioir  reacli,  only  too  glad  for 
an  opportunity  of  filling  the  accident  wards  to  the 
uttermost.  Nor  do  the  hospital  authorities  object 
to  the  number  of  patients  received  under  such  cir- 
cumstances.    It   is  acknowledged  that  one  of  the 


main  objects  of  our  hospitals  is  to  care  for  these 
very  cases,  almost  to  the  exclusion  of  patients  who 
are  afflicted  with  chronic  or  incurable  maladies.  Nor 
does  this  practice  militate  against  the  pecuniary 
prosjjerity  of  the  several  institutions,  inasmuch  as 
the  number  of  accident  cases  cared  for  governs  the 
amounts  contributed  by  the  benevolent.  It  is  a  proof 
to  them  of  the  way  in  which  their  moneys  are  util- 
ized. 

The  organization  of  the  system  in  London  ap- 
pears to  us  to  be  an  unnecessarily  complicated  one. 
It  is  believed  to  be  best  to  jjlace  the  ambulances 
under  control  of  the  municipal  authorities  with  the 
implied  understanding,  as  it  appears,  that  every  hos- 
pital shall  be  prepared  to  receive  all  cases  sent  to 
them.  This  will  be  obviously  unjust  to  smaller  hos- 
pitals without  requisite  facilities,  and  may  seriously 
hamper  the  extended  usefulness  of  the  scheme. 
Much  better  would  it  be  for  each  hospital  to  con- 
trol, as  here,  its  own  ambulance  service,  subject  to 
the  call  of  the  police  authorities  of  its  particular 
district.  This  plan  has  worked  very  satisfactorily 
with  the  larger  hospitals  in  this  city,  and  it  is  diffi- 
cult to  see  how  it  can  be  improved  upon.  In  cases 
of  emergency  demanding  the  use  of  the  ambulance 
system,  there  is  not  time  for  unravelling  the  length 
of  red  tape  which  occasionally  may  happen  in  the 
best  regulated  municipal  government. 


THE   MEDICAL   HISTOBY   OP   HOUSES. 

A  wRiTBE  in  a  recent  issue  of  the  Lancet  has 
broached  the  very  sensible  idea  that  some  measures 
should  be  taken  to  furnish  tenants  with  the  medical 
history  of  their  houses.  It  is  well  known  that  much 
disease  is  spread  among  families  who  are  constantly 
changing  their  residences,  by  the  unsanitary  condi- 
tion of  apartments  which  they  hire.  In  many  in- 
stances the  houses  are  rented  at  low  figures  because 
of  defective  drains,  damp  cellars,  bad  plumbing, 
unhealthful  surroundings,  or  perhaps  because  of  the 
previous  habitation  of  them  by  persons  afflicted 
with  contagious  diseases.  It  does  not  seem  to  be 
an  impossibility  for  the  health  authorities  of  the 
different  towns  to  have  a  list  of  houses  in  which 
contagious  diseases  have  been  known  to  occur,  or 
in  which  conditions  inimical  to  health  are  known  to 
exist,  for  general  reference  by  the  public.  Such  a 
list  would  be  of  great  value  to  the  large  number  of 
families  who  are  at  this  season  of  the  year  looking 
around  for  new  homes.  In  all  instances  a  critical 
examination  of  the  cellars  and  drains  is  more  im- 
portant than  the  inspection  of  the  parlors  and  U]>]ier 
floors.  And  yet,  how  seldom  is  this  done,  and  how 
often  the  tenants  suffer  in  consequence.  If  health 
boards  would  keep  a  black  list  of  unhealthy  houses 
the  landlords  of  the  same  would  find  it  to  their  in- 
terest to  look  more  particularly  to  the  sanitary 
welfare  of  their  tenants. 


THE   MEDICAL  RECORD. 


351 


THE    TREATMENT     OP     STPHIMS    "WTTHOUT     MEBCURT — 
A   NEW   ABORTIVE   METHOD. 

Dr.  J.  Edmund  Guntz,  of  Dresden,  in  a  work  just 
published  by  him,  makes  some  novel  announcements 
regarding'  tlie  treatment  of  sypluUs.  If  true,  they 
are  of  the  highest  importance,  for  he  claims  to  be 
able  '  not  only  to  do  away  with  mercury  in  syphilis, 
but  in  a  large  jjroportion  of  cases  to  abort  the  dis- 
ease. 

It  is  now  over  twelve  years  since  Dr.  Giintz  first 
wrote  on  this  subject.  He  is,  therefore,  not  a 
novice  in  the  matter.  In  1869  he  advocated  the  use 
of  bichromate  of  potassium  as  being  a  useful  drug 
in  treating  syphilis. 

He  could  not  prove  any  very  great  advantages  for 
it,  however,  at  the  time.  It  acted  slowly  and  was  apt 
to  disturb  the  stomach,  but  being  convinced  that 
there  was  something  in  the  drug,  he  set  at  work  to 
find  some  way  of  getting  more  into  the  system  with- 
out producing  functional  disturbance.  For  a  time 
he  combined  the  bichromate  with  the  nitrate  of 
potassium,  and  gave  pills  containing  about  A-  gr.  of 
each  three  times  a  day.  With  these  pills  he  pro- 
duced "remarkably  favorable  results."  Yet  the 
action  was  slow,  and  when  a  prompt  amelioration 
of  symptoms  was  needed,  as  in  malignant  cases,  the 
remedy  would  hardly  meet  the  expectations. 

From  the  favorable  results  obtained  by  giving  the 
various  minerals  in  solutions  with  carbonic  acid 
water,  our  author  was  led  to  attempt  administer- 
ing chromium  in  the  same  way,  and  with,  as  he  now 
claims,  very  great  success.  He  found  that  much 
larger  doses  could  be  taken  in  this  form,  and  that  a 
profounder  impression  on  the  system  could  thus  be 
made.  As  a  maximum  dose  he  was  able  to  give 
three  and  a  half  gi'ains  (.3  grammes)  daily  of  bi- 
chromate of  potassium  in  about  600  grammes  of 
carbonic  acid  water,  this  being  divided  into  five 
doses.     Larger  amounts  provoked  vomiting. 

This  "  chromwater,"  as  he  calls  it,  could  also  be 
given  daily  for  weeks  and  months  in  all  forms  of 
syphilis  without  detriment  to  the  health. 

Having  described  his  method  of  giving  the  drug, 
Dr.  Giintz  discusses  its  action  upon  the  initial  stage 
of  syphilis  and  upon  the  disease  itself  after  its  full 
development  in  the  system. 

In  estimating  the  possible  value  of  any  drug  as 
an  abortive  of  syphilis,  the  numerous  sources  of 
error  are  referred  to.  The  existence  of  and  difterence 
between  true  chancre  and  chancroid  are  admitted. 

The  following  are  his  statistics  : 

Within  one  and  a  quarter  years  the  author  treated 
194  cases  of  chancre.  For  comparative  study  he 
selects  only  85  of  these,  since  in  the  others  there 
were  sources  of  eiTor.  In  11  of  these  85  cases  the 
sores  were  cauterized.  The  remainder  were  treated 
with  nothing  but  the  chromwater ;  and  in  17  of  them 
constitutional  syphilis  failed  to  appear.     In  order 


to  avoid  every  possible  chance  of  mistake  the  author 
excludes  10  of  this  47.  Even  then  there  were  left  37 
patients,  or  over  one-half,  who,  when  given  chrom- 
water alone,  developed  no  after-symptoms.  It  is 
not  stated,  however,  how  long  they  were  watched, 
except  that  18  were  under  observation  for  159  days. 

Still  more  favorable  results  took  place  with  the 
11  cases  in  which  the  initial  lesion  was  cauterized. 
Of  these  only  two  developed  symptoms  of  constitu- 
tional syphilis. 

Of  the  85  patients,  therefore,  presenting,  as  Dr. 
Giintz  asserts,  initial  lesions  of  syphilis,  19,  under 
the  "  chromwater"  treatment,  remained  entirely  free 
from  the  disease.  This  is  certainly  a  very  extraordi- 
nary showing  and  will  be  received  with  a  great  deal 
of  incredulity. 

If  this  new  agent  is  given  after  constitutional 
symptoms  make  their  appearance,  its  action  is  to 
ameliorate  the  disease  and  hasten  its  course.  It 
is  efficient  even  in  cases  where  mercury  fails,  and  it 
acts  more  pleasantly  and  promptly.  In  fact,  the 
disease  is  "  in  the  shortest  time  definitely  cured." 

The  author  has,  for  several  years,  used  the  chrome 
salt  exclusively  in  the  treatment  of  syphilis,  and 
has  given  it  in  more  than  a  thousand  cases.  He 
thinks  that  the  day  of  mercury  is  over.  He  has 
recorded  the  histories  of  a  large  number  of  his 
cases. 

Dr.  Giintz  has  also  used  his  chromwater  with 
the  best  results  in  diphtheria. 

He  suggests  that  the  drug  acts  by  reason  of  its 
powerful  oxidizing  properties.  Without  commit- 
ting himself  to  any  germ  theory,  it  is  thought  that 
there  is  certainly  a  specific  poison  which  develops 
in  the  various  contagious  diseases.  And  in  chro- 
mium we  have  an  agent  that  is  inimical  to  the  syphi- 
litic poison  while  it  does  not  harm  the  system  itself, 
but  rather  benefits  it. 

The  importance  of  Dr.  Giintz's  claims,  and 
the  caution  with  which  they  should  be  received,  are 
alike  api^arent  and  need  no  comment. 


A   PLEA    FOR   IRREGULAR    PRACTITIONERS. 

A  CORRESPONDENT  of  the  Times,  who  writes  with  too 
much  fairness  to  be  personally  interested,  puts  in  a 
plea  for  the  irregular  practitioners.  His  argument 
contains  nothing  new,  but  it  presents  that  side  of 
the  question  with  unusual  force  and  clearness. 

He  says  :  "  No  matter  what  may  be  said  or  en- 
acted, there  are  many  people  who  have  lost  all  faith 
in  regular  practitioners,  even  the  most  eminent,  and 
who  have  faith  in  some  irregular  practitioners,  per- 
haps even  in  some  quack.  Now,  to  say  to  these  peo- 
ple, You  shaU  not  consult  whom  you  choose,  and  if 
you  will  not  be  treated  by  a  regular  with  a  diploma 
you  shall  not  be  treated  at  all,  does  not  seem  right." 
"  If  a  man  believes  he  can  be  helped  when  sick  by 
any  one,  whether  with  a   diploma   or  not,  he  will 


352 


THE  MEDICAL  RECORD. 


think  himself  injured  and  deprived  of  his  rights  if 
forbidden  to  consult  that  person,  as  he  virtually 
would  be  by  this  act.  It  may  even  be  a  question 
if  such  a  law,  so  abridging  a  man's  rights  to  seek  ad- 
vice where  he  chooses,  is  constitutional." 

The  argument  is  speciously  candid. 

The  facts,  however,  are  only  given  for  one  side. 
The  object  of  law  is  to  protect  society.  Laws  are 
framed  to  do  this  with  as  little  interference  with  in- 
dividual liberty  as  possible.  The  medical  profession 
as  a  mass  (not  the  "eminent  men"  alone)  advocate 
a  medical  law,  because  they  believe  that  the  safety 
and  good  health  of  society  demand  it.  If  it  narrows 
slightly  individual  choice,  this  is  a  minor  evU.  Many 
laws  do  the  same.  It  seems  to  us  that  every  candid 
and  intelligent  man  will  admit  that  it  is  safer  for 
society  not  to  allow  men  who  have  no  medical  edu- 
cation, and,  generally,  no  scruples,  to  offer  to  treat 
disease,  and  thus  to  take  upon  themselves  the  re- 
sponsibility of  life  and  death. 

It  is  charged  that  medical  men  wish  the  law  in 
order  to  protect  themselves— that  it  is  the  project 
of  a  ti-ades-union. 

We  answer  that  the  chief  object,  as  stated  above, 
is  to  protect  life  and  prevent  suffering,  especially 
among  the  ignorant  members  of  society.  The  medi- 
cal profession  naturally  urges  the  law  most  strongly 
because  its  members  are  best  able  to  know  the  in- 
jury which  ignorance  and  inesperience  can  do. 
They  know,  too,  how  easily  credulous  the  people 
are  toward  any  pretences  of  a  medical  character. 

We  are  quite  willing  to  admit  that  there  is  some 
of  the  esprit  (lit  corps  in  our  position.  We  do  not 
like  to  run  a  race  with  old  hacks,  or  contest  the 
game  of  life  with  gamblers  and  cheats.  The  in- 
stinct of  self-respect  and  self-preservation  is  natural 
and  just. 

But  the  main  point  is  that  the  proposed  medical 
law  is  one  intended  primarily  for  the  protection  ot 
society,  and  not  for  the  benefit  of  the  physician. 


SOME     PUKTHEU    EXPBKIMBNTS    REOABDING    BACTERIAL 
PATHOIiOOT. 

Some  recent  experiments  by  Kosenberger,  of  Wurz- 
burg,  are  of  especial  interest  in  connection  with  the 
report  on  diphtlieria  reviewed  in  our  last  issue. 

Dr.  Rosenberger  took  the  blood  or  secretions  of  ani- 
mals (guinea-pigs)  which  had  died  from  septicnemia. 
The  septic  fluid  contained  large  numbers  of  micro- 
cocci, and,  when  inoculated,  was  actively  virulent 
in  minute  amounts. 

He  heated  this  virus  to  a  temperature  of  140^  C. 
(about  ;iOO'  F.)  for  two  liours,  and  then  injected  this 
cooked  virus  into  his  experiment-animals.  He  found 
that  tliey  still  died  of  septiciemia  ;  also  that  tlioir 
blood  was  full  of  tlio  micrococci  ordinarily  seen  in 
septiciomia,  and  tliat  a  small  drop  of  it  was  as  actively 
poisonous  as  in  septicmmia  produced  by  ordinary 
methods.     The  cooked  virus  was  proved  to  be  ster- 


ile, so  far  as  organisms  are  concerned,  by  placing 
some  of  it  in  meat  extract,  which  remained  clear  for 
weeks.  It  is  stated  also  that  this  heated  virus  was 
filtered,  in  some  cases  at  least,  but  that  it  was  still 
active.  It  was,  however,  in  no  case  so  acl^ve  as  the 
original  virus,  since  at  least  a  cubic  centimetre  was 
needed  to  produce  a  fatal  effect. 

Dr.  Eosenberger's  conclusions  from  his  experi- 
ments are  that  heat,  while  it  sterilizes  or  destroys 
the  micro-organisms  of  septicaemia,  does  not  destroy 
the  virus,  which  must  be,  therefore,  a  chemical  or 
unorganized  body.  It  is  further  infei'red  that  this 
virus  has  the  power  to  cause  the  rapid  development 
of  bacteria  in  the  body,  but  that  these  bacteria  are 
only  secondary  elements  in  the  disease.  Neverthe- 
less, the  bacteria  play  an  important  role,  for  by  them 
the  poison  is  spread  and  increased  in  amount. 

According  to  this  view  of  the  pathology  of  septic 
diseases,  neither  micro-organisms  are  alone  the 
cause,  nor  a  chemical  poison.  A  union  of  both  is 
necessary. 

Dr.  Rosenberger's  experiments  are  very  suggest- 
ive, and  do  not  seem  improbable.  Several  recent 
investigators  have  ajiparently  shown  that  innocuous 
organisms  may  become  poisonous,  and  this  was  the 
view  offered  by  Wood  and  Formad  in  explanation 
of  the  develoj^ment  of  malignant  dijjhtheria.  We 
find,  however,  one  statement  made  regarding  Rosen- 
berger's exjieriments,  which  throws  some  suspicion 
upon  his  accuracy.  He  says  that  the  cooked  virus 
was  also  filtered,  and  that  the  clear  filtered  fiuid  was 
poisonous.  Now,  it  has  been  shown  by  Ciu'tis  and 
Satterthwaite  that  the  infectious  material  of  putrid 
and  diphtheritic  substances  is  particulate,  and  will 
not  pass  through  a  fine  filter.  It  is  not  to  be  sup- 
posed that  the  septic  virus  exists' in  any  different 
state.  We  must,  therefore,  wait  for  some  confir- 
mation  of  Rosenberger's  experiments  before  drawing 
any  conclusions  from  them. 


WHAT   IS   HE    GOING   TO  DO  ? 

The  graduation  of  some  five  or  six  thousand  young 
medical  men  during  the  present  spring  is  an  event 
of  deep  importance  to  the  profession.  What  are 
they  going  to  do  ?  is  the  que.stion  asked,  not  only  by 
the  parties  especially  interested,  but  by  the  profes- 
sion and  public  at  large.  Tlie  New  York  Times, 
which  always  discusses  medical  questions  with  more 
than  ordinary  fairness  and  intelligence,  has  recently 
applied  itself  to  the  problem  just  suggested.  There 
is  now,  it  says,  in  the  United  States  one  physician 
to  every  five  hundred  inhabitants.  The  ratio  of  sick 
to  well  during  the  year  is  estimated  at  about  twenty 
per  one  thousand,  including  the  paupers.  This 
would  give  about  ton  patients  to  each  practitioner; 
but  of  these  many  are  too  poor  to  pay,  and  many  do 
not  call  in  a  physician,  so  that  five  or  six  patients 
are  all  that  can  be  allowed  for  each  medical  man. 


THE   MEDICAL  RECORD. 


353 


Another  method  of  studying  the  question  is  as 
follows :  The  ratio  of  deaths  is,  for  the  whole 
country,  not  far  from  twenty  per  one  thousand  annu- 
ally. For  every  death  there  are  about  twenty-five 
cases  of  sickness,  or  five  hundred  cases  per  one 
thousand  annually.  This  would  give  an  average  of 
two  hundred  and  fifty  patients  per  year  for  each 
physician.  But  this  number  must  be  reduced  nearly 
one-half,  by  subtracting  those  who  do  not  pay,  and 
those  who  are  not  ill  enough  to  need  a  physician. 
With  the  present  number  of  physicians,  therefore, 
there  would  be  two  or  three  patients  per  week  for 
each,  if  they  were  equally  divided. 

What  need  is  there,  then,  for  six  thousand  new 
doctors  annually  ?  If  they  do  what  they  expect,  if 
they  practise  and  prosper,  it  must  be  at  the  ex- 
pense of  those  already  in  the  field. 

SUNDAY   EECKEATIONS. 

Several  leading  clergymen  in  this  city  have  boldly 
spoken  in  favor  of  suitable  recreation  for  the  labor- 
ing classes  during  the  Sabbath.     The  subject  is  cer- 
tainly one  of  more  than  passing  importance.    Afi"ect- 
ing  as  it  does  the  physical  as  well  as  moral  welfare 
of  communities,  it  deserves  free  and  candid  discus- 
sion.    The  working  classes  are  interested  more  par- 
ticularly in  any  proposition  having  for  its  object  a 
weekly  respite  from   the  daily  routine  of  toil.     To 
restrict  their  much  needed  rest  to  attendance  upon 
church  and  the  observance  of  puritanical  rules  of 
conduct   is    neither   reasonable    nor   philosophical. 
Rest  is  a  purely  relative  term  and  is  associated  more 
or  less  with  enjoyable  relaxation  of  mind  and  body. 
The  true  indications  for  either  are  not  always  ful- 
filled by  listening  to  a  prosy  sermon  in  the  morning 
and  by  dozing  over  a  religious  iieriodical   in   the 
afternoon.     To  many  these  occupations  are  spiritu- 
ally restful  and  physically  recuperative,  but  with  the 
larger  majority  something  more  is  needed.     Clerks, 
mechanics,    and   laborers  are   almost    entirely   de- 
barred from  any  recreation  whatever  save  what  can 
be  obtained  on  the  Sabbath.     By  such  a  trip  into 
the  country,  a  stroll  in  the  woods,  or  an  excursion 
to  the  seaboard  may  hardly  be  considered  as  mortal 
sins.     The  day  of  rest  should  not  be  made  irksome 
by  the  enforcement  of  arbitrary  rules,  even  as  afi'ect- 
ing  Christian  observances.     Innocent   amusements 
cannot  possibly  be  antagonistic  to  them.     In  fact, 
the  people  who  can  rest  only  on  Sundays  should  be 
encouraged  to  avail  themselves  of  every  opportunity 
for  change  of  conditions   and  surroundings.     Our 
free  libraries  should  be  opened  to  the  men  and  wo- 
men who  can  use  them  at  no   other  time,  and  our 
picture  galleries  can  in  no  more  effectual  manner 
fulfil  their  higher  missions  than  by  fostering  a  taste 
for  the  pure  and  beautiful  among  those  whose  better 
days  are  spent  in  the  dull  hard  drudgery  of  bread- 
winning. 


THE    AMERICAJJ    RED    CROSS    SOCIETT    AND    THE    MISSIS- 
SIPPI  StTTTEREES. 

The  American  Red  Cross  Society  has  very  properly 
come  to  the  front  with  an  appeal  for  the  aid  of  the 
sufferers  from  the  flooded  districts  along  the  Mis- 
sissippi. As  will  be  recollected,  this  organization  is 
a  branch  of  the  Society  of  the  Red  Cross  of  Geneva, 
and  has  recently  been  created  in  this  country  with 
the  twofold  object  of  succoring  the  woimded  in  time 
of  war,  and  during  peace  of  affording  assistance  to 
all  such  as  suffer  from  floods,  pestilence,  and  fire. 

We  have  before  taken  occasion  to  refer  to  the 
good  oflices  which  this  society  can  render  in  just 
such  calamities  as  the  one  under  consideration,  and 
that  its  national  character  peculiarly  fits  it  for  the 
same. 

There  is  no  more  practical  way  of  proving  its 
utility  and  the  real  reasons  for  its  organization  than 
in  the  manner  and  method  of  its  appeal. 


Hcuinu0  ariis  XXotkte  of  ^ooks. 


A  Manual  of  Organic  Materia  Medica.  By  John 
M.  Maisch,  Phar.  D.,  12mo,  pp.  459.  Philadel- 
phia :  Henry  C.  Lea's  Son  <t  Co.     1882. 

In  this  little  work  we  find  a  catalogue  of  the  drugs 
derived  from  the  animal  and  vegetable  kingdoms. 
Each  article  is  considered  as  to  its  origin,  habitat, 
description,  constituents,  and  properties.  These  di- 
visions are,  except  the  last,  briefly  but  admirably 
written,  but  belong  rather  to  the  department  o*f 
pharmacognosy  than  materia  medica  as  commonly 
understood.  In  pharmacology  and  pharmacognosy 
Professor  Maisch  stands  pre-eminent  as  a  writer, 
but  in  the  few  lines  devoted  to  the  "  properties  "  of 
drugs,  he  carries  us  back  full  fifty  years,  and  again 
defies  the  old  proberb,  "  Sutai- ne  supra  crepidam." 
The  book  is  well  printed  on  fine  paper,  and  suitably 
illustrated. 

The  Child  op  Promi.se  ;  or.  The  Isaac  of  Medicine 
and  Ishmael  the  Half  Brother,  etc.  By  William 
Mellen  Cate,  M.D.  12mo,  pp.  280.  'Washing- 
ton :  H.  B.  Burnham  ct  Co.     (N.  d.) 

This  work,  so  far  as  we  can  understand  it,  appears 
to  be  an  attempt  to  draw  a  parallel  between  regular 
medicine  and  homoeopathy  on  the  one  hand,  and 
certain  scriptural  facts  on  the  other.  The  attempt 
is  conceived  in  bad  taste  and  carried  out  with  little 
regard  to  logic. 

Sir  Thomas  Browne's  Religio  Medici,  Letters  to 
A  Friend,  etc.,  and  Christian  Morals.  Edited 
by  W.  A.  Greenhill,  M.D.  London  :  Maomillan 
&  Co.,  1881. 

The  author  of  this  famous  little  book  was  born  in 
London,  in  1605,  three  years  before  the  birth  of  John 
Milton,  and  eleven  years  before  the  death  of  Shake- 
speare. He  was  educated  at  Winchester  and  Oxford. 
He  afterward  studied  medicine  on  the  continent  and 
took  his  degree  at  Leyden  in  16.33.  A  few  years 
after,  he  settled  at  Norwich,  where  he  remained 
during  the  rest  of  his  life  as  a  practitioner.  He 
was  a  man  of  rare  genius,  possessing  great  intellec- 


354 


THE  MEDICAL  RECORD. 


tual  power  and  extensive  learning.  Coleridge  speaks 
of  him  as  the  "  philosopher  of  Norwich." 

He  was  the  author  of  several  books  and  pamph- 
lets, bvit  his  greatest  work  was  the  "  Keligio  Medioi. 
He  tells  us  in  the  preface  that  it  was  not  intended  . 
for  publication,  but  was  "  composed  at  leisurable 
hours  for  his  private  exercise  and  satisfaction."  The 
manuscript  of  this  work  was  loaned  to  his  friends, 
and  by  some  of  them  transcribed  and  pubhshed 
without  the  author's  knowledge  or  consent,  in 
1642.  ,^  ,. 

Sir  Thomas  himself,  soon  after,  gave  a  new  edi- 
tion to  the  world. 

During  the  author's  lifetime  there  were  no  less 
than  eight  editions  of  his  work  published,  and 
since  that  day  manv  editions  have  appeared.  The 
author  died  in  1G82,  just  two  hundred  years  ago. 
Surely  a  book  which  has  lived  so  long,  and  of  which 
a  new  edition  has  just  been  brought  out,  ought  to 
contain  something  worth  the  reading,  and  that  it 
does  no  one  who  has  carefully  read  it  will  deny. 

The  "Religio  Medici"  is  made  up  of  reflection.?, 
often  quaint  and  curious,  but  always  original,  upon 
the  doctrines  of  the  Christian  religion  and  upon 
Christian  conduct  and  life.  The  being  of  God,  the 
Trinity,  the  nature  of  the  Soul,  Creation,  the  Bible, 
Miracles,  Faith,  Providence,  Sleep,  Charity,  Death, 
and  Kesurrection— these  are  but  a  few  of  the  many 
themes  which  the  author  discusses  in  his  striking  and 
original  manner.  Only  occasionally  does  he  refer 
to  his  profession.  On  page  137  he  says,  "  Some  think 
there  were  few  Consumptions  in  the  Old  World, 
when  men  lived  much  upon  milk  ;  and  that  the 
aacient  inhabitants  of  this  Island  were  less  troubled 
with  coughs  when  they  went  naked  and  slept  in 
caves  and  woods  than  men  now  injchambers  and 
feather-beds." 

In  his  "  Letter  to  a  Friend,"  written  on  the  oc- 
casion of  the  death  of  an  intimate  friend,  he  refers 
incidentally   to   certain   diseases    prevalent   in  his 

The  "  Christian  Morals,"  which  have  been  called 
"a  continuation  of  the  ReHgio  Medici,"  was  written 
near  the  end  of  liis  life,  and  was  published  after  his 
death.  Thoiigb  full  of  quaint  and  original  sayings,  it 
is  in  many  respects  inferior  to  the  "  Keligio  Medici." 
It  shows  greater  learning  in  the  more  extended  use 
of  Latin  quotations  and  in  the  more  frequent  refer- 
ence to  the  events  of  ancient  and  medieval  history. 
The  same  deep  vein  of  piety  pervades  the  book,  and 
it  shows  the  author's  wondrous  insight  into  human 
character. 

In  the  "Appendix"  we  learn  that  in  1840  some 
workmen  who  were  emploved  in  digging  a  vault  in 
tlie  chancel  of  the  church  of  St.  Peter's  Mancroft, 
Norwich,  accidentally  broke,  with  a  blow' of  the 
pickaxe,  the  lid  of  a  coffin,  which  proved  to  be  that 
of  Sir  Thomas  Browne.  The  bones  were  found  to 
be  in  a  good  state  of  preservation.  The  skull,  which 
was  particularly  well  iireserved,  is  now  kept  under  a 
glass  case  in  the  Museum  of  the  Norwich  Hospital. 
"What  would  the  good  and  saintly  Sir  Thomas  have 
said  if  he  could  have  foreseen  this;  for  on  page  05 
of  "Religio  Medici,"  he  says  of  himself,  "  .\t  my 
death  I  mean  to  take  a  total  adieu  of  the  worhl,  not 
caring  for  a  monument,  history,  or  ei)itai>li,  not  so 
much  as  the  rare  memory  of  my  name  to  be  found 
anywhere  but  in  the  universal  register  of  God." 
Atid  in  his  "  Letter  to  a  Friend"  he  calls  it  a  "  tragi- 
cal abomination  "  for  us  "  to  be  knaved  out  of  our 
graves  to  have  our  skulls  made  drinking-bowls 
to  delight  and  sport  our  enemies." 


In  the  last  paragraph  of  the  "Religio  Medicj," 
"  our  Physician  concludeth  that  there  is  no  happiness 
but  in  God,"  and  we  conclude  by  saying  that  this  is 
the  most  complete  and  satisfactory  edition  of  this 
classical  work  which  has  yet  appeared.  The  editor, 
Dr.  Greenhill,  deserves  gi-eat  credit  for  the  pains  he 
has  taken  and  the  amount  of  patient  labor  he  has 
expended  in  the  preparation  of  his  notes  and  in  the 
very  complete  index. 

Transactions  of  the  Medical  Society  of  the  State 

OF  New  Yobk.  1881. 
As  the  contents  of  the  volume  have  already  been 
mentioned  in  detail  in  our  report  of  the  proceedings 
of  the  society,  published  a  year  ago,  it  will  only  be 
necessaiy  at  present  to  refer  to  the  contributions  on 
medical  'topics  which  are  of  unusual  interest,  and 
impart  a  special  value  to  the  work.  Among  the  most 
instructive  articles  are  the  following  :  "The  Treat- 
ment of  Double  Talipes  Equino  Varus  by  Open  In- 
cision," by  A.  M.  Phelps,  M.D.,  of  Chateaugay, 
N.  Y.  ;  "  Early  Diagnosis  of  Some  Nervous  Dis- 
eases,''' bv  E.  C.  Seguin,  M.D.,  of  New  York  ;  "  Cica- 
tricial Contraction  of  the  Thumb  and  Fingers,  and 
of  the  Palm  of  the  Hand,  Resulting  from  a  Burn," 
by  A.  C.  Post,  M.D.,  LL.D.,  of  New  York  ;  "Sym- 
pathetic Neuro-Retinitis,"  by  David  Webster,  M.D., 
of  New  York  ;  and  "Pathology  of  Orbital  Tumors," 
by  C.  S.  Bull,  M.D.,  of  New  York.  The  volume  pre- 
sents its  usual  attractive  appearance,  and  constitiites 
an  important  part  of  the  literature  of  medical  society 
transactions. 

The  Diseases  of  "Women.      By   Arthub   W.  Edls, 
MD.,  Loud.,  F.R.C.P.,  M.R.C.S.     Philadelphia: 
Henry  C.  Lea's  Son  &  Co.     1882. 
It  has   been  the   endeavor   of  the   author  of  this 
volume  to  give  such  an  account  of  the  diseases  inci- 
dental to  women  as  will  prove  a  reliable,  practical 
".linical  guide  to  the  student  and  practitioner.     His 
article  on  "  Means  of  Physical  Diagnosis  "  is  a  detailed 
enumeration  of  the  various  means  for  the  determina- 
tion of  variations  from  the  normal  condition  of  the 
female  generative  organs.     In  treating  of  the  sub- 
ject of  displacements  of  the  uterus,  after  dismissing 
the  causation  and  symptomatology  rather  briefly,  he 
dwells  at  consideralile  length  upon  the  mechanical 
treatment,  in  order  to  fairly  represent  the  question, 
not   to   recommend  the   practitioner  to   place   too 
much  reliance  upon  mechanical  contrivances.     The 
inflammatory  and  functional  disorders  of  the  viscus 
are  each  dealt  with  in  such  a  manner  as  to  bring 
out   their  most   salient  points.      The  chapters   on 
"Abdominal    Tumors"  are  quite  exhaustive,   great 
stress  being  jjlaced  on  the  importance  of  accuracy 
in  making  diflerential  diagnoses  ;  to  this  end  special 
attention  has  been  given  to  the  classification  of  symp- 
toms.   The  author  ascribes  to  hysteria,  as  a  di.stinct 
disease,  sufficient  significance  to  devote  to  it  one 
chapter,  in  which  hs  considers  its  pathology,  causa- 
tion, symptoms,  and  treatment,  stating  as  his  belief 
that  the  essential  character  of  the  morbid  state  is  an 
exaggeration  of  involuntary  motility,  and  a  diminu- 
tion of  the  power  of  the  will  ;  the  emotional,  sensa- 
tional, and   reflex  movements  are  in  excess,  while 
the  voluntary  are  defective.   The  illustrations  chiefly 
consist  of  diagrams  representing  the   various   dis- 
placements of  the  uterus,  methods  of  operation  in 
cases  of  ruptured  perineum  and  vesico-vaginal  fis- 
tulfp,  and  ditTorential  diagnoses  of  tumors.     Figures 
of  instruments  likely  to  be  of  use  to  the  practitioner 
have   been  incorporated  in    the  text.     While   the 


THE  MEDICAL  RECORD. 


355 


volume  lacks  evidence  of  original  research  and  pre- 
sentation of  new  pathological  developments,  it  is  a 
very  useful  book  to  the  general  practitioner,  because 
of  simplicity  and  conciseness  in  the  arrangement 
and  consideration  of  its  subject-matter. 

Transactions  of  the   State   Medical  Society   of 

Wisconsin. 
Dr.  Senn  has  contributed,  in  the  present  volume, 
an  article  on  the  '•  Progi-ess  of  Surgery  "  that  gives  an 
admirable  epitome  of  the  year's  work,  and  evinces 
an  unusual  degree  of  painstaking  labor  and  discrim- 
ination. Dr.  J.  G.  Meachem,  Jr.,  in  his  repoTt  on 
"New  Remedies,"  has  another  most  commendable 
article,  wherein  he  differs  from  many  of  those  who 
have  essayed  similar  enterprises  under  the  inspira- 
tion of  enterprising  drug-houses.  After  enumerat- 
ing some  twenty-four  new  remedies,  he  says,  in  all 
probability,  not  more  than  half  a  dozen  will  prove 
to  have  a  permanent  value.  And  yet  he  realizes, 
with  every  intelligent  physician,  that  pharmacy  and 
chemistry  have  done  and  are  doing  much  for  us  at  the 
present  time,  by  giving  us  the  means  of  administer- 
ing effective  remedies  under  some  agreeable  form. 

With  a  series  of  reports  such  as  these,  and  made 
to  embrace  the  chief  topics  into  which  medicine  is 
now  divided,  each  member  of  the  society  might  have 
a  handbook  of  reference  that  he  would  be  compelled 
to  consult,  and  from  which  he  could  always  get 
pleasure  and  profit. 


Hrports  of  Societies. 


NEW  YORK   SUEGICAL   SOCIETT. 

Stated  Meetinri,  January  24,  1882. 

Dr.  T.  M.  Markoe,  President,  in  the  Chair. 

The  paper  for  the  evening  was  read  by  De.  Lewis 
S.  PiLCHER,  and  entitled 

THE  CARE  OF  THE  TRACHEA  AFTER  ITS  INCISION  FOR 

THE  RELIEF  OF  CROUP.  (See  p.  342.) 
Dr.  a.  C.  Post  said  that  he  was  present  at  the 
American  Medical  Association  when  Dr.  Martin  read 
his  paper  on  tracheotomy  without  tubes,  and  was 
much  interested  in  the  experience  which  the  writer 
gave  at  that  time.  Before  resorting  to  this  metliod 
Dr.  Martin  had,  in  common  with  surgeons  in  gen- 
eral, anxiety  with  reference  to  keeping  the  tube  un- 
obstructed, necessitating  not  infrequently  the  at- 
tendance of  skilled  assistants  to  watch  the  "patients. 
The  writer  mentioned  that  upon  one  occasion  he 
•was  obliged  to  perform  the  ojjeration  and  had  no 
tube  at  hand,  and  he  then  tried  the  plan  of  keep- 
ing the  edges  of  the  wound  open  without  a  tube  and 
found  it  satisfactory.  After  that  he  operated  sev- 
eral times  and  intentionally  left  the  tube  out,  and 
had  been  pleased  with  tlie  results.  Dr.  Post  had  re- 
sorted to  Dr.  Martin's  method  in  two  cases  where  he 
wished  to  perform  tracheotomy  as  a  preparatory 
step  to  a  subsequent  operation,  and  in  both  instances 
he  found  it  eminently  satisfactory.  By  attaching 
the  lining  membrane  of  the  trachea  to  the  skin  with 
sutures,  and  drawing  the  lips  of  the  wound  apart, 
and  securing  the  thread  with  adhesive  plasters  about 
the  neck,  a  much  larger  opening  was  maintained  in 
the  trachea  than  could  be  by  the  use  of  the  tube. 
In  both  his  cases  it  was  easier  to  keep  the  opening 


free  from  obstruction  than  when  the  tube  had  been 
employed  for  a  similar  purpose.  In  Dr.  Martin's 
cases  the  opening  was  maintained  for  a  number  of 
consecutive  days  without  inconvenience.  Probably 
it  would  be  advantageous,  in  many  cases,  to  di.spense 
with  the  tube  and  adopt  Dr.  Martin's  method. 

Dr.  James  L.  Little  remarked,  that  in  a  paper 
read  before  the  society  IMarch  23, 1880,  he  called  at- 
tention to  the  difficulties  sometimes  met  with  in 
permanently  removing  the  tube  after  tracheotomy. 
Since  then  he  had  had  three  cases  of  recovery  after 
tracheotomy  for  croup.  In  the  first  case  the  tube 
was  allowed  to  remain  three  months,  in  the  second 
nine  months,  and  in  the  third  it  was  removed  at  the 
end  of  the  eleventh  or  twelfth  day. 

The  tube  was  allowed  to  remain  for  the  reason  that 
the  children— one  being  five  years  of  age— had  difli- 
culty  in  breathing  and  speaking  as  soon  as  the  tube 
was  removed,  and,  following  the  rule  given  in  his 
paper,  he  allowed  it  to  remain  until  the  children 
could  breathe  freely  and  .speak  distinctly,  thus  show- 
ing that  all  olistruction  between  the  tracheal  wound 
and  the  mouth  had  disappeared.  In  one  of  the 
cases,  reported  at  the  time  he  read  his  paper,  the 
tube  was  removed  after  it  had  been  worn  three 
weeks,  and  the  patient  nearly  suffocated  before  it 
could  be  replaced.  After  it  was  reinserted  it  was 
allowed  to  remain  nearly  three  months  before  the 
child  could  breathe  freely  and  speak  distinctly. 
The  non-fenestrated  tube  was  used,  because  he  had 
found  that  the  fenestrated  one  was  frequently  a 
source  of  considerable  irritation. 

Dr.  Little  asked  Dr.  Pilcher  if  he  had  experienced 
any  difficulty  in  removing  the  tube  permanently. 
He  also  exhibited  a  tracheotomy  tube  made  of 
aluminum.  It  was  lighter,  less  ap"t  to  corrode,  and 
less  expensive  than  silver.  It  was  the  first  trache- 
otomy tube  that  had  been  made  of  this  metal,  and 
was  of  the  usual  shape,  but  non-fenestrated. 

Dr.  Pilchee  said  that  the  only  one  of  his  cases  in 
which  there  was  serious  difficulty  in  removing  the 
tube  permanently  was  that  in  which  it  was  retained 
for_  twenty-eight  days.  In  all  the  other  cases  in 
which  recovery  occurred  it  was  possible  to  remove 
the  tube  by  the  seventh  day.  In  the  ca.se  from 
which  the  specimen  presented  to  the  society  was 
taken,  it  was  not  until  the  fourteenth  day  after  the 
operation  that  the  canula  was  dispensed  "with.  He 
was  inclined  to  think  that  he  should  make  more  per- 
sistent efforts  now  than  at  that  time  to  suppress  the 
tube.  The  possible  evil  effects  are  so  gi-eat  that 
efforts  should  be  made  to  remove  the  tube  at  the 
earliest  possible  moment. 

Dr.  Lange  asked  as  to  where  the  opening  in  the 
trachea  was  made  in  Dr.  Martin's  cases,  above  or  be- 
low the  isthmus. 

Dr.  Post  thought  that  it  was  below. 
Dr.  Lange  had  adopted  Dr.  Martin's  method  in 
one  case.  The  patient  was  a  year  and  a  half 
old,  and  veiy  fat.  The  opening  "was  made  above 
the  isthmus,  and  he  subsequently  found  that  there 
was  constant  danger  of  its  being"  entirely  closed  by 
the  child  covering  it  -n-ith  the  chin.  He  was  obliged 
to  lay  the  child's  head  quite  low,  and  to  carefully 
watch  the  opening.  The  child  died  on  the  second 
day  as  the  result  of  the  disease  for  which  the  opera- 
tion was  performed. 

He  had  performed  tracheotomy  twenty-six  times 
with  nine  recoveries,  and  had  not  seen  serious  dis- 
advantage from  the  use  of  the  canula.  In  a  few 
instances  slight  erosion  within  the  trachea  occur- 
red ;  at  least  it  was  so  assumed,  because  of   very 


356 


THE  MEDICAL  RECORD. 


slight  streaks  of  blood  seen  in  the  sputum.  He  al- 
ways used  the  fenestrated  canula,  as  wide  a  one  as 
possible,  and  removed  it  as  early  as  could  be  done. 
After  five  or  six  days  he  removes  the  internal  tube, 
and  then  uses  a  cork,  which  closes  perhaps  one-half 
of  the  external  opening,  and  from  day  to  day  a  little 
larger  cork  is  used  until  finally  the  opening  is  en- 
tirely closed.  If  the  child  is  able  to  sleep  one  night 
with  the  canula  entirely  closed,  he  removes  the 
canula,  and  in  none  of  his  cases  had  it  been  neces- 
sary to  use  it  again. 

He  had  never  seen  so-called  granulations  except  in 
one  case,  where  they  may  have  occurred  after  the  ex- 
ternal opening  had  been  closed.  In  that  instance 
dyspncea  occurred,  but  disappeared  after  the  child 
had  a  severe  fit  of  coughing  attended  hy  expectora- 
tion of  a  small  fleshy  mass,  probably  granulations. 
No  farther  trouble  ensued. 

Dr.  Lange  had  also,  for  the  most  part,  dispensed 
with  inhalations,  because  he  had  not  been  able  to  see 
that  they  were  of  any  special  service,  either  as  palli- 
atives or  to  check  the  progress  of  the  disease.  The 
only  benefit  he  had  seen  from  their  use  was  that, 
perhaps,  in  some  cases,  expectoration  was  rendered 
easier.  As  a  substitute  he  applies  a  disinfected 
sponge,  moistened  at  short  intervals  with  tepid  wa- 
ter and  changed  as  often  as  cleanliness  requires. 
He  recently  endeavored  to  disinfect  the  external 
wound,  before  opening  the  trachea,  by  washing  it 
with  a  solution  of  carbolic  acid  or  powdering  it  with 
iodoform,  and  he  never  covers  the  wound  afterward 
except  to  put  a  small  rag,  covered  with  vaseline, 
under  the  lower  edge  where  the  expectoi-ation 
comes,  and  twice  a  day  iodoform  is  powdered  beliind 
the  canula.  He  had  had  diphtheria  of  the  wound 
occur  only  once  after  this  plan  had  been  adopted, 
and  in  that  case  final  recovery  took  place. 

Dr.  Lange  had  not  had  the  impression  that  early 
tracheotomy,  by  which  he  meant  tracheotomy  at  an 
early  stage  of  the  diseaee,  rendered  prognosis  more 
favorable.  All  the  patients  upon  whom  he  had 
performed  the  operation  early  had  died.  Such  a 
result  might  be  explained  by  the  severity  of  the  dis- 
ease, but  he  was  under  the  impression  that  in  most 
of  the  cases  in  which  good  results  were  obtained 
the  tracheotomy  was  performed  at  a  time  when  the 
process  of  the  disease  had  begun  to  yield,  the  be- 
binning  of  the  end  of  the  disease  had  appeared  ;  and 
the  children,  so  far  as  the  disease  was  concerned, 
were  approaching  recovery.  On  the  other  hand,  he 
had  had  two  cases  of  severe  diphtheria  in  which  re- 
covery took  place,  although  in  one  of  them  the 
disease  extended  from  the  nose  and  fauces  to  the 
bronchi,  and  the  child  expectorated  shreds  of  mem- 
brane for  ten  or  eleven  days.  With  reference  to  the 
time  when  the  operation  should  be  performed,  he 
thought  that,  as  yet,  no  rules  could  be  laid  down. 
The  operation  was  solely  a  symptomatic  one,  as  he 
thought,  and  was  important  simply  because  it  gave 
the  patient  a  supply  of  air. 

Db.  Oeoror  R.  Fowler,  of  Brooklyn,  on  invita- 
tion by  tlie  Pxosident,  said  that  his  experience  in 
tracheotomy  extended  over  a  series  of  twenty  cases, 
with  a  saving  of  2.^  per  cent.,  perhaps  ratlier  below 
the  average  results  obtained  >)y  gentlemen  who  had 
performed  tlio  0|ierati<>n  in  a  large  number  of  cases. 
In  reflecting  upon  that  series  of  cases  in  connection 
with  Dr.  Lange's  remarks,  ho  was  jm]iresscd  with 
the  fact  that  if  there  was  one  thing  more  than 
another  which  aided  in  obtaining  the  beat  results,  it 
was  the  early  performance  of  the  operation.  He 
also  recalled  the  fact  that,  in  two  of  his  successful 


cases,  the  disease  had  reached  the  stage  when  sup- 
puration existed  between  the  mucous  and  the  pseu- 
do  membrane,  and  casts  of  the  trachea,  more  or  less 
complete,  had  been  expectorated.  He  was  ahso  im- 
pressed by  the  fact  that,  in  the  vast  majority  of  fatal 
cases,  the  patients  died  from  secondary  processes  in 
the  pulmonary  alveoli,  or  the  finer  bronchial  tubes, 
and  he  was  ready  to  believe  that  those  processes 
had  been  set  up,  before  the  operation,  by  the  suc- 
tion force  of  the  continued  labored  respiratory  ef- 
forts. 

As  to  dispensing  with  the  tube,  he  had  been  led 
to  believe  more  and  more  that  it  was  a  source  of 
troublesome  iiTitation,  and  frequently  of  a  fatal  re- 
stilt.  He  believed  that  its  presence  frequently 
caused  ulceration  of  the  tracheal  walls,  especially 
when  the  most  common  form  of  tube  was  used.  It 
had  been  liis  misfortune  to  have  one  patient  die 
from  hemorrhage  into  the  trachea  following  the  use 
of  a  fenestrated  tube,  and  he  thought  it  was  caiised 
by  the  pressure  of  the  sharp  edge  of  the  opening 
against  the  tissue  that  came  up  into  the  tracheal 
wound.  That  led  him  to  say  that  he  thought  the 
fenestra  is  almost  always  placed  too  high  up  in  the 
tubes  in  ordinai-y  use.  He  devised  the  instrument 
exhibited  by  Dr.  Pilcher,  bearing  in  mind  the  fact 
that  buckling  of  the  posterior  wall  of  the  trachea 
does  frequently  occur,  and  for  the  pui-pose  of  obvi- 
ating that  process,  he  had,  in  his  last  two  cases,  op- 
erated with  the  Paquelin  cautery.  In  one  case  he 
used  the  instrument  and  attempted  to  dispense 
with  the  tube,  but  the  patient  died  liecause  of 
other  deposits  of  exudation  upon  the  wound  tract ; 
the  exudation'did  not  occur  in  the  larynx  or  trachea. 
He  believed  that  it  was  imjwrtant  to  remove  the 
tube  once  or  twice  a  day,  in  all  cases,  and  exnmine 
the  condition  of  the  trachea.  Such  explorations  of 
the  trachea  would  frequently  lead  to  the  discovery 
of  detached  or  partially  detached  products,  that 
could  be  removed  by  curved  forceps.  Such  forceps 
he  regarded  as  almost  indispensable  to  an  ordinary 
tracheotomy  case  of  instruments.  His  own  method 
of  using  them,  was  to  introduce  the  blades  into  the 
trachea  without  the  tube,  open  them,  and  during 
the  violent  eflbrt  at  coughing,  almost  certain  to  oc- 
cur, quickly  close  them  and  withdraw  the  instru- 
ment. Certainly,  with  two  or  three  attempts,  the 
portions  of  detached  membrane  could  be  caught 
and  withdrawn.  Care,  however,  was  necessary  lest 
the  bridge  of  mucous-membrane  at  the  bifurcation 
of  the  trachea  be  seized  and  an  attempt  made  to 
pull  the  whole  bronchial  apparatus  from  the  patient. 

Dr.  Lange  conceded  to  the  early  operation  one  ad- 
vantage, namely,  that  it  might  save  something  of  tlie 
strength  of  the  patient ;  biit  he  thought  that  it  did 
nothing  toward  preventing  the  continuance  of  the 
disease,  even  though  the  operation  was  performed 
as  low  down  as  possible.  In  most  cases  the  process 
has  already  extended  downward  to  or  below  the 
point  at  wliieli  the  opening  in  the  trachea  is  made, 
as  shown  by  the  a|>pearance  of  membrane  at  the 
time  the  operation  was  performed.  He  had  operated 
in  two  cases  quite  early,  where  dyspmea  ))ersisted 
after  traclieotoniy,  and  the  main  process  was  located 
below  the  tracheal  opening.  Both  children  died. 
He  was  unable  to  see  how  the  fenestra  could  give 
rise  to  ii'ritation  so  long  as  the  internal  tube  was 
present. 

Dr.  Post  remarked  that  when  the  operation  was 
peformed  iipon  adults,  the  fenestrated  tube  was  im- 
portant to  allow  sjieech. 

Dr.  Little  said  that,  in  his  cases,  when  the  non- 


THE  MEDICAL  RECORD. 


357 


fenestrated  tube  was  usetl,  the  jjatients  liad  no  difti- 
cultyin  talking. 

Db.  Post  referred  to  one  case  in  bis  own  prac- 
tice wben  there  was  tedema  of  the  glottis,  and  it 
became  necessary  to  perform  tracheotomy,  simple 
incision  failing  to  afl'ord  relief,  and  the  imtient  was 
unable  to  communicate  with  friends,  except  by 
means  of  the  fenestrated  tube. 

Dr.  Keyes  referred  to  two  cases  in  which  he  per- 
formed tracheotomy,  to  aflbrd  relief  from  stenosis  of 
the  larynx,  due  to  syphilis.  One  patient  was  an 
adult,  and  wore  a  non-fenestrated  tube  three  or  four 
years. 

The  other  case  was  that  of  a  child,  who  wore  out 
three  or  four  silver  non-fenestrated  tubes,  and  she 
would  always  put  her  linger  upon  it  when  she  wished 
to  talk.  Her  syphilitic  stenosis  finally  yielded  to 
treatment,  and  she  recovered  entii-ely. 

Dr.  Little  referred  to  the  rajiidity  with  which 
the  opening  closed  when  the  tube  was  removed  in 
his  cases,  when  it  was  worn  so  long.  In  one  case 
no  ail'  could  be  felt  passing  through  the  tracheal 
wound  at  the  end  of  two  liourt:.  In  one  case,  in 
which  the  tube  had  been  worn  three  months,  no  air 
passed  through  the  tracheal  opening  at  the  end  of 
half  an  hour  after  the  tube  was  removed.  In  the 
case  in  which  the  tube  was  worn  for  one  year  the 
opening  closed  in  three  hours  so  that  air  was  not 
admitted.  Dr.  Little  also  stated  that,  out  of  thirty 
or  forty  cases  of  tracheotomy,  he  had  had  five  reco- 
veries, and  in  each  one  of  the  live  cases  no  mem- 
brane was  detected  in  the  trachea  at  the  time  of  the 
operation,  nor  was  membrane  expectorated  after  the 
operation. 

In  all  the  cases  in  which  membrane  was  found  in 
the  trachea  at  the  operation,  or  was  esi^ectorated 
from  it  afterward,  the  patients  died. 

In  tsvo  of  his  successful  cases  the  operation  was 
performed  when  the  patients  were  suffering  from 
diphtheritic  croup.  In  the  other  cases  the  children 
had  symptoms  of  membranous  croup,  and  in  all  the 
cases  the  operation  was  performed  late. 

EXTIRPATION   OF   THE   UTERUS. 

Dr.  Lange  narrated  a  case  as  follows  :  A  patient, 
thirty-two  years  of  age,  had  been  suffering  from  sar- 
coma of  the  uterus  for  six  or  seven  years,  and  had 
been  operated  upon  a  number  of  times  by  different 
surgeons.  About  three  months  ago  he  saw  her  in 
consultation  with  Dr.  Hoeller,  and  operated  upon 
her.  He  removed  a  considerable  mass  of  soft  sub- 
stance, and  cauterized  the  walls  of  the  uterus  ;  but 
four  or  five  weeks  later  a  new  growth  could  be  de- 
tected. The  patient  being  willing,  Dr.  Lange  then 
determineTl  to  extirpate  the  uterus.  The  operation 
was  especially  difKeult,  because  of  the  extensive  ad- 
hesion of  the  bladder  to  the  uterus,  and  it  became 
necessary  to  separate  with  the  knife  the  union  that 
existed  over  the  entire  anterior  surface  of  the  uterus, 
which  had  reached  the  size  of  the  organ  at  the  fourth 
or  fifth  month  of  pregnancy.  During  the  entire  op- 
eration one  assistant  held  his  finger  in  the  bladder, 
as  a  guide  to  the  knife  upon  the  outside. 

The  uterus  was  adherent  posteriorly,  but  not  so 
firmly  as  to  the  bladder,  and  it  was  separated  with 
less  difficulty.  The  operation  was  performed  by 
laparotomy,  and  drainage-tubes  were  introduced,  as 
proposed  by  Bardenheuer.  of  Cologne ;  that  is,  a 
T-shaped  drainage-tube  from  the  vagina,  and  an- 
other one  without  lateral  openings,  parallel  to  the 
first,  but  a  little  above  it.  Through  the  second 
drainage-tube  the  injections  were  made.    No  sutmes 


were  applied,  but  below  everything  was  left  open. 
The  abdominal  incision  was  closed  in  the  usual 
manner.  The  operation  was  very  lengthy,  and,  at 
its  close,  the  patient  was  very  much  exhausted.  The 
reaction  was  not  very  great,  and  subsequently  the 
progress  of  the  case  had  been  favorable  for  recovery. 
One  attack  of  obstnu-tion  of  the  intestine  occuiTed, 
which  gave  rise  to  pain,  tympanites  and  rise  of  tem- 
perature, weak  pulse,  etc.,  and  apparently  peritoneal 
irritation  ;  but  under  the  constant  use  of  ice-cloths 
externally,  and  opium  with  champagne  internally, 
the  symptoms  subsided.  The  cystitis  has  improved, 
and  there  is  scarcely  any  secretion  from  the  vagina. 
The  drainage-tube  was  removed  on  the  fourth  day. 
The  first  injections  were  of  thymol,  and  caused  se- 
vere pain,  and  the  presence  of  the  drain  itself  seemed 
to  maintain  the  painful  sensations. 

Afterward  the  borated  solution  was  used  for  in- 
jections, and  it  did  not  give  rise  to  pain.  The  ova- 
ries were  not  removed,  because  (1)  they  were  im- 
bedded in  diffuse  adhesions,  and  (2)  because  of  the 
urgency,  on  aecoimt  of  the  condition  of  the  patient, 
to  complete  the  oj^eration.  Silk  ligatures  were 
used.  The  soft  parts  left  above  the  vagina  seemed 
to  have  retained  their  vitality.  The  lateral  portions 
of  the  vaginal  portion  were  left,  in  order  that  the 
ligatures  might  have  a  firm  hold.  It  was  the  ninth 
day  after  the  operation,  and  there  was  fair  prospect 
of  recovery. 

[Februaiy  14,  1882. — The  patient  is  without  fever; 
her  general  condition  is  good,  and  there  is  only  a 
very  small  amount  of  supjiuration  from  the  vaginal 
portion.  Dr.  Lange  regarded  the  [>atient  as  out  of 
danger,  yet  deemed  it  advisable  to  keep  her  in  bed 
for  a  short  time  longer.] 

OMENTUM  REMOVED  FROM  A  CASE  OF  STRANGULATED 
HERNIA — OMENTAL  HERNIA  OF  THE  TUNICA  VAtilNALIS. 

Db.  Jas.  L.  LriTLE  presented  a  specimen  with  the 
following  history :  It  was  removed  from  a  patient, 
twenty-four  years  of  age,  who  entered  St.  Luke's 
Hospital  with  a  strangulated  hernia  and  symptoms 
of  peritonitis,  from  which  he  died  twenty  hours  after 
the  oi^eration.  At  the  operation  it  was  foiand  that 
the  contents  of  the  hernial  sac  consisted  of  omentum 
covered  with  a  thick  layer  of  lymph,  as  also  was  the 
testicle  and  spermatic  cord.  It  was  not  deemed 
advisable  to  reduce  the  omentum,  and,  therefore,  a 
strong  ligature  was  applied  and  the  portion  pre- 
sented cut  off. 

The  ca.se  was  interesting  because  it  was  one  of 
omental  herniti  of  the  tunica  vaginalis.  It  had  been 
down  twelve  years,  and  had  been  reducible  until 
strangulation  occurred,  and  a  truss  had  been  worn 
a  portion  of  the  time. 

Dr.  Little  asked  for  the  opinion  of  the  society 
with  reference  to  the  treatment  of  inflamed  intestine 
in  strangulated  hernia.  He  had  met  with  two  cases 
in  which  the  gut  was  covered  with  a  thick  layer  of 
lymph,  and  had  reduced  it,  but  in  both  instances 
the  symptoms  of  strangulation  remained,  and  the 
patients  died. 

In  one  case,  a  strangulated  femoral  hernia,  he  be- 
lieving gangrene  of  the  intestine  existed,  opened  the 
gut,  and  a  free  bleeding  surface  followed  the  incision ; 
on  closer  examination  he  found  that  the  surface  of 
the  gut  was  covered  with  a  thick  layer  of  lymph,  the 
result  of  inflammation  in  the  sac.  The  stricture  was 
divided,  and  an  artificial  opening  was  left  through 
which  a  portion  of  the  faices  escaped  for  several 
weeks.  This  gi-adually  closed,  and  the  patient  made 
a  complete  recovery. 


358 


THE  MEDICAL  RECORD. 


Dr.  Steh-son  said  that  several  cases  were  reported 
in  the  Archives  Generales  about  a  year  ago,  in  which 
the  stricture  was  divided  and  the  intestine,  in  the 
condition  referred  to  by  Dr.  Little,  simply  drawn 
into  the  opening,  left  there  without  being  opened, 
and  good  results  were  obtained. 

The  society  then  proceeded  to  the  transaction  of 
miscellaneous  business. 

NEW  YORK  PATHOLOGICAl,   SOCIETY. 

Slated  Meeting,  February  22,  1882. 

Dk.  E.  C.  Skgdin,  President,  in  the  Chaie. 

ovarian  tumor — double  ovariotomy. 

Dr.  N.  Bozeman  presented  a  specimen  which  was 
interesting  with  reference  to  certain  pliysical  signs 
in  the  diagnosis  of  ovarian  tumors.  The  j>atient, 
twenty-six  years  of  age,  tall  and  slender,  presented 
herself  for  examination  on  February  9th,  and  gave  the 
following  liistory  :  She  was  married  two  years  ago, 
and  her  first  child  was  born  in  November,  1880. 
The  labor  was  normal.  A  short  time  after  her  con- 
finement a  bloody  discharge  occurred  which  con- 
tinued for  six  weeks,  then  subsided,  but  afterward 
recurred  at  intervals  of  two  weeks,  lasting  for  five 
or  six  days,  and  so  went  on  nntil  May,  1881,  when  a 
tumor  was  first  noticed.  From  that  time  it  grew 
rapidly,  and  attained  an  enormous  size.  On  De- 
cember 4,  1881,  her  family  physician  tapped  it  and 
drew  oif  four  gallons  of  fluid.  When  Dr.  Bozeman 
first  saw  her  the  abdomen  measured  forty-five  inches 
in  circumference,  and  she  was  in  good  general  con- 
dition— not  suffering  from  pain,  breathing  was  not 
difficult,  and  there  were  no  sjjecial  symptoms.  The 
abdomen  ijresented  all  the  characteristics  of  uni- 
locular cyst,  and  fluctuation  was  distinct  through- 
out. The  uterus  measured  three  and  a  half  inches, 
and  was  anteflexed.  There  was  dulness  over  the 
left  loin,  indicating  that  the  cyst  originated  in  the 
left  ovary.  Ovariotomy  was  decided  upon,  and  was 
performed  February  17,  in  the  usual  manner.  "When 
the  sac  was  reached,  it  was  tapped  and  five  or  six 
gallons  of  fluid  were  removed.  It  was  then  found 
that  adiiesions  were  extensive,  but  especially  in  the 
right  Oiac  and  lumbar  regions,  and  it  was  with  con- 
siderable difficulty  that  they  were  broken  up.  It 
was  soon  dis<-overed  that  the  tumor  had  its  oi-igin 
in  the  right  ovary,  and  that  there  was  u  solid  jior- 
tion  which,  witli  the  sac,  weighed  ten  or  twelve 
pounds,  and  rested  to  the  left  of  tlie  spinal  column, 
and  gave  rise  to  the  dulness  upon  percussion,  thus 
leading  to  the  error  in  diagnosis  with  reference  to 
the  origin  of  the  growth.  The  great  size  of  the 
parent  cyst  explained  the  di.stinct  fluctuation  over 
the  abdomen.  The  entire  tumor  weighed  fifty-three 
pounds.  The  fixation  of  the  uterus  in  the  ante- 
flexed  position  was  explained  by  the  extensive 
spreading  out  of  a  portion  of  the  cyst  and  its  adhe- 
sion in  tlie  utero-vesical  pouch.  The  left  ovary  also 
contained  a  few  small  cysts,  was  about  double  the 
normal  size,  and  it  also  was  removed. 

There  was  extensive .  hemorrhage  from  the  ])ari- 
etes  of  the  abdomen,  which  was  arrested  by  the  in- 
troduction of  tlie  ([uill  suture,  and  allowing  it  to 
remain  oiglitcen  hours.  There  was  considerable 
rea<'tion,  the  temperature  reaching  102;°  F.,  and  the 
pulse  120.  By  the  application  of  the  ice-coil  to  the 
abdomen,  and  the  caji  to  the  liead,  the  temperature 
at  the  end  of  thirty-six  hours  was  down  to  lliVr '  F., 
the  pulse  to  100,  and  the  subseciuont  progress  of  the 


case  was  satisfactory.  Clinically,  the  case  was 
interesting  with  reference  to  fluctuation,  and  dul- 
ness upon  percussion  over  the  left  loin. 

Dr.  Henry  J.  Ctarrigxtes  presented  microscopic 
specimens  and  pencil  sketches  illustrating 

ANATOMY   AND   HISTOLOGY  OF  A  CYST  OF  THE  PANCREAS, 

removed  from  a  living  woman  by  Dr.  N.  Bozeman, 
December  2,  1881,  and  presented  to  the  society  De- 
cember 14,  1881  (see  Medical  Record,  vol.  xxi.,  p. 
46).  The  contribution  appears  in  full  on  page  of 
this  number. 

Du.  Geo.  L.  Peabody  referred  to  a  large  cyst  of 
the  pancreas,  presented  to  the  society  by  Dr.  Jane- 
way. 

in  Januaiw,  1879,  Dr.  Peabody  made  an  autopsy 
on  the  body  of  a  man  in  which  he  found  a  large  cyst 
of  the  pancreas  that  had  ruptured.  It  had  been 
supposed  that  the  man  died  of  internal  hemorrhage. 
There  was  half  a  pailful  of  fluid  in  the  peritoneal 
cavity  containing  brownish  flakes.  Dr.  Peabody 
believed  that  it  was  a  retention  cyst,  as  a  number  of 
calculi  were  found,  and  the  walls  of  it  were  made  up 
of  connective  tissue,  lined  with  cylindrical  epithe- 
lium, the  same  as  seen  in  Dr.  Garrigues'  specimen. 

Dr.  Bozeman  said  he  had  found  the  record  of 
one  case  of  pancreatic  cyst  in  Gross'  "Pathological 
Anatomy,"  published  in  1845.  The  specimen  was 
found  in  the  body  of  a  man  at  the  military  hospital 
at  Cadiz.  The  cyst  was  about  the  size  of  a  child's 
head,  and  contained  fluid  having  a  dark  brownish 
color. 

Dr.  Newman,  in  behalf  of  Dr.  Rodenstein,  pre- 
sented a  specimen  of 

tumor   of   the    liREA-ST, 

removed  from  a  patient  fifty-one  years  of  age,  who 
had,  two  years  before,  fallen  and  struck  her  breast 
against  a  stone.  Nothing  was  thought  of  the 
accident  until  six  months  ago,  when  she  began  to 
have  sharp  pains,  and  upon  examination  there  was 
found  a  hard  mass  about  the  size  of  a  walnut.  The 
pains  continued  ;  the  tumor  increased  in  size,  espe- 
cially during  the  last  two  months,  and  it  was  evi- 
dent that  the  entire  gland  was  becoming  rai)idly 
involved.  On  January  1,  1882,  Dr.  Rodenstein,  as- 
sisted by  Drs.  Ives  and  Newman,  removed  the  entire 
gland,  and  all  suspicious-looking  tissues.  On  Feb- 
ruary 12tli  the  case  was  doing  well. 

Tlie  specimen  was  referred  to  the  Committee  on 
Microscoi)y. 

Dr.  L.  Pkabody  presented  a  heart  whicli  \\\\\f- 
trated. 

ANEirRISM    OF   THE    MITRAL    VALVE, 

It  was  removed  from  the  body  of  a  woman  sixty 
years  of  age,  who  had  been  under  observation  two 
days  in  the  Chamber.s  Street  Hospital.  During  that 
time  she  gave  symptoms  of  chronic  Bright's  disease 
from  which  she  died.  Besides  the  kidney  sym])t(ims, 
she  had  a  double  mitral  murmur,  ipiite  marked. 
The  heart  showed  marked  liypertro])liy  of  the  left 
ventricle,  but  there  was  not  sufficient  valvular  lesion, 
apparently  at  least,  to  account  for  it.  and  it  \yHs 
doubtless  due  to  the  chronic  difl'use  ne})hritis,  wliich 
was  very  evident  by  both  naked  eye  and  microscopi- 
cal examination.  The  auenrism  of  the  mitral  valve 
was  of  small  size,  its  opening  was  ovoidal  in  shape, 
the  longest  in  horizontal,  diameter  being  one- 
of  an  inch,  and  its  shortest,  or  vertical,  diameter 
being  one-sixteenth  of  an  inch,  and  the  sac  into 
which  it  led  upon  the  lower  surface  of  the  anterior 


THE   MEDICAL  RECORD. 


359 


segment  would  hold  half  of  an  average  size  green 
pea.  The  sac  contained  a  small  quantity  of  fluid 
blood.  In  the  neighliorhood  of  the  aneurism  were 
several  patches  of  atheroma,  and  probably  it  origi- 
nated in  an  atheromatous  process.  Besides,  there 
were 

BECENT  VEGETATIONS  UPON  THE  AORTIC  VALVE, 

but  not  sufficiently  large,  probably,  to  interfere  with 
its  function. 

In  the  same  case  was  found 

A    SMALL   ERECTILE   TUMOK   UPON    THE    UPPER   SURFACE 
OP   THE  LrS"ER. 

The  structure  of  the  growth  was  demonstrated  with 
microscopic  specimens,  and  was  distinctly  cavernous, 
consisting  of  0])en  spaces  which  were  tilled  with 
blood  and  bounded  by  walls  that  contained  a  large 
number  of  cells  of  muscular  fibre  of  the  involuntary 
variety.  Dr.  Peabody  regarded  the  growth  as  not 
an  uncommon  one  upon  the  liver,  as  he  had  seen, 
probably,  a  dozen  specimens  within  a  year. 

Dr.  Gibney  presented  a  specimen  in  behalf  of  a 
candidate,  after  which  the  society  went  into  execu- 
tive session. 


lilEDICAL   SOCIETY  OF  THE   COUNTY  OF 
NEW  YOEK. 

Slated  Meeting  March  27,  1882. 

De.  F.  K.  Sturgis,  President,  in  the  Chair. 

The  Comitia  Minora  recommended  the  adoption  of 
the  following  resolutions  : 

THE   plumbing   LAW. 

Whereas,  It  is  reported  in  the  press  that  it  is  jjro- 
posed  to  induce  the  present  Legislature  to  amend 
Chapter  450  of  the  Laws  of  1881,  known  as  the 
Plumbing  Law ;  and 

Whi'rens,  That  law,  during  the  short  time  it  has 
been  in  force,  has  been  of  great  benefit  to  this  com- 
munity ;  and 

Whereas,  The  Board  of  Health,  to  whom  has  been 
intrusted  the  carrying  out  of  the  details  for  the  en- 
forcement of  the  measure,  have  acted  with  great 
moderation  and  discretion  and  to  the  satisfaction  of 
those  whose  opinions  are  entitled  to  consideration  ; 
and 

Wliereas,  The  Board  of  Health  have  asked  for  no 
changes  in  the  law  at  the  jiresent  time  ; 

Therefore  he  it  Resolved,  That,  in  the  judgment  of 
the  County  Medical  Society,  it  would  be  unwise,  at 
this  session  of  the  Legislature,  to  in  any  way  amend 
the  present  law,  which  is  one  that  has  given  gTeat 
satisfaction  and  much  needed  protection  to  our  citi- 
zens, and  which  has  evoked  the  approval  of  the 
press  of  this  country  and  Great  Britain,  and  re- 
sulted in  seciuing  similar  enactments  in  other  com- 
munities. 

special     HOSPIT.ALS     FOR     SCARLET     PEVEK,     MEASLES, 
AND  DIPHTHERIA. 

Whereas,  No  hospitals  exist  upon  Manhattan 
Lsland  proper,  at  which  cases  of  scarlet  fever,  mea- 
sles, and  diphtheria  are  received  for  treatment,  but 
such  as  are  sick  with  these  diseases  have  to  be 
transported  at  present  to  Blackwell's  Island,  antl 
in  the  future  wiU  be  sent  to  North  Brothers  Lsl- 
and, if  they,  for  any  reason,  cannot  be  accommo- 
dated where  they  reside,  such  a  journey  to  those  sick 


with  the  above-mentioned  diseases  being  dangerous 
to  the  life  and  health  of  the  invalid  ; 

Therefwe  be  it  Resolred,  1.  That  it  is  the  impera- 
tive duty  of  the  proper  authorities  to  set  apart  from 
the  lands  belonging  to  the  city  an  appropriate  place 
for  the  erection  of  a  hospital'or  hospitals  for  per- 
sons sick  with  scarlet  fever,  measles,  and  diphtheria. 

2.  That  this  society  memorialize  the  Legislature 
to  direct  the  Commissioners  of  the  Sinking  Fund  of 
the  City  of  New  York  to  transfer  to  the  care  of  the 
Board  of  Health  of  said  city  such  lauds  situated  on 
the  river  front  of  the  East  Kiver  as  shall  be  declared 
by  resolution  of  the  Board  of  Health  of  said  city  a 
proper  and  suitable  place  for  such  hospitals,  provid- 
ing that  the  same  shall  be  first  approved  in  writing 
by  the  Mayor  of  said  city. 

3.  That  the  proper  authorities  should  appropriate 
sufficient  funds  for  the  erection  and  maintenance  of 
such  hospital  or  hospitals. 

4.  That  the  President  of  the  Society,  Dr.  A.  Jacobi, 
and  the  Chairman  of  the  Committee  on  Hygiene,  be 
appointed  a  committee  to  urge  on  the  parties  before 
mentioned  the  speedy  execution  of  this  undertaking. 

Signed  by  Drs.  E.  G.  Janeway,  D.  B.  St.  John 
Boosa,  Stephen  Smith,  Eichard  H.  Derbv,  and 
Francis  M.  Weld. 

Dr.  Chas.  F.  Stillman  then  read  a  paper  on 

OBLIQUnV  OF  THE  PELVIS  AND  ITS  TREATMENT. 

(See  p.  337.) 

The  paper  being  before  the  society,  Dn.  Lkwis  A. 
S.^TEE  said  that  he  had  always  thought  the  deformity 
was  not  the  disease,  but  simply  the  sequel  of  some 
disease,  and  that  sacro-lumbar  curvature  did  not 
exist  except  as  the  resiilt  of  some  disease  or  abnor- 
mal condition. 

Dr.  Stillman  said  that  he  spoke  of  it  as  an  inde- 
pendent condition  only  in  the  same  sense  as  club- 
foot or  lateral-rotai-y  curvature  of  the  spine  were 
regarded  as  diseases. 

Dr.  Satre  thought  that,  the  curvattu'e  was  the 
result  of  some  other  defect  or  disease,  and  when 
that  disease  or  defect  was  cured  or  coiTected,  the 
deformity — curvature  if  that  be  the  deformity — took 
care  of  itself  substantially.  He  thought  it  was  hard- 
ly proper,  with  that  view  of  the  subject,  to  name  sa- 
cro-lumbar curvature  as  a  separate,  distinct  afl'ection, 
and  suggested  a  serious  consideration  of  the  proposed 
nomenclature  before  it  was  urged  for  adoption. 

The  lateral  curvature  of  the  spine  was  very  com- 
monly the  result  of  inequality  in  the  length  of  the 
limbs,  and  by  equalizing  them  the  curvature  was  at 
once  con-ected.  In  the  same  way  he  would  regard 
sacro-lumbar  curvature,  and  would  not  regard  it  as 
a  deformity  except  as  the  result  of  some  antecedent 
condition  or  disease.  Again,  concerning  the  defor- 
mity associated  with  hip-disease,  he  regarded  it  as 
the  result  of  contraction  of  the  soft  parts  during  the 
inflammatory  stage.  Distortion  of  the  pelvis  fol- 
lowed, which  could  not  be  relieved  excei:>t  by  making 
extension  in  the  direction  of  xhe  deformilii,  and  any 
mode  of  making  extension  without  observing  that 
principle  he  regarded  as  bad  practice.  It  was  not 
the  kind  of  splint,  but  the  principle  involved  in  the 
api^lication  of  the  extending  force,  in  order  to  get 
the  limbs  into  the  proper  jiositiou.  The  photograph 
presented  by  Dr.  Stillman  illustrated  how  impru- 
dently a  thick-soled  shoe  could  be  applied,  injudi- 
ciously increasing  the  deformity.  Any  person  could 
produce  the  amount  of  distortion  of  the  ]5elvis  ex- 
hibited by  raising  the  sole  of  the  foot.  That  dis- 
tortion took  place  at  the  sacro-lumbar  junction  was 


360 


THE  MEDICAL  RECORD. 


apparent,  but  unless  connected  with  some  inequality 
of  the  limbs,  some  inflammatory  action  producing 
abnormal  muscular  contraction,  he  doubted  its  ex- 
istence, and  if  the  disease  or  defect  upon  which  it 
depended  could  be  cured  or  overcome,  the  deform.- 
ity  would  correct  itself. 

Dr.  M.  .Tosiah  Roberts  had  been  much  pleased 
with  the  mechanical  ingenuity  displayed  in  Dr. 
Stillman's  apparatus ;  but  at  the  same  time  he 
thought  that  the  instrument  jjlaced  upon  the  boy 
was  faulty  in  carrying  out  the  idea  for  which  it  was 
intended.  He  thought  that  both  of  the  zones  or 
girdles  which  encircled  the  body  were  rather  nar- 
row, especially  the  pelvic,  and  made  pressure  upon 
too  small  a  surface.  In  order  to  get  a  firm  basis  upon 
which  to  exert  mechanical  force,  it  seemed  to  be 
requisite  to  have  a  much  larger  zone,  one  covering 
a  greater  portion  of  the  hijjs  and  gluteal  muscles. 
The  extension  appeared  to  be  all  that  could  be  de- 
sired, except  that  if  elastic  tension  were  incoi-porated 
it  would  certainly  improve  the  instrument. 

Dr.  Roberts  then  illustrated  upon  the  blackboard 
the  manner  in  which  elastic  tension  could  be  applied 
for  the  correction  of  sacro-lumbar  cuivature  and 
the  tilting  of  the  trunk  manifested  in  certain  cases 
of  lateral  rotary  curvature  after  the  plaster-of-Paris 
jacket  wa.s  applied  as  accurately  as  possible.  As 
soon  as  the  apparatus  was  removed,  in  certain  cases, 
the  weakness  of  the  lower  dorsal  muscles  was  such 
as  to  allow  the  body  to  tilt  to  one  side,  and  still 
again  in  some  cases  there  was  an  unusual  amount 
of  projection  of  the  abdomen.  These  tendencies 
could  be  readily  overcome  by  inserting  into  the 
jacket,  while  it  was  being  aj^plied,  strips  of  perfo- 
rated tin  to  which  small  rings  had  been  soldered,  and 
through  these  rings  an  elastic  cord,  of  the  size  of  a 
lead  pencil,  perhaps,  coTild  be  passed,  and  it  would 
exert  sufficient  traction  to  overcome  the  tendency 
to  the  i)erpetuation  of  the  deformity  on  account  of 
weakness  of  the  muscles.  For  example,  the  ten- 
dency of  the  trunk  to  tilt  to  the  right,  looking  upon 
the  back,  could  be  overcome  by  inserting  a  ring  at 
the  upper  right-hand  corner  posteriorly,  another 
at  the  lower  left-hand  corner  over  the  pelvis,  and 
through  these  pass  the  elastic  cord  and  extend  it 
down  the  thigh  and  leg  and  secure  it  at  some  point 
on  the  outside  of  the  leg  low  down.  The  amount  of 
traction  required  was  not  very  much,  the  weight  of 
the  apparatus  added  did  not  exceed  two  or  three 
ounces,  and  the  results  according  to  his  observa- 
tion had  been  very  satisfactoi-y.  The  same  principle 
could  be  applied  to  the  other  cases  mentioned. 

Dr.  James  S.  Green,  upon  invitation,  remarked 
that  he  had  often  noticed  certain  conditions  left 
after  the  cure  of  hip  disease,  angular  and  rotary 
lateral  curvature  of  tlie  spine,  which  no  ai)]mratus 
he  had  ever  been  able  to  use  had  conected  ;  and 
therefore  he  had  not  regarded  the  cases  as  com- 
pletely cui-ed,  because  there  remained  certain  con- 
ditions due  to  the  fact  that  the  muscular  contraction 
upon  the  opposite  side  had  not  been  overcome. 
The  cases  wliich  Dr.  Stillman  had  presented  to  the 
society  had  been  under  his  own  observation  also, 
and  he  had  been  much  interepted  in  their  study. 
The  question  of  obliquity  of  the  pelvis,  and  its  rela- 
tion to  the  i)arallelism  of  the  shouldei-s,  was  a  ques- 
tion which  had  not  heretofore  been  presented  to 
the  profession,  and  he  regarded  it  as  one  worthy  of 
careful  consideration. 

Dr.  Stillman  said  it  was  with  hesitation  that  he 
had  brought  the  subject  before  the  profession,  and 
yet  it  had  seemed  to  him  to  be  proper,  because 


there  had  been  so  little  said  concerning  the  sacro- 
lumbar  curvatui-e.  The  lateral  rotary  curvature  was 
essentially  a  secondary  condition,  and  occuiTed  uHh- 
out  limp.  The  sacro-lumbar  curvature  was  always 
accompanied  by  limp.  If  the  latter  was  not  to  be 
treated  as  a  primary  affection,  neither  should  the 
former  be.  The  equality  of  the  pelvis  and  shoTilders 
must  be  maintained,  and  if  the  muscles  did  not  do 
it,  an  instrument  should  be  applied  to  assist  them  ; 
and  if  muscular  contraction  did  not  exist,  artificial 
muscles  should  be  applied  to  make  up  for  the  defi- 
ciency. 

With  reference  to  Dr.  Roberts'  elastic  cord.  Dr. 
StUlman  thought  its  tendency  was  to  make  undue 
traction  upon  each  joint  over  which  it  passed,  as  the 
knee  and  bip,  and  in  that  way  it  might  do  perma- 
nent injury  to  the  articulations.  To  effectually  re- 
lieve deformity,  whether  in  the  back  or  a  joint,  he 
believed  it  to  be  necessaiy  to  make  local  extension. 
This  was  secured  by  the  plaster  jacket,  hut  if  the 
same  end  could  be  secured,  and  at  tlie  .same  time 
the  motions  of  the  back  not  hindered  at  all,  he  re- 
garded it  as  decidedly  the  preferable  method  of 
treatment. 

The  Secbetaet  announced  the  death  of  Dr.  John 
Osboi-n.  in  the  sixty -fourth  year  of  his  age. 

The  President  announced  the  hour  of  the  funeral, 
and  invited  the  members  of  the  society  to  attend. 

The  society  then  adjourned. 


Corrcsponticnce. 


THE  WHITE  LINE  IN   THE  FISSUEE  OF 
THE   COETEX   C.\LCAEINA. 

To  THE  Editor  of  The  Mf.dicjl  Record. 
StR  :  Dr.  Dalton,  in  describing  as  novel  and  not 
previously  noticed  the  distinctness  of  the  "white 
line"  in  the  coi-tex  of  the  fssiirn  cakarina*  mnst 
have  been  unaware  of  the  fact,  that  not  alone  this 
feature,  but  others,  which  he  does  not  refer  to  and 
evidently  does  not  recognize,  are  to  be  found  de- 
tailed and  figured  in  several  test-books  published 
ten  years  ago.  Tlie  extent  of  the  peculiar  appear- 
ance' in  question  is  more  accurately  described  in 
Henle's  work  on  anatomy  (iii..  2,  p.  276,  edition  of 
1871)  than  in  the  report  of  Dr.  Dalton's  communica- 
tion ;  and  in  Strieker's  text-book  on  histology 
(p.  710,  edition  of  1872)  the  minute  anatomy,  the 
comparative  morphology,  and  the  extent  of  this 
white  streak  are  described  with  an  accuracy  leaving 
little  to  be  desired.  It  may  not  be  uninteresting  to 
note  that  Meynert,  over  ten  years  ago,  surmised  that 
the  visual  area  of  the  cortex  corresponded  some- 
what to  the  extent  of  this  white  line,  and  that  the 
white  lino  is  really  douVile,  each  division  containing 
a  special  kind  of  cortical  pyramidal  cells,  known  as 
the  "  solitary  cells." 

Edwabd  C.  Spitzka,  JI.D. 


Woman's  JMEDiCAii  Cotaege. — The  twelfth  annual 
commencement  of  the  Woman's  Medical  College  of 
Chicago  was  held  February  28th.  The  degree  of 
Doctor  of  Medicine  was  conferred  upon  twenty-three 
graduates. 

•  I  rrosumo  Omt  this  wm  Intended  by  the  "  fissure  of  cnlcaiinl "  in 
the  roiiort. 


THE  MEDICAL  RECORD. 


361 


ARMY  NEWS. 
Official  List  of  Changes  of  Stations  and  Duties  of  Offi- 
cers of  the  Medical  Department,  United  States  Army, 
from  March  19,  1882,  to  March  25,  1882. 

Alesandee,  It.  H.,  Major  and  Surgeon,  Laving 
reported  at  these  headquarters,  will  report  to  the 
Commanding  Officer  District  of  New  Mexico,  Santa 
Fe,  for  duty  as  Attending  Surgeon  at  District  Head- 
quarters, and  Post  Surgeon,  Fort  Marcy,  New 
Mexico.  S.  O.  59,  Department  of  the  Missouri, 
March  20,  1882. 

Tkemaine,  W.  S.,  Captain  and  Assistant-Surgeon. 
Assigned  to  duty  at  Fort  Porter,  N.Y.  S.  O.  51, 
Department  of  the  East,  March  24,  1882. 

DicKSox,  J.  !M.,  Captain  and  Assistant-Surgeon. 
Assigned  to  duty  at  Fort  Adams,  B.  I.  S.  O.  51, 
Department  of  the  East,  C.  S. 

Tayloe,  B.  D.,  Captain  and  Assistant-Sui"geon. 
Granted  leave  of  absence  for  twenty  days,  to  take 
effect  on  arrival  at  Fort  Ringgold,  Tex.,  of  a  medi- 
cal officer  from  Fort  Brown,  Tex.  S.  O.  26,  Depart- 
men   of  Texas,  March  16,  1882. 


iHeMcal  3tcms   antr  tlctus. 


CoNTAGiors  DisKiSEs  —  Wf.ekt.y  Statement.  — 
Comparative  statement  of  cases  of  contagious  diseases 
reported  to  the  Sanitary  Bureau,  Health  Department, 
for  the  two  weeks  ending  March  25,  1882. 


i 

i 

S 

1.- 

. 

WeekBndinK 

3 

Is 

II 

■r  g 

1 

1 

1 

K 

n 

a 

2. 

1 

Eh 

•^ 

to 

X 

March  18,  1883. 

8 

9 

343 

3 

166 

110 

36 

0 

March  25,  1882. 

6 

4 

3.34 

4 

134 

93 

31 

0 

The  MiAJn  Medical  College,  Cincinnati,  O.,  held 
its  twenty-second  annual  commencement  on  March 
9th.     Forty-one  students  wei-e  graduated. 

Specifics  fob  Bkight's  Disease. — Dr.  S.  Neumann, 
of  Vienna,  recently  reviewed  some  of  the  later  thera- 
peutical measures  recommended  for  Bright's  disease. 
He  concludes  by  saying,  as  did  Liebermeister  some 
years  ago  :  "  The  more  complete  becomes  our  knowl- 
edge of  Bright's  disease,  the  more  certain  is  it  es- 
tablished that  there  is  no  sijecilic  remedy  or  meas- 
ure for  it."  Bright  announced  essentially  the  same 
thing  in  his  earh"  descriptions  of  the  disease. 

It  may  be  considered,  therefore,  one  of  the  few 
certainties  of  medicine  that  the  disease  is  incurable, 
except  in  its  very  early  stages.  Yet  our  religious 
journals  say  it  is  all  right  for  them  to  announce  cui-es 
and  curers  of  this  disease  to  their  readers. 

The  Value  of  "  Ceede's  Method  "  of  expelling 
the  i)lacenta  has  recently  been  tested  by  compara- 
tive experiments.  Fehling,  of  Stuttgart,  used  Credo's 
method  in  a  series  of  ninety  cases.  The  placenta 
was  left  to  come  away  itself  in  ninety-five  cases. 
The  following  were  the  results  : 

In  the  first  series  (Crede's  method)  the  average  loss 
of  blood  for  each  patient  was  169  grammes  (  3  vss.). 
The  time  before  the  placenta  came  away  averaged 


7.7  minutes.  In  the  second  series  the  average  loss 
of  blood  was  235  grammes  (  3  vij.  \^o).  The  time  bo- 
fore  expulsion  was  13.4  minutes.  In  eighty-five  of 
the  ninety  cases  treated  by  Crede's  method  the 
membranes  came  away  entire.  In  ninety-one  of 
ninety-five  cases  left  alone  the  membranes  came 
away  entire. 

Sanitaey  Conventions  are  becoming  popular  in 
the  West.  One  will  be  held  at  Greenville,  Mich.,  on 
Tuesday  and  Wednesday,  April  11  and  12,  under  the 
auspices  of  the  State  Board  of  Health.  Addresses 
on  subjects  pertaining  to  public  health  will  be  de- 
livered at  the  sessions  of  the  convention,  followed 
by  general  discussion  of  the  subjects  treated.  Among 
the  subjects  i^roposed  tor  discussion  are  the  follow- 
ing : 

"  The  Prevention  and  Eestriction  of  Small-pox, 
Diphtheria,  and  Scarlet  Fever;"  "The  Disposing 
of  Decomposing  Organic  Matter  ;"  "  Pure  Air:  Why 
we  should  Have  It  and  How  we  shall  Get  It ;" 
"  School  of  Hygiene  ;"  "  The  Relation  of  the  News- 
paper Press  to  Sanitary  Reform." 

An  exhibition  of  sanitary  apparatus  is  also  pro- 
vided for,  and  invitations  have  been  extended  to 
manufacturers  and  dealers  in  articles  conducive  to 
health,  to  forward  samples  of  theu-  wares  for  exhibi- 
tion at  the  convention. 

William  T.  Smith,  M.D.,  son  of  the  late  President 
Smith,  has  been  appointed  Lecturer  on  Anatomy  and 
Physiology  in  Dartmouth  Medical  College. 

Poisoning  from  Canned  Food. — At  a  recent  meet- 
ing of  the  Chicago  Medical  Society,  Dr.  S.  I.  .A.very 
reported  several  cases  of  poisoning  in  a  family  from 
eating  of  canned  sardines.  Dr.  Bartlett  reported  simi- 
lar cases  from  eating  jiressed  corned  beef.  Dr.  Tilley 
reported  cases  of  poisoning  from  eating  bluefish. 
Dr.  W.  H.  Curtis  attributed  the  poisoning  in  such 
cases  to  the  presence  of  a  peculiar  ferment  in  the 
food  eaten.  Dr.  Ingals  considered  that  the  fault 
might  lie  with  the  food  before  canning. —  Chicago 
Medical  Eeview. 

De.  David  King,  an  eminent  physician,  of  Rhode 
Island,  died  at  his  home  in  Newport  on  the  7th  ult. 
He  belonged  to  one  of  the  di.stinguished  colonial 
families  of  New  England.  He  was  bora  in  1812,  and 
gi-aduated  at  Brown  University  and  Jefferson  Medi- 
cal CoUege.  He  was  successively  Vice-President, 
President,  and  Censor  of  the  Rhode  Island  State 
Medical  Society,  and  member  of,  and  delegate  to,  the 
American  Medical  Association  ;  he  was  also  Presi- 
dent of  the  Newport  Historical  Society  from  1853 
to  the  time  of  his  death.  His  literary  and  histori- 
cal tastes  led  him  to  collect  a  rare  and  valuable  li- 
brary of  many  thousand  volumes,  much  of  the  same 
character  as  the  remarkable  library  of  the  late  Mr. 
Brinley. 

The  Tl-rkish  Bath  for  the  treatment  of  horses  is 
a  novelty  lately  introduced  by  a  veterinarian  of  this 
city. 

Db.  Junod,  of  Junod's  Boot  fame,  died  Februarv 
25,  1882. 

De.  Theodore  Schwann,  the  discoverer  of  the 
cell  as  the  basis  of  animal  tissue,  died  recently. 

De.  D.  a.  Wise  has  been  appointed  Superintend- 
ent of  the  Asylum  for  the  Insane,  Williamsburg,  Va. 

RrsH  Medical  College. — The  thirty-ninth  an- 
nual commencement  of  this  college  was  held  in 
Chicago  February  21st.     Dr.  J.  Adams  Allen,  Presi- 


362 


THE  MEDICAL  RECORD. 


dent  of  the  college,  conferred  the  degree  of  Doctor 
in  Medicine  to  one  hundred  and  seventy -nine  gradu- 
ates. Honorary  degrees  were  confen-ed  upon  Dr. 
J.  Milner  Fothergill,  of  London,  England,  and  Prof. 
Giovanni  Paladino,  of  Naple.s,  Italy.  Ad  eundem 
degrees  were  conferred  ujion  Drs.  I.  N.  Danforth 
and  .J.  S.  Knox. 

Dr.  C.  K.  Carpenter  delivered  the  valedictory  for 
the  class.  Dr.  De  Laskie  Miller  made  the  address 
on  the  part  of  the  faculty. 

The  Missouri  Medic.u.  CoiyLEOE  Clinicai,  Am- 
phitheatre, in  the  city  of  St.  Louis,  recently  erected 
at  a  cost  of  about  fourteen  thousand  dollars,  is 
modestly  stated  by  our  Western  brethren  to  Ije  the 
finest  amphitheatre  of  the  kind  in  the  world.  The 
room  is  .5.5  feet  square,  with  a  skylight  16x20  feet — 
thus  giving  perfect  illumination.  Commodious  tiers 
of  seats,  with  high  backs — thus  preventing  the  put- 
ting of  feet  upon  them — capable  of  seating  four 
hundred  or  more,  are  well  an-anged. 

Iodoform  externally  applied,  in  cases  of  children, 
is  said  to  produce,  sometimes,  great  mental  disturb- 
ance and  even  temporary  insanity. 

Ex-Pbesidbnts'  Prize  of  the  Medical  SocrExy 
OF  Virginia. — The  ex-presidents  of  the  above  so- 
ciety, have  decided  to  ofier  annually,  a  prize  for  the 
best  essay  on  some  selected  medical  subject,  and  a 
prize  for  the  best  essay  on  some  selected  surgical 
subject.  Each  prize  this  year  will  be  a  gold  medal, 
of  fifty  dollars  in  value,  or  its  equivalent  in  money. 
Prizes  are  open  for  competition  to  all  members  of 
the  society.  The  subject  of  the  medical  essay  this 
year  will  be  :  "  Alcohol,  its  Use  and  Effects  as  a 
Bsverage  and  Medicine."  The  subject  for  the  sur- 
gical essay  this  year  will  be  :  "  Eecent  Progress  in 
Abdominal  Surgery." 

Morphia  and  Codeia. — The  following  conclusions 
of  Dr.  ,T.  B.  Garrison  regai'ding  morphia  and  codeia 
are,  we  think,  much  too  favorable  toward  the  latter. 
Pare  codeia  often  fails  to  relieve  pain  satisfactorily. 
It  is  very  probable  that  codeia  of  the  shops  often 
contains  much  morphine  with  it.  We  give  Dr. 
Garrison's  views  as  published  in  the  Western  Medical 
Rsporler  : 

First. — Codeia  is  a  greater  cardiac  stimulant,  as 
indicated  by  the  force  and  volume  of  the  pul.se. 

Second. — It  is  a  more  powerful  diffusible  stimulant, 
elevating  the  temperature  and  exciting  the  cajiil- 
laries.  Large  doses  jsroduce  intense  itching  with 
an  erythematous  redness  of  the  skin,  thereby  indi- 
cating its  use  in  all  internal  congestions,  save,  per- 
haps, those  of  cerebral  or  spinal  origin. 

Third. — It  does  not  check  the  secretions  to  such  an 
extent  as  morphia ;  it  is  therefore  indicated  when 
it  is  desired  to  avoid  locking  up  the  liver,  con- 
stipating the  bowels,  or  lessening  expectoration. 

Fourth. — It  is  greatly  loss  dangerous  than  morphia, 
no  lethal  dose  having  been  recorded  ;  yet  so  potent 
an  agent  should  necessarily  be  exhibited  with  due 
caution.  Its  comparative  safety  recommends  its  use 
in  infantile  therapeutics  where  morphia  is  so  rarely 
tolerated. 

Fifth. — It  is  7i«p«r  followed  by  the  intense  nausea 
which  so  often  coutra-indicates  the  use  of  morjihia  ; 
and  frequently  no  uni)leasant  after-effects  are  no- 
ticed, referable  to  its  oxliibition. 

Si.dh. — Tliero  is  less  danger  of  the  indiU'tion  of  the 
opium  hnlii.l  from  repeated  doses  than  is  the  case 
with  morphia,  which  should  be  a  matter  of  serious 
consideration  in  making  a  choice  between  the 
two. 


Dentlstry  as  a  Specialty. — At  a  recent  banquet 
of  the  Chicago  Dental  Society  some  interesting  re- 
marks concerning  the  present  and  future  of  dental 
surgei-y  were  tendered  by  W.  W.  Allport,  M.D., 
D.D.S.  After  alluding  to  the  early  efforts  of  Dr. 
Harris  and  others  to  establish  a  chair  of  oral  sur- 
gery in  some  of  our  medical  colleges,  and  the  final 
establishment  of  our  first  dental  college  in  Balti- 
more, the  speaker  called  attention  to  the  present 
facilities  for  dental  education  in  this  country.  Dr. 
Allport  holds  that  a  general  medical  education  is  as 
necessary  as  a  foundation  in  dentistry  as  in  ophthal- 
mology, gynecology,  or  any  other  department  of 
operative  medical  science,  and  thinks  that  at  no  dis- 
tant day  such  a  foundation  will  be  required  ;  and  in 
this  we  heartily  agree  with  him. 

The  Illustrated  (Quarterly  of  IVIedicine  and 
Surgery,  edited  by  George  Heniy  Fox,  Clinical  Pro- 
fessor of  Diseases  of  the  Skin,  College  of  Physicians 
and  Surgeons,  New  York,  and  Frederick  B.  Sturgis, 
Professor  of  Venereal  Diseases,  Medical  Department, 
University  of  the  City  of  New  York,  is  a  new  candi- 
date for  i^rofessional  favor. 

Each  number  of  the  Qnnrterly  will  consist  of  four 
quarto  plates,  printed  on  fine  quality  of  cardboard, 
10x12  inches,  with  twenty- four  or  more  quarto 
pages  of  accompanying  text,  printed  on  superfine 
paper.  The  test  will  contain  descriptions  of  the 
cases  represented  by  the  ])lates,  and  other  papers, 
illustrated,  when  necessary,  by  means  of  wood  en- 
gravings. 

The  first  number,  which  is  a  model  of  its  sort,  con- 
tains elegantlv  illustrated  articles  bv  Dr.  A.  C.  Post, 
Willard  Parker,  J.  L.  Little.  T.  G.  Thomas,  F.  H. 
Bosworth,  Samuel  Sexton,  and  T.  K.  Pooley.  E.  B. 
Treat  of  this  city  is  the  publisher.  The  general 
make-uji  of  the  journal  is  in  the  form  and  on  the  plan 
of  the  photogi'aphic  illustrations  of  skin  diseases, 
which  proved  itself  so  deservedly  popular  with  the 
profession.  We  wish  it  abundant  success.  The 
subscription  price  is  eight  dollars  u.  year ;  single 
numbers,  two  dollars. 

Atteiipt  to  Shoot  an  Asylum  Supekintendent. 
— On  the  afternoon  of  the  16th  ult.,  an  insane  man 
stepped  into  the  doorway  of  the  private  otfice  of 
Dr.  John  P.  Gray,  of  the  State  Lunatic  Asylum, 
and  fired  at  him.  Chaplain  Gibson,  Dr.  Blumer, 
and  John  Gray,  son  of  Dr.  Gray,  were  present  at  the 
time.  The  bullet  (38  calibre)  entered  Dr.  Gray's 
face  jnst  six-eighths  of  an  inch  below  the  outer  angle 
of  the  left  eye,  passed  five  and  three-eightlis  inches 
through  the  face,  back  of  the  nose  and  out  through 
the  right  cheek,  two  and  one-eighth  inches  below 
the  outer  angle  of  the  right  eye  and  one  inch  back 
of  a  vertical  line  drawn  from  that  jioint  and  from 
thence  into  the  window-casing.  aVxnit  five  feet  from 
where  the  doctor  sat.  Dr.  Gray  was  able  to  walk  to 
his  room  and  bathe  his  face.  No  shock  followed. 
The  assailant  gave  himself  up.  He  was  not  an  in- 
mate of  the  asylum,  but  had  been  emiiloyed  at  the 
Turkish-bath  rooms  in  the  city.  For  the  past 
eighteen  months  he  has  labored  under  the  delusion 
that  he  was  an  ambassador  sent  from  heaven  to 
shoot  Dr.  Gray.  After  the  shooting  he  went  home 
and  told  his  friends  that  he  had  shot  Dr.  Gray  and 
would  give  himself  up.  He  went  to  the  jail  and  un- 
loaded a  perfect  arsenal.  He  was  afterward  taken 
to  the  station-house,  and  said  that  lie  had  had  a 
duty  to  perform  and  had  done  it.  We  are  glad  to 
learn  that  Dr.  Gray  is  doing  well,  with  every  pros- 
pect of  ultimate  recovery. 


.THE  MEDICAL  RECORD. 


363 


As  Act  to  Kehulate  the  Peactice  op  Medicine 
is  before  the  Legislature  of  Virginia. 

Philadelphia  Medical  Chakities.  — Jobn  D. 
Lankenan,  who  is  about  having  finished,  at  bis  own 
expense,  a  wing,  costing  .•#60,000,  to  the  German 
Hospital,  is  soon  to  erect  a  Home  for  Aged  Couples, 
to  cost  .'510,000,  on  the  addition  to  the  hospital 
grounds  which  be  bought  some  time  ago  for 
§10,000. 

Female  Medical  Graduates. — JTineteen  students 
were  graduated  at  the  Women's  Medical  College, 
in  Philadelphia  March  IG.  Five  of  the  ladies  were 
from  Pennsylvania,  three  each  from  Massachusetts 
and  Ohio,  two  each  from  Maine  and  Indiana,  one 
from  New  York,  and  one  each  from  Denmark,  the 
Hawaiian  Islands,  and  Burmah. 

The  IMarixe  Hospital  Service  has  decided  to 
extend  its  usefulness  to  Portland,  Oregon,  and  As- 
sistant-Surgeon Charles  E.  Banks  has  been  ordered 
from  San  Francisco  to  Portland  to  assume  charge 
of  the  senice  there. 

Surgeon  H.  W.  Austin,  of  the  Marine  Hospital 
Service,  has  been  ordered  from  Washington  to  Cin- 
cinnati, relieving  Surgeon  Walter  Wjman,  who  has 
been  ordered  to  Baltimore. 

College  Examtsations  for  the  DECiREE  of  Doc- 
torate.— Dr.  J.  G.  Meachem,  of  Racine,  Wis., 
thinks  that  independent  examining  boards  for  grad- 
uates are  not  needed,  and  that  the  medical  facul- 
ties of  the  several  leading  colleges  are  the  best 
judges  of  the  qualifications  of  candidates. 

Locomotives  vs.  Malaria. — Dr.  Z.  T.  Dellenbaugh, 
of  Cleveland,  Ohio, writes :  "  In  The  SIedical  Record 
for  February  28,  1882,  page  199,  I  note  Surgeon 
William  S.  King's  letter  on  '  Locomotives  and  their 
Influence  on  Malaria.'  The  late  Colonel  Thomas  A. 
Scott  reiJeatedl.v  called  the  attention  of  my  preceja- 
tor,  Professor  .loseph  Pancoast,  to  this  very  subject 
several  years  ago,  and  cited  the  self-evident  infre- 
quency  of  malarial  affections  along  the  line  of  the 
Pennsylvania  Central  Railroad  in  particular,  as  com- 
pared with  the  condition  existing  when  first  built 
and  shortly  afterward. 

"  When  Professor  Pancoast  iaformed  me  of  the 
views  advanced  by  Colonel  Scott,  I  maintained  that 
it  was  not  due  so  much  to  the  presence  of  the  road 
and  running  trains  as  to  the  better  drainage,  in- 
creased cultivation,  etc.,  of  the  adjacent  farms.  The 
proximity  of  a  railroad  in  rural  districts  enhances 
the  value  of  the  land,  it  being  customary  to  drain 
and  cultivate  high-priced,  lietter  than  low-priced, 
lands.  At  the  same  time  it  is  an  undoubted  fact 
that  locomotives  radiating  heat  and  fast-moving 
trains  will  produce  considerable  upward  as  well  as 
side  current,  but  in  itself  would  scarcely  aft'ect  a 
space  beyond  the  company's  way-right.  Colonel 
Scott  attributed  much  of  this  salubrious  effect  to 
the  products  of  the  enormous  amount  of  coal  con- 
sumed along  the  line  of  the  road,  emitting  carbon 
in  the  form  of  soot,  sulphur,  sulphurous  and  sul- 
phuric acid  and  other  antizymotic  gases." 

Large  Bequests  to  Medical  Charities. — The 
medical  and  other  charities  of  this  city  recently  re- 
ceived some  very  handsome  bequests  from  the  late 
Miss  Sarah  Burr,  who  died  ]\Iarch  1st,  worth  about 
$3,000,000.  .•?200,000  is  given  for  the  establishment 
of  a  new  Dispensary  (of  which  there  is  no  especial 
need  at  present).  This  is  to  be  called  the  Good 
Samaritan  Dispensary.      ^30,000   is   given  for  the 


maintenance  of  ten  free  beds  in  St.  Luke's  Hospital 
and  the  same  sum  for  a  like  jjurpose  is  given  to  the 
Woman's  Hospital.  The  Northeastern  Dispensary, 
Home  for  Consumptives,  Home  for  Incurables,  So- 
ciety for  the  Relief  of  the  Ruptured  and  Crippled, 
Nursery  and  Child's  Hospital,  New  York  Infant  Asy- 
lum, German  Hosjiital,  Mount  Sinai  Hospital,  St. 
Mary's  Hospital  for  Children,  Hahnemann  Hospital, 
Asylum  for  Lyiiig-iu  Women.  St.  John's  Guild  Float- 
ing Hos])ital,  the  Training  School  for  Nurses,  get 
each  .■?10,()OO.  The  Ophthalmic  Hospital,  Ophthalmic 
and  Aural  Institute,  Northern,  Demilt,  and  Harlem 
Dispensaries,  Harlem  Hospital  and  Dispensary  for 
Women  and  Children,  Northwestern,  Eastern,  and 
West  Side  German  Dispensaries,  Western  Dispen- 
sary for  Women  and  Children,  and  Manhattan  Eye 
and  Ear  Hospital  get  each  ^?5,000. 

It  will  be  seen  that  very  few  charities  are  forgotten. 
St.  Luke's,  The  Woman's  Hospital,  and  the  North- 
eastern Dispensary,  wiU  get  the  lai'gest  sums.  The 
money  is  all  to  be  paid  within  two  years.  The  total 
amount  given  to  the  medical  charities  alone  is 
nearly  half  a  million. 

Transactions  of  International  Medical  Con- 
cress. — The  transactions  of  the  recent  International 
Medical  Congress,  last  August,  have  made  their  ap- 
jiearance  with  a  promjjtness  which  does  great  credit 
to  the  executive  committee.  It  is  stated  in  the  pre- 
face that  the  four  royal  octavo  volumes  contain 
2,552  jjages,  180  illustrations,  450  communications, 
jjrinted  in  the  language  selected  by  each  author, 
and  reports  of  858  speeches. 

Volume  I.  (648  pages)  contains  the  account  of 
the  general  meetings,  the  general  addresses,  the 
lists  of  members  and  committees,  and  the  rules, 
together  with  the  reports  of  the  work  done  in  the 
museum,  and  in  the  sections  of  anatomy,  physiology, 
pathology,  and  materia  medica. 

Volume  II.  (616  pages)  contains  reports  of  the 
sections  of  medicine,  surgery,  and  military  medi- 
cine. 

Volume  III.  (680  pages),  contains  reports  of  the 
sections  of  ophthalmology,  diseases  of  the  throat, 
skin,  ear,  and  teeth,  and  mental  disease. 

Volume  IV.  (608  pages),  contains  reports  of  the 
sections  of  diseases  of  children,  obstetric  medicine 
and  surgery,  and  state  medicine. 

Mr.  J.  W.  Klockmann,  No.  2  Langham  Place,  Lon- 
don, W.,  the  publisher,  is,  we  understand,  jji-epared 
to  supply  paper-liound  sets  to  members  upon  the 
receipt  of  five  shillings  for  postage.  The  jirice  to 
non-members  is  ten  shillings  and  sixpence  each,  or 
two  i^ounds  two  shillings  for  the  set  in  paper 
covers. 

As  we  have  previously  noticed,  the  secretaries  of 
some  of  the  sections  are  prepared  to  supply  the  re- 
ports of  those  secHons  separate  from  the  rest  of  the 
Transactions. 

The  American  .Tournal  op  Neubology  and  Psy- 
CHi.iTRT,  the  first  number  of  which  is  out,  presents  an 
excellent  appearance.  An  especially  interesting 
feature  is  the  editorial  notes  and  comments.  The 
journal  is  also  to  have  a  department  devoted  espe- 
cially to  the  'needs  of  the  general  practitioner. 

Prizes  at  Commencement  of  the  American  Vet- 
erinary College. — At  the  recent  commencement 
of  the  American  Veterinarv  College,  the  following 
)>rizes  were  awarded  by  Professor  A.  W.  Stein, 
M.D.  :  A  gold  medal,  given  by  the  Board  of  Trus- 
tees, for  the  best  general  examination,  to  Samuel 
James  Kemp,  Jr.,   D.V.S.,  of  New  Y'ork  ;  a  set  of 


364 


THE  MEDICAL  RECORD. 


standard  medical  books,  by  the  Alumni  Association, 
for  the  second  best  general  examination,  to  Lester 
H.  Howard,  D.V.S.,  of  Massachusetts  ;  a  gold  medal, 
given  by  New  York  State  Veterinary  Society,  for  the 
best  practical  examination,  was  given  to  Samuel 
James  Kemp,  Jr.,  of  New  York.  The  anatomical 
prize,  to  the  junior  class,  was  awarded  to  W.  Ber- 
tram Noyes,  of  Boston,  Mass. 

Southern  Medical  Coiimencem:ents. — The  Medi- 
cal College  of  South  Carolina  held  its  annual  com- 
mencement March  2,  1882.  Degi-ees  were  conferred 
upon  twenty  graduates.  Drs.  E.  ^Vasdin,  J.  E. 
Berley,  and  A.  D.  Williams,  received  the  prizes.  The 
Dean  read  a  rejjort,  in  which  we  are  glad  to  see  it 
announced  that  the  college  has  adopted  a  three 
years'  graded  course.  It  is  at  present  optional,  but 
will  be  made  imperative  soon. 

The  commencement  of  the  medical  department 
of  the  University  of  Georgia,  at  Augusta,  took  place 
on  February  28th.  The  degree  of  M.D.  was  con- 
ferred upon  twenty-three  candidates. 

The  Medical  College  op  Ixdiana  held  its  annual 
commencement  March  1st.  The  gi-aduating  class 
numbered  lifty-nine. 

The  Aldamt  Medical  College  held  its  annual 
commencement  on  March  1st.  Degrees  were  con- 
ferred upon  fifty-four  graduates.  The  address  was 
delivered  by  Dr.  S.  O.  Vander  Poel,  and  contained 
much  excellent  advice.  The  annual  banquet  took 
place  in  the  evening,  and  it  was  largely  attended  and 
very  successful. 

The  Central  College  of  Physicians  and  Sue- 
geons,  Indianapolis,  Ind.,  held  its  annual  commence- 
ment February  28th,  at  which  degrees  were  conferred 
on  eight  students,  several  being  women.  The  an- 
nual address  was  delivered  by  Prof.  A.  W.  Brayton, 
and  we  liave  rarely  read  so  frank  and  intelligent  a 
discussion  of  the  question  of  "  the  higher  medical 
education  "  as  he  presented.  Speaking  of  the  sur- 
plus of  physicians,  he  said  :  "  This  excess  of  doctors 
is  due  to  four  causes  :  First,  too  many  colleges ;  sec- 
ond, no  gradation  of  courses,  the  second  year's  work 
being  repeated  to  the  same  classes ;  third,  lack  of 
entrance  examinations,  and  fourth,  and  worst  of  all, 
the  granting  of  degrees  by  medical  faculties  having 
a  financial  interest  in  the  college  and  the  success  of 
the  graduates.  In  this  city  there  are  five,  in  Fort 
Wayne  two,  in  Evausville  one,  in  all  eight  medical 
colleges  graduating  in  Indiana  this  week  180  stu- 
dents, while  Chicago  confers,  through  her  eight  col- 
leges, ."iSO  degrees,  and  Cincinnati,  Louisville,  and 
St.  Louis,  as  many  more.  Over  a  thousand  doctors 
this  week,  all  graduated  within  a  radius  of  two  hun- 
dred miles."  He  refers  to  the  American  peculiarity 
of  being  doctored,  as  follows  :  "  Foreigners  do  not 
call  a  physician  for  every  ailment.  Our  people  have 
ready  money,  spend  it  freely,  and  are  the  most 
'doctored'  people  on  earth." 

Many  Parlsian  Druggists  have  connections  by 
telephone  with  the  large  liotels  and  physicians"  of- 
fices. In  this  way  prescriptions  and  messages  are 
telephoned. 

Academy'  op  Sciences. — The  NewY'ork  Academy 
of  Sciences,  at  its  recent  annual  meeting,  elected  the 
following  officers  for  the  ensuing  year  :  Prof.  J.  S. 
Newbury,  President  ;  Prof.  B.  N.  Martin,  Vice- 
President  :  A.  R.  Leeds,  Corresponding  Secretary  ; 
O.  P.  Hubbard,  Becording  Secretary  ;  J.  H.  Hinton, 
Treasurer  ;  Dr.  Louis  J'llberg,  Librarian  ;  Prof.  1). 
S.  Martin,  G.  N.  Lawrence,  Thomas  Eggleston,  Prof. 


Trowbridge,  Drs.  A.  C.  Post  and  Louis  Elberg, 
Councillors  ;  and  B.  G.  Amend,  B.  B.  Chamberlain, 
C.  F.  Cox,  Prof.  H.  L.  FairchUd,  and  W.  H.  Leggett, 
Curators. 

Advancing  the  Standard. — "Ti-ustee"  writes: 
"  In  a  '  leader  '  in  The  Medical  Record  of  March 
11th,  speaking  of  advancing  the  standard  of  medical 
education  you  say,  '  the  three  medical  schools  of  this 
city  are  about  on  a  par  regarding  standards  for 
graduation,  etc'  At  the  moment  you  had  forgot- 
ten, no  doubt,  tlftit  the  regular  curriculum  of  the 
College  of  Physicians  and  Surgeons  has  tn-o  mcmths 
longer  course  of  cantjudsoiy  instruction  annually 
than  the  other  schools,  the  spring  courses  of  the  other 
schools  not  being  essential  to  gi'aduation.  This 
statement  is  not  made  in  any  spirit  of  criticism,  but 
only  in  the  interest  of  the  '  advancing  standard '  of 
which  you  speak." 

Dekmatolysis — Fihroma  Pendulum. — At  the  Uni- 
versity Medical  CoUege,  March  28,  1882,  Dr.  H.  G. 
Piffard,  Professor  of  Dermatology,  presented  a 
uni(iue  illustration  of  "  dermatolysis "  in  the  per- 
son of  Herr  Haag,  the  so-called  "India  Rubber 
Man,"  or  the  man  with  an  elastic  skin.  In  com- 
parison, a  man  who  liad  a  fibroma  pendulum  of  the 
scalp,  was  exhibited,  the  disease  consisting  of  hy- 
pertrophy of  the  white  connective  tissue  of  the  skin. 
In  this  instance  the  integument  has  no  more  than 
the  normal  amount  of  elasticity.  This  condition 
has,  by  some,  been  called  dermatolysis,  but  when 
compared  with  the  case  of  Herr  Haag,  it  was  readily 
seen  that  the  fibroma  pendulum  is  not  a  true  der- 
matolysis, or  loosening  of  the  skin. 

Two  hundred  and  twenty-five  years  ago  a  case  of 
loosening  of  the  skin,  or  true  dermatolysis,  existed, 
and  has  been  described  by  Makron  (?),  who  says  that 
"  in  1657  a  Spaniard,  twenty-five  years  of  age,  pre- 
sented himself  to  our  hosi^ital,  who  could  grasp  the 
skin  of  the  right  breast,  or  shoulders,  and  stretch  it 
out  untH  it  covered  his  mouth,  and  a  like  elasticity 
existed  in  other  parts  of  the  body."  The  skin  of 
Herr  Haag  has  the  normal  appearance,  except  that 
the  small  veins  show  much  more  distinctly  than  nor- 
mal. He  has  always  been  aware  that  his  skin  was 
looser  than  that  of  other  persons,  and  noticed  it 
when  compared  with  the  skin  of  other  boys.  When 
drafted  for  military  service  in  his  native  country, 
the  surgeon  in  examining  Iiim  noticed,  to  his  sur- 
prise, that  the  skin  could  be  stretched  out  in  broad 
folds,  and  on  account  of  tliis  abnormality  regarded 
him  as  entitled  to  exemj^tion  from  doing  militai-y 
duty,  and  lie  was  discharged.  While  under  tlie  ob- 
servation of  dermatologists  in  Vienna,  a  section  of 
skin  was  removed  from  the  anterior  aspect  of  the 
right  arm,  for  microscopical  examination,  and  the 
report  was  that  there  was  no  cliange  in  the  skin  it- 
self, but  there  was  a  decided  absence  of  the  sub- 
cutaneous fat  and'cellnlar  tissue,  which  permitted 
the  skin  to  slide  and  be  stretched  over  the  body. 
At  any  part  of  the  body  the  skin  did  not  stretch  to  a 
very  great  extent  longitudinally,  but  transversely  or 
laterally  it  could  be  drawn  out  to  five  or  six,  or 
more  times  the  normal  distance,  and  as  soon  as  the 
traction  was  removed  it  returned  to  the  normal  po- 
sition and  appearance. 

By  the  aid  of  a  calcium  light,  arranged  by  Dr.  M. 
N.  Miller,  and  a  prism.  Prof.  Piffard  was  alile  to  as- 
certain the  spectrum  of  the  blood  in  the  Ininian  cir- 
culation, and  it  was  demonstrated  that  it  yielded  the 
ordinaiy  double  absorption  bands  of  oxy-henioglobin, 
and  not  the  spectrum  of  reduced  hemoglobin. 


Vol.  XXI.-No.  14. 
April  8,  1882. 


THE  MEDICAL  RECORD. 


365 


©riginol  Cffmmunlcatlons. 


SUSPICIOUS  organisjms  in  CROTON- 

WATER. 
Br  EPHE-UM  CUTTEB,  A.M.,  M.D., 

PRINCIPAL    AM.   INST.   MICROLOGT   MED.    DEPT..    NEW  YORK  ;   MEMBER 
PniLOSOPBICAL    SOCIETY,    GREAT    BRITAIN.    ETC. 

The  experience  of  a  medical  man  tleals  with  almost 
all  branches  of  natural  science  and  instruments  of 
precision.  This  is  well  shown  in  the  medical  examina- 
tion of  hydrant  drinking-waters,  to  determine  their 
potabUity.  Mineralogy  tells  that  water  is  a  mineral 
(nither  hard  on  those  who  believe  all  minerals  to  be 
poisons)  ;  chemistry  tells  of  the  organic  impurities 
ascertained  by  its  determination  ;  and  now  mor- 
phology (or  the  science  of  forms)  tells  of  the  forms 
found  in  the  water,  whether  organic  or  mineral. 
Botany  tells  of  the  plants  and  plant-tissues,  zoology 
of  the  animals  and  animal  tissues  and  organs.  So 
that  while  the  medical  man  may  not  be  a  botanist, 
chemist,  zoologist,  or  mineralogist,  still  his  judg- 
ment of  water  is  based  on  what  evidence  is  pi-e- 
sented  by  these  divisions  of  natural  science  outside 
his  own  field.  The  chemical  investigations  of  water 
are  of  great  value  and  cannot  be  disregarded.  Still 
chemists  themselves  confess  their  inability  to  reveal 
the  whole  truth  of  the  suspicious  organisms  in  hy- 
drant-water, for  the  reason  that  while  they  can  give 
the  amount  of  organic  impurity,  they  cannot  tell 
its  classification  or  characters,  which  botany  and 
zo'ilogy  alone  can  give. 

Por  example,  tell  a  chemist  to  analyze  the  objects 
found  in  a  city  street ;  he  would  burn  them  to  ash, 
aad  give  you  the  elements  found  in  the  ash ;  but 
aay  one  could  do  better  than  this,  for  inspection 
reveals  at  once  the  presence  of  human  beings,  cars, 
cirriages,  horses,  etc.  So  when  hydi-ant-water  is 
examined  under  the  microscope  there  is  found  such 
a  hirge  variety  of  species  of  plants  and  animals,  that 
when  a  microscopist  is  asked  an  opinion  as  to  the 
p  stability  of  the  water,  he  is  quite  at  a  loss.  For 
examijle,  a  late  examination  of  one  or  two  specimens 
of  Croton  drawn  from  a  bath-tub  faucet  to  the  amount 
of  thirty  or  forty  gallons  in  all,  if  all  diatoms  were  in- 
cluded, would  count  up  over  one  hundred  recogniz- 
able forms,  saying  nothing  of  those  not  recognized. 

Not  that  Croton  is  more  full  than  many  others,  for 
the  writer  has  studied  over  thirty  different  water 
supplies,  from  Dover,  N.  H.,  to  Chicago,  Jll.,  and 
Richmond,  Va.,  and  Croton  stands  well  among  all  of 
them.  (See  Appendix  A,  and  compare  with  Appen- 
dix B,  water  from  the  Plum  Spring,  Mantua,  O.) 

In  order  to  show  the  train  of  thought  developed 
by  such  studies,  it  will  be  the  scope  of  this  paper 
to  say  something  about  the  organisms  found  that 
are  suspicious. 

These  are  figured  in  the  cut  from  life  by  Dr.  Cuz- 
ner,  of  Peekskill.  The  writer  selected  and  made  the 
mounts  whence  they  were  drawn,  -1.50  diameters. 

Understand  they  are  referi'ed  to  as  xuspicioits,  and 
a&po$sihfy  nocgnt.  What  is  said  must  be  taken  in  a 
suggestive,  rather  than  in  a  didactic  manner,  with 
such  practical  remarks  as  may  occur  in  passing. 

A.  Epithelia. — These  are  very  common'^in  all  hy- 
drant drinking-waters,  but  not  so  abundant  in  well- 
waters.  Those  in  the  cut  were  thought  to  be  human, 
though  they  might  have  come  from  some  other  ani- 
mal.    Note  the  little  oblong  dots  by  the  side  of  the 


place  of  nucleus  :  these  dots  constitute  a  parasitic 
vegetation,  such  as  are  seen  in  the  epithelium  of 
consumptives  (O.,  Fig.  1),  cases  of  typhoid  fever, 
scarlatina,  diphtheria  ii-ide  the  elegant  drawings  of 
Salisbury's  monograph  on  diphtheria  soon  to  be 
published  by  GaiUaril's  Journal). 

Now,  these  epithelia  have  a  resistarce  to  decay 
like  hair,  and  it  is  wonderful  that  they  do  not  perish 
sooner  when  exposed  in  water.  They  must  travel 
in  the  air,  on  the  wings  of  winds,  as  they  are 
abundantly  found  in  the  central  upper  surface  water 
of  lakes  far  removed  from  sources  of  pollution.  It 
is  suspected  that  epithelia  of  small-pox,  or  typhoid 
fever,  or  measles,  or  dijihtheria  may  communicate 
these  diseases.  Certainly  it  has  been  a  far  more 
profitable  subject  of  thought  to  the  writer  than 
tojucs  that  generally  agitate  medical  societies.  It 
seems  as  if  the  soil  of  the  human  habitat  must  be 
prepared  by  a  lessening  of  vitality  or  softening  of 


Fig.  1. — Crgani 


the  resistance  to  vegetation,  just  as  farmers  plough, 
han-ow,  and  manure  their  soil — adapting  their  pro- 
cesses to  the  different  crops  to  be  sown  and  raised. 
In  other  words,  if  the  human  system  is  in  splendid 
order,  no  doubt  it  will  resist  the  communication  of 
most  disease  vegetations  by  epithelia.  Are  all 
drinkers  of  Croton  in  splendid  condition  ? 

Bacteria. — The  group  marked  B,  Fig.  i,  and  dots 
inside  A,  are  microscopical  objects  of  minutest  form 
and  simjilicity  of  structure.  They  are  protoplasmic, 
or  bioplasmic,  automobile,  capable  of  arranging 
themselves  into  varied  forms  and  shapes,  and  re- 
producing themselves  by  division  into  countless 
hosts.  There  are  differences  of  opinion  in  relation 
to  the  exact  nature  of  bacteria.  Perhai^s  the  larger 
moiety  of  those  who  have  studied  them  regard  them 
as  ultimate  forms  of  life — like  the  desmids,  for  ex- 
ample. But  there  are  others,  the  writer  among 
them,  who  regard  them  merely  as  embryonal  forms 
of  alga'  or  fungi?  capable  of  develojiment  in  their 
embi-yonal  state,  and  only  developing  into  the  ma- 
ture or  perfect  forms  when  the  proper  conditions  tie 
given.  Wliat  these  conditions  ai-e  in  all  cases  can- 
not be  told,  but  the  proper  conditions  in  the  so- 
called  bacteria  or  micrococci  of  diphtheria  are  beauti- 
fully shown  in  the  paper  alluded  to  above.  By  simply 
exi>osing  the  secretion  and  membrane  from  a  diph- 
theritic patient  in  a  well-corked,  large-mouthed  vial, 
two-thirds  filled  with  air,  the  full  forms  of  the  micro- 
cocci are  seen  to  be  a  fungus  of  the  mucor  species, 


366 


THE  MEDICAL  RECORD. 


like  that  found  in  dung-rot.  It  is  not  said  tliat 
■)u>ne  of  these  so-called  bacteria  are  the  ultimate  form 
of  development,  but  that  a  great  many  of  them  are 
not,  and  that  great  obscurity  and  confusion  in  ulti- 
mate medical  researches  have  been  brought  about  by 
regarding  bacteria  as  ultimate  forms  of  vegetable 
life.     This  cannot  be  discussed  here  at  length. 

Now,  what  are  the  mature  forms  of  vegetation  to 
which  the  embryonal  forms  shown  in  the  cut  belong  ? 
It  is  not  possible  to  tell  unless  they  are  separated 
and  cultivated.  They  may  be  the  spores  of  algse  or 
fungi,  desmids,  gemiasmas,  polycocci,  yeast,  lepto- 
thrix,  etc.  The  only  way  to  tell  them  is  by  culture. 
The  thing  that  is  suspicious  about  them  is  that  they 
are  almost  identical  with  the  vegetations  that  have 
been  found  in  connection  with  ague,  typhoid  fever, 
measles,  erysipelas,  diphtlieria,  etc.  Here  lies  the 
suspicion,  and  here  is  a  large  field  of  study  for  the 
coming  race  of  medical  men. 

These  suspicions  are  heightened  when  it  is  re- 
m?mbered  that  the  so-called  bacteria  swarm  about 
dead  animals,  or  animal  matter  found  in  water. 
Some  of  these  must  be  regarded  as  the  embryonal 
forms  of  fermentative  vegetations,  which  are  often 
putrefactive. 

Are  these  unpotable  ?  Common  sense  says  so. 
No  one  voluntarily  drinks  fetid  water  if  possible 
to  avoid  it ;  still  there  are  exceptions.  A  few  years 
ago  a  committee  of  Boston  city  government  in- 
spected the  pollutions  of  the  Mystic  water-supply. 
Russell  Brook  was  visited  in  company  with  some  of 
the  tanners  who  had  polluted  the  stream.  One  of 
the  latter,  to  prove  the  innocent  character  of  the 
foul,  fetid,  ash-colored  waters,  drank  a  goblet  of  the 
water  taken  from  the  brook  before  the  committee, 
and  because  he  was  not  made  sick,  adduced  his  his- 
tory as  a  triumphant  proof  of  the  innocent  character 
of  the  supposed  pollution !  This  water,  the  writer 
afterward  found,  swarmed  with  bacteria,  just  like 
those  described.  Still  the  committee  were  not  satis- 
fied, as  they  reported  in  favor  of  a  sewer,  through 
which  the  tilth  from  the  watershed  of  Russell  brook 
now  flows !  As  well  might  a  man  shot  at  -with  a 
bullet,  and  escaping  untouched,  say  that  bullets 
were  not  instruments  of  death  !  The  point  to  be 
considered  is  whether  the  continuous  use  of  water 
polluted  by  the  embryonal  forms  of  vegetable  life 
(b  ictaria)  may  not  produce  disease  in  the  varied 
classes  and  conditions  who  use  a  city  water-supply. 
D,  K,  saprole^nias,  are  two  figures  of  saprolcgnia 
found  in  Croton  water.  Like  such  are  also  found 
growing  parasitically  on  the  bodies  of  dead  flies  ly- 
ing in  water,  fish,  frogs,  and,  in  some  cases,  on  de- 
caying plants.  To  the  naked  eye  they  appear  like 
colorless,  minutely  filamentous  tufts  adherent  to 
such  objects,  forming  a  kind  of  gelatinous  cloud, 
more  or  less  enveloping  them,  tfnder  the  micro- 
scope the  tufts  are  seen  to  consist  of  long,  colorless, 
tubular  filaments,  spreading  out  in  all  directions, 
with  or  without  branches. 

In  the  figure  the  tubes  expand  at  one  end,  and 
narrow  down  to  the  other.  The  !^)orangia  are  at  the 
large  end,  as  seen  in  the  cuts.  The  tubes  are  double 
outlined— made  blue  by  iodine  and  sulphuric  acid — 
hence  cellulose,  containing  a  colorless,  slightly  gran- 
vdar  protoplasm.  Necs  calls  them  .\chyla,  and  there 
i^  consideral)lo  confusion  among  naturalists  about 
them.  Reinsch  thiidis  tlioy  should  be  placed  in  a 
new  order,  half  way  between  alg:p  and  fungi. 

It  is  not,  however,  necessary  for  the  physician  to 
wait  till  this  nomenclature  is  settled  to  consider  its 
.nocen'^v  or  innocency.     Dr.  James  R.  Nichols,  edi  ■ 


tor  of  the  B.  Journal  Chemistry,  last  fall  announced 
his  belief  that  the  scum  or  film  on  fishes,  dead  or 
alive,  produced  the  pollution  of  the  Cochituate. 
This  he  ably  argued  from  the  "  cucumber "  taste 
being  imparted  to  water  in  tanks  by  the  intro- 
duction of  fishes  covered  with  this  film.  We  think 
Dr.  Nichols  is  correct,  so  far  as  he  goes,  and  wc 
would  corroborate  him  by  thus  calling  attention  to 
the  saprolegnias  that  make  up  this  film.  Some  years 
ago  Prof.  Reinsch,  in  Boston,  at  my  request,  ex- 
amined the  saprolegnias  found  on  a  small  fresh- 
water fish,  confined  in  a  tank  at  the  late  aquarium 
of  Mr.  W.  E.  Baker,  on  West  Street.  He  found 
seven  different  saprolegnias  on  this  one  fish,  which 
he  figured  and  described  in  his  report  to  the  writer. 
The  profession  is  indebted  to  Dr.  Nichols  for  his 
presentation,  which  will  serve  for  the  ba.sis  of  future 
inquiry.  It  is  also  pleasant  to  see  a  chemist  like 
him  giving  to  botany  its  proper  place  in  the  estima- 
tion of  the  impurities  in  water.  I  am  glad  to  add, 
there  is  not  an  almndanco  of  saprolegnia  in  Croton. 
If  there  were,  common  sense  would  instinctively  urge 
us  to  the  distal  filtration  of  the  water  before  it  enters 
the  mains,  for  no  one  wants  to  drink  the  vegetation 
of  dead  and  decaying  fish  and  flies. 

Sponges.— G,  Fig.  1,  is  a  spicule  of  fresh -water 
sponge,  spongilla  fluviatilis.  Sponges  belong  to  the 
animal  kingdom. 

Group  1.  Keratosa,  with  horny  fibres.  In  this 
group  come  the  common  sponges  of  commerce, 
marine. 

2.  Calcispongia,  with  calcareous  spicules. 

3.  Silicea,  aquatic,  with  spicules  of  silica  like  nnr 
cut.  The  oflice  of  these  spicules  is  not  settled, 
though  thought  to  be  what  answers  to  the  skeleton  of 
the  animal.  They  are,  however,  characteristic  of 
sponges  when  found. 

The  essential  element  of  the  sponges  is  a  sarcode 
or  protoplasm  or  bioplasm,  which  appears  to  be, 
after  death,  soluble  in  water,  and  hence  will  go 
through  all  filters,  and  contaminate  the  water,  mak- 
ing it  smell  like  dead  worms  or  cucumbers.  This 
the  writer  discovered  some  years  ago  in  the  hydrant 
water  of  Woburn,  Mass.  The  taste  did  not  reveal 
them,  but  the  smell  did !  Lately  (September,  1881), 
however,  the  researches  of  Professors  Remsen  and 
Farlow  have  discovered  the  great  cause  of  pollution 
in  the  Cochituate  to  be  due  to  the  Spongilla  lacustris 
andS.  fluviatilis.  The  writer  quotes  history  eontirni- 
ing  this  as  follows  : 

i-'n-.^^ —Extract  from  Herald,  Boston,  September 
29,  1879,  communicated  by  the  writer,  column  2, 
line  2i  :  "  But  the  most  noxious  of  all,  in  my  opinion, 
are  ihefresh-ii:aiei-  spnni/es.  This,  as  a  cause  of  pol- 
lution, I  think,  is  a  discovery  of  my  own.  At  least, 
the  doctrine  of  the  noccuous'ness  of  .sponges  is  new, 
so  far  as  I  can  learn.  For  many  months  we  (Pro- 
fessor Reinsch,  Dr.  G.  B.  Harriman,  and  myself)  had 
observed  sponge  spicules  in  the  Jlystic  and  other 
waters  in  the  vicinity  of  Boston.  Those  who  are 
familiar  with  sponges  know  that  they  are  jelly  like 
animals,  distended  with  glass-like  skeletons,  broken 
up  into  beautiful  cylindrical  forms,  pointed  at  both 
ends,  sometimes  smooth  and  sometimes  covered  with 
little  spines,  clear  as  crystal,  and  called  spicules. 
We  never  found  the  sponges  these  spicules  came 
from  in  hydrant  water,  the  jelly-like  parenchyma 
being  broken  up  and  dissolved.  Mr.  William  Ed- 
wards, of  South  Natick,  Mass.,  lately  collected  for 
me  some  sponges  growing  on  rocks  in  Charles  River 
at  that  point.  They  were  small,  but  showed  a  layer 
of  spicules  distributed  over  the  outside  of  the  body 


THE  MEDICAL  RECORD. 


367 


of  the  animal ;  but  tlie  sponges  were  so  meagie  in 
quantity  that  they  seemed  insufficient  to  explain  the 
ftbimdajice  of  the  spicules  found  in  Cochituate  water. 
Sooa  after  this,  on  Cliarles  Eiver,  at  a  point  oi>i>o- 
site  Ridge  Hill  Farm  railroad  station  in  Wellesley, 
I  discovered  a  crisp,  green,  rough  branch-like  object, 
between  three  and  four  feet  long  and  one  half  inch 
in  diameter.  On  examination,  it  was  found  made 
up  of  green  aarcode,  or  protoi^lasmic  jelly,  from  the 
conical  eminences  of  which  were  shooting  forth  as, 
it  vomited  from  a  volcano,  spicules  of  sponge.  To 
my  mind  the  presence  of  this  immense  sponge  is  a 
sufficient  exjilanation  of  the  abundant  source  of  the 
spicules  of  this  kind  of  sponge,  so  frequently  met 
with  in  our  drinking-water.  Fui-thermore,  on  keep- 
ing a  portion  of  the  specimen  in  a  tumbler  of  water 
for  a  few  hours,  the  water  acquired  exactly  the  pecu- 
liar rank,  fishy  odor  that  gives  the  cucumber  smell 
and  taste.  In  my  opinion,  if  the  observations  made 
by  me  are  verified  by  others,  these  large  fresh- 
water sponges  constitute  the  gi'eatest  impurity  of 
our  drinking-water,  as  they  furnish  an  abundant 
field  for  the  develojiment  of  the  noxious  vibrioues, 
bacteria,  and  fungi.  I  will  add  that  the  bad  odor  I 
have  named  should  be  a  sufficient  warning  to  u.sers 
to  be  cautious  in  the  use  of  such  water.  The  sponges 
are  now  on  exhibition  at  the  Wellesley  Hotel." 

Second. — Subsequently  I  discovered  a  mass  of 
sponges  in  the  Charles  river  large  enough  to  fill  a  two- 
bushel  basket.  This  I  collected  and  showed  to  vari- 
ous parties,  among  whom  were  Prof.  A.  Hyatt,  of  the 
Natural  History  Society,  Boston.  He  refen-ed  nie 
to  a  Mr.  Thomas  Higgins,  salt  merchant,  of  Liver- 
pool, Eng.,  as  the  greatest  authority  on  fresh-water 
sponges.  Mr.  Higgins  kindly  responded  at  some 
length  to  my  communication,  thanking  me  for  the 
specimen  I  sent  packed  in  a  half-gallon  jar  in  alco- 
hol, and  saying  that  the  specimen  was  deposited  by 
him  in  the  Museiim  of  Natural  History,  at  Liver- 
pool, as  coming  from  me  in  the  behalf  of  this  evi- 
dence of  water  pollution. 

Mr.  T.  Metcalf,  of  Metcalf  &  Co.,  39  Tremont 
Street,  furnished  the  alcohol ;  Dr.  G.  B.  Harriman, 
94  Tremont  Street,  Boston,  and  Mr.  Amos  Haynes, 
5  Central  Street,  Boston,  assisted  in  this  matter,  and 
cau  testify  to  the  truth  of  this  statement. 

Third. — In  an  open  letter  from  the  writer — found 
in  the  (^Inbe,  Boston,  March,  1880,  published  by  the 
City  Water  Board,  column  1,  line  58 — occur  these 
words :  "  But  included  in  the  above  are  always  found 
the  spicules  of  sponges  ;  indeed  I  cannot  remember 
a  hydrant  water  that  I  have  examined  without  find- 
ing the  sponge  spicules.  I  have  been  led  to  infer 
that  the  fresh-water  sponges  are  a  great  cause  of 
pollution.  They  are  of  immense  size. 
Observers  reported,  at  s  late  demonstration  I  gave 
your  Board  at  City  Hall,  similar  large  masses  of 
sponges  found  in  the  Cochituate  Lakes  and  Concord 
River.  ...  At  Fresh  Fond,  Cambridge,  the 
screens  of  the  water- works  have  often  been  observed 
to  be  covered  with  portions  of  broken-up  sponges, 
giving  forth  the  fetid,  familiar  odor  of  worms  and 
cucumbers.  There  is  no  doubt  that  sponges  are  a 
source  rf  pollution." 

The  above  evidence  applies  with  force  to  Croton. 
When,  about  one  year  ago,  there  was  a  great  com- 
plaint of  the  hydrant  water  in  New  York,  the  spic- 
ules of  sponges  were  very  abundant,  and  once  in  a 
while  seveial  spicules  were  found  sticking  through 
a  yellowish  mass  that  appeared  to  be  dead  sarcode 
or  protoplasm. 

There  is  no  doubt,  then,  that  sponges  do  contam;'- 


nate  Croton  water  when  the  water  ta-stes  badly,  and 
that  the  complaints  of  those  who  dislike  it  are  tot 
groundless. 

Felomy.ras  (I,  I,  Ij. — Pelos  (mud),  and  myxa  (mu- 
cus). These  are  protoplasmic  animals  classed  with 
the  rhizopods — rhizos  (root),  and  poda  (foot) — root- 
footed  animals. 

They  are  freah-watet  organisms,  forming  large 
amceboid  masses  of  brown  or  yellowish  color.  They 
gorge  themselves  with  mud,  and  jierhaps  might 
well  be  called  by  the  English  signification,  «n/rf 
7nuciises. 

These  are  common  in  Croton  and  hydrant  waters. 
For  a  long  time  I  was  accustomed  to  call  them 
masses  of  humus,  as  they  appeared  in  broken,  irreg- 
ular, shnjieless  masses,  but  having  found  quite  a 
niimber  of  perfect  forms  in  greater  abundance  when 
the  water  tasted  badly,  and  since  they  are  closely 
allied  to  the  sponges,  I  think  they  should  be  in- 
cluded in  the  estimation  of  animal  impurities,  like 
the  sponge.  I  have  thought — but  I  may  be  mis- 
taken—that the  I'eculiar,  dry  bitterness  of  the  water 
might  be  due  to  the  pelomyxas,  as  I  have  found 
them  speciallv  abundant  at  that  time. 

Other  rhizopods,  as  difflvgia  (J,  Fig.  1;  C,  Fig.  1), 
nebela  (F,  Fig.  1  j,  phigiojjliri/s  (L,  Fig.  1),  E,  mnupha. 
I  think,  when  killed  like  sponges  by  the  drought 
and  excessive  waste  of  water,  by  the  mud  being  laid 
bare,  that  they  must  polhife  the  water  ;  how  njuch, 
in  our  present  state  of  knowledge,  cannot  be  told 
exactly.  Here  is  a  wide  field  of  efibrt  oj^ened  for 
exploration,  and  it  is  ff  rvently  hoped,  for  the  sake 
of  State  medicine  and  public  health,  it  will  be  im- 
mediately thoroughly  occupied. 

These  all  are  found  in  the  hydrant  water,  showing 
that  they  have  the  power  to  locomot€  away  from  the 
mud  supposed  to  be  their  only  habitat,  through  the 
upper  and  marginal  portions  of  the  lakes.  Indeed 
some  of  them  I  have  obtained  by  dipping  water  with 
a  tumbler  from  the  central  surfaces  of  lakes  !  When 
alive  and  healthy  I  suppose  they  are  not  suspicious 
— only  when  dead  and  decaying. 

Geminsmn  rerdans  (H,  Fig.  1). — This  is  interest- 
ing as  being  one  of  the  so-called  ague  plants,  found 
in  great  abundance  in  ague  tracts  in  and  near  this 
city  in  low  marshy  or  boggy  soils  in  the  morning 
before  the  sun  is  up— gi'owing  up  in  the  night  and 
killed  by  sunlight.  Found  on  soils  above  named,  in 
August,  September,  and  October,  but  quite  common 
in  Croton  water  washed  to  from  the  watershed. 
Studies  into  the  mode  in  which  they  cause  ague 
prove  their  introduction  into  the  system  by  inhala- 
tion, so  that  when  taken  into  the  stomach  it  is  not 
probable  they  induce  the  disease,  though  in  old 
cases  they  are  found  in  the  blood,  urine,  sweat,  and 
•sputa  of  patients.     It  would  bear  studyirg. 

M,  Fig.  1,  is  a  collection  of  common  ijeast-pAants 
found  in  Croton  more  at  some  times  than  others,  and- 
more  likely  to  be  injurious  the  longer  ihe  water  is 
kept  standing  in  vessels.  Eeinsch  regards  yea.st  as  a 
poison  when  present  in  quantifies,  ard  says  that 
were  it  not  killed  by  baking,  bread  would  be  a  poison 
to  man.     This  should  be  studied  carefully. 

N,  Fig.  1,  Lepiiithri.r. — Most  abundant  sometimes 
on  letting  Croton  water  stand'  twenty-four  hours. 
While  the  leptothrix  buccalis  of  every  one's  mouth 
is  innocent,  it  is  a  siibject  of  inquiry  to  know  whether 
the  one  whose  delicacybannot  be  represented  here  in 
a''cut,  is  nocent  or  net. 

O,  Fig.  1,  is  an  epillielium  from  the  skin  of  a 
consumptive  with  a  collection  of  yeast-plsnts  within. 

By  way  of  suggestion,  in  closing,  for  protection  of 


368 


THE  MEDICAL  RECORD. 


any  who  desire  it,  the  best  mode  is  to  filter  through 
coooa  cloth,  often  changed  and  removed,  and  then 
boil  the  water.  If  desired  to  be  drank  cold,  it  may 
be  put  into  clean  bottles,  and  set  into  a  refrigerator. 
To  show  the  difterence  between  Croton  and  well 
water,  in  morphological  points  of  view,  the  follow- 
ing analyses  are  appended  : 

Appendix  A. 
Croton  water  examined,  December,  1881: 
1.  Abundant  Mycelial  Fungus  Fil.  2.  Acineta 
Tuberosa.  3.  Actinophrys  Sol.  4.  Amoeba  Proteus. 
5.  Amoeba  Radiosa.  6.  Amoeba  Verrucosa.  7.  Ana- 
beina  Subtilis.  8.  Anguilla  Fluviatilis.  9.  Anki- 
strodesmus  Falcatus.  10.  Aaurcea  Longispinis.  11. 
Anurcea  Monostylus.  12.  A  new  Rotifer.  13.  Ar- 
cella  Mitrata.  14.  Arcella  Vulgaris.  15.  Argulus.  16. 
Arthrodesmus  Convergens.  17.  Astrionella  Formosa. 
18.  Bacteria.  10.  Bosmina.  20.  Coelastrum  Sphericum. 
21.  Gentropyxis.  22.  Chilomonads.  23.  Clathro- 
cystis  ^13ruginosa.  21.  Cosmariumpiinoculatum.  25. 
Closterium  Lunula.  26.  Cyclops  Quadri  Cauda.  27. 
Cyphroderia  Ampulla.  28.  Cypris  Tristriata.  29. 
Daphnia  Pulex.  30.  Desmids.  31.  Diaptomus  Castor. 
32.  Diatoma  Vulgaris.  33.  Difliugia  (ilobosa.  34. 
DifHugia  Cratera.  35.  Dinobryona.  36.  Diptomus 
Ca.stor  with  Saprolegnia  attached.  37.  Dirt.  38.  En- 
chylspupa.  .39.  EosphoraAurita.  40.  Epithelia  in  great 
abundance.  41.  Euglenia.  42.  Euglypha  Cristata. 
43.  Feather  barbs.  44.  Fragillaria.  45.  Gemiasma 
Verdans,  ague  plant.  46.  Globar  Rotifer.  47.  Gom- 
phospheria.  48.  Humus.  49.  Hyalosphenia  Tinct. 
.50.  Hydra  Viridis.  51.  Leptothrix  writhing  like  a 
snake.  52.  ]\Ielosira.  53.  Monactina  Octinarius.  54. 
Monads.  55.  Navicula.  56.  Nostoc  Com.  57.  Nitz- 
schia.  58.  (EJogonium.  59.  Ovaries  of  Entomos- 
traca.  60.  Pandorina  Morum.  61.  Paramecium 
Aurelianum.  62.  Pediastrum  Pertusum.  63.  Pedi- 
astnim  Boryanum.  64.  Pediastrum  Incisum.  65. 
Pediastrum  Perforatum.  66.  Pelomixas.  67.  Peri- 
dinium  Cinctum.  68.  Plagiophr.ys.  69.  Platyptera 
Polyarthra.  70.  Polycoccus.  71.  Radiophrys  Alba.  72. 
Ram's  horns  Scenedesmus.  73.  Rotifer  Vulgaris.  74. 
Saprolegnia.  75.  Scenedesmus  Acutus.  76.  Scenedes- 
mus Obtusum.  77.  Scenedesmus  Quad.  78.  Sheath 
ofdeadTubellaria.  79.  Silica.  80.  Spherotheca.  81. 
Spicules  of  sponge.  82.  Spirogyra.  83.  Starch 
84.  Staurastrum  Furcigerum.  85.  Staurastrum 
Qvacile.  86.  Staurogenium  Quad.  87.  Synchoeta. 
88.  Tubellaria.  89.  Tetraspora.  90.  Trachelomonas. 
91.  Uvella.  92.  Volvox  Globator.  93.  VorticeUa,  new 
species.  94  VorticeUa  Microstoma.  95.  Other  Vorti- 
celliana.    96.  Yeast. 

Appendix  B. 
Morphological  examination  of  specimen  of  spring 
w.xter  from  the  farm  of  Mr.  George  Plum,  Mantua, 
Ohio: 

■  1.  Bacteria.  2.  Diatoma  Vulgaris.  3.  Epithelium 
from  vegetables  and  animals.  4.  Feather.  5.  Linen 
Fibre.  6.  i\Iiss  of  vegetable  cells,  probably  of  some 
berry.  7.  Protococcus.  8.  Silica  or  sand.  9.  Small 
masses  of  dirt.  10.  Splierotheca — a  Fungus  spore. 
11.  Starch.     12.  Tabellaria.     13.  Woody  fibre. 

The  Air  from  the  North  Pole,  which  geo- 
graphical landmark  has  boen  exciting  much  atten- 
tion of  late,  is  said  by, Tolly  tfl  be  considerably  richer 
in  oxygen  than  the  air  from  the  equator.  This  is 
thought  to  be  duo  to  the  fact  that  in  the  equator 
much  more  oxygen  is  used  up  in  the  building  of 
plants  and  animals. 


THE  BECOGNinON  OF  IVnCEOCOCCI.    ^ 
By  GEORGE  M.  STERNBERG, 

SURGEON  U.S.A. 

A  PAPEB  by  Dr.  Rollin  R.  Gregg,  of  Buffalo,  N.  Y., 
which  appeared  in  The  ISIbdical  Record  of  Febiuaiy  • 
11th,  p.  150,  is  so  well  calculated  to  mislead  those 
who  are  not  familiar  with  the  methods  depended 
upon  for  the  recognition  of  bacteria  by  those  miero- 
scopists  who  have  of  late  years  devoted  themselves 
to  investigations  relating  to  the  role  of  these  or- 
ganisms in  disease,  that  it  seems  to  require  an  an- 
swer in  the  interest  of  those  busy  praotitioneis  of 
medicine  who  have  little  time  for  personal  investi- 
gations, but  whose  practice  must  be  greatly  influ- 
enced by  the  verdict  which  their  judgment  gives 
upon  the  extensive  and  rapidly  extending  array  tf 
experimental  evidence  .spread  before  them  in  medi- 
cal journals  and  scientific  periodicals. 

UnnecessaiT  doubts  and  difficulties  in  the  way  of 
forming  a  correct  judgment,  such  as  the  suggesticn 
or  rather  affirmation,  by  the  writer  in  question  that 
"Wood  and  Formad,  in  their  investigations  relating 
to  the  etiology  of  diphtheria,  have  mistaken  "  ;irtin- 
ules  and  fibrils"  of  fibrin  for  bacteria  of  correspond- 
ing forms,  no  doubt  influence  a  certain  niimber  of 
readers,  and  are  to  some  extent  a  check  upon  the 
diffusion  of  scientific  knowledge. 

That  accomplished  microscopists  like  Drs.  Wood 
and  Formad,  and  by   inference  their  predecessors 


and  fellow-workers  in  the  same  or  parallel  fields  of 
investigation,  including  such  names  as  Pasteur, 
Koch,  Klein,  Burdou-Sanderson,  Eberth,  Oertel, 
etc.,  have  all  along  mistaken  gi-anules  and  fibrils  of 
fibrin  for  the  minute  vegetable  organisms  known 
under  the  general  name  of  bacteria,  and  in  the  words 
of  the  writer  refen-ed  to,  that  "  no  observers  of  these 
assumed  bacteria  appears  ever  to  have  stopped  to 
consider  whether  his  alleged  bacterial  forms  might 
not  be  the  long  and  well-known  forms  of  coagulating 
fibrine  which  are  always  found  existing  in  the  same 
positions  under  precisely  the  same  circumstances," 
is  a  supposition  which  scarcely  needs  refutation  and 
could  hardly  come  from  one  familiar  with  the  litera- 
ture of  the  subject  and  with  the  painstaking  and 
protracted  character  of  many  of  the  experimental 
researches  made  by  men  of  scientific  training  and 
by  the  most  exacting  methods  of  modem  scientific 
research. 

The  investigations  of  many  independent  invesfj- 
gators  have  demonstrated   conclusively  the   abun- 


THE  MEDICAL  RECORD. 


369 


dant  presence  of  micrococci  in  diphtlieritic  exuda- 
tioas,  and  the  real  question  is  no  longer  as  to  the 
presence  but  as  to  the  import  of  these  organisms  in 
such  situations. 

Are  they  accidontallv  present  because  a  suitable 
pabulum  and  conditions  as  to  heat  and  moisture 
favoring  their  development  are  here  found  ?  Or  are 
they  responsible  for  the  specific  inflammation  at 
tended  with  fibrinous  exudation  which  constitutes 
the  local  lesion  in  this  disease  ? 

This  question  I  shall  not  attempt  to  discuss,  as  it 
is  only  by  carefully  conducted  exijerimental  in- 
quiries, such  as  Drs.  Wood  and  Formad  have  under- 
taken, that  it  can  be  decided.  But  the  question  of 
the  presence  of  micrococci  in  diphtheritic  exudations 
is  a  much  simpler  matter,  and,  as  already  stated,  this 


is  definitely  settled  in  the  affirmative,  not  only  by 
the  microscopical  researches  of  Di's.  Wood  and  For- 
mad, but  by  those  of  Eberth,  Oertel.  and  others. 

As.  however,  it  is  well  established  by  the  observa- 
tions of  numerous  microscopists  in  various  parts  of 
the  world  (Remak,  Robin,  Niedhardt,  Billroth, 
Koch.  Biitlin,  Rajipin,  and  others)  that  micrococci 
are  found  in  abundance  in  the  buccal  secretions  ot 
healthy  individuals,  the  mere  presence  of  micro- 
cocci in  diphtheritic  exudation  can  have  but  little 
weight  in  a  consideration  of  the  question  of  etiolo- 
gy, especially  as  the  diphtheritic  micrococci  do  not 
differ  morphologically  from  those  obtained  by  the 
cultivation  of  tongue-scrapings  from  healthy  indi- 
viduals I  ridf.  rej^ort  of  Wood  and  Formad,  Supple- 
ment Xo.  17,  Kiitlimid  Board  of  Health  Bulletin,  p. 
8).  This  morphological  resemblance,  if  not  identity, 
is  shown  by  photo-micrographs  made  by  myself, 
several  of  which  are  enclosed  for  inspection  by  the 
editor  of  this  journal.  Two  of  these  are  from  culture- 
experiments,  made  in  Baltimore,  in  which  sterilized 
rabbit-bouillon  was  inoculated  with  a  little  saliva 
scraped  from  ray  own  tongue.  (Figs.  1  and  2.)  The 
others  fFigs.  3  and  4)  are  from  diphtheritic  material 
sent  me  by  Dr.  H.  C.  Wood  for  the  purpose  of  making 
photo-micrographs  of  the  micrococcus  present.  This 
was  labeled  "Diphtheritic  Material  horo.  Luding- 
ton,"  and  was  spread  upon  a  thin  glass  cover  (dry). 
The  staining  of  the  micrococci  for  the  purpo.se  ol 
photoeri'aphing  was  done  by  myself,  in  this  instance 
with  aniline  violet.  Both  photographs  were  made 
with  a  Zeiss  one-eighteenth  inch  homogeneous  oil 
immersion  objective,  and  the  amplification  is  the 
s\me  in  both — 1,000  diameters. 

With  an  objective  of  this  jjower  the  experienced 


eye  can  easily  recognize  micrococci  of  this  size,  and 
the  expert  is  able  to  decide  by  microscopical  ex- 
amination alone,  that  certain  gi-anules  are  or  are  not 
micrococci,  wheieas  a  lower  power  or  want  of  experi- 
ence in  the  study  of  these  organisms  might  leave  the 
question  in  doubt.  But  where  important  questions 
are  involved  experts  do  not  trust  to  optical  appear- 
ances alone.  Fortunately,  we  have  other  and  very 
positive  methods  of  distinguishing  these  minute 
vegetable  organisms  from  inorganic  gi-anules,  organic 
debris,  or  filyrin  gramdes  and  fibrils. 

Micrococci  are  unicellular  vegetable  organisms 
which,  in  a  suitable  medium  and  under  favorable 
conditions  multiply  rapidly  by  fission,  and  the  most 
reliable  test  is  conceded  by  all  authorities  to  be  that 
of  cultivation  in  a  sterilized  liquid.  Minute  f  ]iher- 
ical  bodies,  which  multiply  by  fission,  and  which  in 
the  process  of  multiplication  are  joined  in  pairs  or 
chaplets,  are  living  organisms,  and  not  granules  of 
fibrin. 

That  the  importance  of  this  test  "was  fully  appre- 
ciated by  Drs.  Wood  and  Formad  is  shown  by  the 
following  extract  from  their  report : 

"The  most  important  distinguishing  point  be- 
tween micrococci  on  one  hand,  and  organic  and  in- 
organic jjarticles  on  the  other  hand,  is  obtained  by 
culture.  Micrococci  will  always  multiply,  though 
some  much  more  rapidly  than  others.  They  elon- 
gate, divide,  form  chains  or  zoogloea  masses,  if 
brought  into  a  suitable  culture-medium." 

We  have  also  chemical  tests  which  are  quite  as 
positive  as  many  of  those  relied  upon  by  chemi.sts 
in  their  laboratory  operations.  The  most  important 
of  these  depend  upon  the  fact  that  bacterial  organ- 
isms resist  the  action  of  strong  acids  and  alkalits 
which  promptly  dissolve  granular  mateiial  of  animal 


origin,  and  that  they  are  deeply  stained  by  the  ani- 
line dyes  and  by  hiematoxylin.  The  application  of 
all  of  these  tests  requires  experience  and  technical 
skill,  but  the  results,  when  proper  precautions  are 
taken,  are  as  definite  as  could  be  desired. 

I  have  been  particularly  interested  in  the  obser- 
vations of  Drs.  Wood  and  Formad,  relating  to  the 
jiresence  of  granules,  believed  to  be  micrococci,  in 
leucocytes  present  in  diphtheritic  material.  Dr. 
Gregg,  in  criticising  tfeis  observation,  says,  "  I  feel 
confident  that  the  micrococci,  to  the  number  of  forty 
or  fifty,  which  Wood  says  he  saw  in  each  white  blood- 
ed!, were  nothing  more  nor  les«  than  the  granv/es 
which  natnrallii  constitute  every  white  blood-cell." 

I  have  myself  frequently  met  with  these  leucocytes 


370 


THE  MEDICAL  RECORD. 


containing  numerous  minute  granules  undergoing 
active  Brownian  movements  iii  the  blood  of  septice- 
mic rabbits,  but  I  have  not  yet  been  able  to  satisfy 
myself  whether  they  are  really  micrococci,  or  whether 
they  are  granules  formed  or  set  free  in  the  diffluent 
and  disorganized  protoplasm  of  a  dead  leucocyte. 
This  is  a  question  to  be  determined  by  continuous 
oqservation  and  by  cultui'e  experiments,  such  as  Drs. 
Wood  and  Formad  are  engaged  in,  and  I  shall  look 
with  interest  for  their  final  decision. 

I  h  ive  elsewhere  suggested  that  possibly  one  of 
the  functions  of  the  leucocytes  is  to  rid  the  blood 
of  bacterial  organisms  which  may  find  their  way 
into  the  circulntion,  and  that  they  do  this  by  pick- 
ing up  these  foreign  bodies — as  they  have  been 
shown,  experimentally,  to  jiick  up  particles  of 
carmine,  etc. — and  disposing  of  them  by  digestion, 
just  as  the  (umrba  picks  up  and  digests  the  nutri- 
tious portions  o  fminute  vegetable  organisms  which 
come  in  its  way. 

If  there,  is  any  truth  in  this  hypothesis,  we  can 
easily  understand  how,  in  case  the  vital  energy  of 
the  leucocyte  was  enfeebled  from  any  cause,  or  the 


\\o. >:':.'•   •••'■/-    .'...•--•7 


reproductive  energy  and  vital  resistance  of  the  en 
gulphed  micrococcus  exceptionally  great,  this  pro- 
vision of  Nature  might  fail  and  the  captured  foe 
might  feed  upon  the  vitals — protoplasm — of  its 
captor,  the  result  being  a  dead  leucocyte  filled  with 
living  micrococci. 

However  this  may  be,  I  can  scarcely  doiibt  that 
the  actively  moving  granules  in  the  leucocytes  of 
septif^icmic  rabbits,  whicli  I  have  rei)eate(ily  ob- 
served in  blood  taken  from  the  heart,  from  the 
liver,  and  elsewliere,  are  of  the  same  natui-e  as  the 
granules  described  as  micrococci  by  Drs.  Wood  and 
Pormad  in  the  leucocvtes  found  in  diphtheritic  false 
membrane.  I  am  quite  familiar  with  the  obscurely 
granular  appearance  of  the  protoplasm  of  living  leu- 
cocytes from  the  blood  of  healthy  men  and  animals, 
but  these  granules,  imbedded  in  the  semifluid  pro- 
toplasm, are  quite  difl'eront  in  appearance  from  tlie 
minute,  highly  refractive  sjiliorical  bodies  which  I 
have  seen  swarming — Brownian  movement-  -in  the 
Kquid  contents  of  cells,  which  I  suppose  to  be 
dead  leucocytes,  contained  in  the  blood  of  septi- 
csemic  rabbits. 

These  are  uniform  in  size,  but  much  smaller  than 
the  micrococci  found  in  human  saliva,  the  intro- 
duction of  whicli  beneath  the  skin  of  a  healthy 
rabbit  produces  fatal  septii-remia,  as  described  in 
mv  special  report  to  tin*  National  Board  of  Health 
(National  Board  nf  Umllh  Bulletin,  April  30,  1881). 


ASPIRATION   OF  THE  KNEE-JOINT.* 
By  WILLIAIM  JUDKINS,  M.D., 


UOME    FOR   TUB 


i:«NATI.  OHIO. 


Dr.  Henry  O.  jMabct,  of  Cambridge,  Mass.,  has  well 
said  t  "  the  landmarks  of  our  fathers  in  suigery  have 
become  of  small  value  in  these  days  of  careful  in- 
quiry and  patient  research,  of  radicalism  andieform." 
Little  respect  is  now  paid  to  dogmatic  teaching. 
Old  truths  are  re-examined,  sifted  from  error  and 
associated  with  new  facts  in  such  a  way  that  new 
teachings  are  evolved,  and  the  "  thiis  far  and  no 
farther"  of  even  our  student  days  is  no  longer 
heeded.  Until  recently  the  peritoneum  was  held 
sacred  from  the  ante-mortem  touch  of  the  scalpel  ; 
yet  to-day  it  is  subject  to  surgical  manipulation  al- 
most without  fear,  and,  with  proper  care,  without 
serious  danger. 

Most  of  us  were  taught  that  accumulations  of 
fluid  in  the  pleural  cavity  should  not  be  surpically 
interfered  with  ;  and  it  is  a  well-known  fact  that  an 
honored  ex-president  of  the  American  Medical  As- 
sociation, Dr.  H.  I.  Bowditch,  of  Boston,  was  subject 
to  criticism  and  reproach,  indeed,  almo.st  ostracized 
by  the  conservative  leaders  of  the  Boston  profession 
for  believing  these  fluids  could  be  withdrawn  with 
benefit,  and  daring  to  put  his  theories  to  the  prac- 
tical test. 

The  instrument  of  Dieulafoy,  with  its  finer  needles 
and  exhaust-bottle,  opened  up  greater  possibilities, 
and  avoided  many  dangers  in  the  evacuation  of  fluids 
from  closed  cavities.  This,  seconded  by  the  indefati- 
gable spirit  of  its  inventor,  called  the  attention  of 
the  profession,  all  over  the  world,  early  to  the  ad- 
vantages of  the  new  instrument,  and  placed  it  in  the 
hands  of  a  large  proportion  of  surgical  practitioners. 
With  it,  new  experiences  have  arisen,  and  naturally 
its  use  in  the  synovial  effusions  of  the  joints  was 
suggested,  esiiecially  that  of  the  knee,  so  long  and 
familiarly  known  as  "  white  swelling." 

The  surgical  experience  of  two  thousand  years  had 
taught  the  extraordinary  danger  to  limb  and  life  of 
injuries  to  the  knee-joint  which  opened  its  cavity  : 
and  no  one  principle  of  surgery  had  been  better  set- 
tled, for  many  generations,  than  that  of  non-inter- 
ference with  the  accumulations  of  fluid  within  the 
joint.  Under  the  influence  of  such  conservatism  it 
is  no  wonder  that  the  question  is  still  sub  judice,  and 
that  many  of  onr  wisest  and  best  surgeons  still  be- 
lieve that  medical  and  external  applications  are  the 
only  advisable  means  to  be  employed  in  the  treat- 
ment of  such  affections. 

Until  Dr.  ^Marcy's  valuable  experience  was  given  to 
the  profession,  not  much  had  been  written  upon  the 
subject.  In  "  Brvant's  Surgery  "  the  following  brief 
note  is  found  :  "  Paracentesis  of  the  joint  is  an  opera- 
tion that  has  been  performed,  and,  in  the  hands  of 
some  surgeons,  with  wondrous  success.  Dr.  I'oyrer, 
of  Calcutta,  is  one  of  its  strongest  advocates,  having 
shown  that  in  tlie  chronic  and  subacute  forms,  much 
good  is  often  obtained  by  the  operation,  if  care  Ic 
taken  to  exclude  the  air  by  carefullv  closing  the 
puncture  and  fixincr  the  joint  on  a  splint. 

"  The  drawing  off'of  tlie  fluid  afiords  instantaneous 
relief.  I  have  performed  this  ojieration  once  with  a 
good  result  in  a  case  in  which  tension  of  tlie  joint 
was  extreme,  and  in  another  case,  0}iprated  on  by 
Mr.    Cock,  a  similar  result  was   obtained.     It  is  n 

•  Ucad   bpforo  tho  Cincinnati  Medical  Society,  February  14,  188?. 
and  tlio  Acadcmv  cif  Medicine,  Tobruary  30,  1S8*. 
tTnins.  Am.  ilcd.  Awn.,  1S79. 


THE  MEDICAL  RECORD. 


371 


practice,  however,  that  ought  to  be  followed  with 
extreme  caution. " 

On  April  1,  1879,  Dr.  Marcy  addressed  one  thou- 
sand circular-letters  to  the  Kurgieal  profession  of 
America,  hoping  by  "  multiijlied  expei-iences  to  aid 
in  settling  a  question  of  so  much  importance." 

Prior  to  Februai-y,  1875,  he  had  never  used  the 
aspirator  for  the  removal  of  fluids  from  the  knee- 
joint.  At  the  time  his  paper  was  read  at  Atlanta, 
Ga.,  in  May,  1879,  he  had  thirteen  cases  of  his  own, 
and  had  reports  from  twenty-two  surgeons,  giving 
the  clinical  histories  of  fifty-three  cases,  making  a 
total  of  sixty-sis  cases ;  sixty-eight  joints  aspii-ated, 
in  &U  one  hundred  and  eighteen  times  ;  the  quan- 
tity of  fluid  varying  from  one-half  an  ounce  to  eight 
or  more  ounces.  The  character  of  the  fluid  was 
serous,  sero-purulent,  and  serosanguineous. 

The  causation  in  one  case  was  syphilitic,  in  two 
cases,  septic ;  in  three,  gononhceal ;  in  four,  chronic 
inflammatory;  in  eight,  rheumatic;  in  ten,  acute 
inflammatory ;  in  twenty-three,  fa'aumatic,  and  in 
eleven,  not  specified.  In  his  own  cases  the  quantity 
of  fluid  varied  from  one  and  one-half  to  sis  and  one- 
halfounces.  Specific  gravity,1012  tolOiO.  Theaver- 
age  quantity  was  about  four  ounces,  and  the  average 
duration  of  treatment  was  about  four  weeks.  Near- 
ly all  the  cases  are  reported  as  excellent  in  result, 
with  perfect  use  of  limb  ;  two  or  three  as  fair  or 
improved  :  and  only  one  death  is  reported  in  which 
suppurative  inflammation  followed. 

Strengthened  in  my  belief  by  the  study  of  Dr. 
Marcy's  hiprhly  valuable  paper  (read  before  the 
American  Medical  Association  at  Atlanta  in  1879  on 
the  subject),  and  to  whom  the  essayist  is  under  many 
obligations  for  aid  in  the  preparation  of  this  article, 
that  this  mode  of  treatment — aspiration  for  effusion 
in  the  knee-joint — was  safe  and  worthy  a  trial,  I  jjio- 

ceeded  to  operate,  October  12th,  on  Mr.  S ,  who 

presented  himself  a  few  days  prior  for  treatment, 
with  the  following  history :  was  twenty-nine  years 
of  age  ;  single  ;  merchant ;  moderate  drinker.  Four 
vears  ago  he  contracted  a  gonon-htea,  with  soft  sore, 
located  on  the  under  part  of  the  gland.  The  latter 
healed  readily  in  two  or  three  weeks.  The  gnnor- 
rhcea  proved  obstinate.  Going  to  an  Eastern  city  to 
attend  college,  he  passed  from  under  the  ^Titer's 
care,  but  from  what  he  now  tells  me  I  have  reason 
to  suppose  a  stricture  of  some  magnitude  resulted. 
Returning  to  the  city  during  the  summer  months,  a 
fresh  gonon-hoea  was  contracted. 

October  9th. — He  called  on  me  with  the  statement 
that  the  discharare  had  been  upon  him  freely  for  two 
days.  Ordinary  treatment  of  an  astringent  injection 
was  ordered. 

October  11th. — Was  t-elephoned  for  early  in  the 
morning,  and,  on  arriving  at  the  patient's  bed- 
side. I  found,  on  examination,  swelling  of  the 
left  knee  joint  measuring  sixteen  inches,  fluctuation 
to  some  extent,  with  excruciating  pain;  discharge 
from  penis  almost  ceased;  temperature,  lOOi'; 
pulse,  112.  Opiates  hypodermically  and  internally 
gave  some  slight  relief.  The  joint  was  painted  with 
colloilinm  cum  cantharide. 

I  found  on  the  next  visit  that  he  had  a  sleepless 
night ;  distention  of  joint  more  marked,  measuring 
seventeen  and  one-half  inches,  an  increase  of  one 
and  one-half  in  twenty-four  hours ;  temperature, 
102i-.  The  cantharides  had  failed  to  raise  a  blister. 
Realizing  the  gi-avity  of  the  trouble,  and  with  the 
hope  of  giving  some  relief,  I  introduced  a  No.  1.  aspi- 
irator  needle,  and  withdrew  four  ounces  of  clear 
;semm.     Great   relief  was  experienced,  and  much 


gratitnde  expressed.     A  plaster-of- Paris  splint  was 

applied  from  the  toes  up   two-thirds  way  of  the 

!  thigh,  with  a  fenestrated  opening  over  the  point  of 

puncture. 
•     Was  seen  again  that  afternoon,  and  found  him 
resting  very  comfortably.     Had   partaken  of  food 
liberally  and  had  slept  for  four  hours.     Temperature 
99°. 
During   the   night   following,   the   swelling    and 
t   pain  increased  ;  temperature  ran  up  to  101*° ;  pulse, 
I   115  ;  re-aspiration  was  performed,  with  tl  e  result  of 
having  three  ounces  and  two  drachms  r  f  fluid  which 
was  chai'acteristic   in  appearance.     ITnder  tie  mi- 
croscope   some    exudation    corpuscles  were    seen. 
Specific    grarity,  1030.      Great   relief  experienced. 
Pot.  iodide,  gr.  xv.,  ordered  every  three  hours. 

Knowing  the  experience  of  Dr.  Marcy   and   the 
testimony  of  Dieulafoy,  that  in  this  class  of  cases 
j  their   obstinacy  is  proverbial,  I  was  no  ways  sur- 
I  prised  to  find  on  my  nest  visit  a  re  accumulation  of 
j   the  fluid,  with  corresponding  increase  of  tempera- 
!  ture  and  jnilse.     The  needle  was  introduced  for  the 
third  time,  and  two  ounces  and  seven  drachms  with- 
drawn.    Fluid  was  of  same  character  as  heretofore. 
I   Specific  gravity,  1025. 

October  15th. — Withdrew  two  ounces. 
October   17th.  —  Withdrew  one   ounce   and   six 
drachms.     From  this  time  on  little  or  no  pain  was 
felt. 

No  injection  of  carbolic  acid  was  used  after  the 
aspirations,  neither  was  the  antisejjtic  sj)ray  em- 
jjloyed.  Within  a  fortnight  after  the  first  introduc- 
tion of  the  needle  he  could  walk  with  the  aid  of  a 
light  cane.  Motion  was  good  and  there  has  been  no 
tendency  to  any  relaxation  of  the  ligaments  up  to 
the  present  time. 

The  aspirator  used  on  this  occasion  was  that 
devised  by  Potain,  which  is  a  modification  of 
Dieulafoy,  and  is  probably  superior  to  it  in  many 
respects.*  "  The  parts  of  this  apparatus  are  an  air- 
pump,  blunt  canuL-B  of  variotis  calibres,  with  blunt- 
r.nd  sharp-pointed  stylets ;  an  intlia-rubber  stopper 
perforated  with  two  curved  tnl>es,  each  having  a  stop- 
cock, a  bottle  and  rubber  tubing.  The  stcpjier  is 
conical  in  shape  and  of  a  size  rendering  it  adaptable 
to  the  necks  of  ordinary  bottles,  varying  in  cajiacity 
from  a  pint  to  half  a  gallon  or  more.  The  bottle  is 
first  exhausted  of  air  by  the  air-pump  :  then  the  ean- 
ula  enclosing  the  sharp  pointed  stylet,  being  attnohf  d 
to  one  of  the  tubes  in  the  stopper  by  a  piece  of  flexi- 
ble tubing,  is  pushed  through  the  integuments  into 
the  cavity  containing  the  fluid  to  be  evacuated.  On 
withdrawing  the  stylet  and  opening  the  stopcock, 
the  fluid  passes  quickly  into  the  bottle.  With  Po- 
tain's  aspirator  all  unpleasant  odors  are  conveyed 
into  the  bottle  reservoir,  and  therefore  do  not  escape 
into  the  patient's  room."  On  one  occasion  only — 
the  first — was  the  eanula  that  conies  with  this  aspi- 
rator Tised,  preference  being  eriven  to  the  one  made 
by  Messrs.  Wocher  \-  Son,  of  this  city,  at  the  sugges- 
tion of  our  distinguished  townsman.  Dr.  W.  W.  Daw- 
son, and  known  asthe  "hooded  point,"  which,  when 
in  position,  prevents  any  probability  of  hemorrhage 
from  the  walls  of  the  cavity  that  may  come  in  con- 
tact with  the  probe  point.  Under  the  date  of  Jan- 
uary 2,  1882,  Dr.  Marcy  writes  : 

"Dr.  Wst.  jTTDKrss : 

"DearSib —  ....  I  have  since  continued 
aspiration  and  injection  of  the  knee-joint  with  increes- 


.  of  Surgery.  Dr.  John  .\£hbui>t, 


■312 


THE  MEDICAL  RECORD. 


ing  confidence  and  success.  Have  aspii-ated  now 
betsveen  one  and  two  hundred  times,  and  often  in- 
jected carbolic  acid,  tbree  per  cent.,  and  in  every 
case  with,  or  followed  by,  improvement.  Every  acute 
case  seen  early  has  recovered  perfectly.  Keported 
to  British  Medical  Association,  last  year.  I  shall  be 
very  glad  to  hear  of  your  good  work  and  to  meet 
you  at  St.  Paul  in  June  next. 

"  Permit  me,  yours  very  resp., 

"H.  O.  Mabct. 

"IIG  ISOYLSXON  SlEEET,  BOSTON,  MiSS." 

One  of  the  many  replies  to  Dr.  Marcy's  circular, 
that  of  Dr.  W.  M.  Fuqua,  of  Hopkinsville,  Ky.,  reads  : 
"Have  operated  twice  by  aspiration,  and  twice 
by  incision.  Three  were  traumatic  cases,  one  re- 
sulting from  erysipelas.  Fluid  withdrawn :  from 
eight  ounces  to  three  drachms  of  healthy  serum. 
Cooperative  treatment :  extension  by  weights,  fomen- 
tations, elastic  bandage,  rest,  and  immobility— by 
splint— if  required.  Convalescent  in  about  thirty 
days.  Subsequent  condition  good ;  limb  safe  ;  flex- 
ibility impaired,  yet  locomotion  well  i^erformed. 

"I  would  advise  always  to  remove  imprisoned 
fluid  by  aspiration,  if  possible.  I  do  not  fear 
attnospiieric  air.  The  asisirations,  to  do  good,  must 
be  done  early.  I  would  not  limit  the  operation  to 
any  class  of  cases.  Passive  motion  was  used  just  as 
early  as  the  cases  would  admit  of  it.  When  the 
joint  was  opened  by  incision,  carbolic-acid  solution 
was  used  once  daily.  Patient  was  sustained  by 
good  diet,  and  stimulants,  if  requii-ed  ;  opium  at 
night ;  and  supported  by  pretty  firm  bandage  —elas- 
tic if  preferred. 

"  This  is  surely  an  important  subject.  When  I 
first  dared  to  open  the  kuee-joint,  my  medical 
brothers  were  appalled,  and  aspiration  of  the  hip- 
joiut  was  regarded  in  the  same  light. 

"  Is  it  not  our  important  duty  to  give  an  outlet  to 
pus  in  lumbar  and  psoas  abscess  also  ?  " 

Januaiy  18,  1882,  I  received  the  following  from 
the  doctor : 

"My  Dear  Doctor: 

" ....     In  reply  to  yours  of  13th,  will  state 
I  have  seen  four  cases  of  synovitis  of  the  knee-joint, 
and  one  case  of  synoWtis  of  the  ankle  joint  since 
my  communication  to  Dr.  Marcy  in  1S79.     .     .     . 
Two  of  these  cases   were   aspirated   at   once,  one 
treated  by  plaster  bandage,  and  the  other  by  elastic 
compression,  extension  and  splint,  after  aspiration. 
In  til's  one  c.ise,  the  plaster  bandage  was  removed 
tour  times — was  permitted  to  go  about  on  a  crutch — 
he  p3vfectly  recovered.  The  other  case  recovered  with 
slight  impaii'msnt  of  motion,  due  to  organization  of 
inflammatory  products  within  the  joint.     My  third 
case,  a  girl  of  fourteen,  after  fairly  recovering  from 
a  serous  dvsentery  had  swelling  and  efTiision  in  left 
knee-joint.     Aspiration  was  not  permitted  ;  but  she 
slowly   recovered  by   means   of    compression   with 
elastic  b  mdage  and  blisters.     Now,  what  relation 
did   the   effusion   bear  to   the  dysentery? — was   it 
pysemic?    The  foui-th  case  also  treated  by  compres- 
sion with  elastic  bandage,  blisters,  etc.     The  two 
cases  perfectly  recovered  in  two  months.     The  case 
of  synovitis  of  ankle-joint,  the  result  of  an  injury, 
at  first  I  was  disposed  to  regard  as  scrofulous  ;  he 
w.is  pale,  bloodless,  sleepless,  and  without  appetite  ; 
pain  and  tenderness  intense  upon  the  slightest  mo- 
tion.    Aspiration  greatly  relieved  him,   and  being 
u-nble  to  mike  extension,  because  of  the  want  of 
s  litable   appliances,    I  simply  applied  the  plaster 


bandage,  which  was  removed  from  time  to  time  as 
the  swelling  became  less.     He  recovered  perfectly 
after  four  montlis.     Injuries  to  the  joints,  and  their 
effects    ultimately   on   the    constitution,   induce   a 
,  pathological  state,  which,  at  first  sight,  would  be 
regarded  as  scrofulous.     I  think  in  all  sincerity  I 
can  state  that  I  have  never  seen  a  Potts'  disease  of 
the  .spinal  column,  a  ruorbiis  coxariua,  or  the  chronic 
osseous  disease  of  the  tarsus  and  carpus  that  was 
not  of  traumatic  origin.         ..... 

,"  I  am,  Doctor, 

"  Very  truly  yours, 

"W.   M.   FuQtJA." 

Our  well  known  neighboring  surgeon.  Dr.  Kearns, 
of  Covington,  Ky.,  in  reply  to  my  note,  rctxams  my 
circular,  January  25,  1882,  with  the  following  an- 
swers : 

Number  of  cases.     One. 

Cause.     SuiDposed  to  be  rheumatism. 

Number  of  asisirations.     One. 

Amount  of  fluid  withdrawn.     None. 

Was  plaster  splint  used  ?    Yes. 

How  long  under  treatment  ?    Eight  months. 

Result.     Ankylosis. 

Remarks. — Eapid  enlargement,  which,  after  two 
months'  treatment  with  blisters,  iod.  potash,  mer- 
curial inunction,  and  plaster  splint,  seemed  to  con- 
tain fluid  ;  joint  freely  entered.  No  fluid  found  ;  no 
unpleasant  results  from  needle ;  leg  commenced 
flexing  ;  great  pain  and  threatened  dislocation.  Len- 
der chloroform  extended  ;  plaster  sjjliut  resumed. 
Eesult,  perfect  health,  with  a  permanently  straight 
and  stiff  leg. 

Dr.  William  A.  Byrd,  of  Quincy,  111.,  Secretary 
of  the  Surgical  Section  of  the  American  Medical 
Ass^ciation  writes,  January  29,  1882  : 


"William  Judkdjs,  M.D.  : 

"  Dear  Doctor — Your  favor  of  the  26th  came  duly 
to  hand.  My  first  aspiration  of  the  knee-joint  was 
done  in  1875  for  hydrops  articuli,  from  gonorrho'al 
rheumatism.  There  were  sixteen  asijiiations,  as  fol- 
lows :  July  15,  1875,  6  ounces  ;  July  16th,  6  ounces,  2 
drachms  ;  July  17th,  2  ounces ;  July  18tli,  7  ounces  ; 
July  2l3t,  5.20  A.M.,  3  ounces;  July  21st,  9  r.M.,  8 
ounces  ;  July  2-l:th,  1  ounces  ;  July  25th,  6  ounces  ; 
July  ;51st,  1  ounces  ;  August  2d,  7  ounces  ;  August 
5th,  5  ounces,  4  drachms ;  August  (ith,  6  ounces ; 
August  7th,  4  ounces;  August  8th,  5  ounces;  Au- 
gust 9th,  i  ounces,  2  drachms ;  August  10th,  4 
ounces  ;  August  14th,  3  ounces. 

"  There  were  seventy-nine  ounces  of  fluid  removed 
by  the  sixteen  aspirations ;  the  greatest  amount  in 
one  day  lieing  eleven  ounces,  which  was  removed  by 
a  morning  and  evening  opor.ition.  At  times  aspira- 
tion was  jserformed  when  there  was  not  much  fluid 
in  the  joint,  but  experience  taught  me  to  aspirate 
whenever  the  temperature  was  high.  After  the  ope- 
ration, the  temperature  would  invariably  fall  thur 
or  four  degi'ces  within  an  hour.  I  was  assisted  iit 
various  times  in  the  treatment  of  this  case  l>v 
Dis.  I.  T.  W.  Wilson,  J.  W.  Nile?,  William  and 
Charles  Zimmerman,  Joseph  I?oI>bins.  and  J.  D. 
Smith,  of  Slielbina,  Mo.  I  learned  from  this  case 
that  the  best  i>oint  for  insertion  of  the  netdle 
to  remove  all  the  fluid,  was  at  the  inner  and  lower 
border  of  the  patella.  In  addition  to  aspiration,  I 
used  Dr.  L.  A.  Sayre's  ap)>ariitus  for  oxtonsion  of 
the  knee-joint,  with  .strapping  with  adhesive  plaster. 
I  hUve  aspiiated  the  knee-joint  a  good  many  times 
since,  but  never  but  twice  on  the  same  subject,  on 


THE   MEDICAL  RECORD. 


373 


account  of  following  the  operation  mth  Dr.  H.  A. 
Martin's  elastic  bandage,  applied  snuglv  from  the 
foot  to  above  the  joint.  There  has  been  perfect  re- 
covery with  the  use  of  the  joint  in  every  case.  The 
earlier  the  aspiration  and  the  use  of  the  elastic 
bandage  the  more  speedy  the  recovery.  I  have 
not  limited  aspirations  to  the  knee-joint,  but 
have  resorted  to  it  in  the  ankle-  and  elbow-joints 
with  equally  as  good  results.  AVhile  conversing 
about  the  aspiration  of  joints  with  Dr.  Edward 
Hays,  of  Hannibal,  Mo.,  something  over  a  year  ago, 
a  woman  came  into  the  office  having  a  swollen 
elbow-joint,  with  great  pain  and  high  fever.  She 
had  received  no  injury  to  the  joint.  I  aspirated  the 
joint  at  once,  getting  but  about  a  drachm  of  fluid, 
and  apjjlied  the  elastic  bandage.  The  relief  was  im- 
mediate, and  her  recovery  was  complete  in  less  than 
a  week.  I  have  had  cases  of  asijiration  of  the  knee, 
where  there  was  high  fever  and  great  pain,  become 
free  of  fever,  pain,  and  swelling,  and  be  able  to  walk 
upon  the  limb  with  ease  and  comfort  within  four 
days  after  the  ojieration  and  the  apijlication  of  the 
elastic  bandage.  Some  of  these  cases  I  described 
in  an  article  in  the  Baltirnore  Independent  Prarli- 
tioner  of,  I  believe,  September,  1880,  pp.  422-424. 
I  thought  that  I  had  a  copy  of  the  journal,  but  find 
that  it  has  been  misplaced,  so  that  I  am  unable  to 
send  it  to  you.  The  article  is  entitled  '  Some  Sug- 
gestions in  Regard  to  the  Treatment  of  Gonorrha'al 
Rheumatism.'  There  is,  I  believe,  an  influence  ex- 
erted upon  the  nerves  by  the  retained  fluids,  that 
tends  to  keep  up  the  inflammation  and  fever  that 
has  never  been  satisfactorily  explained  to  me.  The 
same  view  is  entertained  by  Mr.  Lister,  and  is  ably 
set  forth  in  his  address  on  ''  The  Relation  of  Micro- 
organisms to  Inflammation,'  delivered  before  the 
Pathological  Section  of  the  International  Congress, 
last  August,  and  published  in  the  London  Lancet. 
American  reprint,  for  January,  1882.  You  will  find 
his  remarks  upon  draining  of  housemaid's  knee,  p.  4, 
very  apropos. 

"  Hoping  that  I  have  not  wearied  you  with  this 
rather  disjointed  letter  about  joints,  and  that  vou 
may  have  a  good  paper  for  the  Surgical  Section  of 
the  American  Medical  Association,  at  its  meeting  in 
St.  Paul,  next  June,  I  remain, 

"  Very  truly  yours, 

"  WlLL,I.\M   A.  BtRD." 

Dr.  E.  H.  Bradford  of  Boston,  Jlass.,  published 
in  the  Boston  Medical  and  Sut-gicnl  .Toxiriud,  a  few 
years  since,  a  review  of  the  foreign  literature  on  this 
subject,  which  is  very  nprooos.  Dieulafoy*  re- 
ported one  year  since  that  he  had  aspirated  the 
knee-joint  two  hundred  times.  He  believes  the  op- 
eration is  a  rational  and  efficient  one  in  a  large  class 
of  cases.  He  uses  the  Xo.  2  needle,  first  placing  a 
rubber  bandage  around  the  knee,  leaving  uncovered 
the  place  of  puncture.  His  point  of  election  is  the 
external  cul-de-sac  of  the  joint,  on  a  level  with  the 
upper  border  of  the  patella,  and  about  two  centi- 
metres outside  of  this  bone.  Compression  is  used 
as  soon  as  the  fluid  is  evacuated,  bv  a  flannel  band- 
age applied  from  the  foot  up  to  the  thigh.  This  is 
removed  in  twenty-four  hours,  and,  if  fluid  has  col- 
lected it  is  re-aspirated. 

The  number  of  aspirations  needed  varies  greatly. 
Bloody  and  other  effusions  into  tie  joint  following 
external  injury  usually  disappear  rapidly,  and  re- 
quire but  one  or  two  aspirations  before  a  cure  is 

*  Gaz.  des  Hopitatuc,  May  18,  187b'. 


effected.  Serofibrinous  exudations  (hydrarthrosis) 
vary  in  the  number  of  aspirations  from  one  to  six  ; 
but  though  the  treatment  is  long,  the  time  before 
recovery  is  certainly  shorter  than  that  during  treat- 
ment in  any  other  way.  Blennorrhagic  hydrarthrosis 
is  much  more  obstinate  than  any  other  form.  More 
aspirations  are  needed  before  recovei'y,  and  the  exu- 
dation returns  quickly. 

Scriber,  of  Baden,  advises  incision  and  drainage 
of  the  knee-joint  in  chronic  serous  inflammation  ; 
in  chronic  disease  of  the  knee-joint  with  granula- 
tion, where  there  is  efl'usion  and  no  caries ;  in  acute 
puralent  affections  of  the  joint  with  evident  fluctua- 
tion ;  and  in  acute  serous  effusions,  when  the  pain 
is  so  severe  as  to  exhaust  the  patient.  Incisions  are 
to  be  made  on  both  sides  of  the  patella,  and  a  thick 
drainage-tube  is  inserted ;  before  the  insertion  of 
the  tube,  the  joint  is  to  be  washed  out  with  a  solu- 
tion (two  and  one-half  to  five  per  cent.)  of  carbolic 
acid.  In  chronic  cases,  if  there  are  sinuses  and 
fetor,  a  solution  of  chloride  of  zinc  (twelve  per  cent.) 
is  used  instead.  The  operation  is  to  be  done  with 
the  strictest  antisejitic  i:]recaution.  In  acute  cases 
the  tube  should  be  removed  in  three  or  four  days  if 
[  the  wound  is  sweet.  If  the  secretion  does  not  di- 
minish quickly  the  joint  should  be  washed  out  again, 
but  the  tube  .should  not  be  left  longer  than  ten  days, 
for  fear  of  irritation  of  the  cartilages.  In  chronic 
cases,  however,  the  tube  may  be  allowed  to  remain 
for  twenty  to  thirty  days.  The  number  of  cases  re- 
ported as  treated  in  this  way  is  six.  No  evil  result 
took  place  in  any  of  the  cases,  and  the  recovery  is 
said  to  have  been  complete.  Where  there  is  caries 
I  of  the  bone  i>resent,  it  is  the  opinion  of  Scriber  that 
excision  offers  the  readiest  method  of  treatment. 

Heinecke,*  however,  reports  two  unusual  cases 
where  the  joints  were  incised  antiseptically,  and  a 
sequestrum  and  disease  of  the  tibia  were  found  ;  the 
sequestnim  was  removed  ;  the  diseased  bone  was 
chiselled  out  and  scraped  away.  Recovery  with 
some  motion  ensued  in  both  cases.  Heinecke  cites, 
as  examples  of  the  advantage  gained  from  the  use 
of  anti.septic  piecautions,  ten  cases  of  affection  of 
the  knee  joint  treated  in  the  Magdeburg  Hospital, 
where  the  knee-joint  was  incised  and  washed  out. 
In  all  but  two  the  joint  was  opened  under  spray. 
In  two  the  opening  was  caused  by  a  wound,  but 
the  joint  was  washed  out  with  antiseptic  solutions, 
and  treated  antiseptically.  In  seven  cases  the  re- 
sult was  cure,  with  the  establishment  of  perfect 
motion.  In  three  suppurative  knee-joints  (two,  the 
above  mentioned  joint-affections  complicated  with 
necrosis  of  the  tiliia)  there  was  only  limited  motion 
on  recovery.  Of  the  seven  entirely  successful  cases, 
one  was  an  acute  serous  inflammation  ;  one  hydrops 
articuli  fibrinosus  ;  one,  sanguineous  efl'usion  ; 
three  were  punctured  wounds  of  the  knee-joint ;  one 
was  the  removal  of  a  loose  cartilage  from  the  joint. 

Schiillerf  reports  two  cases  of  antiseptic  incision 
and  drainage  of  the  knee-joint ;  one  in  a  case  of 
chronic  synovitis  with  sero-purulent  exudation. 
Recovery  followed,  but  details  are  not  given.  A 
second  case  was  one  of  acute  suppurative  inflamma- 
tion of  the  knee-joint  following  an  attack  of  erysip- 
elas.    The  patient  died  in  fourteen  days. 

Rinne  J  reports  eleven  cases  of  knee-joint  affec- 
tion tapped  with  a  trocar,  and  washed  out  with  a 
three  per  cent,  solution  of  carbolic  acid.  Of  these 
eleven,  in  five  there  was  no  reaction  after  the  sur- 

•  Dentschc  Zeitschrift  fur  Chirnr^e.  1S78.  10th  Bd.,  p.  296. 
t  Deutsche  Med.  Woch.,  November  24.  1877. 
}  Centtalblatt  fur  Chirnrgie,  December  8,  1877. 


374 


THE  MEDICAL  RECORD. 


gical  interference  ;  in  four  there  was  slight  fever 
and  a  temporary  return  of  the  fluid.  Nine  are  re- 
ported to  have  been  completely  cured,  apparently, 
with  recovery  of  motion  at  the  joint ;  one  died  of 
tuberculosis  ;  one  was  imjiroved,  but  was  unable  to 
walk  without  the  help  of  a  stick. 

One  fact  will  be  readily  admitted  :  that  experts 
in  anti.septic  surgery  are  much  more  bold,  and  claim 
better  results  than  other  surgeons.  Kanke's  statis- 
tics, read  before  the  "  General  Congress  of  Sur- 
geons," show  unusually  good  results,  which  are 
attributed  by  the  writer  to  antiseptic  treatment. 
Out  of  seventeen  cases  of  02Jen  wounds  of  the  larger 
joints,  fourteen  recovered,  with  motion  at  the  joints, 
both  in  cases  where  there  was  injury  to  the  bone 
and  where  there  was  none.  In  the  three  which  re- 
covered with  ankylosis,  the  patients  did  not  come 
under  treatment  until  after  supijuration  had  been 
established.  In  no  case  did  death  follow.  Schiil- 
ler,  in  his  report  of  the  surgical  clinic  at  Greifswald, 
gives  the  results  of  twenty  cases  of  knee-joint  affec- 
tions treated  by  Hueter's  method  of  injection  (with 
a  subcutanaovis  syringe)  of  a  solution  of  carbolic 
acid  (two  to  three  per  cent).  The  injection  is 
made  either  into  the  thickened  capsule,  or  into  the 
granulations  on  the  extremities  of  the  bones  form- 
ing the  joint.  It  is  reported  to  have  been  particu- 
larly useful  in  serous  and  serofibrinous  effusions. 
In  such  cases,  more  was  gained  in  days  and  weeks 
by  the  injection  than  by  months  of  other  treatment. 
Of  the  twenty  cases  of  knee-joint  disease  ti-eated  in 
this  way  (five  serous  and  sero-fibrinous  synovitis, 
two  hydrops  articuli,  two  chronic  arthritis,  eleven 
fungous  synovitis),  improvement  is  noted  in  all  of 
the  cases,  except  two  ;  of  these,  one  died  of  erysipe- 
las, following  the  prick  of  the  needle,  and  the  other 
underwent  excision.  The  method  is  not  considered 
applicable  in  purulent  synovitis.  Thus  it  may  seem 
that  many  of  the  leading  European  surgeons  are 
much  more  bold  in  treatment  of  diseases  of  the 
knee  joint  than  those  of  our  own  country. 

It  is  well  known,  that  the  differences  between 
the  synovial  and  serous  membranes  are  not  very 
great.  The  innermost  layer  of  the  synovial  mem- 
brane is  completely  invested  with  nucleated  cells. 
Over  extensive  portions  of  the  membrane,  in  silver 
preparations,  two  series  of  tracings  are  detected. 
The  upper  layer  corresponds  quite  closely  with  the 
outlines  of  tlie  endothelium.  The  underlying  layer 
shows  the  characteristic  vascular  net-work,  with 
long  rhomboidal  and  square  meshes,  the  serour 
canaliculi  being  intermediate.  Bohm  claims  to 
have  shown  that  the  blood-vessels  open  into  and 
actually  communicate  with  the  serous  canaliculi. 
Hueter  asserted  that  he  had  never  observed  such 
conditions,  except  in  inflammation,  when  the  ten- 
sion of  the  subs_vno\'ial  lymph-patlis  was  consider- 
ably increased  ;  while  Landzert,  by  employing  his 
silver  method,  brings  the  lympliatics  here  into  dis- 
tinct view. 

It  is  not  difficult  to  picture  the  histological 
changes  which  are  produced  in  acute  iuHammation. 
The  serous  exudation,  the  capillary  injection,  the 
veno'is  stasis,  are  the  first  factors,  wliich,  unrelieved, 
rapidly  go  on  to  produce  pathological  results  that 
have  long  been  known  to  the  profession  as  among 
the  most  disastrous  known  to  surgery.  Under  the 
pressure  and  inflammatory  clnnges,  softening  of 
the  synovial  membrane  may,  and  probably  in  most 
instances  does,  take  place.  The  cai'tilages  and 
osseous  structures  reiidily  become  im])licated,  and 
their  integrity  impaired,  while  the  ligaments  them- 


selves are  so  often  involved  in  these  disastrous 
changes,  that  Mr.  Paget  selects  them  as  an  illustra- 
tion of  the  effect  of  inflammatory  softening,  such  as 
permits  that  great  yielding  of  them  "which  we  al- 
most always  observe  in  cases  of  severely  inflamed 
joints." 

"  We  may  see  such  changes  in  the  ligaments  of  aU 
joints,  but  we  examine  the  effect  of  the  softening 
best  in  diseased  knee-  and  elbow-joints.  The  liga- 
ments, softened  during  the  inflammation,  yield  to 
the  weight  of  the  di.stal  and  unsupported  part  of 
the  limb,  and  the  joint  is  disturbed.  Then,  if  the 
inflammation  subsides,  and  the  normal  nutrition  of 
the  joint  is  restored,  the  elongated  ligaments  re- 
cover their  toughness,  or  are  even  indurated  by  the 
organization  or  contraction  of  the  inflammatory  pro- 
ducts within  them.  But  they  do  not  recover  their 
due  position,  and  thus  the  joint  is  stiffened  in  the 
distortion  to  which  its  ligaments  had  yielded  in  the 
former  period  of  inflammation  and  permanent  dis- 
abOity  results. 

"  The  lesson  which  the  clinical  testimony  of  this 
paper  teaches,"  continues  Marcy,  and  to  whom  I 
justly  believe  belongs  the  laurel  crown  for  so 
prominently  bringing  before  the  profession,  the  ad- 
visability of  this  operation,  "  is  to  operate  early, 
reaspirate  as  often  as  the  fluid  accumulates  ;  aid  by 
rest,  compression,  and  fixation  of  the  joint.  If 
thereby  we  can  avoid,  in  large  measure,  such  de- 
plorable results  as  above  pictured,  and  such  as  pre- 
sent themselves  to  the  study  of  every  practitioner  of 
medicine,  may  we  not  feel  that  our  profession  has 
taken  another  step  in  the  right  direction,  and,  by 
the  establishment  of  tnith,  added  in  some  share  to 
the  divinity  of  our  art?  " 

210  Race  .Street,  Cisciknati,  Feliruary,  )8S2. 


THE  SUCCESSFUL  REDUCTION  OF  A 
BACKWARD  DISLOCATION  OF  THE 
RADIUS  AND  ULNA  SE^'EN  MONTHS 
AFTER  THE  IN.JURY. 

By  GEORGE  E.  BREWER, 

BUFFALO,    NEW    YORK. 

A  BACKWAKD  dislocation  of  the  elbow  of  seven 
months'  standing,  reduced  by  Dr.  Julius  F.  Miner,  of 
Buffalo,  recently  came  under  my  observation. 

The  extreme  rarity  of  such  cases,  and  the  readi- 
ness with  which  reduction  was  accomplished,  led 
me  to  a  careful  study  of  the  subject  as  pi'esented  by 
surgical  authors. 

I  was  very  much  surprised  to  see  how  little  was 
said  in  our  books,  or  published  in  our  journals  :  tin 
whole  subject  being  dismissed  with  the  almns! 
unanimous  conclusion  that  such  reductions  were  im- 
practicable if  not  impossible. 

I  was  also  much  surprised  to  find  how  uniformly 
unsuccessful  had  been  the  efforts  of  even  the  most 
experienced  sui'geons  in  attempting  to  better  this 
condition,  some  authors  even  going  so  far  as  to 
assert  tliat  it  should  not  be  attempted  after  the 
sixth  woeli. 

Hamilton,  in  his  valuable  work  on  fractures  and 
dislocations,  cites  but  two  instances  of  its  success- 
ful reduction  after  seven  months,  one  in  his  own 
practice  and  one  reported  by  Starch. 

With  Dr.  Miner's  permission  I  report  the  follow 
ing  case,  tnisting  that  it  may  prove  instructive  tn 
those  interested  in  the  subject  of  old  dislocations. 

Edward  IMcCarty,  aged  twenty-one,  of  Crawford 
Co.,  Penn.,  in  August  last  received  a  fall  which  re 


THE  MEDICAL  RECORD. 


3?6 


suited  in  a  backward  dislocation  of  the  radius  and 
ulna.  The  injury  was  such  as  to  baffle  all  attempts 
at  reduction  made  by  neighboring  physicians. 
March  loth,  about  seven  months  after  the  injury,  he 
consulted  Dr.  Miner,  who  found  upon  examination, 
that  the  dislocation  was  complete,  both  bones  of  the 
forearm  being  distinctly  felt  resting  on  the  humerus 
about  three  inches  above  their  normal  position,  the 
coracoid  process  of  tlie  ulna  firmly  imbedded  in  the 
olecranon  fossa,  and  the  arm  immovably  extended. 

The  patient  was  at  once  given  a  private  room  in 
the  Butfalo  General  Hospital,  when,  on  the  following 
day,  Dr.  Miner  in  the  presence  of,  and  assisted  by, 
many  of  his  professional  friends,  renewed  the  at- 
tempt at  reduction. 

The  patient  was  thoroughly  etherized.  Forcible 
extension  was  then  made  upon  the  arm.  This  was 
followed  by  an  unsuccessful  attempt  at  flexion, 
clearly  showing  further  extension  necessary  before 
flexion  could  be  accomplished.  The  tendon  of  the 
triceps  was  now  divided  about  an  inch  above  its 
attachment  to  the  olecranon.  Very  powerful  exten- 
sion was  then  made  (the  combined  efforts  of  four 
men),  this,  with  forcible  flexion,  pronation,  and 
supination  was  continued  for  nearly  three-quarters 
of  an  hour.  Then  measurement,  the  ease  with 
which  the  arm  could  be  flexed,  and  absence  of  de- 
formity, all  indicated  that  the  dislocation  had  been 
successfully  reduced. 

The  arm  was  dressed  at  right  angles,  without  a 
splint,  and  the  patient  placed  in  bed. 

March  17th. — Considerable  swelling  of  the  parts. 
Passive  motion  attended  with  pain.  Pulse,  110. 
Temperature,  99". 

March  19th. — Patient  sitting  ujs.  Passive  motion. 
Pulse,  90.     Temperature,  98  . 

March  22d. — One  week  after  the  operation.  Motion 
without  pain,  but  limited,  owing  to  the  cpdematous 
condition  of  surrounding  tissues.  Patient  left  the 
hospital  and  went  to  his  home  in  Pennsylvania,  witli 
evei\v  indication  that  complete  recovei-y  and  good 
motion  would  eventually  be  obtained. 

In  these  old  dislocations  of  the  forearm,  especially 
where  the  displacement  is  considei'able,  the  con- 
tracted triceps  offers  the  chief  muscular  resistance 
to  replacement. 

Dixi  Crosby,  of  New  Hampshire,  successfully  re- 
placed two  old  luxations  of  this  kind  by  fracturing 
the  olecranon.  This  method  has  also  been  success- 
fully practised  Viy  Hamilton  and  others.  Subcuta- 
neous section  of  the  tendon  of  the  triceps  seems  to 
possess  all  the  merits,  while  it  lacks  some  of  the 
disadvantages  attending  the  fracture  of  the  olecra- 
non. 

Since  the  above  was  written,  Dr.  Miner  informs 
me  that  in  October,  1869  assisted  by  his  friend  and 
colleague,  the  late  Prof.  Sanford  Eastman.  M.D.,  he 
reduced  a  similar  dislocation  in  the  same  manner. 
Dr.  Harrington,  who  also  assisted  Dr.  Miner  at  that 
time,  says  that  the  dislocation  was  of  nearly  a  year's 
standing.  As  no  record  was  made  of  the  case  at  the 
time,  he  is  unable  to  state  positively  just  how  much 
time  had  elapsed  since  the  injury. 

Dr.  Miner  suggests  that  the  reason  more  cases  of 
the  kind  have  not  been  reported,  is  not  that  such 
dislocations  have  not  been  reduced,  but,  as  in  his 
flj'st  case,  no  records  were  preserved! 


A  Teaixisg  School  for  Nurses  is  to  be  estab- 
lished in  connection  with  the  MaiT  Fletcher  Hos- 
pital, at  Burlington,  Vt. 


ATEOPINE  POISONING  SUCCESSFULLY 
TREATED  BY  MORPHINE. 

By  J.  W.  FLYNN,  M.D., 

NEW   YORK. 

On  January  16,  1882,  Mrs.  H- called  at  my  oflSce 

stating  that  her  child,  fifteen  months  old,  had  drank 
some  "  eye  drops"  which  had  been  prej)ared  for 
another  child  of  the  same  family.  Upon  questioning 
the  mother,  I  found  the  child  had  taken  about  a  tea- 
spoonful  of  the  mixture.  Knowing  it  to  be  a  two- 
grain  solution  of  atropine,  I  concluded  to  test  the 
value  of  morphia  as  an  antidote.  On  my  way  to  her 
house  she  told  me  she  paid  no  attention  to  the  child 
until  some  friends  noticed,  about  one  hour  after  tak- 
ing the  solution,  he  began  to  stagger  and  grab  at 
imaginary  oVijects.  She  then  placed  him  in  her  lap 
and  he  caught  hold  of  her  as  if  falling,  and  crying  as 
if  he  were  greatly  frightened  at  something. 

Upon  my  anival,  I  found  him  in  a  semi- comatose 
condition,  pupils  fully  dilated,  resi^iration  fifty  per 
minute,  pulse  could  not  be  counted  on  account  of 
tetanic  twitchings  of  the  whole  body.  Face  and 
neck  looked  like  a  child  suffering  from  an  attack  of 
scarlet  fever.  Gave  some  sulphate  zinc,  but  he  could 
not  swallow.  At  1  p.m.  I  injected  3  m.  Mag.  sol.; 
opisthotonos.  1.0.5  p.m.,  passed  into  a  comatose  con- 
dition ;  pulse,  160.  1.10  p.m.,  injected  3  m.  Mag.  sol. 
1.20  P.M.,  injected  3  m.  Mag.  sol.  and  15  m.  brandy. 
1.30  P.M.,  opi-sthotonos  well  marked.  1.45  p.m.,  in- 
jected 5  m.  Mag.  sol.  and  20  m.  brandy.  2  p.m..  pulse, 
144,  irregular  ;  respiration.  22  ;  reflex  irritability  to- 
tally abolished  ;  jnipils  the  same.  2.30  p.m.,  resjiira- 
tion  ceased  during  a  tetanic  convulsion  ;  resorted  to 
artificial  respiration,  electricity,  and  cold  douches. 
3  P.M.,  redness  j^assing  away,  pupils  the  same  ;  pulse, 
144,  irregular;  respiration.  22  ;  extremities  cold; 
placed  hot  irons  to  feet  and  mustard  to  chest.  3.15 
P.M.,  respiration  ceased.  3.35  p.m.,  pupils  the  same  ; 
injected  5  m.  Mag.  sol.  and  20  m.  brandy  ;  tempera- 
ture, 98°  F.  :  face  pale.  4  p.m.,  respiration  ceased  ; 
opisthotonos.  4.10  p.m.,  respiration,  22  ;  pulse,  144  ; 
irregular.  4.45  p.m.,  injected  5  m.  Mag.  sol.,  18  m. 
brandy,  and  5  m.  tr.  digitalis ;  large  tracheal  rales. 
5.  p.m.,  pupils  commence  (?)  to  contract ;  pulse,  140  ; 
respiration.  22.  5.30  p.m..  my  friend.  Dr.  E.  J. 
O'Connell,  passed  a  soft  catheter  into  the  trachea 
and  withdrew  (sucked)  a  quantity  of  brownish  mu- 
cus, which  seemed  to  relieve  the  little  sufl'erer  ; 
pupils  contracting  ;  no  response  to  light.  6  p.m., 
respiration  ceased  ;  pulse,  140,  irregular.  6.30  p.m., 
respiration  ceased  ;  injected  20  m.  brandy.  7.30  p.m., 
respiration  ceased.  7.40  p.m.,  respiration  ceased. 
8  p.m.,  pulse,  120 ;  respiration,  18  ;  slight  reflex  ir- 
ritabilty ;  pupils  contracting.  8.30  p.m.,  respiration 
ceased.  8.50  p.m.,  respiration  ceased.  9  p.m.,  pulse, 
120;  respiration,  10  ;  temperature,  98' F  ;  opened 
his  eyes  and  moved  his  head  to  one  side.  9,30  p.m., 
attempts  to  sit  up.  10  p.m.,  is  quite  restless  and 
seems  to  be  in  pain  ;  pupils  vei-y  large  ;  light  causes 
him  to  close  his  eyes.  Gave  him  some  milk,  he  grab- 
bed the  glass  with  great  avidity,  but  could  not  swal- 
low much  ;  face  pale.  Prescribed  1|  drop  tr.  ojiii 
every  hour. 

January  17th,  12  M. — Had  a  convulsion  which 
lasted  about  thirty  minutes. 

From  this  time  on  he  made  a  slow  recovery,  suf- 
fering greatly  from  tympanites,  vomiting,  and  in- 
ability to  pass  his  urine.  Pupils  remaining  large  for 
some  days.  On  January  21st,  desquamation  of  the 
skin  on  face  and  neck. 


376 


THE  MEDICAL  RECORD. 


The  points  of  interest  in  the  case  are  the  action  of 
the  pupil,  the  pulse,  and  the  cessation  of  respiration 
80  often.  It  may  be  noticed  that  it  was  seven  hours 
before  any  marked  contraction  of  the  pupil  oc- 
curred, the  pulse  remaining  high  throughout.  The 
cessation  of  respiration  somewhat  alarmed  me  at 
first,  thinking  I  (and  I  suppose  others  will  say)  had 
given  too  much  morphia,  but  it  was  due  to  a  te- 
tanoid convulsion,  especially  marked  in  the  arms 
and  body,  each  time  the  cessation  took  place.  The 
respiration  remained  at  22  per  minute  for  seven 
hours,  suddenly  falling  to  18,  and  an  hour  later  to 
16.  After  this  no  more  convulsions  occurred.  I  re- 
sorted to  artificial  respiration  principally  (electricity 
seemingly  not  having  much  effect  on  respiration) 
each  time  respiration  ceased. 

If  I  ever  have  the  fortune  (?J  to  get  a  similar  case, 
I  will  use  morphia  again  and  push  it,  and  will  not 
place  much  reliance  upon  the  pupil  or  pulse,  bait  be 
guided  by  the  respiration. 

Before  concluding,  I  must  return  thanks  to  Drs. 
B.  J.  O'Connell  and  P.  H.  Flynn  for  their  kind  as- 
sistance, and  also  the  keeping  of  the  notes  of  the 
case. 
246  East  Seventy-foubth  Street. 


lUports  of  i^ospitaU 


QUEEN  CHABLOTTE'S  LYING-IN  HOSPITAL, 

LONDON. 

Under  Cake  of  DR.  GRIGG. 

PORRO'S  OPEB.WION— CHILD  SAVED — DEATH  OP   MOTHER 

FROM     SEPTICiEMJA,    TWENTI-FODR    HOURS     AFTER 

OPERATION. 

The  patient  was  admitted  at  10.20  p.m.  on  Decem- 
ber 10,  1881,  having  been  sixteen  hours  in  labor. 
This  was  her  second  pregnancy,  she  having  pre- 
viously (September,  1880)  aborted  at  the  third 
month.  She  was  a  diminutive  woman,  forty-two 
inches  in  height  and  was  in  a  weak  state  when  ad- 
mitted. The  pulse  was  96,  and  temperature  99.8°  F. 
Tongue  clear  and  the  bowels  had  been  opened. 
The  pains  wei-e  feeble  and  infrequent.  The  lower 
limbs  exhibited  extreme  deformity  from  rickets,  but 
the  pelvic  deformity  was  not  recognized  by  the  pupil 
mid^vife  who  had  charge  of  the  cajse.  The  resident 
medical  officer  examined  the  patient  on  his  return 
to  the  hospital  at  4.30  a.m.,  when  he  found  the  os 
uteri  dilated  transversely  to  the  extent  of  1  i  inches, 
and  the  measurement  of  the  conjugate  diameter  at 
the  brim  only  11  inches.  The  following  measure- 
ments were  also  taken  :  Between  the  trochanters,  llA 
inches  ;  from  the  symphysis  pubis  to  right  anterior 
superior  spinous  process,  5}  inches  ;  ditto,  left,  5J 
inches ;  external  conjugate  diameter  normal  (7 
inches).  Dr.  Grigg  was  summoned,  and  after  con- 
sultation with  the  other  members  of  the  stafi',  Coosa- 
rean  section  was  determined  on. 

At  2.30  P.M.,  December  lltli,  tlie  patient  was 
chloroformed,  and  Dr.  Grigg,  assisted  by  Sir  W. 
MacCormac  and  Dr.  Boulton,  performed  Ciesarean 
section  and  extracted  a  living  child,  which  was  21 J 
inches  in  length  and  weighed  6  lbs.  5  oz.  The  pla- 
centa came  away  readily.  The  incision  was  six 
inches  in  length,  extending  from  the  umbilicus  to 
half  an  inch  above  tlie  |)ul)e8.  Hemoi-rhage  was 
controlled  by  pressure  and  by  iced  sponges  applied 


to  the  cavity  of  the  uterus  and  to  the  cut  surfaces. 
That  from  the  placental  site  was  veiw  slight,  but  the 
total  hemorrhage  was  considerable,  nearly  a  pint. 
The  operation  was  not  done  entirely  antiseptically  ; 
it  was  finished  in  Porro's  method  by  removing  the 
uterus,  broad  ligaments  ovaries,  and  Fallopian  tubes. 
The  uterus  was  divided  close  to  the  internal  os,  and 
a  double  ligature  was  passed  through  each  broad  Ij 
ligament  and  the  ligament  divided  between  the  lig- 
atured portions.  The  remaining  portion  of  uterine 
tissue  was  tightly  grasjjed  by  a  wire  fcraseur, 
brought  outside  the  internal  wound,  painted  with 
solid  jierehloride  of  iron  and  kept  in  position  by 
thick  steel  needles  ;  the  operation  lasted  an  hour 
and  the  jiatient  bore  it  well.  Antiseptic  dres.sings 
were  applied.  A  subcutaneous  injection  of  ether 
(one  drachm)  wfis  administered  and  some  brandy 
given  by  the  mouth.  Half  an  ounce  of  milk  was 
then  given  by  the  mouth  every  hour  until  shortly 
before  death. 

At  11  A.M.  on  the  12th  the  temperature  was  98.6°; 
respiration,  55  ;  and  the  pulse,  60.  The  patient  stated 
that  she  had  passed  a  good  night,  and  expressed  a 
wi.sh  to  see  her  baby.  At  2  p.m.  Dr.  Grigg  found  the 
patient's  hands  cold,  breathing  rapid,  and  pulse 
almost  imperceptible.  This  state  of  things  had 
come  on  just  as  he  entered  the  room.  Up  to  that 
time  the  patient  was  cheerful  and  feeling  very  com- 
fortable, only  complaining  of  a  sinking  sensation  at 
the  stomach,  and  craving  for  food.  Dr.  Grigg  then 
administered  a  drachm  of  brandy  fin  water)  and 
directed  more  to  be  given  with  an  ounce  of  lieef-tea. 
This  set  up  vomiting  and  the  patient  suddenly  col- 
lapsed, and  died  at  3.30  p.m. 

Necropsy  (eighteen  hours  after  death),  by  Dr. 
AUchin,  Physician  to,  and  Lecturer  on  Pathology 
at,  the  Westminster  Hospital. 

The  measurements  taken  during  life  were  verified 
on  the  cadaver. 

The  body  was  fairly  well  nourished,  muscular,  and 
of  good  color;  rigor  mortis  well  marked.  There 
was  extreme  rickety  deformity  of  the  lower  limbs. 
Externally,  the  wound  apjjeared  perfectly  healthy  ; 
its  internal  appearance  was  also  healthy.  There 
was  commencing  primary  adhesion  to  the  omentum 
with  a  few  specks  of  healthy  lymph.  There  were 
some  ordinary  subperitoneal  ecchymoses  around 
wound.  The  intestines  were  distended  and  their  peri- 
toneal surface  generally  slightly  injected — especially 
in  the  neighborhood  of  the  wound,  where  some  coils 
of  intestine  were  glued  together  by  lymph.  There 
were  a  few  old  adhesions  between  the  right  angle  of 
colon  and  the  under  siarface  of  the  liver.  The  peri- 
toneal cavity  contained  a  few  drachms  of  blood- 
stained viscid  purulent  fluid. 

The  cervix  uteri  and  sigmoid  flexure  were  closely 
adherent  by  recent  lymph,  the  cut  margin  of  the 
posterior  layer  of  peritoneum  intervening  and  Doug- 
las's pouch  being  thereby  obliterated.  A  small 
quantity  of  lymph  intervened  between  the  anterior 
surface  of  jieritoneum  and  the  cervix.  Stump 
deeply  stained  by  pcrchloride.  Extent  of  utenis 
left  mea.sured  2}  inches  vertically.  External  os  and 
vagina  normal.  The  ligatures  on  the  broad  liga- 
ments were  intact.  Ureters  and  rectum  normal,  with 
the  exception  of  a  small  abrasion  on  the  peritoneal 
surface  of  the  latter.  There  were  a  few  submucous 
ecchymoses  in  fundus  of  bladder,  which  was  consider- 
ably displaced  to  the  left,  owing  to  obliquity  of  pel- 
vis. K  slight  abrasion  of  urethra  with  adherent  clot. 
No  subperitoneal  inflammation  in  pelvis.  liiver 
small,  pale,  normal  in  appearance  ;  weight  2  lbs.  o 


THE  MEDICAL  EECORD. 


377 


oz.      Kidneys    and    suprarenal    capsules    normal. 
Spleen  soft. 

A  few  old  firm  adhesions  over  lower  part  of  right 
lung ;  general  firm  adhesions  over  left  lung.  Xo 
fluid  in  either  pleura.  Lungs  healthy  and  crepitant 
throughout. 

Pericardium  contained  two  drachms  of  clear  fluid. 
Heart  substance  firm  and  of  good  color.  Weight 
of  heart,  eight  ounces.  Cavities  moderately  dis- 
tended with  firm  post-mortem  clots,  not  extending 
into  vessels.  No  post-mortem  staining  of  endocar- 
dium. 

Jieinarks  (by  Dr.  Grigg). — This  is  the  first  com- 
plete case  of  Porro's  operation  performed  in  Eng- 
land, i.e.,  the  removal  of  the  uterus  at  or  just  below 
the  internal  os  with  the  entire  uterine  appendages. 
On  reviewing  the  case  the  following  points  are  of 
practical  importance,  and  if  I  have  occasion  to  per- 
form the  operation  again,  I  shall  bear  them  in  mind. 

Firstly,  not  to  extend  the  incision  into  the  uterus 
too  low,  and  not  approach  the  internal  os  by  at  least 
two  inches,  as  the  hemorrhage  was  but  slight  from 
the  upper  zoue  of  the  uterus,  biit  very  profuse  from 
the  lower  portion.  The  danger  arising  from  cutting 
into  the  placental  site  is  more  theoretical  than  prac- 
tical, as  when  once  the  incision  is  made,  the  removal 
of  the  uterine  contents  is  almost  instantaneously 
effected,  and  the  application  of  iced  sponges  to  the 
uterine  cavity  at  once  excites  contraction  and  ar- 
rests the  hemorrhage  from  the  placental  site. 

The  second  point  of  importance  is  the  question  of 
applying  clamps  to  the  broad  ligaments  before  mak- 
ing an  incision  into  the  uterus.  This  was  suggested 
to  me  and  advised  by  Mr.  Knowsley  Thornton  ;  but 
in  practice  this  is  not  possible  without  making  a 
very  large  abdominal  incision  and  drawing  out  the 
whole  uterine  tumor,  as  there  is  not  otherwise  a  suf- 
ficient space  to  apply  any  clamps  to  the  broad  liga- 
ments. The  uterine  cavity  must  be  emptied  first  of 
all  before  proceeding  to  clamp  the  broad  ligaments. 
I-  should  strongly  recommend  the  immediate  appli- 
cation of  clamjjs  to  the  broad  ligaments  on  the 
removal  of  the  foetus,  even  before  delivering  the 
placenta.  By  this  proceeding  much  loss  of  blood 
would  be  avoided.  Besides,  this  would  obviate  the 
necessity  of  ligaturing  both  distal  and  proximal 
sides,  which  prolongs  the  operation. 

The  difficulties  met  with  in  dissecting  the  bladder 
and  rectum  oft"  the  uterus  are  not  so  great  in  an  im- 
pregnated uterus  as  in  an  unimpregnated  one — nor 
is  there  such  a  likelihood  of  injuring  the  ureters. 

Since  reading  the  results  of  Sir  William  McC'or- 
mac's  case  of  removal  of  the  entire  uterus  ( British 
Medical  Jovrnal,  January  li,  1882,  page  61),  the 
question  arises  in  my  mind  whether  it  would  not  be 
desirable  to  remove  the  wire  ligatures  from  off  the 
cervix  after  first  of  all  searing  the  stump  of  the 
cervix  with  the  hot  iron.  The  post-mortem  showed 
that  the  application  of  the  solid  perchloride  of  iron 
is  not  without  danger,  as  the  vessels  were  stained 
for  abovit  two  inches  beyond  the  wire  ligatures, 
although  the  wires  were  drawn  as  tight  as  the  wire 
would  bear.  A  free  opening  into  the  abdominal 
cavity,  to  admit  of  free  drainage,  is,  judging  from 
lie  above  case,  desirable. 

Finally,  as  regards  the  feeding  of  the  patient, 
should  the  system  of  feeding  adopted  with  so  much 
success  in  ovarian  cases  be  used  also  after  this  opera- 
tion ?  I  am  inclined  to  think  not,  the  blood  condi- 
tions not  being  similar.  More  food  is  necessary.  I 
shoTild, however,  to  avoid  sickness,  feed  by  the  bowel 
in  preference  to  the  mouth. 


Should  I  again  have  to  elect  between  Porro's 
operation  and  Cajsarean  section  I  should  decidedly, 
from  my  own  experience,  give  the  preference  to  the 
former,  and  feel  sure,  from  the  course  of  this  case, 
that  the  former  oflers  the  best  chance  of  life  to  the 
mother. 

DEATH   FBOM    rMBILICAL    HEIIOBBHAGE. 

The  following  case  recently  occurred  in  the 
private  practice  of  a  London  obstetric  physician  : 
After  the  birth  of  the  child  the  cord,  which  was  un- 
usually stout,  was  ligatured  with  thread  as  usual, 
two  or  three  inches  from  the  umbilicus,  a  surgical 
knot  being  tied,  and  then  divided  about  an  inch 
from  the  ligature.  The  cord  continued  to  pul- 
sate, a  fact  to  which  he  directed  the  nurse's  attention. 
In  about  seven  minutes  the  mother  flooded  and  the 
child  was  wrapped'in  flannel  and  laid  on  one  side. 
In  about  twenty  minutes,  when  the  flooding  had 
been  controlled,  the  child  was  looked  at  and  found 
to  be  lying  dead  in  a  pool  of  blood.  The  ligature 
was  still  firm.  The  inference  is  that  it  must  have 
been  placed  over  a  nodosity  of  the  cord  and  must 
have  slipped  on  to  a  portion  of  smaller  calibre, 
and  thus  became  slightly  loosened.  This  case 
would  tend  to  show  that  to  dispense  with  the 
ligature  altogether,  as  some  German  writers  have 
advocated,  is  a  plan  not  without  danger. 


The  Use  of  Mercttrt  and  other  EE5rEDrE.s  dj 
THE  Treatment  of  Ssphtus.  —  Dr.  G.  H.  Fox,  of 
New  York,  has  published  some  views  on  the  thera- 
peutics of  syphUis  that  are  the  results  of  an  ex- 
tended experience.  He  first  lays  it  down  as  an 
axiom  that  mercury  is  our  most  valuable  remedy, 
biit  hastens  to  add,  as  a  corollary,  that  its  value  has 
been  overrated.  Some  of  his  worst  cases  of  chronic 
syphilis  have  been  those  in  which  mercury  has  been 
given  persistently  for  one  or  two  years  ;  in  this  con- 
nection the  value  of  hygiene  and  tonic  measures  are 
strongly  urged  upon  the  profession.  Syphilis,  in 
his  opinion,  tends  to  a  spontaneous  cure,  at  least 
in  the  majority  of  instances,  and  in  most  acquired 
forms  is  far  less  malignant  than  is  usually  supposed. 
Many  cases  will  progress  satisfactorily  to  a  cure 
without  mercury.  Of  all  the  various  methods  by 
which  mercury  may  be  introduced  iato  the  system, 
that  by  internal  medication  has  advantages  over 
others  by  inunction,  baths,  or  hypodermic  injection. 
No  locally  irritant  action  should  be  permitted,  and 
indeed  the  doses  may  be  so  small  as  not  to  give  the 
slightest  danger  of  salivation.  The  duration  of  treat- 
ment should  be  related  to  the  severity  of  the  case 
and  the  success  that  attends  the  therapeutical  mea- 
sures. 

Iodide  of  potassium  has  also  a  positively  curative 
effect  in  syphilis,  though  excellent  authorities  may 
oppose  this  view.  It  does  its  work  quickly  or  not 
at  all.  In  this  connection  he  urges  attention  to  the 
danger  that  attends  the  use  of  large  doses,  and  ob- 
serves that  he  has  seen  syphilitic  patients  dying  in 
hospitals,  where  heroic  doses  of  potash  were  hasten- 
ing the  fatal  termination.  Iron  and  cod-liver  oil 
are  iiseful  adjuvants,  the  former. especially  as  an 
astringent  to  countei-act  the  laxative  effects  of  mer- 
cury, the  latter  for  the  syjihilitics  who  have  a  stru- 
mous diathesis,  or  for  late  lesions  that  are  unusti- 
allv  persistent. — Sew  York  Medical  Jownal,  March, 
1882. 


378 


THE  MEDICAL  RECORD. 


The  Medical  Record: 

21  iDccklg  Journal  of  flTeDicinc  anb  Sitrgcrg 


OEORQE  F.  SHRADY,  A.M.,  M.D.,  Editor. 


PUBLISHED   BY 
Win.  WOOD  Sc  CO.,  No.  27  Great  Jones  St.,  N.  If. 

New  York,  April  8,  1882. 

FREEDOM  IN  CONSULTATIONS. 

Judging  from  the  criticisms  in  certain  of  our  con- 
temporaries concerning  the  recent  action  of  the 
Medical  Society  of  the  State  of  New  York,  the  time 
has  come,  apparently,  for  the  profession  of  the  Em- 
pire State  to  bow  itself  in  the  dust,  to  cry  "  Unclean ! 
unclean  !  "  and  to  beg  for  mercy.  This  state  of  things 
is  the  more  to  be  deplored,  perhaps,  as  the  so-called 
sin  was  deliberately  committed  in  the  full  light  of 
reasonable  accountability,  and  evidently  with  a  prop- 
er regard  for  the  responsibility  which  the  adoption 
of  a  new  code  involved.  In  fact,  the  State  Society 
has  succeeded  in  creating  a  genuine  sensation  in 
several  smaller  medical  circles,  and  protestations 
are  bubbling  over  in  resolutions  condemning  the 
course  taken  by  this  organization,  and  predicting 
possible  medical  excommunication  for  all  its  mem- 
bers. From  these  standpoints,  the  prospects  are 
gloomy,  indeed,  and  the  medical  men  of  this  State 
are  in  need  of  some  of  the  consolation  which  be- 
longs to  the  discussion  of  the  other  side  of  the 
question. 

It  was  hardly  supposed,  when  the  new  code  was 
adopted,  giving  freedom  of  action  to  every  man  re- 
garding consultations,  that  there  would  be  a  lack 
of  opposition  to  the  movement  by  outsiders.  When- 
ever an  old  rut  is  left  and  a  new  road  projected,  the 
first  passengers  generally  have  a  rough  time  of  it. 
They  must  expect  this,  and  bounce  over  the  old 
prejudices  as  best  they  can.  In  so  far,  perhaps,  the 
State  Society  has,  in  a  measure,  come  to  a  realizing 
sense  of  the  radical  character  of  its  recent  depart- 
ure*. But  as  yet  there  is  no  sign  of  weakening  as  to 
the  stand  taken.  In  reality,  there  is  no  good  reason 
why  there  should  be.  Far  from  being  in  the  wrong, 
the  profession  of  this  State  have  taken  a  much- 
needed  step  in  advance.  The  cry  that  concessions 
have  been  made  to  irregular  practitioners  is  simply 
absurd.     The  assertion  that  the  honor  of  the  regular 


profession  has  been  sacrificed  to  the  mere  expe- 
diency of  obtaining  extra  consultations  is  ridiculous. 
The  profession  of  this  State  have  a  birthright  which 
has  never  been  for  sale  for  any  such  price.  The 
action  regarding  free  consultation  was  based  solely 
upon  the  principle  that  medicine  was  a  broad  and 
liberal  profession,  and  that  every  barrier  which  in- 
terfered with  the  expansion  of  its  usefulness  and  the 
increase  of  its  influence  should  be  broken  down. 
The  soundness  of  this  doctrine  cannot  be  questioned 
even  by  the  most  contumacious  sticklers  for  the 
National  Code.  The  best  reason  for  rebuking  bigotry 
and  dogmatism  is  to  be  found  in  the  fact  that  we 
are  free  from  any  suspicion  of  them  ourselves.  And 
this  results  when  the  opportunity  is  given  to  every 
one  desiring  it  to  search  for  truth  wherever  it  may 
be  hidden,  and  in  his  own  way. 

He  is  simply  expected  to  settle  in  his  own  mind 
what  it  may  be  his  duty  to  do  in  the  premises,  and 
personally  assume  the  responsibility  of  its  result. 
It  is  safe  to  presume  that  there  is  honor  and  intelli- 
gence enough  in  the  profession  to  allow  the  details 
of  action  to  take  care  of  themselves.  If  thus  much 
cannot  be  trusted  to  individual  members  of  the  pro- 
fession, then  no  code  is  of  any  use. 

Although  the  liberty  of  action  was  practically  the 
same  before,  so  far  as  the  restrictions  of  the  code 
were  concerned,  it  was  never  so  explicitly  defined  as 
now.  For  instance,  there  is  really,  even  according 
to  the  American  code,  no  provision  to  prevent  con- 
sultation with  so-called  homtt'opaths  or  irregulars. 
That  the  clause  referring  to  it  is  understood  to  mean 
otherwise  must  be  admitted.  Whatever  may  have 
been  the  reasons  heretofore  for  inserting  it,  it  is 
quite  certain  they  do  not  apply  to  the  present  state 
of  affairs.  The  provision  in  the  American  code  to 
which  we  have  referred  is  to  the  following  effect : 

"  But  no  one  can  be  considered  as  a  regular  prac- 
titioner or  a  fit  associate  in  consultation  whose 
practice  is  based  on  an  exclusive  dogma,  to  the  re- 
jection of  the  accumulated  experience  of  the  profes- 
sion and  of  the  aids  actually  furnished  by  physiolo- 
gy, pathology,  and  organic  chemistry." 

The  educated  homa'opaths  of  the  present  day 
certainly  do  not  come  under  this  reference,  nor,  in 
fact,  do  the  majority  of  the  lesser  lights  who  still 
trade  upon  the  mere  name  of  a  sect.  But  further 
than  this,  a  comprehensive  interpretation  of  its  sup- 
posed spirit  is  perfectly  consistent  with  the  action 
of  the  State  Society.  A  sufficiently  wide  latitude  is 
given  for  a  choice,  in  consultation,  between  the  hon- 
est man  who,  believing  in  certain  methods  of  cure, 
is  yet  not  exclusive  in  his  views,  and  who  is  willing 
to  drop  sectarian  principles ;  and  the  one  who  pins 
his  entire  faith  on  a  single  theory,  who  sees  no  chance 
for  salvation  beyond  his  own  creed,  and  who,  while 
pretending  to  believe  in  God,  boldly  declares  that 
Mahomet  is  his  only  prophet.  The  latter  apostles 
are  either  fools  or  knaves,  and  from  either  point  of 


THE   MEDICAl/ RECORD. 


379 


view  can  never  be  met  even  half-way  by  sincere  and 
earnest  men.  There  is  no  danger  that  consultations 
with  such  men  can  or  will  be  held  by  any  respect- 
able member  of  the  medical  profession  in  this  State 
or  anywhere  else.  Each  man  reserves  the  privilege 
of  satisfying  himself  on  these  matters  before  he  con- 
sents to  take  any  step  one  way  or  the  other. 

Of  course  we  hear  all  sorts  of  absurd  things  con- 
cerning the  desertion  of  the  old  ilag,  of  going  over 
to  the  enemy,  of  acting  in  defiance  of  all  the  prin- 
ciples of  right  and  justice  regarding  professional 
associations,  and  of  doing  many  other  terrible  things 
tending  to  encourage  quackery.  But  in  reality  the 
State  Society  has  only  done  a  common-sense  thing. 
It  merely  states  that  any  medical  man  who  chooses 
to  act  according  to  his  best  judgment  in  consultation 
with  any  honest  practitioner  whatsoever  can  do  so 
without  being  subjected  to  discipline  for  such  opin- 
ion's sake.  He  is  not  recommended  to  consult  with 
any  one  whom  he  may  consider  an  improper  person  ; 
he  can  refuse  to  consult  with  any  one,  regular  or  ir- 
regular, if  he  pleases  so  to  do.  No  effort  is  made, 
directly  or  indirectly,  to  do  aught  to  recognize  quack- 
ery in  any  of  its  forms.  Certainly  the  honor  of 
the  profession  can  as  safely  be  trusted,  perhaps,  in 
the  working  out  of  this  apparent  problem  of  requi- 
site qualifications  for  consultation  as  in  a  blind  obe- 
dience to  the  dicta  of  any  committee  on  ethics. 

The  principle  advocated  is  certainly  proper  and 
just.  It  lies  at  the  very  foundation  of  our  most  treas- 
ured privileges  as  citizens  and  men.  Its  proper  and 
consistent  application  to  the  wants  of  a  progressive 
and  liberal  profession  cannot  be  at  fault.  There  is 
every  excuse  for  being  on  the  side  of  advanced  opin- 
ion, freedom  of  thought  and  independence  of  ac- 
tion, even  at  the  risk  of  showing  our  enemies  and 
carping  critics  that  there  was  some  chance  of  im- 
provement, even  with  us,  who  heretofore  believed 
ourselves  perfect  in  all  things.  Truth  will  doubt- 
lessly be  vindicated  in  the  end.  The  public  will  give 
us  due  credit  for  sincerity  of  purpose.  At  least 
there  is  now  less  reason  than  ever  on  their  jjart  of 
stigmatizing  the  regular  profession  as  an  uncompro- 
mising trades-union. 

We  repeat  that  the  Medical  Society  of  the  State 
of  New  York  has  done  nothing  of  which  it  may  be 
ashamed.  It  can  take  nothing  back,  so  far  as  free- 
dom of  consultation  is  concerned.  The  stand  taken 
is  an  eminently  proper  one,  and  we  hope  it  will  be 
persistently  maintained,  even  at  the  risk  of  non- 
representation  in  the  American  Medical  Association. 
It  will,  in  any  event,  be  only  a  question  pi  time  for 
the  Association  itself  to  follow  the  example  of  the 
Society  of  this  State. 

The  free  and  progressive  spirit  of  medicine  can  no 
more  be  trammelled  by  foolish  restrictions  as  to  the 
conduct  of  its  members  than  can  its  grand  princi- 
ples be  made  to  revolve  upon  doctrinal  points,  or  its 


legitimate  aspirations  be  controlled  by  mere  sectariaD 
influences.  The  religion  of  medicine  is  as  broad  as 
humanity  itself,  and  should  compass  it  at  every 
point ;  its  faith,  founded  on  facts  in  science,  should 
reach  out  in  every  direction  for  new  strength ;  and 
its  mission  to  cure  the  sick  should  not  stop  short 
of  the  \ise  of  every  means  within  honest  reach.  The 
darker  the  places  beyond,  the  higher  we  should  raise 
our  torch,  and  the  more  persistently  and  earnestly 
should  we  press  forward.  The  Medical  Society  of  the 
State  of  New  York  has  striven  by  its  recent  action  to 
give  such  a  doctrine  its  most  liberal  interpretation, 
and  such  a  faith  its  most  practical  turn. 


THE   WAR   AGAINST    ADULTEKATIONS. 

The  constant  inspection  of  foods  and  drugs  by  Gov- 
ernmental authority  has  now  become  a  fixed  policy 
in  most  Euroi^ean  countries.  In  Germany  over  a 
quarter  of  a  million  of  samples  are  sometimes  an- 
alyzed yearly,  with  the  result  of  obtaining  some 
three  or  four  thousand  convictions.  Great  Britain 
shows  its  commercial  instincts  by  its  still  more  ex- 
tensive adulterations.  In  1879,  among  10,772  sam- 
ples examined,  2,978  adulterations  were  found. 

The  war  against  this  species  of  fraud  in  our  coun- 
try has  shown  itself  in  the  attention  paid  to  the  sub- 
ject by  our  Boards  of  Health.  These  organizations 
nearly  always  discuss  the  matter  in  their  annual  re- 
ports. The  State  Board  of  Health  of  New  Jersey 
has  established  a  Council  of  Analysts  to  whom  the 
investigation  of  adulterations  is  referred.  This 
Council  has  made  a  report  which  evinces  rather  more 
labor  than  is  usually  shown. 

It  may  be  of  interest  to  summarize  some  of  the 
results  obtained  by  the  examinations  of  these  New 
Jersey  chemists. 

The  teas  examined  showed  the  adulteration,  ia 
two  out  of  ten  cases,  by  foreign  leaves.  Exhausted 
leaves  were  also  frequently  found. 

The  coffees  in  the  whole  beny  were  found  to  be 
pure.  Coffee  "  essences,"  however,  contained  no 
coffee  whatever,  but  were  made  of  licorice,  chicory, 
and  caramel.  Ground  coffee,  in  almost  all  cases, 
contained  chicory,  corn,  beans,  potato,  or  rye. 

Loaf  and  granulated  sugars  contained  no  glucose. 
Brown  sugars  and  syrups,  however,  contained  from 
ten  to  thirty  per  cent,  of  it.  The  candies  examined 
were  mostly  of  glucose.  About  one-third  of  them 
were  adulterated  with  starch. 

It  should  interest  housekeepers  to  know  that  in 
all  the  twelve  samples  of  sago  and  tapioca  examined, 
no  sago  or  tapioca  was  found,  but  only  corn  and 
wheat  starch. 

The  investigations  into  the  quality  of  spices  gave 
about  the  usual  results.  Almost  all  of  them  are 
adulterated  ;  corn  starch  and  wheat  flour  being  the 
usual  foreign  admixtures. 

Vinegars  were  found  to  be  purer  than  is  usually 


380 


THE  MEDICAL  RECORD. 


supposed.  Pickles,  however,  in  almost  all  cases, 
coatained  copper.  The  "uncoppered"  pickle  is 
distinguished  by  being  of  a  yellowish  color,  while 
the  others  are  green. 

We  referred,  some  time  ago,  to  a  possible  source 
of  danger  to  households  in  the  use  of  canned  goods. 
In  most  cases  very  small  amounts  of  tin  and  lead 
are  found  in  these  preparations.  In  a  quart  can  of 
asparagus  there  were  over  four  gi-ains  of  dissolved 
tin  with  very  evident  traces  of  lead.  In  canned 
tomatoes  there  were  also  found  marked  evidences 
of  tin  and  lead,  the  latter  evidently  coming  from  the 
solder.  There  were  not  enough  examinations  made 
to  allow  of  any  positive  statements  to  be  made  re- 
garding the  danger  from  canned  foods.  It  is  prob- 
able that  some  varieties  of  vegetables  act  much  more 
powerfully  than  others  upon  the  tin. 

The  subject  of  the  adulteration  of  Jersey  milk  oc- 
cupies a  large  space  in  the  State  report,  and  is  too 
vast  for  discussion  here.  The  New  Jersey  farmer 
has  gradually  grown  into  the  accentuated  conscious- 
ness that  he  possesses  a  sacred  right  to  do  two  things 
—water  his  milk,  and  sell  his  vote  to  the  railroads. 
These  two  privileges,  together  with  his  unshaken 
faith  in  Presbyterianism,  form  the  tripod  upon 
which  rest  tlie  State's  temporal  progress  and  spir- 
itual well-being.  New  Jersey  milk,  if  conscious, 
would  feel  an  uneasy  sensation  of  neglect  if  not 
diluted,  like  an  infant  robbed  of  its  morning  bath. 
The  pump  is  more  to  our  neighbor  milkman  than 
drink ;  and  as  long  as  every  one  cannot  be  a  bank 
cashier,  he  will,  we  fear,  stick  to  this  next  best  source 
of  revenue.  The  New  Jersey  Board  of  Health  find 
that  nearly  all  samples  which  they  examined  at  first 
were  watered.  They  have  secured  some  temporary 
improvement,  but  only  that. 

But  we  trust  that  the  war  against  this  and  other 
adulterations  will  still  be  kept  up.  Success  is,  un- 
fortunately, most  needed  where  it  is  most  difficult  to 
secure  it. 


THE   StrPERVISION   OF   PRn'ATE   M.\D-HOUSES. 

A  CASE  has  recently  been  brought  before  the  Penn- 
sylvania courts  which  is  instructive  both  as  regards 
the  regulation  of  medicine  and  the  protection  of  the 
insane. 

It  appears  that  there  is  in  Philadelphia  a  certain 
Dr.  Livingston,  who  keeps  what  he  terms  a  "  Home  " 
for  the  treatment  of  the  in.sane.  One  branch  of  his 
establishment  was  put  in  charge  of  Mr.  E.  M.  Clif- 
ford, a  man  with  neither  a  licence  nor  a  medical 
•education.  Complaint  was  recently  made  again.st 
him  for  practising  without  a  diploma,  contrary  to 
law.  He  was  also  charged  with  maltreating  and 
drugging  some  of  his  patients.  He  is  to  be  tried 
for  the  illegal  practice  of  medicine,  and  it  will  bo 
a  satisfactory  precedent,  if,  as  seems  probable,  he  is 
convicted. 


But  another  important  fact  was  developed  by  the 
arrest  of  the  man  Clifford. 

At  the  _"  Home  "  of  which  he  was  in  charge,  a 
number  of  the  insane  were  confined  and  entirely  de- 
prived of  their  liberty.  This  was  done  without 
there  being  required  any  previous  certificates  of 
lunacy  from  examining  physicians.  And  it  appears 
that  the  Pennsylvania  law  so  reads  that  certificates 
are  not  neces.sary  for  the  incarceration  of  lunatics, 
or  supposed  lunatics,  in  i^rivate  homes.  If  a  person 
wishes  to  put  a  troublesome  relation  in  a  private 
mad-house  he  has  only  to  get  the  permission  of 
the  proprietor.  This  latter  gentleman  can  say  that 
his  institution  is  a  home,  and  the  law  cannot  in- 
terfere. 

The  Philadelphia  press  justly  complains  that  the 
law,  if  it  can  really  be  interpreted  as  above,  is  de- 
fective, and  leaves  a  way  open  for  great  abuses. 

In  this  State  the  law  provides  for  such  institu- 
tions, and  requires  a  medical  certificate  of  insanity 
before  any  person  can  be  secluded  in  any  public 
or  private  institution,  home,  or  retreat  for  the  in- 
sane. 

It  would  be  well  for  other  States  to  inquire 
whether  their  laws  have  not  the  same  defect  as 
those  of  Pennsvlvania. 


EXTENDING   THE   OEGANIZ.\TION   OF   CHAEITY. 

The  attempts  to  organize  charitable  work  in  Bos- 
ton, Philadelphia,  and  this  city  are  not  only  bearing 
fruit  directly,  but  their  example  is  stimulating  in- 
terest elsewhere.  The  good  work  is  extending,  and 
we  are  glad  to  learn  that  Newark  has  recently 
undertaken  it.  A  Bureau  of  Associated  Charities 
has  been  organized  in  that  city  upon  much  the  same 
plan  as  that  adojated  here. 

The  objects  of  the  association  are  to  secure  the 
co-operation  of  the  churches,  benevolent  societies, 
and  individuals  of  Newark  in  the  work  of  relieving 
the  poor. 

But  the  Society  also  aims  to  do  the  more  positive 
work,  such  as  is  undertaken  in  this  city  by  the  So- 
ciety for  the  Belief  of  the  Poor.  It  will  try  to 
diminish  begging  and  pauperism,  to  encourage 
thrift  and  self-dependence. 

The  organizers  of  the  Society  show  good  sense 
in  announcing  certain  limitations  to  their  work. 
Thus,  it  will  neither  solicit  nor  receive  funds  for 
the  purpose  of  almsgiving,  and  it  will  be  entirely 
secular  in  its  work. 

If  any  society  can  be  effective  in  teaching  people 
to  dislike  dei^endence  and  to  pay  for  services  ren- 
dered, medical  men  will  feel  grateful  toward  it, 
from  motives  not  entirely  philanthropic,  nor  yet 
entirely  selfish.  After  the  pauper  himself,  the  doc- 
tor perhaps  suffers  as  much  as  any  class  from  the 
misuse  of  charities  and  the  spirit  of  pauperism  in- 
culcated by  ill-judged  benevolence. 


THE  MEDICAL  RECORD. 


381 


THE   CCTRE   OP   WRITER'S   CRAMP   AKD   ALLIED  DISEASES. 

Some  months  ago  a  story  was  going  the  rounds  of 
the  medical  journals  to  the  effect  that  a  Mr.  Wolf, 
a  writing  master,  had  discovered  a  cure  for  writer's 
cramp.  At  Paris  he  cured  several  cases  taken  from 
Charcot's  clinic,  and  tliey  were  reported  by  Yigou- 
roux  in  La  Progri-s  Midical.  It  now  appears  that 
the  originators  of  the  method  employed  by  Wolf 
were  two  physicians,  brothers,  Drs.  Thos.  and  Aug. 
Schott,  living  in  Bad-Nauheim.  Dr.  Thos.  Schott 
has  recently  written  (Deutsche  Medizinal-Zeif-ung)  an 
account  of  his  method,  which  he  says  he  taught  to 
the  writing-master  referred  to  some  three  years  ago. 
The  Schott  treatment  consists  in  a  carefully  ap- 
plied series  of  active  and  ijassive-- gymnastic  move- 
ments, combined  with  nerve-  and  muscle-massage. 

The  passive  gymnastics  are  done  by  the  patient 
alone.  The  fingers,  hand,  forearm,  and  arm  are 
each  separately  and  carefully  put  through  every 
movement  possible  for  from  six  to  twelve  times. 
After  each  movement  there  must  be  a  moment  of 
rest.  The  duration  of  the  exercise  is  from  twenty 
to  forty  minutes. 

The  active  gymnastics  require  the  helj^  of  another 
person.  Each  sejsarate  muscle  is  again  brought 
into  action,  but  at  the  same  time  an  opposing  force 
is  used  by  the  attendant.  Thus  when  the  forearm 
is  to  be  flexed  on  the  arm,  the  attendant  places  his 
hand  on  the  patient's  wrist  and  makes  a  steady  and 
even  pressure  until  the  flexion  is  complete.  And  so 
for  the  rest  of  the  muscular  movements. 

Great  stress  is  laid  ujjon  the  muscular  contraction 
and  its  opposing  force  being  slow,  steady,  and  even, 
from  beginning  to  end.  The  duration  of  these 
movements  should  be  about  the  same  as  in  the  pas- 
sive gymnastics.  They  should  be  repeated  two  or 
three  times  daily. 

The  massage  is  ajiplied  to  the  nerves  first,  then 
to  the  muscles.  The  nerve-massage  consists  in 
stroking  the  skin  over  the  course  of  the  radial,  ulnar, 
and  median  nerves  as  high  up  as  the  brachial  plexus. 
The  strokes  should  be  at  first  soft,  then  gradually 
stronger,  then  soft  again. 

In  the  muscle-massage  the  rubbing  should  be 
firmly  done,  but  without  great  pressure. 

In  both  kinds  of  massage  there  should  be  no 
pinching  or  heavy  pressing,  and  the  strokes  should 
be  made  centripetally. 

Dr.  Schott  says  that  permanent  ciu'e  cannot  be 
induced  in  three  weeks,  but  that  it  will  in  almost  all 
cases  result  within  six  to  eight  weeks.  His  i^ractice 
has  been  chiefly  with  the  cramps  of  piano-players 
and  of  writers.  Those  occurring  in  telegraph  ope- 
rators, violin-players,  needlewomen,  etc.,  he  has 
had  no  experience  with,  but  he  believes  that  equally 
good  results  would  follow  the  use  of  his  method  in 
all  forms  of  the  di.sease. 

The  Schott  treatment  is  new  only  in  detail.  Its 
usefulness  in  many  cases  seems  undoubted. 


Eeports  of  Soctctiea. 


NEW   YORK  PATHOLOGICAL   SOCIETl. 

Stated  Meeting,  March  8,  1882. 

Dr.  Edward  C.  Seguin,  President,  in  the  Chair. 

Dr.  George  L.  Peabody  presented  specimens  re- 
moved from  the  body  of  a  man  thirty- seven  years  of 
age,  who  presented  the  usual  symptoms  of  chronic 
dift'use  nephritis,  together  with  evidence  of  dilatation 
of  the  heart.     The  heart  showed 

ECCENTRIC    HTPERTROPHy   WITHOUT    VALVULAR    LESION. 

The  organ  weighed  seven  hundred  and  fifty  grammes 
(twenty-five  ounces),  and  the  left  ventricle  was 
much  dihited.  The  exi)lanation  of  the  condition 
of  the  heart  suggested  by  Dr.  Peabody  was  that  it 
was  primarily  cardiac  hypertrophy,  occapioned  as 
the  result  of  chronic  Bright's  disease ;  that  the  dila- 
tation was  secondary,  possibly  due  to  some  acute 
disease  of  the  heart,  and  took  place  toward  the  close 
of  life.  Microscopically  the  muscular-  fibre  exhibited 
a  large  amount  of  fat,  more  abundant,  however, 
upon  the  left  than  upon  the  right  side.  The  aorta  was 
in  the  condition  of  advanced  atheroma. 

The  lung  presented  was  interesting,  because  it 
showed  the  lesions  of 

PIGMENT  INDURATION, 

which  were  illustrated  by  microscopic,  sections.  They 
exhibited  hypertrophy  of  the  walls  of  the  air-vesi- 
cles, dilatation  of  the  capillaries,  and  abundant  de- 
posit of  pigment  in  the  epithelium. 
The  kidneys  were  evidently  the  seat  of 

CHRONIC   DIFFUSE   NEPHRITIS. 

The  cortex  was  thinned  markedly  ;  the  markings 
were  obscure.  The  surface  was  granular,  and  micro- 
scopic sections  showed  hyaline  cast  material  in  the 
tubules,  atrophy  of  the  Malpighian  bodies,  complete 
in  some  places,  incomplete  in  others,  and  a  granular 
condition  of  the  epithelium  in  all  the  tubules. 

The  liver  illustrated  pigment  induration  in  the 
area  surrounding  the  central  vessels  of  the  lobules. 

The  qiletn  contained  the  remains  of  two  old  in- 
farctions. 

PRIMARY  SARCOMA   OF   BRAIN. 

Dr.  Peabody  also  presented  a  specimen,  accom- 
panied with  the  following  history  :  J.   W ,   fifty 

years  of  age ;  English ;  married  ;  bookkeejjer ;  was 
admitted  to  the  New  York  Hospital  October  2, 
1881.  Says  his  parents  died  suddenly,  both  hav- 
ing been  found  dead  in  bed.  They  ha-<l  nine  chil- 
dren, of  whom  only  one  is  dead,  he  having  died  of 
some  liver  disease".  The  others,  excepting  the  pa- 
tient, are  healthy.  Patient  admits  having  had  gonor- 
rhcea  once,  but  emphatically  denies  syphilis.  Has 
been  a  drinker  of  beer  and  whiskey.  Had  erysipelas 
in  childhood,  whicli  accounts  for  certain  scars  on 
one  of  his  legs.  Has  never  had  rheumatism.  Gives 
no  history  of  renal,  pulmonary,  or  cardiac  disease, 
or  of  injury. 

Last  winter,  after  a  shower-bath,  he  experienced  a 
sense  of  numbness  in  the  left  foot,  from  the  great  toe 
to  the  ankle,  which  persisted  for  some  time.  In  the 
early  part  of  this  year  he  felt  somewhat  run  down  in 
general  health,  but  with  no  very  definite  symptoms. 
For  this  he  travelled.  Last  June  (four  months  ago), 
in  the  early  morning,  while  still  in  bed,  he  had,  on 


382 


THE  MEDICAL  RECORD. 


awaking,  a  dull  pain  about  the  left  hip-joint  and  a 
sensation  as  if  all  were  gone  below  that  on  the  left 
side.  Unable  at  this  time  to  move  the  left  leg. 
Soon  thereafter  there  began  a  spasmodic  up-and- 
down  jerking  of  the  whole  pelvis,  excruciating 
pains  in  the  left  foot,  leg,  and  thigh,  and  sudden 
violent  clonic  spasm  of  the  whole  left  lower  extrem- 
ity (the  thigh  being  suddenly  and  completely  fle.xed 
upon  the  abdomen).  The  pain  then  seemed  to 
creep  up  to  the  left  arm  and  to  the  neck.  After  this 
he  lost  consciousness,  and  remained  unconscious  for 
an  hour.  On  regaining  consciousness  there  was  no 
aphasia,  but  the  tongue  was  terribly  bitten.  After 
the  attack  he  regained  completely  the  power  in  his 
limbs. 

The  patient  then  remained  in  good  health  up  to 
two  or  three  weeks  ago,  at  which  time,  under  the 
same  circumstances  and  surroundings,  he  had  a  sec- 
ond attack,  which  differed  from  the  first  only  in  that 
he  did  not  lose  consciousness  and  did  not  bite  his 
tongue.  He  regained  power  on  the  same  day  and 
went  to  his  place  of  business  as  usual.  Six  days 
ago  he  had  a  third  attack,  exactly  like  the  second, 
except  that  it  Viegan  by  clonic  spasms  in  the  left 
arm.  During  the  next  two  days  he  went  to  his  busi- 
ness. During  the  following  two  days  he  was  just 
able  to  drag  himself  about.  After  this  time  he  had 
to  give  up,  being  able  to  get  out  of  bed  only  with 
assistance.  Loss  of  muscular  power  has  daily  deep- 
ened. 

There  has  been  no  cincture  pain,  or  sphincter 
trouble,  no  pain  in  the  head  and  no  aphasia ;  also 
no  urinary  or  alimentary  disturbance. 

On  admission,  pulse,  respiration,  and  temperature 
are  normal.  He  is  fairly  nourisheil.  There  is  no 
ceclema,  no  loss  of  cutaneous  sensibility,  consider- 
able, though  not  complete  loss  of  power  in  left  up- 
per and  lower  e.xtremities.  Trial  with  dynamometer 
shows  left  hand,  0  ;  right  hand,  80.  Keflex  on  irri- 
tating sole  of  left  foot  is  diminished,  though  present. 
There  are  no  ocular  symptoms,  no  deviation  of 
tongue.  Heart,  lungs,  liver,  and  spleen  seem  nor- 
mal. 

During  the  mouth  following  his  admission,  he 
had  at  intervals  of  a  few  days,  marked  convulsive 
movements  of  the  left  side  of  his  body  and  extrem- 
ities. He  was  during  this  time  given  only  bromides 
of  potassium  and  ammonium,  with  an  occasional 
small  dose  of  morphine.  It  was  noticed  that  after 
each  of  these  spasmodic  attacks  the  jjatient  would 
lose  temporarily  the  little  remaining  power  of  his 
left  extremities  for  several  hours. 

At  the  beginning  of  his  second  month  in  hospital, 
November  19th,  he  was  given  mixed  treatment, 
which  consisted  of  hydrarg.  biniodid.,  gr.  ,V,  and 
potass,  iodid.,  gr.  x.  This  was  given  three  times  a 
day.  During  the  month  of  November  there  was  no 
marked  change  in  liis  condition.  Tbe  muscular 
spasms  became  rather  more  frequent  and  his  gen- 
eral nutrition  suffered  perceptibly.  Up  to  this  time 
there  had  been  no  headache. 

Early  in  December  his  convulsions  became  moi'e 
severe  and  more  general,  and  then  for  the  first  time 
since  he  came  under  observation  tliey  were  accom- 
panied l)y  periods  of  complete  unconsciousness, 
which  lasted  several  hours.  At  this  time,  too,  he 
began  to  complain  of  intense  pain  over  the  right 
hemicranium. 

Occasional  rigidity  of  the  right  lialf  of  the  body 
was  now  noted. 

On  December  17th  it  was  noted  that  the  right 
half  of  his  body  was  quite  stiff,  and  that  spasmodic 


contractions  of  the  muscles  of  the  right  hand  and 
forearm  occurred.  The  face  was  distorted  and  drawn 
to  the  right,  and  the  tongue  deviated  toward  the 
right.  The  patient  lay  in  a  dull,  lethargic  condi- 
tion very  much  of  tlie  time,  but  could  be  roused  to 
answer  questions  about  himself.  He  passed  urine 
and  f;eces  involuntarily.  There  was  no  strabismus. 
From  time  to  time  now  his  temperature  became  ele- 
vated to  a  slight  extent,  never  reaching  101'.  On 
December  20th  he  became  comatose  and  his  tem- 
perature rose  to  10-1.1°  F.  From  this  time  his  tem- 
perature steadily  rose  until  he  died  comatose,  of 
heart  failure,  at  10..30  p.m.  on  December  21st,  with  a 
temperature  of  108.7'  F. 

Aufopsi/  twelve  hours  after  death.  Body  ema- 
ciated. Rigor  mortis  well  marked,  no  oedema. 
There  are  superficial  scars  on  the  external  aspect  of 
left  leg — none  on  the  penis  or  elsewhere.  The  follow- 
ing measurements  of  the  limbs  were  made  :  Circum- 
ference of  thigh  at  middle — right.  Hi  inches  ;  left,  12^ 
inches  ;  circumference  of  legs  four  inches  below  pa- 
tella— right,  10|  inches  ;  left,  lOJ  inches  ;  circumfer- 
ence of  arms  at  middle — right,  8J  inches  ;  left,  7 
inches ;  circumference  of  forearm  3  inches  below 
olecranon — right,  8^  inches  ;  left,  7i  inches. 

Kigor  mortis  was  less  firm  on  left  side.  There  was 
a  small  superficial  bed-sore  over  the  upper  part  of 
the  sacrum. 

Brain. — There  was  marked  flattening  of  the  convo- 
lutions generally, which  was  more  marked  on  the  right 
side.  The  pia  mater  was  whitened  and  thickened, 
and  firmly  attached  to  the  dura  over  the  posterior 
part  of  the  first  frontal  convolution  on  the  right 
side.  After  removing  the  brain  from  the  calvareum 
and  placing  it  upon  its  base  it  was  noticed  that  the 
left  hemisphere  fell  away  from  the  median  line, 
partially  collapsing  as  usual.  The  right  hemisphere 
did  not  collapse  at  all,  its  highest  point  (fissure  of 
Kolando)  being  on  a  plane  three-fourths  of  an  inch 
higher  than  the  corresponding  point  of  the  left. 
There  was  a  bulging  of  the  anterior  two-thirds  of  the 
right  hemisphere  inversely  across  the  median  line. 
There  was  distinct  fluctuation  obtained  over  the  an- 
terior half  of  the  riglit  hemisphere.  The  brain  was 
then  v'ut  into  chromic  acid  for  hardening,  it  being 
merely  noted  in  addition  that  the  arteries  at  the 
base  are  normal. 

On  subsequent  examination  of  the  brain,  a  tumor 
was  discovered  in  the  right  hemisphere,  ovoid  in 
shape,  with  a  long  antero-posterior  diameter  of  two 
and  one-fourth  inches,  and  a  short  diameter  of  one 
and  one-third  inch.  It  began  posteriorly  in  the 
white  matter  just  at  the  terminal  portion  of  the  fis- 
sure of  Rolando,  and  lay  beneath  the  upper  half  of 
the  ascending  fi-ontal  convolution  and  the  posterior 
part  of  the  first  frontal  convolution.  It  had  invaded 
and  destroyed  much  of  the  gray  matter  of  these  two 
eonvohitions,  liut  did  not  seem  to  have  reached  any 
other  gray  matter. 

Microscopically  the  tumor  was  foiind  to  Vie  made  up 
chiefly  of  round  cells  with  some  spindle-cells  in  a 
very  tine  fibrous  stroma,  and  without  any  special 
arrangement.  He  jdaced  a  section  of  it  under  the 
microscojjo  and  it  was  seen  that  the  only  feature  of 
interest,  in  addition  to  those  mentioned,  was  that  it 
contained  many  blood-vessels,  some  of  which  were  of 
large  size.  It  was  to  be  considered,  therefore,  a  sar- 
coma. The  other  viscera  were  substantially  normal. 
The  Pkksident  remarked  that  Dr.  Peabody's  speci- 
men of  tumor  of  the  brain  was  a  valuable  contribu- 
tion to  localization.  It  was  situated  in  nearly  the 
same  location  where  he  had  found  a  tumor  in  two  or 


THE  MEDICAL  RECOED. 


383 


three  cases,  with  corresponding  symptoms.  The 
tumor  occupied  the  upper  part  of  the  motor  area, 
involving,  to  a  certain  extent,  the  paracentral  lobule, 
and  ho  thought,  from  the  epileptiform  attacks  in 
the  left  foot  and  leg,  that  the  tumor  began  at  that 
point  and  extended  anteriorly. 

Not  many  months  ago  he  met  with  a  central  tumor, 
and  the  patient  had  dragging  of  the  right  foot  for  sev- 
eral months,  afterward  right  hemiplegia,  and  still 
later  epileptiform  attacks  upon  the  left  side  with  no 
aj^hasia,  anil  there  was  carcinoma  of  the  ascending 
frontal  and  parietal  convolutions  near  the  longitudi- 
nal fissure.  In  that  case  thei-e  was  no  lesion  of  the 
optic  nerve. 

CON'TKACTED  MEATUS  UBDJABIUS  AS  A  CAtJSE  OF  SPASM 
AT  THE  NECK  OP  THE  BLADDER,  CYSTITIS,  AND  HT- 
DR0NEPHE0SI9. 

Dr.  F.  N.  Otis  presented  the  urethra,  bladder,  ure- 
ters, and  kidneys  removed  from  the  body  of  a  man, 
fifty-five  years  of  age,  who  had  sutfered  constantly 
for  more  than  twenty  years  with  frequent,  dilBeult, 
and  painful  micturition.  The  patient  stated  that  his 
troubles  began  with  a  gononhiea,  from  which  he  did 
not  sufler  very  much  during  the  acute  stage,  but 
chronic  urethritis  lasted  for  a  long  time,  and  finally 
the  bladder  became  aflected  ;  but  during  the  last  five 
or  six  years  his  trouble  had  been  chiefly  urethral.  He 
took  various  internal  remedies,  and  was  also  treated 
for  stricture.  When  he  first  suffered  from  frequent 
urination,  which  after  a  time  became  painful,  he  was 
treated  for  cystitis,  and  finally  stone  was  suspected 
on  account  of  the  intractability  of  the  vesical  symp- 
toms. He  was  under  the  care  of  Dr.  Metcalfe,  and 
when  the  case  seemed  to  be  more  surgical  than 
medical  it  was  turned  over  to  Dr.  Van  Buren,  who 
examined,  and  failing  to  detect  any  .stone  in  the 
bladder,  regarded  it  as  a  case  of  cystitis  arising  from 
disturbed  sexual  hygiene  among  other  things,  and 
kept  up  by  causes  of  that  character,  and  he  treated 
the  patient  by  making  local  applications  to  the  blad- 
der and  the  use  of  internal  remedies.  This  method 
of  treatment  was  continued  for  a  number  of  years, 
but  the  dilliculty  was  not  materially  benefited — 
sometimes  lietter,  at  other  times  worse.  The  fre- 
quency of  urination  and  the  pain  continued.  The 
patient  next  went  to  Europe  and  was  under  the  care 
of  Sir  Henry  Thompson,  who  examined  the  bladder 
for  stone,  but  found  none.  It  had  been  suspected, 
on  account  of  j^iain  in  the  region  of  the  right  kidney, 
that  a  calculus  existed  in  the  pelvis  of  that  organ, 
and  that  view  was  sustained  by  Sir  Henry. 

From  London  the  patient  went  to  Paris  and  was 
under  the  care  of  Civiale,  who  gav"e  him  such  a 
thorough  examination  for  stone  in  the  bladder  that 
he  was  unable  to  leave  his  bed  for  two  months,  but 
found  none  ;  nor  did  he  find  any  condition  of  the 
bladder  which  accounted  for  the  difficulty  of  urina- 
tion. 

Failing  to  get  relief  in  Europe  the  patient  re- 
turned to  New  York,  and  went  the  rounds  among  the 
regulars  and  the  irregulars,  proprietary  medicines, 
spiritualists,  etc.,  and  at  last  came  again  under  the 
care  of  Dr.  Metcalfe,  who  treated  him  in  a  general 
way  for  a  number  of  years.  The  only  relief,  and 
this  was  partial,  which  he  obtained  came  from  the 
occasional  introduction  of  a  sound — 2.5  mm.  Fr. 
passed  readily — into  the  bladder,  and  in  the  mean- 
time he  was  seen  by  several  men  and  was  the  subject 
of  a  variety  of  diagnoses. 

When  Dr.  Otis  saw  him  on  December  30,  1881,  he 
was  feeble,  emaciated,  and  tremulous,  and  he  had 


recently  suffered  from  chills,  followed  by  fever  and 
sweating.  Urination  occurred  about  every  fifteen 
minutes,  and  was  attended  with  the  most  intense 
agony.  The  pain  was  referred  chiefly  to  the  neck 
of  the  bladder,  somewhat  over  the  pubis,  and  in  the 
perineum,  but  no  pain  anywhere  else.  His  urine 
was  habitually  more  or  less  purulent,  but  there  was 
nothing  in  it  to  indicate  organic  disease  of  the  kid- 
ney or  bladder.  The  patient  had  had  one  or  two 
attacks  of  pain  refened  to  the  left  side,  thought  to 
be  renal  colic,  but  Dr.  Otis  was  unable  to  detect  any 
tenderness  in  that  region.  The  jienis  was  3f  inches 
in  circumference,  and  had  a  urethral  orifice  of  (hirtj- 
five. 

On  examining  with  the  uretbrometer,  he  found 
that  the  urethra  measured  37,  and  there  was  a  con- 
traction nearly  one  inch  from  the  orifice  to  25  or  26, 
and  as  the  instrument  was  brought  out  it  indicated 
35. 

Having  seen  cases  where  such  an  amount  of  con- 
traction 2Jroduced  spasm,  ijrolonged  cystitis,  and 
difficulty  of  urination,  extending  over  a  period  of 
eight  or  ten  years,  as  proved  by  the  relief  of  such 
trouble  upon  the  division  of  such  an  orifice,  he 
proijosed  to  divide  the  orifice  and  make  it  corre- 
spond with  the  urethra  behind  it.  The  patient  was 
etherized  January  1,  1882,  and  Dr.  Otis  made  the 
necessary  division,  so  that  a  No.  37  solid  steel  sound 
passed  by  its  own  weight  into  the  bladder,  demon- 
strating the  entire  freedom  from  stricture  at  any 
point. 

For  nearly  four  days  after  the  operation  he  was 
entirely  free  from  pain  referable  to  the  bladder  or 
penis,  but  there  was  complete  incontinence  of  urine. 
During  this  time  he  had  occasional  attacks  of  what 
seemed  to  be  renal  colic. 

On  the  fourth  day  he  began  to  have  some  control 
over  the  jjassage  of  urin^,  and  in  the  latter  part  of 
the  same  day  there  was  slight  pain,  which  increased 
as  the  control  over  the  urine  increased  ;  yet,  it  never 
recurred  to  the  degree  it  existed  before  the  opera- 
tion. 

Suddenly,  on  the  fifth  day  after  the  operation, 
and  for  the  first  time,  he  comjslained  of  pain  in  the 
head  of  his  penis,  and  immediately  a  series  of  .spasms 
occurred  like  those  from  which  he  had  previously 
suffered,  and  continued  at  intervals  of  ten  or  fifteen 
minutes.  After  two  days  he  began  to  show  some 
symptoms  of  ura-mia,  and  on  the  fourth  day  after 
the  occurrence  of  the  pain,  attributed  to  the  sudden 
appearance  of  a  stone  in  the  bladder,  he  passed  into 
coma  and  died. 

The  autopsy  was  made  by  Dr.  William  H.  Welch, 
who  furnished  the  following  report : 

"By  request  only  the  abdominal  organs  were  ex- 
amined. 

"Kidneys. — Both  kidneys  are  enlarged.  The  fibrous 
capsule  is  adherent  to  the  surface  of  the  organs. 
The  cortical  substance  presents  a  grayish,  nearly 
uniform  appearance,  with  little  trace  of  the  normal 
markings.  The  pyramids  are  in  great  part  en- 
croached upon  by  the  dilated  calyces.  No  abscesses 
are  present  in  the  kidneys.  The  pelvis  and  calyces 
of  each  kidney  are  greatly  dilated  and  contain  tur- 
bid ammoniacal  urine.  The  ureters  are  likewise  di- 
lated, so  that  their  calibre  equals  nearly  that  of  the 
small  intestine.  The  walls  of  the  ureters  are  thick- 
ened. No  obstruction  to  the  passage  of  urine  ex- 
ists, either  in  the  pelvis  of  the  kidneys  or  in  the 
ureters. 

"  Bladder. — The  wall  of  the  bladder  is  thickened  to 
about  four  times  its  normal  diameter.    The  thicken- 


384 


THE  MEDICAL  RECORD. 


ing  affects  all  of  the  coats  of  the  bladder,  but  espe- 
cially the  muscular  tissue.  The  mucous  membrane 
of  the  bladder  is  thickened  and  presents,  in  many 
places,  especially  about  the  base,  slight  elevated, 
grayish,  discolored  patches,  such  as  are  .seen  in  so- 
called  diphtheritic  cystitis.  The  capacity  of  the  blad- 
der is  about  that  of  the  normal  organ.  Its  contents 
are  ammoniaoal  urine  and  a  small  calculus.  This 
calculus  is  about  an  inch  in  length  and  conical  in 
shape,  resembling  somewhat  a  canine  tooth.  Such 
a  calculus  might  have  been  formed  in  one  of  the  di- 
lated renal  calyces.  The  calculus  is  apparently  of 
recent  formation,  being  very  friable,  and  composed 
wholly  of  phosphates,  without  a  nucleus  of  uric  acid 
or  oxalate  of  lime,  as  shown  by  chemical  examina- 
tion. 

"  Urethra  and  prostate. — The  prostate  is  of  about 
the  norma]  size,  and  had  not  occasioned  any  obstruc- 
tion so  far  as  could  be  detected.  The  calibre  of  the 
urethra  seemed  to  be  normal,  presenting  no  evi- 
dence of  stricture. 

The  spleen  is  somewhat  enlarged  and  surrounded 
by  firm  fibrous  adhesions.  The  liver,  stomach,  and 
intestines  present  no  noticeable  change.  The  mi- 
croscopical examination  of  the  kidney  showed  a 
marked  new  growth  of  fibrillated  connective  tissue, 
which  is  infiltrated  with  lymphoid  cells.  The  unif- 
erous  tubes  are,  in  jilaces,  compressed  and  atro- 
phied, in  places  dilated,  in  places  filled  with  fatty 
epithelium. 

"  Diagnosis. — Chronic  cy.stitis  with  dilatation  of 
the  ureters.  Hydronephrosis  and  chronic  inter- 
stitial nephritis.  The-  cause  of  the  cystitis  is_  not 
apparent." 

Remarks. — Dr.  Otis  thought  that  in  absence  of 
any  other  cause,  absence  of  obstruction  of  any  kind 
to  account  for  the  thickened  bladder,  the  dilated 
ureters,  and  the  hydronephrosis,  we  must  be  per- 
mitted to  suggest  the  possibility  of  all  the  difficulty 
having  been  produced  by  spasm  reflected  from  irri- 
tation at  a  distant  pai-t.  The  case  was  strictly  in 
line  with  cases  which  he  had  presented  to  the  pro- 
fession before,  cases  where  cystitis,  frequent  urina- 
tion, spasm  at  the  neck  of  the  bladder  had  continued 
for  a  long  time,  and  apparently  the  only  difficulty 
to  which  these  .symptoms  could  be  attributed  was 
contraction  of  the  meatus  urinarius,  not  greater  than 
in  the  present  case,  and  the  proof  that  the  supposi- 
tion was  correct  was  found  in  the  disappearance  of 
the  trouble  immediately  after  division  of  the  con- 
tracted orifice. 

The  stone  presented  was  evidently  of  recent  exist- 
ence in  the  bladder,  and  it  could  be  readily  seen 
how  it  applied  itself  to  dilated  calyx  upon  the  left 
side  nearest  the  ureter.  Dr.  Otis  thought  that  the 
stone  came  down  into  the  bladder  at  the  time  the 
patient  first  suffered  from  pain  in  the  head  of  his 
penis,  and  from  that  moment  a  series  of  spasms 
came  on  which  terminated  in  the  uricmia  that  caused 
deatli. 

(Tobocontinnoa.) 


ReMOVAI,  of  PtiASTEBOP-PARI'i  Band.^oes. — Dr.  F- 
H.  Murdock,  of  Bradford,  Pa,,  says  :  A  very  conve- 
nient way  to  remove  a  plasterof-Paris  V)andage  is  as 
follows  :  Take  a  strong  solution  of  nitric  acid,  and 
by  means  of  a  camel's  hair  pencil  paint  a  strip  across 
the  bandage  at  the  most  desirable  point  for  division. 
The  acid  will  so  soften  the  plaster  that  it  may 
be  readily  divided  by  means  of  an  ordinary  jack- 
knife. 


ACADEMY  OF  aiEDICINE,  CINCESnSTATI,  O. 

Staled  Meeting,  February  20,  1882. 
Thad.  a.  Keamt,  M.D.,  President,  in  the  Chair. 
Db.  William  Jitdkins  read  an  interesting  essay  on 
aspiration  of  the  knee-joint  (see  p.  370). 

Dr.  Whittaker  remarked  that  though  the  sub- 
ject presented  this  evening  was  of  a  purely  surgi- 
cal nature,  the  question  of  aspiration  also  belonged 
to  medicine  as  well,  and  he  therefore  hoped  to  be 
excused  for  discussing  the  subject  of  aspiration  in 
general.  The  honor  of  first  having  brought  aspira- 
tion to  the  notice  of  the  profession  jiroperly  belongs 
to  Dr.  Bowditoh,  of  Boston,  who  rejiorted  two  hun- 
dred and  fifty  operations  for  pleurisy  previous  to  the 
year  1870.  A  few  years  later,  1873,  Dieulafoy  brought 
out  an  improved  aj^pai-atus  for  aspiration,  and  from 
that  time,  stimulated  by  the  enthusiasm  of  the  in- 
ventor himself,  the  practice  of  aspiration  for  fluids 
in  the  different  cavities  of  the  body,  including  even 
the  skull,  became  more  general.  Dieulafoy  at- 
tracted special  attention  by  his  success  in  treating 
irreducible  hernia,  when  he  claimed  to  have  reduced 
twenty  out  of  twenty-seven  cases,  according  to  this 
plan.  The  success  of  the  aspirator  is  a  striking  ex- 
ample of  the  necessity  of  some  tangible  means  of 
illustration  liefore  a  practice  will  be  universally 
adopted.  It  was  the  same  thing  with  auscultation 
and  perciission,  which,  though  recommended  for 
years  jjreviously,  was  not  adojited  by  the  profession 
at  large  until  the  stethoscope  and  percussion-ham- 
mer were  introduced. 

Aspiration  belongs  to  the  gi-eatest  triumphs  in 
modern  medicine,  notwithstanding  the  opposition 
it  has  met  with  from  different  authors.  Fox,  es- 
pecially, proclaimed  against  this  operation  in  pleu- 
risy in  the  last  four  years,  and  his  objections  at- 
tracted considerable  notice  on  accoimt  of  its 
apparent  dangers  as  pointed  out  by  him.  Subse- 
quent testimony,  however,  disproves  this  view.  The 
most  frequent  use  for  the  aspirator  in  medicine  is 
for  pleurisy,  when  the  relief  by  aspiration  is  imme- 
diate, devoid  of  danger,  and  frequently  not  attain- 
able by  other  means.  In  acute  pleurisy,  aspiration 
ought  to  be  made  after  three  weeks.  In  pericardial 
effusions  the  aspirator  is  also  of  infinite  value,  as  it 
establishes  the  diagnosis  as  well  as  serves  as  the 
best  means  of  therapy. 

Surgeons  have  been  rather  slow  in  adopting  as- 
piration for  effusions  into  joints.  It  is,  therefore, 
most  gratifying  to  hear  that  .American  surgeons  did 
so  much  to  introduce  this  operation  in  these  regions 
also  ;  foreigners  seemed  to  have  generally  incised 
the  cavities  of  joints  and  washed  them  out.  This 
procedure  is  connected  with  danger  to  the  joint  on 
account  of  the  admission  of  air,  which  is  obviated 
by  the  use  of  the  aspirator.  The  joint  that  seems 
to  suffer  most  from  the  accumulation  of  fluid  is  the 
knee.  The  speaker  never  had  an  opportunity  to 
perform  the  operation  in  hydrarthrosis  ;  he  had  once 
a  case  where  he  was  very  anxious  to  aspirate,  but 
consent  was  not  given.  Thinking  that  the  habita- 
tion might  have  something  to  do  with  the  chronic 
rheumatic  affection,  he  suggested  to  the  patient  a, 
change  of  residence,  after  which  the  effusion  disap- 
peared in  two  weeks,  never  to  retiirn.  He  also  re- 
membered a  case  of  ponorrlural  rheumatism  of  six 
months'  duration.  This  jiatient  also  refused  aspira- 
tion, whereupon  the  speaker  applied  the  constant 
electric  current  and  the  disease  disappeared.     This 


THE  MEDICAL  RECOED. 


385 


is  surprising  when  it  is  considered  that  gonorrhoeal 
inflammation  of  the  knee-joint  is  usually  ranked  as 
the  most  obstinate.  It  is  now  generally  admitted 
that  gonorrhoea  is  jijiemic  in  chaiacter,  caused  by 
the  absorption  of  the  poison  after  the  primaiy  acute 
symptoms  have  subsided.  But  joint  affections  may 
come  on  after  any  acute  infectious  disease,  as  ty- 
phoid fever,  etc. 

Aspiration  ought  to  have  a  wider  range  of  use 
than  it  has.  Some  years  ago  the  speaker  aspii-ated 
a  bladder  in  a  patient  who  suffered  retention  of 
urine  from  a  fractured  pelvis.  This  j)atient  was  a 
somnambulist,  and  had  fallen  out  of  a  window  dur- 
ing one  of  his  attacks,  fracturing  the  pelvis.  The 
aspiration  was  made  in  the  bladder  twenty-six 
times. 

Dr.  Eavogli  said  he  could  not  believe  in  a  gonor- 
rhoeal  arthritis.  He  had  attended  a  venereal  clinic  in 
Italy  many  years  and  never  saw  a  case  of  gonor- 
rhceil  inflammation  of  the  joint.  The  disease  is  gen- 
erally local,  confined  to  a  blenorrhagia  of  the  mu- 
cous membrane  of  the  urethra,  and  if  theie  is 
simultaneously  a  a  inflammation  of  the  knee  it  is 
only  incidental.  The  rheumatism  in  .such  jjatients 
depends  oa  other  causes.  As  a  class  the^se  persons 
lead  an  irregular  life,  drink  wine  and  beer  freely, 
etc.  There  can  be  no  direct  connection  with  the 
knee.  A  gonorrhueal  orchitis  occurs  by  transmission 
of  the  disease  through  the  spermatic  cord,  it  can 
even  attain  the  kidneys,  though  this  is  rare,  but  has 
no  direct  connection  with  the  knee-joiut.  As  for  as- 
piration it  is  not  necessary  in  serous  effusions.  The 
serous  membrane  is  very  extensive  and  presents  a 
large  absorbing  surface ;  iodine  locally  and  a  fixed 
immovable  apparatus  is  sufficient  to  promote  absorp- 
tion. If  the  effusion  last  a  long  time  a  wire  may  be 
drawn  through  the  synovial  sac,  by  which  the  fluid 
may  be  drained  off  entirely,  a  closure  being  )ue- 
vented  by  the  presence  of  the  wii-e.  This  method 
is  not  very  painful  and  very  effective.  In  purulent 
effusions  it  is  necessai-y  to  be  cautious  on  account  of 
the  dangers  of  py:T?mia  by  the  admission  of  air.  It 
is  therefore  best  to  wait  until  nature  decides  the 
point  of  opening,  and  then  a  free  incision  should  be 
made.  The  speaker  objected  to  injections  with  car- 
bolic acid  solutions  on  account  of  the  dangers  of 
poisoning  which  may  take  place  from  absorption  of 
this  substance  by  the  serous  membrane.  He  had 
frequently  seen  symptoms  of  carbolic  acid  poisoning 
arise  from  the  use  of  the  spray  in  Listerism. 

Db.  Whittakeb  replied  that  he  must  maintain 
that  the  existence  of  a  gonorrhceal  arthritis  is  possi- 
ble. It  is  true  there  may  be  a  coincidence  of  the 
two  affections,  and  as  such  they  were  at  first  re- 
garded ;  but  the  frequent  occurrence  of  inflamma- 
tion of  the  joint,  with  gonorrhuea,  shows  that  it  is 
more  than  a  coincidence,  namely,  a  sequence.  Heart 
disease  stood  in  the  same  relation  to  rheumatism 
until  the  connection  was  established  bvthe  frequent 
occurrence  of  these  two  diseases.  Of  course  the 
possibility  of  any  of  these  affections  existing  inde- 
pendently is  not  thereby  to  be  denied.  Some  per- 
sons will  have  gonorrhoea  without  the  consequent 
arthritic  trouble,  just  as  others  wiU  be  subject  to 
scrofula  and  yet  have  not  the  white  swelling  com- 
mon in  such  persons.  Arthritis  is  a  common  comi>li- 
cation  of  pyiemia,  and  may  depend  on  infection  of  a 
varying  nature,  and  occurs  in  the  histoi-y  of  certain 
infectious  diseases.  The  speaker  failed  to  see  the 
connection  of  the  inprestion  of  wine  and  beer  with 
rheumatism  in  gnnorrhoeal  patients  ;  neither  can  ex- 
posure to  cold  always  account  for  the  rheumatism, 


as  these  persons  are  generally  careful  to  guard 
against  exposure.  An  irritation  is  conveyed  to  the 
joints  in  various  ways.  A  gonorrha-al  bubo  de- 
pends on  an  infection  thiough  the  lymiih-channels. 
This,  however,  does  not  mean  that  we  are  to  expect 
the  same  consecutive  results  as  in  syphilis.  Even 
the  mere  introduction  of  a  catheter  may  set  up  an 
urethral  fevei-  followed  occasionally  by  orthritis. 
What  the  infecting  cause  may  be  is  hard  to  say : 
perhaps  micrococci  that  enter  the  blood  or  lymph- 
vessels  in  gonorrhoea,  or  are  earned  in  by  catheter- 
ization. 

Aspiration  is  a  trivial  measure  when  compared 
with  opening  the  joint  by  means  of  an  incision.  As 
for  the  introduction  of  a  wire  through  the  synovial 
sac,  the  speaker  regarded  it  as  an  antiquated  therapy, 
much  more  painful  and  dangerous  than  aspiration, 
liable  to  result  in  iinkylosis  just  as  well  as  the  seton 
or  silk  thi'ead,  formerly  used  for  that  purpose. 

Db.  Judkks,  in  concluding  the  discussion,  said 
that  the  pain  in  effusions  of  the  knee-joint,  of  an  in- 
flammatory character,  is  so  excruciating  that  imme- 
diate relief  is  sought.  This  aspiration  will  give,  as 
testified  by  Dieulafoy  and  many  others  after  him. 
Compared  with  the  aspirator  the  passing  of  a  wire 
through  the  joint  seemed  to  him  also  an  unnecessaiy 
infliction  of  pain.  The  speaker  had  never  used  car- 
bolic acid  injections  into  joints,  for  fear  of  setting 
up  a  poisoning  by  the  absoi-ption  of  this  agent. 


CINCINlSfATI    aiEDICAL    SOCIETY. 

Staled  Meeting,  February  14,  1882. 
Db.  G.  BeUITL,  PBE.SrDEKT,  IN  THE  Chaie. 

Discrssiox  of  Dr.  Wm.  Judkins'  paper  upon  aspira- 
tion of  the  knee-joint  (see  page  370). 

Db.  a.  M.  Beows  remarked  that  the  propriety  of 
aspiration,  when  it  becomes  necessary  to  open  the 
knee-joint,  is  not  to  be  questioned.  It  is  not  only 
the  best,  but  the  only  safe  mode  of  proceeding.  But 
he  thought  it  unnecessary  to  perforate  the  joint 
unless  the  contained  fluid  be  punilent.  His  experi- 
ence in  the  few  cases  he  had  tieated  led  him  to  be- 
lieve that  non-pui-ulent  collections  could  lie  more 
successfully  managed  by  the  elastic  bandage  and 
fixation  of  the  limb.  Tlie  painful  tension  would  be 
relieved  and  absorption  be  promoted  by  this 
course. 

Db.  ScmvAZsrEYEB  agreed  with  the  last  sj^eaker 
that  aspiration  was  not  necessary  unless  the  presence 
of  pus  coidd  be  shown,  and  narrated  a  case  he  had 
successfidly  treated  by  bandages  and  splint  alone. 
This  pain  and  swelling  of  the  knee-joint  was  exces- 
sive, but  the  exploring  needle  showed  clearly  that 
the  contained  fluid  was  not  purulent.  To  evacuate 
pus  he  thought  aspiration  the  only  method  to  be 
adopted. 

Db.  Caeb  stated  that  he  thought  this  operation  to 
be  one  of  gi-eat  value  ;  he  had  resorted  to  it  in  one 
case,  and  the  result  confirmed  his  belief.  The  case 
referred  to  was  that  of  a  child  one  year  old  with  a 
suspicion  of  hereditary  syphilitic  taint.  The  knee 
was  gi'eatly  swollen,  and  upon  palpation  gave  every 
indication  of  the  presence  of  fluid.  Ten  ounces  of 
pus  was  drawn  off'  by  the  as)iirator  and  no  untoward 
symptom  followed.  Dr.  A.  M.  Brown  saw  the  case 
at  the  time.  In  six  weeks  all  trouble  had  disap- 
peai-ed  from  the  knee.     No  ankylosis  followed. 

Db.  W.  B.  Dams  thought  this  ojieration  shoirld  be 
resorted  to  in  all  suitable  cases,  as  it  was  pro\  en  by 


386 


THE  MEDICAL  RECORD. 


the  many  reports  cited   by    the  essayist  to  be  per- 
fectly safe  and  very  prompt  in  relieving  pain. 

Dr.  Ke.irnet  remarked  that  he  had  had  no  experi- 
ence in  aspiration  of  the  knee,  but  if  npon  further 
trial  it  should  prove  to  be  as  safe  as  is  claimed  by 
the  autliorities  quoted  in  the  essay,  it  would  un- 
doubtedly be  of  great  service,  for  tlie  relief  of  pain 
is  a  most  important  element  in  the  treatment  of  dis- 
eases of  this  joint.  But  in  this,  as  well  as  in  all  other 
innovations  upon  established  modes  of  practice,  we 
have  at  first  only  the  favorable  evidence,  only  the 
saccessful  cases  have  been  reported.  In  a  matter 
so  grave  as  opening  the  knee  joint  we  would  do  well 
to  suspend  judgment  until  the  witnesses  on  the  other 
side  have  been  heard  from. 

Dr.  C.  p.  JoDKtNS  remarked  that  he  had  no  expe- 
rience in  perforation  of  the  knee-joint,  but  thought 
a  disposition  was  prevalent  in  the  profession  to  re- 
sort to  the  use  of  the  knife  or  aspirator  for  that 
purpose  in  many  cases  where  a  course  less  hazard- 
ous would  be  equally  if  not  more  successful.  His 
experience  in  tapping  hydrocele  and  the  abdominal 
cavity  led  him  to  believe  the  trocar  and  canula  just 
as  safe  as  the  aspirator.  The  inflammation  after 
tapping  a  hydrocele  is  not  the  result  of  the^  opera- 
tion itself,  but  arises  from  the  irritating  injections 
generally  used.  If  a  twenty-five  per  cent,  solution 
of  carbolic  acid  be  injected  the  ]>atient  can  go  about 
his  business  at  once  without  inconvenience. 

Dr.  John  Davis  remarked  that  while  the  reports 
collected  by  the  essayist  showed  that  aspiration  of 
the  knee-joint  mav  be  done  often  and  with  great  re- 
lief, yet  he  thought  there  was  risk,  and  so  grave  a 
matter  as  perforation  should  not  be  thought  of  when 
a  cure  could  be  effected  by  other  means.  In  his 
practice  stimulating  applications  and  compression 
with  constitutional  treatment  had  generally  jiroved 
suffiiMent.  While  he  did  not  condemn  the  operation, 
he  would  not  resort  to  it  except  in  a  case  of  very 
great  urgency,  where  the  jjvesence  of  pus  could  be 
positively  demonstrated.  The  Doctor  then  referred 
to  two  oases  of  perforation  of  the  knee-joint  which 
had  come  tinder  his  observation.  The  discharge 
was  long-continued  with  frequently  recurring  inflam- 
mation, and  final  recovery  with  partial  ankylosis. 


CATaAUTIOS  OIVEN  Hl'PODERMICALLY. — Dr.  G.  Frou- 
miiller  repeats  a  7)revious  statement  of  his  (Memora- 
hilien,  February,  ISS'2)  that  the  subcutaneous  injec- 
tion of  Merck's  aloin  acts  promptly  and  efficiently  as 
a  cathartic.  He  uses  a  solution  of  aloin  in  water 
(1-25).  A  passage  from  the  bowels  follows  within 
throe  to  five  hours  except  in  cases  of  obstinate 
constipation. 

Solutions  of  extract  of  aloes  are  not  eflScient,  as 
they  are  in-it  iting  locall v.  Concentrated  decoction  of 
senna  leaves  was  tried  by  injection,  but  without 
favorable  results. 

Dr.  Froum'iller  thinks  the  aloin  injections  will 
prove  useful  in  cases  of  gastric  catarrh  or  cancer  ; 
also  in  the  insane  and  nnconsciovis,  and  lymph- 
spaces,  and  thus  to  help  the  removal  of  inflammatory 
products.  It  is  said  by  Dr.  Klein  to  diminish  intra- 
ocular pressure  and  to  relieve  pain.  It  is  therefore 
helpful  in  certain  forms  of  glaucoma  and  of  ciliaiy 
nenralgia. 

It  is  contra-indicated  in  acute  inflammations  or 
whore  there  is  great  conjunctival  or  corneal  sensi- 
tiveness. 


^oxxt&poribince. 


MEDICAL  AND  SANTT.YEY  NOTES  ON  THE 
FOREIGN  SETTLKNIENTS  OF  EASTERN 
AND  SOUTHERN  ASLA. 

To  THE  Epitor  of  The  SIeuical  Rbcobd. 

Snt :  Settlements  of  the  representatives  of  Western 
nations  on  the  shores  and  rivers  of  Eastern  Asia  have 
gi'eatly  increased  within  the  past  few  years.  From 
Pekin  to  the  most  southern  extremity  of  the  Malay 
Peninsula  they  now  number  some  twenty  or  more. 
The  largest  of  these  contain  of  "foreign  residents" 
from  two  to  five  thousand,  and  the  smallest  from 
fifty  to  two  hundred. 

In  all  these  we  find  medical  men  of  more  than 
ordinai-y  attainments,  many  of  whom  are  attached 
to  hospitals  for  foreigners  and  natives.  The  Chinese 
Maritime  Customs  have  a  physician  in  all  the  treaty 
ports,  wlio  report  semi-annually  to  its  medical  direc- 
tor (Dr.  K.  Alex.  Jamison)  the  sanitary  condition  of 
their  resjiective  localities,  and  the  diseases  which 
prevail  among  both  foreigners  and  natives.  These 
are  printed  at  the  expense  of  the  Chinese  Govern- 
ment for  gratuitous  distribution.  The  material  thus 
collected  will  soon  be  sufficient  to  justify  some  cor- 
rect conclusions  as  to  the  medical  geography  of  this 
quarter  of  the  globe,  the  knowledge  of  which  is  at 
present  exceedingly  meagre  and  unsatisfactory.  It 
is  not  our  object  at  this  time,  however,  to  more  than 
touch  upon  some  points  of  this  subject  which  may 
be  of  possible  interest  to  the  general  reader. 

The  diseases  affecting  foreign  residents  in  Eastern 
Asia  necessarily  depend  greatly  on  the  latitude  and 
sanitary  surroundings  of  their  settlements. 

Pekin,  being  open  to  the  diplomatic  representa- 
tives of  the  treaty  powers  and  missionaries  only, 
contains  but  few  foreigners  compared  with  the  jilacos 
to  be  hereafter  mentioned.  Being  in  iO'  north  lati- 
tude, the  climate  is  one  of  extremes  of  heat  and 
cold,  as  elsewhere  in  the  same  parallel.  The  rain- 
and  snow-fall,  however,  is  very  light,  the  former  be- 
ing in  a  whole  year  little  more  than  that  of  a  single 
twenty-four  hours  in  more  southern  latitudes.  The 
diseases  are  those  which  belong  to  inland  cities  in 
the  same  latitude  in  other  parts  of  the  world.  Theie 
is  one  hospital  for  natives,  in  connection  with  the 
London  Missionary  Society.  Number  of  outdoor 
patients  during  the  vear  1877,  8,28-t ;  indoor  for 
the  same  year,  20.  Miss  Dr.  Howard,  an  American 
missionary,  has  also.  I  believe,  a  hospital  for  women 
in  Pekin,  and  is  doing  some  excellent  work,  espe- 
cially among  the  higher  classes  of  Chinese. 

In  addition  to  these,  there  is  a  refuge  or  asylum 
for  opium-smokers,  a  report  of  which  is  before  me. 
The  number  of  indoor  jiatients  treated  in  1S78  and 
1879  were  78  and  08  respectively ;  out-patients,  225 
and  385  for  the  same  years  respectively.  The  insti- 
tution is  supported  by  voluntary  subscription  and 
the  sale  of  pills  claimed  to  have  the  effect  of  reliev- 
ing or  curing  those  addicted  to  the  habit  of  opium- 
smoking.  Curiously  enough  the  report,  though 
made  by  a  medical  man.  does  not  give  the  composi- 
tion of  these  pills.  The  success  of  the  refuge  is 
claimed  to  be  encouraging  and  in  many  respects  sat- 
isfactory. 

In  connection  with  the  agitation  now  goinpr  on  in 
the  English  Parliament  on  the  opium  traffic  with 
China  and  a  more  or  less  general  interest  taken  in 
the  subject  by  philanthropists  elsewhere,  I   have 


THE  MEDICAL  RECORD. 


387 


taken  some  pains  to  make  inquiries  of  respectable 
medical  men  in  China  as  to  the  real  extent  of  the 
evil.  There  appears  no  difference  of  opinion  as  to 
the  widespread  use  of  the  drug  by  all  classes  of  the 
people,  and  as  to  its  steady  increase.  Especially  is 
this  the  case  among  the  wealthy  and  generally  well- 
to-do.  A  pipe  of  opium  is  to  the  Chinepe  host  what 
a  glass  of  sherry  is  to  the  Western  gentleman,  and 
is  offered  to  guests  in  the  same  way — as  a  sign  of 
hospitality.  In  a  word,  opium  smoking  is  in  China 
what  dram-drinking  is  in  England  and  America,  no 
more  nor  no  less. 

Their  degrading  and  demoralizing  effects  are  not 
very  different,  though,  of  the  two,  opium-smoking 
is  the  least,  as  it  simply  renders  its  victim  harmless 
and  inoffensive,  and  leads  to  crime  only  as  a  means 
of  obtaining  the  drug  to  satisfy  the  appetite  for  it. 
The  horrid  picture  of  emaciation  of  its  victims,  as  is 
often  represented,  is  not  the  direct  effects  of  the 
di-ug,  but  of  insufficient  nuta'ition  or  starvation,  as  a 
man  who  is  able  to  pay  for  both  food  and  opium 
presents  no  such  appearance. 

Some  curious  results  have  been  obtained  by  Dr. 
AvTcs,  colonial  surgeon  of  Hong  Kong,  in  the  treat- 
ment of  jjrisoners  who  are  the  victims  of  ojuum- 
smokiug.  He  finds  that  the  sudden  and  comjilete 
withdrawal  of  the  drug  from  old  and  even  confirmed 
opium-smokers,  is  not,  as  a  rule,  attended  with  the 
fearful  consequences  it  is  supposed  to  be,  and  that 
a  restless  night  or  two  is  all  that  is  suffered  from, 
though  the  subject  may  have  declared  that  he  would 
certainly  die  without  it  or  some  substitute  for  it. 
The  following  experiment  was  made  by  Dr.  Ayres 
with  a  number  of  opium-smokers,  who  claimed  to  be 
good  judges  of  samples  of  the  drug.  A  given  sjieci- 
men  was  divided  into  three  equal  parts.  From  the 
first  all  the  morphia  was  extracted,  the  second  was 
left  in  its  original  state,  containing  seven  and  one- 
half  per  cent  of  morphia,  and  to  the  third  was  added 
seven  and  one-half  per  cent,  of  morphia,  making 
fifteen  per  cent.  This  was  all  put  in  the  little  pots, 
or  in  packages,  the  same  as  when  offered  at  retail. 
These  three  specimens  were  given  to  the  smokers 
referred  to,  and  after  a  fair  trial  all  were  declared 
to  be  equally  good.  Dr.  Ayres  admits  that  he  is  at  a 
loss  for  an  explanation  of  this,  unless  it  is  that  the 
actual  amount  of  the  active  principle  of  the  drug 
inhaled  by  the  smoker  in  all  cases,  is  but  a  very 
small  part  of  that  which  the  gum  contains;  That 
quite  a  percentage  remains  in  the  ash  is  well  known, 
and  a  further  loss  is  probably  sustained  by  the  de- 
composition of  a  certain  amount  of  the  morphia  from 
the  action  of  the  heat  necessary  to  ignite  the  mass. 
I'l  conclusion,  the  Doctor  thinks  that  the  evil  effects 
of  opium-smoking  is  much  exaggerated  Indeed,  he 
states  po!)ilireJii  that  compared  with  opium-eating 
they  are  infinitely  less.  I  find  this  to  be  the  opinion 
of  medical  men  generally  all  over  the  East.  Also, 
that  but  few,  compai'atively  of  those  that  smoke  are 
e.rce.«(>je  in  its  use  any  more  thau  are  the  wine- 
drinkers  of  the  west,  and  that  if  its  evils  could  be 
estimated,  it  would,  as  I  have  already  intimated,  be 
found  /ess  than  that  of  the  use  of  intoxicating  drink 
elsewhere. 

After  this  somewhat  long  digression,  I  will  now 
resume  my  observations  on  medical  and  sanitary 
matters  generally  in  the  East.  After  Pekin,  Shang- 
hai is  the  next  settlement  of  importance  of  foreign- 
ers on  the  China  coast,  and  contains  a  population  of 
2,107  representatives  of  -western  nations,  and  99,000 
natives.  It  is  situated  on  the  delta  of  the  Yang-tse, 
the  Mississippi  of  Asia.    Its  sanitary  surroundings 


are  bad,  and  its  water-supply  can  hardly  be  ■worse, 
though  recently  much  money  has  been  expended  for 
its  imjjrovement.  There  are  in  this  city  eleven  med- 
ical men  in  civil  practice,  six  Irish,  two  Ameri- 
cans, two  Germans,  and  one  French. 

There  are  five  hospitals,  one  for  foreigners  alone, 
and  four  for  Chinese.  The  total  number  of  deaths 
among  foreigners  for  1880  was  78.  Eight  of  these 
Therefrom  accidental  drowning,  12  phthisis,  3  liver 
abscess,  10  diarrho'a,  -S  dysentery,  1  cholera  infantum, 
and  4  diseases  of  the  heart.  Miscellaneous  diseases 
were  the  causes  of  the  remaining  deaths,  though  no 
more  than  two  from  any  one  of  them.  This  is  an 
exceedingly  good  showing,  considering  all  the  cir- 
cumstances of  the  place  and  climate.  It  may  be 
said,  however,  that  most  of  the  residents  are  in 
good  circumstances,  and  if  at  all  indisposed,  go  to 
health  resorts  up  the  coast  or  to  Japan,  and  those 
suffering  from  chronic  complaints  return  home,  per- 
haps to  die.  The  majority,  however,  if  not  falling 
positively  ill,  .sufl'er  more  or  less  from  the  debilitat- 
ing efl'ects  of  the  climate  and  require  frequent  and 
prolonged  change.  This  is  especially  the  case 
with  women  bearing  children.  The  diseases  pe- 
culiar to  children  appear  more  common  than  in 
Japan,  thus  dijjhtheria,  measles,  whooping-cough, 
etc.,  are  not  infrequent.  Cholera  sometimes  occnis 
for  four  or  five  successive  summers  among  foieipn- 
ers  as  well  as  natives,  though  the  cases  among  the 
former  are  u.sually  few.  Hong  Kong,  an  English 
colony,  between  eight  hundred  and  nine  hundred 
miles  farther  south,  is  situated  on  an  island,  and 
contains  about  five  thousand  foreigners  and  two 
hundred  and  fifty  thousand  Chinese. 

The  climate  of  the  place  is  semi-tropical  and  the 
air  heavily  loaded  with  moisture  the  gi'cater  part  of 
the  year.  It  has  4  hospitals  :  1  government,  1  civil 
or  municipal,  1  native,  and  1  lock.  The  civil  hospi- 
tal is  for  both  foreigners  and  natives.  The  native 
hospital  is  for  natives  alone,  and  the  physicians  and 
system  of  medical  treatment  are  entirely  Chinese. 
It  is  built  of  granite,  and  consists  of  two  two-story 
buildings,  a  council  hall,  small-pox  wards,  and  dis- 
pensary, and  has  accommodations  for  ICO  men  and 
.50  women.  The  yearly  admissions  are  1,700.  It 
has  an  out-door  department,  with  a  daily  attendance 
from  seventy- five  to  one  hundred.  It  is  supported 
entirely  by  private  subscription,  and  was  originally 
built  to  take  the  place  of  what  is  called  the  "  dying- 
house,"  i.  e.,  a  place  for  Chinese  to  die  in,  as  they 
have  a  great  dislike  to  anyone  dying  in  their  house, 
hence  many  during  their  last  moments  were  taken 
out  in  the  street  to  expire.  Xow  they  are  taken  to 
this  place  instead.  Though  there  are  ten  physicians 
in  attendance,  the  name  "dying-house"  is  not  mis- 
applied, as  few  really  serious  cases  ever  recover 
when  taken  to  it.  The  place  is  kept  fairly  clean  (for 
Chinese)  and  the  ventilation  good.  The  treatment 
of  surgical  cases  especially  is  something  horrible  to 
witness.  In  fact,  the  cases  are  not  treated,  as  we 
understand  the  term,  but,  if  we  are  not  mistaken, 
often  assisted  to  die,  by  the  use  of  thoroughly  irra- 
tional and  barbarous  means.  We  cannot  understand 
the  reason  for  not  employing  foreign  surgeons  here, 
as  the  Chinese  usually  have  great  faith  in  Western 
surgeons,  though  they  may  reject  their  medical  treat- 
ment. 

The  Chinese  hospital  of  Dr.  Kerr  at  Canton  affords 
an  example  of  this  confidence,  as  his  operations  for 
stone  now,  I  believe,  outnumber  those  of  any  other 
man.  The  next  settlement  in  order  is  the  French 
colony  of  Saigon.    It  is  situated  up  one  of  the  large 


988 


THE   MEDICAL  RECORD. 


rivers  of  Cochin  China,  and  is  said  to  be  exceedingly 
unhealthy.  Singapore,  at  the  lowest  point  of  the 
Malay  j)eninsula,  is  only  one  degree  from  the  equa- 
tor. This  is  also  a  flourishing  English  colony,  and 
numbers  about  25,000  foreign  residents.  A  volumin- 
ous report  of  the  colonial  surgeon  is  before  me,  but 
I  will  only  make  a  few  extracts  from  it. 

The  climate  is  one  of  perpetual  summer.  The 
average  temperature,  or  a))proximate,  as  it  is  termed, 
for  the  whole  year  is  80.3°  F. ;  maximum  shade,  87.9° 
F. ;  minimum,  72.4°  F.  Though  so  near  the  equator,  it 
will  bo  seen  that  the  thermometrioal  rise  is  not  what 
is  often  experienced  in  high  temperate  latitudes. 
This  is  owing  to  the  excessive  rains  that  fall  almost 
the  year  round,  amounting  to  a  yearly  average  of 
from  11.5  to  140  inches ;  the  greatest  amount  in  one 
day  in  1880  was  24  inches.  The  so-called  "  Straits 
settlements"  under  English  rule  in  the  Malay  penin- 
sula are  four.  The  number  of  patients  admitted 
into  the  hospitals  of  these  places  in  1880  were,  Eu- 
ropeans, 5.59;  natives,  1,3,929.  The  mortality  is  one- 
half  what  it  was  a  few  years  ago,  before  the  present 
medical  and  sanitary  organizations  were  completed. 
An  epidemic  of  beriberi  broke  out  in  the  Goals  in 
1878,  and  was  also  severe  in  1879.  The  mortality 
was  from  16  to  20  per  cent. 

Among  the  residences  of  the  better  class  in  Singa- 
pore there  is  little  sickness  compared  with  many 
places  in  more  temperate  climates,  and  the  per- 
centage of  deaths  relatively  small.  Malarial  fevers 
are  the  most  common  forms  of  disease,  though  the 
types  are  not  usually  severe.  Typhus  fever  and 
cholera  are  rare.  That  Singapore  should  have 
escaped  the  recent  ravages  of  the  latter  in  the  Dutch 
East  Indies  is  somewhat  a  matter  of  surprise,  especi- 
ally as  there  was  no  quarantine  enforced.  The  only 
explanation  which  can  be  offered  for  it  is  that  the 
settlement  has  an  excellent  aqueduct  water-supply. 

The  cholera  epidemic  in  -lava  has  just  begun  to 
show  signs  of  abatement.  I  regret  that  an  attack  of 
fever  has  made  it  impossible  for  me  to  visit  Batavia, 
the  scene  of  the  greatest  ravages  of  the  scourge. 

I  am  told  bv  those  wlio  were  there,  however,  that 
two  to  three  hundred  tliou.sand  would  be  a  low  esti- 
mate of  the  deaths  from  the  disease  during  the  last 
three  months.  In  some  villages  of  five  to  six  hun- 
dred inhabitants,  not  more  than  one  hundred  and 
fifty  escaped  with  their  lives.  The  mortalitv  r.ate 
was  very  high— estimated  bv  the  Dutch  physician 
at  80  to  90  per  cent.  This  "is  the  third  time  that 
Java  has  been  visited  by  a  severe  epidemic  of  cholera 
within  the  last  eight  years. 


Ceylom,  January,  1SS2. 


DujVnb  B.  Sisdions,  M.D. 


STATE  EXAMNATIONS  IN  ALABAMA. 

To  Tns  Editor  of  The  Mbiiical  Recohd. 
Sir  :  I  have  recently  read  several  articles  in  your 
joumal  on  the  subject  of  State  examinations  and 
legal  requirements  for  tJiose  who  propose  beginning 
the  practice  of  medicine.  A.-,  you  have  not  men- 
tioned the  laws  of  Alabama  on  tliis  subject,  I  take  it 
for  granted  you  are  unaware  of  them.  These  laws 
have  accomplished  great  good  during  the  iive  years 
of  their  existence,  not  only  by  returning  to  their 
colleges  recent  graduates  who  were  incompetent, 
but  in  freeing  the  State  of  those  great  evils  tliat 
travelled  from  State  to  State  and  im])osed  upon  the 
afflicted  and  credulous.      "  The  renowned  cancer 


doctor'*  will  not  "stop  for  three  days  only,"  but 
gives  our  State  a  wide  berth.  Under  the  laws  of 
Alabama,  each  County  Medical  Society  is  authoiized 
to  elect  a  board  of  five  censors,  whose  duty  it  is  to 
examine  all  applicants  who  are  graduates  in  medi- 
cine, and  who  j)ropose  beginning  the  practice  of 
medicine.  A  State  board  is  authorized  to  examine 
all  who  apply,  and  to  license  when  qualified,  v  ith- 
out  regard  to  their  ha\'ing  attended  college  ;  and  no 
one  can  begin  the  practice  of  medicine  in  this 
State,  under  penalties  of  the  law,  without  going  be- 
fore the  County  or  State  Board  and  obtaining  a 
license. 

J.  H.  GtJNN. 

Calera,  Ati..  March  8,  1883. 


A   PLEA  FOR  BO^TNE  VIRUS. 

To  THE  Editob  of  The  Medical  Record. 
Sir:  In  an  article  entitled  "Ineffective  Vaccine 
Virus,"  which  apjieared  in  your  issue  of  April  Ist, 
the  \^Titer  gives  his  experience  at  some  length  in 
the'fuse  of  bovine  virus,  complains  of  its  general 
inefficiency,  and  states  tliat  his  usual  success  is 
about  twelve  and  one-half  per  cent,  in  primary  sub- 
jects, his  latest  experience  having  been  with  in- 
fants "  from  a  few  hoiirs  to  a  few  weeks  old."  All 
physicians  of  experience  in  vaccinating  know  how 
difficult  it  is  to  obtain  satisfactory  results  with  in- 
fants of  so  tender  an  age,  as  compared  with  those 
somewhat  older.  Still,  even  taking  this  fact  into 
consideration,  his  results  were  astonishingly  poor. 
A  short  time  ago  one  of  the  physicians  of  this  de- 
partment vaccinated  four  of  these  infants  from  the 
Maternity  Hospital,  and  three  of  the  vaccinations 
or  seventy-flve  per  cent,  were  successful. 

The  reason  why  physicians  are  not  so  successful 
with  bovine  as  with  humanized  lymph  is  not  en- 
tirely due  to  the  inefficiency  of  the  virus,  but 
partly,  also,  to  the  wrong  method  of  the  physician 
in  using  it.  To  secure  the  best  results  from  bo%'ine 
virus,  the  arm  must  be  scarified,  and  not  denuded  ; 
and  the  scarifications  should  be  made  as  large  as  an 
ordinary  thumh-nai!  or  a  silver  h<ttf-<lime.  Enough 
blood  should  be  drawn  to  well  moisten  the  quill,  in 
order  to  dissolve  the  virus  and  render  it  capable  of 
absorption.  Water  should  never  be  used  for  this 
purpose.  Care  should  be  exercised  not  to  draw 
too  much  blood.  Should  this  inadvertently  occur, 
it  is  only  necessary  to  wipe  it  away  and  wait  till  the 
excessive  flow  ceases.  Then  the  vims  should  be 
well  rubbed  in,  and  the  arm  allowed  to  remain  bare 
until  perfectly  dry.  It  would  seem  that  the  bo\-irp 
virus  is  less  concentrated  than  the  humanized,  and 
more  diluted  witli  serum  ;  hence  it  is  necessary  tlint 
it  should  be  aiqilied  to  a  larger  surface  and  in  larger 
quantity.  Therefore,  the  quill  or  bonei  points  in 
general  use  at  the  present  time  are  more  fully 
charged  than  formerly,  wlien  only  humanized  virus 
was  om|)loved.  Accordingly,  one  of  these  points  is 
not  sutllciont  for  two  vaccinations,  as  many  ]ihy- 
sicians  seem  to  suppose.  If  more  attention  were 
paid  to'these  directions,  and  tlie  charged  end  of  the 
quill  always  used,  better  results  would  be  obtained. 
It  should  bo  borne  in  mind  that  warmth,  moisture, 
and  exposure  to  the  air  destroy  virus  very  (piickly. 
It  should  always  be  kept  in  a  tiglitly  closed  bottle, 
in  a  cool,  dry  ))liice,  and  even  then  it  is  advisable 
that  it  should  not  be  used  aft-»^r  it  has  been  on  hand 
for  two  weeks. 

It  is  not  claimed  that,  oven  in  the  Iiands  of  ex- 
perts, bovine  virus  is  quite  as  uniformly  reliable  a» 


THE  MEDICAL  RECORD. 


389 


humanized.  For  instance,  in  1875  the  results  in 
this  department  in  24,1100  piimaiy  vaccinations  with 
humanized  vims  were  8G.G5  per  cent,  successful; 
while  last  year,  in  21,450  with  bovine  vims,  82.66 
per  cent,  were  successful ;  iu  December  last,  out  of 
1,495  primai-y  vaccinations,  with  bovine  virus,  our 
success  was  94  per  cent. 

Shortly  after  beginning  the  use  of  bovine  virus, 
we  found  that  the  difference  was  so  slight  as  to  jus- 
tify us  in  giving  up  the  humanized  entirely.     That 
was  early  in  1876,  and  we  have  never  had  any  desire   | 
to  return  to  it  since.     Both  kinds  were  used  as  dried 
lymph  on  quill  slips  or  points.     \Yhen  humanized   | 
vims  is  used  direct  from  tlis  vesicle — arm  to  arm  ' 
vaccination —the  success  is  much  greater.  j 

Your  correspondent  also  complains  of  the  irregu-  i 
larity  -nith  which  the  vesicles  appear,  and  of  a  pecu- 
liar  "  raspberry  "  vesicle,  which  forms  at  the  seat  of  j 
vaccination  occasionally.  It  is  true  that  bovine  ] 
virus  will  not  always  develop  vesicles  with  the  same 
uniform  regularity  as  we  find  in  using  the  other ; 
but  the  dia'erence  is  slight,  and  met  with  only  in 
virus  which  is  beginning  to  deteriorate,  and  it  is 
such  virus  also  that  produces  these  '•  raspberry,"  or, 
as  they  are  more  commonly  called,  fungous  or  abor- 
tive vesicles.  The  latter  are  cellular  in  structure, 
closely  resembling  a  vaccine  vesicle  in  all  appear- 
ances, except  as  to  color.  This  is  a  dark  or  dusky 
red,  like  a  naevus.  They  aj^pear  a  little  later  than  a 
true  vaccination  and  remain  unchanged  for  from 
two  to  four  weeks,  when  they  dry  up,  forming  a 
brown  scab  which  eventually  falls  off',  leaving  no  scat: 
TUey  cause  little  or  no  inconvenience  and  do  no  harm, 
except  to  mislead  the  patients  and  sometimes  even 
physicians.  It  should  bo  distinctly  understood  that 
they  are  not  vaccinations,  in  any  sense  of  the  word, 
and  that  those  upon  whom  they  appear  should  be 
immediately  revaccinated.  In  some  cases  there  is 
considerable  itching  and  a  well-marked  areola 
forms  ;  with  such  there  is  a  possibility  that  they 
possess  a  certain  amount  of  prophylactic  power,  but 
this  is  so  uncertain  that  the  results  should  always 
be  looked  upon  as  failures. 

Although  bovine  vims  has  been  in  use  in  this 
country  rather  extensively  for  the  past  ten  years,  the 
details  of  propagating,  preserving,  and  using  it  are 
not  as  fuUy  understood  as  they  probably  will  be  in 
the  near  future.  State  Boards  of  Health  in  all  parts 
of  the  country  are  considering  the  subject  of  its  cul- 
tivation, regarding  it  as  a  public  necessity  which 
should  be  under  official  supervision  and  furnished 
gratuitously  to  all.  This  will  be  a  great  improve- 
ment on  the  present  method,  which  permits  anyone 
to  advertise  the  sale  of  it,  as  of  any  article  of  mer- 
chandise. And  it  is  our  sincere  hope  that  the  Em- 
pire State  will  be  the  first  to  inaugurate  this  reform. 
jj.  B.  Tatlob,  M.D., 
Inspector   of  Vaccination. 

He M.TH  DEPAnT.MEN-T.  301  Mctt  Street.  N.  T..  Apiil  5,  1S?9. 


Um  Jnstrumentg. 


Stretching  the  Optic  Nkrte. — Dr.  Kiimmell,  of 
Hamburg,  has  stretched  the  optic  nerve  seven  times 
in  five  cases.  The  eyesight  had  been  partly  or  com- 
pletely lost  from  atrophy  of  the  ojitic  nerves.  The 
operation  is  done  by  making  a  slit  in  the  lower  and 
outer  part  of  the  conjunctiva  near  the  cornea.  A 
curved  hook  is  passed  in  and  back,  the  optic  nerve 
is  caught  and  stretched,  "not  too  strongly."  Very 
slight  symptoms  followed  the  operation.  In  those 
cases  where  the  blindness  was  not  complete,  there 
was  some  improvement. 


SUEGICAL  NEEDLE  FOR  WIRE  SUTUEES. 
Bi  WILBUE  P.  MORGAN,  M.D., 

BALTIMORE.  MD. 

Dissatisfied  with  the  old  and  clumsy  way  of  drag- 
ging the  wire  through  the  tissues,  by  means  of 
silk  threads  or  ordinary  surgical  needles,  I  thought 
there  might  be  some  simpler  method  by  which  sil- 
ver sutures  could  be  i)laced  exactly  where  they  were 
wanted,  and  looked  about  for  means  to  accomplish 
the  purpose.  The  gutter-eyed  needle  and  the  needle 
with  a  screw-hole  in  the  end  not  proving  success- 
ful in  my  hands,  I  took  a  piece  of  tubing,  such  as 
they  make  hyijodermic  needles  of,  and  cut  ofi"  a 
piece  two  inches  in  length,  one  end  of  which  was 
filed  to  a  point.  One  quarter  of  an  inch  from  the 
other  end  or  heel  of  the  tube,  I  filed  a  space  one- 


sixteenth  of  an  inch  wide,  and  half  way  through  the 
tube.  After  cleaning  away  the  filings  and  pohshing, 
I  had  the  needle  wished  for. 

To  thread  it,  take  a  silver  wire  and  bend  one  end 
of  it  upon  itself,  making  the  bent  portion  a  little 
less  than  one- sixteenth  of  an  inch  in  length,  and 
press  it  closely  to  the  adjacent  wire,  then  pass  the 
straight  end  of  the  wire  through  the  one-fourth  of  an 
inch  of  tubing  left  at  the  heel  of  the  needle,  from 
before  baekwaid,  and  when  the  wire  has  been 
drawn  through  its  whole  length  the  bent  end  of  the 
wu-e  be  found  occupying  the  space  filed  from  the 
side  of  the  needle,  and,  pressed  closely  in,  will  give 
no  trouble,  and  can  be  used  as  easily  as  a  sewing- 
needle  through  a  piece  of  cotton. 

The  needle  can  also  be  threaded  from  the  rear  by 
passing  in  the  wire  straight  and  bending  it  in  the 
space,  cutting  off  any  undue  length  to  prevent  it 
catchiog  in  the  tissues  as  it  passes  through. 

F.  Arnold  it  Son,  of  this  city,  have  made  me  some 
of  these  needles,  and  have  made  them  quite  strong 
by  filling  up  and  solidifying  the  tubing  which 
forms  the  anterior  jiart  of  the  needle. 


ARMY  NEWS. 

Official  List  of  Chnnge,s  of  Stations  and  Duties  of  Offi- 
cers of  the  Medical  Department,  United  States  Army, 
from  March  26,  1882,  to  April  1,  1882.    ' 

Alexander,  E.  H.,  Major  and  Surgeon,  having  re- 
ported at  these  headquarters,  will  report  to  the  com- 
manding officer.  District  of  New  Mexico,  Santa  Ff, 
for  duty  as  Attending  Surgeon  at  District  Head- 
quarters, and  Post  Surgeon,  Fort  Marcy,  N.  M. 
S.  O.  59,  Department  of  the  Missouri,  March  20, 
1882. 

Tkemadje,  W.  S.,  Capt.  and  Asst.  Surgeon.  As- 
signed to  dutv  at  Fort  Porter,  N.  Y.  S.  O.  51,  De- 
partment of  the  East,  March  24,  1882. 

Dickson,  J.  M.,  Capt.  and  Asst.  Surgeon.  So 
much  of  Paragraph  2,  S.  O.  51,  0.  S.,  as  relates  to 
him  is  revoked,  and  he  will  proceed  to  Fort  Mo- 


390 


THE  MEDICAL  RECORD. 


Henry,  Md.,  and  report  to  the  commanding  officer 
for  duty  at  that  post.  S.  O.  52,  Headquarters,  De- 
partment of  the  East,  March  25,  1882. 

Gardner,  Edwin  P.,  Capt.  and  Assist.  Surgeon. 
To  report  in  person  to  the  Commanding  General, 
Department  of  the  Columbia,  for  assignment  to 
duty.     S.  O.  71,  A.  G.  O.,  March  28,  1882. 

GARDEfER,  John  De  B.  W.,  Capt.  and  Asst.  Sur- 
geon. To  report  in  person  to  the  Commanding 
General,  Department  of  Arizona,  for  assignment  to 
duty.     S.  O.  71,  A.  G.  O.,  March  28,  1882. 

BoBiNSON,  Samcel  Q.,  Capt.  and  Asst.  Surgeon. 
To  report  in  person  to  the  Commanding  General, 
Department  of  the  Columbia,  for  assignment  to 
duty.     S.  O.  71,  A.  G.  O.,  March  28,  1882. 


iMelrical  Jtcms  antr  tlems. 


OoNTAOioua  Diseases  —  Weekly  Statement.  — 
Oompirative  statement  of  oases  of  contagious  diseases 
reported  to  the  Sanitary  Bureau,  Health  Department, 
for  the  two  weeks  ending  April  1,  1882. 


Week  Ending 

i 

s 

1 

b 
J3  > 

4 

i 
1 

1 

234 

■a  . 

la 
1 

o 
4 

134 

1 

1 
a 

92 

i 

m 
31 

i 
& 

March  25,  1883. 

6 

0 

April      1,  1882 

11 

5 

248 

5 

200 

82 

32 

0 

The  Focrth  Annoal  Commencement  of  the  Co- 
lumbia Veterinai-y  College  and  School  of  Com- 
p.irative  Medicine  took  place  at  Chickering  Hall. 
Degrees  of  D.V.S.  were  conferred  upon  twelve 
graduates  by  Dr.  Alexander  Hadden,  President  of 
the  College."  Certificates  of  honor  were  given  to 
fourteen  junior  students.  The  prizes  were  awarded 
by  Professor  J.  H.  Gunning.  They  were  as  follows  : 
E.  A.  MoLellan,  gold  medal ;  H.  C.  Slee,  silver  medal ; 
D.  L.  Johnston,  silver  medal ;  E.  S.  Breder,  case  of 
foot  instruments;  W.  A.  Soula,  case  of  veterinaiy in- 
struments ;  H.  C.  Slee,  set  of  veterinary  works ;  E. 
A.  McLellan,  mouth  speculum.  Edward  S.  Breder 
delivered  the  valedictory.  The  address  of  the  even- 
ing was  delivered  by  Dr.  Ezra  M.  Hunt,  Secretary  of 
the  New  Jersey  State  Board  of  Health.  Tlie  speaker 
reviewed  the  growth  of  comparative  medicine,  and 
showed  its  increasing  prominence  and  importance. 

Race  PREirDicE  among  Baltijiore  Phtsicians. — 
The  following  account  of  the  recent  action  of  the 
Biltimore  ^Medical  and  Surgical  Society  is  given  in 
the  daily  press  and  carries  its  own  comment  and 
condemnation.  We  are  glad  to  believe  that  the  ex- 
clusion of  a  qtialified  physician  from  a  Medical  So- 
ciety on  account  of  his  color  was  the  work  of  bnt  a 
few.  But  it  is  imfortunate  that  this  few  sliould  have 
the  power  to  bring  reproach  upon  the  profession  by 
an  action  which  was  narrow-minded  and  cowardly. 
At  the  last  weekly  meeting  of  the  Baltimore  ]\Iedical 
and  Surgical  Society  the  Committee  of  Honor  j)re- 
sonted  the  names  of  several  candidates  for  member- 
ship, with  its  approval,  for  action  on  the  part  of  the 
Society.  A  member  rerpiosted  the  committee  to  re- 
pjrt  the  color  of  tha  ciudidates.     Much  excitement 


followed  the  question,  and  it  was  staff  d  that  one  of 
the  applicants  for  membership  was  Dr.  Whitdeld 
Winsey,  a  colored  practitioner,  whose  office  is  at  No. 
116  East  Fayette  Street.  In  the  di.scussion  that 
followed  many  of  the  leading  members  of  the  so- 
ciety, several  of  whom  are  Professors  in  the  med- 
ical colleges  of  the  city,  stated  that  they  had  met 
Dr.  Winsey  in  consultation,  and  that  he  was  an 
intelligent  and  experienced  physician  and  sur- 
geon, a  graduate  of  the  Harvai-d  University  Medi- 
cal School,  and  that  he  had  been  a  residtnt  phy- 
sician in  one  of  the  most  prominent  Massachu- 
setts hospitals.  No  facts  were  brought  forward 
detrimental  to  the  professional  or  personal  charac- 
ter of  Di-.  Winsey,  and  as  the  constitution  of  the 
society  says  that  any  physician  of  good  profcsi^ional 
and  moral  standing  shall  be  eligible  to  membership, 
and  makes  no  mention  as  to  the  color  of  apjiUeants, 
it  was  expected  that  the  application  would  be  favor- 
ably acted  upon.  But  the  ballot-bos  was  found  to 
contain  seven  black  balls,  five  being  sufficient  to  re- 
ject an  applicant.  There  were  about  twenty-five 
votes  cast.  After  the  adjournment  of  the  society 
much  indignation  was  expressed  by  prominent  mem- 
bers of  the  profession  at  the  action  taken.  The 
cause  given  for  their  conduct  by  those  who  voted 
against  Dr.  Winser  was  jnirely  his  color,  one  of 
them  stating  that  his  Southern  birth  prevented 
him  from  recognizing  a  negro  practitioner.  A  dis- 
tinguished Maryland  medical  Professor  replied  that 
he  had  carried  a  sword  in  the  Confederate  Army, 
but  that  his  i)olitical  sentiments  would  never  inter- 
fere with  his  recognition  of  scientific  merit  in  a 
member  of  the  colored  race.  Dr.  Winsey  is  a  man 
of  fine  appearance,  in  the  prime  of  life.  He  would 
be  taken  for  a  Caucasian  by  any  one  who  was  not 
aware  of  his  African  descent,  and  is  generally  recog- 
nized by  the  i^hysicians  of  the  city  who  are  asked  to 
meet  him  in  consultation. 

PrIOBITT   in   the  HlTStANE  TREATMENT  OF  InSANITT. 

— According  to  the  majority  of  authorities,  Philip 
Pinel  was  the  first  to  remove  from  the  insane,  their 
chains,  and  to  treat  them  as  human  beings.  This 
proud  preeminence  is  now  disputed,  and  with  ap- 
parently good  reason.  Pinel,  it  would  appear  from 
an  article  translated  from  an  Italian  journal,  by  Dr. 
Workman,  of  Toronto  {Alieiust  atid  N'nirnhrfisl, 
January,  1882),  was  preceded  by  Chiarugi  in  his 
noble  attempt.  '  The  former  removed  the  chains 
from  forty  insane  at  the  BicOtre ;  earlier  than  this 
Chiarugi  bad  completed  a  model  asylum.  The  his- 
tory of  the  rational  treatment  of  the  insane  seems  to 
require  rewriting  in  some  of  its  chapters.—  C/iiaigo 
Medical  Kerieir. 

loDOFOBM  IN  Anal  Fissire. — Dr.  Ferdinand  See- 
ger,  of  this  city,  writes:  "As  aproj/os  to  the  iodo- 
form discussion,  I  desire  to  call  attention  to  its  value 
in  anal  fissure.  Some  years  ago  I  was  a  victim  of 
this  painful  atl'ectiou.  I  tried  eveiw  sort  of  local  ap- 
plication but  without  result,  and  in  desjmir  of  any 
other  source  of  relief,  had  almost  made  up  my  mind 
to  submit  to  an  operation,  when  it  occurred  to  nie 
to  try  iodoform  in  the  form  of  suppositories.  I  did 
so  in  a  strength  of  three  grains,  and  with  magical 
efiect.  The  very  first  one  gave  immediate  relief, 
and  a  cure  speedily  resulted.  I  have  since  used 
this  treatment  in  quite  a  number  of  cases,  and  vrith 
good  results  in  every  case  but  one.  A  mild  aperient 
should  be  given  until  the  healing  process  has  ad- 
vanced sufficiently,  and  the  patient  should  be  cau- 
tioned against  a  constipated  habit. 


THE  MEDICAL  RECORD. 


391 


"  In  the  single  case  where  the  iodoform  failed,  I 
tried  hamamelis  siipj)ositories  in  the  strength  of  a 
quarter  of  a  grain.  The  etlect  was  fully  as  satisfac- 
tory as  that  obtained  from  the  iodoform  in  the  other 
eases,  but  as  the  hamamelis  has  a  tendency  to 
cause  throbbing,  fulness,  and  other  jiains  in  the 
head,  it  requires  to  be  used  with  caution. 

"  Such  ot  my  professional  friends  as  have  tried  this 
treatment  are  enthusiastic  in  its  jjraise,  and  as  I  have 
not  seen  it  mentioned  by  any  one  else,  I  am  so  bold 
as  to  suggest  its  trial  to  others  through  your  excel- 
lent journal. 

"  I  can  endorse  most  of  what  has  been  said  as 
to  the  value  of  iodoform  in  nasal  and  laryngeal 
ulceration.  I  tried  it  in  several  cases  of  diphtheria, 
but  the  results  were  not  such  as  to  encourage  per- 
sistence." 

A  Bogus  Medical  College. — We  have  received 
through  the  kindness  of  Dr.  Brodie  the  "annual 
announcement  of  the  Detroit  University  Medical 
Department,"  together  with  some  local  comments 
upon  the  same. 

The  announcement  has  an  imposing  appearance. 
There  is  a  list  of  thirteen  professor's  and  twenty-one 
lecturers.  The  professors  have  the  novel  prefix  of 
"Venerand,"  "Very  Venerand,"  or  "Right  Vene- 
rand."  There  are  chairs  on  almost  every  subject, 
including  "  pyrology,"  "  anthropology,"  and  "  sani- 
tive  science." 

It  appears  that  in  reality  "  the  large  and  commo- 
dious structure  "  advertised  as  used  by  the  college 
is  upstairs  over  a  grist-mill ;  that  the  president  is  a 
cancer-doctor  and  a  graduate  of  Buchanan's  "  Insti- 
tute," and  that  the  dean  makes  a  specialty  of  "  elec- 
trized anti-parasitic  oxygen." 

Pasteur's  Splenic  Fever  vaccine  matter  is  to  be 
tried  in  i'rnssia.  The  Minister  of  Agriculture  has 
empowered  a  commission,  of  which  Virchow  is  a 
member,  to  investigate  its  value. 

Hu.\[ANIZED  VERSU.S  Bo^iNE  Vuics. — Dr.  E.  M. 
Snow,  Superintendent  of 'the  Boai-d  of  Health,  Prov- 
idence, R.  I.,  made  some  statements  at  the  last 
meeting  of  the  State  Medical  Society,  which  deseiTe 
some  attention.  He  had  used  humanized  vaccine 
virus  in  about  twenty-six  thousand  cases.  This  virus 
had  undoubtedly  been  transmitted  from  arm  to  arm 
since  the  time  of  Jenner,  and  probably  this  is  the 
only  true  humanized  virus  in  the  country.  Tlie 
local  and  constitutional  effects  of  this  virus  are  pre- 
cisely the  same  from  day  to  day,  as  those  described 
by  Jenner.  His  description  is  perfectly  reproduced 
by  the  vaccinations  every  week. 

In  regard  to  the  prot2ction  from  small-pox  given 
by  the  humanized  virus,  it  is  ab.solntely  perfect. 
Dr.  Snow's  experience  on  this  point  had  been  so 
positive  and  certain,  that  he  had  no  patience  in 
talking  with  those  who  denied  that  vaccination  pre- 
vented small-pox.     He  related  some  cases. 

On  the  other  hand,  with  regard  to  bovine  virus. 
Dr.  Snow  had  had  no  experience  ;  he  had  not  tised 
it;  but  he  had  known  something  of  its  effects  when 
used  by  others.  He  had  known  two  cases  in  which 
children  lost  their  lives  from  small-pox  because 
the  bovine  virus  did  not  take  effect.  He  had  known 
from  others  of  scores,  and  probably  hundreds  of 
cases,  in  which  the  bovine  virus  failed  to  produce 
any  result.  He  believed  it  was  generally  acknowl- 
edged that  the  bovine  virus,  as  used  in  this  city, 
was  very  uncertain  in  its  results. 


The  Sewer-gas  Thuoet,  and  the  drinking-water 
theory  of  the  origin  of  typhoid  fever,  have  formed 
the  subjects  of  a  warm  debate  among  Vienna  sanita- 
rians during  the  past  winter.  The  battle  is  not  yet 
ended. 

Fractube  of  Clavicle  Treated  without  Appa- 
ratus.— Dr.  H.  R.  Porter,  Bismarck,  D.  T.,  March 
15,  1882,  communicates  the  following:  "The  case 
of  fracture  of  the  clavicle  treated  without  appa- 
ratus, reported  in  IMedical  Record  of  March  4, 
1882,  by  Dr.  Newton,  U.  B.  Army,  prompted  me  to 
report  the  following  case,  which  occurred  in  the 
same  month,  and  about  the  same  time  last  January. 

"Doctor  S ,  while  making  a  night  visit,  fell  off 

the  sidewalk,  a  distance  of  about  three  feet,  fractur- 
ing the  left  clavicle  near  the  middle. 

"I  was  called  in  the  morning  and  found  the  parts 
tender,  swollen,  and  painful,  and  the  Doctor  very 
irritable.  1  proceeded  to  put  the  fractured  ends  of 
the  bone  in  place,  and  to  apply  the  old  wedge-shape 
pad,  etc.,  when  the  Doctor  coldly  informed  me  that 
he  would  not  have  any  apparatus,  that  the  least 
touch  hurt  him,  and  he  would  let  it  go  without  any 
dressing.  I  told  him  that  he  was  the  judge  and 
knew  the  consequences,  and  left  him.  Nothing  was 
done  in  the  case.  He  wore  a  large  overcoatwithout 
putting  the  left  arm  in  the  sleeve,  and  sinqdy  did 
exactly  as  the  case  reported  by  Dr.  Nevstou,  viz.: 
"  He  merely  favored  his  left  arm  by  cari-ying  his 
hand  in  his  breast ;  he  did  not  use  a  sling."  In 
about  four  weeks  the  bones  were  firmly  united  with 
but  very  little  overlapping.  The  result  was  as  good 
as  is  often  met  with  when  the  best  apparatus  is  -used 
by  the  ordinaj'y  practitioner,  or,  perhaps,  the  skilful 
siu-geon.  I  met  the  Doctor  every  day  during  his  treat- 
ment of  his  fracture.  He  was  very  careful  to  w  alk 
on  smooth  gi-ound,  and  the  left  arm  received  no 
unnecessary  motion,  and  no  Irenlmetit.  The  Doctor 
remarked  that  he  had  made  worse  jobs  than  that  on 
other  peojDle,  and  I  believe  I  have  too." 

Resigning  a  Peofessokship. — Dr.  Samuel  D. 
Gross,  for  twenty-six  years  Professor  of  Surgeiy  at 
the  Jefferson  Medical  College,  has  placed  his  resig- 
nation in  the  hands  of  the  President  of  the  Board  of 
Managers.  It  is  understood  that  Dr.  Gross  retires 
on  account  of  advancing  age  and  an  indisposition  to 
continue  the  fatiguing  duties  of  his  lectureship,  and 
that  the  duties  attached  to  the  chair  he  has  filled 
wiU  be  divided  between  his  son,  Dr.  Samuel  W. 
Gross,  and  Dr.  John  H.  Brinton. 

The  late  Dr.  Pancoast,  of  Philadelphia  was  one 
of  the  most  oijulent  of  American  i^hysicians.  His 
estate  is  valued  at  about  one  million  dollars.  It  is 
said  that  Dr.  Gross — another  eminent  doctor — and 
he  used  frequently  to  play  checkers  until  late  hours, 
and  that  no  other  diversion  pleased  him  so  much. 
He  was  of  old  Quaker  stock,  and  through  life  i>re- 
ser\-ed  many  of  the  quaint  traits  of  that  people,  of 
whom  the  witty  Sydney  Smith  said  that  he  "  did  not 
believe  there  ever  was  a  Quaker  baby ;  that  is 
to  say,  one  born  with  a  broad  brim  ana  in  full 
quake." — Harper's  Weekly. 

Ought  I  to  do  it  ? — A  correspondent  from  Min- 
nesota, who  signs  himself  "  True  Blue,"  writes  :  "I 
am  a  graduate  of  the  University  of  Pennsylvania, 
where  I  served  two  years  as  an  interne  at  Biockley. 

Two  years  since  I  settled  in  X ,  where  there  aie 

nowpractising  six  physicians  ;  two  homoeopaths,  two 
regular  physicians  who  affiliate  with  the  homoeopaths, 
besides  a  regular,  who  was   once   president  of  the 


392 


THE  MEDICAL  EECORD 


State  Medical  Society,  and  myself.  With  the  excep- 
tion of  the  last  I  am  on  good  terms  with  all  the  other 
physicians,  socially  and  professionally.  They  are 
all  that  could  be  desired.  In  fact,  one  of  the  homoeo- 
paths is  my  wife's  cousin,  and  is  the  professional 
attendant  of  all  her  family  who  are  resident  here.- 

"  The  old  doctor,  as  we  call  him,  and  myself,  are  the 
only  members  of  the  State  Society  in  good  standing. 
The  other  two  regulars  have  been  expelled  for  con- 
sulting with  homoeopaths.  This,  of  course,  cuts  me 
oS'  from  their  professional  counsel,  which  was  of  the 

greatest  value  to  me  during  my  first  year  in  X .  In 

fact,  I  am  indebted  to  them  for  my  start  in  practice. 
On  the  other  hand,  the  old  doctor  sold  me  a  sjjav- 
ined  horse  for  .S150,  upon  my  arrival,  and  when  I 
forced  him  to  take  the  horse  back,  somehow  he  gi'ew 
to  dislike  me,  and,  I  fear,  is  not  my  fiiend,  as  he 
has  taken  several  of  my  patients  from  me,  to  spite 
the  other  fellows,  as  he  calls  them — meaning  the  two 
who  befriended  me  and  gave  me  cases.  I  will  do  the 
man  the  justice,  however,  to  say  that  outwardly  he 
is  the  very  Bayard  of  regulars,  and  he  hates  a  homoeo- 
path as  he  hates  sin. 

"  Well,  three  months  ago  a  man  came  to  get  me  to 
attend  a  fractured  leg  of  one  of  his  men,  it  was  a 
pay  patient,  and  I  needed  the  pay  for  it  bad  to  pay 
the  nurse  who  wa.s  now  caring  for  my  wife. 

"  I  thought  it  strange  that  I  should  have  the  pa- 
tient, as  my  friend  was  the  family  physician  of  his 
employer,  who  came  for  me,  and  I  asked  him  if  Dr. 
A.  was  not  at  home,  for,  although  I  would  not  con- 
sult with  him,  I  would  not  steal  his  patient.  '  Yes,' 
he  replied,  '  but  I  desire  to  have  you  take  charge  of 
it.'  Oh,  Mr.  Editor,  this  was  the  happiest  moment  of 
my  life.  A  seventy-five  dollar  ease,  and  a  surgical 
one,  too  ! 

"  When  I  told  my  wife  of  it  that  night,  it  did  her 
lots  of  good ;  it  just  seemed  to  encourage  her. 

"I  was  more  than  competent  for  the  case,  for  I 
had  had  twenty-thi-ee  cases  like  it  in  hospital,  and 
had  more  than  once  been  complimented  by  Profes- 
sor Gross  on  my  aptness  with  fractures. 

"  At  the  end  of  the  third  week,  although  everything 
was  pi-ogressing  finely,  I  thought  best  to  have  con- 
sultations, for  fear — no  I  had  nothing  to  fear,  I  knew 
I  was  right.  Still  I  called  in  the  old  doctor,  and, 
unfortunately  for  me,  he  happened  to  be  in  liquor, 
else  he  could  not  have  used  the  language  he  did. 
Drinking  was  his  chief  fault. 

"'H — 1 !' said  he,  '  he'll  have  a  stiff  ankle.  Move 
it,  man,  move  it — every  day — so — so,'  and  the  doc- 
tor very  rudely  moved  tlie  foot  before  I  could  stop 
him.  From  this  the  case  went  on  from  bad  to 
worse.  Still  every  week  I  took  the  old  doctor  with 
me.  Six  weeks  had  now  elapsed,  and  no  union. 
The  patient  was  very  uneasy  and  next  day  the  em- 
ployer would  be  home,  and  I  knew  instead  of  my 
fee,  I  should  receive  my  dismissal ;  and  I  was  poor 
and  discoui-aged,  and  worn  out  with  care  for  my 
wife,  when  I  overheard  the  following  between  the 
patient  and  my  counsel :  '  Doctor  will  I  have  a  good 
leg?'  'Good  leg;  no,  you  won't.'  'For  Uod's 
sake!  why  not,  doctor?'     'Because   you  Iiave  got 

a  d fool  attending  you  ;  you  were  thrown  to  him 

by  Dr.  A.  as  charity,  or  foi  him  to  practise  on. 
Why,  he'd  starve  if  these  other  fellows  didn't  send 
him  patients.' 

"I  said  to  my  little  wife  that  night,  '  Lucy,  I  am 

sorry  I  did   it,  but  I  just   said,  "  You  ,  , 

,  ,  old  hog."  Then  I  took  the  wash- 
stand  by  two  legs  and  knocked  him  down  stairs,  and 
this  broke  his  collar-bone.' 


"  This,  too,  seemed  to  do  my  little  wife  much  good, 
and  it  encouraged  her. 

"As  for  the  old  doctor,  he  entirely  ignores  me,  and 
sends  for  one  of  the  irregular  doctors  to  treat  him. 
Now  I  am  the  only  regular  physician  there  is  in  town, 
as  I  have  prefened  charges  against  the  old  doctor 
for  consulting  with  these  other  men.  Ought  I  to 
do  it  ?  " 

[This  is  triily  a  complicated  case.  The  ethical 
pomts  should  be  decided  in  accordance  with  the 
rales  prevalent  in  the  locality  where  the  parties  re- 
side. We  think,  however,  that  justice  should  be 
tempered  with  mercy,  and  insomuch  as  our  corre- 
spondent has  broken  the  old  gentleman's  collar-bone, 
he  might  with  propriety  let  the  matter  rest  there  ; 
indulging  also  in  the  ho2ie  that  the  "irregular"  will 
do  his  work  well.  Our  correspondent  will  possibly 
have  to  wait  for  the  spring  crop  of  new  doctors  be- 
fore he  can  hold  any  more  consultations. — Eu.] 

The  Garfield  Memorial  Hospital. — At  a  meet- 
ing of  those  directing  the  movement  for  the  erection 
of  this  hospital  in  Washington,  it  was  announced 
that  nearly  enough  money  had  been  obtained  to 
justify  beginning  the  work  of  erection. 

The  Jeffeeson  Medical  College  held  its  annual 
commencement  on  March  3flth,  and  graduated  a 
class  of  2-17.  It  is  stated  in  the  daily  press  that  the 
degree  of  D.D.  was  conferred  on  the  Eev.  I.  L. 
Nichelson  and  the  Rev.  Charles  Maison,  of  Philadel- 
phia, and  the  degi-ee  of  LL.D.  on  Dr.  Thomas  Addis 
Emmett,  of  New  York.  The  granting  of  degiees  in 
divinity  and  laws  by  a  medical  college  is  rather  an 
unusual  procedure. 

Db.  Lamson. — Great  efforts  are  being  made  to 
save  Dr.  Lamson.  It  is  said  now  that  he  was  a 
monomaniac  on  the  subject  of  aconitine.  When  he 
was  a  physician  in  the  hospitals  dtiring  the  Tnrko- 
Eussian  war,  he  used  aconitine  as  a  remedial  agent 
as  freely  as  if  it  would  cure  all  things.  He  gave  so 
much  of  it  that  it  was  observed  and  comijlaiued  of 
by  the  other  doctors,  who  believed  he  was  crazy  on 
that  sizbject.  The  young,  man  he  was  accused  of 
murdering  died  of  an  overdose  of  that  poison  given 
by  the  defendant. 

An  Important  Change  in  the  French  Naval 
Medical  Service  has  been  made,  by  which  the  pow- 
ers of  the  medical  officers  have  been  greatly  en- 
larged. The  change  puts  all  the  naval  hospital 
establishments  under  the  care  of  the  medical  otlicers. 
They  had  previously  been  under  direction  of  the 
commissariat  officers.  The  medical  corps  could  do 
nothing  but  attend  the  sick,  they  could  not  even 
discharge  a  nurse. 

The  National  CofNciL  of  Zurich  has  decided  on 
making  vaccination  compulsory. 

Herr  WicKERSHEniER,  the  inventor  of  the  fluid 
for  preserving  anatomical  and  pathological  })repara- 
tions,  is  reported  to  have  discovered  a  means  of  pre- 
serving bread,  meat,  and  beer,  for  a  long  time. 

Skoda. — A  new  street  in  the  neighborhood  of  the 
General  Hospital  in  Vienna,  is  to  bear  the  name  of 
"  Skoda  Street"  {Skodagasse),  in  honor  of  tlie  cele- 
brated physician  and  clinical  professor. 

The  jMrNifiPAL  CorNciL  of  Tillefranciik.  in  the 
department  of  the  Khino,  has  voted  the  erection  of  a 
statue  to  the  illustrious  physiologist,  Chuide  Ber- 
nard. It  is  to  be  placed  in  the  square  which  already 
bears  his  name. 


Vol.  XXI.-No.  15.1 
AprU  15.  1882.    I 


THE  MEDICAL  RECORD. 


393 


©rt0inal  Comtininicftttons. 


A   MOST   R.VEE.  POSSIBLY  UNIQUE,  CASE 

OF  CtExek.\l  eruption  of  VACCINLV. 

Br  HENRY  AUSTIN  MARTIN,  M.D., 


In  the  month  P mi riul  (May)  of  the  yearVIII.  (1800) 
of  the  French  Republic,  one  aud  indivisible,  met  in 
Paris  an  assemblage  not  only  of  illustrious  pliTSicians, 
bat  of  citizens  eminent  in  many  arts  and  professions. 
This  meeting  was  the  germ  of  the  famous  "  Comiti! 
central  <le  Vaccine."  With  it  were  associated  and  in 
correspondence  similar  committees  in  every  depart- 
ment of  France.  The  object  of  aU  these,  forming  one 
harmonious  whole,  was  not  only  to  inaugurate  and 
establish  the  practice  of  vaccination  in  France,  but 
to  collect  and  publish  aU  attainable  information  in 
regard  to  the  history  and  phenomena  of  vaccinia.  In 
no  other  country  was  vaccination  hailed  with  the 
same  loyal  enthusiasm  of  all  cultivated  classes.  In 
no  counti-y  was  its  investigation  carried  on  with  so 
much  zeal  and  intelligence. 

To  the  real  student  of  vaccination  (there  are  a  few) 
a  precious  monument  remains  of  the  labors  of  the 
Comiti  in  the  series  of  reports  published  in  Paris 
by  the  central  body,  containing  as  they  do  all  that 
was  most  valuable,  original,  and  siiggestive  in 
the  reports  of  the  niimerous  corresjjonding  provin- 
cial committees.  The  first  of  these  was  published 
in  1803  {Fan  XL).  It  is  a  stout  octavo  ;  its  author, 
Dr.  Husson,  Secretary  of  the  Committee,  a  name  il- 
lustrious among  those  of  tlie  earliest  disciples  of 
Jenner.  I  know  no  volume  in  the  vast  literature 
of  the  subject  so  full  of  interesting  and  important 
materiel.  This  was  followed  almost,  if  not  quite, 
every  year  for  forty  years  by  similar  reports,  whose 
authors,  or  rather  editors,  were  always  men  of  the 
very  first  authority  of  t'le  time.  The  series  for  the 
last  forty  years  is  of  reports  appearing  at  irregular 
and  less  fi'equent  intervals,  and  possessing  certainly 
far  less  merit  than  their  early  predecessors.  These 
reports,  often  reaching  the  dimensions  of  volirnies, 
contain  an  immense  accumulation  of  original  narra- 
tives of  the  normal  and  abnormal  phenomena  of  vac- 
cinia, and  of  the  often  wise  and  very  often  foolish 
surmises  and  theories  founded  upon  them.  Even  a 
merely  superficial  "going  through  "  this  series,  as  is 
the  manner  of  the  species,  might  make  the  fluent 
writer  of  "  e.rhaitstire  paper.':,"  and  college  lectures 
and  text-books,  blush  to  find  how  long  ago  and  how 
repeatedly  his  favorite  original  observations  and 
theories  had  been  fully  recorded,  broached,  and  ex- 
ploded. 

I  am  so  fortunate  as  to  possess  an  approximatively 
complete  set  of  these  reports,  many  of  which  are 
now  extremely  rare  ;  and  whenever  I  see  an  orig- 
inal observation  or  peculiarly  brilliant  and  quite 
newtheory  in  vaccination,  I  turn  to  their  pages  with 
perfect  confidence,  hardly  ever  disappointed,  of  find- 
!  ing  it  somewhere  among  the  first  five  years  after 
J1800.  °  ^ 

I  Very  recently,  a  case  has  come  under  my  notice, 
j  Which,  as  I  cannot  find  its  parallel  in  this  vast  maga- 
|Zine  of  exceptional  cases,  may  -well  be  assumed  to 
I  be  very  uncommon,  if  not  unique,  and,  on  that  ac- 
icount  alone,  perhaps  worthy  of  permanent  record. 
Tt  seems  to  me,  however,  far  more  worthy  of  notice, 
ithan  from  its  mere  raritv,  in  connection  with  that 


theory  of  the  absolute  essential  identity  of  variola 
and  vaccinia  which  a  good  many  physicians  assume 
to  have  been  demonstratively  proved  ;  an  opinion  in 
which  others,  not  quite  so  ardent,  are  hardly  ye^  pre- 
pared to  agree  with  them.  The  case  was  a  most 
perfect  and  undoubted  one  of  general  vaccinal  erup- 
tion. What  any  competent  and  careful  observer 
would  call  a  general  spontaneous  eruption  of  vac- 
cinia has  always  been  a  very  rare  anomaly,  a  very 
large  proportion  of  cases  so  heralded  and  recorded 
having  most  clearly  been  either  eruptions  of  rari- 
cella  01  (rom  aiito-raccinali07i,  or  contact  with  another 
raccinee.  I  find  no  ease  in  all  the  literature  of  vacci- 
nation which  I  have  toiled  through  in  this  special 
research,  in  which  a  ye-vaccinated  nursirg  mother 
communicated  undoubted  vaccinia  to  her  nursling 
through  the  medium  of  lactation,  and  such,  without 
doubt,  was  the  case  I  now  put  on  record. 

A  lady  of  Boston,  aged  36,  was  re-vaccinated  on 
the  13th  day  of  February,  1S82,  with  bovine  vaccine 
virus.  On  the  same  day  one  of  her  two  children,  a 
boy  aged  three,  was  also  vaccinated,  but  the  other, 
a  seven  months'  infant  at  the  breast,  was  not  sub- 
mitted to  the  operation.  The  reason  for  this  omis- 
sion was  that  the  latter  was  sufl'ering  from  eczema 
capitis  {criisia  lactea),  and  the  physician  feared  an 
aggravation  of  the  eczematous  eiujition  from  vacci- 
nation, and  a  consequent  considerable  and  very 
undesirable  burden  of  care  to  the  mother,  in  case 
her  own  secondary  vaccination  should  be  at  all 
troublesome.  The  vaccination  of  the  mother  was 
effective,  but  only  a  slight  vaccinal  effect  was  noticed 
— itching,  slight  efflorescence,  and  a  faint  approach 
to  vesicular  eruption  and  areola,  Init  on  the  1st  of 
March  (Wednesday)  the  slight  scab  which  had  fol- 
lowed it  had  fallen.  On  that  day,  the  sixteenth  after 
the  mother's  revaccination,  it  was  observed  that  the 
infant  was  somewhat  fretful  and  feverish,  and  a  num- 
ber of  little  red  pimples  were  seen  on  the  arms  abciit 
and  below  the  elbows.  On  the  third  day  after  this 
I  Saturday)  these  had  so  increased  in  size,  changed 
in  character,  and  multiplied  in  number,  and  so  many 
others  had  appeared  on  other  jiarts  of  the  body,  that 
the  attending  physician  was  called.  It  was  very 
noticeable  that  the  portions  of  the  surface  on  which 
the  eruption  of  eczema  had  been  most  marked,  were 
the  seats  of  the  most  abundant  eruption  of  this  new 
visitation. 

The  physician  in  attendance  on  the  case  most 
kindly  afforded  me  repeated  opportunities  of  seeing 
it,  and,  on  the  flr.st  occasion,  visited  it  with  me,  de- 
siring my  opinion  as  to  its  character,  for  it  had  ap- 
peared to  him  so  very  much  like  small-pox  that,  as 
a  measure  of  prudence,  he  had  reported  it  to  the  Iccal 
boai-d  of  health.  I  first  saw  it  on  Monday,  March  5th. 
the  fourth  day  after  the  ccmmencing  eruption  had 
been  noticed  on  the  arms,  and  the  twentieth  after  the 
mother's  re-vaccination.  I  found  the  infant  very 
fretful,  and  continually  trying  to  scratch  the  parts 
most  covered  by  the  eruption.  When,  however,  the 
mistaken  application  of  vaseline  on  rags  was  re- 
moved, the  most  irritable  parts  of  the  skin  bathed, 
and  then  dusted  freely  with  finely  powdered  starch, 
this  symptom  subsided  considerably.  The  tempera- 
ture was  slightly  elevated,  not  more  than  two  degrees 
above  normal.  On  examining  the  entire  surface  of 
the  body,  at  least  four  hundred  clearly  defined, 
perfectly  circular,  invariably  umbilicated  vesicles 
were  apparent.  The  two  forearms,  chiefly  on  their 
lower  surface,  the  ankles,  and  legs  below  the  knees 
and  the  left  cheek  were  the  sites  of  certainly  all  but 
about  one  hundred  of  these.     The  remninder  were 


394 


THE  MEDICAL  RECORD. 


scattered  about  on  other  parts  of  the  surface,  singly 
and  in  groups  of  two,  three,  or  more.  The  surfaces 
of  the  abdomen  and  of  the  back  were  almost  free  from 
them.  On  the  upper  part  of  the  chest,  the  upper 
arms,  the  thighs,  the  neck,  forehead,  and  right  cheek, 
were  very  nearly  all  the  vesicles  not  found  on  the  two 
forearms,  the  legs,  and  left  cheek.  On  these  five 
places,  when  I  first  saw  the  case,  the  eruption  was 
nearly  confluent,  the  vesicles  being  closely  colierent. 
The  eruption  had  wonderfully  tlie  appearance  of 
that  of  variola  on  the  fifth  or  sixth  day.  The  vesicles 
were,  however,  more  perfectly  and  invariably  abso- 
lutely circular.  No  matter  how  near  to  each  other, 
not  one  vesicle  varied  in  the  slightest  degree  from  a 
perfect  round.  On  the  arms — on  one  2)articularly — a 
considerable  number  of  the  vesicles  had  been  torn 
open  by  the  patient,  exhibiting  very  clearly  the  pecu- 
liar cellular  structure  of  the  vaccine  vesicle,  and  from 
these  exuded  a  considerable  amount  of  a  perfectly 
colorless,  pellucid  fluid.  Ai-ound  each  separate  ves- 
icle and  group  of  them,  was  a  bright  areola  of  limited 
extent  and  of  more  symmetrical  approach  to  a  circular 
outline  than  observed,  at  a  certain  stage,  around  the 
pustules  of  riiriolii,  varloloiil,  or  varicella.  Counting 
the  first  day  (March  1st)  on  which  the  papular 
eruption  was  first  noticed  by  the  mother  as  corre- 
si^onding  with  the  fourth  day  after  vaccination,  as  I 
think  it  fair  to  do,  the  day  I  first  saw  the  case  would 
be  the  ninth,  the  day  on  which  the  areola  of  vaccinia 
from  vaccination  direct  from  the  heifer  (with  heifer- 
transmitted  COW-230X)  begins  to  appear,  but  the  day 
on  which  the  ai-eola  of  vaccinia,  induced  by  one 
(human)  remove,  virus  iafulli/  formed.  My  diagno- 
sis was  of  a  general  eraption  of  vaccinia  ;  that  it  was, 
when  I  first  saw  it,  at  its  acme,  and,  if  I  was  right, 
that  desiccation  would  rapidly  follow. 

I  very  much  regret  that  I  did  not  procure  photo- 
graphs of  this  case  on  the  day  of  my  Jirst  visit, 
but  it  was  quite  late  in  the  day,  and  on  visiting  it 
in  the  forenoon  of  the  next  day  (Tuesday),  I  found 
that  the  beautiful,  clear  definition  of  every  vesicle 
had  almost  entirely  disappeared  or  been  much  modi- 
fied. 

Desiccation  had  not  only  commenced,  but  very 
considerably  advanced,  and  already  a  confluent  scab 
covered  a  lai'ge  portion  of  the  surface  on  which  the 
eruption  had  been  most  abundant.  It  was  too  late 
to  take  any  photogi'aph  which  would  give  the  per- 
fectly satisfactory  and  convincing  idea  of  the  erup- 
tion which  one  taken  the  previous  day  would  have 
afforded.*  The  vesicles  had  not  appeared  simul- 
taneously, but  had  come  out  as  in  variola,  only 
that,  instead  of  first  appearing  on  the  forehead  and 
back  of  neck,  and  regularly  and  gradually  descend- 
ing to  the  feet,  they  had  appeared  on  the  arms  and 
afterward  on  other  parts  of  the  body,  without  any 
ascertainable  symmetry,  but  selecting  those  parts  of 
the  skin  on  which  the  eruption  of  eczema  had  been 
most  troublesome,  very  few  vesicles  appearing  on 
parts  of  the  surface  not  previously  so  occuj)ied.  I 
took  two  moulds  in  gutta  percha  of  parts  of  the  up- 
per arm,  on  one  sido,  on  which  still  remained  a  few 
characteristic  vesicles.  Into  those  I  cast  plaster-of- 
Paris,  and  the  casts  thus  obtained  exhibit  an  image 
of  a  few  of  the  vesicles,  and  on  two  or  three  of  these 
the  umbilication  is  clearly  perceptible,  but  the  iso- 
lated vesicles  wore  much  smaller  than  the  older 
ones  of  which  the  nearly  confluent  patches  were 
composed.    I  charged  seven  or  eight  of  mv  •'iniiref." 

*  I  undoratond  thtit,  bohio  hour»  nftor  I  saw  tho  case  at  niv  second 
vlult,  a  photoifraphtc  ncffatlve  of  it  w(u  takon.  I  havo  not  seen  any 
print  trom  this. 


ivory  points*  from  some  of  the  vesicles  which  still 
exuded  a  little  fluid  on  puncture.  Desiccation  bad 
been  much  more  rapid  than  is  ever  noticed  of  the 
two  or  three  vesicles  usually  resulting  from  ordinary 
vaccination,  as  rapid  as  is  ever  noticed  in  even  the 
very  slightest  cases  of  that  most  insignificant  of  all 
exanthematic  affections,  slight  post-vaccinal  vario- 
loid. Fever  and  areola  had  entrely  disappeared,  the 
latter  even  around  the  large  semi-confluent  patches. 
The  child  seemed  comfortable,  and  to  have  no  in- 
clination to  scratch  the  skin  anywhere.  I  visited 
the  case  again  on  the  Uth  (Thursday).  I\Iany  scabs 
had  been  rubbed  oft',  but  over  each  of  the  confluent 
patches  they  remained  adherent,  except  where 
somewhat  broken  off'  at  edges. 

■Where  the  removal  of  scabs  exposed  the  surface 
beneath,  it  was  evident  that  the  crn-itim  had  not  been 
involved  to  such  a  degiee  as  to  endanger  pitting  of 
the  single  vesicles  or  small  gi'oups  of  them.  I  again 
saw  the  child  on  the  1.5th  or  16th.  The  mother 
gave  me  quite  a  number  of  the  scabs,  on  many 
of  which  perfect  umbilication  is  evident.  Very  few 
adherent  scabs  remained  on  any  ]3art  of  the  body. 
The  parts  of  the  skin  which  had  been  occupied  by 
the  confluent  and  semi-confluent  patches  had  very 
much  the  appearance  of  a  surface  from  which  the 
scabs  of  cntxta  lactea  have  been  very  recently  re- 
moved. There  was  no  indication  of  loss  of  sub- 
stance below  the  epidermis  or,  of  course,  of 'subse- 
quent pitting.     This  was  my  last  visit. 

It  is  very  noticeable,  since  I  introduced  true  ani- 
mal vaccination  (September,  1S70),  that  more  and 
more  are  noticed  and  reported  of  those  general  erup- 
tions and  rashes,  which  are  constantly  refeiTed  to  by 
the  writers  of  early,  particularly  of  the  very  enrliesi, 
years  of  vaccination,  but  which  certainly  do  not 
complicate,  to  anything  like  such  a  degree  or  in  any 
such  variety,  the  vaccinia  induced  by  the  virus  of 
long  humanization.  'VN'illan,  who  published  an  ad- 
mirable illustrated  quarto  in  1S06  "  On  Vaccine  In- 
oculation," speaks  of  a  profiise  and  general  miliary 
eruption  as  being  noticed  about  once  in  fifty  cases 
of  vaccinia  in  the  human  subject.  I  first  noticed  it 
after  I  commenced  to  use  the  heifer-transmitted 
cow-pox  virus  and  sufliciently  to  corroborate  very 
exactly  "Willan's  approximative  estimate  of  its  fre- 
quency. The  areola  of  the  vaccinia,  induced  by  true 
bovine  virus,  is  much  more  intense  and  marked  than 
in  long-humanized  vaccinia.  Now  and  then,  very 
rarely,  when  the  areola  is  most  vivid,  in  plethoric  in- 
fanta and  children  with  very  vascular  skin,  are  seen, 
within  it,  little  globular  vesicles,  not  at  all  umbili- 
cated,  and  containing  a  fluid  which  on  inoculation  in- 
duces no  effect  whatever.  These  are  nothing  more 
than  little  eft'usions  beneath  the  epidermis,  *ithout 
any  specific  character,  and  mere  results  of  intense 
congestion  of  the  ves.sels  of  the  corium.  The  very 
minute  miliary  eruption  is  composed  of  vesicles 
which,  on  examination  with  the  aid  of  a  good  lens, 


•  I  see  so  many  glowing  commendations  of  these  large  ivory  lancet 
]iolnts  in  the  advertisements  of  fifcn(/«m«M  who  invariably  ftiil  to  men- 
tion who  invented  them,  that  I  may  as  well  take  this  occasion  to  stata 
that  the  large  size  of  the  inodiAcation  of  the  English  vaccine  iwint, 
now  very  universally  used  in  Anierici\  and  coming  into  nse  in  Biiropo, 
was  adopted  for  the  needs  of  animal  vaccination  by  myself,  from  K 
suggestion  of  Marson's,  quoted  in  Seaton's  excellent  hancl-t>ook,  white 
making  the  ivory  point  sharp  and  as  nearly  as  possible  like  the  blada 
of  a  common  lancet,  was  my  exclusive  invention.  It  has  been  found 
very  useful.  I  did  not  patent  it,  though  it  seems  to  he  the  custom  for 
some  professional  men  now  to  do  such  things.  I  undersrai'.d  that  an 
application  has  been  recently  made  to  the  Patent  Office,  by  a  physician, 
to  patent  points  of  quill  made  in  a  way  invented  by  my;*elf  full  thirty 
years  since,  and  employed  constantly  till  I  abandoned  all  others  for  the 
**  lancet "  point  of  ivory.  A  custom  "more  honored  in  the  breach 
than  in  the  observance." 


THE  MEDICAL  RECORD. 


395 


reveal  decided  umbilication.  I  once  charged  two 
points  by  rupturing  several  of  these  minute  ve- 
sicles and  failed  to  induce  vaccinia  in  using  them, 
but  I  do  not  consider  that  experiment  final  and  in- 
tend to  repeat  it.  Besides  these,  are  certain  rashes 
often  like  the  eruption  of  roseola  for  die  riitheln,  or 
German  measles,  to  adopt  modera  nomenclature, 
and  sometimes  like  that  of  measles  or  of  scarla- 
tina, and  now  and  then,  quite  rarely,  like  that  of 
Hrlicarin.  and  occasionally  of  large  red  splashes  or 
blotches  covering  parts  or  all  of  the  body.  These 
eruptions  are  very  fugacious,  vei-y  evanescent,  and 
of  very  little  real  consequence  to  anybody  except 
the  ardent  anti-vaccinator.  They  always  appear  at 
the  time  that  the  areola  is  at  its  acme  of  develop- 
ment, and.  are  not  without  analogues  in  instances 
where  any  very  intense  inflammatory  congestion  oc- 
cupies a  limited  portion  of  the  cutaneous  surface. 
I  am  speaking  of  symptoms  occurring  occasionally 
in  the  vaccinia  induced  by  the  nse  of  pvre  vaccine 
virus,  collected  from  perfectly  typical  vesicles  of  true 
heifer-transmitted  eow-jjox.  I  have  nothing  now  to 
say,  but  by  and  by  a  great  deal,  of  the  innumerable 
symptoms — always  extremely  annoying  and  destruc- 
tive of  the  propliiilnxis  sought,  and  occasionally  ex- 
tremely grave  and  even  fatal — which  have,  and  do, 
and  ■will,  more  and  more  complicate  the  use  of  the 
abominable,  factitious,  fraudulent  prejjarations  of 
so-called  "pure  bovine  bjmpk"  which  ingenious 
ignorance  has  distributed  far  and  wide,  particu- 
lai'ly  during  the  recent  winter,  spreading  misery  and 
disease  and  sowing  broadcast  seeds  of  failure  and 
imperfect  or  quite  delusive  propifn/la.ris,  which,  in  the 
near  future,  will  ripen  into  a  full  crop  of  pseudo 
post-vaccinnl  variola  and  anti-vacciuism. 

But  excuse  this  digression.  "  Out  of  the  fulness  of 
the  heart  the  mouth  speaketh,"and  my  heart  is  pretty 
fall  of  this  subject  of  fraudulent  vaccine  vinis  just  at 
present.  In  all  my  very  long  and  large  experience  of 
vaccination  with  long-humanized  virus,  I  never  saw 
or  knew  of  a  case  of  anything  like  a  general  erup- 
tion of  vaccinia.  I  have  seen  many  eases  of  nomi- 
nnVy,  but  not  really  spontaneous,  vesicles,  the  effect 
of  auto-vaccination,  or  accidental  contact  with  a  vac- 
einee.  Since  I  have  used  heifer-transmitted  cow- 
pox  virus  direct  ft'om  the  animal,  I  have  seen  three 
cases  of  general  vaccinia,  two  besides  that  now  im- 
perfectly narrated,  and  both,  like  that,  were  in 
children  suffering  from  an  extensive  eruption  of 
eczema.  This  is  certainly  not  a  mere  coincidence. 
but  an  extremely  interesting  and  important  obser- 
vation. How  and  whv  interesting  and  imjiortant  I 
purpose  to  tell  in  another  pajjer. 

In  looking  up  the  subject  of  general  vaccinal 
eruption,  I  found  accounts  of  many  cases  of  the 
sort,  almost  all,  however,  being  clearly  not  really 
cases  of  general  eruption  in  the  sense  that  the  erup- 
tion of  variola  or  of  varicella  is  so. 

One  case,  the  nearest  analogue  to  that  I  have 
recorded,  was  so  very  curious  that  I  will  terminate 
this  paper  with  a  translation  of  tiie  account  of  it  in 
the  Rapport  du  Comite  Central  de  Vaccirie  sur  fe« 
Vaccinations  pratiqvee.i  en  France  pendant  t'Ayinre 
1810.      A  Paris  de  I'imprimen'e  Imperiale,  1812. 

"A  girl  aged  four  years  had  been  vaccinated  in  vain 
several  times  in  1809.  She  was  again  Viiccinated 
without  effect  in  1810.  This  persistent  refractori- 
ness of  the  system  to  contract  vaccinia  induced  M. 
Cazals,  a  physician  of  Agde,  to  adopt  the  following 
method  :  He  was  in  the  habit  of  using  the  vaccine 
crust ;  he  thought  this  had  proved  too  feeble  as  an 
external  appliance,  and  to  accomplish  the  desired 


end  he  induced  the  parents  to  give  to  the  child,  as 
a  pretended  vermifuge,  a  pinch  of  powdered  vaccine 
crust.  This  was  done  in  a  tablespoonful  of  soup. 
The  child  suffered  no  inconvenience  till  the  fourth 
day,  at  which  time  the  places  previously  vaccinated 
exhibited  a  slight  appearance  of  effect.  She  suf- 
fered some  evident  languor,  nausea,  and  even  vomit- 
ing as  in  variola.  There  was  very  smart  fever,  with 
faintness,  nervous  restlessness,  and  extreme  prostra- 
tion. This  condition  continued  during  nearly  six 
days,  and  at  the  end  of  that  time  there  ajipeared  a 
general  eruption  of  one  hundred  and  eighty  (180) 
vesicles,  all  of  clearly  vaccinal  type ;  each  followed  its 
natural  course,  the  inflammation  of  the  circle  or 
areola  extending  to  several  millimetres  around  each 
vesicle,  in  many  places  all  the  areohe  combined 
so  as  to  make  one  single  large  area  of  cutaneous 
congestion.  From  the  eleventh  to  the  twelfth  day 
the  areola  declined.  There  remained  some  slight, 
hardly  perceptible  efflorescence,  and  fever  ceased 
at  the  l5eginning  of  the  thirteenth  day.  On  the 
fourteenth  day  the  scabs  had  become  black  but  did 
not  fall  till  the  twenty-first  day." 

Although  M.  Yigoroux,  who  forwarded  this  obser- 
vation, has  refrained  from  any  comment,  and  con- 
fined himself  to  a  simple  statement  of  the  facts,  the 
committee  cannot  help  regarding  the  proceeding  of 
IM.  Cazals  and  his  conduct  in  employing  it  as  ex- 
tremely bold  if  not  indeed  temeraire,  with  which 
dead  and  buried  reproof  from  many  "  good  doctors," 
whose  souls  "  are  with  the  saints  I  trust,"  I  close  for 
the  present. 

On  looking  over  these  very  hastily  written  pages 
I  find  that  I  have  forgotten  to  state  the  quite  impor- 
tant fact  that,  with  the  points  charged  at  my  second 
visit  (tenth  day),  I  inoculated,  on  the  outer  margin 
of  the  left  labium  piudendi,  a  very  tine  yearling  Jer- 
sey heifer  calf,  which  I  devoted  e.rclvsirely  to  the 
experiment.  I  inserted  the  virus  in  six  jjlaces,  in 
slight  superficial  incisions  of  about  one-third  of  an 
inch  in  length,  and  in  one  place,  on  the  under  side 
of  the  tail  near  its  insertion,  by  inserting  a  thin  soft 
little  scab,  from  the  top  of  a  desiccating  vesicle,  in 
a  deep,  very  oblique  puncture.  On  the  third  day  it 
was  evident  that  all  the  insertions  had  "taken."  On 
the  seventh  day  there  were  seven  fine  typical  vesicles 
at  places  of  insertion,  and  two  so-called  "spontane- 
ous "  vesicles. 

These  were  so  very  evidently  vaccine  vesicles  that  I 
did  not  hesitate  to  chfirge  a  few  points  from  them, 
and  with  these  made  three  primary  and  one  adult 
secondary  vaccination.  These  were  all  siiccessful. 
Two  of  the  primary  cases  exhibited  very  fine  vesi- 
cles and  areolae  at  end  of  ninth  day.  The  third  case, 
was  of  an  irritable  child,  who  managed  to  rupture 
the  two  vesicles  at  points  of  insertion,  but  a  third 
small  "  sj)ontaneoiis  "  vesicle  was  very  perfect  in  all 
respects.  The  re-vaccination  "  took  "  very  slightly, 
but  with  unmistakable  vaccinal  effect.  Neither  have 
I  mentioned  the  size  of  the  vesicles  in  my  narra- 
tive of  the  case.  Although  very  perfect  in  form  and 
type  they  w-ere  smaller  than  seen  in  successful  or- 
dinary vaccination.  The  largest,  of  which  were  the 
gi'eater  number,  were  somewhat  larger  than  the 
average  small-pox  vesicles  (before  maturation), 
while  many  of  the  smallest  were  of  not  hali  that 
average  size.  The  facts  of  the  small  size  of  the 
vesicles,  and  that  no  slough  from  the  trne  skin  and 
consequent  pitting  ensued,  are  interesting,  as  prov- 
I  ing  that  the  far  gi-eater  intensity  of  action,  degree  of 
development,  longer  active  continuance,  and  much 
I  less  rapid  desiccation  of  the  two  or  three  vesicles 


396 


THE  MEDICAL  RECORD. 


of  ordinary  vaccination,  with  the  most  vigorous 
virus,  are  simplv  results  of  the  process  by  which  the 
p.itieat  is  protected  being  confined  to  so  few  points. 
Tuey  add  to  the  proof,  if  addition  were  necessary,  of 
the  importance  of  the  perfect,  full  development  of 
the  ruiiides  and  areolae  of  vaccinia,  and  show  why,  in 
the  u?e  of  the  much-changed  and  deteriorated  virus  of 
very  long  humanization,  it  is  very  important  to  mul- 
tiply points  of  insertion,  as  also  proved  by  Marson's 
thousand  times  requoted  tables. 

It  is  proper  to  state  that  the  two  children  did  not 
sleep  together,  and  if,  under  any  circumstances,  such 
an  e-"ctensive  eruption  could  have  resulted  from  con- 
tinued and  frequent  contact,  no  such  contact  or  op- 
portunity for  it  occurred  in  this  case. 


CASE  OF  FRACTURE  OF  THE  OS  HYOIDES. 
By  JAMES  G.  LA  EOE,  M.D., 

GREESPOIST.    L.  I., 
UEMBER    OF    KINGS    COCNTY    MEDICAL    SOOIETT. 

It  has  occurred  to  me  to  give  for  the  benefit  of 
"  whom  it  may  concern "  the  residue  of  a  rather 
unique  case.  I  use  the  term  advisedly  for  the  rea- 
son that  on  consultation  with  a  number  of  my  con- 
frBres  they  all  agree  as  to  its  rarity.  Besides,  a 
rather  careful  perusal  of  the  different  surgical  au- 
thorities further  strengthens  our  ojainion  in  the 
premises  and  justifies  a  brief  description  of  it. 

.On  the  1st  of  February  last,  I  was  called  to  B.  P. 

J ,  aged  twenty-seven,  mamed,  and  an  engineer 

by  occupation.  He  is  short  of  build  and  very  thin, 
not  weighing  over  one  hundred  and  twenty  jjounds. 
To  describe  the  symptoms  of  his  ailment  at  that 
time  is  to  tell  of  a  slight  tonsillar  trouble,  a  condi- 
tion of  things  to  which  he  is  very  subject. 

A  gargle  of  chlorate  of  potash  and  tannin  speedily 
solved  the  difficulty,  and  he  ventured  to  return  to 
his  work.  Exposure  by  working  in  a  damp  place 
brought  on  a  violent  attack  of  follicular  tonsillitis. 
This  proved  very  obstinate,  but  it  finally  yielded  to 
repeated  topical  applications  of  ferri  persulphatis. 

Five-grain  doses  of  quin.  sulph.  dissolved  in  two 
teaspoonfuls  of  the  elix.  pran.  vu-g.  was  also  given 
every  four  houi-s. 

Although  very  weak,  he  determined  to  go  to  work 
on  the  Monday  morning  following.  After  a  good 
night's  rest  he  arose  early  the  next  morning,  and  as 
he  did  so  thought  he  would  indulge  in  the  luxury 
of  a  good  "gajio."  But  alas,  as  he  "enjoyed"  he 
felt  something  snap  just  below  the  inferior  maxil- 
lary, and  immediately  thereafter  felt  a  .slight  swel- 
ling at  that  point. 

Thereupon  ensued  great  ])ain,  made  more  intense 
by  attempting  to  swallow  the  saliva.  My  first 
thought,  before  examining  him,  was  that  the  in- 
ferior maxillary  had  become  misplaced,  but  a  glance 
proved  the  incoiTectness  of  my  suspicion.  He  di- 
rected my  attention — in  a  very  languid  voice  and 
hard  pressed  for  breath — to  a  small  lump  just  below 
the  inferior  maxillary  and  on  the  exact  jioint  where 
he  felt  "  something  .snap."  It  produced  exquisite 
torture  as  I  pressed.  His  face  presented  as  dis- 
tressed a  look  as  I  have  seen  in  many  a  day.  What 
was  the  trouble?  During  all  my  practice  I  had  never 
seen  a  case  like  this.  Memory,  however,  proved 
equal  to  the  emergency,  and  it  came  back  to  me  like 
a  Hash  after  a  lapse  of  at  least  a  dozen  years.  While 
a  student  at  Bcllevue,  I  remembered  to  have  seen 
the  duplicate  of  this.     It  occurred  in  the  service  of 


Professor  Hamilton.  The  accident  occurred  in  the 
same  manner,  though  usually  the  result  of  direct 
violence.  As,  for  instance,  the  grasp  of  a  murderous 
hand  or  a  blow  to  the  same  jnirpose.  The  question 
to  be  decided  was  :  Is  it  a  fracture  or  dislocation  of 
the  08  hyoides?  When  I  pressed  the  slight  tumor 
and  tried  in  different  ways  to  reduce  it,  it  would  not 
"  down."  My  patient  would  hardly  allow  nie  to 
touch  it  a  second  time.  After  a  while,  however,  he 
grew  reconciled  to  the  inevitable,  and  I  satisfied 
myself  accoi-dingly.  A  slight  crepitus  was  apjiarent 
after  a  careful  examination,  and  I  came  to  the  con- 
clusion that  the  right  cornu  was  involved.  The 
fracture  was  evidently  at  the  junction  with  the  body. 
I  attemjited  to  pass  a  proliang  into  the  pharynx, 
but  my  patient  "  gagged  "  so  that  I  had  to  desist. 
I  handed  him  a  glass  of  water,  and  the  first  mouth- 
ful made  him  tui-n  red  in  the  face.  He  looked  more 
distressed  than  before,  if  that  were  possible,  as  the 
water  returaed  the  same  way  it  had  come.  It  took 
him  some  minutes  to  regain  his  breath  j^ropei'ly.  I 
attempted  to  place  my  fingers  in  the  mouth,  in  or- 
der to  reduce  the  fragments — as  recommended  by 
Holmes — but  met  with  poor  success.  I  came  to  the 
conclusion  to  let  well  enough  alone,  in  order  to  gain 
a  little  breathing-time  for  both  myself  and  patient. 
There  was  so  little  disjilacement  that  nothing  could 
be  gained  by  extreme  measures.  Holding  the  head 
backward  and  pressure  by  means  of  adhesive  straps 
were  alone  recommended,  and  internally  the  usual 
astringents.  Having  no  "  oesophageal  tube  "  handy, 
as  suggested  by  some  surgical  authorities,  I  could 
not  tell  my  patient  to  take  his  food  that  way.  If 
need  be,  I  determined  to  resort  to  the  last  men- 
tioned mode  of  .sustaining  life.  For  the  present, 
perfect  rest  alone  was  advisable,  since  he  was  in  no 
danger  of  suffering  from  asthenia. 

When  I  saw  him  the  next  day  a  little  wine  had 
passed  his  lips.  He  had  managed  to  swallow  it 
almost  drop  by  drop.  It  was  cruel  torture  to  attempt 
anything  of  the  kind,  but  he  realized  how  necessary 
it  was  to  quench  his  natural  thirst  at  least.  In  order 
to  see  how  it  would  work  I  asked  him  to  swallow  a 
little  before  me.  He  did  so  very  slowly,  and  any- 
body who  has  seen  a  victim  of  hydrophobia  when 
water  is  handed  to  him  can  imagine  the  result. 
There  was  a  spasmodic  action  of  the  throat,  an  ago- 
nized face,  and  once,  when  a  few  drops  more  than 
usual  had  jiassed  down,  a  rejection  of  the  same.  He 
pronounced  himself  as  completely  discouraged  at 
the  prospects  before  him.  Though  usually  having  a 
good  appetite,  he  felt  comfortable  without  food  for 
the  first  few  days.  As  time  went  on  he  learnt  tlie 
trick  of  holding  his  head  in  a  certain  position,  there- 
by suffering  less  pain  and  absorbing  more  liquid 
nourishment.  The  position  he  assiimed  was  down- 
ward and  toward  the  right  clavicle. 

I  attempted  several  times  to  pass  the  probang  but 
found  it  impossible  in  view  of  the  increased  hyper- 
SBsthetic  condition  of  the  intestinal  tract. 

Different  authorities  assume  that  the  liead  should 
be  thrown  backward,  and,  as  mentioned  above,  this 
was  ordered.  At  first  I  was  a  little  adverse  to  my 
patient's  use  of  his  discovery,  but  he  jiroposed  to 
take  all  the  comfort  he  could  in  his  sore  strait,  and  I 
could  hardly  blame  him.  In  the  end  it  proved  all 
right. 

At  the  end  of  two  weeks  the  lump  bad  grown  the 
least  bit  smaller,  but  still  the  pain  existed.  For  its 
moral  effect  I  ordered  a  liniment  composed  of  chlo- 
roform, tinct.  opii.  and  lin.  sapon..  to  be  used  four 
or  five  times  a  day."  A  couple  of  days  later  the  sore- 


THE   MEDICAL  RECORD. 


397 


ness  on  the  outside  was  reduced  to  a  minimum,  buu 
it  was  fully  three  weeks  before  it  had  disappeared. 
Meanwhile  the  exquisite  pain  grew  less  when  at- 
tempts were  made  at  deglutition.  Simultaneou.sly,  a.s 
might  be  .supposed,  with  the  disapjjearance  of  tumor 
the  torture  of  the  throat  ceased  to  exist.  It  is  true 
there  was  a  slight  soreness  for  a  day  or  two  after- 
ward, but  that  was  as  nothing  to  what  had  preceded 
it.  My  patient  did  not  seem  to  niiud  this  trifle,  but 
made  haste  to  make  up  for  lost  time  in  exercising 
his  gustatory  powers. 

It  may  be  taken  for  granted  that  he  presented  a 
very  emaciated  appearance  for  the  first  few  days  of 
convalescence,  but  in  due  season  he  gained  the  flesh 
be  had  lost. 

In  writing  on  the  subject  of  fractures  and  disloca- 
tions of  the  OS  hyoides,  the  majority  of  the  different 
surgical  authorities  are  pleased  to  dismiss  the  sub- 
ject with  a  few  curt  lines. 

Holmes,  probably,  is  the  one  exception  who  does 
not.  It  is  true  the  accident  is  of  rare  occurrence, 
but  for  all  that,  like  any  accident,  it  may  occur  to 
any  one  of  the  numerous  readers  of  The  Medical 
Becord  to  meet  with  it  in  his  own  practice.  For 
that  reason  it  would  surely  do  no  harm  to  better 
emphasize  the  subject,  and  a  few  lines  further  will 
not,  I  trust,  prove  out  of  ])lace. 

Hamilton  says  :  "  The  fracture  is  characterized  es- 
pecially by  displacement,  ditliculty  of  deglutition, 
and  sometimes  by  difficulty  in  respiration." 

Of  the  ten  (10|  cases  which  he  found  recorded,  tire 
(;"))  recovered.  Among  the  cases  wliich  recovered, 
three  of  the  fractures  had  been  caused  by  grasping 
the  throat,  and  one  was  caused  by  muscular  action. 
As  to  treatment,  what  alone  had  been  done  in  my 
patient's  behalf  is  mentioned. 

Holmes  says  as  to  diagnosis  :  "  It  is  usually 
caused  by  direct  violence,  but  in  some  instances  has 
been  attributed  to  muscular  action.  .  .  .  The 
symptoms  are  pain  in  the  neck,  inability  to  turn  the 
head,  dysphagia,  or  even  total  inability  to  swallow. 
The  voice  is  hoarse,  the  patient  having  great  diffi- 
culty and  pain  in  speaking.  Symiitoms  of  suffoca- 
tion occasionally  occur,  or  may  be  produced  by 
simple  protrusion  of  the  tongue.  On  examining  the 
throat  externally,  crepitus,  or  some  irregularity  may 
be  detected ;  and  on  looking  into  the  mouth,  not 
unfroquently  ecchymosis  and  swelling  of  the  mucous 
membrane  may  be  found.  The  fragments  occasion- 
ally perforate  the  mucous  membrane  and  more  or 
less  bleeding  may  occur." 

In  an  interesting  monogram  by  Gibbs  of  Church- 
hill,  London,  and  dated  1862,  there  is  narrated  the 
particulars  of  thirteen  (13)  cases  of  fracture.  In  four 
of  these  the  right  cornu  was  broken,  in  five  the  left  ; 
and  in  one  (that  of  a  child)  the  middle  of  the  body 
of  the  bone  was  broken.  In  two  the  precise  seat  of 
the  injury  is  not  stated.  Two  of  the  cases  termi- 
nated fatally. 

As  to  treatment,  Holmes  is  a  little  more  explicit 
than  is  Hamilton.  "  The  displaced  fragments  must 
be  restored  to  their  proper  position.  This  may  be 
efifected  by  passing  the  finger  of  one  hand  into  the  i 
throat,  and  bv  the  other  hand  manipulating  the  bone 
externally.  The  patient  should  be  keptipiiet,  every 
attempt  at  speech  avoided,  and  antiphlogistic  regi- 
men adopted.  Inflammation  may  be  i-elieved  by  the 
application  of  leeches.  If  great  difficulty  of  breath- 
ing should  supervene,  laryngotomy  must  be  per- 
formed. If  the  patient  cannot  swallow  or  finds 
great  difficulty  and  pain  in  doing  so,  the  use  of  the 
oesophageal  tube  is  requisite.     If  the  passage  of  this 


tube  produces  much  pain  or  inconvenience,  nutiient 
enemata  must  be  administered." 

Holmes  quotes,  fvu-ther  on,  a  case  reported  by 
Lalesque.  There  was  con.siderable  hemorrhage  and 
he  had  to  be  fed  by  an  ctsophagiis  tube  for  twenty- 
fivo  days,  and  ultimately  recovered.  In  this  case 
there  was  considerable  deformity,  which  made  deg- 
lutition impossible, 
s  As  to  diagnosis,  Erichsen  makes  no  new  sugges- 
tions. He  calls  attention  to  two  points.  "  Should 
one  piece  of  the  bone  be  driven  much  in,  it  might 
possibly  require  to  be  drawn  forward  with  a  tenacu- 
lum. The  head  should  then  be  fitted  with  a  stiff 
I   pasteboard  collar  to  prevent  displacement." 

The  awkwardness  of  both  the  injury  and  the  po- 
sition in  which  the  neck  must  be  held  makes  the 
l)rospect  anything  but  inviting.  Still  one  can  readily 
understand  under  what  circumstances  this  resort 
would  be  absolutely  necessary. 

Druitt  mentions  emphysema  as  one  of  the  symp- 
toms attendant  on  fi'acture  of  the  os  hyoides.  Fur- 
ther on,  he  says :  "  In  a  case  of  i)eri>endicular  fract- 
ure of  thePthyroid  cartilage  seen  by  Dr.  Gibli,  the 
two  lateral  portions  were  separated  at  jjomum 
Adami,  but  the  only  symptoms  were  loss  of  voice 
and  an  'indescribable  sensation'  in  the  throat." 

This  is  significant  in  view  of  the  close  proximity 
of  the  OS  hyoides.  Would  not  a  slight  fracture  of 
the  latter  bone  be  just  as  liable  to  give  the  same 
dearth  of  diagnostic  data?  It  would  seem  plausible, 
at  least. 

As  to  treatment,  Druitt  indulges  in  the  usual 
"glittering  generalities." 

In  looking  over  Chelius'  work  on  surgery,  as 
translated  hy  Dr.  South,  I  see  that  he  refers  to  the 
accident  under  the  heading  of  "Fractures  of  the 
Tongue-Bone."  The  edition  I  refer  to  bears  the 
date  of  18-17,  and  one  is  struck  at  the  similarity  of 
language  in  the  whole  article  when  it  is  compared 
to  the  more  modern  works  on  surgery.  To  repeat 
what  is  written,  both  as  regards  diagnosis  and  treat- 
ment, would  be  to  reiterate  what  I  have  already 
ipioted. 

The  only  deviation  is  the  remark,  in  parentheses, 
made  by  the  translator.  Dr.  South:  "The  onlv  ex- 
amples of  fracture  of  this  bone  of  wliich  I  am  awaie 
are  those  of  persons  executed  by  hanging,  in  which 
fracture  is  almost  invariably  found." 

Both  in  language  and  experience  it  would  seem 
that  Dr.  South  doubts  the  possibility  of  its  occur- 
ring otherwise  than  by  hanging.  He  does  not  go  as 
far  as  Chelius,  who  insists  that  it  "is  always  conse- 
quent on  direct  external  violence,  and  almost  always 
occurs  in  the  horns  of  the  bone." 

Presumably  they  would  have  both  changed  their 
minds  if  they  but  lived  at  the  present  day,  and  the 
exi)erience  of  our  modern  surgeons  were  open  to 
their  criticism. 

Bryant  makes  no  mention  of  the  subject  under 
consideration.  At  any  rate,  I  have  failed,  after  a 
careful  examination,  to  find  it.  He  possibly  did  not 
think  it  of  enough  importance  to  write  about. 

In  conclusion,  a  word  as  to  my  treatment  of  the 
case  in  question.  As  has  been  seen  it  was  almost 
nil.  Micawber-like,  I  waited  for  something  to  "turn 
up."  True,  the  deformity  was  very  slight,  and  there- 
fore nothing  could  be  gained  by  attempts  at  reduc- 
tion. The  adhesive  straps,  ordered  at  first,  were  not 
insisted  upon,  as  nothing  could  be  gained  thereby. 
Placing  the  head  in  a  stiff"  pasteboard  collar,  to  pie- 
vent  further  displacement  of  the  fracture,  woulo 
have  been  clearly  indicated  had  the  breakage  beeu 


398 


THE   MEDICAL  RECORD. 


larger.  Under  the  circumstances,  I  was  fortunate 
in  meeting  with  a  case  that  did  not  demand  it,  and 
my  patient  was  lucky  in  that  he  was  not  obliged  to 
submit  to  the  imprisonment. 

115  XOBLE  Street,  March  25.  l>^sy. 

THE   FALSE    MEAIBKANES   OF    DIPH 

THERLi. 

By  UOLLIN  E.  GREGG,  M.D.. 

BDFPALO,   N.   Y. 

In  an  able  paper  by  Dr.  Ferdinand  Oohn  npon 
"  Bacteria,"  he  says  : 

"  Every  one  knows  bow  mercilessly  diphtheria  de- 
stroys so  many  promising  lives — an  easily  transmit- 
ted contagion,  which  usually  firmly  seats  itself  in 
the  throat  and  air-passages,  generating  there  a  mem- 
branous formation  which  threatens  immediate  death 
by  suflfocation.  The  microscope  shows  in  all  the 
organs  of  the  diseased  person  numberless  spherical 
bacteria,  heajied  together  in  thick  masses,  which 
pass  through  and  besiege  the  tissues  of  the  muscles, 
vessels,  and  mucous  membrane  ;  everywhere  con- 
gestion, inflammation,  and  a  general  blood-poison- 
ing follow  in  consequence." 

The  inference  from  this  language,  and  especially 
from  the  expression  •'  numberless  spherical  bacteria, 
he  iped  together  in  thick  masses,  which  pass  through 
and  besiege  "  the  mucous  membrane,  etc.,  is,  that 
the  false  membranes  of  diphtheria  are  constituted 
of  bacteria  ;  and  this  is  the  teaching  of  many  bac- 
terists.  But  nothing  in  jiathology  is  better  settled 
than  that  said  membranes  are  composed  of  fibrin. 
Oertel,  in  speaking  of  the  "  Croupous  form "  of 
diphtheria,  says  : 

"  The  characteristic  symptoms  of  this  form  is  the 
exudation  offihrlne.  Almost  immediately  after  the 
'  beginning  of  the  diphtheritic  process,  or  after  a 
more  or  less  free  production  of  pus  has  taken  place 
for  some  ilays,  fibrine  is  poured  out,  not  only  into 
the  epithelium — which  is  already  infiltrated  with 
micrococcus— but  also  into  the  interstices  between 
it  and  the  subepithelial  tissue  of  the  pharyngeal 
mucous  memlirane." 

Flint,    speaking  upon  the  same   subject,  in  his 
"  Practice  of  Medicine,"  1881,  says,  more  concisely: 
"  Diphtheria  is  characterized  anatomically  by  the 
presence,  upon  certain  mucous  membranes,  of  a  fibri- 
nous exudation  in  the  form  of  a  false  membrane." 

One  thing,  however,  is  certain  in  connection  with 
this  subject.  These  false  memVtranes  cannot  be  all 
bacteria,  as  some  would  have  us  infer,  and  all 
fibrine  as  others  say.  They  must  be  made  of  one  or 
the  other  exclusively,  or  of  both  combined  in  some 
proportion.  If  of  both,  in  what  proportion  are 
tliey  combined '!  This  must  be  a  question  that  can 
be  solved.  Certainly,  vegetable  parasites  must  dif- 
fer sufficiently  from  coagulating  fibrin  to  have  tlieir 
diflfering  ways  and  results  discerned.  Then  think 
of  the  absurdity  of  a  diphtheritic  membrane,  which 
is  sometimes  as  iiolished  and  glistening  upon  its 
free  surface,  as  is  the  free  surface  of  a  synovial  mem- 
brane, and  not  unfrei[U9ntly  almost  as  dense  and 
thoroughly  organized — ^think  of  this  being  made  of 
vegetable  organisms  which  have  no  means  or  power 
of  uniting  themselves  together  into  a  homogeneous, 
thoroughly  organized  structure  as  these  false  mem- 
branes generally  are,  while  fibrin  does  do  just  svtch 
things. 

Micrococ  -i,  or  vegetable  granules,  coiild  no  more 
organize  into  a  firm  structure,  niiMubranoiis  or  other- 
wise, than   coild  a  mass  of  mustard-seed,  although 


through  moisture  they  might  adhere  slightly  to  each 
otiier,  as  would  wet  mustard-seed,  but  not  to  coalesce 
into  dense  membranes.  Rod-like  bacteria  or  vege- 
table fibrils  can  only  interlace  to  a  very  moderate 
extent ;  and  spiral  bacteria  intertwine  in  just  as 
limited  a  manner  ;  so  neither  of  these  can  possibly 
organize  to  form  membranes.  We  might  as  well  say 
that  growing-grasses  would  do  that.  Fibrin,  on  the 
contrary,  can  and  always  does  coalesce,  or  fibrillate, 
into  dense  membranes,  whenever  the  opportunity 
otfers,  so  there  need  no  longer  be  any  doubt  as  to 
what  the  false  membranes  of  diphtheria  are,  any 
more  than  what  the  false  membranes  of  pleuritis  or 
peritonitis  are.  Of  course,  it  pus  is  formed  and 
mixed  with  the  fibrin  while  the  latter  is  in  its  fluid 
state,  or  if  great  numbers  of  the  granules  of  broken 
blood-corpuscles  become  mingled  with  the  granules 
of  fibrin,  before  these  can  join  to  form  the  interlac- 
ing threads,  as  must  often  happen,  then  the  mem- 
brane must  be  less  firm  and  more  cheesy,  as  is  also 
often  the  case,  and  simply  because  the  pus,  or  the 
granules  of  broken  Vilood-corpuscles,  hold  the  par- 
ticles of  organizing  fibrin  more  or  less  sei^arated,  so 
they  cannot  unite  together  so  firmly  as  would  other- 
wise be  the  case.  The  meshes  of  the  organizing 
fibrin  are  filled  with  pus  or  cheesy  matter  in  such 
cases,  which  makes  the  membrane  more  friable,  or 
crumbling,  than  would  the  jjure  fibrin. 

As  to  what  Oertel  says  of  the  epithelium  being 
"  already  infiltrated  with  micrococcus,"  before  the 
pouring  out  of  fibrin,  he  is  clearly  in  error  (that  is, 
in  assuming  the  presence  of  actual  vegetable  micro- 
coccus), for  as  soon  as  the  slightest  congestion  is 
established  and  before  the  membrane  begins  to  form, 
fibrin  is  exuded  from  the  capillaries  into  the  inter- 
stitial spaces  of  the  tis.sues,  and  between  the  epithe- 
lial cells,  where  it  commences  at  once  to  coagulate 
into  granules,  and  it  is  these  gi'anules  of  fibrin  that 
he  has  mistaken  for  micrococcus.  Said  granules  are 
certainly  there  as  early  as  he  claims  bacteria  to  be 
there  and  he  must  account  for  them,  and  when  he 
has  done  this  he  will  find  no  need  to  account  for 
them  by  calling  them  what  they  are  not. 

Another  quotation  from  Oertel  will,  perhaps,  show 
this  question  in  a  still  clearer  light.  In  speaking 
in  general  of  bacteria  in  di2Jhtheria,  he  says  : 

"  If  the  disease  increases  in  intensity,  we  can  al- 
ways demonstrate  a  progressive  increase  of  these 
organisms  in  the  infected  parts,  and  in  the  discharge 
from  the  fistula,  established  by  cutting  into  the 
trachea.  I  have  repeatedly  demonstrated  a  rapid 
and  great  increase  of  micrococcus  and  bacterium 
termo,  a  short  time  before  the  formation  of  a  diph- 
theritic layer  on  the  edges  of  the  wound  and  the  oc- 
currence of  consecutive  symptoms." 

Of  course  "  a  rapid  and  great  increa.se  "  of  formo 
resembling  "  micrococcus  and  bacterium  termo," 
covild  be  demonstrated  "  a  short  time  before  the 
formation  of  a  diphtheritic  layer  on  the  edges  of  the 
wound,"  simply  l>ecause  fibrin  had  to  coagulate  into 
granules  and  fibrils  there  in  order  to  form  the  diph- 
theritic layer,  or  membrane,  on  the  edges  of  the 
wound.  There  could  have  been  no  membrane 
formed  there,  but  for  the  fibrin  going  through  thefe 
preliminary  stages  of  its  organization  ;  and  the  great 
error  has  been  in  calling  these  granules  and  fibrils 
of  fibrin  micrococcus  and  bacterium  termo,  that  is, 
vegetable  jiarasitcs.  which  could  not  grow,  or  even 
live  a  day,  under  such  circumstances. 

Let  us  have  this  question  settled  upon  what  we 
know  to  be  scientific  facts,  and  not  npon  guess-work, 
or  upon  unscientific  conclusiors. 


THE  MEDICAL  RECOKD 


399 


A  CONTRIBLTTION  TO  THE  STUDY  OF 
BLEPHARTTIS  CILL\RIS  FROM  A3IE- 
TROPIA. 

Br  GEOKGE  P.  HALL,  M.D., 

The  etiology  of  ciliary  blepharitis,  and  especially  its 
connection  with  the  ditferent  forms  of  ametropia, 
has  of  late  years  attracted  considerable  attention 
from  ophthalmologists,  who,  it  seems,  are  much 
divided  in  opinion — some  maintaining  the  disease  is 
largely  due  to  the  refractive  eiTors  so  often  associ- 
ated therewith  ;  others  that  the  connection  is  merely 
a  coincidence,  and  not  etiological.  In  the  majority 
of  the  leading  text-books  no  allusion  is  made  to  ame- 
tropia as  having  any  liearing  in  a  causative  way  on 
blepharitis.  Dr.  Mittendorf*  advises  us  on  this 
point,  but  it  is,  I  believe,  not  mentioned  in  the 
works  of  Wecker,  Stellwag,  Bonders,  nor  Wells. 
Dr.  A.  Altf  has  studied  the  subject,  and  has  given 
a  tabulated  statement  of  forty- eight  cases  of  bleph- 
aritis, of  which  thirty-nine  were  emmetropic,  five 
myopic,  three  hypermetropic,  and  one  astigmatic. 
In  estimating  the  refraction  in  these  cases  Dr.  Alt 
fails  to  mention  the  use  of  atropia,  so  we  are  left  to 
infer  that  he  did  not  paralyze  the  accommodation  in 
anv  of  them.  Studied  with  a  view  to  determine  if  it 
be  a  fact  that  inflamed  lids  do  really  depend  in  some 
cases  on  uncorrected  errors  in  refraction,  the  value 
of  Dr.  A.'s  statistics  is,  to  say  the  least,  lessened  by 
his  failure  to  use  atropia,  for  we  all  know  that  many 
hyperopic  eyes  do  not  manifest  any  H..  and  Dr. 
AgnewJ  has  demonstrated  "the  insufficiency  of  the 
ophthalmoscope  as  the  sole  test  of  errors  of  refrac- 
tion." Dr.  F.  0.  Hotz  I  records  eighteen  cases  ob- 
served by  him  in  private  jjractice.  Of  these,  four 
were  hyperopic,  one  myopic,  and  one  astigmatic. 
Dr.  H.  also  tested  the  refraction  in  his  cases  without 
atropia.  Dr.  Erisman  has  reported  some  cases,  how 
many  I  do  not  know,  not  having  had  access  to  his 
paper.  Dr.  D.  B.  St.  J.  Eoosa,  in  a  paper  read  be- 
fore the  International  Congi-ess  of  Ophthalmology 
in  1876.  tabulates  thirty-one  cases  occurring  in  his 
private  practice.  Of  the  thirty-one,  twenty-.six  were 
ametropic.  Dr.  R.  states  that  he  used  atropia 
whenever  it  was  allowed.  Subsequently  the  same 
author  gave  an  additional  table  of  forty-eight 
cases  observed  at  the  Manhattan  Eye  and  Ear  Hos- 
pital, showing  ametropia  in  forty-two.  Later  on  he 
adds  a  third  table  i|  of  forty  cases  occurring  in  his 
private  practice  since  his  first  report,  showing 
thirty-eight  ametropic  cases. 

To  the  above  I  add  a  report  of  ten  cases  as  given 
below. 

Case  I. — Miss  L.  E ,  aged  twenty-one,  has  had 

blepharitis  for  eighteen  months.  Has  asthenopia  ac- 
commodativa  and  irregular  astigmatism  with  V.  =  ; ''-, 
in  each  eye.  This  case  proved  very  obstinate,  and 
nothing  but  atropia  seemed  of  any  benefit.  I  fin- 
ally lost  sight  of  her. 

Case  II.— C.  W ,  colored,  eight  years  of  age. 

Blepharitis  has  existed  probably  two  years.  No 
estimate  was  made  of  the  refi-action.  The  lid 
trouble  yielded  very  slowly,  but  completely,  to  ap- 
propriate treatment. 

Case  III.— Miss  E.  T ,  aged  twenty-five.     Lid 

disease   has   existed  three  months.     V.  =  5S  ;  under 

*  Disea-iea  of  the  Eve  iinti  Enr.  p.  27. 

t  Arch.  OphthKlmoi    asd  Otol.,  vol.  vi..  p.  ISO. 

}  Trans.  Arn.  Ophthalmolog.  Soc.  16J0. 

S  Chicaeo  Med.  Jour,  and  Exam.,  April.  1S78. 

i  Ophthal.  and  Otic.  contriblltionK  by  Drs.  Roosa  and  Ely. 


atropia,  tH  w.+l  s.*  Muscles  and  A.  normal. §  Or- 
dered -r.75  8.,  which,  with  simple  local  treatment, 
gave  permanent  relief. 

Case  IV. — J.  T ,  aged  thirty.  Blepharitis  re- 
cent. V.=5S.  O.D.V.  =  ?Sw.-2.5  s.C-.5cy.;  axis, 
125°.  O.S.V.=|S  w.— 3  8.3— .5  cy.;  axis,  90°  Very 
slight  change  under  atropia.  The  lid  trouble  yield- 
ed kindly. 

Case  V. — Miss  Josie   O ,   aged   twenty-three. 

Blepharitis  for  one  year,  with  accommodative  as- 
thenopia. O.D.Y.  =  tS  :  tS  w.-:i^,Tcy.;  axis,  180^  O. 
S.V.  =  »H  :  jfr  w.  — jV  cy.;  axis,  175°.  In  this  case 
homati'opine  hydrobromate  was  the  mydriatic  used. 

The  above  glasses  were  ordered  with  relief  to  all 
unpleasant  symptoms. 

Case  VI.— Miss  B.  F ,  aged  twenty-two.     Has 

complained  of  inflamed  lids  for  some  months.  V.= 
^S  ;  under  homatropine,  sunk  to  ^Jhr  :  ?il  w.  +1^^  s. 
— +,\-  cy.;  ax.,  45°  in  O.D.;  \%  vr.+  h  s.C-i-tV  cy.; 
ax.,  i20°'in  O.S.  Ordered  -l-2^,j  s.,  combined  with 
fiill  cylindrics.  Miss  F derived  great  satisfac- 
tion from  the  glasses,  and  the  blepharitis  disap- 
peared. 

Case  VII. — G.  D ,  aged  ten.     Had  blepharitis 

three  years  ago,  which  was  apparently  cured.  Two 
months  ago  it  returned,  and  compelled  him  to  quit 
school.  V.  =  fg;  under  atropia,  O.D.Vt=;,t7  :  jK  w. 
+  1.25s.  O.S.V.  =  *iy  :  }!;  w.^1.25  s.  He  was  given -t- 
1  s.  for  each  eye,  and  shortly  afterward  resumed  his 
school  duties. 

Case  M;II.— Mrs.  N.  D ,  aged  thirty-iwo.   Has 

recurring  attacks  of  blepharitis,  with  styes.  O.D. 
V.  =  5o  :  under  ffl  :  ?S  W.-I-.75  s.C;4-.75  cy.;  ax.,  90°. 
O.S.V.  =  5;t  :  atropia  IS  :  fS  w.  +  l  S.C  +  -50  cy.;  ax., 
95°.  The  above  formula  was  somewhat  modified  and 
glasses  ordered.  This  patient  also  suftered  from 
asthenopia,  which  was  improved,  though  not  alto- 
gether relieved. 

Case  IX.— Miss  A.  C ,  aged  eighteen.      Has 

been  greatly  annoyed  by  blepharitis,  with  styes. 
V.  =  }','i;  under  homatropine  V.  =  i;;  :  fS  w.  +1.25  s. 

Jliss  c was  unwilling  to  use  glasses   even  for 

study,  which  she  was  finally  forced  to  quit  tempo- 
rarilv.     At  last  account  she  was  improving. 

Case  X. — H.  P ,  aged  twenty-four.     Has  had 

blepharitis  for  two  years.  Has  been  treated  in  the 
usual  local  way  without  marked  benefit.  V.  =  ?5f ; 
under  atropia,  O.D.V.  =  §S  :  IS  w.+A"  s.C+?^if  cy.; 
ax.,  25°.  O.S.V.  =  5f(  :  1"  w.-!-,V  s.^-rh  cy.;  ax.,  180°. 
Has  some  asthenopia.  Ordered  the  above  formula 
for  near  work.  The  refractive  error  is  here  very 
slight,  but  serves  well  to  illustrate  the  value  of  cor- 
recting-lenses.  The  blepharitis  soon  disappeared, 
and  the  patient,  thinking  himself  well,  ventured  to 
lay  aside  his  glasses.  In  three  weeks  he  returned, 
for  the  disease  was  reappearing.  Kept  him  under 
atropia  for  over  two  weeks,  when  the  blepharitis 
again  disappeared,  after  which  he  used  his  glasses 
steadily  for  near  work.  Result  in  evei^  way  satis- 
factory. 

Summarizing,  we  have  of  Dr.  Alt's  cases  eighteen 
per  cent,  ametropic.  Dr.  Hotz,  thirty-three.  Dr. 
Roosa's,  eighty-eight,  and  of  my  own  ninety  per 
cent.  My  table  is,  it  is  true,  not  very  large,  but 
it  is  of  value,  inasmuch  as  all  but  one  of  the  cases 
were  observed  under  the  full  influence  of  a  my- 
driatic, aid  their  refraction  carefully  estimated. 
Dr.  Alt's  cases  certainly  show  a  small  percentage  of 
ametropia,  and  Dr.  Hotz's  do  not  .show  a  large  one  ; 
but  are  we  to  accept  these  statistics  as   indicating 


'  Metric  syrtem. 


400 


THE  MEDICAL  RECORD. 


the  real  refractive  condition  of  eyes  in  which  no 
mydriatic  was  used  ?  For  my  part  I  agi'ee  entirely 
with  Dr.  Roosa,  who  expresses  his  "unwillingness 
to  accept  statistics  made  up  in  this  way."  Dr.  H. 
even  goes  so  far  as  to  acknon-ledge  that,  had  he 
used  atropia,  some  cases  might  have  shown  a  slight 
degree  of  hypermetropia.  He  does  not  believe  that 
refractive  errors  play  any  part  in  the  causation  of 
blepharitis.  Dr.  H.  also  seems  to  think  there  is  no 
strain  on  a  myopic  eye  unless  improper  glasses  are 
used.  The  niajorityof  ophthalmologists  will  prob- 
ablv  not  agree  with  him  in  that  view. 

If  we  accept  the  two  first  tables  as  they  are,  and 
take  the  sum  of  the  four,  we  have  altogether  195 
cases  of  blepharitis  ciliaris,  of  which  130  are  associ- 
ated with  ametropia.  This  is  about  sixty-six  per 
cent.,  which  fact  is  certainly  quite  remarkable,  if  it  be 
a  mare  coincidence,  as  some  would  have  us  believe. 

In  conclusion  I  will  say  that  I  am  fully  convinced 
that  ciliary  blepharitis  is  not  unfrequently  caused 
by  the  long-continued  strain  resulting  to  an  eye  from 
an  uncorrected  error  in  its  refraction. 

REDUCTION  OF  TEMPERATURE  BY  THE 

USE  OF  DRY  COLD. 

By  J.  W.  STICKLER,  M.D., 

ORANGE.  N.  J. 

Mt  reason  for  calling  the  attention  of  the  profession 
to  this  method  of  reducing  supra-normal  tempera- 
ture is  founded  on  the  conviction  that  by  its  use 
the  same  result  may  be  attained  as  in  the  employ- 
ment of  cold  water,  with   less   inconvenience   and 


W^^txy^yi-KKKyyi^^y'/ 


u 


V 


risk  to  the  patient.  The  diagram  above  represents 
the  bed  which  I  have  designed,  as  a  convenient 
means  of  applying  the  cold  air.  The  bed  consists 
of  three  separate  parts  :  1,  the  bedstead  proper  ;  2, 
an  ice-drawer ;  3,  a  crib  to  support  the  bcdi^lothes. 
The  bed  is  made  of  wood,  having  a  framework  six 
feet  long  and  two  feet  six  inches  wide,  supported  on 
legs  eighteen  inches  high  The  open  space  included 
between  the  four  sides  of  the  bed  is  provided  with  a 
network,  or  springs,  upon  which  the  patient  lies. 
The  drawer  is  of  the  same  length  and  breadth  as  the 
bed,  and  eight  inches  in  depth,  its  inner  side  having 


a  zinc  plating.     In   the  centre  of  the  floor  of  the 
drawer  there  is  an  opening  for  the  escape  of  water. 
The  drawer  has  a  sliding  motion,  and  can  be  re- 
moved from  the  bed.     The  crib  is  similar  to  those 
in  common   use   in  the  hospitals.     A\hen  it  is  de- 
siVed  to  reduce  a  fever  temperature,  the  following 
plan  may  be  adopted  :  after  placing  a  pillow  at  the 
head   of   the   bed,   put   the  patient  wrapped   in  a 
blanket  or  sheet,  upon  the  bed,  then  adjust  the  crib 
and  cover  it  with  a  blanket  and  the  bedclothes,  tak- 
ing care  to  have  them  drop  over  each  end  of  the 
crib,  in  order  to  exclude  as  perfectly  as  possilile, 
the  warm  air  of  the  apartment.     An  ice-bag  should 
be  apjjlied  to  the  head  to  prevent  a  determination 
of  blood  to  that  part.     Next,  till  the  drawer  with  the 
frigoritic  mixture,  consisting  of  about  fifty  pounds 
of  ice,  well  cracked,  mixed  with  about  ten  pounds 
of  rock  salt,  covered  with  a  sheet  or  blanket.     The 
drawer  having  been  put  into  its  place  under  the  bed, 
the  jjatient  will  be  confined  in  a  space,  whose  tem- 
perature, according  to  observations  made,  will  fall 
to  48°  F.  in  three-quarters  of  an  hour.    This  tempera- 
ture can  be  maintained  at  least  two  hours  without 
renewing  the  ice  and  salt.     In  places  where  such  a 
bed  could  not  be  made  or  procured,  one  similar  in 
principle  could  veiw  easily  be   improvised,  in  the 
following  manner  :  Put  the  cooling  mixture  into  any 
receptacle  at  hand,  large  enough  to  close  in   the 
space  under  the  bed,  or  use  several  small  vessels, 
observing  the  precaution  to  have  such  vessels  in 
contact  with  the  slats  or   springs,  with   no   inter- 
spaces for  the  admission  of  warm   air.     The  crib 
may  be  made  of  barrel-hoops  connected  at  proper 
distances  by  means  of  laths  or  other  suitable  pieces 
of  light  wood.     Such  a  contrivance  would  answer 
the  I'urpose  of  the  bed  first  described. 

I  suggest  the  use  of  cold  air  in  the  place  of  cold 
water,  because — 

First. — Cold  air  acts  continuously  with  equal  in- 
tensity upon  all  parts  of  the  exjiosed  surface.  This 
is  not  true  in  the  case  of  eflusion,  for  whether  the 
application  be  intermittent  or  continuous,  the  wiixi- 
mum  effect  must  obtain  at  and  near  the  jwintwliere 
the  cooling  agent  first  comes  into  contact  with  the 
body.  In  the  use  of  the  bath,  unless  the  required 
temperature  is  secured  liefore  immersion  of  the  pa- 
tient, the  same  is  true,  for  on  the  addition  of  ice  or 
cold  water  to  produce  a  lower  temperature,  there 
must  be  for  a  time,  different  degrees  of  cold  to 
which  the  body  is  exposed,  hence  the  liability  to 
chilliness  and  shock  gi-eater  than  when  air  of  uni- 
form temperature  is  used. 

Surond. — After  having  the  cold  air  applied,  the 
patient  need  not  be  removed  from  the  bed,  as  proper 
clothing  may  be  added,  and  the  drawer  containing 
the  cooling  mixtiire  withdrawn. 

Third. — There  is  no  wetting  of  the  patient,  with 
subsequent  drying. 

Fourth. — The  process  is  much  less  troublesome 
than  the  use  of  cold  water. 

After  operations  upon  women,  for  the  removal  of 
abdominal  tumors,  this  method  might  have  a  great 
advantage  over  etTusion  or  bath,  as  the  patient  may 
be  placed  ujjon  the  bed,  and  remain  there  till  re- 
covery, the  cold  air  being  a]ii)lied  when  necessan', 
in  tlM!  manner  indicated.  In  many  cases  of  .sun- 
stroke, in  which  tliere  is  excessive  heat  of  the  skin, 
the  benefit  to  be  derived  from  this  plan  of  treatment 
seems  manifest.  To  maintain  a  moderate  degree  of 
cold,  place  a  thin  mattress,  or  folded  blanket  under 
tlie  patient,  leaving  the  crib  covered  as  before.  In 
this  way  the  temperature  of  the  bed  is  so  modified 


THE  MEDICAL  RECORD. 


401 


as  to  render  it  safe  for  the  patient  to  remain  in  it 
indefinitely.  This  fact  recommends  its  use  to  a 
large  chxss  of  patients  who  have  enough  fever  to  in- 
duce restlessness  and  wakefuhiess,  for  in  such  a  1  n-d 
their  condition  is  not  aggi'avated  by  the  iuttuence  of 
warm  air  and  heated  bedclothes,  both  of  which  very 
often  have  a  pernicious  efiect  on  the  patient.  It 
seems  that  its  range  of  application  may  be  quite  as 
extensive  as  that  of  any  present  method,  and  it  may 
be  mentioned  here  that  the  bed,  without  any  altera- 
tion, may  be  used  to  induce  diaphoresis,  by  simply 
filling  the  drawer  with  hot  water,  kejit  up  to  a  tem- 
perature of  212'^  F.,  by  the  use  of  an  alcohol  lamp 
underneath  the  drawer. 


tU^orts  0f  hospitals. 


THE  USE  OF  IODOFORM  IN  BRITISH  HOS- 
PITALS. 

(From  our  London  Correspondent.) 

This  substance  is  now  extensively  used  in  Great 
Britain.  It  is  chiefly  employed  as  an  external  ap- 
plication, but  is  also  given  internally  by  a  few  physi- 
cians. 

Locally,  it  is  used  for  soft  and  hard  chancres, 
syphilitic  and  other  ulcers,  cancerous  sores,  as  a 
dressing  for  wounds,  eczema,  impetigo,  lupus,  laryn- 
geal and  phaiyngeal  affections,  mammary  and  other 
tumors  (to  promote  absorption),  hemorrhoids,  ony- 
chia, etc. 

Internally,  it  is  given  mainly  for  syphilitic  affec- 
tions. Cases  of  poisoning  from  its  use  have  been 
reported  from  the  continent,  but  none  have  as  yet 
occurred  in  Great  Britain.  No  case  of  iodism  has 
yet  been  published  as  resulting  from  its  use. 

The  methods  of  employing  it  by  different  ishysi- 
cians  and  surgeons  at  several  of  the  hospitals  are 
briefly  summarized  below. 

At  University  College  Hosj^ital,  Mr.  Berkeley 
HiU  uses  it  a  good  deal  for  soft  chancres.  He  re- 
commends that  it  should  be  applied  in  the  form  of 
powder  twice  a  day,  the  sore  having  been  previously 
washed  and  dried.  Some  lint  or  cotton-wool  is  then 
applied,  and  over  this  a  piece  of  oil-silk  ;  in  some 
cases,  e.  g.,  over  external  parts  such  as  the  groin,  j\Ir. 
Hill  also  prescribes  an  ethereal  solution.  In  either 
case,  he  doas  not  advise  its  use  when  the  sore  is  in- 
flamed. For  hard  chancres  he  recommends  powdered 
iodoform  as  a  local  application  every  six  hours,  care 
being  taken  to  keep  the  sore  clean.  Mr.  B.  Hill  has 
also  used  it  internally  in  cases  of  syphilis  during  the 
last  few  years.  Mr.  Godlee  employs  it  for  eczema  and 
some  cases  of  lupus.  Ten  grains  of  iodoform  and  a 
drachm  of  oil  of  eucalyptus  are  made  into  an  oint- 
ment with  an  ounce  of  vaseline.  Dr.  Crocker  applies 
it  in  cases  of  eczema  attended  with  offensive  dis- 
charge. He  uses  it  both  combined  with  eucalyptus 
as  above,  and  also  as  a  simj^le  ointment  made  up 
with  lard  (ten  grains  to  the  ounce).  He  finds  the  dis- 
charge becomes  much  less  offensive  under  its  use. 

At  Kmg's  College  Hospital,  Mr.  Watson  Clieyne 
employs  in  cases  of  gonorrhrea  soluble  bougies  con- 
taining iodoform  and  oil  of  eucalyptus.  Mr.  Cheyne 
claims  that  by  this  method  gonorrhcea  may,  in  many 
cases,  be  arrested  in  the  first  stage.  Mr.  Cheyne 
believes  in  the  specific  nature  of  the  gonorrhtcal 
discharge,  and  considers  that  these  bougies  act  by 
destroying  the  germs. 


At  Charing  Cross  Hospital  it  is  much  used  as  an 
application  to  soft  chancres  by  Mr.  J.  H.  Morgan 
and  Mr.  Astley  Bloxam.  Mr.  Morgan  believes  it  to 
have  a  detergent  action  on  foul  sores,  but  does  not 
think  it  has  a  direct  healing  action.  He  informed 
the  writer,  however,  that  he  recently  had  a  case  in 
which  he  removed  a  cystic  tumor  from  the  neck  (not 
antiseptically),  and,  after  washing  the  wound  out 
with  carbolic  lotion,  scattered  some  powdered  iodo- 
form over  its  surface.  The  edges  were  then  drawn 
together,  covered  with  some  more  iodoform,  and 
then  covered  up.  On  removing  the  dressings  in  a 
few  days,  the  wound  was  found  to  have  healed  by 
first  intention.  Where  the  smell  is  an  objection  to 
its  use,  Mr.  Morgan  employs  it  mixed  with  an  equal 
bulk  of  tannin. 

At  the  Lock  Hospital,  Mr.  Astley  Bloxam  em- 
ploys iodoform  for  both  soft  and  hard  chancres. 
In  the  latter  case  he  combines  its  local  application 
with  the  internal  administration  of  mercury. 

At  the  London  Hospital  it  is  used  (powdered)  as 
a  dressing  for  wounds.  Mr.  Eivington  employs  it 
for  this  purpose  somewhat  extensively.  Mr.  Reeves 
frequently  uses  it  as  a  local  application  to  the  ulcers 
met  with  in  the  later  stages  of  syphilis.  From  the 
hospital  records  it  appears  that  about  one-third  of 
the  cases  now  under  Mr.  Beeves  are  using  iodo- 
form in  one  way  or  another.  As  he  uses  it  mainly 
for  syphilis,  the  great  prevalence  of  the  disease  at 
the  East  End  is  only  too  apparent. 

At  the  British  Hospital  for  Diseases  of  the  Skin, 
Mr.  Balmanno  Squire  prescribes  it  as  a  local  applica- 
tion for  the  contagious  impetigo  of  young  children. 
He  directs  that  the  scabs  should  be  first  softened 
and  removed,  the  surface  gently  dried,  finely  pow- 
dered iodoform  (diluted  with  starch  if  necessary) 
dusted  over  the  surface,  and  lastly  a  thin  layer  of 
glycerine  painted  on.  This  should  be  done  every 
two  hours.  Mr.  Squire  has  found  this  induce  a 
marked  imj^rovement  within  even  a  few  days,  the 
discharge  quickly  changing  its  character  from  puru- 
lent to  serous. 

At  the  Hospital  for  Diseases  of  the  Throat,  iodo- 
form is  a  favorite  remedy.  Some  time  since  it 
was  (dissolved  in  ether)  freely  used  as  a  spray  in 
ozoena,  and  other  nasal  cases.  Some  of  the  staff 
here  also  mix  it  with  other  substances,  to  apply  to 
the  interior  of  the  larynx  by  insufflation.  In  the 
Pharmacopoeia  of  this  hospital  there  is  a  formula,  in- 
troduced by  Dr.  Whistler,  for  pastilles  of  iodoform, 
each  containing  one  grain  with  a  basis  of  glycerine 
and  gelatine.  These  are  much  used  in  .syphDitio 
eruptions  of  the  mouth,  tongue,  and  throat.  There 
is  also  a  form  for  nasal  bougies,  each  containing 
half  a  grain,  and  an  "insufflation"  for  ear  cases,  in- 
troduced by  Dr.  Woakes.  It  is,  perhaps,  most  exten- 
sively used  at  this  hospital  by  Dr.  Prosser  James,  he 
having  been  the  first  to  recommend  it  as  a  local  ap- 
plication in  diseases  of  the  throat  and  nose,  and  also 
as  an  internal  remedy  in  syj^hilis  and  some  other  dis- 
eases. He  applies  it  either  pure  or  diluted,  according 
to  circumstances,  with  an  indifferent  powder,  such 
as  starch  or  lycoi^odium,  to  syphilitic  ulcers  in  the 
mouth  and  pharynx  ;  also  by  means  of  a  proper  in- 
sufflator, to  ulceration  in  the  larynx,  either  syphilitic 
or  tubercular.  In  the  latter  case,  mostly  mixed  with 
a  small  quantity  of  morphia,  and  diluted  W'ith  fn 
equal  part  or  more  of  starch.  In  the  phai-yus,  he 
generally  employs  it  pure.  Some  time  ago  he  used 
it  freely  in  a  case  of  cancer  of  the  tonsils,  and  it 
seemed  at  first  to  afford  considerable  relief,  but 
after  a  while  lost  its  power.      In  another  case  of 


402 


THE  MEDICAL  RECORD. 


n 


cancer  extending  on  to  the  tongue,  it  produced  so 
much  pain,  even  when  mixed  with  morphia,  that  it 
was  discontinued.  In  all  these  cases  Dr.  James  in- 
sists on  the  necessity  of  reducing  the  iodoform  to 
the  finest  jiowder.  Internally,  Dr.  James  has  used 
it  for  many  years — indeed  from  its  lirst  introduc- 
tion. He  gave  it  in  one-grain  pills,  commencing 
with  three  daily,  and  gradually  increasing  to  nine 
a  day,  or  more.  Of  late  years,  he  uses  two  grain 
pills,  and  increases  the  number  gradually,  as  in  the 
former  case.  In  the  hospital  Pharmacopceia  these 
pills  are  made  witb  one  grain  of  sugar  of  milk 
and  Buffieient  glycerine  of  tragacanth  to  make  a 
pill  of  proper  consistence.  Dr.  James  remarked 
one  day  at  his  clinic  that,  in  private  practice,  the 
smell  of  the  substance  being  a  disadvantage,  he 
conceals  it  by  mixing  the  iodoform  with  eqiial 
weights  of  balsam  of  Peru  and  liquorice  powder. 
This  forms  a  good,  firm  pill,  without  further  excipi- 
ent.  He  gives  it  thus  internally  in  tertiary  syjihilis, 
as  it  rapidly  arrests  ulceration,  and,  contrary  to 
what  is  stated  in  a  recent  text-book,  it  is  n<il  so 
likely  as  potassium  iodide  to  produce  iodism,  and 
he  has  never  known  it  do  so,  although  he  has  con- 
tinued the  pills  for  months  together.  He  also  uses 
the  drug  internally  for  chronic  glandular  enlarge- 
ments and  other  strumous  manifestations ;  also  in 
lupus  and  lupoid  affections. 

At  Edinburgh,  iodoform  is  used  largely  in  the 
Royal  Infirmary,  and  with  very  good  results.  Mr. 
Chiene  uses  it  in  his  wards  for  nearly  all  forms  of 
sores,  more  especially  for  specific  sores,  sy])hilitic 
and  strumous  ulcers.  The  part  is  either  dusted  with 
the  powder,  or  else  the  iodoform  is  made  into  an 
ointment,  and  thus  applied.  Mr.  Chiene  sometimes 
applies  a  charcoal  poultice,  to  deodorize  the  surface 
before  applying  the  iodoform.  He  employs  it  in 
this  way  in  large  syphilitic  ulcers  and  gummata, 
thus  bringing  the  part  into  a  healthy  condition.  It 
is  also  used  in  cutaneous  diseases. 

Dr.  T.  R.  Eraser,  the  Professor  of  Materia  Medica 
in  the  University,  recommends  it  in  his  lectures  as  a 
local  anajsthetic  and  antiseptic  in  cutaneous  dis- 
eases, syphilitic  lalcerations,  enlarged  joints,  and 
also  glandular  enlargements.  He  also  recommends 
it  in  the  form  of  a  suppository  (each  containing 
seven  gi-ains),  iu  fissure  or  h-ritation  of  the  anus,  and 
in  hemorrhoids.  For  an  ointment  he  advises  one  to 
one  and  one-half  drachm  of  iodoform  to  an  ounce 
of  simple  ointment.  Dr.  Fraser  believes  that  iodo- 
form possesses  all  the  advantages  of  iodine,  without 
the  local  irritating  properties  of  the  latter. 

In  the  maternity  department  of  the  Royal  Infirm- 
ary, Dr.  A.  G.  Miller  uses  it  for  soft  chanerous  sores 
in  women,  in  the  following  method  :  Some  pow- 
dered iodoform  is  placed  in  a  small  muslin  bag,  and 
given  to  the  patient,  who  is  directed  to  apply  it 
herself  to  the  affected  part.  Dr.  Miller  uses  it  ex- 
tensively in  these  cases. 


A  U.viQUE  Case— Bulbar  Pak.vly.sis  CrnKi).— Dr. 
Heller,  of  Toplitz,  reports  a  remarkable  case  of  a 
patient  suffering  from,  as  ho  affirms,  true  bulbar  or 
glosso-labio-phai7ngeal  paralysis,  who  was  nearly 
cured  in  a  few  months  by  the  daily  use  of  baths 
nlone.  The  patient  had  suffered  for  about  nine 
months  before  ho  was  put  under  this  treatniont.  He 
could  then  liardly  swallow  at  all,  and  could  not  speak 
intelligently.  His  improvement  began  within  three 
weeks.  The  case  is  very  carefully  reported,  and 
there  seems  to  be  no  room  for  error  in  diagnosis. — 
St.  Petersburg  Medicinische  Woch. 


|Jr0grea»  of  ifflcitcol  Science. 


Treatment  of  Cutaneous  PRUBrrcs. — General  itch- 
ing of  the  cutaneous  surface,  is  usually  due,  accord- 
ing to  Dr.  Purdon  of  the  Belfast  Hospital  for  Skin 
Diseases,  to  derangement  of  the  liver  from  abuse 
of  alcoholics,  or  from  jaundice.  For  such  diseases 
the  "blue  pill  "and  seidlitz  powder  are  the  ac- 
cepted popular  remedies.  In  any  such  case  he  finds 
it  most  desii'able  to  give  a  hepatic  stimulant,  and  he 
recommends  "rag-weed,"  under  the  form  known  as 
Succus  sene.cionis  Jacobce,  as  prepared  by  Grattan  A: 
Co.,  of  Belfast.  [There  is  an  undoubted  error  in  the 
English  name,  the  writer  manifestly  intending  to 
use  the  word  "  rag-wort,"  for  a  plant  of  the  genus 
Senecio,  the  rag- weed  belonging  to  the  genus  Am- 
brnsid.]  The  dose  is  from  one  teaspoonful  to  two 
tablespoons,  either  with  or  without  a  teaspoonful 
of  sulphiu',  and  should  be  taken  early  in  the  morn- 
ing. As  regards  local  treatment,  he  advocates  the 
Turkish  bath,  or  sponging  of  the  body  with  vine- 
gar or  borax,  which  give  relief  for  some  hours. 
That  most  annoying  variety,  pruritus  ani,  is  asso- 
ciated, as  a  general  rule,  with  portal  derangement, 
and  often  occurs  in  connection  with  piles.  In  such 
cases  he  succeeds  with  tar  locally,  while  internally 
is  given  podophyllin,  rag-wort,  or  black  pepper. 
In  pruritus  vulvte  he  finds  the  trouble  may  be 
sometimes  traced  to  the  oidinm  albicans,  and  he 
recommends  injections  of  hot  water  and  the  apphca- 
tion  of  sulphurous  acid  locally.  Careful  diet,  and 
the  use  of  lactic  acid  in  conjunction  with  the  above 
will  give  temporary  relief,  at  any  rate.  In  pruritus 
scroti,  which  is  usually  due  to  urethral  troubles,  he 
uses  the  catheter  and  iodoform  suppositories.  Pru- 
ritus of  any  kind,  whether  general  or  local,  is  always 
due  to  some  special  constitutional  difficulty. — The 
Practitioner,  Januai-y,  1882. 

Tripier's  Aju'utation  of  the  Foot. — Mr.  P.  T. 
Hayes,  of  Kingston,  has  now  operated  twice  accord- 
ing to  the  jilan  advocated  by  Tripier,  of  Lyons,  the 
first  case  having  been  briefly  reported  in  the  Britinh 
Medical  Journal,  February  26,  1881,  and  being  the 
first  operation  by  this  method  upon  the  living  sub- 
ject. Encouraged  by  the  favorable  report  received 
from  this  patient,  some  eighteen  months  after  the 
operation,  he  has  repeated  it  with  good  success. 
Tripier's  plan  was  designed  to  overcome  the  di.sad- 
vantages  resulting  from  Chopart's  medio-tarsal  disar- 
ticulation, iu  which  malposition  of  the  foot-remains 
often  resulted.  Tenotomy  in  the  hands  of  Petit 
and  Bouvier  having  failed  to  overcome  the  deformity, 
re-amputation  was  not  infrequently  done,  and  iu 
France,  at  least,  the  operation  finally  met  with  dis- 
favor. Gnidcd  by  the  dissections  of  Malgaigne, 
Sf dillot,  and  Legouest,  who  attributed  the  "  lark- 
heolod  "  deformity  and  freqiient  valgus  to  mechani- 
cal ))res.sure  between  tlie  bodily  weight  transmitted 
through  the  tibia  on  the  one  hand,  and  the  re.si.it- 
ance  of  the  ground  on  the  other,  Tripier  conceived 
the  plan  which  has  assumed  Ids  name.  The  different 
steps  in  the  procedure  are  as  follows  : 

He  commences  with  a  skin  incision  at  the  outer 
edge  of  the  tendo  Achillis,  on  a  level  with  the  ex- 
ternal malleolus.  The  line  of  incision  is  at  first 
downward  and  forward,  and  afterward  forward,  so 
as  to  pass  two  fingers'  breadth  below  the  malleolus, 
and  then  to  approach  by  a  finger's  breadth  the 
upper  part  of  the  base  of  the  fifth  metatarsal  bone. 


THE  MEDICAL' RECORD. 


403 


From  this  point  tlie  incision  is  to  be  cairied  upward, 
forward,  and  inward,  so  as  to  reach  the  inner  mar- 
gin of  the  tendon  of  the  extensor  hallucis  proprius, 
just  behind  the  first  tarso-metatarsal  articulation. 
The  knife  shouUl  now  be  made  to  cut  downward  and 
forward,  so  as  to  enter  the  sole  of  the  foot  a  finger's 
breadth  in  front  of  the  dorsal  wound.  The  incision 
is  then  to  be  carried,  with  a  gentle  forward  curve, 
outward  and  backward,  until  it  can  be  made  con- 
tinuous with  the  first  portion  of  the  wound  below 
the  outer  malleolus.  The  divided  integument  hav- 
ing undergone  some  degree  of  retraction,  the  dorsal 
and  plantar  structures  are  to  be  divided  half-an  inch 
behind  the  superficial  wound  ;  the  soft  parts  are 
then  to  be  separated  from  the  bones,  extreme  care 
being  taken  to  preserve  uninjured  the  vessels  con- 
tained in  the  inner  part  of  the  plantar  flap.  The 
surgeon  will  find  it  convenient  at  this  stage  to  dis- 
articulate the  cuboid  and  scaiihoid  from  the  os 
calcis  and  astragalus,  just  as  in  Chopart's  amputa- 
tion. Having  done  so,  he  will  proceed  to  divide  and 
separate  the  periosteum  from  the  under  surface  and 
posterior  extremity  of  the  os  calcis,  up  to  the  level 
of  the  sustentaculum  tali,  -where  the  bone  is  to  be 
sawn  throiigh,  in  a  direction  from  behind  and  within, 
forward  and  outward,  so  as  to  leave  a  surface  which 
will  be  at  right  angles  with  the  axis  of  the  tibia, 
when  the  limb  is  caused  to  assume  the  ordinary 
position  for  walking  and  standing.  All  sharj)  bone- 
edges  and  angles  should  now  be  rounded  otl'.  The 
posterior  tibial  nerve  is  to  be  exposed  in  the  plantar 
flap,  and  divided  as  high  as  possible,  with  a  view 
to  prevent  risk  of  neuroma.  The  vessels  having 
been  secured,  and  drainage-tubes  having  been  in- 
serted, the  flaps  are  to  be  brought  together  and  the 
limb  so  dressed  as  to  secure  moderate  flexion  of  the 
ankle-joint  during  the  period  of  repair. 

The  following  advantages  claimed  for  the  opera- 
tion are  : 

First. — That  comparatively  short  flaps  will  be 
found  suflicient  to  afford  complete  covering  for  the 
bone  surfaces. 

Second. — The  tendons  will  have  been  divided  well 
in  front  of  their  sheath-connections  with  the  astrag- 
alus and  OS  calcis,  so  that  when  they  form  new 
attachments  the  muscles  which  act  upon  them  will 
be  capable  of  regulating  flexion  and  extension  of  the 
ankle-joint. 

Third. — Section  of  the  os  calcis  wiU  at  once  prove 
whether  the  bone  is  healthy  throughout,  and  in  the 
event  of  there  being  feny  evidence  of  central  disease 
the  operation  can  very  readily  be  converted  into  a 
disarticulation  at  the  ankle. 

Foiirtk. — Removal  of  the  lower  part  of  the  os  cal- 
cis in  the  manner  described  leaves  an  extremely 
broad,  even  surface,  which  at  once  secures  the  patient 
against  risk  of  subsequent  distortion  and  causes 
pressure  to  be  diiifused  over  .such  a  considerable  ex- 
tent of  soft  tissue  as  to  render  the  chance  of  ulcer- 
ation weU-nigh  impossible.  Besides  other  advan- 
tages attendant  upon  this  operation,  the  wound 
heals  rapidly,  and  within  a  very  short  space  of  time 
the  limb  becomes  capable  of  sustaining  the  entire 
weight  of  the  body. 

A  New  Mydriatic. — Emmert  finds  the  hydriodide 
of  hyoscine  superior  as  an  agent  for  dilating  the  pu- 
pil to  any  of  the  drugs  previously  employed  for  this 
purpose,  such  as  atrojiine,  duboisine,  hyoscyamine, 
etc.  The  alkaloid  is  obtained  from  the  so-called 
amorphous  hyoscyamine,  and  forms  with  hydriodic 
acid  well-defined  crystals,  while  the  muriate  is  amor- 


phous. The  chief  advantages  of  this  preparation, 
as  compared  with  atropine  and  duboisine,  are  that 
it  acts  much  more  promptly  and  powerfully.  Using 
the  eye  of  a  rabbit  for  experiment,  the  results  were 
as  follows  : 

Half  per  cent,  solution  of 

atropijo  hyopcin. 

sulph.  hytiriod. 
Width  of  pupil  [at  beginning  of  experiment).    2.5  mm.  2.5  mm. 

"  "  5  minutes  later 2.5  mm.  .'5.0  mm. 

10        ■>         "     8.0  mm.  10.0  mm. 

"            '*         15        *■         "    (maximal  dil- 
atation)... 10.0mm.  10.5  mm. 

One-tenth  per  cent,  solution  of 

atropiiE  hyoBcin. 

snlph.  hydriod. 

Width  of  pupil  (nt  beeinnin;;  of  experiment).    2.5  mm.  2.5  ram. 

•'  "         10  minutes  liiter 2.5  mm.  3.0  mm. 

13        ■•         "     4.26mm.  9.5  mm. 

17        "         '■     6.5mm.  lU.5mm. 

"           "        25        *'         "      (maximnl  di- 
latation...    9.5  mm.  10.5  mm. 

Upon  the  author  using  a  half  per  cent,  solution  of 
atropije  sulph.  for  the  left,  and  a  one-tenth  i>er  cent, 
solution  of  hyoscine  hydriod.  for  the  right  eye,  the 
results  were  as  follows  : 

Left  eye.  Eight  eye.. 

Width  of  pupil  (before  experiment) 2.5  mm.  2.5  mm. 

'■         14  minutes  later 2.5  mm.  4.0  mm.. 

20        '•  ■'      3.5  mm. 

.'  '•         25         '•  " 6.5  mm.  8.0  mm. 

»•  "         66        *•         '-'      (maximal  di- 

laUtion) ...  8.0  mm.  8.5  mm. 

Similar  results  were  obtained  in  other  individuals- 
with  diseased  eyes.  Thus,  in  several  cases  of  in- 
flammatory afl'eclions  of  the  cornea,  where  atropine 
and  duboisine  had  produced  no  dilatation,  hyoscine 
acted  promptly  and  favorably.  Moreover,  in  cases 
of  recent  and  old  iritis,  with  posterior  synechia, 
hyoscine  invariably  caused  dilatation  of  the  pupil, 
and  frequently  riipture  of  the  adhesions.  Again, 
the  hydriodide  of  hyoscine  does  not  irritate  the  con- 
junctiva. Stronger  solutions  than  a  half  per  cent, 
should  not  be  emijloyed,  as  they  have  given  rise  to 
symptoms  of  poisoning,  consisting  in  dryness  of  the 
throat,  disturbances  of  vision,  hallucinations,  de- 
lirium, and  unconsciousness.  In  fact,  even  the  half 
per  cent,  solution  must  be  used  with  caution,  as  in 
two  of  the  author's  cases  general  symptoms  made 
their  appearance. — Correspondenz-blaU  fuer  ScJnrei- 
zer  Aertze,  January  15,  1882. 

Gastric  Lesions  in  Bright's  Disease.— The  gas- 
tric symptoms,  such  as  nausea  and  vomiting,  which 
so  frequently  occur  in  cases  of  Bright's  disease, 
have  often  been  attributed  to  retention  within  the 
system  of  certain  constituents  of  the  urine,  which 
act  either  by  inducing  some  chemical  alteration  of 
the  gastric  secretion,  or  perhaps  by  exciting,  in 
some  not  clearly  understood  way,  a  change  in  the 
physiological  niovements  of  the  stomach.  Little, 
if  any,  attention  has  been  devoted  to  the  study  of 
the  anatomical  conditions  underlying  these  symp- 
toms. See  assumes  that  the  continued  secretionof 
urea  by  the  gastric  mucous  membranes  gives  rise  ■ 
at  first' to  functional  disturbances  only,  but  finally, 
ulcerating  lesions  may  develop.  Hlava  and  Thorn- 
aver  examined  the  stomach,  post-mortem,  in  many 
cases  of  Bright's  disease.  Their  conclusions  are- 
thus  stated  :  1.  True  interstitial  gastritis  not  infre- 
quently develops  during  the  course  of  acute  and 
chronic  nephi-itis.  2.  It  cannot  be  demonstrated 
that  this  pathological  condition  is  caused  by  uras- 
mia,  nor  that  it  is  directly  dependent  upon  the  pres- 
ence of  the  renal  afi'ection.  It  is  possible  that  both 
the  gastric  and  the  renal  disease  arise  from  the  sama 
exciting  causes,  but  this  is  also  as  yet  a  mere  as- 
sumption.    3.  In  numerous  instances  where  no  dys* 


404 


THE  MEDICAL  RECORD. 


paptic  symptoais  were  proseat  during  life,  the  gaa- 
trio  mucous  meaabrane  was  found  healthy.  It  is 
therefore  probable,  they  think,  that  many  of  the 
o  ises  of  dyspepsia  which  do  occur  during  the  course  of 
nephritis,  ai"e  dependent  upon  an  interstitial  gastritis. ' 
■ — Allgememe  Mod.  Gentral-Zeilurig,  January  18,  1882. 
A  CoxTRiBnnoN  to  the  Treatment  op  Frac- 
TUKES  OP  THE  Thigh  IN  Ohildhood. — In  the  Ber- 
Uiier  Klbiische  Wochenschrift,  of  February  28,  1881, 
Jicubasch  published  an  adverse  criticism  on  the 
treatment  of  fractures  of  the  thigh  in  very  young 
cUildren  by  vertical  extension  of  the  limb,  claiming 
that  this  method  was  often  productive  of  a  fatal  re- 
sult by  reason  of  hypostatic  pulmonary  affections. 
According  to  Kummel  this  accident  is  more  imagi- 
niry  than  real.  It  was  not  met  with  in  any  of  the 
f  jrty  cases  treated  by  vertical  suspension  under  the 
charge  of  Scheie  and  Martini.  In  other  I'espects  the 
method,  he  tliinks,  is  far  superior  to  any  other  plan 
of  treatment.  It  was  applied  in  all  cases  of  simple 
fracture  of  the  thigh  occurring  in  children  under  two 
ya  vrs  of  age ;  in  older  ones  only  when  hori/.ontal  ex- 
tension had  to  be  abandoned  because  of  frequent  and 
unavoidable  soiling  of  the  dressings  by  excrement. 
The  results  were  invariably  good.  In  only  one  in- 
stince  was  shortening  detected,  and  this  did  not  ex- 
caad  one  centimeter.  On  the  contrary,  a  lengthen- 
ing of  t'.ie  fractured  extremity  to  the  extent  of  one 
to  at  most  two  centimeters  was  observed  a  few 
tiii33,  but  this  elongation  disappeared  soon  after 
the  patients  recommenced  to  walk.  Although  it 
might  have  been  A  priori  supposed  that  rotary  dis- 
location would  be  likely  to  occur,  this  was  not  the 
case  in  any  instance,  even  when  the  children  were 
very  active.  In  otherwise  healthy  and  well-nour- 
ished children  consolidation  was  usually  sufficiently 
firm  after  the  lapse  of  three  weeks  to  allow  of  the 
removal  of  the  apparatus.  In  rachitic  or  otherwise 
debilitated  patients  consolidation  was  delayed  for 
a  period  of  ten  to  twelve  weeks  or  longer.  Tlie 
method  of  extension  was  the  ordinary  one,  namely 
by  strips  of  adhesive  plaster,  not  passing  above  the 
point  of  fracture,  and  retained  in  position  by  a  flan- 
nel or  other  roller  bandage. — Berliner  Kliniache  TT')- 
chenschri/l,  January  2.3,  1882. 

CuBAR.'i.  IN  Hydrophobia. —Penzoldt  reports  a 
cise  of  rabies  in  a  boy  of  eleven  years,  in  which  very 
larg3  doses  of  curara  were  administered,  at  first  with 
apparent  benefit,  but  later  without  the  slightest  pal- 
liition.  The  drug  was  given  hypodermically  at  first, 
in  doses  of  0.00.5  gramme,  rapidly  increased  to  0.02 
gramme,  and  at  short  intervals.  Altogether,  in 
twenty -six  hours,  OA'Mi  gramme  was  employed,  of 
which  0..S6  gramme  was  used  in  ton  and  onelialf 
hours.  It  was  not  thought  advisable  to  push  the 
drug  any  further,  as  symptoms  of  paresis  of  the  res- 
piratory muscles  made  their  appearance,  although 
•there  was  no  appreciable  paralysis  of  the  vohmtary 
muscles.  Tlie  solution  of  eurara  employed  was 
known  to  be  active,  a  single  dose  of  0.02  gramme, 
previously  injected  in  a  dog  weighing  G.H  kilo- 
grammes liaving  quickly  caused  the  death  of  the 
animal.  Penzoldt  regards  the  case  of  hydrophobia, 
Tjported  by  Offenberg  as  having  been  cured  by 
c  irara,  as  an  instance  of  lyssopliobia,  the  patient 
h  iving  some  years  before  nursed  an  individual  dnr- 
iigafatal  attack  of  genuine  lyssa.  The  suspected 
aiimal  was  killed  immediately  after  biting  the  wo- 
man. The  symi>tom3  were  somewhat  similar  to 
those  of  hydrophobia,  very  much  modified  by  hys- 
teria.    In  conclusion,  Penzoldt  believes  that  ctirara 


has  some  value  in  alleviating  the  oesophageal  and 
respu-atory  spasm,  but  exercises  no  directly  curative 
influence  on  the  disease.  It  should  certainly  not  be 
used  to  the  exclusion  of  chloral,  chloroform,  etc., 
the  last  mentioned  being  invaluable  from  a  humani- 
tarian standpoint,  if  only  for  procuring  euthanasia. 
— Berliner  Klinische  Wochenschrift,  January  23,  1882. 

loDOFOBM-PoisoNiNo. — Of  late  numerous  instances 
of  serious  and  fatal  intoxication  after  the  free  use  of 
iodoform  in  the  treatment  of  fresh  wounds  have  been 
reported.  Mikulicz  observed  a  fatal  result  after  the 
employment  of  forty  grammes  of  the  powdered  drug. 
Schede  believes  that  many  individuals  exhibit  an 
idiosyncrasy  in  this  respect,  which  is  the  more  dan- 
gerous as  the  .symptoms  of  poisoning  often  develop 
with  great  intensity  without  any  premonitory  signs, 
and  cannot  be  arrested  by  the  prompt  removal  of 
the  agent  from  the  wound.  Schede  thus  tabulates 
his  experience  :  1.  Slight  deviations  from  the  nor- 
mal conditions  occur  very  frequently  under  the  guiee 
of  a  marked  elevation  of  temperature  shortly  after 
the  application  of  iodoform ;  subjective  sensations 
do  not  accompany  this  febrile  rise.  2.  In  an- 
other series  of  cases,  whether  fever  be  present  or 
not,  whether  the  wounds  are  small  or  large,  recent 
or  old,  the  patients  are  depressed,  are  inclined  to 
silence,  or  are  easily  led  to  weep,  complain  of  head- 
ache, loss  of  appetite,  or  of  a  taste  of  iodoform  in 
whatever  is  eaten.  The  pulse  is  usually  accelerated 
and  is  small,  soft,  and  compressible.  These  symp- 
toms may  develop  after  the  emi>loyment  of  icdo- 
form-gelatine  sticks,  but  rapidly  disapjjear  after  the 
removal  of  the  cause.  3.  Associated  with  a  contin- 
ued or  transient  elevation  of  temperature,  the  puke 
becomes  very  frequent,  as  high  as  150  to  180  in  the 
minute,  both  in  children  and  adults ;  at  the  same 
time  the  patients  may  feel  comixiratively  well ;  they 
are  restless,  perhaps  suffer  from  a  vague  sense  of 
discomfort  or  loss  of  apjietite ;  this  condition  may 
occur  after  the  iodoform  dressing  has  been  well 
borne  for  several  weeks,  and  demands  the  immediafe 
removal  of  every  trace  of  iodoform  from  the  wound, 
otherwise  there  is  imminent  danger  of  the  super- 
vention of  alarming  symptoms,  i.  With  enormous 
frequency  of  the  pulse  there  is  a  corresponding  ele- 
vation of  temperature,  which  signs,  combined  with 
clearness  of  the  mental  faculties,  a  moist  red  tongne, 
a  septic  condition  of  the  wound,  and  the  total  ab- 
sence of  positive  changes  on  post-mortem,  distin- 
guish this  state  from  septic;omia.  Schede  met  witli 
an  instance  of  the  above ;  the  patient  was  a  robust 
young  man  in  whom  a  suppurating  bubo  of  the  groin 
following  gonorrhoea  had  been  extirpated,  and  the 
wound  dressed  with  iodoform  by  some  physician ; 
the  removal  of  the  dressings  was  of  no  avail,  the 
patient  dying  a  week  later.  5.  In  other  cases,  aftei 
exhausting  operations,  but  where  the  pulse  has  re 
mained  strong,  the  plugging  of  the  wound  with 
iodoform  is  followed  by  rapid  and  fatal  collapse.  6. 
In  other  cases  cerebral  manifestations  occur.  In 
children  these  are  liable  to  simulate  an  acute  menin- 
gitis, yet  on  jiost-mortem  o\aminati(m  the  organs  nre 
found  in  an  apparently  healtliy  condition.  In  adults 
obscure  cerebral  disturbances  may  progress  to  a 
fatal  termination,  or  may  assume  the  guise  of  acute 
mania  or  a  severe  type  of  melancholia,  with  .suicidal 
tendencies.  According  to  Schede,  no  large  fresh 
wounds  should  bo  treated  with  iodoform.  Granu- 
lating wounds  are  more  exempt  from  danger.  Sticks 
of  iodoformized  gelatine  are  comparatively  innocu- 
ous.—  CentralblotI  filr  Chirimjie,  January  21,  1882. 


THE  MEDICAL  RECORD. 


4(  5 


Hates  on  Excision  op  the  Knee. — Mr.  Hayes  has 
recorded  his  experience  on  knee-joint  excision  dur- 
ing the  past  ten  years  of  liis  practice.  Of  fourteen 
patients  wlio  underwent  the  operation  for  chronic 
progressive  articular  disease,  eleven  recovered  witli 
useful  limbs.  In  three  secondary  amputation  was 
required,  and  of  these  two  died.  The  steps  of  the 
operation  are  as  follows :  Having  flexed  the  lee; 
moderately  so  as  to  define  the  posterior  margins  ot 
the  femoral  condyles,  he  cuts  from  one  of  them  to 
the  other,  straight  across  the  ligamentum  patella? 
and  into  the  joint.  At  this  stage  the  patella  may  he 
dissected  from  its  attachments,  but  if  fixed  to  the 
femur  its  separation  will  probably  be  postponed  un- 
til after  division  of  fibrous  connections  between  the 
femur  and  tibia.  He  prefers  cutting  through  the 
lateral  ligaments  before  proceeding  to  the  division 
of  either  the  normal  or  abnormal  structures  occupy- 
ing an  intra-artioular  position  ;  also,  when  dealing 
with  the  latter,  ha  keeps  the  leg  strongly  flexed,  and 
directs  the  cutting  edge  of  the  knife  against  the  ar- 
ticular surface  of  the  head  of  the  tibia  rather  than 
toward  the  ligamentum  posticum.  He  never  at- 
tempts to  clear  the  posterior  aspect  of  either  the 
femur  or  the  tibia  before  apjilying  the  saw,  but  sev- 
ering the  bone  from  before  backward  breaks  through 
the  posterior  surface  of  each  lione.  This  is  done 
with  a  view  to  avoid  injuring  the  posterior  ligament 
and  corresponding  fibrous  connections  between  the 
femur  and  tibia,  it  being  an  advantige  to  presei-ve, 
if  possible,  these  tissues,  as  they  not  only  assist  to 
maintain  contact  between  the  sa\\-n  surfaces,  but 
also,  should  suppuration  occur  in  spite  of  antiseptic 
dressings,  they  will  in  all  probaliility  prove  a  barrier 
against  the  entrance  and  burrowing  of  pus  into  the 
popliteal  space. 

In  putting  up  the  limb  he  gives  in  detail  the  fol- 
lowing steps  to  be  adopted.  Presuming  that  the 
operation  has  been  performed  under  antiseptic 
methods,  the  spray  should  now  be  directed  across 
the  region  of  the  knee,  and  to  avoid  any  unneces- 
sary wetting  of  splint,  bandages,  etc.,  carbolized 
sponges  are  to  be  maintained  in  contact  with  the 
angles  of  the  wound,  so  as  to  absorb  all  blood-flow 
while  the  leg  and  thigh  are  being  washed  and  ban- 
daged. 

The  surgeon  next  applies  a  soft  flannel  roller 
evenly,  but  loosely,  around  the  limb  from  the  toes 
to  a  point  about  two  inches  below  the  inferior  lip 
of  the  operation  wound,  and  over  this  a  second 
roller  is  to  be  adjusted,  thus  providing  the  leg  with 
a  sufficiently  thick  and  soft  covering.  In  like  man- 
ner the  thigh  from  the  gi-oin  to  a  point  about  two 
inches  above  the  wound  is  to  be  loosely  encased 
with  a  couple  of  flannel  rollers.  The  limb  being 
ready  for  application  of  the  splint,  the  jiatient  is  to 
be  broTight  Ihoronghhj  under  the  influence  of  ether, 
90  as  to  produce  complete  relaxation  of  the  muscles. 
The  splint  consists  of  two  concave  pieces  of  per- 
forated iron — the  one  moulded  so  as  to  fit  the  pos- 
terior aspect  of  the  leg,  and  the  other  adapted  to 
receive  the  posterior  surface  of  the  thigh.  They  are 
connected  posteriorly  by  means  of  a  strong,  flat,  but 
nan-ow  bar  of  iron,  so  bent  as  to  form  an  oblique 
step  about  three  inches  long,  and  having  the  end  to 
which  the  leg-piece  is  attached  exactly  one  inch  in 
advance  of  that  fixed  to  the  thigh-piece.  This 
apparatus  is  to  be  provided  with  pads  arranged  for 
leg  and  thigh — the  leg-pad  being  made  thicker  be- 
low than  above — and  then  it  is  to  be  carefully  ad- 
justed behind  the  limb.  A  soft  pad  is  now  to  be 
liid  in  front  of  the  the  thigh,  near  its  lower  end,  and 


upon  this  pad  a  concave  piece  of  iron  about  4 
inches  long  by  from  2i  to  3  inches  wide,  is  to  I  e 
placed. 

The  next  step  is  to  firmly  secure  the  thigh  in 
the  upper  part  of  the  splint.  This  is  done  by 
encircling  the  splint  and  limb  ■with  a  strong 
strap,  which  is  to  be  tightly  buckled  across  the 
upper  part  of  the  anterior  fmall  splint,  whilft  lowtr 
down  the  strap  of  a  Petit's  tourniquet  is  to  be 
fixed,  the  brass  of  the  tourniquet  resting  agairst 
the  anterior  splint.  As  both  straps  will  have  bet n 
drawn  extremely  tight  it  is  clear  that  one  or  two 
turns  of  tlie  tourniquet  will  fiinily  press  liack  the 
lower  end  of  the  femur  so  as  to  render  the  anterior 
surface  of  that  bone  flush  with  the  anterior  surface 
of  the  tibia. 

Entrusting  the  upper  part  of  the  limb  to  his 
assistants,  the  surgeon  next  proceeds  to  incase  tie 
foot  in  several  turns  of  a  gypsum  bandage,  which  is 
to  be  carried  upward,  encircling  the  leg  and  lover 
part  of  the  splint  as  high  as  the  point  at  which  iLe 
flannel  bandage  terminates.  Whilst  this  is  being 
accomplished  the  foot  must  be  held  at  right  angles 
to  the  leg,  lest  extension  of  the  ankle  should  rciur 
and  prove  a  source  of  trouble  at  a  later  period.  Wl  en 
the  operator  has  satisfied  himself  (hat  the  limb  has 
been  properly  arranged  and  secure  d,  the  wound  is  to 
be  closed,  while  drainage  is  to  be  juovidcd  for  by  hav- 
ing short  flanged  tubes  inserted  either  at  the  angles 
of  the  original  wound  or  through  buttrn  hole  aper- 
tures which  may  be  made  still  farther  back.  After 
the  application  of  antiseptic  dressings,  the  limb  is 
to  be  swung  by  means  of  a  loop  of  calico  passed 
behind  the  leg-piece  of  the  splint  and  tied  to  the 
bars  of  a  strong  and  high  fracture-cradle.  A  foot- 
piece  is  found  altogether  unnecessaiT,  as  the  gypsum 
bandage  encircling  the  leg  and  splint  constitutes  a 
firm  boot.  Shortness  of  the  thigh-piece,  combined 
with  .suspension  of  the  leg,  enaljles  the  patient  to 
assume  the  sitting  posture,  and  change  position  with- 
out risk  or  discomfort. — Dublin  Journul  of  Medical 
Science,  February,  1882. 

The  Etiology  of  PtrEBPEE.\L  Eci,asipsi.\. — Prof. 
T.  Halbertsma,  of  Utrecht  ( VolAmmin's  Sammbivfi 
Klinischei-  Vorlriige,  No.  212),  defends,  in  a  slightly 
altered  form,  the  theory  concerning  the  causation 
of  puerperal  convulsions  advanced  by  him  in  1871. 
He  believes  that  the  majority  of  cases  of  puerperal 
eclampsia  are  due  to  the  retention  of  urine  caused 
by  pressure  or  by  traction  upon  the  ureters.  He 
refers  the  con^^llsions  to  ursemia,  due  to  the  defi- 
cient elimination  of  urea  consequent  upon  exces- 
sive distention  of  the  pelves  of  the  kidneys.  Dr. 
Halbertsma  bases  his  theory  upon  the  following 
facts  :  The  urine  of  patients  suffering  from  eclamp- 
sia is  altered  both  in  quality  and  quantity.  The 
bladder  is  normal,  and  the  kidneys  usually  too  lit- 
tle diseased  to  occasion  the  symptoms;  eclsmpsia 
is  specially  observed  in  twin  pregnancies,  and  in  old 
primipara?,  i.e.,  in  cases  attended  by  stenosis  or  oc- 
clusion of  the  ureters  from  pressure.  In  certain 
cases  an  autopsy  has  demonstrated  the  existence  of 
retention  occasioned  by  compression  of  the  ureters. 
The  author  claims  that  his  hypothesis  satisfactorily 
explains  the  sudden  occuiTence  of  convulsions  at 
the  end  of  pregnancy,  and  during  or  soon  after  labcr, 
at  times  when  the  intrapelvic  pressure  or  its  after- 
effects are  most  marked.  Dr.  H.  also  admits  the 
existence  of  another  class  of  cases  in  which  eclf  mp- 
sia  is  due  to  renal  disease  complicating  pregnancj-, 
but  not  caused  by  it.^ 


406 


THE  MEDICAL  RECORD. 


The  Medical  RECortD: 

21  tUecklg  lonrnal  of  fllcbitinc  anli  Surgeru 


GEORGE  F.  SHRADY,  A.M..  M.D.,  Editor. 


PUBLISHED   BY 
mn.  WOOD  dc  CO.,  no.  27  Great  Jonea  St.,  N.  ¥. 

New  York,  April  15,  1882. 

STATE  EXAMINATIONS  FOE  LICENSE. 

As  yet  no  active  opposition  to  the  proposed  law  for 
making  State  examinations  for  a  degree  compulsory 
has  been  developed.  From  a  perfectly  impartial 
standi)oint,  and  on  the  assumption  that  the  provi- 
sion of  the  act  may  be  properly  carried  out,  there  is 
bat  one  opinion  regarding  the  utility  of  the  meas- 
ure. In  a  word,  the  profession,  as  a  whole — that 
part  of  it,  certainly,  not  directly  interested  in  the 
management  of  medical  schools— are  in  favor  of 
strict  and  independent  examinations  for  the  doctor- 
ate degree. 

There  are  some  schools  in  the  State  above  the 
suspicion  of  granting  diplomas  to  persons  who  are 
not  properly  qualified  ;  but  there  are  others  not  so 
scrupulous  regarding  those  upon  whom  they  may 
be  empowered  by  their  charters  to  grant  licenses. 

This  is  notoriously  the  case  with  certain  iiTeguIar 
schools  who  fraudulently  sell  their  diplomas.  At 
present,  there  is  no  way  of  preventing  these  osten- 
sibly respectable  diploma  mills  from  forcing  upon 
the  legalized  practitioners  of  this  State  any  number 
of  disreputable  and  incompetent  individuals  who 
are  privileged  by  law  to  trade  upon  the  title  of 
Doctor  of  Medicine.  Indeed,  it  is  loudly  whispered 
that  some  of  the  regular  schools  are  not  free  from  the 
accident  of  occasionally  at  least  gi-.aduating  and  li- 
censing individuals  who  may  not  be  able  to  pass  a 
perfectly  independent  board.  It  cannot  bo  said  that 
reputable  colleges  would  risk  their  good  reputa- 
tions by  doing  such  a  thing  wilfully,  but  they  cer- 
tainly do  it  nevertheless,  and  there  is  not  a  gradua- 
ting class  that  cannot  number  a  due  proportion  of 
men  who  arc  entirely  unfit,  either  by  previous  edu- 
cation, medical  training,  or  clinical  advantages,  to 
practise  the  healing  art.  And  yet  the  profession  is 
expected  to  protect  these  men  in  their  ignorance 
and  receive  them  into  full  fellowship,  osten.sibly  for 
the  reasons  that  there  is  no  better  way  of  licensing 


men,  and  that  any  and  every  self-constitiited  medical 
school  shall  have  its  required  patronage  and  pros- 
per accordingly. 

This  is  practically  what  the  situation  is,  at  pres- 
ent, with  a  profession  already  overcrowded  and  with 
medical  schools  too  numerous  to  mention.  The 
good  intentions  of  the  colleges  are  hardly  to  be 
taken  into  account  as  offsetting  the  possibilities  of 
grave  abuses  of  their  present  privileges.  If  a  few  of 
the  schools  are  honest,  there  is  no  reason  why  all 
should  be  so. 

Some  of  the  leading  colleges  aim  at  a  high  stand- 
ard, but  others  do  not.  All  can  advance  their  stand- 
ard with  benefit  to  the  profession,  but  only  a  com- 
paratively few  make  any  pretensions  to  move  in  a 
direction  tending  to  lessen  the  size  of  the  classes. 
And  yet  the  diploma  from  one  college  is  as  good  as 
that  from  another,  and  the  possessor  is  to  be  accepted 
and  respected  by  a  profession  which  is  bound  by  a 
code  to  stand  by  him  through  thick  and  thin,  to  en- 
dorse his  acts,  good  or  bad,  to  throw  a  mantle  of 
charity  over  his  ignorance  and  protect  his  interests 
with  the  sacredness  of  obligation,  which  is  under- 
stood to  belong  to  medical  bi-others.  When  doctors 
were  scarce,  this  was  tolerable.  The  bottom  limit  of 
necessity  in  this  regard  has,  however,  been  reached 
long  ago,  and  now  the  yearly  frothing  over  of  medi- 
cal recruits  is  noticeable  by  the  most  casual  ob- 
server. 

No  great  harm  can  come  now  to  the  country  by 
lessening  the  supply  of  young  doctors  by  creating  a 
uniform  standard  of  qualification  and  insisting  upon 
enforcing  its  requirements.  And  this  is  one  of  the 
fundamental  arguments  in  favor  of  compulsory  State 
examinations,  and  must  be  so  considered  by  every 
one  not  pecuniarily  connected  with  a  medical  school. 
The  time  has  passed  when,  for  the  sake  of  the  pros- 
perity of  any  medical  school,  the  profession  shall  be 
forced  to  accept  any  and  every  graduate  licensed  by 
said  school.  On  general  principles  the  colleges 
should  not  be  allowed  to  fix  their  own  standards  and 
then  have  the  privilege  of  gi-anting  licenses  founded 
on  the  same.  At  best  it  is  the  loosest  possible  way 
of  doing  business.  Technically  speaking  it  guaran- 
tees no  qualification  besides  that  which  belongs  to  a 
standard  that  is  essentially  arbitrary  and  unreasona- 
ble. Consequently  the  profession  at  large  are  in 
favor  of  fixing  a  maximum  degree  of  qualification, 
and  of  enforcing  it  by  the  compulsory  examinations 
by  State  medical  boards  of  examiners  who  shall  be 
pledged  to  absolute  inpartiality. 

As  has  been  said  before,  this  plan  cannot  possibly 
interfere  with  the  mere  granting  of  diplomas  by  the 
different  colleges,  but  merely  with  the  licensing 
of  individuals  to  practi.se  on  their  authority  alone. 
Before  that  can  be  done,  tlie  actual  value  of  the 
diplomas  are  to  bo  duly  tested  by  a  State  examining 
board. 


THE  MEDICAL  RECORD. 


407 


It  is  scarcely  to  be  expected  that  any  respect- 
able medical  school  will  care  to  oppose  a  measui-e 
so  obviously  for  t^e  advancement  of  the  general 
interests  of  the  profession,  and  for  the  real  good 
of  all  concerned.  On  the  contrary,  it  is  to  the  in- 
terest of  the  regular  and  honest  colleges  over  the 
State  to  give  the  law  their  hearty  support,  earing 
only  for  the  guarantee  of  the  appointment  of  per- 
fectly impartial  examiners.  The  leading  institutions 
can,  if  they  will,  be  equal  to  any  emergency  in 
which  they  may  be  placed  by  the  requirements  of 
any  examining  board  whatsoever,  and  the  best 
school,  the  one  whose  professors  have  taught  the 
most  faithfully,  and  whose  systems  have  been  most 
comprehensive  and  perfect,  will  always  be  on  the 
winning  side  as  to  the  number  of  graduates  who 
pass.  The  lesser  one-horse  institutions,  not  able  to 
hold  their  own,  must  of  necessity  drop  out  of  line. 
This  is  the  proper  way  to  effect  the  necessary  reform. 
Compulsory  State  examination  is  a  radical  measure, 
bat  it  is  the  only  one  which  can  be  consistently  ad- 
vocated in  the  best  interests  of  the  profession  at 
large,  and  even  of  the  colleges  themselves. 


THE  FUNCTIONS  OF  THE  CEREBRAL  CORTEX. 

Professor  Exner,  of  Vienna,  has  made  a  contribu- 
tion to  the  subject  of  cortical  localization,  which  is 
of  unusual  interest  and  importance.  The  method 
which  he  employed  in  his  investigations  was  a  new 
one.  He  collected  over  a  thousand  reported  cases  of 
brain  lesions.  Out  of  these  he  selected  169  as  being 
sufficiently  well  described  to  suit  his  purpose.  He 
then  mapped  out  uj^ona  model  all  those  parts  of  the 
cortex  which  he  found  could  be  affected  w^thout 
necessarily  producing  any  motor  or  sensoi-y  distxub- 
ances.  The  regions  thus  outlined  were  called 
"latent."  Having  mapj)ed  out  his  "latent" 
regions,  he  proceeded  to  study  the  cortical  areas 
for  the  special  muscle-groups  and  senses.  He 
found  that  lesions  in  certain  regions  would  in  some 
cases  produce  particular  paralyses  or  sensory  dis- 
turbances ;  in  other  cases  they  would  not.  These 
regions  he  called  relative  "  areas."  Those  regions, 
injury  of  which  always  caused  a  particular  disturb- 
ance, he  called  "  absolute"  areas.  In  the  "relative" 
areas  there  were  points  where  lesions  produced 
effects  in  a  large  per  cent,  of  cases,  and  other 
points  where  symptoms  were  more  rarely  pro- 
duced. Thus  he  could  describe  a  "  relative  "  area 
as  being  more  or  less  "intense  " — that  is,  more  or 
less  sensitive  to  injury. 

With  this  explanation  of  the  special  terms  our 
author  adopts,  we  can  understand  the  description 
given  of  his  results. 

The  "  latent  region,"  in  which  injuries  may  occur 
without  necessarily  producing  motor  or  sensory 
disturbance,  differed  slightly  in  the  two  hemispheres. 


On  the  right  side  this  region  included  the  whole  of 
the  surface  except  the  precentral  and  postcentral 
(otherwise  known  as  the  anterior  and  posterior  as- 
cending) convolutions,  the  paracentral  lobule,  and  a 
part  of  the  convex  and  inferior  sui-faces  of  the 
occipital  lobes. 

On  the  left  side  the  latent  area  was  much  smaller. 
The  non-latent  surface  includes  all  the  parts  cor- 
responding to  those  just  mentioned  and,  in  addi- 
tion, all  the  parietal  and  most  of  the  occipital  lobes. 
In  other  words,  the  cortex  of  the  left  hemisphere 
can  hardly  be  injured  in  any  part  except  the 
frontal  lobes  without  symptoms,  by  which  we  mean 
sensory  or  motor  disturbances. 

This  greater  sensitiveness  of  the  left  hemisphere 
is  due  to  the  fact  that  the  visual  centres  are  more 
developed,  and  widely  diffused  in  it.  As  a  whole, 
the  ratio  of  sensitiveness,  in  the  sense  just  described, 
between  the  left  and  right  hemispheres  is  about  as 
3  to  2. 

The  different  motor  fields  are  located  about  as 
follows  : 

The  "  absolute  "  motor  field  for  the  upper  extremi- 
ties in  the  right  hemisphere  includes  the  paracentral 
lobule,  the  precentral  gyrus,  except  its  lowermost 
portion,  and  the  upper  half  of  the  postcentral  gyrus. 
The  "  absolute  "  motor  field  for  the  left  hemisphere 
is  nearly  the  same  as  for  the  right,  but  extends  back 
farther  and  includes  some  of  the  superior  parietal 
lobule.  The  "relative"  fields  for  these  extremities 
on  both  sides  shade  off"  with  diminished  "  intensity  " 
from  the  "  absolute  "  centres. 

The  "  absolute "  centre  for  the  hand  is  at  about 
the  middle  of  the  precentral  gyrus. 

The  "  absolute  "  field  for  the  lower  limbs  is  veij 
nearly  the  same  as  that  for  the  upper.  They  do  not 
differ  very  much  on  the  two  sides  except  that  on  the 
left  the  area  is  a  little  larger  and  is  placed  a  little 
farther  back,  including  more  of  the  postcentral  and 
less  of  the  precentral  gyrus. 

The  identity  of  the  areas  for  upper  and  lower  ex- 
tremities is  a  very  interesting  fact,  if  it  be  a  fact. 
Exner  explains  the  phenomena  of  separate  paralyses 
of  arm  and  leg  by  stating  that  the  areas  for  the  arm 
are  more  sensitive  than  those  for  the  leg.  Lesions 
which  are  sufficiently  destructive  to  paralyze  the  for- 
mer would  not  necessarily  affect  the  latter. 

The  facial  nerves  have  an  "  absolute "  field  upon 
the  left  side,  but  only  a  "relative"  field  upon  the 
right.  It  is  situated  at  the  lower  part  of  the  pre- 
central and  contiguous  part  of  the  inferior  frontal 
gyri.  On  the  left  side  the  field  is  not  only  an  "  ab- 
solute" one,  but  it  stretches  farther  back  than  does 
that  of  the  right  hemisphere. 

The  tongue  has  no  "  absolute "  centre  on  either 
side.     Its  relative  centre  is  near  that  for  the  face. 

Exner's  studies  confirm  the  view  that  muscles 
which  during  life  are  innervated  at  the  same  time. 


408 


THE   MEDICAL  RECORD. 


have  a  ".ommon  centre  on  each  side  of  the  brain. 
Such  muscles  are  those  which  move  the  eyes.  When 
their  centres  are  injured  upon  one  side  of  the  brain, 
the  result  may  bs  a  bilateral  paralysis.  But,  as  the 
centre  on  the  other  side  is  not  damaged,  this  par- 
alysis soon  disappears.  The  frequent  existence  of 
temporary  paralysis  of  the  external  and  internal 
recti  in  cerebral  hemorrhage  is  thus  explained.  This 
fact  of  a  common  centre  can  be  used  also  to  explain 
other  paralytic  phenomena. 

The  conclusions  reached  regarding  the  location 
of  the  speech-centre  are  somewhat  different  from 
those  now  accepted.  There  is,  says  our  author,  no 
"  absolute  "  speech  area.  The  most  "intense"  por- 
tion of  the  "  relative  "  field  is  situated  on  the  pos- 
terior part  of  the  left  inferior  frontal  convolution 
(the  place  to  which  the  spaech-centre  is  usually  re- 
ferred) and  the  contiguous  part  of  the  precentral 
gyrus.  From  here  it  extends  back  and  down,  in- 
cluding jjart  of  the  upper  temporal  and  part  of  the 
occipital  lobes.  The  more  a  lesion  apjiroaehes  the 
"  absolute  "  centre  for  the  arm,  the  more  likelihood 
is  there  of  causing  agraphia.  The  more  the  lesion 
encroaches  on  the  tipper  temporal,  the  more  jirob- 
able  is  it  that  there  will  be  word-deafness. 

Before  describing  the  sensory  areas,  we  would  call 
attention  to  the  fact  that  Exner's  studies  confirm 
certain  views  regarding  the  relation  of  the  motor- 
cells  of  the  cortex  to  special  groups  of  muscles.  It 
is  generally  believed  that  the  large  motor-cells  (cells 
of  Betz)  are  connected  with  large  muscles  and  con- 
trol the  grosser  muscular  movements.  Now  these 
cells  are  found  particularly  well  developed  along 
the  greater  longitudinal  fissure  in  the  paracentral 
lobule  and  upper  parts  of  the  ascending  convo- 
lutions. And  here  we  find  the  areas  for  the  mus- 
cles of  the  extremities.  On  the  other  hand,  the  cells 
lower  down  on  the  convexity,  are  smaller  and 
younger,  and  they  coi-respond  to  the  later  devel- 
oped and  more  specialized  centres  for  the  move- 
ments of  the  hand,  face,  eyes,  tongue,  and  laryngeal 
muscles. 

As  regards  the  sensory  areas,  Exner  makes  the 
very  interesting  statement  that  the  tacliln  area,  or 
area  for  common  sensation,  is  nearly  identical  with 
the  motor  areas  for  the  extremities.  This  confirms 
also  previous  hypotheses  that,  wliile  the  motor 
fibres  are  connected  with  the  largo  pyramidal  cells 
of  the  third  cortical  area,  the  sensory  fibres  connect 
with  the  smaller  cells  of  the  fourth  and  fifth  layers. 

Kegarding  the  visual  centre,  Exner  confirms,  to  a 
certain  extent,  the  views  of  Munk  and  the  later 
experiments  of  Ferrier  and  Yeo. 

There  is,  he  say.s,  no  "absolute"  visual  centre. 
The  most  "intense"  part  of  the  "relative"  area  of 
vision  is  in  the  upper  and  middle  occipital  lobes, 
extending  thence  into  the  cuneus.  The  older  view 
that  the  angular  gyrus  is  the  visual  centre  in  man 


must,  if  we  accept  Exner's  (and  Mnnk's)  conclu- 
sions, be  modified  or  abandoned. 

In  conclusion,  Exner  claims  to#how  that  the  right 
hemisphere  contains  more  "intense"  sensoi-y  areas 
than  the  left.  It  may  also  be  more  intimately  con- 
nected with  aflferent  impulses  from  the  ^^scera.  Le- 
sions of  it  are  more  fatal.  The  view  of  Brown- 
Sfquard,  that  the  right  hemisphere  has  more  to  do 
with  emotions,  receives  some  additional  plausibility. 

As  regards  the  actual  part  which  these  cortical 
areas  play  in  producing  movements,  Exner's  studies 
corroborate  the  view  that  they  are  places  in  which 
there  is  an  intermediation  between  afferent  and 
efferent  impulses. 

They  constitute  the  region  where  conscious  and 
voluntary  movements  are  organized  and  sent  out, 
but  not  originated,  properly  speaking.  Impulses 
from  the  lower  or  from  the  ideational  centres  are 
here  brought  systematized  and  then  reflected  down 
as  voluntary  movements. 

The  establishment  of  the  view  that  the  cortical 
areas  are  diffused  and  overlapjiing,  not  sharply  de- 
fined centres,  is  an  important  one  if  it  can  be  ac- 
cejited.  It  must  be  rememliered,  however,  that 
there  are  a  good  many  possibilities  of  error  in  Ex- 
ner's methods,  since  he  used  cases  of  cerebral  tu- 
mors to  work  up.  Some  of  his  conclusions  must 
be  accepted,  therefore,  with  considerable  caution. 


ATMOSPHERIC  OZONE   IS  ITS   KEIiATlON   TO   DLSEASE. 

A  cojiMTiTEE  of  the  American  Medical  Association, 
through  the  agency  of  Dr.  G.  H.  Long,  of  Chicago, 
has  instituted  a  series  of  experiments  regarding  the 
amount  of  oxydizing  agents  (ozone,  peroxide  of  hy- 
drogen) and  organic  gases  in  the  air.  It  is  intended 
that  the  investigation  shall  embrace  three  closses  of 
data :  those  concerning  the  existence  of  oxydizing 
agents,  etc.,  in  the  air  in  different  parts  of  the  coun- 
try throughout  the  year  ;  those  concerning  the  prev- 
alence of  acute  diseases  at  the  same  tiifie  ;  and 
finally  those  concerning  the  daily  meteorological 
conditions  of  the  different  places. 

The  scheme,  as  will  be  seen,  is  a  comprehensive 
one  and  likely  to  bring  out  some  facts  of  value  in 
eour.se  of  time.  .\t  present  only  experiments  (or 
testing  the  amount  of  ozone  in  the  air  have  been  in- 
stituted, and  these  for  only  a  short  time.  The  methods 
employed  consist  in  the  use  of  various  test-papers 
which  arc  exposed  to  the  air.  These  are  the  "  Schorn- 
bein  paper,"  which  consists  of  filter  pai)er  on  which 
is  sjiread  a  thin  paste  composed  of  starch  (TjO),  potns. 
iodide  (5),  and  water  (1000).  This  paper  when 
moistened  in  clear  water  and  exjjosed  to  the  air 
turns  a  blue  color  if  ozone  be  present.  A  second 
and  veiy  delicate  test  ]>aper  is  made  from  thallous 
hydrate.  A  less  delicate  test  is  that  of  filter-]>aper 
dipped  in  tincture  of  guaiacum.    These  test-papers, 


THE  MEDICAL  RECORD. 


409 


with  color  scales,  have  been  furnished  to  different 
observers  at  Boston,  New  York,  Philadelphia,  Balti- 
more, Pittsburg,  New  Orleans,  Chicago,  St.  Paul, 
Lansing,  Lawrence,  Denver,  and  San  Francisco. 

Rejjorts  for  but  one  month  have  as  yet  come  in, 
and  nothing  of  course  can  be  said  as  to  what  the  ex- 
periments will  eventually  show.  In  most  of  the 
stations  there  were  no  indications  of  the  presence 
of  ozone.  In  a  few  places,  as  in  Michigan,  the 
amount  was  so  great  that  the  test-papers  were  found 
too  delicate. 

The  institution  of  these  experiments  marks  the 
beginning  of  the  closer  study  of  atmospheric  condi- 
tions in  their  relation  to  disease.  There  is  much  to 
learn  here,  and  we  trust  there  will  result  some  defi- 
nite contribution  to  our  knowledge. 


LEGISL.\TIVE   PROTECTION  AG.tESST  ^IINEREAL   DISEASES. 

The  subject  of  the  prevention  of  venereal  disease 
by  legislation  was  brought  up  at  a  meeting  of 
the  Medico-Legal  Society,  April  5th.  Dr.  Gihon, 
U.S.N.,  presented  essentially  the  same  paper  which 
was  read  by  him  before  the  American  Public  Health 
Association  a  year  and  a  half  ago.  The  extent  and 
evils  of  venereal  disease  were  fervidly  portrayed,  and 
the  great  need  of  preventing  their  baneful  effects 
was  urged.  The  measure  suggested  to  secure  this 
end  was  the  classing  venereal  affections  with  other 
contagious  diseases,  and  the  granting  local  or  State 
health  boards  authority  to  treat  them  as  they  would, 
tor  example,  small-pox.  It  would  further  be  made 
a  crime  for  one  individual  knowingly  to  communi- 
cate venereal  disease  to  another.  A  draft  of  such  a 
bill  was  submitted  for  criticism. 

The  discussion  for  the  most  part  drifted  off  in- 
to purposeless  talk  concerning  vaccinal  syphilis. 
Enough  was  said,  however,  to  show  that  the  views 
of  the  reader  of  the  paper  were  considered  to  be 
somewhat  high-colored,  and  his  proposed  law  hardly 
a  practicable  one. 

Dr.  Gihon  has  undertaken  to  champion  a  fight 
against  venereal  disease.  His  task  is  an  unsavory 
one,  and  exposes  him  to  much  imintelligent  if  not 
unjust  criticism.  But  the  cause  is  good,  and  he  can 
be  fairly  assailed  only  as  regards  the  special  methods 
he  advocates  for  carrying  out  his  views. 

There  are  probably  from  one  and  one-half  to  two 
millions  of  syphilitics  in  the  United  States.  This  is 
a  serious  fact,  yet  not  so  frigbtfid  as  is  painted.  If 
we  may  believe  Dr.  Taylor,  ninety-nine  out  of  a  hun- 
dred adults  will  get  well  if  properly  treated.  They 
are  liable  to  communicate  the  disease  in  a  dozen  dif- 
erent  ways.  The  other  eleven  were  pictured  most 
vividly,  and  not  without  much  exaggeration,  by  the 
speaker  of  the  evening.  There  is  nothing  to  be 
gained  by  inflammatory  descrijitions  of  vinilent  nap- 
kins, bed-clothes,  knives,   car-cushions,  etc.,  when 


appealing  to  a  body  of  scientific  men,  though  such 
arts  may  tickle  the  medicolegal  imagination.  The 
evil  is  propagated  by  sexual  immorality,  not  by 
soiled  linen,  and  against  this  the  fight  must  be 
made. 

While  not  directly  advocating  it.  Dr.  Gihon 
affirmed  his  belief  in  regulating  prostitution,  as  is 
done  abroad.  In  presenting  his  arguments  he  some- 
what disingenuously  failed  to  refer  to  the  sani- 
tary working  of  these  regulations  in  European  cities. 
As  is  known,  they  do  not  secme  very  good  results 
there.  To  the  plan  suggested,  of  treating  venereal 
diseases  as  we  would  small-pox  or  scarlet  fever  and 
compelling  isolation,  one  objection  arises  which 
will  be  very  hard  to  meet.  To  accommodate  those 
■isolated  in  hospitals,  the  hospital  accommodation 
would  have  to  be  at  least  doubled,  and  the  expense 
of  building  and  muning  the  institutions  would  be 
enormous.  The  impracticability  of  such  a  proposi- 
tion was  shown  by  Dr.  Simon  when  it  was  proposed 
some  years  ago  to  extend  the  working  of  the  Con- 
tagious Diseases  Act  to  the  civil  population. 

"Whether  a  law  making  it  criminal  to  communicate 
syphilis  would  be  eflective  is  a  question  for  la-njers 
to  decide.  On  the  face  of  it,  this,  too,  seems  imprac- 
ticable. 

There  has  been  a  mistake  in  attempting  to  deal 
with  this  question  from  a  sanitary  standpoint  alone. 
It  has  a  moral  and  a  political  side  also.  Those  who 
aim  to  make  the  matter  purely  a  sanitary  one,  will 
fail  to  secure  any  relief  from  the  disease,  and  will 
never  receive  much  sympathy  from  the  intelligent 
public. 


KIDDER   ON   SCABLATIKAL   BLOOD. 

In  proportion  as  scientific  research  brings  into  light 
points  hitherto  obscure,  showing  how  certain  symp- 
toms may  be  accounted  for,  and  how  diseased  con- 
ditions may  be  treated,  does  it  aid  the  jiractitioner 
in  elevating  the  practice  of  medicine  to  a  plane 
much  higher  than  the  one  upon  which  it  now  rests. 
To  this  end.  Dr.  J.  H.  Kidder,  U.  S.  Navy,  has,  with 
gi-eat  care,  examined  microscopically  the  blood  of 
scarlatina  and  typhoid  fever,  with  the  following  re- 
sults :  Scarlatina  blood,  at  the  time  of  greatest  in- 
tensity of  the  disease,  contains  very  minute,  sijheri- 
cal,  highly  refracting  globules,  of  a  vinous  red  color, 
attached  to  the  leucocytes.  Besides  these  globules, 
the  leucocytes  present  well  defined  curved  lines  of 
double  contour,  upon  which  the  globules  are  often 
so  disposed  as  to  suggest  the  idea  that  there  is 
some  close  relation  between  them.  The  globules, 
as  describeed,  have  not  been  observed  by  him  in  or 
upon  the  leucocytes  of  healthy  blood,  nor  in  those 
of  malarial  fevers,  typhoid  fever,  or  beri-beri.  Tliey 
may  be  the  small  corpuscles  described  by  M.  Schultze 
(RoUet,  in  Strieker's  "Histology,"  vol.  i.,  p.  379),  or 


410 


THE  MEDICAL  RECORD. 


the  hK  matoblasts  of  Hayem  (Satterthwaite's  "  Histol 
ogy,"  New-  York,  1881,  p.  47),  or  they  may  be  cliarac 
teristic  of  the  blood  of  scarlatina,  and  probably  other 
acate  exanthemata.  In  the  blood  of  typhoid  fever  were 
found  ill-defined,  opaque  spherules,  mostly  within 
the  substance  of  the  leucocytes,  and  neither  colored 
or  highly  refracting.  These,  however,  are  not  re- 
g  vrded  as  distinctive  marks  of  typhoid  blood.  The 
photo<'raphic  illustrations  which  accompany  Dr. 
Kidder's  article  are  very  clear  in  outline,  and  are  so 
arraac^ed  as  to  show  the  comparative  difference  in 
the  appearance  of  the  various  microscopic  sections. 
Tbis  work  is  an  indication  of  what  the  Government 
mav  accomplish  through  its  oflBcial  representatives 
in  diffusing  valuable  accurate  information,  which 
not  oulv  serves  as  material  for  use  in  the  field  tff 
prastice',  but  removes  obstacles  to  the  progress  of 
expansive  study. 

mcports  of  Societies. 


NEW  YOEK  PATHOLOGICAL  SOCIETY. 

Staled  Meeting,  March  8,  1882. 
Dr.  Edward  C.  Seouin,  President,  in  the  Chair. 

(Contiuued  from  page  384.) 
DESQUAMATIVE   PNEUMONIA— TUBEROTOAB   ENTERITIS. 

Dr    Pptnam-Jacobi  presented  the  lungs  a,nd  intes- 


tine  of  a  child  fifteen  months  old,  who  had  sue 
cumbed  to  tubercular  enteritis  and  pneumonia,  ilie 
history  was  very  imperfect,  containing  little  beyond  a 
statenient  of  long-standing  diarrhcea.  The  principal 
interest  of  the  autopsy  centred  in  the  right  hing. 
Before  opening  the  chest  percussion  showed  absohite 
dulness  over  the  wliole  anterior  surface  of  the  right 
lun<^  The  upper  lobe  was  found  adherent  to  tlie 
Dleura  throughout  the  entire  extent  of  its  anterior 
surface,  and  principally  so  at  the  apex,  where  tearing 
of  the  adhesions  revealed  a  group  of  minute  caverns. 
Tbe  entire  lobe  was  solidified.  The  interesting  cir- 
cum^t-mce,  however,  was  that  this  sohdiflcation  dif- 
fere  1  entirely  from  that  of  a  hepatised  pneumonia. 
The  lun"  tis.^ue  throughout  the  lobe  looked  com- 
pletely amemic,  W.IS  smooth,  yellowish  white— a  color 
about  midway  bc.tween  the  difluse  gray  and  the 
diffuse  yellow  tubercular  infiltration  of  Ijaennec. 
Neither  blood  nor  air  could  be  squeezed  out  of  the 
surface  of  a  section.  ,.,     ,.  ,         ii 

Microscopic  examination  of  the  tissue  showed  le- 
sions identical,  on  the  one  hand,  witli  the  '■genuine 
descinamative  pneumonia"  of  Buhl;  on  tlu>  other 
liand,  with  an  aggregation  of  structures,  each  re- 
somblin-'  the  second  species  of  miliary  tu\)ercle,  as 
rocBntly'doscribed  by  Delafleld.  In  any  given  area 
could  bo  observed— 1st,  large,  irregular  spaces,  from 
which  all  trace  of  alveolar  structure  had  disap- 
peared, and  which  wore  occupied  by  two  kinds  of 
cells  f'<)  polvgonal  cells  of  various  shapes  and  size.s, 
e/idently  altered  epithelium,  (h)  small  angular  ele- 
ments sometimes  non-nucleated,  sometimes  with  a 
nucleus  almost  filling  the  cell ;  there  were  endently 
two  atrophic  tubercle  elements;  'id,  adjoining  the 
foregoing  ai)aces   were   smaller  ones,  formed  from 


the  coalescence  of  two  or  more  alveoli,  and  sm- 
rounded  by  a  thickened  alveolar  wal  ;  t^^  contents 
of  these   spaces   were   identical  with  .tl^a     ot    the 
others ;  3d,  alveolar  spaces,  norma  m  size,  but  more 
or  less  tilled  with  the  foregoing  elements,  and  then 
always  infiltrated  with  small  cells  ;  in  some  ot  these 
loops  of  capillaries  persisted,  in  many  were  extra- 
vasated  blood  corpuscles  ;  4th,  whenever  a  bronchial 
tube  appeared  in  the  section,  its  walls  were  observed 
to  be  infiltrated  in  the  same  manner     In  the  sec- 
tions so  far  made  no  blood-vessels  had  been  lound 
These  lesions  were  entirely  absent :  Ist,  the  so-calUd 
tubercle  nodules  with  a  giant  ceU  m    heir  centre 
this  corresponds  to  Delatield's  remark  that  m  tu- 
bercle two  distmct  species  of  nodules  exist,  one  of 
which  has,  the  other  has  not,  giant  cells,  and  that 
the  two  species  are  not  found  together  in  the  same 
lunK  ■  2d,  in  the  second  place,  m  spite  of  the  pxo- 
fouSd  aniemiaof  the  tissue,  thtie  were  no  maB^es 
of  amorphous  caseous  detritus,  such  as  so  geneially 
exists  in  tubercular  pneumonia  ;  ad,  and  finally,  there 
were  hardlv  any  leucocytes,  and  no  aggregations  of 
pus     The  "middle  and  inferior  lobes  of  the  right 
lung,  and   the   lower  lobe   of  the  left,  oflered  the 
usual  appearances  of  broncho-pneumonia ;  the  left 
upper  lobe  was  healthy.  ,      .,,         ,   , 

The  mesentery  was  studded  with  nodules,  con- 
sisting of  enlarged  glands.  Those  nearest  the  hilus 
of  the  mesentery  were  often  as  large  as  hickoi^ 
nuts  were  perfectly  white,  and  section  showed  them 
to  be  nearly  entirely  composed  of  cheesy  matter. 
Near  the  free  border  of  the  mesentery  existed  a 
number  of  small  bodies,  the  size  and  shape  of  leu- 
tils,  and  dark  violet  in  color.  The  small  intesliEe 
contained  a  number  of  round  ulcers.  .    , .     , 

The  history  of  the  case  would  seem  to  indicate 
that  the  disease  began  in  a  catarrhal  enteritis,  and 
that  consecutivelv  to  this  the  mesenteric  glands  bad 
first  engorged,  then  undergone  caseous  degeneratK  n. 
There  was  no  evidence  that  the  pneumonia,  although 
tuberculous,  was  due  to  infection  from  these  glands. 
There  were  no  isolated  miliary  tubercles  either  in 
the  lung  tissue  or  in  pleura,  peritoneum,  or  arach- 
noid Rather  did  this  extensive  lobar  inhltration 
seem  to  result  from  the  cachexia  induced  by  the  in- 
terruptions to  intestinal  digestion  and  ateorption. 

Dr  Satterthwaite,  as  bearing  upon  the  question 
of  the  existence  of  a  caseous  centre  from  which 
general  tuberculosis  might  have  developed,  asked 
whether  the  enlarged  mesenteric  glands  were  pri- 
mary or  secondary. 

Dr.  Jacobi  thought,  from  the  history  of  illness 
l>eginning  in  a  dianhcea,  that  the  primary  affection 
was  in  the  intestine,  and  that  the  pulmonaiy  troul.  e 
did  not  correspond  with  general  tuberculosis  m  it- 
ordinary  form.  ,  ,  ,,  ,  f  1  n,;  ;.; 
Du  Satterthwaite  regarded  the  form  of  phthisis 
called  diffused  infiltration  of  tubercle  (I.aennec),  caee- 
ous  pneumonia  (Niemeyen,  and  desquamative  pneii- 
monia,  or  tuberculous  pneumonia  (Buhl),  as  one  and 
the  same  lesion,  and  secondary  to  cheesy  foci,  in 
the  specimen  presented  he  thought  that  there  ww 
miliary  tubercles  at  the  apex  of  the  lung,  and  lo 
pneumonic  changes  were  probably  seccndiiry  to  tiv 
infiltration  of  the  apex,  and  showed  tuberculous 
caseous  contree. 


FIBROMA    (?)    OF   THE    ABDOMINAI.  WALL. 

Dr.  0.  K.  Brtopon  presented  a  tumor,  weiglm 
two  pounds  and  eight  ounces,  and  removed  from  tl . 
abdominal  wall  of  a  woman,  twenty-seven  years  o 
ag(\    the  mother  of   three  children,   the   youngest 


THE  MEDICAL  RECORD. 


411 


being  born  in  December,  1881.  In  the  second 
month  of  her  last  pregnancy  she  first  noticed  a  tu- 
mor in  the  right  iliac  fossa  about  the  size  of  a  man's 
fist.  She  subsequently  went  into  a  large  hospital, 
specially  devoted  to  the  treatment  of  diseases  of 
women,  where  the  tumor  was  regarded  as  ovarian. 
Early  in  February  she  came  under  Dr.  Briddon's  ob- 
servation in  the  Presbyterian  Hospital,  when  he 
found  a  tumor,  measuring  eight  inches  in  its  longest 
and  four  inches  in  its  shortest  diameter,  situated  in 
the  right  iliac  fossa,  parallel  with,  and  about  two 
inches  above  Poupart's  ligament,  dense,  so  mobile 
that  it  could  be  nearly  surrounded  with  the  hands, 
and  at  first  he  regarded  it  as  a  solid  ovarian  tumor. 
It  was  examined  by  several  men  eminent  in  the  class 
of  affections  to  which  the  tumor  was  sujiposed  to 
belong,  and  by  them  regarded  as  ovarian  in  char- 
acter. It  was  subsequently  examined  by  a  gentle- 
man still  more  eminent,  who  thought  that  it  was  not 
ovarian,  and  probably  not  connected  with  the  pel- 
vic viscera. 

Studying  the  tumor  from  time  to  time,  Dr.  Brid- 
don  finally  reached  the  conclusion  that  it  was  not 
ovarian,  and  probably  not  of  pelvic  origin.  As  it 
increased  in  size  it  become  more  and  more  fixed, 
and  it  was  decided  that  the  proper  mode  of  treat- 
ment was  to  remove  it.  Dr.  Briddon  then  regarded 
it  as  a  sarcoma  develoi^ed  in  the  connective  tissue  of 
the  abdominal  walls,  and  by  others  also  it  was 
thought  to  be  a  sarcoma. 

On  Saturday,  March  4th,  the  tumor  measured  nine 
inches  in  its  longest  and  five  inches  in  its  shortest 
diameter,  and  an  operation  was  performed  for  its  re- 
moval. The  growth  was  readily  exposed,  and  was 
found  to  be  so  closely  incorporated  with  the  lo^er 
portion  of  the  internal  oblique  and  transversalis 
muscles  as  to  render  the  separation  difficult.  This 
was  particularly  noticeable  where  the  fibres  arise 
from  the  outer  half  of  Pouj^art's  ligament,  and  at 
their  insertion  into  the  crest  of  the  pubes. 

On  removal  of  the  mass  it  was  found  that  the 
peritoneum  had  been  exposed  over  an  area  of  four 
inches  square,  was  very  considerably  thickened, 
and  covered  with  the  dense  transversalis  fascia. 

The  tumor  was  probably  developed  from  the  trans- 
versalis fascia,  and  the  microscopic  examination  was 
being  made  by  Dr.  Satterthwaite,  who  would  report 
concering  its  character. 

Dr.  Satterthwaite  said  that  he  had  not  had  an 
opportunity  to  examine  sections  to  much  extent, 
but  so  far  it  had  presented  the  usual  appearance  of 
a  fibroma,  and  Dr.  W.  H.  Porter,  who  examined  the 
tumor  when  it  was  fresh,  and  also  had  made  micro- 
scopic sections,  thought  it  was  a  simple  fibroma. 
Farther  report  would  be  made. 

Dr.  Be^'erlt  Eobinson  presented  a  specimen  of 

GASTRIC  ULCER — EROSION   OF   THE   PANCREATIC  ABTEP.Y. 

It  was  removed  from  the  body  of  a  woman  forty-six 
years  of  age,  a  widow,  who  had  suffered  from  obscure 
gastric  symptoms  for  a  year  or  more,  and  died  in 
Charity  Hospital  Februaiy  13,  1882.  She  was  ad- 
mitted February  7th. 

There  was  no  hereditary  disease  in  her  family,  so 
far  as  she  could  remember,  and  she  never  knew  of 
any  member  having  had  a  hemorrhage.  She  was 
the  mother  of  three  children,  living,  youngest  being 
seventeen  years  old.  Widowed  at  thirty,  climac- 
teric at  forty-two.  Had  always  been  accustomed  to 
the  use  of  porter,  but  never  used  other  stimulants 
except  tea,  of  which  she  had  been  an  excessive 
drinker  since  childhood. 


Immediately  after  the  menses  ceased,  she  began 
to  experience  vague  pains  in  the  back.  They  in- 
creased, became  dull,  boring,  and  contiLUous.  Alter 
eating  she  had  painful  eructations,  and  frequently 
vomited  ;  could  not  sleep  on  her  back. 

The  lungs  were  normal ;  the  heart  was  hyper- 
trophied,  mitral  regurgitation.  Four  hours  alter 
admission  had  a  profuse  gastrorrhagia;  unable  to 
speak,  still  vomiting  blood  in  tluid  form  ;  surface 
cold  ;  pulse  imperceptible  ;  pupils  dilated  ;  respiia- 
tions  sighing  ;  sphincters  intact. 

Hemorrhage  checked  by  ergot,  fl.  ext.  hypoder- 
mically.  Ice  per  orem,  ice-bag  to  the  epigastrium. 
She  lost  about  sixteen  ounces  of  blood  on  February 
8th.  From  this  she  somewhat  rallied.  Could  retain 
only  milk,  whipped  eggs,  and  soaked  bread.  Ke- 
mained  without  notable  change  until  February  13th, 
when  the  hemorrhage  recurred,  eight  ounces,  and  the 
died  in  collapse. 

Autojjsj/.  fifty-two  hours  after  death,  by  Dr.  Max- 
well. Body  emaciated,  skin  pale,  rigor  mortis  pre- 
sent. 

Head. — Not  examined. 

Thorax.- — Bands  of  adhesion  on  the  left  side. 

Lungs. — Emphysematous  ;  moderate  oedema  and 
hypostatic  congestion  of  dependent  portions. 

Heart. — Marked  hypertrophy  of  left  ventricle  ; 
cavities  nearly  empty  ;  walls  firm  ;  color  normal. 

Valves. — Tricuspid  orifice  larger  than  normal  ; 
thickened  and  roughened  calcareous  nodules  on  cne 
of  the  anterior  leaflets  ;  on  post.-segment  of  valve 
several  roughened  si^ots,  three  small  deposits  of 
fibrine.  Mitral  orifice  also  larger  than  normal,  with 
moderate  thickening  of  free  margin  at  certain 
points  and  some  thickening  of  chordae  tendinse. 
Aortic  valves  and  aorta  normal,  except  blood-staining 
of  the  intima  ;  the  endocardium  is  similarly  blood- 
stained. 

Abdoinen.—TDie  omentum  firmly  attached  to  pelvic 
organs  by  old  adhesions.  The  stomach  attached  to 
anterior  border  of  pancreas,  about  three  inches  from 
its  tail.  This  adhesion  gives  the  greater  cvlt\  ature  a 
scalloped  outline. 

Stomach  contains  six  ounces  of  blood  coagula.  On 
its  posterior  wall,  about  three  inches  from  cardiac 
orifice,  a  large  chronic  ulcer,  oval  in  outline,  three- 
fourths  of  an  inch  broad,  one  and  one-fourth  of  an  inch 
long;  its  long  diameter  corresponds  with  the  trans- 
verse diameter  of  the  stomach.  The  edges  of  the  ulcer 
are  smooth,  slopiugevenly  down  to  the  base,  with  only 
moderate  hardness  to  be  felt.  From  about  the  centi  e 
of  the  base  a  projecting  (one-fourth  of  an  inch)  throm- 
bus with  a  narrow  opening  in  its  centre.  Inserting 
a  small  broom-stem  into  this  channel,  and  slitting 
up  with  scissors,  proved  this  channelled  thrombus  to 
partially  occlude  an  erosion  of  the  main  trunk  of  the 
pancreatic  artei-y.  The  latter  was  proved  by  tracing 
it  up.  The  erosion  had  been  probably  about  one- 
sixth  by  one-eighth  inch  in  diameter.  The  pancre- 
atic artery  was  empty.  Two  cicatrices  existed  in 
the  anterior  wall  of  stomach,  directly  opposite  to 
ulcer  described.  The  mucous  membrane  ot  stomach 
was  softened  (postmortem)  and  blood-stained. 

Intestines. — Abnormal  amount  of  blood-stains  no- 
ticed in  duodenum  but  extends  no  farther  ;  other- 
wise normal. 

Liver. — Diminished  in  size  ;   thickened  capsule  ; 
granular  surface  ;  cin-hotic  ;  anaemic. 
Spleen. — Small;  firm;  pale. 

Kidnei/s. — Diminished  in  size,  thickened,  and  ad- 
herent capsules  ;  surface  pale,  granular,  dotted  with 
cysts  of  varying  size,  and  on  section  shows  a  general 


412 


THE  MEDICAL  RECORD. 


atrophy  of  botli  portions.  Most  marked  of  the  cor- 
tex (anaemic).     Chronic  diffuse  nephritis. 

Uterus  and  >4y^/)e?iti<((/es. —Evidences  of  old  peri- 
metritis ;  the  uterus  and  ovaries  are  atrophied. 

Dr.  SiTTERTHWAiTE  had  made  a  post-mortem  in  a 
case  of  gastric  ulcer,  where  there  were  no  symptoms 
until  just  before  death.  About  two  days  before 
death  the  p.itient,  a  girl,  eomj^lained  of  abdominal 
pain,  which  the  autopsy  showed  to  be  due  to  perfor- 
ating peritonitis,  the  perforation  in  the  stomach  be- 
ing suifineiitly  large  to  admit  the  little  fiuger,  and 
situated  in  the  middle  portion  of  the  anterior  wall. 
There  had  been  adhesions  between  the  stomach  and 
omentum.  There  was  no  organic  cardiac  or  vascular 
disease  to  account  for  the  ulcer  on  the  theory  of 
embolism. 

Dr.  Pdinam-Jacobi  asked,  if  in  cases  of  repeated 
hematemesis,  marked  pulsation  of  the  abdominal 
aorta  had  been  noticed.  A  cose  had  been  iinder 
her  observation  in  which  vomiting  of  blood  occurred 
at  different  times,  and  after  an  interval  of  ten  years 
a  violent  attack  developed,  and  the  only  local  symp- 
tom was  marked  pulsation  of  the  abdominal  aorta, 
which  ceased  after  the  vomiting  of  blood  stopjjed. 
The  patient  was  a  woman,  and  recovered. 

Dr.  Eobinson  thought  that  the  symptom  had  no 
special  significance  in  connection  with  vomiting  of 
blood. 

M0BBC3  MACULOSUS  TVERTHOFII — ACTTIE  PURPUBA  H-EM- 
OBRHAOICA. 

Db.  W.  Griiii  WrLiE  presented  specimens  illustrat- 
ing the  above  affection,  and  with  the  following  his- 
tory :  Mr.  C,  aged  35  ;  born  in  New  York.  He  had 
known  the  patient  for  the  past  five  years,  and  had 
treated  him  at  different  times  for  debility,  and  de- 
pression of  spirits,  and  rheumatic  diathesis.  For 
several  years  past  he  was  subject  to  a  dry,  scaly 
eruption,  showing  itself  maiidy  over  the  lower  ex- 
tremities. He  was  always  more  or  less  depressed, 
and  rarely  felt  entirely  well,  but,  except  the  ei-up- 
tion,  had  no  definite  disease.  For  several  years  as 
a  young  man  he  had  used  stimulants  freely,  and, 
e'coept,  perhaps,  during  the  past  few  months, 
rarely  drank  stimulants  of  any  kind.  About  six 
months  ago  he  was  advised  to  change  his  occupa- 
tion, that  of  bookkeeper.  After  this  he  acted  as 
purser  on  a  steamer  that  made  regular  trips  to  dif- 
fereut  parts  in  Central  America.  The  change 
seemed  to  be  of  beneiit  to  him,  aaid  he  gained  in 
strength  and  flesh.'  Two  weeks  before  his  death  he 
returned  from  a  voyage  of  several  weeks,  and  "  on 
landing  felt  heavy  and  bilious,"  as  he  expressed  it, 
and  took  a  purgative  ;  after  this  he  felt  very  well 
until  throe  days  before  he  died.  Dr.  Wylio  saw  the 
patient  on  Wednesday  evening,  February  2'2d,  when 
he  complained  of  being  drowsy,  and  somewhat 
nauseated.  His  pulse  was  good,  and  temperature 
in  axilla  0SJ°  F.,  and  nothing  imusual  about 
him  was  noticed.  Ordered  one-half  grain  podo- 
phyllin  at  bedtime,  and  mineral  water  to  be  taken 
next  morning.  The  next  morning  (Thursday) 
Dr.  Wylie  was  sent  for,  and  on  arrival  found  the 
patient  vomiting  a  slight  amount  of  frothy  fluid. 
Pulse  under  90  and  temperature  normal.  Ordered 
small  doses  of  ipecac.  In  the  afternoon  the  vomit- 
ing had  increased,  and  when  he  visited  the  jiatient 
he  found  him  writhing  in  pain,  which  was  located 
as  being  worse  over  the  lower  part  of  the  right  lobe 
of  liver,  and  extending  across  the  alidomon.  His 
f.ico  was  flushed,  but  temperature  was  i)8J'  F., 
and    pulse    90.      One-fourth   of  a  grain    of  mor- 


phine was  given  hypodermically.  The  next  day 
(Friday)  Dr.  Wylie  saw  him  at  H  a.m.,  when  he 
found  that  the  morphine  acted  like  a  charm,  and 
kept  the  patient  from  vomiting  until  8  p.m.,  when 
the  same  symptoms  returned.  His  jjulse  was  90, 
and  temperature  98^'  F.  Abdomen  somewhat 
sunken,  tense,  and  as  hard  as  a  board.  Face 
vei-y  much  flushed,  and  of  a  deep  yellowish  or 
orange  tint.  Eyes  were  suffused,  and  lids  puffed. 
No  ecchymotic  spots  were  noticed.  The  jjain  was 
described  as  pulsating  and  stinging  with  each 
heart-beat,  and  caused  an  oppressed  feeling  about 
the  diaphragm.  Heart-sounds  were  somew  hat  feeble 
but  seemed  otherwise  normal.  It  was  supposed 
that  the  patient  might  be  passing  a  gall-stone,  and 
he  gave  one-third  grain  of  morjjhine  hypodermically. 

At  11  P.M.  of  the  same  day  he  saw  the  patient  again, 
and  was  surjirised  at  the  change  in  his  appearance 
since  morning.  From  the  lower  part  of  abdomen  to 
the  roots  of  his  hair  he  was  deeply  flushed  and  looked 
as  though  his  skin  was  stained  a  deep  orange  color. 
His  eyes  were  literally  black  and  blue,  the  conjunc- 
tiva was  suffused  with  blood,  and  protruded  between 
the  lids  at  the  corners  ;  his  neck  and  bodj"  down  to 
the  waist  was  dotted  with  hundreds  of  dark  bluish 
hemorrhagic  spots,  from  size  of  a  jiin-head  to  a  bean. 
The  abdomen  was  very  tense  and  somewhat  sunken. 
Pain  and  occasional  vomiting  were  the  same  as  in 
the  moi'ning.  Pulse,  95 ;  temperature,  98^  ;  and 
mind  perfectly  clear.  He  had  retained  very  little 
food.  Dr.  Wylie  considered  his  condition  danger- 
ous, but  gave  him  i  gr.  morjihine  hypodermically, 
and  arranged  for  a  consultation  early  the  next 
morning.  The  patient's  mother  remained  with  him 
fcff  more  than  an  hour,  and  at  3.30  a.m.  came  to  his 
room  to  see  him.  At  this  time  he  was  easy,  and  he 
persuaded  her  to  go  to  her  room  and  leave  him  for 
the  night.  At  0.15  a.m.,  when  she  again  returned  to 
his  room,  he  was  dead.  Dr.  Wylie  saw  the  body  at 
7  A.M.,  the  extremities  were  cold,  body  warm,  but  he 
could  elicit  no  signs  of  life.  Dr.  Loomis  .saw  the 
body  soon  afterward  and  recognized  the  case  as  one 
of  purpura. 

10  A.M.,  same  day  (Saturday),  assisted  by  Dr.  J.  S. 
Howe,  an  .autojisy  was  made.  The  front  of  the  body, 
above  the  middle  of  the  thighs,  was  covered  with 
hemorrhagic  spots,  varying  in  size  from  a  mere  dot 
to  size  of  a  bean.  The  face  and  legs  below  the  knees 
were  free  from  these  hemorrhages.  Eyelids  bluish- 
black,  conjunctiva  swollen  and  protruding,  cornea 
bloody,  and  pupils  moderately  dilated.  Gums 
covered  with  dried  blood,  bloody  discharge  in  ears. 
Back  of  neck  and  body  deeply  discolored.  Prepuce 
long,  and  when  forced  back  showed  e\'idence  of  phi- 
mosis of  long  standing.  Abdomen  sunken  and  more 
thickly  studded  with  hemorrhagic  spots  than  any 
other  jiart  of  surface.  Neck,  inside  of  arms  and 
thighs  pretty  well  covered  also.  An  incision  was 
made  from  upper  end  of  sternum  to  pubis  in  the  me- 
dian lino.  Hemorrhages  were  found  in  the  muscles, 
in  the  connective  tissue,  and  in  serous  coats.  These 
hemorrhages  were  l>otli  large  and  small,  some  as  largo 
as  a  linger-nail  and  much  longer.  Those  in  the  lirm 
tissues  were  flat,  those  in  looser  tissues  were  round 
and  irregular  shaped. 

There  were  hemorrhages  into  the  omentum  and  in 
different  parts  of  the  iioritoneum,  especially  the 
upper  part  covering  diajihrapm. 

Intestines  were  firmly  adherent  to  a  large  and 
tensely  distended  gall-bladder,  and  the  tissues  adja- 
cent to  the  duct  were  matted  together  with  old  adhe- 
eiona. 


THE   MEDICAL  RECORD. 


413 


Liver  and  spleen  apparently  healthy  and  free  from 
hemorrhages. 

Kidneys  about  normal  size,  with  some  hemor- 
rhages in  the  membranes  of  the  outer  coat. 

The  sternum  was  removed  and  hemorrhages  were 
found  in  tlie  pleura.    None  were  noticed  in  the  lungs. 

The  pericardium  was  dotted  ^rith  hemorrliagic 
spots,  both  inside  and  outside.  .Wiont  three  ounces 
fltiid  were  found  in  the  pericardium,  supposed 
to  be  post-mortem.  The  heart,  or  rather  the  ser- 
ous lining,  was  dotted  with  numerous  little  hemor- 


The  blood  was  dark,  and  everywhere  fluid  and 
thin  ;  no  clots,  except  in  the  meshes  of  the  tissues 
were  found.     Brain  not  examined. 

Dr.  S.A.TrERTHw.\iTE  referred  to  a  case  in  which 
he  was  present  at  the  autojasj-,  and  presented  the 
specimens  to  the  society  in  behalf  of  a  candidate. 
The  patient  was  a  remarkably  robust  woman,  who 
had  had  common  intermittent  fever,  and  had  recov- 
ered entirely.  She  had  had  two  attacks  of  iirticaria, 
a  disease  which  has  been  spoken  of  as  occurring  in 
connection  with  morbus  maculosus,  and  they  oc- 
curred without  any  assignable  cause.  The  occur- 
rence of  the  hemorrhage  was  preceded  by  a  chill. 
The  first  hemorrhages  were  two  ecchymoses  upon 
the  wrist,  and  some  spots  in  the  mouth,  noticed  in 
the  morning,  and  in  the  afternoon  of  the  same  day 
there  was  a  large  hemorrhagic  exudation  beneath 
the  mucous  membrane  under  the  tongue,  and  some 
spots  upon  both  sides  of  the  fauces.  He  did  not 
succeed  in  ari'esting  the  hemorrhages.  The  patient 
was  transferred  to  the  St.  Luke's  Hos25ital,  where  she 
came  under  the  cai-e  of  Dr.  Robinson. 

Dk.  Robin.sox  said  that  he  succeeded  in  arresting 
the  hemorrhage  by  the  use  of  ergotine  hypodermi- 
eally,  and  moderate  general  faradization.  The  ef- 
fect of  these  remedies  was  so  marked  that  he 
thought  if  they  could  have  been  employed  earlier 
jjossible  permanent  benefit  might  have  followed. 

In  answer  to  a  question,  Dk.  Wylie  ascribed  the 
cause  of  death  to  hemorrhages  into  the  brain,  prob- 
ably occurring  when  the  vomiting  came  on  the 
morning  the  patient  died. 

Dr.  PoT.v.iM-.jACOBi  observed  that  these  cases  of 
purpura  seemed  to  depend  on  a  fermentative  metabol- 
ism of  nitrogenous  substances,  probably  initiated  in 
the  liver,  and  which  brought  them  into  relation  with 
three  great  morbid  processes :  rheumatism,  known 
in  certain  cases  to  present  a  very  mild  form  of  pur- 
pura among  its  symptoms,  the  poliosis  rheumatica  ; 
lithiemia,  which  essentially  consisted  in  morliid 
metabolism  of  nitrogenous  substances  ;  finally,  py- 
aemia, whose  symptoms  could  be  induced  by  injec- 
tion into  the  blood  of  the  filirine  ferment  derived 
from  serum  globulin,  a  natural  alliuminoid.  The 
cases  of  spontaneous  pyaemia  that  had  been  recently 
observed  in  the  course  of  rheumatism,  showed  what 
profound  changes  can  be  induced  in  the  blood  by 
certain  modifications  of  the  fibrine-forming  process 
which  certainly  goes  on  in  rheumatism.  It  is  con- 
ceivable that  in  the  peliosis  rheumatica  the  hemor- 
rhages should  really  be  due  to  capillary  emboli. 
caused  by  this  excess  of  fibrine.  But  in  the  fatal 
cases  of  purpura  recorded  by  Drs.  Wylie  and  Bob- 
inson,  death  certainly  could  not  be  explained  by 
such  emboli,  nor  even  by  loss  of  blood.  It  seemed 
much  more  probable  that  a  profound  alteration  of 
the  blood  existed,  which  first  impaired  the  nutri- 
tion of  the  capillary  walls,  permitting  their  ruptiirp, 
then  became  unfit  to  sustain  any  vital  organs.  It 
would  be  extremely  interesting  to  know  whether 


the  alkalinity  of  the  blood  became  diminished  dur- 
ing life  in  these  cases. 

Dr.  Peabody  suggested  that  purpura  rheumatica, 
which  was  rarely  accompanied  with  hemonhages 
from  mucous  membranes,  and  from  which  patients 
generally  recovered,  shoidd  be  separated  from  pur- 
pura hemorrhagica,  a  much  more  serious  and  latal 
disease. 

Dr.  Satterthwaite  said  that  in  the  case  which 
came  under  his,  and  also  Dr.  Eobinson's  observa- 
tion, there  was  no  rheumatism  whatever.  He 
thought  it  very  important  to  sejjarate  purpura  rheu- 
matica from  purjiura  hsemorrhagica. 

BOVINE   TUBERCULOSIS. 

Dr.  S.atterthwaite  presented  two  sets  of  speci- 
mens of  bovine  tuberculosis  from  cows,  one  represent- 
ing the  early,  the  other  the  advanced  stages  of  the  dis- 
ease. In  the  first  set  of  sjiecimens,  it  was  observed 
that  one  or  more  cretaceous  deposits  were  present  in 
each  lobule,  while  the  adjacient  tissue  appeared  to  be 
unaflected.  In  the  second  series,  the  lobules  were 
each  completely  tilled  with  chalky  masses,  exhibit- 
ing a  concentric  arrangement,  and  in  many  instances 
distending  the  lobule  to  the  utmost.  This  was  a 
striking  example  of  the  "pearl  disease"  (perLsucht 
— pom  melitire),  that  occurred  so  frequently  in  the 
bovine  race  when  in  confinement,  and  which  had 
been  said  by  Charles  Creighton,  of  Cambridge,  to 
occur  in  the  human  being.  In  the  second  case  the 
pleurffi  were  covered  with  "grapes  "  or  "angle-ber- 
ries," pendulous  tumors  of  varying  size  connected 
with  the  serous  membrane,  some  no  bigger  than  a 
pea,  while  one  that  was  sessile,  measured  several 
inches  in  diameter.  Each  of  them  was  cretaceous 
in  the  centre  and  there  seemed  to  be  a  general 
agreement  among  histologists  that  their  histological 
structure  was  identical  with  that  found  in  the  hu- 
man gray  and  yellow  tubercles.  As  to  the  bruited 
ijuestion,  whether  the  milk  of  tuberculous  cows,  or 
the  meat  of  any  of  the  animal  products  could  convey 
the  disease  to  human  beings,  it  might  be  said  tbat 
the  majter  was  still  sub  judice,  even  Virchow,  alter 
four  years  of  labor,  declaring  that  the  transmission 
of  the  bovine  disease  could  rot  ns  yet  be  proved. 

^  That  Dean  S'mFT  sufTered  from  Mfni&re's  dis- 
ease, or  labyrinthine  vertigo,  is  shown  as  clearly  as 
can  be  by  Dr.  Bucknill  in  a  recent  number  of  Braiti. 
At  the  age  of  seventy-four,  and  not  before,  he  be- 
came insane  and  hemiplegic  with  ajihasia.  The 
form  of  insanity  was  dementia  arising  from  general 
decay  of  the  brain. 

Dr.  Bucknill  gives  some  light  to  the  critics  who 
have  been  accustomed  to  blame  severely  Swift's 
treatment  of  Esther  Johnstone.  He  says:  "One 
final  consideration  is  that  the  oppressive  and  dis- 
abling nature  of  Swift's  lifelong  disease  has  been 
greatly  underrated  in  the  more  severe  of  the  criti- 
cisms which  have  been  made  with  regard  to  his  con- 
duct to  Esther  Johnstone.  I  do  not  know  that  laby- 
rinthine vertigo  would  necessarily  incapacitate  a 
man  for  the  performance  of  marital  duties,  but  it 
certainly  might  be  a  barrier  to  them  more  formid- 
able than  unprofessional  critics  are  likely  to  suppose 
possible.  Dr.  Beddoes  suggested  that  Swift  was 
impotent  from  youthful  dissipation,  of  which  there 
is  not  a  tittle  of  evidence.  May  not  the  great  and 
grave  disease  of  which  I  have  adduced  such  copious 
evidence  have  been  the  real  reason  why  Swift  did 
not  live  with  the  woman  whom  it  is  certain  that  he 
loved  with  the  most  tender  and  persistent  devotion  ?  " 


414 


THE  MEDICAL  RECORD. 


NEW  YORK  ACADE]kIY  OF  MEDICINE. 

Stated  Meeting,  April  6,  1882. 

FoRDTCE  Barker,  M.D.,  LL.D.,  President,  ix  the 
Chair. 

Dr.  J.  W.  Thompson,  of  Paducah,  Ky.,  and  Dr. 
Sfcaton,  of  North  Carolina,  were  introduced  to  the 
Academy,  and  invited  to  seats  upon  the  platform. 

The  Corresponding  Secretary  announced  the  death 
of  Dr.  Edward  M.  Beadle,  one  of  the  original  foun- 
ders of  the  Academy,  and  Dr.  Gouverneur  M.  Smith 
oifered  a  preamble  and  resolutions,  which  were  unan- 
imously adopted.  « 

The  President  appointed  Dr.  John  G.  Adams  to 
prepare  a  memoir,  to  be  read  at  some  future  meet- 
ing of  the  Academy.  ! 

The  special  order  for  the  evening  being  the  Re- 
port of  the  Delegates  to  the  Medical  Society  of  the 
State, 

Db  Austin  Flint  moved  that  the  report  be  ac- 
cepted, and  that  the  further  consideration  of  the 
topics  contained  therein  be  indefinitely  postponed. 
Unanimously  carried. 

The  paper  for  the  evening  was  then  read  by  Dr. 
Fessenden  N.  Otis,  and  entitled, 

"  CASE  OP  persistently  KECtJRRING  .SPASM  OF  THE 
BLADDER  RESULTING  IN  THICKENING  OP  ITS  WALLS, 
DILATION  OF  THE  UBETEBS,  AND  HYDRONEPHROSIS — 
DEATH   FROM   URiEMIA — PATHOLOGICAL   SPECIMEN." 

Preliminary  to  the  case  indicated  in  the  title  of 
the  paper,  Dr.  Otis  referred  to  two  others  in  which 
there  were  symptoms  almost  identical  with  those 
which  had  been  observed  in  connection  with  genito- 
urinary disturbances  due  to  reflex  causes.  The 
first  was  that  of  an  encysted  vesical  calculus.  The 
stone  was  i-emovej  by  the  median  operation  of  lithot- 
omy. Much  difficulty  was  encountered  in  finding 
the  calculus  after  the  bladder  had  been  opened.  To 
facilitate  exploration  in  similar  cases.  Dr.  Otis  sug- 
gested the  use  of  a  moderately  flexible  wire,  doubled 
so  as  to  make  a  loop,  perhaps  three-fourths  of  an 
inch  long,  to  project  from  the  end  of  the  index  fin- 
ger, around  which  the  wire  was  twisted,  passing  up- 
ward and  secured  about  the  wrist.  No  accident  or 
complication  attended  or  followed  the  operation, 
and  the  patient,  a  miner,  was  discharged,  cured,  on 
the  morning  of  tlie  tenth  day. 

The  second  case,  illustrating  spasm  of  the  orifice 
of  the  bladdor  from  reflex  irritation,  was  published 
in  the  Hospital  Qiizulte  for  .Tune  22,  1870.  The  case 
which  formed  the  basis  of  the  paper  was  then  re- 
ported. [See  Report  Path.  Soc,  Medical  Record, 
April  8,  1882.] 

The  interest  in  the  case  centred  in  the  persistent 
clo.sing  of  the  orifice  of  the  bladder,  the  result,  as 
Dr.  Otis  believed,  of  irritation  at  some  point,  and  re- 
flected through  the  urethra,  in  this  instance  the  irri- 
tation being  due  to  a  narrowed  canal  of  the  meatus, 
the  contraction  for  the  distance  of  half  an  incli  be- 
ing to  No.  25  and  2(i.  He  believed  that  the  difficulty 
was  reflex  in  origin,  depenilent  chiefly,  if  not  wlioUy, 
upon  a  contracted  meatus  urinarius,  and  that  if  this 
condition  liad  been  appreciated  fully  early  in  life, 
nmch,  if  not  all,  of  the  agrmi/.ing  suffering  which 
the  patient  ondunsd  might  have  been  avoided. 
Special  reference  was  made  to  the  views  of  Civiale 
and  Sir  Henry  Thompson  upon  this-  subject,  who 


believed  that  obstruction  at  the  orifice  of  the  mea- 
tus might  give  rise  to  extremely  obscure  urinary 
troubles,  and  also  to  his  own  nineteen  ca.ses,  re- 
ported in  a  paper  read  before  the  New  York  Acad- 
emy of  Medicine. 

The  paper  being  before  the  Academy,  Db.  A.  C. 
Po.sT  said  he  had  been  well  satisfied  that  in  a  num- 
ber of  cases  of  urethral  or  vesical  irritation,  the  con- 
tracted state  of  the  meatus  urinarius  had  been  an 
important  element  in  maintaining  the  irritation 
which  had  existed.  He  thought  it  was  often  the  case 
in  senile  enlargement  of  the  prostate.  There  were 
many  cases  in  which  great  difficulty  was  encoun- 
tered in  the  introduction  of  instruments  for  the  pur- 
pose of  evacuating  the  bladder,  and  he  had  known 
some  instances  of  that  kind  in  which  difficulty  of 
catheterism  was  obviated  by  dividing  the  meatus.  A 
man  sixty  years  of  age  had  suffered  for  some  time 
with  urinary  difficulty  with  enlarged  prostate,  and 
it  had  been  necessary  to  evacuate  the  bladder  with  a 
catheter.  Only  an  instrument  of  vei-y  moderate 
size  could  be  introduced.  Dr.  Post  enlarged  the 
meatus,  introduced  a  large  catheter,  and  it  passed 
into  the  bladder  readily,  and  gave  the  patient  com- 
plete relief.  He  then  dilated  the  orifice  liy  means 
of  large  steel  sounds,  and  in  the  course  of  a  few  days 
the  patient  dispensed  with  the  use  of  the  catheter, 
and  it  had  not  since  been  necessary  to  return  to  the 
instrument. 

A  case  of  close  stricture  of  the  urethra  was  men- 
tioned, in  which  he  obtained  a  very  satisfactory  re- 
sult in  a  similar  manner. 

Dr.  E.  L.  Keyes  differed  with  Dr.  Otis  concern- 
ing the  etiology  in  the  case  which  formed  the  basis 
of  his  paper,  and  for  the  following  reasons  :  In  the 
first  place,  it  seemed  to  him  that  relief  of  reflex 
spasm  of  the  urethra,  obtained  by  introducing  instru- 
ments, was  mainly  due  (1)  to  the  direct  influence 
upon  the  sensibility  of  the  deep  urethra,  and  (2)  in 
a  mechanical  way  upon  the  contracted  muscle,  and 
besides  the  size  of  the  instrument  was  particularly 
important. 

Many  cases  certainly  did  have  persistent  symptoms 
of  stricture  which  proved  to  be  simply  cases  of 
spasm  of  the  urethra.  A  case  in  point  was  men- 
tioned. 

Many  eases  did  undoubtedly  get  well  of  spasm 
of  the  urethra  by  the  passage  of  large  sounds, 
whether  they  had  small  meatus  or  not,  if  not  too 
small,  and  without  cutting  the  urethra. 

Many  cases  which  did  not  get  well  by  the  passage 
of  soimds  might,  and  probably  did,  recover  after 
these  points  of  narrowing  had  been  erased.  But  it 
seemed  to  him  that  recovery  in  cases  in  which  these 
narrowed  points  had  been  incised  was  on  account  of 
the  fact  that  a  large  instrument  could  be  brought  to 
bear  upon  tlie  deep  urethra. 

It  would  bo  interesting  to  know  whether  any  eases 
of  spasm  of  the  deep  urethra  had  been  cured  by 
incising  the  meatus,  and  not  passing  sounds  after- 
ward. 

Dr.  Otis  said  that  he  had  done  it  in  a  number  of 
cases,  and  the  result  had  been  satisfactory. 

Dr.  Kf.yrs  further  remarked  that  many  cases,  in 
which  relief  had  not  boon  afforded  by  the  passage  of 
reasonably  large  sounds,  had  not  boon  cured  by  in- 
cisions in  the  urethra,  while  there  was  no  otlier 
evidence  of  disease  in  the  urinary  passages,  and  the 
vesical  mucous  membrane  was  undoubtedly  not  in- 
flamed. .V  case  was  mentioned  in  which  a  patif  it, 
apparently  in  the  best  of  health,  sutTered  from  nt- 
tacks  of  retention  of  urine  lasting  for  hours.      He 


THE   MEDICAL  RECORD. 


415 


was  subjected  to  a  great  variety  of  treatment  with- 
ont  relief,  and  finally,  abcut  a  year  ago,  bis  urethra 
was  treated  upon  the  principle  of  relieving  anterior 
constrictions,  and  passing  large  sounds.  In  that 
manner  his  urethra  was  brought  fully  iip  to  its  nat- 
ural calibre,  but  not  a  particle  of  Vienetit  followed.  At 
present  his  urethra  would  take  Xo.  35  or  36  readily, 
and  the  instrument  enter  the  liladder  without  dif- 
ficulty. Xotwitlistanding  this  fact  the  patient  had 
in  this  condition  been  subject  to  attacks  of  per- 
sistent spasm  of  the  urethra  for  several  years,  the 
mucous  membrane  of  the  bladder  was  without  doubt 
physically  sound,  and  there  was  no  pus  in  the 
urine. 

With  reference  to  the  case  reported  by  Dr.  Otis, 
Dr.  Keyes  oft'ered  the  following  explanation  of  the 
persistently  recurring  spasm,  namely,  a  gentleman 
reaches  a  certain  period  in  life,  and  then  acquires  a 
gonorrhcea,  which  is  the  beginning  of  his  trouble. 
Before  that  time,  despite  a  small  meatus  of  his 
urethra,  he  has  had  no  symptoms  whatever.  His 
trouble  begins  after  an  attack  of  urethritis.  This  is 
not  amcommon.  Then  the  patient  has  calculous  at- 
tacks which  aid  in  causing  spasm  about  the  bladder, 
so  commonly  seen  in  connection  with  irritation  in 
the  kidney.  It  is  probable  that  during  all  this  time 
the  patient's  urine  contains  pus ;  at  least  such  had 
been  the  fact  in  the  cases  he  had  seen. 

Dr.  Otis  said  that  pus  was  present  in  the  urine 
most  of  the  time  in  the  case  reported. 

Dr.  Ketes  :  Finally  an  incision  of  the  meatus 
was  made  and  temporarily  the  spasm  yielded,  Imt 
reaction  developed,  due  to  the  irritation  from 
the  calculus  found  in  the  bladder,  or  to  the  pas- 
sage of  instruments,  or  other  causes,  and  the 
uraemia  manifested  itself  which  killed  the  patient. 
He  thought  it  was  a  case  that  originated  in  gonor- 
rhoea! cystitis,  going  on  to  pyelitis  upon  both 
sides. 

Dr.  J.  W.  S.  GorLET  thought  that  one  of  the 
corresponding  fellows  of  the  Academy  had,  many 
years  ago,  graphically  described  the  class  of  cases 
to  which  the  one  reported  by  Dr.  Otis  belonged. 
Mercier,  the  corresponding  fellow  alluded  to,  says 
that  these  troubles  originate  in  a  persistent  chronic 
cervical  cystitis  following  a  ui-ethritis,  a  cervical  cys- 
titis which  gives  rise  to  intense  congestion  of  the 
capillaries  and  small  vessels  underlying  the  mucous 
membrane,  thus  causing  what  he  calls  contracture 
of  the  urethro-vesical  orifice.  He  speaks  of  spas- 
modic contracture  and  permanent  contracture. 
Spasmodic  contracture  follows  chi'onic  urethritis, 
and  is  curable.  The  permanent  contracture,  if  left 
to  itself,  is  incurable.  He  calls  the  permanent  con- 
tracture a  muscular  valvule,  the  vahnile  causing  im- 
pediment t^  urination,  hypertrophy  of  the  median 
portion  of  the  prostate,  residual  urine,  constant 
contraction  of  the  bladder  to  expel  it,  hvpertrophy 
of  the  vesical  walls,  cvstitis  from  decomposition  of 
the  residual  urine,  inflammation  of  the  ureters,  pye- 
litis, pyelo-nephrosis,  acute  interstitial  nephritis, 
superimposed  upon  a  subacute  or  chronic  condition, 
and  death. 

A  patient  may  have  permanent  contracture  for  a 
great  many  years  without  suffering  more  than  the 
inconvenience  caiised  by  stagnant  urine.  Of  course, 
stagnant  urine,  acting  like  a  foreign  body  in  the 
bladder,  will  give  rise  to  spasmodic  contractions  : 
but,  that  the  bladder  may  contract  without  irritation 
from  within  or  obstacle  at  the  urethro-vesical  ori- 
fice. Dr.  Gouley  could  not  conceive.  He  could  not 
conceive   that   spasm  of  the  urethra  would  cause 


chronic,  habitual  retention  of  urine.  In  nearly  all 
such  cases  as  that  described  by  Dr.  Otis,  the  ob- 
stacle is  at  the  urethro-vesical  orifice,  and  a  very 
interesting  jjoint  is  that  at  post-mortem  examina- 
tion it  is  not  easy  to  discover  a  urethro-vesical  val- 
vule. To  do  so,  the  bladder  must  be  examined  with 
the  greatest  care,  and  from  above.  It  should  not  be 
slit  open  along  its  anterior  border,  and  the  prostatic 
portion  of  the  urethra  cut,  but  the  uiethro-vesical 
orifice  shoTild  be  examined  from  within.  Mercier 
says  that  diagnosis  of  muscular  valvule  can  be  made 
with  certain  instruments,  jiarticularly  the  rectangu- 
lar sound,  and  Dr.  Gouley  has  made  some  improve- 
ments upon  this  sound  by  which  diagnosis  of  both 
the  nniscular  and  the  prostatic  valvule  can  be  jiosi- 
tively  made.  For  one,  he  was  thoroughly  convinced 
of  the  truth  of  Mercier's  statements,  as  he  had  had 
a  number  of  cases  which  he  had  been  studying  for 
several  years,  and  they  fully  sustained  the  views  of 
that  author,  who  had  written  nearly  a  volume  on  the 
subject. 

Dr.  Gouley  then  refei-red  to  a  case  of  incarcerated 
vesical  calculus  under  his  caie. 

■5  'Dr.  F.  H.  H.\milton  agreed  with  Dr.  Otis  in  the 
view  that  examjdes  of  occlusion  of  the  meatus 
urinarius  must  be  a  frequent  source  of  irritation  at 
the  neck  of  the  bladder,  perhaps  chronic  cystitis 
and  pyelitis,  but  the  exceptions  were  very  frequent. 
His  experience  did  not  imjily  that  it  was  so  constant 
as  the  teachings  of  Dr.  Otis  would  seem  to  indi- 
cate. 

Db.  Otis,  in  closing  the  discussion,  said  he  was 
not  at  all  certain  that  the  relief  in  a  considerable 
proportion  of  cases  was  not  due,  as  sugge-'ted  by 
Dr.  Keyes,  to  the  passage  of  an  instrument  through 
the  deep  urethra  into  the  bladder.  He  had  been  of 
the  opinion  that  in  many  of  these  cases,  this  was 
essential  in  order  to  afford  relief.  But  he  was  more 
confident  that  the  independent  influence  of  the  mea- 
tus was  suflicient  to  produce  marked  trouble  at  the 
neck  of  the  bladder.  He  was  not  at  all  disposed  to 
dispute  as  to  the  modus  (qienmdi  by  which  the  re- 
lief was  aflbrded  in  these  cases :  but,  in  those  gi'ave 
cases  not  infrequently  seen,  he  thought  it  worth 
while  to  try  the  method  of  making  the  meatus  cor- 
respond to  the  normal  calibre  of  the  urethra,  and 
passing  a  fidl-sized  sound  into  the  bladder.  He  was 
satisfied  that  a  considerable  number  of  cases  would 
be  cured  in  this  manner,  and  if  that  was  true  we 
could  afford  to  wait  for  the  exact  explanation,  which, 
perhaps,  might  never  be  obtained.  Dr.  Hamilton 
had  justly  said  that  many  patients  with  contracted 
meatus  have  no  trouble,  as  much  the  largest  por- 
tion of  the  human  race  have  contracted  orifices  in 
proportion  to  the  size  of  the  urethral  canal.  But 
there  were  cases  in  which  .such  trouble  existed  ; 
and,  as  a  rule,  there  was  a  history  of  sexual  excess, 
and  the  entire  apparatus  was  in  a  state  of  sensitive- 
ness peculiarly  adapted  to  taking  on  reflex  dis- 
turbances. He  had  noticed,  particularly,  that  the 
patients  who  suffer  in  this  way  have  had  gonorrhoea, 
many  of  them  have  a  large  amount  of  cicatricial 
deposit  in  the  anterior  part  of  the  urethra,  and  it 
had  occun-ed  to  him  that  jiossibly  the  terminal  ex- 
tremities of  the  nerves  were  involved  in  the  indura- 
tion, and  that  iiTitation  was  produced  in  that  way. 
However  it  might  be  explained,  as  a  matter  of  fact 
division  of  the  orifice  of  the  meatus,  in  a  large  num- 
ber of  cases,  relieves  irritation  along  the  line  of  the 
genital  apparatus,  extending  even  to  the  spinal  cord 
and  brain. 

The  Academy  then  adjourned. 


416 


THE  MEDICAL  RECORD. 


OBSTETRIC  SECTION. 
Stated  Meeting,  March  28,  1882.  '. 
Henrt  E.  Crampton,  M.D.,  in  the  Chaih. 

PELVIC    HEMATOCELE. 

Dr.  H.  Gbiswold  reported  two  cases  as  follows  : 

Case  I. — Mai-y  M ,  twentv-tbree  years  of  age; 

of  a  large,  full  habit ;  nervous  temperament ;  Irish 
parents  ;  had  been  married  five  years  ;  had  had  two 
abortions,  one  at  three  months,  the  other  at  five 
months,  induced,  as  she  thinks,  by  her  avocation  — 
that  of  laundress — but  was  finally  delivered  at  full 
term  of  a  living  child,  leaving  her  with  a  lacerated 
cervix  and  partial  laceration  of  the  perineum — the 
latter  not  extending  through  the  perineal  body. 

Three  months  after  labor  she  called  at  his  office 
and  gave  the  following  history  :  The  lochia  had 
never  ceased.  The  evening  before,  while  standing 
at  the  table,  she  felt  very  dizzy  with  sharp  pain  in 
the  left  side,  and  a  feeling  as  if  her  insides  were 
dropping  out.  This  was  accompanied  by  cramj^s  in 
the  stomach,  and  nausea,  a  frequent  and  painful 
micturition,  constipation,  and  a  bloody  leucorrh<ea. 

Examination  showed  the  vagina  almost  occluded 
by  a  soft  tumor  dissecting  up  the  wall  between  the 
uterus  and  rectum.  The  uterus  had  been  pushed 
up  out  of  reach,  and  all  the  parts  were  very  sensitive. 
She  was  confined  to  bed,  and  the  symptoms  were 
treated  with  anodynes,  diuretics,  mild  cathartics, 
and  the  hot  douche.  In  two  weeks  the  effusion  had 
disappeared,  leaving  no  hardness  save  thickening 
and  shortening  of  the  left  broad  ligament. 

Case  II. — Mary  W ,  thirty -eight  years  of  age  ; 

Irish  descent ;  small,  nervous,  and  the  mother  of 
two  children.  The  labors  were  natural,  but  says 
she  has  never  been  well  since  the  birth  of  the 
youngest  child.  Four  years  afterward  she  presented 
herself  for  treatment  for  endocer\'icitis  and  metrites, 
but  becoming  impatient  at  the  slow  jirogress  to- 
ward recovery,  she  abandoned  all  treatment  and 
devoted  herself  to  the  usual  labor  of  housekeeping 
for  a  growing  family.  Two  yeai-s  after  this,  and  six 
years  after  her  last  conception,  she  had  an  abortion 
at  the  eighth  week,  preceded  and  accompanied  by 
a  cellulitis.  The  decidua  was  expelled  on  the  four- 
teenth day.  The  uterus  was  surrounded  by  a  good 
deal  of  induration,  and  there  was  considerable  con- 
stitutional disturbance. 

The  case  then  parsed  into  the  hands  of  another 
physician,  and  Dr.  Griswold  learned  that  suppura- 
tion followed,  ending  in  a  discharge  of  pus  by  the 
anus.  The  remaining  induration  wae  treated  by 
local  galvanization — one  pole  in  the  vagina  and  the 
other  over  the  abdomen — which  completely  restored, 
as  he  had  been  told,  the  mobility  of  the  uteru.s. 

Five  years  afterward,  and  eleven  years  after  the  birth 
of  the  youngest  living  child,  she  came  to  Dr.  Gris- 
wold's  office  complaining  of  severe  pelvic  and  abdomi- 
nal pains,  frequent  and  painful  desire  to  urinate,  not 
passing  more  than  a  teasponnful,  with  increased  pain 
after  the  effort,  and  obstinate  constipation.  Digital 
examination  showed  a  largo,  moderately  soft  exu- 
dation filling  Douglas'  cul-de-sac.  The  utenis  was 
pressed  forward  and  u))ward  so  as  to  bo  distinctly 
felt  above  the  i)ul)is,  tl>o  exudation  also  being  felt 
behind  it  through  the  abdominal  wall.  Tlie  bladder 
was  practically  obliterated— a  tcaspo(niful  of  urine 
occasioning  intense  pain.  The  attack  had  com- 
menced the  day  before  and  was  increasing  in  sever- 
ity.    She  was  confined   to   bed.     Opiates,  diapho- 


retics, warm  fomentations,  and  mild  catbaitics  were 
employed.  The  symptoms  were  but  partially  alle- 
viated, and  Dr.  Noeggerath  was  called  in  consulta- 
tion. Hiematocele  was  diagnosticated  and  an  ope- 
ration proposed  and  decided  upon.  The  patient 
being  etherized,  an  aspirating  needle  was  introduced, 
confirming  diagnosis.  An  opening  was  made  with 
a  grooved  gorget,  along  which  a  double  hook  was 
passed  into  the  opening,  which  was  then  enlarged 
with  the  fingers  and  the  clots  evacuated.  The  sac 
was  thoroughly  washed  with  a  solution  (five  per 
cent.)  of  carbolic  acid.  This  was  repeated  every 
three  hours  during  the  day,  followed  by  an  injec- 
tion of  tincture  of  iodine  for  three  days,  when  a  ten 
per  cent,  solution  of  chlorine  water  was  substituted 
for  the  cai'bolic  acid.  The  sac  rapidly  contracted, 
the  constitutional  symptoms  subsided,  and  at  the 
end  of  three  weeks  the  wound  had  entirely  olosed. 
Care  had  been  taken  that  a  premature  closing  of 
the  woimd  should  be  avoided,  by  a  frequent  intro- 
duction of  the  finger. 

Recovery  seemed  almost  complete.  Mobility  of 
the  uterus  was  restored,  Imt  a  leucorrhcea  remained, 
and  the  menstruation  anticipated  its  retui-n  by  from 
five  to  eight  days. 

She  remained  sterile,  although  there  was  no  evi- 
dence but  that  the  sexual  act  was  satisfactory  to 
both  parties. 

Remarks. — We  all  are  aware  that  hsematocele  is 
but  a  symptom,  like  a.scites,  but,  like  dropsy,  by  its 
mechanical  disturbance  sometimes  requires  special 
treatment.  In  the  first  case  the  onset  was  marked 
with  distinctness  by  constitutional  symptoms  of  loss 
of  a  quantity  of  blood — dizziness,  nausea,  etc.  The 
sharp  pain  in  left  side  probably  indicated  the  coiir.«e 
of  the  bleeding  from  the  uterus  through  the  Fallo- 
pian tube. 

The  rajsid  and  entire  absorption  of  the  effused 
blood  promoted  by  rest  and  the  other  means  used 
encourages  us  to  expect  that  much  can  be  done  by 
such  treatment. 

In  the  second  case  we  are  taught  not  to  hesitate 
to  resort  to  an  operation  for  relief,  for  notwithstand- 
ing the  long  and  grave  history  of  [previous  peri-uter- 
ine inflammation  and  the  extensive  wound  neces- 
sary to  relieve  the  fluid,  the  patient  made  a  rapid 
and  satisfactory  recovery. 

The  practical  points  seem  to  be  to  try  for  a  rea- 
sonable time  the  usual  means  to  promote  absorption, 
but  at  the  first  sign  of  constitutional  infection,  as 
shown  by  rise  in  temperature,  fre(|uent  chills,  sweat- 
ing, etc.,  evacuate  the  sac  thoroughly  and  establish 
complete  drainage. 

As  it  is  difficult  to  ligate  bleeding  vessels  in  this 
situation  the  knife  should  be  avoided  and  the  open- 
ing made  with  blunt  dilating,  tearing  instruments, 
or  the  paquelin  thermo-cautery. 

Dr.  Sell  had  seen  several  cases  of  pelvic  h.'vma- 
tocele  and  had  treated  them  by  rest  and  the  use  of 
internal  remedies  in  preference  to  operative  inter- 
ference. Of  course  he  would  operate  rather  than 
allow  septicii'mia  to  develop  and  progress  with  its 
dangerous  consequences. 

Dr.  E.  C.  Harwooo  added  one  case  which  occurred 
in  a  jiatient,  twenty-four  years  of  age,  who  l)a<l 
been  married  only  a  short  time.  Ho  attributed  the 
haunatocelo  to  exertion  in  lifting.  It  filled  Douglas' 
cul-de-sac,  crowded  the  uterus  up  out  of  the  jielvis, 
and  interforrcd  with  the  bladder.  The  ])atient  had 
frequently  recurring  chills.  The  mass  was  aspirated 
through  the  vagina,  and  about  one  pint  of  offensive 
material  removed.     Eecovery  was  complete,  and  the 


THE  MEDICAL  RECORD. 


417 


woman  had  since  borne  two  children,  and  the  labors 
w  re  normal. 

Dr.  a.  S.  HrNTEH  remarked  that  be  had  not  ex- 
perienced any  difficulty  in  making  a  diagnosis  in 
cases  of  pelvic  ha'matocele.  The  sudden  develop- 
ment of  intense  pelvic  pain,  ■with  fainting  or  col- 
lapse, were  usually  sufficient  to  give  the  clue  to  the 
real  nature  of  the  difficulty. 

In  one  case  that  came  under  his  observation,  in- 
tense pelvic  pain  followed  coition  immediately,  and 
upon  examination  he  found  a  soft  mass  occupying 
the  whole  of  Douglas"  cul-de-sac.  The  acute  symp- 
toms were  very  intense.  The  case  was  treated  by 
the  use  of  opiates,  hot  water  vaginal  injections,  and 
iodide  of  potassium,  and  at  the  end  of  ten  days  the 
eflusion  had  entirely  disappeared,  so  that  defecation 
and  sexual  congress  could  be  accomplished  without 
inconvenience. 

In  another  case  the  pelvis  was  apparently  filled, 
and  after  jiassing  the  acute  stage,  in  which  the  pain 
was  intense,  the  patient  was  bed-ridden  for  two 
months,  when  the  tumor  emptied  into  the  rectum 
and  a  good  recovery  followed.  The  woman  after- 
ward bore  children  without  difficulty.  He  believed 
that  this  patient  would  have  been  benefited  by  early 
evacuation  of  the  sac. 

Dr.  Post  remarked  that  it  would  be  interesting  to 
know  whether  or  not,  in  such  cases,  there  was  any 
material  which  could  be  injected  into  the  sac  and 
serve  the  double  purpose  of  liquefying  the  coagula- 
tion and  guarding  against  putrefaction.  Again,  it 
would  be  interesting  to  know  whether  or  not  there 
would  be  any  danger  in  treating  the  cavity  after  Mr. 
Callender's  method  of  disinfecting  abscesses. 

Dr.  Harwooi)  said  that  he  used  aspirator  needles 
attached  to  an  ordinary  stomach-inrmp,  and  after 
the  fluid  had  been  evacuated  the  sac  was  refilled 
with  an  antiseptic  solution.  The  fluid  removed  was 
thick  and  tarry. 

ExfeNSION    OF    THE    HEAD    PREVENTED   BY   SHORTENED 
U.MBILICAIj   CORD. 

Dr.  F.  v.  White  narrated  a  case  in  which  labor 
was  considerably  retarded  from  the  fact  that  the 
head  did  not  extend,  but  after  a  time  it  was  deter- 
mined that  extension  was  prevented  by  the  shorten- 
ing of  the  cord  from  being  wound  around  the  neck 
of  the  child  twice. 

A  SEVIPIJS  JIETHOD  OP  RESUSCITATIXfl  A  STILL-BORN  CHILD. 

In  this  case  the  child  was  with  some  difficulty  re- 
suscitated. Dr.  John  Shrady  was  in  consultation 
in  the  case,  and  he  resorted  to  the  following  method 
with  satisfactory  results.  Place  a  piece  of  thin  cloth, 
)ike  a  handkerchief,  over  the  mouth  of  the  child, 
till  the  lungs  with  fresh  air,  and  then  gently  blow 
through  the  cloth,  while  the  nose  is  held  to  prevent 
escape  of  air,  and  tlie  stomach  is  gently  pushed  in 
to  prevent  the  air  from  entering  that  organ. 

A  method  which  Dr.  White  had  very  frequently 
resorted  to,  with  excellent  results,  was  rubbing  a 
small  quantity  of  chloroform  along  the  spine. 

Dr.  Post  referred  to  the  tendency  to  the  occur- 
rence of  convulsions  within  twenty-four  or  thirty-six 
hours  in  resuscitated  children. 

Dr.  Sell  referred  to  a  case  in  which  he  succeeded 
in  restoring  the  child  after  working  an  hour  and  a 
half,  but  it  died  twenty-three  hours  afterward  with 
convulsions.     It  was  a  case  of  breech  presentation. 

Dr.  Harwood  had  found  Kidder's  "  Galvano- 
Electrical  Machine"  most  servicealile  in  resuscitat- 
ing still-born  children,  applving  the  current  through 
his  own  hands  placed  over  the  thorax  and  spine. 


Dk.  Hdnter  was  unable  to  understand  how  a 
short  cord  could  prevent  descent  of  the  child  and 
extension  of  the  head. 

Dr.  Post  remarked  that  if  the  placenta  was  firmly 
attached,  and  the  cord  was  placed  sufficientlj'  upon 
the  stretch,  either  the  uterus  would  invert,  or  the 
cord  rupture,  or  the  labor  be  obstructed. 

Dr.  Geiswold  referred  to  a  case  in  which  an  ex- 
ceedingly short  cord  gave  way  with  an  audible  noise 
while  the  head  was  being  delivered  with  forceps, 
and  at  once  the  delivery  was  completed  with  the 
greatest  ease. 

Dr.  Hunter  thought  that  the  cord  was  not  suffi- 
ciently firm  to  offer  such  resistance  as  would  inter- 
fere with  the  natural  forces  of  the  uterus. 

Db.  J.  Lewis  Smith  remarked  that  cases  had  been 
rejiorted,  and  he  had  also  met  with  such,  in  which 
labor  had  been  retarded  by  a  short  cord. 

fistula   in    ANO   in    A    CHILD   THREE   YEARS   OLD. 

Dr.  a.  C.  Pcst  referred  to  a  case  in  which  there 
was  a  fistula  in  ano  in  a  child  three  years  of  age. 

Db.  White  had  seen  one  in  a  child  seven  years  of 
age. 

The  Section  then  adjourned. 


Covrcspoutifiifc. 


A    QUESTION    OF    ETHICS    IN    NORTH 
CHINA. 

To  THE  Editor  of  The  Medical  Record. 

Deab  Sir  :  Practitioners  of  medicine  in  this  country, 
sejjarated  as  they  necessarily  are  from  the  advisory 
and  controlling  influence  of  medical  societies,  are, 
to  a  very  gi'eat  extent,  a  law  unto  themselves,  and 
as,  in  a  majority  of  cases,  the  fields  of  practice  are 
several  hundreds  of  miles  apart,  and  unopposed,  the 
questions  aflecting  professional  ethics  are  neither 
frequent  or  diflicult  to  deal  with,  as  a  rule.  Never- 
theless, questions  of  a  serious  nature  do  occasionally 
arise,  and  as  for  the  most  part,  they  are  without 
precedent,  it  is  wise,  I  think,  whenever  they  are 
calculated  to  become  causes  of  constant  dissension, 
to  submit  them  to  authoritative  and  disinterested 
arbitration.  I  have  therefore  to  beg  you  will,  either 
through  the  columns  of  the  Kecord  or  by  post,  give 
your  opinion  on  the  following  case,  which  occurred 
in  my  practice  during  the  past  summer. 

I  was  called  to  attend  a  lady  medical  missionary 
connected  with  one  of  the  interior  stations  of  a  large 
and  flourishing  American  society,  who  had  come  to  the 
port  for  rest  and  treatment  I  paid  her  almost  daily 
visits  for  a  month,  journeying  some  four  miles  on  each 
visit,  thereby  consuming  time  which,  during  the  pres- 
sure of  summer  work,  had  a  very  distinct  value.  At 
the  expiration  of  that  period,  she  wrote  to  say  that 
as  she  was  then  convalescent,  slie  no  longer  required 
my  services,  and  would  be  glad  to  receive  my  bill. 
I  then  called  on  her  to  say  that  as  against  herself  I 
had  no  account,  but  if  it  were  a  mission  afl'air  I 
would  do  as  she  had  requested.  She  assured  me 
she  had  no  reason  to  regard  herself  as  on  a  different 
footing  from  other  members  of  the  society  for  whose 
medical  bills  annual  provision  is  made  by  the  "  Home 
Board,"  whereujion  I  r.endered  a  bill  for  thirty-three 
per  cent,  of  my  usual  charges,  out  of  consideration 
for  the  society  and  its  work.  I  heard  nothing  more 
of  the  matter  for  a  fortnight,   when  I  received  a 


418 


THE  MEDICAL  RECORD. 


grossly  insulting  lettar  from  the  Mission  treasurer, 
demanding  howl  presumed  to  present  a  bill  "for 
attending  a  regular  graduate  of  a  respectable  col- 
lege," and  thus  "  availing  myself  of  her  sex  to  insult 
her."  Finally,  he  concluded  by  threatening  to  "  ex- 
pose" me  if  I  would  not  consent  to  withdraw  my 
claim,  and  also  that  he  should  feel  obliged  to  use 
his  best  efforts  to  injure  my  social  and  professional 
standing.  I  replied  in  brief  that  as  my  bill  was  a 
society  obligation,  and  in  no  way  affected  the  pecu- 
niary interests  of  my  late  patient,  I  failed  to  see  by 
what  right  he  demanded  "the  courtesy  of  the  pro- 
fession," or  why  the  society  he  represented  should 
consider  itself  entitled  to  dictate  my  free  list.  There 
the  matter  rests,  and  for  my  month's  attendance  I 
have  not  received  even  a  note  of  thanks.  And  now 
may  I  ask  if  you  i-egard  governments,  corporations, 
and  societies  as  having  a  right  to  expect  gratuitous 
attendance  on  their  medical  officers  under  the  plea 
of  professional  etiquette  ?  If  so,  do  you  not  consider 
general  practitioners  are  entitled  to  expect  these 
salaried  officers  to  abstain  from  private  practice  ? 

I  ask  for  the  reason  that  it  is  a  too  frequent  cause 
of  complaint  in  the  East  that  medical  missionaries 
and  naval  surgeons  encroach  on  the  domain  of  the 
local  medical  men  wherever  they  may  be  stationed 
for  the  time  being  ;  and  Tintil  good  taste  or  authority 
puts  a  stop  to  the  jiractice,  I,  for  one,  shun  no  "ex- 
posure "  of  my  strong  objections  to  admit  such  gov- 
ernments and  societies  to  the  courtesies  of  the  pro- 
fe.ssion,  unless  it  can  be  proved  that  by  so  doing  I 
confer  a  monetary  favor  on  my  professional  col- 
league. 

Enclosing  my  card,  I  remain,'; 

Yours  faithfullv, 

P.  A.   R. 
North  China,  December  8,  1381. 

[The  case  in  question  should  be  settled  in  accord- 
ance with  the  code  of  ethics  in  force  in  the  wi-iter's 
neighborhood.  Judged  by  the  New  York  standard, 
our  correspondent  is  entitled  to  payment  for  his 
■services,  as  "gratuitou.s  attendance  cannot,  however, 
be  expected  from  physicians  called  fiom  a  distance" 
<N.  Y.  Code  of  Ethics,  lines  77  and  78).— Ed.] 

INEFFECTn'E  VACCINE   YTRVS. 

To  THE  Editor  ok  The  Medical  Record. 

Dear  Sib  :  Dr.  J.  B.  Taylor,  in  his  remarks  on  my 
article  on  "  Ineflfective  Vaccine  Virus,"  published  in 
your  last  issue,  commits  an  error  which  I  hope  you 
will  allow  me  to  correct.  He  says  that  the  writer 
"  states  that  his  usual  success  is  about  twelve  and 
one-half  per  cent,  in  primary  subjects."  Nothing  of 
the  kind  is  found  in  the  article  in  question.  All  I 
say  atjout  my  personal  experience  with  the  virus 
bought  in  different  places  in  this  city  is  that  it  is 
more  an  exception  than  a  rule  that  the  first  vaccina- 
tion takes,  and  that  within  a  year  I  have  had  three 
(primary)  cases  in  which  I  vaccinated  throe  times 
in  vain  before  finally  a  fourth  attempt  was  success- 
ful. 

I  shall  try  the  scarification  recommended  by  Dr. 
Taylor,  although  it  is  difficult  to  see  why  it  should 
work  better  than  the  abrasion  recommended  by 
other  specialists. 

I  am  very  glad  that  my  article  ]»as  called  forth  Dr. 
Taylor's  remarks  on  the  raspberry-like  "  fungus  or 
abortive  vesicles  "  which  "  rai,'*Iead  the  patients  and 
fiometimes  even  physicians  " 

Respectfully  yours, 

H.  J.  GARRianEs.  M.D. 


ARMY  NEWS." 

Official  List  of  Changes  of  Stations  and  Duties  of  Offi- 
cers of  the  Medical  Department,  United  States  Army, 
from  April  2,  1882,  to  Aprd  8,  1882. 

Greenxeaf,  Charles  E.,  Major  and  Surgeon.   Re- 
lieved from  duty  in  Department  of  Dakota,  to  pro-       J 
ceed  to  New  York  Citv,  and  on  amval,  report  by       B 
letter  to  the  Surgeon-General.     S.  O.  78,  A.  G.  O.,       fl 
April  5,  1882. 

WooDHCLL,  A.  A.,  Major  and  Surgeon,  now 
awaiting  orders,  to  report  in  person  to  the  Com- 
manding Officer  of  the  Recruiting  Department, 
David's  Island,  N.  Y.  H.,  for  duty  at  that  post.  S.  O. 
78,  C.  S.,  A.  G.  O. 

Williams,  John  W.,  Major  and  Surgeon.  Re- 
lieved from  duty  in  Department  of  the  Missouri,  to 
proceed  to  Washington,  D.C.,  and  report  to  the  Sur- 
geon-General.    S.  O.  78,  C.  S.,  A.  G.  O. 

Waters,  W.  E.,  Major  and  Surgeon.  Relieved 
from  duty  in  Department  of  Texas,  to  proceed  to 
Washington,  D.C.,  and  report  to  the  Surgeon- 
General.     S.  O.  78,  C.  S.,  A.  G.  O. 

Jaqvett,  G.  p.,  Major  and  Surgeon.  Relieved 
from  duty  at  Da\-id's  Island,  N.  Y.  H.,  to  proceed  to 
his  home  and  report  bv  letter  to  the  Surgeon- 
General.     S.  O.  78,  C.  S.,"A.  G.  O. 

Brown,  J.  M.,  Major  and  Surgeon.  Relieved  from 
duty  in  Department  of  the  Missouri,  to  proceed  to 
Cincinnati,  O.,  and  on  arrival  report  bv  letter  to 
the  Surgeon-General.     S.  O.  78,  C.  S.,  A."  G.  O. 

Cleart,  p.  J.  A.,  Captain  and  Assistant-Surgeon. 
Relieved  from  duty  in  the  Department  of  the  East, 
and,  on  expiration  of  his  present  sick  leave  of  ab- 
sence, to  report  bv  letter  to  the  Surgeon-General. 
S.  O.  78,  C.  S.,  A.  G.  O. 

Lauderdale,  J.  V.,  Captain  and  Asisistant-Sirr- 
geon.  Having  i-eported  by  letter  to  these  Headquar- 
ters, is  assigned  to  duty  at  Fort  Sully,  D.  T.,'to 
which  post  he  will  proceed  and  report  for  duty.  S. 
O.  17,  Department  of  Dakota,  March  27,  1882. 

Moselt,  E.  B.,  Captain  and  Assistant  Surgeon. 
Relieved  from  duty  in  the  Department  of  the  Platte, 
to  proceed  to  New  York  City  and,  on  arriving,  report 
bv  letter  to  the  Surgeon-General.  S.  O.  78,  C.  S., 
A.  G.  O. 

Macs,  L.  M.,  Captain  and  Assistant-Surgeon.  Re- 
lieved from  duty  at  David's  Island,  N.  Y.  H.,  and  to 
report  in  person  to  the  Commanding-General,  De- 
partment of  the  Missouri,  for  assignment  to  dutv.  S. 
O.  78,  C.  S.,  A.  G.  O. 

KiLROCRNE,  H.  S.,  Captain  and  Assistant- Surgeon. 
Relieved  from  duty  in  Department  of  the  East,  and 
to  report  in  person  to  the  Commanding  General  De- 
partment of  Dakota,  for  assignment  to  dutv.  S.  O. 
78,  C.  S.,  A.  G.  O. 

Taylor,  M.  E.,  Captain  and  Assistant-Surgeon. 
Relieved  from  duty  in  Department  of  the  Missouri, 
to  proceed  to  St.  Louis,  Mo.,  and,  on  arrival,  report 
by  letter  to  the  Surgeon  General.  S.  O.  78,  C.  S., 
A.  G.  O. 

CoRni:siER,  W.  H.,  Captain  and  Assistant-Surgeon, 
now  awaiting  orders,  to  report  in  person  to  the 
Commanding-General,  Department  of  the  East,  for 
assignment  to  duty.     S.  O.  78,  C.  S.,  A.  G.  O. 

Ci:ninoham,  T.  .\.,  Captain  and  Assistant-Surgeon. 
Granted  leave  of  absence  for  fifteen  days,  to  take  ef-    I 
feet  on  arrival  of  \.  \.  Surgeon   .Vrtaud  at  Mount     ' 
Vernon  Barracks.  .\la.     S.  ().  ll>.  Department  of  the 
South.  April  :i,  1882. 

Davis,    W.    B.,   Captain    and    Assistant-Surgeon, 


THE  MEDICAL  EECORD. 


419 


now  awaiting  orders,  to  report  in  person  to  the 
Commanding-General,  Department  of  the  Platte,  for 
assignment  to  duty.     S.  O.  78,  C.  S.,  A.  G.  O. 

Cheebonniek,  a.  v..  Captain  and  Medical  Store- 
keeper. Granted  leave  of  absence  for  four  months  on 
surgeon's  certificate  of  disability.  S.  O.  77,  A  G. 
O.,  April  4,  1882. 


iEeiiral  Jt^msi   antr  Utvos. 


Contagious  Diseases  —  Wefkt.y  Statement.  — 
Comparative  statement  of  cases  of  contagious  diseases 
reported  to  the  Sanitary  Bureau,  Health  Department, 
for  the  two  weeks  ending  April  8,  1882. 


Week  Ending 

Is 

1 

II 

i 

■s 

1 

1 

i 

K 

u 

sa 

s 

3 

H 

H 

oi 

m 

April       1,   1883. 

11 

5 

348 

0 

200 

82 

33 

0 

AprU      8,  1883 

18 

3 

30-3 

6 

177 

103 

13 

0 

American  INIedicai.  As.sociation. — The  Secretary 
of  the  Surgical  Section  of  the  American  Medical  As- 
sociation requests  all  gentlemen  who  are  ■WTiting 
papers  to  be  read  before  that  section  at  its  nest 
meeting  to  notify  him  at  least  one  month  before  the 
time  of  meeting,  and  also  to  give  at  the  same  time 
the  titles  of  their  papers  and  their  probable  length. 
By  so  doing  the  titles  will  be  published  in  time  for 
the  members  to  be  jarejjared  for  the  proper  dis- 
cussion of  the  various  subjects,  and  he  suggests 
that  all  gentlemen  taking  part  in  the  debates  re- 
duce their  remarks  to  writing,  so  that  the  report 
can  be  made  more  accurate  and  valuable  as  a  mir- 
ror of  present  scientific  thought.  Communications 
should  be  addressed  Wm.  A.  Byrd,  M.D.,  Secretary 
Surgical  Section  American  Medical  Association,  407 
Jersey  Street,  Quincy,  Illinois. 

The  "  PoWDER-BLOWER  "  FOR  lODOFOBM. — Dr.  W.  M. 

Chamberlain,  of  this  city,  writes  :  "Dr.  Sands,  in  his 
paper  on  iodoform,  commends  the  use  of  the  peppei-- 
box  as  an  instrument  for  applying  the  drug.  I  have 
lately  employed  the  domestic  powder- blower,  devised 
and  dedicated  to  the  '  cimex  lectularius,'  for  this  pur- 
pose. With  it  it  is  easy  to  incrust  the  walls  of  sin- 
uses and  hollow  wounds.  It  sends  the  powder  just 
where  it  is  wanted,  makes  it  stick  to  the  surface, 
avoids  soiling  the  fingers  or  bedding,  and  minimizes 
the  smell  and  the  waste.  The  latter  is  a  consideration, 
for  iodoform  is  expensive." 

Keflex  Genital  Irrit.\tion. — Dr.  William  G.  Wil- 
son, of  Shelbyville,  Illinois,  wi'ites  :  "The  case  of 
reflex  genital  irritation  to  the  ear,  recited  by  Dr. 
Samuel  Sexton  in  his  communication  to  The  Medical 
Record  of  Mai-ch  25th,  to  explain  his  object  in 
pointing  it  out  in  the  discus.sion  of  Dr.  Foster's 
paper  at  the  December  meeting  of  the  Materia 
Mediea  Society,  has  forcibly  reminded  me  of  a  case 
that  I  have  had  under  observation,  and  since  such 
cases  are  comparatively  so  infrequent  that  not  one 
of  the  three  or  four  doctors  to  whom  I  have  men- 
tioned it  ever  met  wiih  a  similar  one,  I  thought  it 
might  be  of  interest  to  some  of  the  readers  of  the 
Kecobd. 


A  physician  since  his  first  recollection  has  been 
subject  to  reflex  otalgia  from  initation  of  the  glans 
penis,  such  as  is  caused  by  the  imprisonment  of  a 
hair  in  the  corona  for  several  hours  hy  the  prepuce. 
It  is  accompanied  by  tinnitus,  and  appears  to  be 
propagated  from  the  glans  in  the  direction  of  the 
ear.  The  otalgia,  when  the  irritation  is  on  the  mid- 
dle of  the  dorsum  of  the  glans  or  extends  to  both 
sides,  is  in  both  ears,  but  only  in  the  ear  correspond- 
ing to  the  side  on  which  is  the  irritation  when  but 
one  side  is  afl'ected.  Though  the  pain  is  not  severe, 
the  patient  is  so  distressed  by  an  indescribable  at- 
tendant nervousness  that  he  gets  rid  of  the  primary 
irritation,  together  with  the  ear-trouble,  the  first  op- 
portunity, by  the  application  of  a  little  cold  water  to 
the  glans." 

The  Buffalo  Medical  College  has  had  the  li- 
brary of  the  late  Dr.  White  donated  to  it.  At  its 
commencement,  February  21st,  sixty-five  students 
were  gi-aduated. 

Bovine  vs.  Human  Verus. — Dr.  Kempf  ( Louisville 
Med.  Keu-s)  finds  that  bovine  virus  takes  in  but  a 
minority  of  cases.  If,  however,  the  crust  from  the 
first  humanized  virus  be  used,  the  vaccination  takes 
in  nearly  every  case. 

OoPHOKECTOMy  has  been  made  the  basis  of  a  suit 
for  malin-actice  in  Grand  Kapids,  Michigan.  It  is 
claimed  that  the  operation  was  both  uncalled  for 
and  bunglingly  done,  as  the  patient  died. 

The  Tennessee  State  Medical  Societt  meets  on 
the  first  Tuesday  of  May. 

At  the  Commencement  op  the  Medical  and  Den- 
tal College  of  Tennessee  Universitv  fifty-three 
doctors  and  twelve  dentists  were  graduated. 

St.  Petersburg,  a  city  of  nearly  a  million  in- 
habitants, has  seventeen  hospitals,  with  a  sick  popu- 
lation of  eight  thousand  two  hundred  and  forty- four. 

Medical  iEsTHETics.  —  The  "Song  from  'Pa- 
tience,' "  published  in  the  Record  some  time  ago,  has 
been  widely  quoted,  and  not  always  properly  credited. 
It  was  written  by  a  member  of  the  Record  staft'. 
The  Ccmacla  Medical  and  Surgical  Journal  has  given 
it  a  more  cosmopolitan  character  by  adding  the  fol- 
lowing verses : 

"A  Toronto  medical  man, 

A  money  grub,  get-all  you-can, 
A  society-shirker,  night-and-day-worker. 
Stick-in-the-mud  young  man. 

**  A  Montreal  medical  man. 

In-a-very-great-hurry  young  man. 

A  rhubarb-and-jatap.  cabat-a-gallop, 

Case-in-the-straw  young  man."' 

London  beer  is  adulterated  with  salt  to  make  the 
customer  drink  more.  This  addition  is  not  found 
necessary  in  New  York. 

Stphilis  in  Asia,  though  long  common  in  the 
larger  cities,  was  not  introduced  into  the  smaller 
until  about  thirty  years  ago.  At  that  time  about  2 
per  cent,  of  the  population  had  syphilis,  now  20 
per  cent,  are  afiected. — Dr.  P.  Oaidzolcyan,  in  De- 
troit Clinic. 

A  Prolific  Woman.— Dr.  J.  J.  Rockwell  relates 
the  history  of  a  patient  who  gave  birth  to  seven 
children  in  twenty-seven  months,  five  being  within 
a  year.  The  mother  was  twenty-eight  years  old, 
and  herself  a  twin.  The  children  were  born  as 
twins  twice,  and  triplets  once.  They  aU  died  within 
a  few  weeks. —  Oliio  Medical  Journal. 


430 


THE  MEDICAL  RECORD, 


"ChBONIC     PriEMIA     FROM     GONOBRHCEA "    IS     the 

title  of  a  very  carefully  written  article  by  Surgeon- 
Genersil  Wales  in   Walsh's  Retrospect. 

Dr.  Reuben  A.  Vance  has  been  elected  Professor 
of  Operative  Surgery  and  Clinical  Surgery  in  the 
Medical  Department  of  Wooster  University,  Cleve- 
land, Ohio. 

New  Signs— The  sign  painter  is  now  very  busy, 
and  the  young  graduate  is  bent  on  getting  the  most 
for  his  money. 

The  KENTncKT  State  Medical  Society  met  April 
5th,  in  the  city  of  Louisville. 

THERAPEnilCAL   INDICATIONS   FOB   EbGOT. — Dr.    E. 

Evetzky,  in  the  N'ew  York  Medical  Journnl,  after  a 
careful"  study  of  that  drug,  sums  up  his  views  re- 
garding its  action  under  five  heads  : 

First :  Disorders  of  the  circulation  and  diseases 
of  the  organs  of  circulation.  Second  :  Paretic  con- 
ditions of  the  organs  composed  of  organic  muscular 
tissue,  the  circulatory  system  excepted.  Tliird : 
Inflammatory  and  other  morbid  enlargements  and 
growths.  Fourth :  Abnormal  secretions.  Fifth  : 
Svmptoms  referable  to  the  nervous  system,  and  de- 
pending chiefly  upon  circulatory  disorders  within  it. 
la  regard  to  contraindications  to  the  use  of  ergot, 
it  should  be  used  with  extreme  caution  in  patients 
with  an  enfeel)led  heart.  Pregnancy  is  not  an  ab- 
solute contraindication.  The  use  of  the  drug 
should  be  suspended  during  menstruation,  unless  it 
is  civen  for  some  special  condition  of  that  function. 
To^avoid  disturbiug  the  digestion  it  is  best  to  give 
the  drug  by  the  rectum  or  hypodermically. 

Madrid  has  twenty-three  medical  journals,  Paris 
a  much  larger  number. 

The  Cook  Coontt  Hospital,  Chicago,  is  to  be 
placed  in  part  under  the  professional  control  of  hom- 
(Bopaths,  and  the  other  part  under  the  care  of  the 
regular  medical  profession. —  Ohio  Medical  Journal. 

Stabling  Medical  College  has  graduated  52 
students  this  year;  Columbus  Medical  College, 
59. 

A  SocrETY  FOB  Physical  Eesearch  has  recently 
been  formed  in  Dublin,  with  Professor  Henry  Sidg- 
wick,  of  Trinity  College,  Cambridge,  as  its  Presi- 
dent. The  object  is  to  examine  into  and  explain  by 
phvsical  laws  the  various  recondite  phenomena  of 
mesmerism,  spiritualism,  etc. 

The  legal  position  of  a  Professor  in  a  college, 
according  to  a  recent  decision  of  the  Supreme  Court 
of  Pennsylvania,  is  merely  that  of  an  employee.  He 
can  be  summarily  dismissed  at  any  time,  therefore, 
by  the  corporation  owning  the  college. — Philadel- 
phia Medical  Times. 

HoFBATH  Professor  Bn.LBOTn  has  been  to  Bor- 
deaux with  his  two  assistants,  Drs.  Wolfer  and 
Gersuny,  in  order  to  perform  the  operation  of  re- 
section of  the  stomach.  Germany  ha«  again  con- 
quered France. 

An  Old  Physician.— Dr.  Karl  Friedrich,  of  Hen- 
singer,  Professor  in  tlie  University  of  Urarburg,  on 
February  28th  celebrated  his  ninetieth  birthday  and 
the  seventieth  year  of  his  professional  practice. 

Dr.  Alfred  L.  (jARROLl,  of  Staten  Island,  intends, 
it  is  said,  to  remove  to  Baltimore,  having  been 
elected  one  of  the  Faculty  of  the  Johns  Hopkins 
Universitv. 


On  Mineral  Pulp  as  an  Adulterant  of  Bread. 
— A  sample  of  bread  made  from  flour  adulterated 
with  soapstone  pulp,  in  the  proportion  of  two  ta- 
blespoonfuls  of  the  adulterant  to  a  teacupful  of 
flour,  together  with  a  specimen  of  the  pulp,  has 
been  submitted  to  the  National  Board  of  Health  for 
examination  by  a  correspondent  in  Easton,  Pennsyl- 
vania. It  is  considered  unlikely  that  this  adultera- 
tion is  used  to  any  great  extent. 

The  Medico-Legal  Society  has  received  cash  sub- 
scriptions of  .S600  and  a  large  number  of  books  for 
the  new  library  they  are  forming. 

Death  of  Dr.  Edward  L.  Beadle. — Dr.  E.  L. 
Beadle  died  last  week  at  his  residence,  near  Pough- 
keepsie.'  Dr.  Beadle  was  formerly  a  prominent  prac- 
titionei-  in  this  city.  He  held  many  offices  in  medi- 
cal and  other  societies.  He  was  a  Public  School 
Commissioner  of  this  city  between  1840  and  1850 ; 
was  President  at  one  time  of  the  New  York  County 
Medical  Society,  and  for  many  years  Vice-President 
of  the  College  of  Physicians  and  Surgeons,  and  one  of 
the  Trustees  of  Columbia  College.  He  held  the  two 
last-named  offices  at  tlie  time  of  his  death.  He  was 
also  at  different  times  President  of  the  Medical  and 
Surgical  Society,  and  one  of  the  managers  of  the  In- 
stitute for  the  Blind. 

Death  bates  in  1880. — New  York  Citv,  2G.31  per 
1,000 ;  Philadelphia,  21.G5 ;  Brooklyn,  ^li.SS  ;  Bos- 
ton, 23.7  ;  Baltimore,  2-1.32  ;  London,  22.2  ;  Paris, 
29.0  ;  Berlin,  29.9  ;  Vienna,  27.2  ;  Amsterdam,  27.2  ; 
Copenhagen,  25.0;  Stockholm,  28.8;  St.  Peters- 
burg, 46.1  ;  Madrid,  40.1 ;  Kome,  32.0. 

Payment  of  the  Govebnment  Exteets.  — Mr.  Sco- 
ville,  counsel  for  Guiteau,  has  prepared  .a  petition 
to  the  House  of  Eepresentatives  asking  that  the  bill 
recently  introduced  to  pay  medical  experts  for  the 
Government,  be  amended  by  adding  a  section  au- 
thorizing the  Department  of  Justice  to  audit  and 
pay  claims  for  legal  services  of  counsel  for  the  de- 
fense. 

Miss  Lonsdale,  who  came  prominently  forward 
some  time  ago  as  a  defender  of  unpopular  changes 
introduced  into  Guy's  Hospital  under  the  new  ma- 
tron, and  who  is  also  author  of  the  "  Life  of  Sister 
Dora,"  has  handed  over  the  profits  derived  from  pub- 
lication of  the  latter  work — no  less  a  sum  than  1,200/. 
— in  aid  of  a  convalescent  hospital  at  Milford,  near 
Stafford.  This  is  designed  to  be  a  memorial  to 
"Sister  Dora,"  who  founded  and  chieflv  maintained 
the  Cottage  Hospital  at  Walsall.  It  will  cost  2,000/., 
toward  which  1,400/.,  including  tlie  1,200/.  referred 
to,  has  been  subscribed. 

The  New  Y^ork  Neurological  Society  held  its 
annual  meeting  April  4,  1882.  The  following  offi- 
cers were  elected  for  the  ensuing  year  :  President, 
E.  C.  Spitzka,  M.D.  ;  First  Vice-President,  William  J. 
Morton,  M.D.  ;  Second  Vice-President,  A.  D.  Rock- 
well, M.D.  ;  Recording  Secrelari/,  Grjeme  M.  Ham- 
mond, M.D.  ;  Corresponding  Secretari/,  ISIary  Put- 
nam-Jarobi,  M.I).  ;  Treasurer,  E.  0.  Hai-wood,  M.D.  ; 
Councillors.  T.  A.  McBride,  M.D.,  W.  K.  Birdsall, 
M.D.,  E.  C.  Seguin,  M.D.,C.  L.  Dana,  M.D.,  L.  C. 
Gray,  M.D. 

A  Picture  by  Baraul,  containing  five  hundred 
members  of  the  International  Congress,  is  com- 
pleted. 

A  New  Hospital  in  Bridgeport,  Conn.,  is  likely 
to  be  built. 


Vol.  XXI.-No.  le 
April  22.  1883. 


THE  MEDICAL  RECORD. 


421 


©riginal  Cecturc0. 


CLINICAL  LECTURE  ON  A  CASE  OF  PAEA- 
PLEGIA. 

Delivered  at  St.  Mary's  Hospital,  London, 
ByC.  HANDFIELD  JONES,  M.B.,  Cantab.,  F.K.S., 

SENIOR   PHYSICIAN   TO  THE  HOSPITAL. 
FAIiL CONCUSSION,    NOT    SETERE,    OF   SPINE CONSECU- 
TIVE   MTELITIS    OP     GEABUAL     DEVELOPMENT — PEEI- 
KBAL   ABSCESS   AND   SLOUGHING PBOLONGED   TREAT- 
MENT— ULTIJIATE   COMPLETE   KECOVEEY. 

Gentlbsien  :  The  case  I  am  about  to  bring  before  vou 
eicited  a  good  deal  of  interest  while  the  patient  ■was 
yet  with  us,  and  I  glidly  accede  to  the  request  made 
to  me  by  one  of  my  former  clerks,  that  I  should 
make  it  the  subject  of  a  clinical  lecture.  Most  cases 
carefully  observed  afford  us  one  or  more  useful  les- 
sons, and  this  is  certainly  true  of  our  text  for  to- 
day.    So  let  us  jjroceed  to  our  story.     H- ,  aged 

thirty,  came  to  us  tirst  early  in  August,  1881.  He 
had  Ijeen  a  soldier,  and  looked  it  every  inch  of  him. 
Not  a  carpet  knight,  or  of  the  Lounge  Brigade,  who 
thinks  it  "  a  baw  to  be  a  real  soldier,"  as  Punch  puts 
it.  He  had  seen  active  service,  and  knew  the  smell 
of  powder.  His  manner  was  that  of  one  who  was 
trained  to  discipline,  who  had  learned  to  respect 
himself  and  others.  And  there  was  also  the  impress 
of  culture  upon  him,  as  indeed  there  well  might  be, 
for  he  came  of  gentle  lilood,  and  had  gi-aduated  at 
Oxford,  as  we  heard  later.  He  came  to  us  only  for 
a  few  days,  at  the  request  of  one  of  our  governors, 
for  he  was  on  his  way  to  Chelsea  Hospital,  but  could 
not  be  admitted  until  the  Circumlocution  Office  had 
got  some  necessary  papers  ready.  Ordinarily  under 
such  circumstances  he  would  have  come  and  gone 
with  little  thought  on  our  part,  as  his  condition  was 
regarded  hopeless,  and  he  did  not  ask  us  for  treat- 
ment. But  I  chanced,  or  shall  I  say,  was  led  to  see 
him.  And  seeing  him  I  could  not  but  feel  for  him. 
There  he  lay,  a  stalwart  young  man,  in  the  veiy 
prime  of  his  days,  a  hopeless  paraplegic,  apparently 
laid  aside  from  an  honorable  calling  in  which  he 
might  have  won  fame,  and  reduced  to  live  out  the 
many  weary  years  of  a  bed-ridden  life  in  an  asylum. 
He  might  have  repeated  to  himself  the  sad  lines  of 
an  old  plaint,  which,  perhaps,  you  may  remember : 

•'  They  are  gone,  they  are  all  passed  by  ; 

They  in  Avhose  wiirs  I  had  borne  ray  part : 
They  whom  I  loved  with  a  brother's  lieart : 
Thev  have  left  me  here  to  die. 
Sound  iisain.  Clarion  : 
Clarion  poor  thy  blast ; 
Sound,  for  the  captive's  dream  of  hope  is  past  " 

Something,  perhaps,  of  the  physician's  instinct,  some 
insufficient — I  admit — examination,  some  moulding 
of  the  mental  conception  by  the  longingwill,  led  me 
to  conceive,  and  think,  and"  say  that  I  did  not  regard 
his  case  as  hopeless.  I  knew  not  then,  or  at  least 
imperfectly,  how  much  had  been  done  for  him,  what 
crafty  i  kraftig)  brains  and  skilful  hands  had  worked 
for  him  through  ten  weary  months,  yet  with  small 
success.  Had "  I  fully  appreciated  this,  I  should 
probably  have  been  silent,  and  not  ventured  to  re- 
kindle hopes  that  had  well-nigh  died  out.  But  hav- 
ing committed  myself,  when  the  poor  fellow  eagerly 
caught  at  the  straw  I  had  thrown  to  him,  and  pressed 
to  be  allowed  to  come  to  St.  Marv's  to  be  under  my 


care,  I  could  not  draw  back.  I  believe  I  half  re- 
pented of  my  audacious  speech  when  I  was  thu 
challenged  to  carry  it  into  effect,  and  represented  to 
him  that  he  would  get  as  good  medical  care  at  Chel- 
sea Hospital  as  any  I  could  give  him,  and  that  it 
might  not  be  desirable  for  him  to  quit  so  soon  the 
refuge  which  was  open  to  him.  But  it  was  of  no 
avail,  and  accordingly  some  six  or  eight  weeks  later, 
on  October  12,  1881,  he  was  again  admitted  into  our 
wards.  He  gave  us  the  following  history  :  His  father 
died  of  heart  disease,  at  the  age  of  seventy-five  ;  his 
mother  is  still  living,  but  has  been  a  confirmed 
invalid  as  long  as  he  can  remember.  Brothers  and 
sisters  are  fairly  healthy.  When  in  India,  in  1878, 
he  had  what  was  called  enteric  fever  for  four  months — 
"  half  the  regiment  had  it."  He  had  ague  once  be- 
fore the  fever,  and  .several  times  afterward.  He  also 
had  a  slight  sunstroke.  He  has  had  palpitaticn  cf 
the  heart  all  his  life,  more  or  less,  ard  especially  of 
late  years.  No  history  or  indication  of  syphilis. 
Has  been  somewhat  wild,  but  not  intemperate.  Hia 
general  good  conduct  seems  to  be  gfflimed  by  Lis 
statement  that  he  was  shortly  to  have  been  reccm- 
mended  for  a  commission  when  his  illness  com- 
menced. 

On  November  8,  1879,  he  was  pursuing  the  enemy 
in  Afghanistan,  when  his  horse  fell,  gnd  he  came 
down  in  a  sitting  posture.  He  got  up,  mounted 
again,  continued  the  pursuit,  and  rrde  back  into 
camp,  a  distance  of  a  mile,  not  knowing  that  he  was 
hurt.  He  did  regular  duty  for  a  day  and  a  half, 
having  no  local  pain,  only  feeling  geneially  flioken. 
On  the  afternoon  of  the  second  day  he  was  lying  in 
his  tent  when  he  was  suddenly  seized  with  severe 
pain  in  the  perineum.  He  was  then  taken  to  the 
field  hospital,  and  on  the  fifth  day  after  his  fall  an 
abscess  was  opened  in  his  perineum.  He  lay  up  and 
had  the  abscess  dressed  for  a  month,  and  then  was 
sent  with  invalids  to  Peshawni'.  He  was  carried  in 
a  dhoolie,  and  owing,  as  it  was  supposed,  to  severe 
jolting,  an  abscess  formed  in  the  scrotum.  When 
he  got  to  Peshawur  he  was  insensible,  and  remaicf  d 
so  on  and  off"  for  three  or  four  days,  Was  in  a  high 
fever  until  the  ab.scess  biirst.  Part  of  the  skin  of  st  ro- 
tum  and  penis  sloughed  away.  He  lay  ill  till  Feb- 
rnai'y  18,  1880,  when  he  was  invalided  to  England. 
When  he  reached  Deolatie  he  was  found  by  tie  sur- 
geon to  be  paraplegic.  Until  this  time  neilher  he 
nor  bis  medical  attendants  had  any  idea  that  his  in- 
ability to  walk  proceeded  frcm  any  other  cause 
than  weakness. 

On  May  24,  1880,  he  went  to  Netley  and  remained 
there  till  November  15th  of  the  same  year,  when  he 
was  discharged  as  unfit  for  further  service.  Dr.  Vacy 
Ash;  an  old  St.  Mai-y's  man,  had  him  in  charge  dur- 
ing his  stay  at  Netley,  and  has  favored  me  with  the 
following  note  respecting  his  ccnditiop  :  "  My  own 
impression  from  his  tale  was  that  the  sudden  shock 
in  the  saddle  from  the  horse  buck- jumping,  rujitured 
the  urethra,  either  by  direct  violence  or  from  mus- 
cuhir  exertion,  admitting  of  extravasation  of  urine 
and  subsecjuent  suppuration  and  sloughing.  I  have 
myself  seen  a  similar  result  from  a  somewhat  similar 
accident.  It  could,  I  think,  have  been  in  no  wav  due 
to  the  effect  of  the  paralysis  at  so  early  a  date.  The 
direct  effect  of  the  blow  on  the  spinal  column  is 
somewhat  obsciire.  The  symi>toms  developing  so 
slowly  points  to  concussion  rather  than  pressure 
fi'om  clot.  Whichever  it  was,  consecutive  myelitis 
undoubtedly  followed,  the  anterior  columns  suffering 
most.  His  symptoms  here  pointed  to  derangement 
of  the  system  from  want  of  exercise  and  nutrition  ; 


422 


THE  MEDICAL  RECORD. 


dyspepsia,  evidenced  by  furred  tongue,  constipation, 
etc.  His  ui'ine  contained  triple  pliosphates  and  epi- 
thelial debris.  He  suliered  also  from  severe  vertigo. 
His  heart,  lungs,  and  temperature  were  normal  for 
the  most  part.  He  had  perfect  control  over  bladder 
and  rectum.  In  the  recumbent  position  he  could 
pull  up  his  legs  and  feel  the  bedclothes.  In  at- 
tempting to  walk,  his  legs  dragged.  Shooting  pains 
were  frequently  complained  of,  invarial)ly  produced 
when  near  a  tire,  and  then  only  he  felt  his  legs  cold. 
My  own  private  notes  on  his  case  bear  this  epitome 
out.  I  could  do  him  no  good  in  spite  of  the  con- 
tinuous current  of  electricity  and  the  usual  remedies 
in  such  cases." 

During  the  time  which  elapsed  between  his  leav- 
ing Netley  and  entering  the  Queen  Square  Hospital 
ha  resided  at  Tunbridge  Wells,  and  was  under  the 
care  of  an  excellent  practitioner  there,  but  I  do  not 
know  what  treatment  was  employed. 

Nearly  five  months  after  he  left  Netley  he  was  re- 
ceived into  the  Queen  Square  Hospital,  and  placed 
under  Dr.  Radcliffe's  care.  I  am  very  much  in- 
debted to   hiui   and   to   his   medical  resident.   Dr. 

Baevor,   for  the  following    notes  of  H 's   case, 

which  they  have  kindly  sent  me  :  "  Duration  of  pa- 
tient's stay  in  tiie  hospital  from  .Vpril  ith  to  August 
8th,  1881.  He  looked  a  strongly  made  man.  Arms 
and  upper  part  of  body  not  affected.  Spine  is  free 
from  curvature,  but  is  tender  to  percussion  from  the 
seventh  dorsal  vertebra  downward,  but  especially  in 
the  lumbar  region,  where  slight  percussion  causes 
much  wincing.  He  sometimes  has  pain  in  lower 
part  of  spine,  shooting  upward,  and  at  same  time 
has  then  the  feeling  of  a  tight  cord  round  his  waist. 
His  legs  do  not  look  very  wasted,  but  he  says  they 
are  much  smaller  than  they  used  to  be.  He  cannot 
move  the  hips,  knees,  or  ankles  at  all,  but  can  just 
flex  the  toes  a  very  little.  No  stiffness  in  the  joints. 
Both  legs  feel  cold  below  the  knees.  P.itellar  tendon 
reflex  increased  on  both  sides.  No  ankle  clonus. 
Plantar  reflex  just  obtiined  on  both  sides.  Abdom- 
inal and  e2Jigastric  reflexes  present  on  both  sides. 
Sensibility  not  affected,  but  on  outer  jiart  of  right 
tliigli,  as  far  as  the  knee,  the  skin  feels  different  to 
him,  and  he  has  curious  tingling  there.  Sphincters 
not  affected  ;  he  can  hold  his  water,  and  is  not 
obliged  to  pass  it  so  soon  as  he  feels  the  desire  to 
mi  ;turate.  He  was  ordered  liq.  hydr.  bichl.,  3  j.,  t.  d., 
anl  the  constant  current  passed  from  the  back  to 
th;  feet  in  water,  and  then  the  current  to  be  re- 
versed two  or  three  times. 

"  .June  13th.  — Is  able  to  move  his  legs  a  little.  Or- 
dered to  lie  on  his  bed,  and  to  practise  moving  his 
legs,  the  attendant  helping  him. 

"July  7th. — Is  able  to  extend  and  flex  the  ankles 
wliMi  one  knee  is  crossed  over  the  other ;  complains 
o'  sivere  aching  pains  in  his  lind)S." 

H )  says  that  Dr.  Radcliffe  employed  the  constant 
current  every  day,  and  he  thinks  that  ho  derived 
very  material  benefit  from  it. 

Wo  now  commence  our  own  reports.  Patient  is 
a  tall,  intelligent,  fairly  well-nourished  man,  has 
1)3  in  muscular,  estimates  that  his  legs  are  nearly 
one-third  smaller  than  when  he  wa-i  in  health.  Ho 
u-ied  to  weigh  150  pounds,  his  woiglit  about  tsvo 
months  later  was  l-loj  pounds,  and  in  all  probability 
w*s  not  more  at  this  date.  He  used  to  measure  IG 
inches  round  his  cilf,  now  he  measures  only  12. 
He  cannot  make  the  least  attomp-t  at  standing,  in 
fact  some  two  or  throe  weeks  later,  when  holding  by 
his  arms  to  a  horizontal  staff,  his  legs  sprawled 
ab^ut   feebly  and  helplessly.     No  anlde  clonus,  or 


plantar  reflex,  but  rather  excessive  patellar  tendon 
reflex  in  both  legs.  Sensation  seems  quite  perfect 
everywhere,  except,  probably,  at  the  lo^\  er  anterior 
part  of  right  thigh,  where  twelve  days  later  electric 
sensibility  was  much  impaired,  though  the  sense  of 
contact  was  good.  In  the  earlier  period  of  hio 
malady,  he  says,  his  legs  were  decidedly  hyperaes- 
thetic.  When  lying  on  his  side,  one  or  other,  he 
can  flex  the  legs  a  good  deal,  but  slowly  and  feebly, 
and  can  extend  them  also,  especially  when  the  limb 
is  lifted  from  the  bed  so  fliat  it  can  move  easily 
without  friction  against  the  bedclothes.  When  he 
is  semi-recumbent  on  his  back  he  can't  move  his 
legs  nearly  so  much  ;  can  scarcely  bend  the  knees  at 
all.  This  is  probably  on  account  of  the  greater 
friction  of  the  soles  on  the  bed.  He  is  quite  unable 
to  overcome  the  resistance  of  a  moderately  strong 
arm.  When  he  is  trying  to  flex  the  lower  limbs  the 
long  flexors  are  felt  quite  rigid,  or  else  in  a  state  of 
tremor.  They  seem  to  be  unable  to  shorten  as  they 
normally  should,  and  with  great  show  of  effort  little 
result  follows.  Sometimes  it  appears  as  if  the  voli- 
tional impulse  could  not  be  limited  to  the  group  of 
muscles  intended  to  be  used  ;  thus,  while  an  eflbrt  is 
being  made  to  flex  the  knee,  the  extensors  are  apt 
to  contract  too,  but  with  more  of  tremor  than  actual 
systole.  He  is  very  sensitive  to  chill,  which  will 
cause  tremor  also.  His  intellect  is  quite  clear.  He 
sleeps  well  He  has  perfect  control  over  both  bow- 
els and  bladder.  The  large  muscles  on  the  anterior 
aspect  of  Ijoth  thighs  and  both  legs  were  very  inert 
to  faradization.  The  cun-ent  was  felt  slightly  in  the 
posterior  part  of  right  thigh,  the  large  muscles  here 
are  inert ;  current  is  felt  still  less  in  left  thigh,  and 
its  posterior  muscles  are  quite  inert.  The  posterior 
miiscles  of  the  right  calf  are  quite  inert,  but  the  cur- 
rent is  felt  well.  State  of  left  calf  almost  certainly 
similar,  but  not  mentioned.  With  galvanization 
(interrupted)  the  anterior  muscles  of  right  and  left 
thighs  are  qiiite  inert,  and  current  is  hardly  felt. 
The  anterior  tibial  muscles  of  both  legs  are  inert, 
the  current  is  felt  more  in  the  left  than  in  the  right. 
The  posterior  muscles  of  both  thighs  are  all  inert, 
those  ot  both  legs  are  in  same  state.  Eight  gluteus 
maximus  responds  to  current,  which  is  keenly  felt. 
Left  gluteal  region  is  very  sensitive,  and  muscle 
responds  well. 

Heart's  dulness  area  small,  imimlse  weak,  but  in 
normal  site  ;  both  sounds  faint ;  no  murmur.  Pulse 
70,  compressible,  regular,  soft.  Lungs  normal,  ex- 
pand well.  Appetite  fair,  but  he  has  been  trou- 
bled with  water-brash  the  last  three  weeks.  Bow- 
els quite  regular.  Splenic  dulness  extends  from 
sixth  rib  to  crest  of  ilium.  Ordinary  diet ;  wine,  4oz. 
Quiniffi  disulphatis,  gr.  v.,  t.  d.  Balm  c.  pot.  snl- 
phuret,  3  iv.,  o.  n.  i 

October  Mth  — Had  sulphur  bath  for  twenty  min- 
utes last  night ;  after  being  in  it  some  time  he  got  j 
light-headed,  a  feeling  of  dread  came  over  him.  and  he 
feared  to  be  left  alone  ;  lie  felt  so  weak  that  he  could 
hardly  raise  his  arms  to  the  edge  of  the  batli :  per- 
spiration poured  otf  his  head,  and  he  felt  much  , 
weaker  than  when  lie  went  in.  When  taken  out  he  \ 
was  in  a  half  fainting  condition,  niul  when  put  to 
bed  soon  went  to  sleej).  All  next  day  he  had  head- 
ache, and,  on  first  waking,  his  sensations  were  simi- 
lar to  those  of  a  man  who  has  taken  too  much  over- , 
night.  Otherwise  he  feels  well  to-day.  A  second  i 
bath  the  following  night  for  only  fifteen  minutes  I 
was  borne  better;  he  shivered  considerably  after  it ; 
wine  was  given.  A  mustard  bath  some  ihiys  Intt  r 
made  him  red  all  over  like  a  scarlatinal  patient,  ano 


THE  MEDICAL  RECORD. 


423 


pro.hieed  some  mental  excitement,  ■n-hich  passed  ofi' 
in  an  hour  or  so.  The  object  of  these  cutaneous 
stimulations  was  to  excite  reflexly  the  elements  of 
the  injured  spinal  cord  to  a  better  nutrition.  The 
idea  was  rational,  but  the  trials  I  made  were  not 
encouraging  and  were  not  continued.  On  passing  a 
catheter  to  ascertain  the  state  of  the  urethra  it  was 
found  throughout  excessively  sensitive,  and  this,  to- 
gether with  tlie  evident  hyper^xcifabilitj  of  the 
lower  limbs,  seemed  to  indicate  a  trial  of  calmatives. 
So  on  October  17th  the  quinine  was  replaced  by 
the  following :  Ammon.  bromid.,  gr.  sv.  ;  tr.  beUa- 
don.,  \.  XV.;  spt.  chlorof.,  Tr^^.  x.  ;  aq.  chlorof.,  t  j., 
t.  d.  On  21st  a  blister,  3x2  inches,  was  applied 
to  lumbar  spine.  Passive  exercise  of  the  limbs  was 
performed  daily,  and  the  continuous  current  passed 
through  their  different  segments  for  seventy-five 
minutes  daily  also. 

October  27th. — When  he  tries  to  flex  his  knees  it 
is  very  e%'ident  that  he  cannot  direct  the  volitional 
stimulus  to  the  flexor  muscles  alone,  the  extensors 
act  at  the  same  time.  Both  heels  are  of  a  full  dull 
red,  a  pale  spot  from  iiressure  fades  rather  slowly. 
Phosphori,  gi\  is  t.  d.,  commenced  three  days  ago. 
Dose  of  bromide  to  be  increased  to  gr.  xx.,  and  of  tr. 
ballad,  to  TH^.  xx;  pot.  iod.,  gr.  v.,  to  be  added. 

November  1st. — He  can,  by  gieat  exertion,  bend 
both  knees,  raising  the  ham  more  than  a  hand- 
breadth  from  the  bed,  but  a  great  deal  of  spasm 
occurs,  and  the  long  flexors  get  very  rigid ;  the 
•  quadriceps  extensor  also  acts  to  some  extent.  To 
lessen  the  tendency  to  sjjasm,  gr.  -^c,  of  atropia  was  in- 
jected subcutaneously,  but  it  caused  sickness,  and 
was  not  repeated. 

November  10th. — The  muscles  of  all  the  i-egions 
of  the  lower  limbs  above  the  feet  reach  pretty  well 
to  the  current  from  my  own  battery  (faradaic),  which 
gives  a  larger  spark  and  slower  interruptions  than 
the  hospital  one.  The  long  flexors  of  the  thigh  are 
least  active.  He  feels  much  exhausted  after  faradi- 
zation, and  so  he  does  after  efforts  to  iise  his  para- 
lyzed muscles.  The  dose  of  pot.  iod.  which  has  been 
gradually  increased  is  now  augmented  to  gr.  20  and 
is  to  be  taken  with  ammon.  carb.,  gr.  4;  tr.  ciu- 
choniio,  Ij. ;  dec.  cinch.,   ?  j.,  ter  die. 

November  15th.  —  Yesterday,  was  unwell  and 
squeamish ;  to-day,  complains  much  of  giddiness 
and  of  inability  to  read  more  than  two  or  three 
minutes,  the  letters  becoming  blurred  and  fading 
away ;  he  has  nausea,  loss  of  appetite,  general  ma- 
laise, and  passed  a  very  bad  night,  shivering  as  he 
did  when  he  had  ague.  Temperature,  97.4° ;  pulse, 
cordy,  compressible,  76 ;  urine  (of  13th),  clear,  light 
yV^lIow,  neutral,  and  not  albuminous.  Tongue  verv 
fotd. 

November  17th. — Head  was  relieved  decidedly  by 
a  hot  pediluvium  last  night,  but  is  very  bad  again 
to-dav,  he  has  much  vertigo,  and  cannot  fix  his  eyes 
steadily  on  any  object ;  his  head  is  not  painful  but 
uneasy,  not  hot ;  bowels  open.  Temperature  at  4 
P.M.,  98°.  Ordei'ed  tr.  veratri  viridis,  \  ij.  ;  ni. 
c.imph.,  3  ss.  ;  4  tis.  h.,  and  sinapism  to  nucha.  He 
was  relieved  by  the  first  dose  and  sinapism,  and  was 
much  better  the  next  day. 

November  22d. — Has  had  slight  fever  last  two  days, 
commencing  with  100.2"  on  20th  p.m.,  on  21st  mark- 
ing 99.6°  A.M.  and  101°  v.yi.,  on  22d  100°  a.m.  and 
9.S.9°  P.M.,  afterward  normal.  He  feels  better.  Tint 
varies.  Is  always  worse  in  evening  and  all  night, 
better  about  midday.  Is  still  unable  to  read  with 
comfort.  A  few  papules  on  abdomen  ;  much  like 
typhoid  spots,  but  more  x-aised.     Some   diarrhoea. 


Began  yesterday  quinire  disulph.,  gr.  iv.,  quater  die. 
Splenic  dulness  is  extensive,  otcujjying  lower  left 
side  of  chest  for  six  finger-breadths,  and  below  ribs 
reaching  to  crest  of  ilium,  and  anteriorly  extending 
to  V.  n.  1.     Port,   3  vij. 

December  Cth. — His  muscles,  especially  the  quad- 
riceps extensors  of  thighs,  contract  largely  to  a 
pretty  strong  faradaic  current,  yet  tLey  setm  to  tx- 
ert  but  little  force.  This  has  been  observed  some 
time.  He  can,  by  a  great  effort,  which  fatigues  him 
much,  draw  up  his  leg — one  or  other — until  it  is 
(piite  vertical,  the  heel  directly  under  the  knee. 
While  the  long  flexors  of  the  thighs  are  well  con- 
tracted, and  the  hamstring  tendons  tense,  the  legs 
ai'e  not  moved.  He  can  extend  the  flexed  leg  more 
readily,  but  with  little  force.  He  can  move  Lis  toes 
with  the  extensor  communis  digitoruni,  and  the  foot 
at  the  ankle  very  slightly.  He  can  raise  the  heel  a 
very  little  from  the  ground  when  sitting  on  the  edge 
of  his  bed,  but  is  quite  unable  to  lift  the  foot  from  the 
floor.  He  has  much  more  power  of  moving  his  legs 
when  he  lies  down  flat  then  when  he  half  sits  up. 
Quinine  omitted  November  30th.  Bass'  ale,  one  jiint, 
in  place  of  wine  on  December  2d.  Ordered  on  De- 
cember 10th,  ammon.  carbonatis,  gr.  iv ;  tr.  cinchc- 
naj,  3  j. ;  infus.  cascarill.,   t  j.,  t.d.     Port,  ?  iv. 

December  12th. — When  the  current  is  interrupted 
slowly,  moving  the  hammer  with  the  finger  so  as  to 
make  about  two  interruptions  per  second,  the  mus- 
cles contract  very  much  more  strongly  and  eflec- 
tively  than  when  the  interruptions  are  rapid,  and 
the  pain  caused  is  much  less  acute  ;  he  speaks  of  it 
more  as  an  aching. 

December  14th. — With  interrupted  galvanism  very 
little  action  occurs  in  either  quadriceps  extensor, 
but  nmch  pain  is  produced,  he  says  it  feels  like 
tearing  off  the  flesh.  Both  anterior  and  posterior 
groups  of  leg-muscles  act  well,  the  left  best.  Plan- 
tar reflex  distinct  and  equal  in  both  feet.  Abdomi- 
nal reflex  present  also  on  both  sidee. 

December  19th. — Stood  alone  to-day  for  the  first 
time,  only  just,  and  only  for  a  second  or  two.  He 
managed  afterward  with  support  to  walk,  alter  a 
fasliion,  a  few  steps,  his  legs  sprawling  about,  but 
little  under  control.  When  lying  in  bed  on  his  back 
he  can  draw  up  an  eight  pound  weight  by  flexing  his 
legs,  a  cord  being  attached  to  the  weight  and  to  his 
ankles,  and  passing  over  a  pulley. 

December  26th. — Last  four  days  he  has  been  able 
to  get  about  with  the  assistance  of  an  arm,  and  even 
without,  walking  a  good  many  steps.  He  seiiaratts 
his  feet  widely,  and  is  by  no  no  means  firm  on  his 
legs.  He  has  no  power  whatever  of  flexing  the 
thighs  on  the  pelvis.  He  walked  to-day  about  seven- 
teen yards  without  putting  his  stick  to  the  ground. 
On  28th  was  ordered  sodse  hypophosphitis,  gr.  xv. ; 
inf.  cascarill.,  ;  j.,  ter  die;  also  ol.  morrh.,  3  j.,  o.  n. 

December  29th. — In  addition  to  faradizing  the 
quadriceps  and  anterior  tibial  groups  it  was  decided 
to  pay  special  attention  to  the  psoas  muscles.  Long 
interruptions  and  a  moderate  current  to  be  used. 
Current  to  be  passed  from  outer  edge  of  quadratns 
lumboTum  muscle  to  spot  just  below  Poupart's  lig- 
ament, where  the  psoas-iliacus  is.'iues  from  the  ab- 
domen. In  the  evening,  when  walking  about  in  the 
wards,  his  walking  visibly  improved,  the  feet  being 
brought  closer  together,  each  foot  put  well  before 
the  other,  and  the  whole  done  quite  quietly.  He 
said  he  felt  more  spring  in  his  legs. 

January  6.  1S82. — Last  few  days  has  had  mucli 
aching  in  feet  and  sense  of  heat,  the  latter  in- 
creased by  walking,  the  [former  not ;  he  has  also  a 


424 


THE  MEDICAL  RECORD. 


bruised  aching  feeling  in  feet  after  standing  or  walk- 
ing a  little.  The  feet  used  to  be  very  cold,  but  are 
tolerably  warm  now.  The  braised  aching  feeling 
wheu  he  walks  is  exaggerated  into  pain.  The  ach- 
ing decreases  when  he  lies  down,  but  the  sense  of 
heat  does  not.  At  night  he  has  to  shift  his  feet 
about  to  flad  a  cool  place,  whereas  formerly  his 
feet  ware  always  cold.  The  feet  not  only  feel  hot  to 
him,  but  are  actually  hot  (Mr.  Rowe).  When  the 
feet  are  at  rest  he  has  no  pain  or  numbness  in  them, 
only  a  sliglit  sense  of  heat.  He  has  no  other  pain 
than  the  bruised  feeling.  Has  very  little  power  over 
his  feet,  can  walk,  but  can  hardly  use  them  in  any 
other  way.  When  seated  he  can  only  raise  the  heels 
a  little,  the  toes  scarce  at  all.  When  standing  he 
can  raise  his  heels  nearly  an  inch  from  the  floor.  He 
cannot  ascend  stairs,  cannot  raise  at  all  his  whole 
foot  from  the  ground.  Nothing  amiss  to  be  seen  in 
feet.  The  pain  is  most  felt  on  dorsum  of  each  foot 
at  proximal  end  of  metatarsal  bones.  He  had  once 
a  sensatiou  as  if  his  feet  were  wrapped  in  a  poultice, 
but  has  none  of  that  now.  Says  if  his  feet  were  right 
he  could  walk  perfectly.  Has  no  power  of  rising 
from  a  seat,  even  a  high  one,  without  using  his  hands. 
About  this  time,  when  lie  was  seated  on  an  ordinary 
ward  table,  and  was  requested  to  get  on  his  feet,  his 
knees  quite  gave  way  under  him,  he  sank  down,  and 
had  to  be  r.iised  to  his  feet.  He  could  walk  fairly 
well  then.  Has  stiU  some  soreness  and  bruised  feel- 
iag  in  calves.  This  first  appeared  on  January  1st, 
after  a  warm  Vjath.     Urine  quite  normal. 

January  7th. — Walks  very  well  to-day,  raising  his 
advancing  foot  from  the  floor,  but  when  seated  on 
the  edge  of  his  bad  cannot  raise  his  foot  at  all, 
and  only  lifts  the  heel  or  the  toe  slightly.  Wlien 
I  ch  illenge  him  to  raise  his  foot  from  the  floor 
he  replies  that  he  knows  how  to  do  it  with  his 
head,  but  not  with  his  legs.  Has  been  taking 
last  two  days  extracti  ergotse  liquid.,  3  j. ;  pot. 
iod.,  gr.  v.;  aq.,  sj.,  t.  d.  This  I  had  prescribed, 
having  some  apprehension  lest  the  pains  in  the 
feet  should  be  those  of  recrudescing  myelitis,  but  as 
they  seamed  to  be  almost  entirely  i^roduced  by  the 
act  of  walking,  and  subsided  when  he  rested,  and 
as  his  motive  power  was  certainly  improving  I  put 
aside  my  fears  to-day  and  hade  him  resume  the  hypo- 
phosphite  mixture  and  to  take  also  ferri  carb.  sacch., 
gr.  XX.,  bis  die.  The  next  achievement,  attempted 
about  January  12th,  was  to  get  him  to  walk  up- 
stairs. There  is  a  longish  flight  of  stone  steps  lead- 
ing from  his  ward  to  the  floor  above,  with  a  landing 
half  way.  I  led  him  to  the  foot  and  encouraged 
him  to  make  an  effort.  He  looked  up  helplessly  and 
almost  hopelessly  at  the  ascent,  reminding  me  of 
some  baffled  mountain  olamberer,  who  after  long 
toil  quails  at  last  before  the  long  steep  slope  which 
leads  to  the  top.  However,  this  slope  had  what  tlie 
Alpine  slope  has  not,  viz.,  a  stout  balustrade  on  one 
side,  and  a  good  Iiand-rail  on  the  other.  The  latter 
he  grasped  with  his  hands  and  then  chiefly  l)y  drag- 
ging his  frame  higher,  while  his  legs  sprawled  side- 
ways along  the  stairs,  but  still  aided  him  somewhat, 
he  struggled  up.  It  was  quite  remarkable  to  see 
how  little  power  he  had  to  raise  his  feet  at  this 
time,  when  he  was  walking  quite  well  on  a  level 
floor. 

January  24th.  —  .\bout  the  10th  he  managed  to 
get  upstairs  without  liauling  himself  up  by  means 
of  his  hands.  To-day  ho  wont  up  to  tlio  top  landing, 
two  flights,  without  using  his  hamls  and  without 
help  of  any  kind.  He  cannot  c  .rry  the  advancing 
foot  to  the  stair  above  that  on  which  the  other  rests, 


but  places  it  on  the  latter  and  then  repeats  the  move- 
ment. He  says  that  going  up  is  the  hardest  work, 
but  that  the  descent  is  by  no  means  easy,  and  shakes 
him  much.  Of  course  he  feels  tired  in  the  legs  after 
this  exertion,  but  the  distressing  feeling  of  weari- 
ness he  had  before  has  gone.  He  can  raise  his  foot 
from  the  ground  as  high  as  the  other  knee,  and 
though  he  brings  it  down  with  a  stamp  there  is  none 
of  the  running  forward  noticed  before.  Without  using 
his  hands  he  can  Taise  himself  when  sitting  on  his 
bed,  but  the  effort  is  violent  and  is  really  a  throw- 
ing of  himself  forward.  He  can  stand  on  either  leg 
if  he  rests  his  hand  on  anything,  but  he  cannot  keep 
uj)  the  leg  which  is  raised,  or  raise  the  extended 
leg-l 

January  28th. — Went  out  for  a  walk  for  the  first 
time.  Ankles  and  feet  ache  much  from  going  up 
and  down  stairs.  He  cannot  rise  from  a  chair  with- 
out help  ;  cannot  run  at  all. 

February  8th. — Goes  out  every  day  and  gets  less 
tired  each  time.  General  health  is  excellent.  Walks 
up-stairs  far  more  evenly  and  with  apparently  no 
effort.  He  takes  now  the  alternate  stairs  with  each 
foot  (juite  naturally,  and  can  even  do  two  steps  at  a 
time.  Comes  down-stairs  quite  naturally,  though 
he  says  he  has  to  be  careful  to  keep  his  balance.  He 
makes  a  nearer  api^roach  to  a  run  than  hitherto,  but 
it  does  not  amount  to  more  than  a  shamble.  Can 
rise  to  his  feet  from  a  chair  quite  easily  and  quietly 
now,  but  a  few  days  ago  he  had  to  make  a  consider- 
able effort,  and  his  legs  jerked  him  up  and  down  for 
a  second  or  so  after.  His  feet,  which  used  to  he  cold 
at  night,  are  now  very  hot,  and  ache  a  goi^d  deal. 
Temperature  of  soles  of  feet  about  January  2-ith  was 
98.-!'.  Patella  reflex  is  still  exaggerated.  Can  walk 
round  the  Serpentine  with  only  two  rests.  Mr.  .Rowe 
remarks  that  any  one  seeing  him  walk  about,  or  go 
up-stairs  would  think  nothing  was  the  matter  \Wth 
him.  He  left  the  hospital  to-day.  His  power  of 
flexion  and  extension  of  his  legs  far  exceeded  the  re- 
sistance which  could  be  exerted  by  an  ordinary  arm. 

IiKmarks. — The  ptdhoiogy  of  this  case  seems  toler- 
ably clear.  I  had  originally  imagined  that  the 
perineal  mi.schief  had  a  good  deal  to  do  in  the 
matter,  and  that  the  paraplegia  was,  to  some  extent 
at  least,  of  inhibitory  origin  ;  but,  after  careful  ex- 
amination, I  gave  up  this  view,  and  aiTived  indepen- 
dently at  the  same  opinion  as  Di'.  Ash.  The  mye- 
litis could  not  have  been  of  great  severity,  could 
hardly  have  caused  destructive  softening  or  fibroid 
degeneration,  or  notable  wasting  of  the  nerve- tissue. 
The  diminution  of  his  leg  mu.scles,  gastrocnemii, 
etc.,  by  four  inches  in  the  girth,  was  of  bad  omen,  but 
though  so  much  liad  gone,  a  large  amount  yet  re- 
mained, which,  though  seriously  devitalized,  was 
capable  of  recuperating  its  faculties  satisfactorily. 
Some  atrophy  of  the  cells  in  the  anterior  horns  must, 
I  suppo.se,  have  occurred,  but  fortunately  did  not 
jn'ogress.  Probably  his  young  age  stood  him  in  good 
stead,  and  his  generally  sound  constitution.  Had  he 
been  twenty  years  older,  had  he  been  strumous  or 
syphilitic,  the  event  might  liavo  been  \e\-y  different. 
I  think  wo  do  not  always  sufllciently  consider  the 
quality  of  the  tissues  involved  in  cases  of  inflamma- 
tion, the  degree  of  their  resisting  jiower  ;  we  are  too 
apt  to  think  of  inflammation  as  a  uniform  ]u-occss. 
Yet,  practically,  the  recuperative  power  of  the  tissue 
rules  the  issue.  The  lesion  was  localized  in  the 
lower  part  of  the  cord,  but  seems  not  to  have  in- 
volved its  whole  tliic'vuess.  While  the  origins  of  the 
crural  and  sciatic  nerves  were  gravely  affected,  those 
of  the  gluteal  and  the  rectal  and  vesical  were  intact. 


THE  MEDICAL  RECORD. 


425 


This  looks  as  if  some  spots  in  the  cord  had  not  been 
invaded  by  the  inflammatory  process,  or,  at  any  rate, 
had  suffered  slightly.  As  the  abdominal  reflex  was 
present  when  he  was  at  his  worst,  it  is  pretty  cer- 
tain that  the  lesion  never  extended  above  the  origin 
of  the  eighth  dorsal  nerve,  and  probably  not  so  high. 
The  deficiency  of  the  plantar  reflex  indicates  that 
the  lesion  extended  very  low. 

The  si/mploms,  especially  in  their  subsidence,  pre- 
sented much  that  was  interesting.  At  first,  and  for 
a  considerable  time,  tremor  was  a  marked  feature.  It 
occurred  whenever  the  volitional  stimulus,  though 
able  to  produce  some  normal  contraction,  failed  of 
its  due  effect,  either  from  fault  in  the  muscle  or 
nerve,  or  in  both.  It  was  evidently  to  a  large  extent 
involuntary,  resembling  a  good  deal  the  ankle 
clonus,  and,  like  it,  depended  very  much  upon  a 
morbid  excitability  of  the  nervo-muscular  api^aratus. 
Tremor,  whether  senile  or  alcoholic,  or  tonic  (as 
mercurial),  or  resulting  from  fatigrie,  always  iftiplies 
diminution  of  "  resistance,"  of  that  jjower  by  which  a 
nerve-cell  regulates  the  evolution  of  force.  The 
failure  of  this  faculty,  often  existing ^<rti-//ia.ssf(,  with 
failure  of  that  which  generates  force,  conditionates 
hyper-excitability.  Together  with  tremor,  rir/idity  of 
half-contracted  muscle  was  often  present.  It  seemed 
when  the  muscle  could  no  longer  shorten,  from  its 
inability  to  move  the  weight  of  the  limb  or  to  over- 
come friction,  that  it  became,  as  it  were,  tetanized. 
This  phenomenon  was  evidently  allied  to  tremor, 
and  was  probably  produced  in  the  same  way,  viz., 
by  rapid  escajje  of  stimidus.  The  blending  of  the 
two  is  well  described  in  one  of  Mr.   Kowe's  notes. 

"  When  H attempts  flexion  the  muscles  become 

hard  and  tense,  but  after  a  time  flexion  stops  and 
tremor  begins,  the  muscles  still  continuing  hard." 

Another  noteworthy  point  was  the  sloicness  with 
which  motor  impulses  arrived  at  the  muscles.  His 
own  remark  was  :  "  I  will  to  perform  a  movement 
some  time  before  I  feel  the  execution  of  it."  Even 
at  an  early  date  it  was  observed  that  his  muscles 
acted  in  a  dilatory  manner  to  faradism,  though  the 
contraction,  when  it  occurred,  was  fairly  good.  We 
could  not  measure  accurately  the  time  occupied  in 
the  passage,  but  it  certainly  appeared  to  be  much 
longer  than  that  which  would  have  been  required  in 
the  healthy  state,  the  normal  rate  of  transmission 
being  variously  estimated  at  one  hundred  to  two 
hundred  feet  per  second.  On  November  28th,  half 
a  second  intervened  between  the  word  of  command 
and  the  action. 

It  was  also  observed,  especially  during  the  earlier 
period  of  his  stay,  that  he  had  difiiculty  in  'lirecling 
his  volitional  impulses  to  the  part  intended,  and 
that  they  sometimes  seemed  inclined  to  go  astray, 
arriving,  for  instance,  at  extensor  muscles  when  they 
should  have  been  confined  to  flexors. 

Both  tliese  latter  defects  indicate  that  the  paths 
along  which  the  nervous  influences  should  have  tra- 
velled were  not  freely  opened  ;  that  its  transmission 
was  more  or  less  impeded,  perhaps  by  the  molecular 
changes  in  the  axis  cylinders  not  being  effected  read- 
ily. The  same  hyijothetical  explanation  may  also  be 
applied  to  the  next  feature  I  have  to  notice,  viz  , 
that  he  was  aWe  to  v<i!k  much  belter  after  beinf/  on  hh 
feel  some  time  than  he  cotJd  aifrst.  Indeed,  he  used 
to  have  so  much  stiffness  of  his  limbs  in  the  morn- 
ing on  awaking,  that  for  some  time  he  felt  quite 
crippled,  and  this  continued  even  after  he  had  im- 
prove 1  considerably.  Prima  facie,  one  would  have 
thought  that,  after  a  long  repose,  the  nerve-cells 
would  have  accumulated  a  greater  store  of  energy 


than  they  could  contain  previously,  tut  it  appears 
that,  thoiigh  this  may  be  the  case,  the  energy  cannot 
be  so  readily  evolved  at  the  first  essay.  The  same 
may  be  noticed  in  states  where  there  is  no  actual 
disease,  as  in  commencing  senility.  In  all  these, 
preliminary  exertion  may  not  increase  the  amount 
of  energy  liberated,  but  may  increase  the  facility  of 
its  transmission,  so  that  the  result  is  that  more  work 
can  he  performed.  ] 

Cohhiess  of  the  feet  and  limdity  were  doubtless  dc- 
jiendent  on  a  tonic  contraction  of  the  arteries  quite 
similar  to  that  which  is  produced  by  cold.  This 
seems  to  be  almost  a  necessary  result  of  inaction  of 
the  large  muscles,  which  when  functioning  vigor- 
ously withdraws  from  the  vasomotor  nerves  the  ner- 
vous energy  which  at  other  times  keejis  the  vessels 
more  or  less  constricted.  In  states  marked  by  mus- 
cular debility  and   hyperaisthesia — and   H "s  at 

this  time  was  such — the  vasomotor  nerves  of  the 
limbs  are  often  unduly  excitable.  This,  of  course, 
checks  free  blood-flow  in  the  muscles,  and  imprdes 
their  nutrition.  During  recovery,  when  the  large  mus- 
cles of  the  limbs  were  being  exerted  to  the  utmost 
eveiy  day,  the  op23osite  condition  of  vasal  paialy- 
sis,  and  perhaps  somewhat  excessive,  natuially  s-u- 
pervened.  A  curious  circumstance  was  that  he 
coidd  exert  notably  morej/o«e)'  vith  his  long fle.rors 
when  lying  nearly  flat  in  the  bed  than  when  half-sit- 
ting up.  I  can  only  account  for  this  on  the  hyj^o- 
thesis  that  in  the  latter  position  some  nerve-force 
was  diverted  to  other  muscles  than  those  of  the 
lower  limbs,  so  that  a  less  amount  was  available  for 
the  jjroduction  of  flexion.  The  increasing  energy  and 
effectiveness  of  the  muscular  contractions  as  improve- 
ment went  on  was  very  remarkable.  Long  after  he 
was  able  to  walk  about  very  fairly  well  he  hod 
scarce  any  power  to  raise  his  foot  fiom  the  giourd, 
and  was  quite  unable  to  rise  to  his  feet  when  sitting 
on  a  common  chair.  Yet  one  would  have  thought 
that  the  muscular  fiower  (of  the  same  muscles) 
which  enabled  him  to  do  the  one  would  have  en- 
abled him  to  do  the  other.  The  muscles  certainly 
were  all  able  to  contract  well,  but  more  energy  was 
required  for  the  latter  actions  than  for  the  former, 
and  this  the  nerve-cells  could  not  at  first  supply. 
In  fact,  to  rise  easily  from  a  chair  was  almost  the 
last  of  his  achievements;  for  some  time  it  reqaiired 
great  effort,  and  was  followed  l>y  gi'eat  tremor. 

The  absence  of  ankle  clonus  coincident  vith  excess  nf 
knee  reflex  seems  to  be  unusual.  Dr.  Gowers  sa_'\s 
that  it  is  just  in  such  conditions  that  the  clonus  is 
best  studied.  I  do  not  think  much  can  be  inferred 
from  the  absence  of  clonus,  certainly,  its  presence 
is  much  more  s.igniflcant  In  a  well-marked  case  of 
syphilitic  myelitis  recently  under  my  care,  the  plan- 
tar and  knee  reflexes  and  ankle  clonus  were  all 
absent. 

The  treatment  consisted  mainly  in  the. administra- 
tion internally  of  quinine  or  bark,  and  ammonia, 
with  phosphorus  and  hypophosphites  ;  the  use  of 
the  latter  especially  coincided  with  rapid  improve- 
ment. Quinine  seemed  to  bedemanded  both  by  the 
malarious  disease  he  had  had  and  by  the  j^ersistent 
enlargement  of  his  spleen,  but  I  cannot  say  that  it 
was  of  any  marked  utility.  Iodide  and  bromide 
were  given  for  short  periods,  but  did  not  avail  mtich. 
Electricity  was  used  largely.  The  constant  cun-ent 
was  applied,  tlie  positive  pole  at  the  dorsal  region, 
the  negative  at  the  feet,  with  much  regularity,  until 
the  later  part  of  his  stay.  Faradization  was  also 
used  frequently,  and  appeared  to  be  really  bene- 
ficial ;  he  said  he  always  felt  better  after  it.     This 


436 


THE   MEDICAL  RECORD. 


testimony  is  tlie  more  reliable  because  be  often  suf- 
fered a  good  deal  from  it.  His  temiierament  was 
not  very  tolerant  of  pain,  and  the  cutaneous  surface 
of  his  lower  limbs  had  at  one  time  been  "decidedly 
hyperfcsthetic,"  and  probably  were  so  still,  to  some 
extent.  The  employment  oi  slow  interniulions  was  a 
great  gain,  the  effect  being,  according  to  Mr.  Howe's 
report,  to  cause  much  less  pain  and  to  produce  in- 
finitely more  lively  contractions  even  from  inert 
groups  of  muscles  than  had  been  obtained  before. 
Duchenne  (p.  7J:'2)  speaks  very  positively  to  the  same 
eBfect.  A.  slowly  interrupted  galvanic  current  was 
very  much  more  painful  than  the  slowly  interrupted 
fiii'adaic ;  he  described  the  former  as  causing  a  sen- 
sation like  tearing  off  the  flesh.  "Where  so  many 
remedies  were  employed  it  is  impossible  to  speak 
conftdently  of  the  effect  of  any  one,  and  even  to 
speculate    is   perhaps    not  wise.       Nevertheless,  I 

confess  that  while  watching  H 's  case  I  had  the 

same  idea  suggested  to  me  which  Dr.  R.  Reynolds 
has  expressed  in  his  little  work  on  electricity  (p. 
39),  where  he  says,  "  It  is  probable  that  in  these 
cases  the  stimulation  of  the  periplieral  ends  of  the 
muscular  nerves  may  have  some  reflex  influence 
on  the  nutrition  of  the  cord,  and  may  assist  in  the 
general  process  of  repair."  As  there  is  no  doubt 
t'lat  damage  may  be  done  to  the  nerve-centres  by 
a  violent  faradization  (vide  Duchenne,  p.  117),  there 
i  I  at  least  a  presumption  tliat  a  moderate,  gentle  ap- 
plication of  the  current  may  have  a  converse  effect. 
At  p.  824  of  T.  N.  D.  I  me'ution  facts  observed  by 
me,  showing  that  the  influence  of  the  faradaic  cur- 
rent extends  beyond  its  track,  and  may  be  diffused 
centripetally  to  the  nerve-centres.  Passive  more- 
ments  were  diligently  performed  by  my  energetic 
coadjutor,  Mr.  Rowe,  and  aided,  I  really  think,  not 
a  little  the  recovery.  Their  effect  was  to  produce 
a  feeling  of  warmth  in  the  paralyzed  parts  and  great 

comfort.    H always  felt  as  if  he  could  get  up  and 

walk  immediately  after.  I  would  certainly  advise  you 
never  to  omit  this  procedure  in  similar  cases.  The 
modus  operandi  of  these  movements  I  conjecture  to 
be  of  the  same  nature  as  that  of  local  faradization; 
they  probably  improve  the  nutrition  both  of  the 
paralyzed  parts  and  of  their  nerve-centres.  The 
fundamental  idea  in  all  such  operations  is  the  soli- 
darity of  our  organs.  A  nerve  is  but  an  extension  of 
a  nerve-centre.  The  ixni^oxiajici:  oi  persevering  trent- 
menl  in  chronic  cases,  even  very  unpromising  ones, 
and  of  measures  thoroughly  and  painstakingly 
carried  out,  is  well  illustrated  by  two  cases  of  in- 
veterate paraplegia  treated  by  Dr.  Morgan,  of  Man- 
ch°.ster,  whom  I  am  glad  to  claim  as  an  old  St. 
Mary's  man.  He  employed  electro-puncture  (vide 
Lancet).  Let  your  motto  be  in  dealing  with  disease, 
"Nnnqunm  die  mori"  (Never  des))air).  It  is  said 
Napoleon  telegraphed  from  the  field  of  Waterloo, 
"  I  have  beaten  the  English,  but  they  won't  go." 
Of  course  they  wouldn't ;  they  did  not  admit  that 
they  were  beaten,  and  so  a  few  hours  later  he  had  to 
go  himself. 

As  to  the  svmptoras  occurring  Ijetween  November 
14th  and  '2tth,  consisting  of  vertigo,  inability  to 
road,  anorexia,  general  malaise,  .slight  pyrexia,  and 
diarrlxr^a,  I  hardly  know  what  cause  to  assign  them 
to.  They  may  have  proceeded  from  a  recurrence  of 
malarial  disorder,  or  from  influenza.  However  this 
may  be,  they  had  no  connection  with  the  para- 
plegia. 

The  last  point  I  wish  to  ask  your  attention  to  is 
the  citK.se  of  our  patient's  recover;!  after  the  previous 
f.iilures.     'To  the  lay  mind  it  is  no  doubt  sufficient 


to  say  that  he  passed  into  the  hands  of  another 
practitioner,  who  of  course  employed  some  other 
remedy  which  the  others  did  not,  and  therefore  he 
got  well.  But  I  am  sure  neither  I  nor  you  could 
hold  shell  language.  The  names  of  Netley  and  of 
Queen  Square  Hospital,  are  sufficient  guarantees 
that  the  best  skill  was  employed  for  our  patient. 
Our  diagnosis  was  the  same  as  their  diagnosis  ;  our 
treatment,  with  the  exception  of  the  hypophosphites, 
and  perhaps  faradization,  was  practically  the  same 

as  theirs.     Up  to  a  late  period  in  H 's  case  I  had 

repeated  questionings  with  myself  whether  I  should 
not  resort  to  the  bichloride  which  Dr.  Kadcliffe  had 
administered,  though  I  did  not  then  know  it.  Why, 
then,  you  may  ask,  did  not  recovery  ensue  earlier? 
I  believe  the  answer  is  contained  in  the  fact  that  ho 
came  to  us  last.  We  had  the  advantage  of  time,  and 
not  only  that,  but  of  all  that  had  Iieen  done  before. 
The   last  ounce   broke   the   camel's  back.      While 

H ,was  at  Netley  the  malady  was  too  recent  to 

be  easily  modified  ;  while  he  was  at  Queen  Square 
improvement  commenced  and  the  disorder  began 
to  yield,  so  that  when  he  came  under  our  hands  the 
task  was  materially  easier  than  it  had  been  to  our 
predecessors.  This  was  a  chronic  disease,  but  im- 
agine an  acute  one — say  pneumonia  or  typhus — 
and  you  wUl  see  at  once  how  important  the  element 
of  time  may  be.  The  patient  has  been  extremely  ill 
for  several  days,  no  decided  improvement  has  yet 
appeared,  the  fiiends  naturally  get  anxious  and  im- 
patient, and  resolve  to  have  other  advice.  You  are 
called  in  perhaiis  a  day  or  two  before  tlie  crisis,  and 
prescribe  some  fresh  remedy.  The  patient  takes  a 
few  doses,  and  forthwith  (as  soon  as  the  crisis 
comes)  is  wonderfully  better,  and  recovers  well. 
Now  are  you  to  acquiesce  tacitly  in  the  praises 
that  may  be  showered  upon  yon  for  your  wonder- 
ful success,  and  your  imagined  .superiority  to  the 
adviser  who  has  preceded  you?  Das  sey  fern,  I 
tinast,  woiild  be  the  hearty  disclaimer  of  every  oin- 
of  you.  So  is  it  mine  as  regards  the  case  befoii 
us. 

One  word  more  only  I  mu.st  add,  and  that  is  tli' 
expression  of  my  sincere  thanks  to  my  excellent 
clerk,  Mr.  Rowe,  who  carried  out  all  my  instructiou.s 
with  rare  zeal,  perseveilance,  and  ability. 


The  Phenomena  or  PARTiitrnoN  in  the  Lo-w-eb 
Animals. — The  British  .UedicalJovmal  caXU  attention 
to  the  prominence  given  to  zoological  or  comparative 
pathology  at  i-ecent  sessions  of  the  Pathological 
Society.  '  In  speaking  of  the  field  liere  open  for  in- 
vestigation, it  says  : 

"  "The  nature  and  causes  of  the  remarkable  bone  and 
joint  diseases  simulating  osteo-arthriti.s,  gout,  rheu- 
matism, and  syphilis,  in  animals,  offer   a  wide  field  ] 
for  research.     Equally  remarkable  is  the  subject  of 
parturition  in  animals.     The  female  tapir,  in  giving 
birth  to  her  oflspring,  at  the  Zoc'Uogical   Gardens 
last  week,  appears   to  have  had  an  almost  painless 
labor;    the  agonies  suffered  by  the  hippopotamus, 
and  the  laceration  of  her  perin.vum  when  her  first  calf  | 
was  V)orn  at  the  gardens,  are  well  known  to  British  i 
zoiilogists  ;  as  is  the  fact  that  i>ure  blood  exudes  in  [ 
lai'ge  drops  from  her  skin  umlersuch  circumstances, 
and  even  during  paroxysms  of  what  appenr  to  be  ill 
temper.     Remarkable  fact.s  of  this  kind  might  well 
be  ajipliod  to  scientific  purjioses  and  considerations, 
and  r.ot  left  merely  to  adorn  the  pages  of  sporting 
journals." 


THE  MEDICAL  RECORD. 


427 


©riglmil  Conituunlcatlons. 


THE  QITESTION  OF  LAPAEOTOjMY  FOR 
THE  RELIEF  01'  ACUTE  INTESTINAL 
OBSTRUCTION.* 

By  HENRY  B.  SANDS,  M.D., 

NEW  TOKK. 

The  remarks  which  I  desire  to  make  in  tlie  present 
communioation  have  been  suggested  to  me  by  the 
following  singular  case  that  recently  came  under  my 
observation. 

On  the  evening  of  Jannary  22, 1  was  asked  by  Dr. 
Draper  to  see  a  gentleman  sixty-?even  years  of  age, 
who  had  been  suffering,  during  the  previous  forty- 
eight  hours,  with  symptoms  of  obstruction  of  the 
bowels.  The  patient  was  a  clergyman,  who  had 
formerly  been  robust  and  healthy,  but  whose  strength 
had  within  the  past  year  visibly  declined  without 
any  assignable  cause.  Impaired  appetite  and  scanty 
alviue  evacuations,  were  the  only  symptoms  that  had 
attracted  his  attention.  To  overcome  what  was  be- 
lieved to  be  an  attack  of  ordinary  constipation,  he 
had  taken,  during  the  two  days  previous  to  my 
visit,  four  compound  cathartic  pills,  in  divided  doses, 
and  a  saline  cathartic.  These  remedies  induced  one 
or  two  scanty  stools,  but  caused  restlessness  and 
discomfort ;  and  after  taking  the  last  dose  on  January 
21st,  he  began  to  hiccough  and  vomited  the  contents 
of  the  stomach,  mixed  with  bile.  When  I  first  saw 
him,  the  intestinal  obstruction  seemed  to  be  com- 
plete, and  it  continued  so  up  to  the  time  of  his 
death,  wliich  occuiTed  on  January  30th,  ten  days  after 
the  commencement  of  the  attack.  Two  or  three 
times  during  his  illness  he  voided  a  small  amount  of 
fl.itus  per  anum  ;  and  hopes  were  entertained  that 
fecal  evacuations  would  follow.  Nothing  was  passed, 
however,  except  the  nutritive  enemata  and  the 
enemata  of  water  which  were  emj^loyed  several  times 
with  the  view  of  overcoming  the  obstruction.  The 
vomiting  became  stercoraceous  on  the  fourth  dav, 
the  fecal  character  of  the  matter  vomited  growing 
more  decided  as  the  disease  progressed.  At  first, 
the  urine  was  scanty,  but  afterward  it  was  passed  in 
normal  quantity.  A  remarkable  feature  in  the  ease 
was  an  entire  absence  of  abdominal  pain.  Tympa- 
nites came  on  very  slowly,  and  was  not  at  all  marked 
until  two  days  before  death. 

At  the  time  of  my  first  visit,  Dr.  Draper  and  my- 
self carefully  examined  the  abdomen  without  dis- 
covering any  clue  as  to  the  cause  of  the  obstruction. 
The  abdominal  wails  were  soft  and  elastic,  the  only 
departui-e  from  the  normal  condition  being  a  slight 
resistance  offered  to  deep  pressure  when  made  in 
the  right  hypochondrium.  But  no  defined  tumor 
could  be  distinguished.  Opium  was  administered  to 
allay  hiccough,  and  the  use  of  this  drug,  either  alone 
or  in  combination  with  belladonna  or  acetate  of  lead, 
was  continued  until  toward  the  close  of  life.  Dr. 
Van  Buren  saw  the  patient  on  January  23d  and  24th, 
and  Dr.  Weir  on  the  days  following.  Dr.^Van  Buren 
cinjectured  that  the  obstruction  might^be  due  to 
the  impaction  of  a  mass  of  undigested  food  at  some 
point  of  the  small  intestine  already  nan-owed  by  a 
cancerous  growth.  This  supposition  was  strength- 
ened by  the  result  of  an  examination  of  the  matters 
vomited.  Some  of  these  contained  blood,  and  under 

•  Read  before  the  New  York  Surgical  Society,  February  14,  1883. 


the  microscope  were  found  by  Dr.  Draper  to  esljibit 
a  number  of  large  cells,  having  large  nuclei  and  nu- 
cleoli. Dr.  Weir  suspected  that  the  obstruction 
was  situated  in  the  large  intestine  ;  and,  with  the 
view  of  removing  it,  three  or  four  copious  injections 
of  water  were  administered  while  the  patient  was  in 
the  knee  elbow  position.  Tlie  water  entered  freely 
to  the  amount  of  five  pints,  but  returned  without  a 
trace  of  fecal  matter. 

On  January  28,  the  obstruction  remaining  unre- 
lieved, it  was  decided  to  etherize  the  patient  and 
make  a  manual  exploration  of  the  rectum.  This 
was  done  with  a  negative  result,  the  rectum  being 
naturally  so  narrow  at  the  level  of  the  peritoneal  re- 
flexion over  the, second  part  of  the  gut,  as  to  jjrevent 
my  hand  from  passing  beyond  it.  The  abdomen 
was  then  kneaded  in  the  ho2ie  of  overcoming  some 
obstruction,  concerning  the  seat  or  nature  of  which 
none  of  us  could  foi-m  a  definite  opinion.  Colotomy, 
enterotomy,  and  laparotomy  were  considered  and 
rejected,  the  two  former  as  being  too  uncei-tair,  and 
the  latter  as  being  both  uncertain  and  dangerous, 
in  view  of  the  patient's  age,  ill-health,  and  enfeebled 
condition.  Indeed,  at  that  time  there  were  ominous 
signs  of  heart-failure,  and  any  severe  operatic  n  would 
doubtless  have  proved  fatal. 

On  January  2'.(th,  croton  oil  was  given,  in  the  hope 
of  removing  a  X'ossible  fecnl  impaction.  The  medi- 
cine failed  to  overcome  the  obstruction,  and  caused 
an  increase  of  vomiting  and  hiccough.  The  jiatient 
sank  rapidly  dm-ing  the  night,  and  died  on  Janu- 
ary 30th. 

A  post-mortem  examination  showed  that  the  ob- 
stniction  had  been  caused  by  a  gall-stone,  nearly  cy- 
lindrical in  shape,  measuring  IJ  inch  in  its  longer, 
and  1}  inch  in  its  shorter  diameter.  This  was 
found  in  the  ileum,  about  four  feet  from  the  ileo- 
cfecal  junction.  The  intestine  above  the  obstruct- 
ed point  was  congested  and  distended,  while  that 
Vielow  it  was  pale  and  collapsed.  An  examina- 
tion of  the  gall-bladder  revealed  a  large  ulcerated 
opening,  through  which  the  calculus  had  doubtless 
escaped  into  the  duodenum,  to  which  the  gall- 
bladder was  fiimly  adherent.  Evidences  of  chronic 
adhesive  peritonitis  were  present  in  the  neighbor- 
hood of  the  gallbladder  and  duodenum,  the  parts 
being  indurated  and  matted  together  by  plastic 
lymph.  Besides  the  lesions  described,  the  liver  was 
quite  fatty,  and  the  kidneys  granular. 

In  reviewing  this  unfortunate  case,  the  most  strik- 
ing feature  noticeable  is  its  obscurity.  Intestinal 
obstruction  depending  on  the  impaction  of  a  gall- 
stone is  exceedingly  rare,  constituting  not  quite  four 
per  cent,  of  all  cases.  It  is  also  said  to  be  four  times 
more  frequent  in  females  than  in  males.  Often  the 
obstruction  is  preceded  by  one  or  more  attacks  of 
hepatic  colic,  with,  perhaps,  jaundice  ;  and  the  pain 
attending  the  obstruction  is  almost  uniformly  sud- 
den and  violent.  Occasionally  the  calculus  may  be 
felt  through  the  abdominal  wall,  or  its  situation  in- 
dicated by  the  discovery  of  a  spot  tender  on  pres- 
sure, and  dull  on  percussion.  In  the  case  reported, 
these  aids  to  diagnosis  were  all  wanting.  The  attack 
was  preceded  by  neither  colic  nor  jaundice,  was  rn- 
aeoompanied  with  pain,  nor  did  the  calculus  give 
any  physical  sign  of  its  presence  in  the  intestiral 
canal.  Moreover,  some  of  the  symptoms  were  evi- 
dently misleading,  such  as  the  mild  course  of  the 
disease  during  the  first  week,  the  entire  absence  of 
pain,  the  history  of  previously  failing  health,  with 
scanty  fecal  evacuations,  and  the  discovery  in  tie 
matters  vomited  of  blood-globules  and  epithelial 


J  28 


THE  MEDICAL  RECORD. 


structures  suggestive  of  cancer.  In  sliort,  tlie  symp- 
toms characteristic  of  the  existing  lesion  were  ab- 
sent, while  those  present  led  to  erroneous  conclusions 
respecting  the  cause  of  the  disease.  The  case  thus 
affords  a  conspicuous  illustration  of  the  diagnostic 
difficulties  that  beset  the  surgeon  in  his  endeavor 
to  give  a  right  interpretation  to  the  complex  group 
of  symptoms  so  often  met  with  in  those  suffering 
from  intestinal  obstruction. 

If  the  cause  of  obstruction  in  the  case  reported 
had  been  known,  would  the  operation  of  abdominal 
section  have  been  indicated  ?  I  think  that  the  an- 
swer to  this  question  must  be  somew-hat  qualified. 
If  our  knowledge  were  limited  to  the  fact  that  a 
gaU- stone  was  the  cause  of  obstruction,  laparotomy 
would,  in  my  judgment,  be  a  very  doubtful  expe- 
dient, inasmuch  as  such  obstructions  are  well  known 
to  have  been  overcome  by  the  efforts  of  nature, 
aided  in  some  instances  by  medical  treatment,  or  by 
the  simple  surgical  expedient  of  abdominal  taxis. 
Much  larger  gall-stones  than  the  one  now  exhibited 
have  been  passed  per  anum,  and  in  many  cases  that 
recovered  the  symjjtoms  were  very  acute.  In  the 
"  Med.  Chir.  Transact."  of  181.5  (vol.  vi.,  p.  98),  Mr. 
Thomas  records  the  case  of  a  lady,  aged  sixty-three, 
who,  after  suffering  for  five  days  with  the  symptoms 
of  complete  intestinal  obstruction,  was  suddenly  re- 
lieved by  coitions  fecal  discharge,  in  one  of  which 
was  found  a  biliary  calculus  a  little  more  than  an 
inch  in  diameter.  It  is  a  cmious  circumstance  that 
this  patient  had  an  u-reducible  hernia,  containing 
intestine,  thi-ough  which  the  calculus  must  have 
passed,  and  that  during  her  illness  the  hernia  was 
regarded  as  being  the  cause  of  obstruction,  an  ojjera- 
tion  not  being  performed  merely  for  the  reason 
that  the  patient  would  not  submit  to  it. 

In  the  twelfth  volume  of  the  "Med.  Chir.  Trans." 
Mr.  Brague  reports  the  case  of  a  lady,  aged  sixty- 
five,  who,  after  complete  obstruction  had  existed  for 
six  days,  was  relieved  by  the  passage  of  two  calculi, 
the  larger  of  which  weighed  176  grs.  The  patient's 
symptoms  were  very  severe,  and  at  one  time  her 
situation  was  believed  to  be  hopeless.  Her  recovery 
was  ascribed  to  the  action  of  purgatives — croton-oil 
(three  drops),  castor-oil,  and  colocynth  being  the 
principal  medicines  employed. 

An  extraordinary  instance  of  recovery  is  related 
by  Dr.  Omond,  and  quoted  by  Thudichum  in  his 
treatise  on  gall-stones.  The  patient  was  a  woman, 
aged  forty,  and  complete  obstruction  existed  for 
nearly  four  weeks,  when  some  feculent  matter  was 
voided.  At  the  end  of  five  weeks  a  biliary  calculus 
was  passed,  which  measured  three  inches  iu  circum- 
ference. Stercoraceous  vomiting  set  in  on  the  third 
day,  and  continued  for  three  weeks.  Purgatives 
were  administered  by  the  mouth  and  by  rectal  ene- 
mata. 

Cases  are  also  recorded  in  which  recovery  took 
place  under  the  administration  of  opium  and  bella- 
donna, which  by  many  authorities  are  regarded  as 
preferable  to  purgatives  in  the  management  of  the 
afTection  now  under  consideration. 

The  only  statistical  account  of  this  class  of  cases 
which  I  have  found  is  that  given  by  Buchaussoy,* 
who  reports  twenty  cases  of  acute  intestinal  obstruc- 
tion caused  by  gall-stones.  Of  this  number,  six,  or 
nearly  one-third,  recovered.  It  may  well  be  doubted 
whether  this  ratio  of  mortality  will  ever  be  reduced 
by  lapiro-enterotoiny,  whoa  we  consider  the  ad- 
vanced age  and  tlie  usually  feeble  health  of  those 

*  CongrdB  M^diooChirnrgical  cle  Fmnce,  Iro  Session. 


persons  in  whom  the  accident  occurs,  the  concomi- 
tant lesions  of  the  liver  and  intestine,  the  inten- 
sity of  the  symptoms,  and  the  uncertainties  of 
diagnosis.  However  this  may  be,  it  is  evident 
that  cases  of  this  kind  are  by  no  means  altogether 
hopeless,  and  that  they  are  less  dangerous  than 
those  of  obstruction  depending  on  many  other 
causes.  On  the  other  hand,  surgery  has,  unfortu- 
nately, no  triumphs  to  record  in  dealing  with  these 
cases  by  laparotomy.  I  am  able  to  refer  only  to  one 
instance  in  which  the  operation  has  been  done.  In 
March,  1879,  Mr.  Bryant  operated  on  a  woman  aged 
fifty,  who  had  suffered  during  seventy-two  hours 
previously  with  symptoms  of  complete  intestinal 
obstruction,  which  Mr.  Bryant  believed  to  depend 
on  volvulus,  band,  or  intestinal  hernia,  the  pretence 
of  a  gall-stone  not  being  suspected.  But,  upon 
opening  the  abdomen,  a  gall-stone  measuring  l^xli 
inch  was  discovered  in  the  lower  part  of  the  ileum, 
about  a  foot  from  the  caecum.  The  intestine  was 
opened,  the  calculus  extracted,  and  the  wound  in 
the  intestine  closed  by  catgut  sutures.  The  intes- 
tine was  jjunctured,  in  order  to  allow  it  to  be  re- 
turned within  the  abdominal  cavity.  Death  occuired 
eight  hours  after  the  operation,  and  at  the  autopsy 
there  were  found  evidences  of  peritonitis,  some  de- 
gree of  which  was  noticed  at  the  time  of  operation. 
Mr.  Bryant  thought  that  the  operation  in  this  case 
was  performed  too  late.  This  is,  doubtless,  (rue ; 
but  it  seems  equally  certain  that  the  operation  de- 
termined and  hastened  the  fatal  event. 

Notwithstanding  the  facts  before  us,  however,  I 
should  without  hesitation  perform  laparotomy  and 
extract  the  calculus  in  any  case  in  which  a  correct 
diagnosis  could  be  made  at  an  early  period,  and  in 
which  the  size  of  the  calculus  was  such  as  to  ronder 
its  expulsion  through  the  natural  outlet  im])roV'ab)e. 
And,  except  in  those  rare  instances  in  which  the 
calculus  can  be  detected  by  palpation  of  the  anterior 
abdominal  wall,  I  know  of  no  means  by  which  a 
diagnosis  can  be  made,  unless  by  manual  explora- 
tion of  the  rectum.  In  the  case  I  have  reported, 
this  method  yielded,  it  is  ti-ue,  no  important  lesult, 
because  the  rectum  was  exceptionally  narrow,  and 
prevented  the  hand  from  making  the  usual  excur- 
sions. But  had  I  succeeded  in  passing  this  con- 
stricted point,  I  should  unquestionably  have  dis- 
covered the  foreign  body,  and  been  able  to  ascertain 
its  size  and  position ;  for,  at  the  autopsy,  it  was  found 
in  the  hypogastrium,  considerably  below  the  level 
of  the  umbilicus,  which  can  ordinarily  be  reached 
with  entire  safety  by  Simon's  method  of  examina- 
tion. In  future  I  would  be  disposed  to  recommend 
an  immediate  resort  to  manual  rectal  exploration  in 
cases  of  intestinal  obstruction,  because  in  the  ecrly 
stage  of  the  disease,  before  the*  occurrence  of  ab- 
dominal distention,  the  examination  would  be  much 
more  likely  to  afford  the  desired  information  than 
when  undertaken  at  a  later  period,  and  also  because 
it  might  indicate  the  propriety  of  early  operative 
interference,  with  the  maximum  chances  of  success. 
The  general  question  of  the  value  of  laparotomy 
as  an  expedient  in  the  treatment  of  acute  intestinal 
obstruction,  is  one  much  too  wide  for  profitable  dis- 
cussion within  the  limits  of  the  pre.<;ent  paper  ;  but 
I  fear  that  the  mortality  of  the  operation  (estimated 
by  Ijeichtenstern  at  seventy  per  cent.)  would  be 
found  to  be  much  greater  if  the  unsuccessful  cases 
were  duly  recorded.  In  this  matter  I  am  compelled 
to  confess  my  own  delinquency,  as  out  of  three 
cases  in  which  I  have  performed  laparotomy  for 
the  relief  of  intestinal  obstruction,  I  have  published 


THE  MEDICAL  RECORD. 


429 


only  a  single  case,  which  was  successful.  This,  as 
is  known  to  most  of  the  members  present,  was  a 
case  of  intussusception,  occurring  in  an  infant  sis 
months  old,  and  treated  by  operation  eighteen  hours 
after  the  commencement  of  the  disease.  The  two 
fatal  cases  may  be  briefly  told  as  follows  : 

One  was  that  of  a  man  about  forty  years  of  age, 
upon  whom  I  jierformed  laparotomy  in  the  Roose- 
velt Hospital,  in  February-,  1876.  Complete  ob- 
struction, with  severe  pain,  had  existed  for  six  days, 
and  no  cause  could  be  assigned  for  it.  The  abdo- 
men was  gi-eatly  distended,  and  vomiting  was  al- 
most incessant,  although  at  no  time  was  it  .stercora- 
ceous.  The  patient  was  in  fair  condition  at  the  time 
of  the  operation.  An  extensive  inci.sion  was  required 
to  reveal  the  cause  of  obstruction,  which  was  found 
to  be  a  twisting  and  displacement  of  the  c.-ecum  and 
colon,  by  which  the  mesentery  and  the  small  intes- 
tine were  encircled  and  constricted  by  the  meso- 
colon. The  caput  coli  lay  in  the  right  hypochon- 
drium.  By  making  pressure  on  the  distended 
intestines,  I  readily  caused  the  escape  of  their  con- 
tents per  anum ;  and  having  thus  reduced  their 
volume,  I  was  able  to  restore  the  parts  to  their  nor- 
mal position.  Copious  purging  followed  the  opera- 
tion, showing  that  the  obstruction  was  relieved  ; 
but  the  patient  died  of  shock  six  hours  after- 
ward. The  aiitopsy  pi'oved  that  the  obstruction 
had  been  occasioned  simply  by  the  malposition  ot 
the  intestine  already  described. 

The  second  case  terminating  fatally  was  that  of  a 
boy  six  and  one  half  months  old,  whom  1  saw  in 
1879,  in  consultation  with  Dr.  Griswold,  and  on 
whom  I  operated  for  intussusception  of  forty-eight 
hour.s'  duration.  The  child's  condition  was  bad,  but 
•I  operated  because  I  was  certain  that  the  case  would 
end  fatally  if  left  to  itself.  An  incision  three  inches 
long  enabled  me  to  reach  the  intussuscejition,  which 
was  of  the  ileo-csecal  variety,  and  extended  as  far 
as  the  sigmoid  flexure.  Ke-'uction  was  efTected 
with  some  difficulty,  and  was  accompanied  with 
slight  laceration  of  the  intestinal  peritoneum.  The 
intestines  were  replaced  without  force,  and  the 
wound  was  readily  closed  with  .silver  sutures.  The 
child  failed  to 'rally,  and  died  four  hours  after  the 
operation. 

These  cases  are  the  only  ones  in  which  I^|have 
performed  laparotomy  for  intestinal  obstruction. 
But  I  may  properly  cite  a  case  which  has  never,  so 
far  as  I  am  aware,  been  published,  in  which  I  ad- 
vised and  assisted  at  an  operation  performed  a  few 
years  ago  by  a  medical  friend.  The  patient  was  a 
man  about  thirty  years  ot  age,  who  had  suSered 
from  acute  obstniction  for  a  week  before  the  opera- 
tion. No  exact  diagnosis  could  be  made.  "When 
the  abdomen  was  opened,  the  intestinal  coils  were 
found  extensively  adherent  to  one  another,  in  conse- 
quence of  foi-mer  peritonitis  ;  and  a  careful  search 
failed  to  discover  the  nafrure  or  seat  of  the  obstruc- 
tion. The  abdominal  wound  was  closed,  and  the 
patient  died  soon  afterward  from  exhaustion 

The  resulte  of  my  experience,  therefore,  are  not 
very  encouraging;  yet  I  am  well  assured  that  in  my 
onlv  successful  case,  death  would  have  occurred 
without  the  aid  of  the  knife.  I  am  convinced  that 
in  many,  cases  of  intussusception  the  operation  of 
laparotomv  is  an  imperative  duty,  and  that  when 
performed  earlv  it  will  save  lives  that  would  other- 
wi.se  be  inevitably  doomed. 

I  would  also  strongly  urge  the  performance  of  the 
operation  in  certain  cases  of  acute  obstruction  de- 
pending on  the  reduction  of  hernia  en  masse;  on 


the  presence  of  foreign  bodies  that  cannot^be  other- 
wise removed  ;  on  constriction  by  bands ;  cr  even 
in  cases  in  which  the  cause  of  obstmetion  is  un- 
known, provided  this  seems  to  be  invincible,  snd 
when  life  must  otherwise  be  sscrificf  d.  And  I  am 
confident  that  success  will  be  eon  mensurate  with 
our  ability  to  form  an  early  diagnosis  of  the  nioibid 
state,  so  that  the  ojieration  may  be  undertaken  be- 
fore the  patient's  vitality  has  been  sensibly  kweied 
by  the  progress  of  the  disease.  Laparotomy  must 
always  be  our  ideal  in  the  operative  treatment  of 
this  class  of  cases  ;  and  perhaps,  at  some  future  day, 
it  may  be  realized. 

But  there  is  another  class  of  cases  in  which  our 
ignorance  far  exceeds  our  knowledge,  namely, 
those  in  which  the  diagnosis  goes  no  further  than 
to  establish  the  fact  that  obstruction  exists.  Now 
what  should  be  our  rule  of  conduct  here?  This  is 
the  point  on  which  I  would  especially  invite  dis- 
cussion. Is  an  ear!;/  operation  the  preferable  alter- 
native? Is  the  danger  of  delay  greater  than  that  of 
interference?  Shall  we  iierform  laparotomy  os  .<^con 
as  we  are  sure  that  the  obstruction  is  ccnplete? 
This  question  is  somewhat  speculative.  It  is  an- 
swered in  the  cffirniative  by  some  surgeons  of  san- 
guine disposition,  and  also  by  some  ovariotrmists, 
whose  views  are  evidently  biased,  however,  by  their 
special  field  of  observation.  It  seems  hardly  neces- 
sary to  state  that  there  is  no  parallel  between  ovari- 
otomy cases  and  cases  of  intestinal  obstrnctirn. 
The  points  of  resemblance  are  far  less  nun.erous 
than  those  of  contrast ;  and  it  is  idle  to  hope 
that  the  brilliant  successes  of  ovariotomy  will  ever 
mark  the  performance  of  abdominal  section  frrthe 
relief  of  intestinal  obstruction.  I  ccnfess  thfit  I 
feel  a  great  reluctance  to  entertain  the  proposal  of 
immediate  operation,  however  complete  nay  be  the 
obstruction,  unless  I  can  form  a  rf  asorable  conjec- 
ture as  to  its  cause.  One  reason  for  this  feeling  is 
the  uncertainty  attending  the  operation  itself,  many 
explorations  having  failed  to  discover  the  scat  or 
the  nature  of  the  ol'struction,  as  in  one  case  I  have 
already  narrated.  But  my  chief  objection  to  imrre- 
diate  operation  is  based  on  the  fact  that  the  surpern 
can  never  tell  whether  recovery  is  not  possible  with- 
out laparotomy.  If  the  rule  could  be  estsiblishcd 
that  cases  of  this  kind  are  as  little  likely  to  recover 
without  surgical  aid  as  are  cases  of  stronpulated 
hernia,  the  propriety  of  laparotomy  mipht  be  strongly 
urged  as  increasing  the  patient's  chances  of  life. 
But  the  truth  is,  that  a  considerable  number  of 
these  obscure  obstructions,  even  when  severe  in 
character,  are  oxercoioe.  without  resort  to  the  knife, 
and  sometimes  without  any  troatment  whatever.  I 
mav  be  allowed  to  cite  the  following  cases  in  illus- 
tration : 

About  four  years  ago  I  saw  a  young  gentleman 
in  this  city  in  consultation  with  Drs.  Taylor, 
Clark,  and  Metcnlfe.  Four  days  previously  he  had 
been  suddenly  seized  with  abilomin.il  pain,  followed 
by  nausea  and  vomiting.  These  symptoms,  with 
absolute  constipation  and  gradually  increasing  tym- 
panites, continued  up  to  the  time  of  my  visit.  Vom- 
iting occurred  about  every  four  hours,  the  matters 
vomited  being  thin  and  yellow,  but  not  stfrccra- 
ceous.  Pain  was  moderate  in  severity  and  not  local- 
ized. Eeetal  examination  caused  pain  when  the 
finger  was  pressed  in  the  direction  of  the  right  iliac 
fossa,  but  no  tumor  could  be  discovered,  nor  any- 
thing else  to  indicate  the  seat  of  obstruction.  Dr. 
Tavlor  had  administered  purgatives  and  enfmata 
without  effect,  and  had  already  commenced  the  ad- 


430 


t:he  medical  record. 


miaistration  of  opium.  I  punctured  the  distended 
intestine  in  three  places  with  a  hypodermic  needle, 
through  which  there  escaped  a  considerable  quantity 
of  gas,  and  a  little  liquid  f;coes.  It  was  decided  to 
keep  the  patient  moderately  under  the  influence  of 
opium,  to  abstain  from  farther  attempt  to  move  the 
bowels,  to  apply  fomentations  to  the  abdomen,  and 
to  administer  nourishment  by  means  of  rectal  ene- 
mata.  Two  days  later  a  small  amount  of  wind  and 
fseaes  passed  per  anum ;  and  soon  afterward  copious 
fcBCal  evacuations  occurred,  with  entire  cessation  of 
pain,  abdominal  distention,  and  other  symptoms  of 
obstruction.  A  week  later  the  patient  was  conval- 
escent. 

I  am  aware  that  this  case  may  probably  have  been 
one  of  peritonitis,  but  it  had  rather  the  characters 
of  intestinal  obstruction,  and  was  so  considered  by 
all  who  saw  it. 

A  second  case  came  under  my  notice  last  autumn, 
in  consultation  with  Dr.  John  A.  VVyeth,  of  this 
city.  A  gentleman,  sixty-nine  years  of  age,  while 
in  full  heath,  and  without  any  history  of  pi-evious 
illness,  was  attacked  with  obstinate  constipation, 
abdominal  pain,  and  gradually  increasing  tympani- 
tes. There  was  tenderness,  but  no  tumor,  in  the 
right  iliac  fossa.  The  vomiting  was  not  steroorace- 
ous.  0  tthartios  had  been  administered  without  effect. 
Dr.  Wyefch  first  saw  the  patient  four  days  after  the 
commencement  of  the  disease.  He  administered 
morphia,  and  copious  I'ectal  enemata,  nine  pints  of 
water  being  injected  at  one  time.  Five  of  these  ene- 
mata were  employed  during  a  period  of  three  days, 
and  on  the  eighth  day  of  his  illness  the  bowels  were 
freely  moved  and  the  patient  became  convalescent. 

A  third  case  I  saw  live  years  ago,  at  St.  Luke's 
Hospital.  A  German,  fifty-five  years  of  age,  {was 
admitted  on  account  of  obstruction  which  had 
lasted  for  two  days.  The  symptoms  were  pain  in 
the  loiver  part  of  the  abdomen,  constipation,  and 
vomiting.  The  patient  had  suffered  from  an  old  in- 
guinal hernia  on  the  right  side.  He  told  us  that 
the  signs  of  obstruction  came  on  the  day  after  he 
had  lifted  a  heavy  weight.  A  puffy  swelling,  receiv- 
ing a  slight  impulse  on  coughing,  could  be  felt  at 
the  situation  of  the  right  external  abdominal  ring, 
which  was  patulous.  There  was  moderate  abdomi- 
nal distention.  Shortly  after  his  admission,  the  pa- 
tient was  etherized  and  submitted  by  Dr.  Sabine  to 
a  manual  exploration  of  the  rectum.  No  tumor  or 
hernia  could  be  felt,  and  the  putfiness  in  the  ingui- 
nal region  was  thought  to  be  due  to  the  presence  of 
an  empty  hernial  sac.  Opium  was  administered, 
but  the  patient  grew  worse,  and  on  the  fifth  day  of 
the  disease  the  vomiting  was  copious  and  decidedly 
atercoraceous.  Belief  by  free  fecal  evacuations  oc- 
curred on  the  tenth  day.  After  this  time  he  gradu- 
ally improved,  and  was  discharged  from  the  hospital 
cured  in  a  fortnight  later. 

The  London  Lnncet,  of  January  3,  1880,  contains 
an  account  of  a  case  of  obstruction  in  which  the 
symptoms  were  very  severe  and  of  long  duration, 
relief  not  being  afforded  until  the  thirty-ninth  day. 
The  patient  was  a  lad,  seventeen  years  of  ago,  who 
was  attacked  suddenly  with  a  sharp  pain  in  the 
right  iliac  region,  accompanied  with  vomiting  and 
diarrhoea.  On  the  day  following,  signs  of  obstruc- 
tion were  manifest,  and  the  vomiting  became  ster- 
coraoeous.  Ou  the  fourth  day,  the  question  of 
laparotomy  was  considered,  and  the  operation  re- 
jected, the  case  being  regarded  as  hopeless.  Fre- 
quent sterooraceous  vomiting  continued  during  the 
next  ten  days,  and  the  patient's  death  was  moment- 


arily expected.  On  the  thirty-third  day  he  passed 
per  anum  a  small  quantity  of  blood  and  mucus; 
and  on  the  thirty-ninth  day  relief  came,  after  the 
passage  of  what  was  estimated  to  be  a  quart  of 
blood.  Soon  afterward  fecal  matter  and  pus  were 
noticed  in  the  discharges.  He  recovered  slowly,  but 
was  reported  to  be  in  perfect  health  three  months 
later.  The  principal  medicine  employed  was  Do- 
ver's powder.  The  case  remained  obscure  to  the 
last.  Intussusception  was  suspected  on  account  of 
the  hemorrhagic  evacuations,  which,  however,  were 
carefully  examined  without  discovering  any  intesti- 
nal tissue.  It  was  conjectured  that  the  obstruction 
had  been  occasioned  by  a  blood-clot,  the  result  of  an 
intestinal  hemorrhage. 

A  still  more  remarkable  case  is  recorded  by  Dr. 
John  G.  Blake,  in  the  Boston  Medical  and  Surgical 
Journal  of  November  23,  1876.  A  man  forty-six 
years  of  age,  of  excellent  constitution,  who  had  suf- 
fered from  slight  constipation  and  "biliousness" 
for  some  months  previous  to  his  illness,  became  ob- 
stinately constipated,  and  complained  of  soreness  in 
the  lower  part  of  the  abdomen.  Purgatives  were 
taken  without  inducing  fecal  evacuations.  A  careful 
examination  at  the  time  failed  to  reveal  the  cause 
or  seat  of  the  obstruction,  which,  however,  was  af- 
terward thought  to  be  in  the  small  intestine.  No 
movement  of  the  bowels  took  place  for  eighteen 
weeks,  at  the  end  of  which  period  the  patient  had 
hourly  evacuations  of  a  tarry  looking  matt^er,  the 
quantity  voided  in  twenty-four  hours  being  estimated 
at  a  gallon.  Diarrhcea  afterwaid  set  in,  and  a  week 
later  death  occurred  from  exhaustion.  There  was 
no  autopsy.  Hiccough  and  tympanites  were  promi- 
nent features  of  the  disease,  and  the  jirolongation  of 
life  was  ascribed  to  the  free  aspiration  of  the  dis- 
tended intestine,  the  instrument  having  been  em- 
ployed one  hundred  and  fifty  times  while  the  case 
was  in  progress.  Both  gaseous  and  fluid  contents 
of  the  intestine  were  withdrawn  in  large  quantity. 
No  peritonitis  followed  the  numerous  punctiires. 

It  is  needless  to  quote  further  cases.  Similar  exam- 
ples may  be  found  in  large  numbers  scattered  among 
medical  periodicals,  and  in  surgical  treatises.  How 
many  might  be  collected  I  cannot  say  ;  but  I  ima- 
gine that  the  number  would  far  exceed  that  of  re- 
coveries reported  after  lajjarotomy.  They  suffice  to 
prove  that  spontaneous  recoveiw  is  not,  even  in  severe 
cases,  so  very  infrequent;  and  I  think  they  should 
make  us  cautious  in  recommending  laparotomy  at 
an  early  period,  unless  the  indications  for  interfer- 
ence are  tolerably  clear.  The  pathology  of  these 
curious  cases  is  quite  obscure.  Organic  lesions 
probably  exist  in  some  instances,  while  in  others 
spasm  or  paralysis  of  some  pai-t  of  the  intestine  has 
been  imagined  to  aftord  an  adequate  explanation  of 
the  symptoms  presented.  That  fatal  obstructions 
of  an  acute  character  may  be  unattended  by  any  av- 
preciable  material  changes  discoverable  on  post- 
mortem examination  has  been  abundantly  proved  by 
the  testimony  of  several  writers  on  this  subject. 

In  conclusion,  I  venture  to  submit  the  following 
questions  to  the  members  of  the  society  : 

jP/r.f/.'-What  is  the  result  of  their  experience  in 
the  performance  of  laparotomy  for  the  relief  of  acute 
intestinal  olistruction '? 

Seco7i(l  — What  number  of  such  cases  Rave  they 
known  to  terminate  in  recovery  without  operation  ? 
Third.  —Should  laparotomy  be  performed  at  an 
early  period  in  cases  of  acute  obstruction,  when  no 
opinion  can  bo  formed  resi)ecting  its  character  or 
situation  ? 


THE   MEDICAL  RECORD,, 


431 


ON  THE  TREATMENT  OF  SOIME  FORUMS  OF 
INTESTINAL  OBSTRUCTION  BY  OFimi. 

By  Pkofessor  GEORGE  E.  POST,  M.D., 

bTRIAN  PROTESTAKT  COLLEGE,  BEIBUT,  STBIA. 

Intestinal  obstruction  may  be  divided  into  two 
kinds,  c?iro)iic  and  acute.  The  chronic  sort  may  be 
produced  by  the  pressure  of  abdominal  tumors 
caiising  difficulty  in  the  passage  of  the  intestinal 
contents,  increasing  with  the  growth  of  the  tumors, 
as  is  often  observed  in  ovarian,  uterine,  and  mesen- 
teric gro'n'ths,  as  also  in  some  spinal  and  pelvic  ab- 
cesses,  and  in  malpositions  of  the  uterus.  Or  it 
may  be  caused  by  cancer  of  the  gut  itself,  producing 
stricture  which  finally  renders  it  impervious.  Or  it 
may  result  from  inflammatory  adhesions  and  bands 
which  impede  the  natural  peristaltic  motions,  or 
prevent  the  passage  of  scyhala  or  even  soft  faeces. 
Acute  oh.it>-uction  results  from  aniimber  of  causes  : 

1,  Foreign  indigestible  bodies  infarcted  in  any  por- 
tion of  the  bowel ;  2,  internal  strangulated  hernia  ; 
3,  external  strangulated  hernia  ;  -1,  swelling  of  the 
ileociecal  valve  to  such  an  extent  as  to  impede  the 
passage  of  the  faeces  ;  5,  invagination  of  the  ileum 
in  the  colon,  or  a  part  of  the  colon  in  another  part ; 
6,  spasmodic  contraction.  Each  of  these  has  its 
special  mode  of  treatment. 

1.  Frjreign  indigestible  bodies. — These  are  gener- 
ally fecal  masses  which  commonly  collect  in  the 
descending  colon  and  rectum,  and  may  be  best  com- 
bated by  drastic  cathartics,  injections,  and  breaking 
up  the  impacted  fasces  with  the  handle  of  a  spoon 
or  the  finger. 

2.  Internal  stra7igulaled  hernia. — The  diagnosif^  of 
this  state  is  a  matter  of  extreme  difficulty,  but  if  made 
out,  the  treatment  must  be  opening  the  abdomen 
and  releasing  the  strangulated  gut. 

3.  External  strangulated  hernia.  —  If  the  taxis 
should  not  prove  sufficient,  two  courses  of  treatment 
are  open  to  the  surgeon  :  1.  If  the  symptoms  are 
urgent,  and  the  patient  and  his  friends  consent  to 
the  operation,  herniotomy  is  the  proper  procedure  ; 

2,  in  a  considerable  number  of  cases,  however,  the 
symptoms  are  moderate,  i.e..  there  is  little  or  no 
vomiting,  the  pulse  is  but  slightly  or  not  at  all  ac- 
celerated, the  temperature  remains  nearly  or  quite 
normal,  or  in  the  contrary  case,  the  patient  or  his 
family  do  not  consent  to  an  operation.  In  such  cases 
cathartics  not  infrequently  aggiavate  the  trouble  by 
driving  the  contents  of  the  intestines  above  the 
strangulation  forcibly  against  the  incarcerated  |ior- 
tion,  and  causing  irritation  or  inflammation  in  the 
contents  of  the  sac,  and  sometimes  extravasation 
of  faeces  into  the  peritoneum.  In  siich  cases  opirim 
given  by  the  moiith  cr  morphine  hypodermically,- 
combined  with  external  emollients,  frequently  suffices 
to  reduce  the  swelling  and  enable  the  surgeon  safely 
to  repeat  the  taxis  and  reduce  the  hernia,  or,  if  iiTe- 
ducible,  restore  the  permeability  of  the  gut. 

C.\SE  I, — Woman,  aged  seventy-five  years.  IiTe- 
ducible  femoral  hernia  of  left '  side.  "  Not  being 
able  to  have  a  passage  of  the  bowels,  and  having 
other  sy  raiitoms  of  strangulation,  she  took  a  cathartic 
and  used  injections,  with  the  result  of  agKravatinp; 
the  symptoms  of  strangiilation.  When  the  wi-iter 
was  called,  he  was  not  informed  that  the  hernia  had 
been  irreducible  for  years.  There  was  a  swelling  in 
the  groin,  of  the  size  and  shape  of  a  cucumber,  six 
inches  long,  of  an  angry  red  color,  and  very  sensi- 
tive to  the  touch.  The  woman  had  vomited  repeat- 
edly.    After  moderate  taxis,  without  any  result,  she 


was  directed  to  take  half  a  grain  of  oiiium  every  tix 
hours,  or  oftener  if  necessary  to  control  the  jiain, 
and  to  anoint  the  tumor  and  adjacent  parts  with 
belladonna  ointment,  and  to  apply  flaxseed  poulticfs 
over  the  tumor  and  the  whole  of  the  abdomen  below 
the  navel.  This  treatment  was  continued  for  three 
days,  when  the  poultices  were  abandoned,  and  the 
lower  part  of  the  abdomen  and  the  tumor  were 
painted  with  collodion  so  as  to  form  a  thick  invest- 
ment. On  the  sixth  day  of  the  opium  treatment 
she  had  five  spontaneous  movements,  and  on  the 
seventh  the  sweDing  was  soft,  .email  in  size,  and  lit- 
tle sensitive  to  tie  touch.  All  the  symptoms  of 
strangulation,  except  confinement  of  the  bowels, 
passed  away  after  the  first  few  doses  of  opium. 

A  physician  of  Beirut  informed  the  writer  of  a 
simOar  case,  with  a  parallel  result. 

Case  II. — Man,  aged  sixty-five  years,  corpulent, 
with  large  oblique  inguinal  hernia.  The  taxis  jiro- 
duced  no  benefit,  and  as  the  symptoms  were  urgent 
a  cutting  operation  was  proposed.  The  family,  how- 
ever, utterly  refused  to  permit  the  operatif  n.  He 
was  then  put  upon  the  treatment  above  described, 
with  the  exception  of  the  collodion.  In  this  case 
fecal  vomiting  had  occurred,  and  all  the  symptoms 
of  strangulation  were  well  pronounced.  After  sevf  n 
days  of  the  opium  treatment  the  hernia  was  reductd 
spontaneously. 

4.  Tumefacticm  of  the  ileoc<TCal  ralre. — This  con- 
dition sometimes  causes  quite  sudden  ob.struction 
with  pain  and  tenderness  over  the  region  of  the 
valve,  followed  by  distention  of  the  small  intestines 
and  colic.  In  such  cases  cathartics  usaially  do  haim 
by  propelling  the  intestinal  contents  against  an  im- 
passable barrier.  The  opium  treatment  is  the  sheet 
anchor  in  this  class  of  eases. 

Case  III. — Man,  aged  thirty-five  years,  was  con- 
scious of  an  obstruction  which  he  was  unable  to  at- 
tribute to  any  cause.  He  was  treated  by  a  physician, 
at  first  with  cathartics  in  repeated  doses  and  nun  e- 
rous  injections,  with  no  result  except  an  alaiming  in- 
crease of  pain  and  tenderness  and  swelling  in  the 
cjecal  region.  The  same  physician  then  ordered 
twenty  leeches  and  flaxseed  poultices,  and  told  the 
patient  that  he  had  a  ca?cal  abscess  which  must  be 
opened.  The  writer,  being  called  to  perfoim  this 
sei-vice,  but  not  finding  the  symptoms  of  an  abscess, 
but  those  of  an  i]eoca?cal  obstruction,  ordered  six 
gi-ains  of  Dover's  powder  to  lie  taken  at  once,  and 
after  that  tliree  gi-ains  every  three  hours  until  the 
pain  should  have  subsided,  and  thereafter  wlifn  the 
colicky  pain  should  return.  This  treatment  was 
continued  three  days,  with  the  Tise  of  large  poultices 
over  the  right  side  of  the  abdomen,  and  on  the  third 
day  he  had  a  free  passage  of  the  bowels,  after  which 
all  the  symptoms  disappeared. 

Case  TV. — Man,  aged  thirty  years,  was  suddenly 
attacked  with  constipation  and  retention  of  urine. 
He  took  a  powerful  cathartic  on  his  own  responsi- 
bility, but  vomited  it  up  without  any  catharsis.  He 
injected  himself  repeatedly  with  no  effect,  except  to 
increase  the  colic  and  swelling,  as  even  tie  water 
of  the  injection  remained  in  the  larpe  irtestires. 
After  twelve  hours  from  the  onset  of  tlie  symptoms 
the  writer  was  called.  At  that  time  the  countenance 
of  the  patient  was  anxious,  his  belly  distended  ard 
tvmpanitic.  his  pulse  100  and  temperature  102i  F. 
The  swellinp-  was  greatest  in  the  cjecal  region,  where 
there  was  also  great  tenderaess  on  pressure.  The 
urine  was  drawn  with  a  catheter  and  twenty  leechf  s 
applied  to  the  tender  spot,  and  belladonna  ointment 
and  poultices  ordered  over  the  lower  and  right  side 


432 


THE  MEDICAL  RECORD. 


of  the  abdomen.  Three  grains  of  Dover's  powder 
were  administered  every  three  hours.  The  first 
dose  was  vomited,  but  after  that  the  remedy  was 
retained.  The  colicky  pains  began  to  subside  from 
the  first  dose,  and  the  belly  became  softer.  Only 
nine  grains  of  Dover's  powder  were  taken  during 
the  first  twenty-six  hom-s.  The  second  day  the 
pulse  was  9(5,  the  temperature  102'  F.,  and  the  ten- 
derness and  tympanites  diminished.  He  was  directed 
to  take  the  Dover's  powder  only  when  the  pain  was 
severe.  He  continued  in  this  way  to  control  the 
pain  by  the  opiate  for  six  days,  during  which  he 
took  in  all  about  a  drachm  of  Dover's  powder.  The 
pulse  fell  by  degrees  to  84,  and  the  temperature  to 
100^".  During  the  sixth  evening  after  the  beginning 
of  the  treatment  he  had  two  copious  and  very  offen- 
sive stools,  and  was  by  them  entirely  relieved  of  the 
tympanites,  and  of  most  of  the  tenderness  and  colic. 
The  facial  anxiety  had  quite  disappeared.  He  was 
directed  to  take  twenty  drops  of  castor  oil  every  two 
hours  until  he  should  have  a  free  passage  of  the 
bowels.  After  a  free  motion  from  the  oil  during  the 
night  he  was  quite  relieved  of  the  remaining  symp- 
toms. 

Case  V. — The  same  individual  had  a  similar  attack 
some  months  later,  without  retention  of  urine,  and 
recovered  after  the  use  of  the  same  treatment  as 
before,  except  that  morphine  was  used  instead  of 
Dover's  powder.  The  treatment  was  persevered  in 
for  a  week  before  the  bowels  were  moved.  Other 
cases  of  a  similar  nature  have  been  treated  in  a 
similar  manner,  and  with  equally  good  results. 

In  all  of  the  above  cases  the  diet  was  broth  and 
milk  alone  until  after  there  had  been  a  free  evacua- 
tion of  the  bowels. 

It  will  be  plain  to  the  reader  that  the  use  of  opium 
in  all  these  cases  rests  upon  the  same  basis,  and  has 
for  its  object  keeping  the  irritated  or  congested 
or  inflamed  part  still,  untO.  the  irritation  shall  have 
subsided  or  the  congestion  or  inflammation  been 
subdued,  after  which  the  calibre  of  the  bowel  is  re- 
stored, and  natural  peristalsis  clears  it  of  its  con- 
tents. 

A  consideration  of  the  dangers  of  strangulated 
hernia,  and  obstruction  owing  to  swelling  of  the 
ileociecal  valve,  shows  us  that  they  are  not  refer- 
able to  the  incarceration  of  the  faeces  several  days, 
inasmuch  as  this  condition  obtains  in  some  jjersons 
of  constipated  habit  for  ten  days  at  a  time.  More- 
over, the  surgeon  produces  constipation  by  opium 
ten  days  or  more  after  operations  for  vesico-vaginal 
fistula  or  recto-vaginal  fistula,  and  the  physician 
does  the  same  in  inflammation  of  the  peritoneum. 
The  real  danger  lies  in  the  inflammation  of  the 
bowel  or  omentum,  or  their  sloughing,  or  in  inflam- 
mation of  the  peritoneum,  owing  to  rupture  of  the 
bowel  or  bruising  from  taxis.  In  all  these  states, 
excepting  gangrene,  the  opium  treatment  is  valu- 
able ;  and  even  in  cases  of  gangrene  it  may  do  good  by 
stopping  peristalsis  until  the  lymph  effused  around 
the  giingreaed  part  has  attained  consistency  enough 
to  prevent  extravasation  into  the  peritoneum. 

5.  Iiiv/iyinntion  of  the  ileum  into  tlie  colon,  or  of 
a  portion  of  the  colon  into  the  remainder.  This 
state  is  a  difficult  one  to  diagnosticate,  unless  the 
invaginated  gut  is  passed  by  the  rectum  or  detected 
bv  the  finger  or  the  endoscope,  or  by  abdominal  sec- 
tion. In  cases  where  this  is  suspected,  T  believe 
that  the  opium  treatment  is  quite  rational,  liaving 
for  its  object  and  limit  the  subduing  of  the  pain  and 
arresting  of  peristalsis.  The  reasonableness  of  this 
treatment  will  appear  from  a  contemplation  of  one 


of  the  natural  cures  for  invagination,  which  is  by 
sloughing  of  the  intussuscepted  part,  and  its  passage 
per  rectum.  Nothing  can  be  more  obvious  than  the 
necessity  of  inducing  a  state  of  perfect  rest  of  all 
the  parts  involvetl  until  the  connection  between  the 
peritoneum  above  and  below  the  invagination  has 
been  made  secure  by  abundant  deposit  and  suflicient 
organization  of  plastic  lymph  to  prevent  efl'usion 
into  the  cavity  of  the  abdomen,  and  to  lessen  septic 
absorption.  Beside  all  this,  the  opium  allays  the 
colic  and  diminishes  the  tenderness,  symptoms  the 
severity  of  which  aftbrds  a  fair  indication  of  the  gra- 
vity of  each  individual  case.  It  need  not  be  said 
that  the  opium  treatment  is  one  requiring  the  close 
supervision  of  the  medical  attendant,  and  his  utmost 
vigilance,  lest  it  should  mask  symptoms  calling  for 
an  operation. 

6.  S'xismodic  colic  may  resemble  the  foregoing 
states.  It  occurs  generally  in  people  of  constipated 
habit,  and,  although  calling  for  active  cathartics,  is 
well  treated  by  a  preliminary  hypodermic  injection 
of  morphia  over  the  seat  of  pain. 

Case  VI.^A  man  of  constipated  habit,  who  could 
hardly  have  a  movement  of  the  bowels  without  some 
medication,  was  attacked  with  severe  pain  in  the 
right  hypochondrium,  in  front  of  the  angle  of  the 
ascending  and  transverse  colon,  accompanied  with 
vomiting  and  severe  general  disturbance.  In  this 
case  a  hypodermic  of  one-third  of  a  grain  of  mor- 
phine ,was  injected  over  the  seat  of  pain,  as  a  pre- 
liminary to  the  use  of  a  cathartic  and  injection. 
The  .same  course  was  pursued  in  subsequent  attacks, 
and  always  with  the  result  of  facilitating  the  relax- 
ation of  the  spasm  and  the  purgative  action  of  the 
cathartic. 

In  all  cases  except  the  last  it  is  best  to  administer 
opium  by  the  mouth,  owing  to  its  action  on  the  in- 
testinal mucous  membrane  and  muscular  coat,  as 
well  as  the  peritoneum.  In  the  case  of  spasmodic 
colic  I  prefer  the  antispasmodic  efi'ect  of  the  subcu- 
taneous injection,  without  the  astringent  and  seda- 
tive effect  on  the  mucous  membrane  produced  by 
opium  taken  by  the  month,  which  interferes  with 
the  operation  of  a  cathartic. 


Lucas  on  Cross-legged  Pbogression  or  Scis- 
SOR-LEGGED  DEFORMITY. — Two  instances  of  this  un- 
common phenomenon,  due  to  anchylosis  of  both 
hip-joints,  are  jsublished  by  Mr.  Lucas,  of  Cxuy's 
Hospital.  The  disease  commenced  at  first  in  one 
hip,  and  liad  progressed  to  anchylosis  before  tlie 
otlier  joint  was  fairly  invaded.  The  patients  were 
allowed  to  walk  with  the  aid  of  crutches  or  sticks, 
beaiing  weight  on  the  convalescent  limb  ;  gradually 
the  limb  that  was  last  attacked  was  carried  across 
the  other.  Tlie  patient  in  tliis  cross-legged  position 
walks  from  his  knees,  using  them  in  place  of  his 
hips.  The  theory  of  the  development  of  the  mal- 
position is  given  as  follows  :  the  patient  when  com- 
mencing to  walk  on  the  convalescent  limb,  finds 
that,  by  resting  the  other  upon  it,  ke  can  steady  tlie 
one  which  is  now  inflamed,  thus  gaining  relief  from 
pain.  At  the  same  time,  by  the  oblique  position, 
the  limb  is  shortened  and  rendoretl  less  liable  to 
touch  the  ground.  When  he  commences  to  walk  with 
the  aid  of  crutches,  one  knee  resting  tipon  the  other 
supports  it  and  leaves  the  legs  free  for  the  move- 
ments of  locomotion.  When  the  crutches  are  thrown 
aside  the  patient  naturally  finds  himself  in  this 
cross-legged  position. — RepiHntfram  Clinical  Society's 
Transactions,  1881. 


THE  MEDICAL  RECORD. 


433 


|)ro0rc5!)5  of  iiUtiical  Science. 


Baker  ON-  Vaginal  Oyariotomt. — Dr.  W.  H.  Baker, 
instructor  in  gmecology  in  Harvard  Universitv,  in 
publishing  the  liistory  of  a  case  of  vaginal  ovari- 
otomy that  occurred  in  liis  experience,  where  the 
resiilt  was  fatal,  sums  U])  his  views  substantially 
as  follows  :  The  success  now  attending  ovariotomy 
by  abdominal  incision  restricts  the  advantages  of 
tlie  operation  to  a  very  limited  number  of  cases,  and 
these  should  be  where  the  cysts  are  small  and 
their  contents  are  bland,  so  that  removal  can  be  ef- 
fected without  difficulty  and  without  great  danger  of 
septic  peritonitis  from  the  escape  of  any  of  the  fluid 
into  the  peritoneal  cavity ;  or  in  dermoid  cysts  so 
small  as  to  be  removed  through  the  vaginal  incisions 
without  evacuation.  On  the  other  hand  where  ova- 
rian cysts  are  lirmly  adherent  in  the  jjelvis,  drainage 
into  the  vagina  is  recommended,  the  cyst  being 
either  destroyed  by  the  cautery  or  allowed  to  sup- 
purate and  discharge  itself  through  the  line  of  in- 
cision.— Kew  York  Medical  Joitimal,  March,  1882. 

A  FREQrE>fT  Cause  of  Death  from  Chxorofoem, 

AND  THE  BEST   PROTECTION   AGAINST   It. — The   chloTO- 

form  of  the  German  pharmacopoeia,  which  has  a 
specific  gravity  of  1.495  to  l.i96,  readily  undergoes, 
according  to  Dr.  Theodore  Clemens  (Allgemeine  Med- 
icinishe  Central  Zeitung,  January  4,  1882),  a  peculiar 
decomposition.  Chloroform,  thus  altered,  produces 
vertigo,  emesis  and,  finally,  syncope,  which  may  be 
fatal.  Chloroform  made  from  ehloral  is  not  open 
to  the  above  objection.  Dr.  C.  states  that  the  de- 
composition in  question  may  be  prevented  by  adding 
0.5  per  cent,  of  alcohol  to  the  chloroform.  The 
anaesthetic  properties  of  the  latter  are  not  impaired 
bv  the  alcohol.  The  mixture  is  said  to  be  far  more 
agreeable  than  pure  chloroform,  besides  being  more 
easilv  tolerated.  The  same  author  recommends  the 
inhalation  of  pure  alcohol  as  a  powerful  analeptic 
measure  in  various  diseases. 

Accidents  Referable  to  lirprnE  Chloroform — 
A  Keagest  for  the  Detection  of  Impurities,  and  a 
Method  for  their  Kemoval. — Dr.  J.  Lucas  Cham- 
ponnifere,  editor-in-chief  of  the  Journal  deMedicine, 
states  editorially  in  the  February  number  (1882)  of 
that  publication,  that  impure  chloroform  is  very  gen- 
erallv  encountered,  even  in  reputable  pharmacies  and 
hospitals.  The  disagreeable  results  attending  its 
administration  are  slow  supervention  of  anaesthesia, 
dvspnoei,  intermittent  respiration,  emesis,  rigors, 
and  even  death.  The  impure  chloroform  is  turned 
green  by  an  alkaline  solution  of  the  permanganate 
of  potassium,  .and  the  same  reagent  is  the  most  re- 
liable means  for  the  purification  of  the  anresthetic. 
These  facts  have  been  verified  and  confirmed  by  a 
special  committee  of  the  Societf  de  Pharmacie.  All 
the  unpleasant  phenomena  produced  by  the  impure 
article  are  obviated  by  the  use  of  chloroform  puri- 
fied by  the  permanganate  of  potassium. 

FuNCTiON.AL  Torticollis  Treated  by  Resection  op 
the  Spinal  Accessory  Nerve. — M.  Tillaux  reported  a 
case  of  functional  torticollis  to  the  Paris  Academy  of 
Medicine,  at  a  meeting  held  on  January  30,  1882  ( Ga- 
zette des  Hi'ipilaux,  February  2,  1882).  The  patient,  a 
young  woman  thirty-two  years  of  age,  could  retain  her 
head  in  a  normal  position  so  long  as  it  was  supported 
from  beneath.     If,  however,  the  head  was  left  to  it- 


self it  at  once  assumed  the  position  characteristic  of 
right-sided  torticollis,  without  any  appreciable  mus- 
cular contractions.  Tlie  sterao-cleido-mastoid  mus- 
cle did  not  harden  or  shorten  simultaneously  with 
the  occun-ence  of  the  distortion.  The  latter  was 
attended  with  severe  pain  at  the  level  of  the  first 
cervical  vertebra  on  the  left  side.  After  electricity, 
magnets,  metallotherapy,  and  section  of  the  tendon 
of  the  sterno-cleido-ma.stoid  had  been  employed, 
without  result,  M.  Tillaux  performed  resection  of 
the  spinal  accessory  nerve  at  its  exit  from  the  paro- 
tid gland.  .A  portion  of  the  nerve,  three  centimetres 
in  length,  was  removed,  and  immediate  union  of  the 
wound  ensued.  The  patient  was  enabled,  after  the 
operation,  to  prevent  the  occurrence  of  the  distor- 
tion, by  an  effort  of  the  will.  The  inference  that  the 
displacement  could  not  be  invariably  prevented  by 
volitional  effort  seems  justified  by  M.  Tillaux's  admis- 
sion that  the  cure  was  not  comjilete. 

Treatment  op  Malignant  Pustule  sy  Hypodee- 
mic  Injections  of  the  Tincture  of  Iodine. — The 
Arckires  Gentrales  de  Medicine  (February,  1882) 
publishes  the  history  of  a  grave  case  of  malignant 
pustule  successfully  treated  at  the  Hospital  Lariboi- 
sifere  by  the  subcutaneous  injection  of  inire  tincture 
of  iodine.  The  patient  wa.s  a  butcher,  thirty  years  of 
age.  The  wound  from  which,  as  a  focus,  the  inflam- 
mation developed,  was  the  prick  of  a  thistle  con- 
cealed in  the  wool  of  a  sheeji.  The  patient  was  ad- 
mitted three  days  after  the  infliction  of  the  wound, 
and  presented  a  gangrenous  spot  one  centimetre  in  di- 
ameter on  the  wrist,  at  the  seat  of  the  in  jui-y.  Around 
the  gangrenous  focus  there  was  a  zone  of  vesicles, 
six  centimetres  in  diameter.  The  entire  arm  was  red- 
dened and  greatly  swollen,  the  axillary  glands  were 
enlarged,  and  the  side  of  the  thorax  cedematous. 
Three  syringefuls  of  pure  tincture  of  iodine  were  in- 
jected, hypodermically,  at  the  outer  limit  of  the 
vesicular  zone.  Lint,  soaked  in  the  tincture  of 
iodine,  was  applied  over  the  slough,  and  one  giamnie 
of  the  tincture,  with  twenty -five  centigi'ammes  of  the 
iodide  of  potassium,  wereadministered;)e;-orCT)i.  On 
the  day  following  the  operation  the  temperature  had 
fallen  from  39.5°  C.  to  37.2°  C,  the  general  condition 
had  much  improved,  and  the  gangrene  was  arrested. 
The  improvement  was  progressive  and  uninter- 
rupted. The  eschar  produced  by  the  injection 
separated  after  three  weeks,  and  normal  cicatriza- 
tion ensued.  Six  cases  of  malignant  pustule,  suc- 
cessfully treated  by  the  same  method,  are  refeired 
to  in  the  same  article. 

A  Case  or  Resection  of  the  Stomach  fob  Can- 
cer.— -This  bold  operation  appears  to  have  had  its 
advocates  in  Russia,  and  Dr.  Kitajewsky  reports 
one  with  fatal  issue  in  a  woman  fifty-two  years  old. 
She  had  been  suffering  continuously  from  vomiting 
and  was  in  a  pronounced  cachetic  state.  The  tumor 
occupied  the  pylorus,  a  large  extent  of  the  small 
curvature  and  a  portion  of  the  duodenum.  The 
operation  consisted  in  the  removal  of  a  part  of  the 
stomach,  measuring  10  ctm.  along  the  smaller  cur- 
vature, and  9  ctm.  along  the  greater  curvature. 
Sixty-five  sutures  were  used  to  bring  the  edges 
together.  The  operation  lasted  four  hours  with 
no  unpleasant  accident  during  its  performance,  ex- 
cepting a  transient  failure  of  the  heart  and  respira- 
tion. Five  hours  after  the  operation  the  pulse  be- 
gan to  grow  weak,  respiration  became  frequent  and 
shallow,  and  the  patient  died  an  hour  later  in  col- 
lapse. The  tumor  weighed  five  ounces  and  six 
drachms. — Meditz.  Obozrenie,  xvi.,  p.  192. 


434 


THE  MEDICAL  RECORD. 


The  Medical  Recoed: 


Jl  iDtcklg  ilouvnal  of  fllcbicinc  mxi)  Suvgern 


"JEORGrE  F.  SHRADY,  A.M.,  M.D.,  Editor. 


PUBLISHED   BY 
iVn.  WOOD  Sc  CO.,  No.  27  Great  Jones  St.,  N.  Y. 

New  York,  April  22,  1882. 

FREEDOM  IN  CONSULTATIONS. 

VARrous  meflical  societies,  jealous  of  their  high  estate 
in  particular,  and  anxious  for  the  honor  of  the  profes- 
sion in  general,  are  manifesting  in  tlieir  own  way  a 
righteous  indignation  against  the  Medical  Society  of 
the  State  of  New  York  for  presuming  to  make  its  re- 
cent departure  regarding  free  consultations.  Sev- 
eral medical  journals  also  are  unsparing  in  their 
criticism  of  the  course  taken  by  the  profession  of 
New  York,  and  are  evidently  rejoiced  at  the  oppor- 
tunity of  showing  how  easy  it  is  to  fall  from  grace 
when  the  love  of  lucre  takes  possession  of  the  soul. 
All  this  would  be  very  bad  for  us  if  the  charges 
were  based  on  truth.  But  in  all  these  tirades  and 
protestations  there  has  not  been  a  sensible  argu- 
ment offered  to  prove  why  the  stej)  taken  by  the 
New  York  Society  was  a  wrong  one,  not  a  single 
fact  presented  substantiating,  even  in  the  most  in- 
direct manner,  any  of  the  serious  if  not  insulting 
charges  against  the  committee  of  revision,  and  the 
mean  insinuations  against  the  Society  itself.  As 
a  whole  the  attitude  of  the  members  of  the  State 
Society  toward  quackery  in  any  and  all  its  forms  is 
now  precisely  what  it  has  always  been.  There  is 
no  more  danger  of  their  aiding  and  abetting  fraud 
than  before  the  new  code  was  adopted.  Each  man 
is  as  capable  of  judging  what  irregular  practice  is  as 
before,  and  will  decide  accordingly.  Nothing  can  be 
brought  forward  to  prove  that  he  is  not  as  able  and 
as  willing  to  discriminate  between  good  and  bad  as 
his  self-appointed  censor.s  and  liis  ]irotentious  ad- 
vi.ser.s.  The  mere  granting  of  liberty  of  opinion  and 
freedom  of  action  to  members  can  hardly  bo  stig- 
matized as  an  unpardonable  sin.  If  the  American 
Code  denies  such  freedom,  it  is  time  that  the  .■Vmer- 
Oin  Code  was  altered. 

But  in  truth  tlio  provisions  of  the  American  Code 
can  be  as  consistently  followed  by  every  New  York 
man  as  by  some  of  our  immaculate  brethren  in  other 


States,  the  only  technical  diflference  being  in  our 
case  that  the  Society  of  the  State,  in  a  plain  and 
straightforward  manner,  guarantees  protection  from 
petty  discipline  for  every  man  who  may  wish  to  in- 
vestigate truth  in  his  own  way.  No  one  is  expected, 
much  less  forced,  to  consult  with  incompetent  prac- 
titioners and  quacke.  There  is  only  one  platform 
ujjon  which  all  honest  workers  can  meet,  and  that  is 
a  high,  broad,  and  liberal  one.  None  but  the  best  men 
from  any  school  can  reach  it  in  any  event,  and  they 
possibly  can  be  trusted  to  work  out  their  own  sal- 
vation. We  think  the  profession  of  this  State  can 
afford  to  abide  their  time  for  a  calm  verdict  on  their 
course.  It  appears  to  be  quite  possible  that  some 
of  our  contemporaries  who  have  so  unsparingly 
denounced  the  new  code  are  not  the  legitimate 
leaders  of  opinion  even  in  their  own  districts.  Al- 
ready we  are  receiving  from  influential  men  in  every 
part  of  the  country  the  heartiest  endorsements  of 
the  course  of  the  Eecoed  in  its  advocacy  of  freedom 
in  consultations,  and  already  w:e  are  enjoying  the 
proud  distinction  of  being  the  only  journal  that  has 
assumed  the  responsibility  of  being  outspoken  on 
this  question.  We  are  consequently  more  than  ever 
emboldened  to  say  that  despite  the  adverse  com- 
ments of  medical  journals,  despite  the  denunciatory 
resolutions  of  State  Societies,  despite  the  anathema* 
of  medical  orators,  the  Medical  Society  of  the  State 
of  New  York  is  perfectly  right  in  the  stand  it  has 
taken,  and  that  it  must  not  back  down  in  any  particu- 
lar. Several  more  State  Societies  are  yet  to  be  heard 
from  through  ambitious  writers  of  resolutions,  and 
some  fatherly  rebuke  may  still  be  expected  from  some 
of  the  i>residents  of  these  organizations.  It  is  to  be 
hoped  that  the  New  York  men  will  receive  it  all  with 
becoming  grace,  and,  forgetting  and  forgiving,  stand 
firmer  than  ever. 


LAPAROTOMY    FOB   ACUTE   INTESTINAL   OBSTRUCTION. 

Few  questions  present  moi-e  interest  for  the  surgeon 
than  those  referring  to  the  diagnosis  and  treatment 
of  acute  intestinal  obstruction.  It  is  fair  to  pre- 
sume then  that  their  discussion  in  the  papers  of  Drs. 
Sands  and  G.  E.  Post,  will  command  a  widespread 
attention.  To  siu-h  as  may  study  the  cases  pre- 
sented and  the  remarks  thereon,  it  must  be  quite 
apparent  that  the  difficulties  in  the  way  of  making: 
an  accurate  diagnosis  in  any  given  case  of  a^cute  in- 
testinal obstruction  are  very  great  indeed,  and  even- 
when  the  nature  of  the  lesion  is  made  out,  the  line 
of  treatment  is,  in  the  generality  of  cases  at  least,  by 
no  means  settled.  Tliere  are,  indeed,  so  many  con- 
ditions to  be  taken  into  account  before  a  diagnosis 
can  be  arrived  at,  and  such  an  inconstancy  in  what 
may  be  considered  the  characteristic  symptoms  of 
a  given  lesion  producing  obstruction,  that  it  is 
hardly  surjjrising  that  almost  every  case  is  involved 
in  more  or  less  obscurity.  This  fact  is  strikingly 
manifested  in  the  case  reported  by  Dr.  Sands,  and 


THE   MEDICAL  RECORD. 


435- 


which  forms  the  basis  of  his  paper.  Notwithstand- 
ing the  most  careful  study  of  all  the  symptoms, 
the  most  thorough  appreciation  of  their  individual 
and  collective  bearing  upon  the  probable  cause  of 
the  obstruction,  the  patient  died  without  a  diagnosis 
being  made  as  to  the  character  or  seat  of  the 
difficulty.  Unfortunately,  similar  pases  are  quite 
too  common  to  give  much  encouragement  for  a 
positive  diagnosis  in  any  given  instance.  Inas- 
much as  the  question  of  treatment  depends  upon 
the  accuracy  with  which  the  cause  and  seat  of  the 
obstruction  are  determined,  the  discussion  of  the 
expediency  of  laparotomy  for  that  reason  alone,  is 
narrowed  to  very  small  limits.  But  this  is  not  all. 
Laparotomy  is  a  formidable  operation.  It  is  a  last 
chance  for  the  patient,  and  a  very  slim  one  at  that. 
Paradoxical  as  it  may  seem,  the  cases  which,  on  gen- 
eral principles,  demand  it  the  most  urgently — for 
instance,  those  in  which  the  attack  is  sudden  and 
severe  and  the  grave  symptoms  rapidly  progressive, 
are  most  likely  to  die  if  the  operation  is  jaerformed. 
On  the  other  hand,  the  cases  of  slower  progress, 
but  in  which  the  prognosis  would  appear  to  be 
equally  grave,  not  infrequently  recover  if  let  alone. 
Even  when  there  is  every  reason  to  believe  that 
the  obstruction  is  due  to  internal  strangulation, 
the  latter  sometimes  frees  itself  in  a  very  remark- 
able and  unexpected  manner,  and  the  jjatient  is 
restored  to  health.  Taking  into  account  the  diffi- 
culties of  making  a  positive  diagnosis  in  a  given 
case,  and  even  in  a  particular  instance  of  finding 
and  relieving  the  obstruction  when  laparotomy  is 
performed,  and  offsetting  these  against  a  not  un- 
reasonable chance  of  the  patient  finally  recovering 
without  any  operation  whatever,  there  is  no  great 
likelihood  that  laparotomy  will  be  a  very  popular 
procedure.  Indeed,  until  we  can  sufficiently  per- 
fect our  means  of  diagnosis  to  determine  the  seat 
and  character  of  the  obstruction,  and  be  able  to  de- 
cide early,  with  reasonable  positiveness,  that  the  ob- 
struction cannot  be  overcome  short  of  an  operation, 
then  it  would  appear  to  be  the  duty  of  the  surgeon 
to  advise  laparotomy.  But  that  we  are  far  from 
being  certain  on  any  of  these  points  is  made  very 
apparent  by  the  rather  exhaustive  discussion  of  the 
subject  in  the  present  issue. 


THE   TREATMENT   OF    DIPHTHEKIA    IN    THE    P.iST  EIGHT 
TEAKS. 

Diphtheria  has  been  of  late  one  of  the  most  written- 
np  diseases  in  medicine.  The  diligent  reader  comes 
to  regard  the  perennial  flow  of  articles  on  the  sub- 
ject as  a  sad  necessity  of  jorogress. 

Dr.  Ernest  Kormann,  of  Coburg,  has  done  a  work 
which  is  better  than  original.  It  is  a  review  of  the 
literature  concerning  the  treatment  of  diphtheria 
in  the  past  eight  years.  The  number  of  contri- 
butions to  this  branch  of  the  subject  alone  is  very 


large,  being  nearly  one  hundred  and  seventy.  It' 
maybe  a  source  of  gratification  to  know  that  -Ameri- 
cans were  authors  of  about  one-eighth  of  these  ar- 
ticles. The  English  contributions  numbered  only 
nine,  and  the  French  about  the  same. 

It  would  be  impossible  to  give  here  any  adequate" 
summary  of  the  many  views  expressed  in  these  nu- 
merous papers,  but  some  idea  of  their  general  tenor 
would  be,  we  think,  of  interest. 

There  are  articles  by  twenty-four  authors  on  the" 
prophylaxis  of  diphtheria.  These  recommend  va- 
rious measures,  most  of  which  are  known.  The 
most  complete  harmony  is  on  the  subject  of  isola-- 
tion  and  cleanliness.  The  next  most  unanimous 
recommendation  is  as  to  the  value  of  frequent  garg-- 
ling.  The  agents  oftenest  recommended  are  potas- 
sium chlorate  and  lime-water.  But  many  recom- 
mend salicylic  acid,  potassium  permanganate, 
astringents,  myrrh,  hot  and  cold  water,  carbolic  acid, 
etc.  Pencilling  the  throat  with  carbolic  acid  or 
other  disinfectants  is  also  advised.  Internal  medi- 
cines receive  fewer  recommendations  except  in  the 
case  of  infants  who  cannot  gargle.  Potassium  chlo- 
rate, salicylic  acid,  iron,  quinine,  alcohol,  are  among 
the  agents  enumerated  as  of  use. 

Upon  the  treatment  of  diphtheria  proper  there  are- 
one  hundred  and  twenty-five  contributions,  with 
eighteen  more  upon  the  abortive  treatment,  making 
one  hundred  and  forty-two  in  all.  This  represents 
a  gi-eat  deal  of  futile  activity  ;  but  fortunately  sci- 
ence is  helped  by  failures  as  well  as  success. 

A  notable  feature  in  the  various  contributions  is 
that,  no  matter  what  the  agent  recommended,  it  is 
almost  always  an  extremely  efficient  one.  The  lit- 
erature of  the  therapeutics  of  diphtheria  is  essen- 
tially  constructive.  Indeed  it  is  too  much  so,  and. 
some  judicious  iconoclasm  would  be  very  useful. 

It  is  generally  thought  that  when  a  disease  has^ 
many  drugs  which  are  almost  its  specific,  the  real 
specific  is  nature.  But  Dr.  Kormann  suggests  that 
this  does  not  represent  the  whole  truth  for  diphthe- 
ria. That  disease  may  be  in  some  cases  or  localities- 
vei-y  favorably  influenced  by  a  special  remedy  which 
is  of  less  value  at  other  times  or  places.  However 
this  may  be,  it  is  certain  that  no  heterogeneity  of 
remedial  measures  recommended  will  justify  a  phy- 
sician in  adopting  an  expectant  plan  of  treatment  in 
the  di-sease  in  question. 

And  indeed,  the  diversity  in  modes  of  treatment 
is  not  fundamentally  at  all  great. 

We  find  that  two  authors  recommend  flowers  of 
sulphur  blown  into  the  throat.  Thirty-eight  authors 
recommend  the  use  of  some  disinfectant  as  the  es- 
sential thing. 

Twelve  give  especial  prominence  to  potassium 
chlorate  ;  five  to  the  salts  of  iron  ;  thirteen  to  mer- 
cury ;  four  to  local  applications  of  chloral  hydrate  ; 
four  to  alcohol  and  other  stimulants  ;  ten  to  the 
volatile   oils   and   balsams  {turpentine,    eucalyptol, 


436 


THE  MEDICAL  RECORD. 


copaiva) ;  twenty-six  to  pilooarpin ;  two  to  the  ap- 
plication of  digestive  ferments. 

There  is  the  largest  number  of  contributions,  as 
well  as  the  greatest  weight  of  authority  in  favor  of 
some  form  of  antiseptic  and  roborant  treatment. 

The  disinfectants  recommended  most  are  carbolic, 
salicylic,  and  boracic  acids.  Permanganate  of  po- 
tassium, bromine,  chlorine  water,  ozone,  are  also 
mentioned. 

But  whether  disinfectants  are  recommended  or 
not,  chlorate  of  potash  is  the  agent  oftentimes  re- 
ferred to  in  treatment.  The  tincture  of  iron,  so  ex- 
tensively used  in  America,  receives  less  notice  among 
the  German  writers. 

The  use  of  pilocarpin  is  fully  discussed.  On  the 
■whole,  it  seems  to  be  a  failure.  No  one  has  gotten 
the  result  first  claimed  for  it.  It  is  not  a  specific, 
and  several  cases  of  collapse  I'esulting  apparently 
from  its  use  are  reported. 

The  cases  illustrating  the  action  of  the  mercury 
salts  (cyanide,  bichloride,  etc.),  are  in  some  cases 
striking,  but  are  too  few  for  a  satisfactory  conclusion 
to  be  drawn  regarding  them.  The  methods  of  treat- 
ment by  inhalation  of  oxygen,  the  use  of  digestive 
juices,  fluoric  acid,  lime-juice,  chloral,  the  balsams, 
etc.,  as  yet  have  proved  little  for  themselves. 

The  abortive  methods  of  treatment  consist  in  the 
careful  and  complete  removal]  of  the  first  sign  of 
diphtheritic  exudation  ;  the  very  frequent  spraying 
of  the  throat  with  weak  solutions  of  salicylic  acid, 
boracic  acid,  or  of  brandy.  The  inhalation  of  steam 
with  gargles  of  hot  water,  the  local  application  of 
strong  astringents,  or  of  caustics,  and  the  use  of  very 
large  dosea  of  alcohol,  all  of  these  various  measures 
received  about  equal  commendation. 

It  is  apparent  from  a  study  of  the  literature  which 
■we  have  here  referred  to,  that  diphtheria  has  no 
specific,  nor  is  it  likely  to  get  one,  until  we  find 
something  which  will  cure  all  septic  diseases.  But, 
there  has  been  progress  made  in  the  therapeutics  of 
the  disease,  and  an  intelligent  physician  can  save 
many  lives  by  judicious  treatment. 


THE  PATHOLOQIOAL  CHANGES  IN  DEATH  BY  HANOINO. 

Hanging  at  the  present  day  is  the  most  popular 
mode  of  committing  suicide.  Middle-aged  men 
rather  incline  to  firearms  ;  women  to  drowning.  But 
in  the  earlier  and  later  periods  of  life  suspension  is 
most  frequently  employed. 

This  fact,  as  well  as  that  of  the  increasing  preva- 
lence of  suicide,  makes  the  question  of  the  medico- 
legal aspect  of  hanging  an  important  one  to  the 
physieian.  He  is  liable  to  be  called  in  order  to 
decide  whether  a  i)orson  who  is  found  dead  and  sus- 
pended by  the  nock  has  done  the  act  voluntarily  or 
not. 

Tliis  is  by  no  means  an  easy  matter  in  every  case. 
Some  fifty  years  ago,  all  France  was  excited  by  tlie 
question  whether   the  Prince  of    Condfe,  who  had 


been  found  dead  and  hanging  by  a  handkerchief  from 
his  window,  was  murdered  or  had  committed  suicide. 
It  is  now  generally  admitted  that  there  is  no  single 
post-mortem  appearance  which  will  surely  indicate 
that  the  hanging  was  ante-mortem.  The  line  of 
ecchymosis  made  by  the  cord  is  present  in  only  a 
portion  of  cases.  It  is  even  possible  to  produce  this 
ecchymosis  immtediately  after  death.  The  livid  face, 
protruded  or  bitten  tongue,  the  clenched  hands,  the 
ejected  urine,  fjeces,  or  semen,  the  congested  brain 
and  lungs,  all  jioint  to  a  violent  death,  suspension 
and  strangulation,  but  do  not  surely  prove  it. 

The  local  changes  produced  by  the  cord  about  the 
neck  have  been  recently  studied  with  great  dili- 
gence by  Dr.  Adolf  Lesser,  of  Berlin,  and  Professor 
Hoffmann,  of  Vienna.  These  investigators  made  no 
discovery  of  striking  importance,  but  their  examina- 
tions went  to  show  that  the  lesions  of  the  soft  parts 
of  the  neck  are,  as  a  rule,  somewhat  more  extensive 
than  had  been  supposed. 

The  changes  found  in  the  tissue  were  very  numer- 
ous. The  outer  mark  on  the  skin  was  present  in  forty- 
five  out  of  fifty  cases,  in  the  remaining  five  there 
being  no  lesions  except  of  internal  parts. 

There  were  found  fractures  of  the  hyoid  bone,  but 
especially  of  its  cornua.  Also  fractures  of  the  thy- 
roid and  cricoid  cartilages.  It  is  these  latter  frac- 
tures, according  to  Hoffmann,  which  cause  the  loss 
of  voice  that  often  follows,  after  unsuccessful  at- 
tempts at  hanging.  Slight  extravasations  of  blood 
beneath  the  perichondrium,  and  in  the  mucous  mem- 
brane of  the  larynx,  in  the  muscular  tissue,  and  even 
beneath  the  adventitia  of  the  carotids  were  found. 
Kupture  of  the  muscles,  e.specially  of  the  stemo- 
cleido-mastoid,  is  described  as  occurring,  but  is  con- 
sidered by  Hoffmann  to  be  caused  by  the  post-mor- 
tem stiffening  which  shortens  the  stretched  tissue. 
No  description  is  given  of  any  important  lesions  oc- 
curring in  the  vertebral  column  or  spinal  cord.  It 
is  quite  well  known  that  in  suicides  by  hanging 
the  vertebr;c  are  rarely  broken  or  dislocated,  nor  is 
the  cord  often  pressed  upon.  Death  is  by  asj^hyxia 
with  perhaps  in  some  cases  cerebral  hemorrhage.  In 
executions,  where  the  criminal  is  dropped  a  con- 
sideraV)le  distance,  the  vertebrie  are  sometimes  in- 
jured. 

The  investigations  just  described,  if  they  give  no 
absolute  sign  of  death  by  hanging,  at  least  .show  that 
in  alleged  cases  of  suicide,  a  very  careful  examina- 
tion of  the  neck  should  be  made.  The  small  extra- 
vasations that  are  shown  to  be  so  widely  distributed 
point  to  ante-mortem  violence. 

nESIONATION   OF   A    FACtTLTT. 

The  resignation  of  several  members  of  the  post- 
graduate faculty  of  the  Medical  Dejiartment  of  the 
University  of  the  City  of  New  York  has  been  an- 
nounced. As  usual,  under  such  cii-cumstances,  the 
conclusion  has  been  reached  that  there  must  have 


THE  MEDICAL  RECORD. 


437 


been  some  general  cause  for  dissatisfaction  on  the 
part  of  the  gentlemen  directly  concerned  in  the  move- 
ment. This  is  quite  true.  The  significance  of  such  an 
action,  however,  has,  in  many  quarters,  been  some- 
what overestimated.  As  not  unfrequently  happens, 
the  discussion  of  the  reasons  for  the  course  taken  by 
the  resignees  lias  found  its  way  into  the  columns  of 
the  daily  press,  and  the  public  are  being  amused  by 
statements  pro  and  con  concerning  what  is  supposed 
to  be  a  serious  quarrel  among  the  doctors..  This  is 
to  be  deplored.  The  whole  matter  really  narrows 
itself  to  a  simple  disagreement  between  the  govern- 
ing faculty  and  the  membei's  of  the  post-graduate 
corps  of  instructors  as  to  the  powers  and  privileges 
of  each — nothing  more  and  nothing  less.  The  post 
graduate  faculty  desired  to  have,  reasonably  enougli, 
as  it  appears,  a  wider  field  for  work,  and  propor- 
tionate increase  of  facilities  to  such  an  end,  and  the 
governing  faculty  considered  that  such  claims  mili- 
tated against  the  general  management  of  the  under- 
graduate course,  which  to  the  faculty  was  certainly 
of  paramount  importance.  In  so  far  the  faculty  was 
right  also,  as  it  was  impossible,  in  accordance  with 
the  general  policy  of  the  school,  to  dovetail  the  two 
systems  into  each  other.  When  the  issue  finally  was 
reached,  and  the  question  of  what  should  and 
should  not  be  came  up  to  the  surface  of  calm  dis- 
cussion, a  radical  difference  of  opinion  between 
the  two  parties  manifested  itself.  There  was  then 
nothing  for  the  post-graduate  faculty  to  do  but  to 
resign.  We  are  not  aware  that  there  is  any  bad 
feeling  on  either  side  ;  neither  are  we  sure  that  any 
extraordinary  sensation  has  been  created  in  the  pro- 
fession by  the  course  pursued.  We  are  quite  con- 
fident that  the  resigning  faculty  did  not  contemplate 
any  such  thing ;  that  they  intended  to  settle  in  an 
easy  and  natural  way  what,  at  most,  was  a  family 
difficulty,  and  that,  having  done  so,  they  were  left 
free  to  strike  out  modestly  and  quietly  for  a  new 
and  better  field  of  usefulness.  It  is  unnecessary  to 
say  that,  from  such  a  point  of  view,  the  profession 
generally  will  sympathize  with  them  in  their  en- 
deavors to  advance  the  standard  of  medical  educa- 
tion ;  at  the  same  time  it  will  condole  with  them 
on  account  of  the  unenviable  notoriety  wliich  has 
seemingly  attached  itself  to  their  new  departure. 

HOMATBOPIN  IN  THE  TrEAT-MENT   OP  PHTHISIS. — Dr. 

Froumiiller  reports  {Memornhilien)  sixteen  cases  of 
phthisis  with  night-sweats  in  which  homatropin  was 
successfully  used.  The  usual  dose  was  .15  (gr.  iiss.) 
in  pill  form,  or  .015  (gr.  \)  by  injection.  It  was 
found  that  one  injection  would,  as  a  rule,  stop  the 
night-sweats  for  several  days.  The  fever  and  cough 
were  also  lessened,  and  the  drug  seemed  to  have 
the  effect  of  bringing  the  disease  to  a  standstill  for 
a  time.  Tlie  advantage  over  atropin  is  that  it  (ho- 
matropin) produces  its  effects  without  any  toxic 
symptoms,  such  as  widening  of  the  pupil,  dryness 
of  the  throat,  etc.  The  maximum  dose  is  gr.  i  to 
gr.  i.  by  injection." 


Heports  of  Societies. 


IVIEDICAL  AND   CHIETJKGICAL    FACULTY 
OF  THE  STATE  OF  MARYLAND. 

Eighty-foitrth  Annual  Session,  held  at  Ballimore,  Md., 

April  11—15,  188^. 

(Special  Report  for  The  Medical  REConD.) 

The  Eighty-fourth  Annual  Session  of  the  Medical 
and  Chirurgical  Faculty  of  the  State  of  Maryland 
was  held  in  Hopkins  Hall,  Johns  Hopkins  Univer- 
sity, in  the  city  of  Baltimore,  from  April  11th  to  15th, 
inclusive. 

THE  NEW   TOBK   CODE.- — PASTEUE'S   DISCOVERIES. 

The  Faculty  was  called  to  order  at  12  m.,  April  11th, 
by  the  President,  Dr.  Frank  Donaldson,  in  the  pres- 
ence of  about  one  hundred  members  and  delegates. 

He  welcomed  the  delegates  and  members  from  the 
counties,  referred  to  the  deaths  of  Drs.  Samuel  P. 
Smith,  of  Cumberland  ;  E.  Lloyd  Howard,  and  I. 
Davis  Thomson,  of  Baltimore  ;  to  the  favorable  re- 
ception accorded  the  last  year's  volume  of  "  Transac- 
tions," especially  the  papers  relating  to  isolation  of 
the  mammalian  heart  and  the  blood-pressure  in  the 
coronary  arteries ;  and  suggested  the  creation  of  a 
section  on  biology  and  the  offering  of  prizes  for  ori- 
ginal investigations  in  experimental  physiology  and 
therapeutics.  He  predicted  that  a  biological  train- 
ing would  soon  be  considered  an  essential  prerequi- 
site to  the  study  of  medicine.  After  urging  the  im- 
portance of  the  library  and  its  liberal  support,  he 
refeiTed  to  the  action  of  the  New  York  State  Society 
in  the  adoption  of  a  code  of  ethics  at  variance  with 
that  of  the  American  Medical  Association.  The  out- 
side public,  who  see  no  difference  in  what  they  call 
the  several  schools  of  medicine,  consider  the  per- 
mission to  hold  consultations  with  irregular  practi- 
tioners as  the  inauguration  of  a  vei-y  liberal  policy  ; 
but  to  the  medical  community  "  it  appears  irrecon- 
cilable with  common  sense  and  honesty.  A  mo- 
ment's reflection  ought  to  be  sufficient  to  show  that 
no  intelligent  consultation  could  be  held  between 
a  scientific  practitioner  and  the  professed  believers 
in  the  potency  of  infinitesimal  nihilities,  with  Thom- 
sonians,  eclectics,  or  those  professing  to  have  dis- 
covered the  elixir  of  life  or  panaceas  for  all  diseases. 
In  this  State  these  men  are  all  legally  qualified  to 
practice."  He  suggested  that  the  Faculty  reaffirm 
its  adhesion  to  the  Code  of  Ethics  of  the  American 
Medical  Association. 

The  President  next  referred  to  the  International 
Medical  Congress  of  London,  and  to  the  enthusiastic 
reception  accorded  to  M.  Pasteur,  as  illustrating  the 
drift  of  medical  thought  in  the  direction  of  pi-eventive 
medicine,  dwelling  at  length  upon  the  original  re- 
searches conducted  by  this  scientist,  proving  the 
connection  of  certain  diseases  with  living  organisms. 
Their  startiug-point  was  in  the  discovery  of  Cagniard 
de  la  Tour  that  yeast  fermentation  is  due  to  the 
growth  and  development  of  a  vegetable  fungus,  an 
idea  ridiculed  by  Liebig  and  the  chemists.  This 
suggested  that  putrefactive  and  other  kinds  of  de- 
composition might  be  due  not  to  the  action  of  oxy- 
gen upon  unstable  organic  compounds,  but  to  a  new 
arrangement  of  elements,  brought  about  by  the  de- 
veloi:)ment  of  germinal  particles  deposited  by  the 
atmosphere.  Lister  first  applied  this  idea  to  the 
treatment  of  disease  by  seeking  to  exclude  germs 
from  wounds.     The  great  lesson  that  we  learn  from 


^38 


THE  MEDICAL  RECORD. 


Listerism  is  the  value  of  scnipuloua  cleanliness  and 
purity  of  the  air.  The  discovery  of  the  nature  of  the 
contagium  of  pebrine,  the  ailk-worm  disease,  and  of 
charbon — a  fearful  epidemic  which,  in  the  province 
of  Novgorod,  Russia,  alone,  in  three  years,  destroyed 
528  human  lives  and  56,000  of  those  of  horses,  cattle, 
and  sheep — were  successively  described.  It  was  stated 
that  the  blood  of  animals  dead  from  charbon  might 
be  dried  and  kept  foryears,  and  even  pulverized  into 
dust  without  losing  its  power  of  infection.  The 
wool-sorter's  disease  was  believed  to  be  a  modifica- 
tion of  charbon.  The  possibility  of  the  communica- 
tion of  zymotic  diseases  to  man,  who  lives  vipon  veg- 
etables and  herbivorus  animals,  from  the  soil,  through 
the  agency  of  earthworms,  was  suggested.  The 
changes  effected  by  culture  in  germs,  analogous  to 
those  produced  by  cultivation  in  esculent  plants  and 
fruits,  was  a  most  important  observation,  and  has 
led  to  the  protective  vaccination  against  two  dis- 
eases— charbon  and  chicken  cholera — by  the  use  of 
a  mitigated  virus.  The  possibility  of  the  conversion 
of  harmless  into  virulent  micrococci  by  mal- sanitary 
inflaences,  as  foul  air,  darkness,  high  temperature, 
filtli,  etc.,  may  explain  the  occurrence  of  malignant 
.  cases  of  infectious  diseases,  since  all  these  conditions 
are  known  to  be  favorable  to  the  growth  of  vegetable 
fungi.  Tyndal's  observations  in  the  Alps  proved 
the  absence  of  germs  in  the  atmosphere  of  elevated 
localities,  and  the  author  had  acted  for  years  past 
on  the  belief  that  the  arrest  of  progressive  lung  sup- 
puration in  consumptives  resorting  to  the  high  alti- 
tudes was  to  be  attributed  to  this  fact. 

The  power  of  the  protection  afforded  by  the  new 
vaccination  has  been  shown  by  Greenfield,  Tous- 
saint,  and  Pasteur,  but  most  strikingly  by  the  ex- 
perimentum  crucis  of  the  last  in  the  inoculation  of 
fifty  sheep,  twenty-five  of  which  died,  according  to 
prediction,  on  the  following  day.  Recent  researches 
point  strongly  to  the  dependence  of  malaria,  phthisis, 
.  and  scrofula  upon  the  presence  of  germs,  the  in- 
oculation of  which  is  capable  of  producing  these 
diseases,  but  much  is  yet  needed  to  establish  the 
power  of  vaccination  in  the  case  of  other  diseases 
than  tho.se  above  mentioned.  The  germs  must  tir.st 
be  isolated  and  mitigated  by  cultivation.  The  light 
thrown  upon  the  protective  power  of  Jennerian  vac- 
cination by  these  researches  was  then  pointed  out. 
The  vaccine  virus,  by  passing  through  the  human 
bo  \j,  loses  its  original  potency,  the  effect  diminish- 
ing in  direct  proportion  to  the  number  of  cultiva- 
tions. Martin,  of  Massachusetts,  states  that  the 
humanized  virus  never  communicates  vaccinia  to  the 
heifer  beyond  the  third  remove,  whilst  there  is  no 
.  difficulty  in  keeping  up  a  continuous  transmission 
of  vaccinia  by  the  successive  inoculation  from  heifer 
to  heifer.  The  practical  deductions  from  these  facts 
are  obvious.  To  the  use  of  this  virus,  as  furnished 
bv  the  State  vaccine  agent.  Dr.  Regester,  was  at- 
tributed the  efficient  checking  of  the  small-pox  in 
this  community.  Bv  the  use  of  the  bovine  lymph 
the  Jennerian  vaccinia  is  ])roduced  in  all  its  original 
efficacy  without  any  deterioration  of  its  protective 
influence  by  prolonged  liumanization. 

KEPORTS    OP    OPFICETiS    AND    COMMITTEES. 

-The  Corresponding  Secretary,  Dr.  Michael,  read 
letters  of  acceptance  of  honorary  membership  from 
Professors  Goodell,  of  Philadelphia,  and  Mallet,  of 
University  of  Virginia. 

The  Treasurer,  Dr.  Gilman,  made  his  report  for 
■  the  past  year.  The  membership  had  been  dimin- 
-  ished  by  13 — 7  dead,  5  withdrawn,  1  dropped  for 


non-payment  of  dues ;  the  accessions  had  been  28 — 
26  active  and  2  honorary  members.  The  total  re- 
ceipts were  82,24.3.40  ;  total  disbursements,  81,696.- 
57,  leaving  a  balance  on  hand  of  S546.85.  The  assets 
were  .S7,823  (including  library  valued  at  87,000); 
liabilities,  §187.50. 

The  report  of  the  Committee  on  the  Library  was 
presented  by  its  chairman.  Dr.  I.  Edmondson  At- 
kinson. The  report  showed  an  increase  in  the  value 
of  the  library  of  81,000.  Three  hundred  and  twenty- 
five  volumes  had  been  received  during  the  year, 
making  the  present  number  3,069.  Number  of  jour- 
nals regularly  received,  118 ;  of  transactions,  49. 
Total  receipts  for  the  use  of  the  committee,  8493. 
Numerous  donations  of  books,  pictures,  journals, 
etc.,  were  acknowledged,  the  most  interesting  be- 
ing the  minutes  of  the  Harford  County  Medical 
Society  (1797),  a  letter  from  Professor  William  Cul- 
len  (1773)  to  Dr.  Upton  Scot,  the  first  President 
of  the  Faculty,  some  of  the  early  lecture  tickets, 
notes  of  lectures,  ledgers,  etc.,  chiefly  from  the  li- 
brary of  John  Archer.  M.B.,  a  distinguished  physi- 
cian of  jNIaryland  during  the  last  century. 

The  Committee  on  Publication  reported  through 
Dr.  Regester  that  500  copies  of  the  last  year's  trans- 
actions, and  700  copies  of  Professor  Goodell's  ad- 
dress on  "The  Dangers  and  Duty  of  the  Hour"  had 
been  published  and  distributed  at. a  cost  of  8462.80. 

Db.  I\^mp,  of  the  Committee  on  Memoirs,  read 
sketches  of  the  lives  of  Drs.  ,J.  M.  Sullivan,  J.  W. 
Walls,  I.  D.  Thomson,  T.  C.  Maddux,  and  Beniah 
Tifeomb. 

Db.  Lattmek  also  read  a  sketch  of  Dr.  E.  Lloyd 
Howard,  and 

Db.  Chbistopher  Jottnstox,  Jb.,  one  of  Dr.  Samuel 
P.  Smith,  of  Cumberland. 

The  Cnr.ator,  Dr.  Bowie,  pre.sented  a  report  urg- 
ing the  need  of  better  accommodations  for  the 
pathological  specimens  belonging  to  the  Faculty. 

SECTION   ON   SUBGEKT. 

The  report  was  made  by  the  chftirman.  Dr.  L. 
McLaxe  Tiffany.  He  first  presented  a  patient 
upon  whom  he  had  successfully  jierformed 

AMPUTATION    AT   THE   LEFT   Hrp-.TOINT, 

last  November,  on  account  of  a  small-celled  sarcoma 
of  eighteen  months'  duration.  The  bone  suddenly 
gave  way,  establishing  the  diagnosis.  The  tumor 
was  eight  inches  in  diameter.  The  patient,  a  young 
man  aged  twenty,  goes  about  on  crutches.  An 
abscess  formed  about  six  weeks  after  the  oiiera- 
tion,  which  continues  to  weep  at  the  present  time. 
The  stump  looks  well,  and  the  cause  of  the  discharge 
was  not  known. 

Dr.  Tiffany  then  read  a  paper  on 

TREATMENT   OP   CANCER    OP   THE   RECTUM    BY   EXCTISIOX, 
WHTH    REPORT   OF   A    CASE   OF   EXCISION. 

He  described  the  general  characters  of  the  disease, 
and  pointed  out  the  importance  of  their  early  recog- 
nition. In  his  experience  cases  were  generally 
allowed  to  progress  l>eyond  the  possibility  of  relief 
from  operation  before  they  came  to  the  surgeon. 
He  endorsed  in  a  general  way  the  rules  laid  down 
by  Volkmann  regarding  the  selection  of  cases  for 
excision,  and  enforced  the  well-established  rule  not 
to  operate  in  cases  where  the  upper  limit  of  the 
growth  was  beyond  the  reach  of  the  tip  of  the  finger. 
The  following  case  of  excision  was  then  related : 


II 


THE  MEDICAL  RECORD. 


439 


L.  K ,  female,  aged  forty-seven,  single,  bad  a 

tumor  removed  from  the  sacriim  three  years  ago.  A 
year  ago  she  began  to  have  discomfort  about  the 
anus.  She  came  iinder  Dr.  T.'s  care  in  February, 
with  bloody  discbarge,  bearing  down,  during  defe- 
cation severe  j:)ain.  A  saddle- shaped  epithelioma 
was  found,  the  seat  resting  against  the  rectum,  the 
flaps  encircling  the  bowel,  but  not  quite  meeting  in 
front  at  the  median  line.  The  growth  was  movable 
upon  the  subjacent  tissue.  There  were  no  glandular 
enlargements,  and  general  health  was  excellent. 
The  growth  involved  the  lower  three  inches  nearly 
of  the  rectum  behind,  and  one  and  one-half  inches 
in  front.  Excision  was  performed  at  University 
Hospital,  February  27,  18S2,  by  the  incisions  men- 
tioned above.  Both  finger  and  knife  were  used  to 
free  the  bowel  from  adhesions.  The  bowel  was 
divided  with  the  Paquelin  cautery  above  the|gi-owtb, 
and  the  edges  stitclied  to  the  skin,  except  behind, 
where  this  was  impossible  without  excessive  trac- 
tion. The  perineum  was  split  backward  to  the 
coccyx  to  facilitate  drainage.  Frequent  irrigation 
with  warm  carbolized  water  and  general  cleanliness 
constituted  the  after-treatment.  On  the  third  day 
temperature  was  103"  ;  on  the  sixth  it  was  normal. 
The  patient  will  leave  for  home  this  week,  being 
able  to  retain  her  ffeces  unless  very  fluid. 

Should  excision' be  impracticable,  pain  and  ob- 
struction demand  attention.  A  soft  evacuation 
should  be  secured  daily.  Boiigies  were  condemned, 
and  large  injections  only  become  necessary  for  the 
removal  of  hard  masses.  Iodoform  suppositories 
atford  relief,  and  opium  should  be  used  freely. 
Spasm  and  irritability  are  relieved  by  incision  of 
the  sphincter  and  rectum  back  to  the  coccyx. 
Sooner  or  latter  colotomy  becomes  applicable,  on 
account  of  obstruction  and  the  extreme  suffering 
from  the  passage  of  fecal  matter  over  the  ulcerated 
surface.  This  operation  the  author  had  performed 
three  times.  Two  of  his  patients  had  died  some 
time  subsequent  to  the  operation,  the  third  was  still 
living,  over  a  mouth  having  elapsed  since  the  colot- 
omy. This  patient  is  a  man  aged  sixty,  who  came 
under  care  with  an  epithelioma  of  the  anterior  wall 
of  the  rectum,  three  inches  in  diameter  and  adher- 
ent. The  finger  could  not  reach  its  upper  extremity, 
and  excision  was  contra-indicated.  Six  months 
elapsed  before  the  obstruction  became  complete. 
Colotomy  was  done  March  9th.  No  complications 
occurred,  and  the  wound  healed  well  and  rapidly. 
When  distended  the  colon  is  found  without  difli- 
cnlty,  but  if  empty,  the  kidney,  which  can  always  be 
felt  "tlirough  the  subperitoneal  fat,  is  the  best  guide, 
the  colon  renting  on  the  anterior  stirface  of  the 
lower  end  of  this  organ.  An  oakum  pad  and  snugly 
fitting  bandage  are  sufficient  to  retain  the  fseces 
after  the  operation. 

Dk.  G.  Halsted  BovL.iND  read  a  siipplementary 
report  on  two  cases  of 

FRACTURE  OP  THE  INFERIOE  EXTREMITT  OF  THE  RADIUS, 

both  in  males — aged  twenty-four  and  fifty- five — both 
on  the  left  side  and  from  falls  on  the  palm.  The 
first  only  was  accompanied  by  deformity,  which  did 
not  disappear  entirely  under  treatment.  The  plas- 
ter-of-Paris  bandage  was  used  in  tioth  cases. 

The  first  day's  session  then  adjourned. 

The  Sfi'onil  rlai/'s  session  opened  with  the  reading 
of  papers  exhibiting  the  results  of  researches  made 
in  the  Biological  Laboratoi-y  of  the  Johns  Hopkins 
University.  The  first  was  by  Mr.  Wm.  H.  Howell, 
A.B.,  and  Frank  Donaldson,  Jr.,  A.B., 


ON  THE  FORM  OP  THE  PULSE  AND  ON  THE  WEAN  ARTE- 
RIAL PKESSURE  IN  A  DOG  WITH  PERMANENTLY  OPEN 
DUCTUS   ARTERIOSUS. 

A  dog  came  under  observation  presenting  symp- 
toms of  cardiac  disease.  Auscultation  revtaled  hy- 
pertrophy, and  a  loud  rasping  systolic  murmur,  most 
intense  at  thebase,  with  aslight  njuimur,  coincident 
with  the  second  sound.  Tracings  were  made  with 
Marey's  sphygmograph  on  the  femoral  artery.  The 
femoral  arteries  weie  then  laid  bare,  and  a  canula 
introduced  into  each  one,  being  connected  with  an 
ordinaiy  mercury  manometer,  the  other  with  a  Tick's 
federkymographion.  These  tracings  were  all  nor- 
mal, showing  that  the  heart  lesions  and  disturbed 
circulation  did  not  produce  any  alteration  in  the 
pulse  wave  or  arterial  pressure,  as  might  have  been 
inferred  from  the  conditions  found  on  post-mortem, 
which  were  as  follows :  patent  ductus  arteriosus,  al- 
lowing free  communication  between  the  pulmonary 
artery  and  aorta :  considerable  dilatation  of  the 
commencement  of  the  arch,  but  without  atheroma- 
tous change  ;  enlargement  of  the  heart  with  hyjier- 
trophyiof  the  left  ventricle  and  apparent  insufficiency 
of  the  mitral  and  pulmonary  valves  ;  a  pmall  valvu- 
lar fold  at  the  entrance  of  the  ductus  into  the  aorta 
prevented  the  passage  of  the  blood,  forced  from  the 
left  ventricle  into  the  pulmonary  artery,  but  oflering 
no  resistence  to  its  entrance  on  the  recoil  of  the  aorta. 
The  free  communication  of  the  systemic  and  pul- 
monary system  would  have  led  to  the  expectation  of 
a  diminished  pressure,  the  absence  of  which  was 
probably  due  to  increased  force  of  the  heart  or  in- 
creased peripheral  resistance. 

The  second  paper  was  read  by  Dr.  Henry  Sewell, 
Associate  in  Biology,  and  Frank  Donaldson,  Jr., 
A.B.,  and  entitled 

OBSERVATIONS  ON  THE  INFLUENCE  OF  VARIATIONS  OF 
INTEA-CARDIAC  PRESSURE  UPON  THE  CARDIO-INHIB- 
ITORT   INFLUENCE   OF   THE   PNEU5I0GASTRIC   NERVES. 

The  experiments  which  it  is  intended  to  repeat 
upon  the  isolated  mammalian  heart  were  done  prin- 
cipally upon  the  frog  and  terrapin.  The  following 
were  their  results  :  (1)  increase  of  intra  cardiac  pres- 
,sure  by  raising  venous  pressure  diminishes  the  in- 
hibitory power  of  the  vagus  ;  (2)  variation  of  arterial 
pressure  has  no  efiect  on  vagus  efficiency  ;  (3)  with  a 
canula  passed  through  the  semilunar  valves  into 
the  left  ventricle,  increased  arterial  pressure  had  no 
efi'ect  on  the  vagus  until  blood  had  made  its  way 
backward  through  the  auriculo-ventricular  valves 
into  the  auricles,  and  thus  raising  the  ju-essure 
within  them,  indicating  that  insufficiency  of 
the  semilunar  valves  has  no  influence  on  vagus 
inhibition,  and  the  peculiar  effect  of  increase  of 
intracardiac  pressure  on  the  vagus  action  can  only 
exert  itself  during  the  heart's  diastole  ;  (4)  the  ven- 
tricle being  excluded,  variations  of  ijressure  within 
the  sinus  and  auricles  together  was  quickly  mani- 
fested in  the  diminished  efficiency  of  the  vagus ; 
(5)  increase  of  .sinus  pressure  alone  lessens  the  effici- 
ency of  the  vagus.  "  We  have  then  confirmed,"  say 
the'authors,  "  on  the  frog  and  terrapin  that  variation 
of  intra  cardiac  pressure  has  a  very  marked  eflect  in 
modifying  the  intensity  with  which  the  cardio-inhib- 
itory  fibres  of  the  vagus  act  on  the  heart.  It  has 
been  .shown  that  increase  of  systolic  pressure  in  the 
ventricle  is  not  the  cause  of  this  influence  on  the  va- 
gus action.  It  has  been  made  probable  that  the 
result  is  not  due  to  increase  of  systolic  pressure 
within  the  auricle  and  therefore  that  the  whole  heart 
i  is  affected  in  this  respect  by  variation  of  intra-cardiac 


440 


THE  MEDICAL  RECORD. 


pressure  only  during  its  diastole.  We  have  found 
that  increase  of  pressure  within  the  ventricle  at  its 
diastole,  such  as  would  follow  from  semilunar  insuffi- 
ciencv,  has  of  itself  probably  no  effect  on  the  vagiis 
action.  We  huve  shown  that  all  the  effects  which  varia- 
tion of  intra-cardiao  pressure  have  upon  the  efficiency 
of  the  vagus,  can  be  produced  on  the  auricles  and  sinus 
together  or  upon  the  venous  sinus  taken  alone." 

The  third  paper  was  by  H.  H.  Donaldson,  A.B., 
Fellow  of  J.  H.  U.,  and  M.'  Warfteld. 

ON   THE  VARIATION   IN  THE  WORK  OF  TEtB  HEART  UNDER 
DIGITAl-INB. 

The  preparation  employed  was  that  made  by 
Merck,  of  Darmstadt,  and'tlie  slider  terrapin  was 
employed  in  making  the  experiments.  Is  the  rise 
of  pressure  observed  after  the  u.se  of  this  agent  due 
to  the  arterioles  or  to  the  increased  work  of  the 
heart?  Most  authorities  concur  in  the  former  be- 
lief, but  in  1872,  Boehm  claimed  an  increased  heart- 
work  from  moderate  doses— .0005  grm.  to  .001  grm., 
basing  his  conclusions  upon  a  series  of  experiments 
made  upon  the  isolated  frog's  heart,  and  upon  his 
failure  to  discover  constriction  of  the  arterioles. 
The  method  of  feeding  the  isolated  mammal  heart, 
perfected  bv  Professor  Martin,  enabled  Mr.  Donald- 
son to  run  digitalinized  blood  through  the  heart, 
without  otherwise  changing  the  animal's  condition. 
The  venous  and  arterial  pressures  were  always  within 
normal  limits.  The  dose  employed  varied  from  .0003 
grm.  to  .005  grm.  in  100  c.  c.  of  blood.  The  heart 
was  dosed,  and  recovered  from  four  to  six  times  in 
each  experiment,  and  the  experiments  lasted  from 
five  to  ten  hours.  Forty  cases  were  recorded.  Eight 
of  these  were  rejected  on  account  of  imperfections. 
The  remaining  thirtvtwo  led  to  the  following  con- 
clusions :  That  the  work  done  was  always  decreased 
by  digitaline,  the  amount  of  decrease  bearing  a 
rough  proportion  to  the  size  of  the  dose  ;_  that  with 
small  do-ses  there  was  an  initial  quickening  of  the 
pulse  ;  that  it  was  the  percentage  of  the  agent,  not 
the  absolute  quantity,  that  was  the  important  fact  in 
varying  the  heart.  The  main  conclusion  is  sup- 
ported bv  all  the  experiments  so  far  made  on  mam- 
mals. The  inference,  therefore,  was  that  the  work 
of  the  human  heart  is  decreased  by  digitaline,  not 
increased,  as  some  have  maintained. 

ELECTION   OP   MEMBERS. 

The  Faculty  then  took  n.]i  the  names  of  the  thir- 
teen candidates  recommended  by  the  Board  of  Ex- 
aminers for  the  Western  Shore  for  membership. 
Among  these  wore  Dr.  Whitfield  Winsey,  a  colored 
practitioner  of  Baltimore,  and  a  graduate  of  Harvard 
Universitv,  who.se  recent  rejection  by  the  Baltimore 
Medical  and  Surgical  Society  attracted  much  unfa- 
vorable comment  and  criticism.  In  this  case,  how- 
ever, his  election  was  accomplished  without  the  least 
sign  of  opposition,  and  the  reporter  may  add  that 
the  number  of  these  members  of  the  profession  in 
Baltimore  who  object  to  the  election  into  our  medi- 
cal societies  of  a  man  otherwise  qualified,  simply  on 
account  of  his  color,  is  extremely  small,  nor  do  tliey 
all,  by  any  means,  hail  from  the  South. 

INCREASE   OP   MEMnERSF.II"   DUES. 

The  amendment  to  the  constitution  mcreasing  the 
annual  dues  of  members  residing  in  Baltimore  to 
$<<,  of  which  S4  shall  go  to  the  expenses  of  the  Li- 
brarv,  and  also  appropriatincr  S2  of  the  .^n  alreadv 
required  from  country  members  to  tlio  same  object, 
was  then  voted  upon  and  adopted,  after  which  a 
motion  to  adjourn  prevailed.'' 


The  third  day's  session  opened  with  the 

ANNUA!   ORATION, 

delivered  at  noon,  April  13th,  by  Dr.  A.  M.  Faunt- 
LEROY,  of  Virginia,  his  subject  being 

THE   RECIPROOAL    ACTION   OP    MORBID   BODILT   AND 
MENTAL  INFLUENCES. 

The  importance  of  psychology  could  not  be  ignored 
by  the  general  practitio"ner.  The  union  of  mind  and 
body  is  intimate,  but  of  the  mode  in  which  it  is  ef- 
fected we  are  in  profound  ignorance,  and  probably 
always  will  be.  We  recognize  in  the  organism  a 
mental  force  associated  with,  yet  superior  to  the 
vito-phvsical  energies.  The  nervous  system  is  the 
physical  condition  of  psychical  phenomena.  The 
nerve-centres  are  acted  upon  ascensively  by  bodily 
conditions,  whilst  on  the  other  hand,  are  themselves 
influenced  by  such  conditions,  functional  and  organic, 
ascensively.  Gout,  epilepsy,  consumption,  gastro- 
hepatic  derangements,  chorea,  and  above  all  hys- 
teria, exhibit  promptly  the  close  relationship  _  of 
mental  and  bodily  states.  Insanity  in  its  causation 
and  phenomena  exhibits  constant  instances  of  the 
interdependence  of  physical  and  moral  influences. 
When  we  consider  that  the  air  is  full  (so  to  speak) 
of  germs— political,  commercial,  religious— capable 
of  infecting  the  mind  and  destroying  its  balance,  the 
frequent  inheritance  of  a  predisposition  to  insanity 
from  preceding  generations.  Which  maybe  excited  to 
activity  bv  the  slightest  cause,  and  the  delicacy  and 
complexitv  of  the  brain  itself  and  its  intimate  con- 
nection with  the  entire  organism,  our  only  surprise 
should  be  at  the  infrequency  of  insanity.  The  ad- 
dress was  coaiparatively  brief,  and  being  upon  a 
purely  technical  subject,"  its  merits  cannot  be  fully 
appreciated  until  it  is  read.  Upon  its  conclusion,  a 
vote  of  thanks  was  passed,  and  Dr.  Fauntleroy  was 
elected  an  honorary  member  of  the  Faculty. 

SECTION   ON   PRACTICE   OP   MEDICINE. 

The  report  was  read  by  Dr.  Thomas  B.  Evans, 
Chairman.  It  was  entirely  devoted  to  the  causation 
of  disease,  i>articularly  with  reference  to  the  recent 
researches  into  the  nature  of  germs  by  Pasteur  and 
others,  and  went  over  pretty  much  the  same  ground 
embraced  bv  the  President's  address.  One  point 
upon  which  the  author  insisted  was  the  presumptive 
proof  afl'orded  by  these  researches  of  the  identity  of 
vaccinia  with  variola. 

SECTION   ON   OBSTETRICS   AND   OTNECOLOGT. 

The  report  was  made  by  Dr.  Thomas  Opie,  Chair- 
man. It  was  principally  a  review  of  the  work  done 
during  the  year  in  the  section.  Realizing  the  need 
in  Baltimore  of  an  association  of  the  i)hysicians  _es- 
peciallv  interested  in  these  departments  the  section 
had  held  monthly  meetings,  which  had  been  well 
attended  and  the  proceedings  of  which  had  been  of 
very  great  interest.  The  diairman  hoped  that  the 
need  of  an  obstetrical  society  in  Baltimore  (already 
supplied  in  most  of  the  larger  American  cities) 
would  be  obviated  by  the  permanent  continuance 
and  increasing  activity  of  this  section,  which  was 
capable  of  supplvina:  all  the  wants  of  specialists  in 
this  field  without  the  additional  expense  of  a  new 
society,  of  which  there  were  already  enouah  in  Bal- 
timore. Among  the  most  interesting  matters  com- 
ing before  the  section  had  been  the  report  of  a  case 
of  extrauterine  pregnancy  presenting  unusual  and 
difficult  points  in  diagnosis,  by  Dr.  Thos.  A.  Ashby ; 
papers  upon  the  uses  of  the  forceps,  by  the  same 


THE  MEDICAL  RECORD. 


441 


gentleman  and  Dr.  John  Morris ;  a  paper  on  the  use 
I  of  electricity  in  the  treatment  of  amenorrhea,  by 
I  Dr.  A.  Bernard  Browne  ;  cases  of  ovariotomy  during 
pregnancy  and  of  combined  intrauterine  and  abdom- 
j  inal  twin  pregnancy,  by  Dr.  H.  P.  C.  Wilson  ;  a  ca.se 
of  extra-uterine  pregnancy  with  ulceration  through 
the  abdominal  wall,  bvDr.  A.  F.  Erich,  and  a  paper  on 
ergot  by  Dr.  P.  C.  Williams.  Several  of  these  have 
already  been  published  in  the  journals,  and  the 
others  will  soon  appear.  Dr.  Williams  holds  the 
following  views  in  regard  to  the  use  of  ergot.  He 
believes  that  it  will  prevent  abortion  before  the 
fourth  month,  that  it  will  shorten  labor  and  obviate 
exhaustion  in  the  woman,  that  it  will  prevent  dimi- 
nution of  the  pains  from  chloroform,  that  it  will  pre- 
vent post-ijartum  hemorrhage  and  septic  absorption. 
Of  158  cases  of  labor  treated  upon  the  plan  of  short- 
ening its  duration,  and  relieving  pain  by  the  employ- 
ment of  ergot  and  chloroform,  and  of  forceps 
whenever  there  is  unusual  delay,  he  had  lo.st  no 
mothers  and  but  thi-ee  children.  He  believes  that 
erzot  is  useless  in  labor  except  by  hypodermic  injec- 
tion, and  prefers  the  fluid  extract  to  ergotine  for 
this  purpose.  Dr.  Opie  concluded  his  report  by  the 
relation  of  some  case  of  ante-mortem  heart-clot,  the 
specimens  of  which  were  exhibited,  and  by  a  history 
of  six  cases  of  septicsemia  observed  at  the  Maternitc 
Hosi)ital,  and  gave  his  conclusions  that :  (1)  an  at- 
mospheric miasm  was  concerned  in  the  etiology  of 
puerperal  fever ;  (2)  that  there  was  strong  ground 
for  a  belief  in  the  close  relationship  of  eiysipelas  and 
septieiemia ;  (3)  that  many  cases  of  sudden  death  im- 
puted to  heart-clot  may  be  imputed  to  septiciemia. 

SECTION    ON    MATERIA-MEDICA    AND     CHEJUSTET. — UNI- 
FOBMITY   IN   FLUID  MIXTUEES. 

The  report  was  made  by  Dr.  John  R.  UiUiEB, 
Chairman.  It  alluded  to  several  drugs,  new  or 
having  new  apiDlications.  The  most  important  sug- 
gestion in  the  report  was  that  of  a  preparation  of 
all  drugs  capable  of  being  dispensed  in  a  liquid 
form  the  same  bulk  of  which,  say  one  drachm,  would 
represent  the  adult  dose  of  every  such  drug.  The 
author  claimed  that  this  would  much  simplify  the 
work  of  both  physician  and  druggist,  would  render 
the  labor  of  memorizing  less  exacting  upon  the  part 
of  the  former,  and  would  enable  him  at  any  moment 
to  employ  any  one  of  a  great  variety  of  drugs,  thus 
increasing  his  usefulness  and  his  power  to  cope 
with  disease. 

SECTION    ON   SANITAEY   SCIENCE. 

The  report  opened  with  a  paper  by  the  chairman. 
Dr.  John  Morrls,  upon  the  causes  of  the  prevalence 
ot  diphtheria  in  the  Seventeenth  Ward  of  Baltimore 
City.  Thenumberof  deaths  in  this  ward  in  1881,  from 
diphtheria  alone  (as  reported  by  the  City  Health 
Department),  was  140,  the  whole  number  in  the  city 
being  630.  The  author  claimed  that  this  dispropor- 
tionate mortality  in  the  ward  named  was  due  to  the 
excessively  offensive  odors  arising  from  dead  fish 
and  other  animal  matter  employed  in  the  fertilizing 
manufactories.  The  stench  is  so  ofl'ensive  that  the 
residents  are  compelled  to  keep  their  doors  and 
windows  closed  during  the  summer  months,  and 
they  have  been  forced  to  seek  relief  in  the  courts. 
The  author  claimed  that  filth  in  the  air  was  as  nox- 
ious as  that  in  water.  Diphtheria  is  due  to  decom- 
posing animal  matter,  under  whatever  form,  and 
dampness  cannot  alone  generate  the  virus. 

The  session  then  adjourned,  and  many  members 
embraced  an  invitation  to  witness  the  beating  of  an 


isolated  dog's  heart  in  the  laboratory  overhead.  The 
animal  had  been  dead  about  three  hours  at  that 
time,  and  his  limbs  had  already  begun  to  stiflfen. 
In  the  evening  a  reception  was  given  by  the  Presi- 
dent of  the  Faculty  at  his  residence  on  Park  Avenue, 
which  was  attended  by  a  large  number  of  members 
and  delegates. 

The/oiirtli  (Uii/'s  session  opened  at  noon  with  the 
reading  of  a  paper  by  Prop.  H.  Newell  Martin,  M.D., 
D.Sc,  M.A.,  of  Johns  Hopkins  University,  upon 

THE  DJFLrENCE  OF  VARIATIONS  OF  ARTERIAL  PRESSrEE, 
OP  VENOrS  PRESSURE,  AND  OF  TEMPERATURE  UPON 
THE  PULSE-EATE  OF  THE  ISOLATED  MAMMALIAN 
HEART. 

The  author  stated  that  he  had  much  improved 
the  method  of  isolating  the  dog's  heart  from  all  the 
rest  of  its  body  except  the  lungs,  since  his  com- 
munication upon  the  subject  to  the  Faculty  a  year 
ago.  As  now  practised  it  consists  in  aniesthet- 
iziug  the  animal  and  tracheotomiziug  it ;  the  caro- 
tids are  then  exposed,  ligated,  a  canula  placed  in 
the  cardiac  end  of  each,  artilicial  respiration  is 
started,  the  thorax  opened  and  both  subclavians 
tied.  A  wide  canula  is  inserted  into  the  aorta 
just  beyond  its  arch.  The  coronary  arteries  are  the 
only  systemic  arteries  that  now  remain  open,  and 
brain,  trunk,  and  limbs  commence  to  die.  Next 
the  inferior  cava  is  ligated  just  above  the  dia- 
jjhragm,  the  vena  azygos  near  its  junction  with  the 
superior  cava,  and  the  latter  below  the  point  where 
the  left  innominate  joins  it.  All  the  systemic  veins 
excejjt  the  coronary  are  now  closed — the  pulnion- 
aiy  circulation  remains  intact.  Heart  and  lungs  are 
now  alone  the  .seat  of  circulation.  A  large  can- 
ula is  tied  into  the  cardiac  stump  of  the  superior 
cava  and  connected  with  a  reservoir  of  defibrinated 
blood.  The  carotid  canulas  are  opened  and  the 
blood  washed  out  of  the  heart  and  lungs  and  re- 
placed with  defibrinated  blood  from  the  reservoir, 
and  during  this  process  a  thermometer  is  tied  into 
the  left  subclavian,  which  gives  subsequently  the 
temperature  of  the  aortic  and  coronary  blood.  The 
animal  is  then  placed  in  a  warm  moist  chamber  at  a 
temp,  of  38°C.  The  canula  in  the  superior  cava  is 
connected  with  a  Marriott's  flask  filled  with  defibrin- 
ated blood  with  which  the  heart  is  fed.  The  aortic 
canula  is  attached  to  a  rubber  tube  whose  distal 
end  can  be  raised  or  lowered  at  will,  clamjjs  are 
now  removed,  the  blood  from  the  flask  enters  the 
heart  at  a  known  pressure  and  is  thence  pumped  out 
into  the  aortic  tube  ;  this  latter  pours  it  into  a 
funnel  from  which  it  is  conducted  to  an  empty 
Marriott's  flask.  As  one  flask  empties  the  other  fills, 
and  at  any  time,  by  means  of  stopcocks,  the  empty 
one  can  be  disconnected  with  the  heart,  and  the 
other  full  one  used  for  heart  nutrition.  Uniform 
artificial  respiration  is  maintained  by  a  small  water 
engine.  The  carotid  canulas  are  connected  with 
manometers  which  record  pulse-rate  and  arterial 
pressure  on  the  paper  of  a  kymogi-aph. 

Under  these  conditions  we  can  raise  arterial  pres- 
sure by  elevating  the  aortic  tube  ;  we  can  raise  ve- 
nous pressure  by  elevating  the  supplying  flask  ;  we 
can  warm  or  cool  the  blood,  whose  temperature  is 
registered  by  the  thermometer  in  the  aorta.  The 
details  of  the  experiments  performed  upon  the  mam- 
mal heart  by  such  a  mechanism  cannot  be  entered 
into  here,  but  they  proved  conclusively,  according 
to  Professor  Martin,  that  arterial  pressure  (varied 
from  one  less  than  the  normal  to  nearly  double  the 
normal)  had  no  direct  effect  whatever  upon  the  rate 


U2 


THE   MEDICAL  RECORD. 


of  beat  of  the  heart;  that  changes  in  the  venous 
pressure  (varying  from  that  exerted  by  a  column  of 
defibrinated  blood  7  etm.  in  height  to  that  of  one 
3S  ctm.  in  height)  had  no  direct  influence  on  the 
rate  of  the  heart-beat;  that  increase  in  the  tempera- 
ture of  the  blood  increases  in  direct  proportion  the 
frequency  of  the  mammalian  heart-beat.  The  pi'ac- 
tioal  results  to  medicine  from  the  demonstration  of 
the  last  conclusion  were  pointed  out.  The  origi- 
nality, ingenuity,  and  great  value  of  Professor  Mar- 
tin's researches  excited  profound  interest,  and  his 
commnnication  was  received  with  the  greatest  ap- 
plause. Honorary  membership  would  have  been 
conferred  on  him  had  not  the  constitution  prohibited 
it  to  residents  of  the  State. 

The  report  was  continued  by  the  reading  of  a 
paper  by  Db.  William  M.  Kemp, 

A  REVIEW  OF  THE  ACTION  OF  THE  BOARD  OF  HEALTH 
OF  BALTIMOBE  IN  REFERHTNCE  TO  THE  YELLOW  FF.^^3R 
EPIDEinC    IN   PORTSMOUTH   AND  NORFOLK   IN    185.5. 

Dr.  K.  was  at  that  time  Health  Officer  of  Baltimore, 
visited  the  infected  cities  early  in  the  endemic,  and 
investigated  thoroughly  the  circumstances  connected 
with  its  outbreak.  His  conchisions  were  that  it  was 
of  local  origin  and  non-contagious.  He  pointed  out 
with  great  emphasis  that  no  better  evidence  of  the 
non-cominuuicabilit.y  of  the  disease  could  be  ob- 
tained tlian  during  this  endemic,  when  the  freest 
communication  was  permitted  between  the  infected 
ports  and  Baltimore,  and  yet  not  a  single  case  ap- 
peared in  the  latter  city  except  among  refugees. 

The  third  paper  from  this  section  was  by  Dr.  W. 
Chew  Van  Bibber,  and  was  upon  the 

DRINKING   WATER   OF   MABTLAND. 

Much  valuable  local  information  was  given  in  this 
paper.  He  suggested  that  examination  of  the  drink- 
ing water  might  throw  light  upon  the  etiology  of 
malaria.  The  percolation  of  sea-water  through  the 
soil  was  a  possible  source  and  would  seem  to  corre- 
spond with  its  limitation  to  the  tide-water  region. 
The  extent  of  the  tide-water  coast  of  Marvland  was 
reputed  to  be  2,815  miles.  The  water-supply  of 
Baltimore  obtained  from  the  Gunpowder  Kiver' and 
Jones'  Falls  was  stated  to  be  500  gallons  to  each  in- 
dividual in  twentv-four  hours,  and  it  was  believed 
"  that  Baltimore  has  now  the  largest  proportionate 
water  supply  of  any  known  city." 

Tlie  report  of  the  Seclionxon  Anatnmi/.  Pht/niology, 
and  Patholngn,  and  on  P.y/rliohgii  and  Mcdierd  Jnris- 
pnuhiice  xrere  presented  by  Dr.  Randolph  Winslow 
and  J.  S.  CoNR\D,  read  by  title  and  referred  to  the 
publication  committee.  The  titles  were  "  .'Vnoma- 
lies  of  the  Osseous  and  Ligamentous  Systems,"  and 
"Associated  Physiological  and  Pathological  Psy- 
chology of  the  Insane." 

There  was  no  report  from  the  Section  on  Mioroscopi/, 
Micro-Chemistry,  and  Spectral  Analysis. 

SECTION  OK  OPHTHALMOLOai  AND  OTOLOOT. 

The  report  was  read  by  Dr.  J.  J.  Chisolm,  Chair- 
man. The  subjects  treated  were  Eserino,  which  has 
taken  the  place  of  all  other  remedies  in  corneal  af- 
fections ;  Pilocarpin, which  had  produced  the  l)est  re- 
sults in  the  autlior's  hands,  internally  used,  of  all 
the  articles  in  the  pharmacnpcoia  in  aonte  intlamma- 
tions  of  the  eyeball ;  S  ilicvlate  of  Sodium  of  the  gi-eat- 
est  value  in  iritic  and  scleral  intlainniations.  whether 
specific  or  rheumati(! ;  Homatropin  to  bn  preferred  to 
atropia  and  duboisia  on  account  of  its  transient  my- 
driatic efToct ;  Color-Blindness  ;   Myopia  in  School- 


children ;  Antiseptic  Eye  Surgery,  nerve-stretching  in 
Ophthalmic  Practice  ;  Skin-Grafting  in  the  same,  and 
Opticociliary  Neurotomy,  an  Operation  by  which  the 
author  has  obtained  many  excellent  and  permanent 
results. 

He  laid  down  the  following  aphorisms  for  general 
practitioners  practising  ophtbidmology. 

1.  Do  not  blister. 

2.  Do  not  use  nitrate  of  silver. 

3.  Do  not  use  acetate  of  lead. 

4.  Treat  affections  of  the  mucous  surface  by  weak 
astringents — borax,  sulph.  zinc,  tannin — and  cleanli- 
ness. 

5.  Use  weak  solutions  of  eserine  for  corneal  affec- 
tions. 

6.  Atropia  solutions  are  essential  to  break  np 
recent  iritic  adhesions. 

7.  When  in  doubt,  consult  early  with  a  specialist. 
The  session  then  closed. 


The  fifth  and  last  day's  session  opened  at  12  m. 
Volunteer  papers  being  in  order,  Dr.  John  N.  Mac- 
kenzie read  one  on 

DIPHTHEBITIC   ULOEBATION   OF   THE    AIR-PASSAGES,    AND 
ITS   RELATION   TO   PULMONARY   PHTHISIS. 

Are  all  forms  of  ulceration  of  the  upper  air-pas- 
sages associated  with  pulmonary  consumption,  due 
to  the  tubercular  diathesis  or  accidental  accompani- 
ments of  the  latter?  The  author  studied  a  variety 
of  ulceration  which,  in  view  of  its  histological  char- 
acters, he  regarded  as  of  diphtheritic  nature.  The 
erosions  referred  to  are  at  first  superficial,  afterward 
gi'owing  deeper,  are  multiple,  most  abundant  in 
the  lower  trachea  and  bronchi,  never  found  except 
in  phthisical  patients.  Histological  examination 
showed  typical  characteristics  of  diphtheritic  in- 
flammation. Distinct  miliary  tubercles  were  no- 
where to  be  seen.  The  author  attributed  these  J 
ulcerations  to  the  corrosive  action  of  the  foul  con-  H 
tents  of  the  pulmonary  caverns  lingering  in  the  '.  ' 
bronchi  and  lower  trachea.  The  proofs  of  this  mode 
of  origin  are:  (1)  the  predilection  of  the  ulcers  for 
those  places  which  are  in  constant  cwitact  with  the 
sputa ;  (2)  their  increa.se  as  the  lungs  are  ap- 
proached;  (3)  they  can  be  traced  from  the  bifvirca- 
tion  of  the  trachea  into  the  tube  which  leads  to  a 
cavity;  (4)  their  absence,  except  in  cases  of  lung 
cavities  or  advanced  phthisicil  di.«ease ;  (5)  their 
occasional  presence  in  the  oesophagus,  intestines, 
and  stomach,  from  swallowing  of  sputa;  ((">)  their  oc- 
casional presence  in  suppurative  pneumonia  and 
gangrene.  "  These  lesions  may.  therefore,  be  re- 
garded as  the  result  of  an  inoculation,  .so  to  speak, 
of  the  nnicous  memlu'ane  with  the  detritus  from  the 
liroken-down  pulmonary  tissue,  leailing  to  the  for- 
mation of  a  loss  of  substance  pathologically  distinct 
from,  but  possessing  some  of  the  external  character- 
istics of  the  tubercular  ulcer." 

The  next  paper  was  by  Dn. William  Lee,  and  upon 

RECURRENT    HE.VD AMIES   IN   Onn.DREN. 

The  author  drew  attention  briefly  to  certain  facial 

and  nmscular  peculiarities  characterizing  these  cases. 

The  next  paper,  by  Dr.  I.  Edmondson  Atkinson,  on 

SIMPLE   chancre   OP  THE   PREPUTIAL   MARGIN, 

was  read  by  title  and  referred. 

MISCELLANEOUS. 

The  rest  of  the  sessioTi  was  devoted  to  reports  of 
special  committees,  to  miscellaneous  and  nntinisheu 


THE  MEDICAL  RECORD. 


443 


business.  Amongst  these  were  many  subjects  of 
very  great  importance,  especially  the  report  of  the 
Library  Building  Committee,  all  of  which  were  post- 
poned until  a  special  meeting  to  be  held  IMay  2d, 
which  will  therefore  be  the  complement  of  this 
meeting. 

ELECTION   OF   OFFICEKS. 

The  election  of  officers  was  then  held,  resulting 
as  follows:  Presidi'nt,  Dr.  William  I\I.  Kemp;  Vicr- 
PreKideiits,  Drs.  llichard  IMcSiierry  and  Thomas  8. 
Latimer  ;  Recording  Seci-elmy,  Dr.  W.  G.  Regester  ; 
Assii!/<iiit  Smretari/,  Dr.  (J.  Lane  Taneyhill ;  Cm-re- 
sponding Secretary,  Dr.  W.  F.  A.  Kemp ;  Beporting 
Secretari/,  Dr.  Eugene  P.  Cordell ;  Trensurer,  Dr. 
Judson  Oilman  ;  Executive  Committee,  Drs.  Frank 
Donaldson,  P.  C.  Williams,  H.  P.  C.  Wilson,  L. 
McLane  Tiffany,  and  Christopher  .Johnston. 

After  the  passage  of  a  resolution  of  thanks  to  the 
authorities  of  the  Johns  Hopkins  University  for 
courtesies  extended,  and  some  congratulatory  re- 
marks by  the  President  upon  the  harmony  exhibited 
during  the  meeting  and  the  prosperous  outlook  for 
the  future,  the  Eighty-fourth  Annual  Session  was 
declared  adjounied. 


NEW   YOEK   SURGICAL   SOCIETY. 

Stated  Meeting,  February  14,  1882. 

Db.  J.  C.  Hutchison,  Vice-President,  in  the  Chaik. 

FBACTCBE   OF   THE   ELBOW-JOINT — RECENT   SUBJECTIVE 
NERVOUS   SYMPTOMS. 

'  Dr.  E.  L.  Ketes  presented  a  patient  to  demonstrate 
the  perfect  function  of  an  elbow-joint  badly  frac- 
tured during  childhood  and  still  ununited,  and  ex- 
hibiting evidences  of  failure  of  nutrition,  and  sub- 
jective nervous  symptoms  after  quite  recent  active 
use.  The  patient,  a  man  twenty-two  years  of  age,  had 
when  about  five  years  old.  received  a  fracture  of  his 
left  elbow.  From  this  he  recovered,  and  the  joint, 
arm,  and  hand,  gave  him  nojinconvenience  for  about 
fifteen  years.  He  had  been  able  to  follow  the  busi- 
ness of  a  travelling  salesman.  And  all  the  motions 
of  the  forearm  were  equal  with  those  in  the  unin- 
jured limb.  About  one  year  ago  he  changed  his 
occupation,  and  was  more  or  less  engaged  in  the 
active  exercise  of  opening  oysters.  He  soon  began 
to  suffer  from  jjain  in  the  left  forearm,  had  a  sensa- 
tion of  coldness  along  the  course  of  the  ulnar  nerve, 
and  soon  afterward  it  was  noticed  that  some  of  the 
muscles  of  the  hand  had  diminished  in  size.  When  Dr. 
Keyes  examined  the  arm  he  found  that  the  extermd 
condyle  had  been  fractured,  and  remained  ununited, 
a  certain  amount  of  outgi-owth  of  bone  had  occurred  ; 
and  there  was  a  partial  dislocation  outward  of  the 
external  condyle,  carrying  the  head  of  the  radius 
with  it.  There  was  no  atrophy  of  the  muscles  of 
the  forearm,  but  the  limb  was  of  late  numb  and 
painful.  There  was  atrophy  of  the  interossei  of  the 
left  hand,  and  particularly  of  the  adductor  pollicis. 
The  subjective  .symptoms,  as  well  as  the  atrophy, 
had  developed  within  the  last  year  since  he  had 
submitted  the  arm  to  more  active  exei'cise  than  for- 
merly, and  the  question  was  whether  anything  could 
be  done  which  would  be  likely  to  arrest  the  atrojihy 
and  restore  the  sensation  of  the  arm.  He  had  ad- 
vised cessation  from  all  active  exercise  of  the  hand 
and  forearm  together  with  the  use  of  electricity. 

Dr.  Sadine  suggested,  as  a  cause  of  the  nervous 
symptoms,  the  possibility  of  pressure  upon  the  ulnar 


nerve  by  the  bony  growth  in  close  jiroximity  with  it, 
and  if  that  could  be  definitely  ascertained  benefit 
might  follow  removal  of  the  hy2ierostosis. 

Dr.  Post  suggested  that  it  would  be  proper,  as  a 
prophylactic  measure  against  the  develoiiment  of 
the  claw-shaped  hand,  griffe  de  hi  main,  in  case  ap- 
propriate measures  failed  to  effect  a  radical  cuie, 
to  wear  some  mechanical  appliance,  at  least  during 
the  night-time,  to  resist  the  tendency  to  contrac- 
tion. 

Dr.  H.  B.  Sands  then  read  a  paper  on 

THE   question   OF   LAPAJBOTOMT   FOB   THE   RELIEF   OP 
ACUTE   INTESTINAIi   OBSTRUCTION    (see  p.  427). 

The  following  questions  were  submitted  to  the 
members  of  the  society  : 

1.  What  if:  the  result  of  their  e.rperience  in  the  per- 
formance of  laparotomy  for  the  relief  of  acute  intestinal 
obstruction  ? 

Dr.  Er.skine  Mason  had  had  three  cases.  The  first, 
patient,  a  female,  was  in  exceedingly  poor  condition 
at  the  time  of  the  operation  and  the  case  terminated 
fatally.  The  second  was  a  case  of  intussusception 
in  which  ulceration  had  taken  place  with  extrava- 
sation into  the  i^eritoneal  cavity,  and  the  patient 
died. 

The  third  was  supposed  to  be  a  case  of  hernia  re- 
duced en  inasse.  He  found  the  intestine  held  to  the  ab- 
dominal wall  by  a  band,  and  the  patient  died  a  few 
days  after  the  operation  from  suppression  of  urine. 
Dr.  J.  L.  Little  had  performed  the  operation 
once,  in  a  case  of  intussusception  occurring  in  a 
child  four  years  and  eight  months  of  age,  a  patient 
of  Dr.  Laurence  Johnson,  of  this  city.  The  intus- 
susception was  readily  relieved,  but  the  patient  died 
of  shock  six  hours  after  the  operation,  although  be- 
fore it  was  begun  the  child  seemed  to  be  in  good 
general  condition.  There  were  no  adhesions  nor 
peritonitis.  The  intussusception  was  of  the  ileo- 
colic variety.  The  operation  was  jierformed  in 
March,  1S7S.  [See  Medical  PiEcoed,  vol.  xiv.,  p.  6.] 
Dr.  BiiiDDON  had  operated  in  two  cases,  and  both 
terminated  fatally.  One  was  a  case  in  which  a  loop 
of  intestine  was  strangulated  in  another  loop  of  in- 
testine that  had  become  adherent  to  the  wall  of  the 
abdomen.  The  other  was  a  case  of  hernia  into  a 
pouch  in  the  peritoneum  near  the  csoum.  In 
neither  case  could  recovery  take  place,  as  he  be- 
lieved, without  an  operation. 

Dr.  J.  C.  Hutchison  had  had  one  case  of  cseoal 
intussusception  in  an  adult,  and  the  patient  died  of 
shock  after  the  operation. 

2.  What  nvmhcr  of  such  cases  have  they  known  to 
terminate  in  recori'ry  rrilhoul  operation  ? 

Dr.  Post  reported  one  case.  Many  years  ago  he 
was  called  to  see,  in  consultation,  a  boy  ten  years 
of  age,  who  had  had  obstruction  of  the  bowels  from 
an  unknown  cau.se  for  five  days.  There  was  a  hard 
swelling,  somewhat  smaller  than  the  fist,  upon  one 
side  of  the  abdomen — as  he  remembered,  upon  the 
right  side — which  could  be  distinctly  felt  through 
the  abdominal  walls.  All  known  means  for  reliev- 
ing intestinal  obstniction  had  been  adopted,  and  he 
regarded  the  case  as  almost  hopeless,  witliout  lapar- 
otomy. There  was  some  hesitation  with  reference 
to  accepting  the  proposition  to  operate,  and  Dr. 
Ourdon  Buck  was  added  to  the  consultation,  who 
suggested  that  operative  interference  be  postponed 
for  another  day,  and  that  in  the  meantime  the  pa- 
tient take  croton  oil.  Dr.  Post  thought  it  rather 
hazardous  to  administer  the  remedy,  but  acqui- 
esced, and  it  was  given,  and  the  obstruction  was  re- 


444 


THE  MEDICAL  RECORD. 


lieved.  Otiier  active  cathartics  had  been  given  be- 
fore the  croton  oil,  but  no  relief  had  been  afforded. 
Notwithstanding  the  good  result  apparently  due 
to  the  croton  oO,  he  should  feel  unwilling  to  recom- 
mend its  use  in  another  case  under  the  same  cir- 
cumstances. 

Many  years  ago,  also,  he  was  called  iipon  to  per- 
form an  autopsy  upon  the  body  of  a  child  five  or  six 
years  of  age,  who  had  inhaled  a  portion  of  a  peanut- 
shell  into  the  larynx,  and  suffered  from  symptoms 
ot  laryngeal  obstruction,  but  these  were  soon  masked 
by  abdominal  symptoms,  jiaiu,  constipation,  vora- 
itiag,  tympanitis,  and  the  child  tlied.  He  found  the 
portion  of  peauut-shell  in  the  larynx,  and  also  a 
mass  of  small  intestine,  six  feet  in  length,  strangu- 
lated by  a  band  connected  with  the  mesentery,  and 
in  its  interior  was  a  portion  of  what  seemed  to  be  a 
fla  of  a  fish.  Probably  the  violent  coughing  caused 
by  the  foreign  body  in  the  larynx  produced  stran- 
gulation of  the  intestine,  and  doubtless,  laparotomy 
would  have  afforded  a  very  good  chance  of  relief. 

Dr.  George  A.  Peters  had  seen  two  cases.  One 
had  been  alluded  to  by  Dr.  Sands  in  his  paper,  and 
another,  similar  in  its  history,  occurred  in  a  patient 
in  private  practice,  when  it  was  determined  to  wait 
a  little  longer  before  performing  an  operation,  and, 
while  waiting,  Nattire  brought  relief. 

Dr.  Keyes  had  seen  two  cases.  In  one  the  ob- 
struction had  been  prolonged  and  absolute  for  a 
week,  was  ajiparently  high  up,  and  occurred  in  a  pa- 
tient about  sixty-seven  years  of  age.  He  was  under 
the  opium  treatment  when  Dr.  Keyes  saw  him.  The 
patient  had  many  notions  of  his  own,  and  among 
them  was  the  one  that  he  would  be  benefited  by  in- 
jections through  a  long  tube.  He  had  been  relieved 
of  some  intestinal  gases  in  this  way.  "  Jersey  light- 
ning," or  apple-jack,  was  a  substance  he  finally  se- 
lested.  Accordingly  he  injected  a  tumblerful,  and  it 
started  up  intestinal  action  which  gave  him  relief. 
There  was  no  distention  of  the  abdomen.  He  had 
had  a  similar  attack  some  seven  or  eight  years  be- 
fore. The  other  patient  was  a  middle-aged  woman 
who  had  made  a  supper  of  fish,  had  eaten  it  skin 
and  all,  and  had  also  taken  a  large  number  of  grapes, 
swallowing  both  seeds  and  slcins.  It  had  been 
about  two  weeks  since  she  had  had  any  movement 
from  the  bowels.  She  had  constant  and  purely  fecal 
vomiting,  distention  of  the  abdomen,  and  explora- 
tion showed  that  the  rectum  was  entirely  empty. 
There  was  a  tender  spot  at  one  side  of  the  umbili- 
cus, and  she  was  etherized  in  order  that  a  more  com- 
plete examination  of  that  region  could  be  made.  A 
certain  amount  of  genei-al  tliickening  was  found  and 
some  distinct  enlargement,  which  was  supposed  to 
be  fecal.  This  was  kneaded  and  seemed  to  be 
broken  up.  Soon  afterward  the  pati<!nt  had  a  pas- 
sago  which  contained  a  piece  of  fish  skin,  about  six 
laches  long  and  an  inch  wide,  together  witli  a  large 
number  of  grape  seeds  and  gi-ape-.skins.  This  pa- 
tient liad  also  liad  one  previous  attack  of  prolonged 
constipation,  four  or  five  years  before,  wliich  liad 
been  finallv  relieved  by  medicines. 

Di{.  L  ^I.  YxhF.  referred  to  cases  in  which  ob- 
struction of  less  duration  than  in  the  cases  thus  far 
mentioned  had  been  relieved  without  any  operation. 
One  was  a  case  seen  in  consultation  witli  Dr.  Pink- 
him,  of  Montclair,  and  reported  to  the  society  in 
18S0.  [See  Medioatj  Reoord,  vol.  xviii.,  p.  5.'")S.]  In 
that  case  the  svinjitoms  were  persistent  constipa- 
tion, vomiting  of  cofTna  colored  material,  bloody  dis- 
charges, pain  in  the  lower  part  of  tlie  abdomen,  and 
variable   localized    tympanitic    percussion.      There 


was  no  recognized  tumor.  A  manual  exploration  of 
the  bowel  was  made  under  ether,  and  soon  aftee- 
ward  the  patient's  bowels  began  to  move  freely  and 
he  made  a  rapid  recovery. 

The  second  case  was  one  in  which  the  patient, 
eight  months  of  age,  had  bronchitis  that  caused  it  to 
cough  violently,  and  after  an  attack,  during  which 
the  father  dandled  the  child  actively,  it  was  seized 
with  pain.  The  patient  had  always  been  consti- 
pated. When  Dr.  Yale  saw  the  patient  there  was  ap- 
parently collapse,  although  the  temperature  was  not 
below  normal.  There  were  constipation,  bloody 
stools,  and  vomiting,  and  he  regarded  the  case  as 
one  of  intussusception,  which  was  relieved  in  the 
usual  way. 

While  in  attendance  upon  the  child,  the  father 
mentioned  another  case  which  occurred  in  his 
family  several  years  previously,  and  in  which  there 
was  great  pain,  vomiting,  and  bloody  stools,  and  the 
life  of  the  child  was  despaired  of.  Suddenly  she 
passed  a  portion  of  intestine  which  had  sloughed  off, 
enough  to  fiU  an  ordinary  saucer,  and  recovery 
dated  from  that  time. 

Of  fatal  cases  he  had  seen  many. 

Dr.  Po.st  suggested  that  intussusception  stood 
upon  ground  somewhat  different  from  that  occupied 
by  other  causes  of  obstnaction  of  the  bowel,  inas- 
much as  there  was  a  natural  mode  of  relief  for  it 
which  succeeded  in  quite  a  large  proportion  of 
cases.  He  then  referred  to  a  series  of  twenty-four 
reported  cases  which  had  been  left  to  Nature,  in 
which  thirteen  deaths  occurred.  In  the  remaining 
eleven  sloughing  away  of  a  portion  of  intestine  took 
place.  Of  these  two  died  a  short  time  after  the 
sloughing  but  the  remaining  nine  recovered  entirely  ; 
more  than  thirty-three  per  cent,  of  the  entire  num- 
ber. 

He  thought  that  so  large  a  proportion  of  sponta- 
neous cures  did  not  take  place  in  any  other  form  of 
organic  obstruction ;  and  it  was  a  question  whether 
intussusception  might  not  with  greater  safety  be 
left  to  Nature  than  any  other  form  of  obstriiction. 

Db.  Weir  had  liad  no  personal  espei'ience  in  the 
operation  of  laparotomy,  though  he  had  witnessed 
and  assisted  at  its  performance  four  times  by  sur- 
geons present  at  this  meeting.  He  had  obsei-ved 
quite  recently  a  striking  case  in  which  laparotomy 
was  averted  lay  a  continuance  of  the  expectant  treat- 
ment. 

In  this  instance  there  was  an  obscure,  painful 
tumor  in  the  right  side  of  the  abdomen,  just  above 
the  site  of  an  old  inguinal  hernia.  The  patient  had 
but  modei'ate  distention  of  the  abdomen,  with  fre- 
quent stercoraceous  vomiting  of  three  days'  dura- 
tion. He  was  then  seen  by  Drs.  Sands  and  Markoe 
in  consultation.  The  question  of  laparotomy  was 
considered,  but  it  was  voted  to  wait  a  few  hours 
longer,  during  which  time  an  amelioration  of  the 
symptoms  took  place,  and  the  ]>at!ent  recovered 
without  operative  intorforeiice.  During  the  past 
five  years,  since  the  New  York  Hospital  had  been 
rebuilt,  there  have  been  admitted  to  its  wards  only 
five  cases,  including  the  one  just  mentioned,  of  in- 
testinal obstruction.  Pain,  distention,  vomiting — 
only  fecal  once,  however — occurred  in  all,  with  con- 
stipation varying  from  three  to  eleven  days.  They 
all  recovered. 

He  himself  believed  from  a  clinical  view  that  the 
distinction  sought  to  be  preserved  between  an  ii'^ute 
and  chronic  obs' ruction  was  impractioiible.  It  is 
Kcnerally  assumed  that  when  recovery  takes  place  in 
intestinal  obstruction  that  either  an  error  in  diaguo- 


THE  MEDICAL  RECORD. 


445 


sis  had  been  made,  or  tbat  the  cause  of  it  ivas  either 
to  be  assigned  to  a  fecal  or  other  occluding  mass, 
or  to  a  compressing  band,  etc.  Now  such  causes, 
he  would  emphasize,  will  give  rise  to  all  the  symp- 
toms to  be  met  with  in  the  so-called  acute  obstruc- 
tions. He  had  seen,  within  the  last  month,  a  woman 
in  whom  aU  the  features  of  acute  intestinal  obstruc- 
tion, of  three  days'  duration,  were  present ;  pain, 
elevation  of  temperature,  vomiting,  rajiidly  becom- 
ing fecal,  a  certain  amount  of  distention  of  the 
abdomen,  constiijation,  and  some  dulness  just  below 
the  hepatic  region,  but  no  distinct  tumor  or  other 
signs  of  invagination.  Opium  had  been  adminis- 
tered, and  the  temperature  had  fallen  when  he  saw 
the  patient.  This  led  him,  as  in  other  cases,  to  ad- 
vise the  continuance  of  large  enemata,  which  even- 
tually gave  the  patient  relief.  The  obstruction  was 
fecal.  It  is  this  ditiiculty  which  hampers  the  sur- 
geon in  the  resort  to  operative  interference.  Du- 
chassoy  has  shown  that  in  500  cases  of  intestinal 
obstruction  there  were  13i  situated  in  the  large 
intestines,  not  including  the  oases  of  invagination. 
Taking  away  from  these  86  cases  of  strictures,  there 
were  AH  due  to  fecal  masses,  urinary  calculi,  etc. 

In  a  case  of  obstruction,  the  good  efl'ects  of 
medical  or  expectant  treatment  are  most  likely  to 
be  obtained  where  the  obstacle  is  situated  in  the 
large  intestine — a  portion  of  the  alimentary  canal 
whose  condition  as  to  distention  can  readily  and 
safely  be  determined  by  manual  exploration  of  the 
rectum.  While,  therefore,  it  is  true  that  many  cases 
do  get  well  without  an  operation,  yet  this  numljer  is 
quite  small  after  the  appearance  of  undoaibted  fecal 
vomiting,  and  he  himself  would  feel  justified  in  ad- 
vising, in  a  case  where  such  vomiting  had  persisted 
more  than  twenty-foirr  hours,  and  especially  so  in 
those  obscure  cases  where  the  symptoms  of  invagi- 
natun  are  wanting,  the  administration  of  ether,  for 
the  double  purpose  of  permitting  a  more  satisfactory 
resort  to  external  palpation  by  relaxing  the  abdomi- 
nal walls  and  for  the  exjiloration  of  the  rectum  by 
Simon's  method,  which  in  his  estimation  is  of  but  lit- 
tle risk  with  a  hand  less  than  twenty  centimetres  in 
circumference.  The  hand  need  only,  in  many  in- 
stances, be  so  far  introduced  as  to  ascertain  the 
condition  of  the  caput  coli,  and  the  regions  on  this 
level  (though,  finding  the  large  intestine  empty,  it 
would  be  desirable  to  locate,  if  possible,  the  locality 
of  the  obstruction  higher  up).  Shoiild  the  large 
intestine  be  distended,  either  the  use  of  injections, 
etc.,  can  be  continued,  or  colotomy  resorted  to,  as 
the  strength  of  the  patient  or  urgency  of  the  symp- 
toms dictates. 

The  cause  of  death  is  not  peritonitis,  for  that  is 
only  found  in  13  out  ot  '.)2  deaths  from  obstruction. 
Death  results  from  the  exhaustion  of  the  jjatient,   ; 
shown  often  in  sudden  collapse.    The  eai-ly  external  i 
and  internal  exploration  under  ether,  therefore,  will, 
he  would  reiterate,  exclude  invaginations  and  ob-   ' 
structions  (often  relievable)  in  the  large  intestine, 
and  enable  the  surgeon  to  employ  laparotomy  in 
cases  in  which  delay  can  seldom  prove  advantageous.    ' 

Dr.  J.  L.  Little  had  had  four  cases  of  intestinal 
obstruction,  of  which  one  terminated  in  recoveiy 
without  operation.  In  this  case  the  symptoms  ex- 
isted more  than  a  week  and  were  supposed  to  be 
due  to  intussusception.  The  case  was  regarded  as 
hopeless.  |But  a  discharge  from  the  bowels  oc- 
curred, accompanied  by  considerable  quantity  of 
blood  and  the  patient  recovered. 

In  another  case,  in  Norwalk,  Conn.,  a  patient  of  ' 
Dr.  Nolan's,  he  advised  laparotomy,  but  the  patient  i 


refused  to  have  it  performed.  The  cause  of  the  ob- 
struction was  not  known.  Great  relief  was  given 
this  patient  by  repeated  puncture  of  the  intestine, 
through  the  abdominal  walls,  with  a  hypodermic 
syringe,  and  subsequently  with  a  trocar  made  for 
the  purpose.  Death  occurred  from  exhaustion.  No 
autopsy  was  made. 

3.  Should  laparotomy  be  performed  at  an  early 
period  in  cases  of  acnle  obstrnction,  when  no  opinion 
can  be /armed  respecting  its  character  or  situation  ? 

Db.  Bkiddon  thought  that  question  could  not  be 
answered  without  dividing  acute  cases  into  diflerent 
classes.  There  were  acute  cases  in  which,  the  obstrnc- 
tion occurring  high  up  or  low  down,  usually  high,  the 
symptoms  of  collapse  and  shock  were  so  marked  that 
unless  prompt  relief  was  given  by  laparotomy,  the 
patient  woidd  certainly  die  within  two  or  three  days. 
In  other  cases,  where  the  obstruction  was  lower 
down,  perhaps  in  the  lower  portion  of  the  ileum,  or 
in  the  colon,  delay  was  justifiable,  and,  perhaps,  re- 
lief would  take  place  spontaneously  after  the  exj^i- 
ration  of  from  six  to  ten  days.  Again,  the  seventy 
of  the  symptoms  in  acute  obstructions  depended 
upon  the  tightness  with  which  the  intestine  was 
constricted  or  twisted;  and  if  not  very  tight,  lile 
might  be  prolonged  for  a  considerable  period  of 
time,  and  fi'equently  the  measures  adopted  finally 
afforded  the  relief  desired.  In  the  very  acute  cases, 
occurring  with  shock,  collapse,  and  vomiting,  he  be- 
lieved that  laparotomy  was  imperatively  demanded. 
But  in  the  cases  referred  to  in  the  paper,  long  delay 
was  justifiable. 

Dr.  Sand.s  said  that  the  point  he  wished  to  deter- 
mine, if  possible,  was  whether  the  mere  fact  of  ob- 
struction would  imjiel  the  surgeon  to  operate  at 
once,  or  whether  it  would  be  a  safer  practice  to  await 
for  a  time  the  action  of  nature. 

It  was  well  known  that  the  operation  had  been 
performed  too  late  in  many  cases ;  but  it  did  not 
seem  to  be  fully  considered  that  the  alternative,  the 
early  operation,  was  a  dangerous  one.  If  the  sur- 
geon allowed  the  patient  to  die  and  then  opened  the 
abdomen  and  found  a  band  which  could  have  been 
easily  divided,  he  would,  of  course,  regret  that  the 
operation  had  not  been  performed.  But  the  great 
difliculty,  practically,  was  to  determine  iiositively 
whether  or  not  the  obstruction  would  finally  be 
removed  without  operative  interference.  Several 
cases  had  been  mentioned  this  evening,  and  many 
others  were  recorded  in  which  the  obstruction  had 
yielded.  And  the  question  was  whether  that  fact 
should  not  render  caution  necessary  on  the  jjart  of 
the  surgeon  in  the  early  management  of  these  cases. 
Dr.  Peters — I  think  it  should. 
Dr.  Santjs — In  that  event  we  shall  be  tempted  to 
delay  action  until  the  patient's  vital  powers  are  so 
reduced  that  the  success  of  an  operation  will  be 
very  slight,  indeed.  Thus  the  question  might  aiise, 
whether  the  danger  of  delay  would  not  be  greater 
than  the  elanger  of  a  very  early  operation. 

Again,  it  was  to  be  remembered,  that  in  a  case 
of  so-called  ob.struction,  especially  when  developed 
.suddenly,  with  pain,  vomiting,  and  tympanites,  and 
particularly  when  no  tumor  nor  phy.sical  signs  to 
indicate  quite  clearly  the  seat  of  the  obstruction 
were  found,  the  surgeon  could  not  help  suspecting 
that  he  might  make  an  erroneous  diagnosis  if  he 
put  it  down  as  a  case  of  intestinal  obstruction.  Be- 
cause, as  Mr.  Hutchison  had  well  pointed  out,  the 
three  cardinal  symptoms  of  intestinal  obstniction — 
namely,  pain,vomiting,  and  tympanites,  occunedwith 
peritonitis,  and  were  rather  characteristic  of  peri- 


446 


THE  MEDICAL  RECORD. 


toneal  than  of  intestinal  obstruction  ;  for  with  intes- 
tinal obitruotion,  unless  it  is  accompanied  by  peri- 
tonitis, tympanites  is  developed  very  gradually,  and 
often  is  not  marked  until  near  the  close  of  life. 

If,  then,  the  surgeon,  in  the  absence  of  physical 
signs,  relied  upon  pain,  vomiting,  tympanites,  and 
coustipa,tioa,  as  evidences  of  obstruction,  and  opened 
the  abdomen  to  relieve  it,  he  would  incur  the  risk  of 
invading  the  peritoneal  cavity  when  there  was  peri- 
tonitis, but  no  intestinal  obstruction.  That  was 
once  done  by  Dr.  Buchanan,  of  Glasgow,  whose  pa- 
tient, strange  to  say,  recovered,  api>arently  in  conse- 
quence of  the  operation. 

Dr.  Mason  thought  the  patient  should  first  have 
the  full  benefit  of  medicinal  and  other  measures, 
and  then  if  fecal  vomiting  came  on,  and  the  vital 
powers  seem  to  be  failing,  he  should  be  inclined  to 
advise  laparotomy  as  affording  the  best  chance, 
probably,  of  saving  the  patient's  life. 

Db.  Yale  mentioned  one  fact  which  he  thought 
might  have  some  value  as  an  argument  against  the 
eirly  operation,  namely,  the  frequent  existence  of 
iatussusception  in  fatal  cases  of  cntero-colitis  in 
children,  with  many  of  the  symptoms  during  life  of 
obstruction  ;  and  yet  it  was  well  known  that  the  in- 
tussusception did  not,  either  directly  or  indirectly, 
cause  the  child's  death. 

Db.  a.  C.  Post  presented  the  following  report  of 
the  microscopical  examination  made  by  Dr.  T.  E. 
Satterthwaite  of  the  specimen  of  sarcoma  which  he 
presented  to  the  society  January  10,  1882,  the  his- 
tory having  been  given  December  13,  1881.  [See 
Medical  Record,  vol.  xxi.,  i^.  1.34.] 

The  growth  was  confined  chiefly  to  the  anterior 
surface  of  the  tibia,  its  upper  limit  being  three  cen- 
timetres below  the  upper  articular  surface,  and  its 
lower  limit  nineteen  centimetres  distant  from  the  low- 
er articular  surface.  In  length  it  measured  seven- 
teen centimetres;  in  breadth,  ten  centimetres.  The 
growth  seems  to  have  radiated  in  the  usual  way 
from  the  periosteum,  though  the  medullary  cavity 
contained  some  deposits. 

Micrnscopic  examination. — Owing  to  the  imperfect 
condition  of  the  specimen  when  it  reached  Dr. 
Sitterthwaite,  the  microscopic  examination  was  not 
wholly  satisfactory,  though  in  those  parts  which 
admitted  of  preparation,  the  tissue  was  composed 
mainly  of  round  corpuscles  imbedded  in  a  delicate 
homogeneous  matrix  with  occasional  bands  of  con- 
nective tissue.  Interspersed  throughout  the  tissue, 
also,  was  bony  matter,  extravasated  blood,  and  glu- 
tinous material. 

(To  be  continued.)] 


The  Universtty  op  Virginia. — A  correspondent 
of  the  New  Orleans  Medical  and  Surgical  Journal 
writes  as  follows  of  the  University  of  Virginia : 
"  Had  our  Southern  neighbors  no  otlior  boast,  thoy 
might  well  be  proud  of  that  Univer.sity.  Let  us 
see  what  percentage  of  each  class  is  graduated 
there.  I  have  accurate  data  for  two  years  only.  In 
1878-79  there  were  53  men  in  the  medical  class ; 
48  of  these  applied  for  graduation,  and  21  alone 
were  successful.  In  1879-80  there  were  40  in  the 
class ;  31  applied  and  10  only  graduated.  I  liad 
almost  as  soon  l)e  one  of  those  10  as  a  survivor  of 
the  600  at  Bahiklava.  Can  we  wonder  at  the  small 
classes  there?  l?nt  the  men  of  that  facility  prefer  a 
smiU  class  to  a  largo  one,  wliero  the  pen  which 
titles  a  fool  tells  a  lie  at  every  stroke." 


ERSKINE  MASON,  A.M.,  M.D., 

NEW    YORK. 

Stjkgert  has  experienced  a  great  loss  in  the  death 
of  Dr.  Erskine  Mason,  of  this  city,  who  died  quite 
suddenly  on  the  13th  inst.  Dr.  Mason  was  born  in 
this  city  in  1837,  and  was  therefore  in  his  prime  at 
the  time  of  his  death.  He  graduated  from  Columbia 
College,  in  1857,  and  from  the  College  of  Physicians 
and  Surgeons  in  ISGO,  receiving  in  the  same  year 
the  degree  of  A.M. 

He   immediately  settled   in  the   practice   of  his 
profession  in  this"  city,  and  soon  gathered  a  large 
clientfele  as  a  surgeon.     He  was  one  of  the  most  in- 
dustrious and  active  members  of  the  Pathological 
Society,  and  almost  from  its  inception  took  a  lead- 
ing part  in  its  sessions,  rising  to  the  Presidency  of 
that  body  in  1873,  after  passing  only  thirteen  years 
in  medical  practice.     He  was  also  prominent  in  the 
transactions  of  the  American  Medical  Association, 
to  whose  volumes  many  of  his  best  papers  were  con- 
tributed, and  in  the  Medical  Society  of  the  County 
of  New  York,  at  whose  meetings  he  often  presented 
original  surgical  memoirs.  Among  his  contributions 
to  medical  literature  which  have  appeared   in  the 
leading  journals  of  the  day  may  be  specified  his 
papers  on  the  "  Operation  for  Strangulated  Hernia 
without  Opening  the  Sac,"  Medical  Record,  August 
1,  1868  ;  "  Lumbar  Colotomy,"  American  Journal  of 
the  Medical  Sciences,  October,  1873 ;  "  Operation  of 
Laparotomy,"  Medical  Record,  June  10,  1870 ;  and 
"Amputation  of  the  Hip-joint,"  as  the  most  elabo- 
rate and  original  of  his  professional  memoirs.     For 
some  years  he  has  held  the  position  of  Demonstrator 
of  Anatomy  in  the  College  of  Physicians  and  Sur- 
geons.    H3  has  also  been  Adjunct  Professor  of  Sur- 
gery in  the  medical  department  of  the  University  of 
the  City  of  New  York,  and  Assistant  Surgeon  of  the 
New  York  Eye  and  Ear  Infirmary.     He  resigned  his 
position  in  the  University  in  1870,  in  consequence  of 
the  increase  of  his  private  practice.     He  has  also 
held  the  position  of  Surgeon  to  Belle\^le  Hosjiital, 
to  the  Roosevelt  Hospital,  and  to  the  Colored  Home. 
Dr.  Mason  had  acquired  a  very  high  rei^utation 
as  a  bold   and   skilful   operator,  and  he  was  justly 
ranked  among  the  first  surgeons  of  the  city. 

His  death  will  be  widely  regretted.  He  leaves  a 
widow  and  three  children. 

^ — • — ^ 

ARMY   NEWS. 
Official  List  of  Changes  of  Staiions  and  Duties  of  Offi- 
cers of  the  Medical  Department,  United  States  Army, 
from  April  9,  1882,  to  April  15,  1882. 
Cron'kuite,   H.    M.,    Capt.    and    Asst.    Surgeon. 
Granted  leave  of  absence  for  four  months  from  June 
1,  1882.    S.  O.  80,  C.  S.,  A.  G.  O. 

Carvallo,  Carlos,  Capt.  and  Asst.  Surgeon.  The 
extension  of  his  leave  of  absence  on  .surgeon's  cer- 
tificate of  disabilitv,  granted  him  in  S.  O.  250,  No- 
vember 12,  1881,  from  A.  G.  O.,  is  still  further  ex- 
tended six  months  on  account  of  sickness.  S.  O. 
80,  A.  G.  O.,  April  7,  1882. 

BvKNE,  Charles  B.,  Capt.  and  Asst.  Surgeon 
(Fort  Barrancas,  Fla.).  Assigned  to  temporary  duty 
at  Mount  Vernon  Barracks,  Ala.,  during  absence  of 
Asst.  Surgeon  Cunningham.  S.  O.  41,  Department 
of  the  South,  April  12,  1882. 


THE  MEDICAL  RECORD. 


447 


FrsLET,  Capt.  and  Asst.  Smgeon.  Having  re- 
ported at  these  Headquarters,  is  assigned  to  duty  at 
Fort  Concho,  Tex.  B.  O.  35,  Department  of  Texas 
April  8,  1S82. 

Spekcek,  William  G.,  Capt.  and  Asst.  Surgeon. 
Granted  leave  of  absence  for  four  months,  with  i)er- 
mission  to  apjilv  for  an  extension  of  two  months. 
S.  O.  80,  C.  S.,  A.  G.  O. 

King,  William  H.,  Capt.  and  Asst.  Surgeon.  To 
be  relieved  fiom  dutv  in  the  Department  of  the  East 
on  receipt  of  this  order,  and  then  to  proceed  to  his 
home.  Granted  leave  of  absence  until  further  or- 
ders, on  account  of  sickness.  S.  O.  82,  A.  G.  O., 
AprU  10,  1882. 


iHctJiral  Jtcms   anti  Itcuis. 


Contagious   Diseases  —  Weekly    Statement.  ■ 
Oomparative  statement  of  cases  of  contagious  diseases  l 
reported  to  the  Sanit;ii-y  Bureau,  Health  Department, 
for  the  two  weeks  ending  April  15,  1882. 


Week  Endinti 

j^ 

J3   > 

ft 

1 

■a  . 

5  "a 
IS 

S 

1 

1 

1 
& 
1 

H 

n 

to 

a 

a 

B 

m 

tH 

April      8,  1882. 

18 

2 

203 

6 

177 

103 

12 

0 

April    15,  1882 

16 

4 

221 

4 

150 

97 

20 

0 

The  Johns  Hopkiss  Hospital  a>i)  De.  Cakroll. — 
Dr.  A.  L.  Carroll,  of  ISTew  Brighton,  N.  Y.,  writes  : 
With  due  hesitation  to  impugn  the  accuracy  of  any 
statement  made  iu  The  ^Medical  P.ecobd,  I  beg  leave 
to  say  that  the  paragraph  in  your  issue  of  this  date, 
relatmg  to  my  removal  to  Baltimore  and  election  to 
the  faculty  of  the  Hojikins  University  is,  to  the  best 
of  my  knowledge  and  belief,  entirely  without  foun- 
dation. 

Post  Graduate  FACCXTr  op  the  Medical  Depap.t- 

MEVr  OF  THE  UNTVEBSrTY  OF  THE  CiTT  OF  NeW  YoBK. — 

The  following  members  of  the  post-gi-aduate  faculty 
of  this  institution  have  tendered  their  resignations. 
Profe.ssor.s  D.  B.  St.  John  Eoosa,  W.  A.  Hammond, 
J.  W.  S.  Gouler,  M.  A.  Pallen,  F.  E.  Sturgis,  H.  G. 
Piffard,  Stephen  Smith,  and  J.  L.  Little. 

An  AsSOCLiTION  FOB  THE  AdVANCE3IENT  OF  MeDICAL 

Research. — At  a  meeting  of  prominent  medical  and 
scientific  men  in  Loudon,  March  2Sth,  an  Assoeia 
tion  for  the  Advancement  of  Medicine  by  Scientific 
Research,  was  organized.  This  association  is  the 
result  of  the  long  continued  agitation  over  the  sub- 
ject of  vivisection,  and  marks  a  distinct  success,  if 
not  actual  triumph,  of  science  over  a  false  philan- 
thropy. The  society  in  question  does  not  represent 
the  medical  profession  alone.  Its  oflicers  will  in- 
clude the  presidents  of  the  two  colleges  in  England, 
tlie  chief  executive  officers  of  the  Royal  and  other 
societies,  and  representatives  from  all  the  boards 
aid  corporations  associated  in  the  education  or  ex- 
amination of  meil  aiming  to  be  practitioners  of  medi- 
cine. The  association  intends  to  superin  end  the 
work  of  anatomical  study  and  physiological  experi- 
mentation. It  will  give  to  the  public  a  guarantee 
that  such  work  is  properly  done,  and  it  wiU  secure 


safety  and  freedom  from  interruption  to  the  experi- 
menter. The  agitation  over  vivisection  in  England 
has  thus  not  been  without  benefits.  It  has  attracted 
public  attention  to  the  woik  of  medical  men  and 
physiologists.  It  has  shown  the  English  physician 
how  barren  in  scientific  work  his  country  has  be- 
come. With  barriers  now  in  part  removed,  with  a 
society  organized  to  further  and  protect  experi- 
mental research,  there  is  a  prospect  of  much  more 
original  work  being  undertaken  in  Great  Britain. 

The  Charity  Orgakization  Society. — A  bill  to 
incorporate  this  society  has  been  introduced  into 
the  State  Legislature.  Its  incorporators  include  a 
number  of  prominent  medical  men. 

A  COXGRESS  FOR  THE  StUDY  OF  INTERNAL  MeDICIKE 

is  to  be  organized  in  Germany.  Complaint  is  made 
that  while  ojjhthalmologists,  hygieiiists,  Lalneclo- 
gists,  psychiatrists,  surgeons,  etc.,  all  have  general 
organizations,  there  is  none  for  internal  medicine. 
The  proposed  congress  is  to  meet  this  month  at 
Wiesbaden.     Prof.  Seitz  is  to  preside. 

Iodoform  in  Diphtheria  has  been  used  by  Dr. 
Sesemann,  of  St.  Petersburg,  with  favorable  re- 
sults. He  applies  a  mixture  of  iodoform,  one  part ; 
milk  sugar,  three  parts. 

A  CoNGRE,SS  OP  NaTTRALLSTS  AND  GbEEK  PHYSICIANS 

meet  in  Athens,  April  18th. 

A  Provincial  Boabd  op  Health  has  just  been 
created  by  the  Legislature  of  Ontario. 

The  Doctor  as  a  Ministerial  Whip.— Dr.  Widdi- 
field,  M.P.P.,  Ontario,  was  presented  by  the  mem- 
bers of  the  local  legislature  with  a  costly  service  of 
silver,  in  recognition  of  his  services  as  Ministeiial 
Whip  during  the  time  he  was  member  of  the  House. 

Prizes  of  the  Medical  Society  of  London. — At 
the  109th  annual  meeting  of  this  society,  March 
8th,  the  Eothergill  gold  medal  was  bestowed  on  Mr. 
Dolan,  of  Halifax,  for  a  "  Dissertation  on  the  Path- 
ology and  Treatment  of  Whooping-Cough."  A 
silver  medal  was  given  to  Dr.  Allen  Sturge  for  his 
paper  on  "  Muscular  Atrophy ;  "  and  a  silver  medal 
to  the  retiring  Honorary  Secretarv,  Dr.  T.  Gilbert 
Smith. 

Bequests  to  Medical  Charities. — The  Medical 
charities  and  other  institutions  of  this  city  are  again 
fortunate  in  the  matter  of  bequests.  The  late  Dr.  E. 
L.  Beadle,  of  Poughkeepsie,  gavein  his  will  t25,CC0, 
to  be  distributed,  after  its  use  for  a  life  income, 
among  the  following  institutions  :  The  Presbyterian 
Hospital,  St.  Luke's  Hospital,  Kew  I'ork  Eye  and 
Ear  Infirmary,  New  York  Lying-in  Asylflm  for  Wo- 
men, and  New  York  Academy  of  Medicine.  In  each 
of  the  four  first  named,  the  sum  is  to  be  used  to  en- 
dow a  beel  in  Dr.  Beadle's  name  for  poor  patients. 
The  Children's  Hospital  and  Nuisi  ry,  the  N.  Y.  So- 
ciety for  the  Relief  of  Widows  acd  Orphans  of  Medi- 
cal Men,  and  St.  Barnabas  Hospital,  Poughkeepsie, 
each  get  about  .93,000  ;  also  the  Hudson  River  State 
Hospital  and  the  Alumni  Association  of  the  College 
of  Physicians  and  Surgeons.  Dr.  Beadle's  medical 
library  is  given  to  the  New  York  Academy  of  Medi- 
cine. 

Professor  Klebs  has  accepted  a  call  to  the  chair 
of  Pathological  anatomy  at  Zurich. 

Vaccinia  Following  Small-Pox.— Dr.  J.  W.  Bart- 
lett,  of  Chicopee  Falls,  Mass., writes  :  "  I  notice  in  the 
Record  of  February  4th,  an  item  by  Dr.  B.  G.  Bris- 


448 


THE  MEDICAL  RECORD. 


toe,  'Vaccinia  Following  SmaU-Pox.'  Some  two 
months  ago  I  vaccinated  about  nine  hundred  per- 
sons. Among  this  number  (for  experiment)  I  vac- 
cinated four  who,  some  years  ago,  had  small-pox. 
Of  the  four,  one  had  a  perfect  vaccine  pock.  The 
virus  used  was  obtained  of  Dr.  W.  C.  Martin  &  Son, 
Koxbury,  Mass." 

Failuke  of  Hospital  Satukdat  tk  London.— 
The  iStudenl.i'  Journal  states  that  the  institution  of 
the  Hospital  Saturdays  in  London  has  ju'oyed 
practically  a  failure.  After  several  years'  begging 
for  alms  in  the  public  streets,  benefit  performances 
and  other  means,  the  sum  subscribed  by  the  whole 
of  the  working  men  in  London  for  upward  of  one 
hundred  hospitals  is  ridiculously  small,  amounting 
to  a  less  amount  than  the  workmen  on  the  Clyde 
have  often  subscribed  for  a  single  Glasgow  hos- 
pital. 

PoLiTirs  AND  Insane  Asylums. — Dr.  Pvoliert  S. 
Hamilton  has  been  elected  Medical  Superintendent 
of  the  Western  Lunatic  Asylum,  Staunton,  Va.,  by 
the  new  Board  of  Directors,  in  place  of  Dr.  A.  M. 
Fauntleroy.  Dr.  Richard  A.  Wise  likewise  succeeds 
Dr.  Harvey  Black  at  the  Eastern  Lunatic  Asylum, 
Williamsburg. 

Drs.  Fauntleroy  and  Black  have  been  removed 
only  on  account  of  political  reasons.  More  com- 
petent men  could  not  be  found  in  the  profession 
than  the  jjhysicians  removed. —  Va.  Medical  Monthly _ 
Iodoform  and  Naphthol  in  the  Vienna  Gene- 
ral Hospital. — All  wounds,  no  matter  where  they 
are,  and  in  all  the  hospital  clinics  and  wards,  are 
treated  with  iodoform,  and  with  splendid  results. 
Tlie  iodoform  powder  is  rubbed  into  gauze  as  we 
rub  plaster  of  Paris  into  our  bandages.  This  gauze 
is  applied  directly  to  a  wound,  after  freely  dusting 
the  same  with  the  powder ;  over  the  gauze  comes  a 
large  pad  of  absorbent  cotton,  and  over  this  a  large 
piece  of  oiled  silk  or  jaconet ;  then  the  bandage. 
Iodoform  is  a  good  deodorizer,  and  I  have  seen  the 
gauze  strips  taken  from  the  wound  of  an  oesopba- 
gotomy  after  an  eight  days'  stay  with  not  the 
slightest  odor,  and  the  same  from  a  coUum  uteri 
after  removal  of  a  carcinoma.  Prof.  Luecke  of 
Strassburg  is  introducing  naphthol  in  its  place  as  p. 
much  cheaper  and  equally  effective  application. — 
Cor.  Buffalo  Med.  and  Surg.  Journ. 

Billroth  and  Alhert. — Withal,  Prof.  Billroth, 
in  spite  of  his  great  knowledge  and  attainments,  has 
not  the  faculty  of  imparting  it  well  to  others.  He  is 
a  typo  of  the  sturdy,  stout  German  with  whom  life 
has  gone  well,  is  about  sixty  years  of  age,  and  wears 
a  gray,  fuIljGermau  beard.  He  speaks  so  low  gene- 
rally that  tlie  most  of  the  sound  is  lost  in  his  mus- 
tache and  whiskers.  Prof.  Albert,  who  is  much 
younger,  has  all  the  ability  of  Billroth  as  an  oper- 
ator, and  is  a  teacher  who  arouses  enthusiasm  in  all 
who  hear  him.  It  is  more  instructive  to  attend  liis 
clinical  lectures  on  surgery  than  those  of  Billroth. 
Among  the  operations  they  have  performed  diUing 
the  winter  semester,  be.sido  such  as  above  men- 
tioned, are  ti-acheotomies,  lithotomies,  litholapaxies, 
amputations,  resection  of  joints,  rhinoplasties, 
staphylorraphiea,  ligations  of  subclavian,  etc. — Dr. 
Peterson  in  ISufalo  Afi;il.  and  Surij.  Jonrn. 

The  Decline  of  the  Vienna  Medical  School. 
— Dr.  Peterson,  writing  from  Vienna  to  the  llufalo 
Medical  and  Suir/ical  Journal,  says  that  Vienna  is 
now  the  most  expensive  city  in  Europe,  except  Lon- 
don, that  the  assistants  at  the  Vienna  School  prey 


upon  the  students,  most  courses  of  instruction  cost- 
ing from^SlO  to  §25  per  month.  American  and  other 
foreign  students  are  considered  legitimate  subjects 
for  extortion.  The  number  of  eminent  men  in  the 
professorial  chairs  is  less  and  the  ministerium  has 
of  late  become  negligent  of  securing  the  best  talent. 
Since  the  retirement  of  Hyrtl,  who  lives  in  a  villa 
near  the  city,  no  one  of  importance  occupies  the 
chair  of  Anatomy.  Von  Briicke,  in  the  department 
of  Physiology,  is  second  to  no  one  but  the  Eussian 
Purkinje.  In  Pathology  are  Weichselbaum  and 
Hans  Chiari,  private  docents,  one  of  whom  will  be 
chosen  to  go  to  Gratz,  and  from  April  on,  Kundrat. 
In  experimental  Pathology  is  the  well-known 
Strieker.  In  Internal  Medicine  is  Bamberger; 
Adalbert  Duchek,  who  died  a  few  days  ago,  was 
his  associate.  Surgei-y  is  represented  by  Bill- 
roth and  Albert.  On  the  Ear  are  Pollitzer  and 
Urbantschit.sch ;  on  the  Eye,  Arlt  and  Stellwag.  In 
Gynecology  and  Obstetrics  we  have  Carl  and  Gustav 
Braun,  Spaeth,  Rokitansky,  Jr.,  and  Bandl.  On 
Children's  Diseases  are  Widerhofer  and  Monti. 
Kaposi,  the  son-in-law  and  also  successor  of  Hebra, 
has  charge  of  the  clinic  for  Skin  Diseases,  and 
Hebra,  Jr.,  and  Neumann  for  Syphilis.  The  lec- 
tures in  Psychiatry  are  given  by  'Theodore  Meynert 
and  Leidesdorf ;  in  Medical  Chemistry,  Ludwig ; 
Laryngoscopy,  Schrotter  and  Stork  ;  Urinary  Or- 
gans, Ultzmann. 

American  Diplomas  in  Australia. — The  Depart- 
ment of  State  has  received  an  official  communication 
from  Adelaide,  South  Australia,  from  which  it  ap- 
pears that  an  amendment  has  recently  been  efl'eeted 
in  the  medical  laws  of  that  colony,  whereby  the 
holders  of  foreign  diplomas  are  entitled  to  be  regie- 
tered  as  duly  qualified  medical  practitioners.  The 
Department  of  State  has  accordingly  been  asked  to 
furnish  a  list  of  all  the  schools  of  medicine  in  this 
country  which  issue  diplomas,  or  certificates  of  suf- 
ficient value  to  entitle  their  possessors  to  practice 
medicine  in  all  its  branches,  and  to  hold  Govern- 
ment medical  appointments.  The  necessary  steps 
have  been  taken  by  our  Government  to  furnish  this 
information,  which  will  remove  all  obstacles  in  the 
way  of  American  graduates  practising  medicine  in 
South  Australia. — Medical  and  Surgical  Reporter. 

Syphilis  on  the  Fingers  of  Doctors. — Dr.  Fes- 
senden  N.  Otis,  in  Independent  Practitioner,  reports 
eight  cases  in  which  syjihilis  occurred  on  the  fingers 
of  medical  men. 

Children's  Cottage  Hospitals. — Dr.  L.  W.  Ba- 
ker, of  Baldwinsville,  Mass,  writes  that  he  is  securing 
the  erection  near  his  residence  of  cottage  hospital 
for  children.  The  design  is  to  provide  hosijital  ac- 
commodations in  the  country  under  the  best  possible 
hygienic  conditions,  and  fitted  with  all  necessary 
appliances,  in  which  children,  from  the  city  or  else- 
where, suffering  from  chronic  diseases,  may  receive 
medical  care  and  careful  nursing,  together  with  all 
the  advantages  of  fresh  air,  sunlight  and  good  food, 
which  country  life  affords,  thus  greatly  increasing 
by  these  means  their  chances  for  speedy  recovery. 
The  juoject  seems  to  bo  a  good  one  and  to  have  re- 
ceivixl  sup]jin't  from  a  number  of  jihilanthropists 
and  medical  men. 

Ovariotomy,  Cystotomy,  and  EnArotomy  were  all 
performed  at  one  sitting  upon  the  same  patient  by 
Professor  Billroth.  Tiie  patient  had  an  infiltrating 
cancer,  which  necessitated  these  extensive  removals. 
She  was  alive  at  last  accounts. 


Vol.XXI.-No.  17.i 
April  S9.  1888.    I 


THE  MEDICAL  RECORD. 


449 


©rigiual  CjJtnimmicatloits. 


ON  THE  VIOLA   TRICOLOR  (Z.)  AND  ITS 
USE  IN  ECZEjVIA.  ' 

By  HENKY  G.  PIFFAKD,  M.D., 

NEW   TOIIK. 

Gentlemen  :  The  plant  to  which  I  ask  your  atten- 
tion this  evening  is  familiar  to  English-speaking 
people  under  the  simple  name  of  Pansy,  to  the 
French  as  the  Pensee  saiivage,  and  to  the"  Germans 
as  the  Freisamkraul  and  Stiefiniaterchen.  It  gi-ows 
lyild  in  Germany  and  France,  but  in  England  and 
America  is  rarely  met  with  except  under  cultivation. 
The  alterations  in  its  structure  and  appearance  re- 
sulting from  culture,  are  remarkable,  and  are  well 
shown  in  specimens  I  exhibit ;  the  first  being  ex- 
cellent examjiles  of  the  wild  German  plant,  and  the 
others  the  highest  exponents  of  the  florist's  skill. 
These  latter  must  be  regarded  from  a  botanical 
standpoint,  simply  as  beautiful  monstrosities,  and 
from  a  pharmaceutical  and  medical  aspect  as  almost 
unworthy  of  attention.  The  following  statements 
will  apply  exclusively  to  the  wild  plant  growing  on 
the  Continent  of  Europe. 

Hi.itmy. —fio  far  as  I  have  been  able  to  learn,  the 
viola  tricolor  was  first  brought  to  the  notice  of  the 
profession  as  a  remedy  in  eczema  by  Strack,  in  a 
monograph  entitled:  ''Be  Crusta  Lactea  mfmdum, 
ejusdamque  yiecijico  remedio  dissertalio,"  published 
at  Frankfort  a.  M.,  in  1779,  a  copy  of  which  I  show 
you.  Tue  "  specific  remedy  "  referred  to  in  the  title 
of  this  rare  little  book  is  the  viola  tricolor,  known 
in  the  older  pharmacy  as  Jacea.  Strack  was  fol- 
lowed, six  years  later,  by  Dillenius,-  who  gives  viola 
the  same  rank  as  a  specific  in  eczema  that  he  accords 
to  cinchona  and  mercury  in  other  spheres.  He  wrote 
as  follows:  "  In pbirimis  aliia  morbis  a  miasmaie  or- 
tis  hahentur  apecifica,  uti  contra  miasma  febris  inter- 
miUenlis  cortex  pertcvtanus,  contra  cru.ihe  laclece  mi- 
asma Jacea,  contra  si/phiUlidem  merciirius." 

Later,  MuiTay^  quotes  numerous  authors  in  its 
favor.  In  1796,  Hahnemann  makes  brief  mention 
of  it  in  Hufeland's  Journal.  ■>  In  1813,  Graumiiller  ■' 
speaks  of  it  as  specially  useful  in  milk-crust  of  chil- 
dren, in  which,  he  says,  it  is  specific.  In  ISIS, 
Jahn «  speaks  in  the  highest  terms  of  its  usefulness, 
and  Koques, '  in  1837,  calls  it  a  "  precious  plant "  in 
eczema.  Fuchs,'  in  1810,  and  Frank,'  in  1843, 
praise  it  highly.  About  this  time  Hebra  began  to 
exert  an  influence  on  dermatology  in  Germany,  and 
as  he  regarded  eczema  as  a  purely  locul  disease,  and 
devoted  his  energies  to  the  search  for  local  reme- 
dies with  which  to  combat  it,  this  plant  was  neg- 
lected and  its  virtues  were  forgotten.  Modern  Ger- 
man writers,  especially  those  of  the  Hebraic  school, 
rarely  refer  to  it,  and  one  of  the  most  recent,  Kaposi,'" 

188'?'^'"'  "'  '*"'  ""^'""S  of  the  Materia  lledica  Society,  March  2:i, 
''  Diss,  inaug.  de  Lichene  pj-xldato.    Neoguntiic.  1783. 

Apparatus  meclicaminum,  vol.  i.    Giittingen.  17'ja 
'  ^  ol.  ii.,  p.  608. 

'Handbuch  der  phanBaceutisch-medicinischen  Botanik,  vol.  i.,  p. 

'  AnsB-ahl  der  wirksamsten.  einfachen  nnd  znsammcneesetztcn  Arz- 
™™i'tel.  u.  s.  w.,  vol.  ii.,  p.  (i66.     Erfurt. 

Isonveau  Traite  des  Plantes  usnclles.  etc.,  vol.  i..  .390. 
tine       '"'ni'khaften  Veriinderungcn  der  Uaut  u.  ihre  Anhange.     Got- 

lo'tf  '^''"''^''^ikheitcn.    TJebers.  von  Voigt.    Leipzig. 
Leipzie'lSM '^  "'  ^'''""P'^  ^^'  Hautkrankhciten,  p.  101.    Wien  n. 


denies  that  it  possesses  even  the  slightest  influence 
on  the  course  of  cutaneous  affections,  a  statement 
which  is  absolutely  at  variance  with  the  facts,  as 
any  one  who  chooses  to  make  the  experiment  can 
easily  ascertain. 

French  writers  are  almost  unanimous  in  its  favor, 
and  the  drug  is  at  the  present  day  in  constant  use 
at  the  Hupital  St.  Louis  in  Paris. 

In  England  the  drag  appears  to  have  been  little 
used,  and  I  do  not  know  of  a  single  dermatological 
writer  of  that  countiy  who  aUudes  to  it. 

The  American  literature  of  viola  tricolor  is  ex- 
ceedingly scanty,  little  having  appeared  on  the  sub- 
ject. 

/*//,«rOT«c7/.— Strack  preferred  the  fresh  herb,  de- 
prived of  root  and  flowers.  Of  this  he  ordered  a 
"fistful"  (piH/iUum  iinum),  boiled  with  milk,  to  be 
taken  morning  and  night.  In  default  of  the  fresh 
herb  he  used  that  dried  in  the  shade,  macerating 
half  a  drachm  of  the  powder  in  milk  for  two  hours, 
then  boiling  it  and,  after  straining,  giving  it  twice 
a  day. 

This  method  of  administering  the  remedy  appears 
to  have  been  the  favorite  for  many  years,  although 
an  infusion  made  with  water  simply  was  much 
used.  French  writers,  and  especially  Hardy."  rec- 
ommend its  use  in  combination  with  senna.  Per- 
sonally, I  liave  employed  the  dry  herb,  and  prep- 
arations made  from  it,  both  singly  and  in  com- 
bination with  other  drugs.  My  first  use  of  viola 
dates  back  about  fifteen  years,'having  been  led  to 
try  it  in  consequence  of  the  statements  contained  in 
the  writings  of  Hardy.  In  the  beginning  I  used  it 
as  recommended  by  this  author— that  is,  mixed  with 
.senna  in  the  proportion  of  two  parts  of  viola  to  one 
part  of  senna.  An  infusion  with  hot  water  was  made 
and  given  in  doses  suiScient  to  produce  free  ca- 
tharsis for  several  days,  and  afterward  continued  in 
simply  laxative  doses,  the  patient  himself,  if  an 
adult,  adjusting  the  dose  so  that  he  would  obtain 
about  two  loose  stools  a  day.  Later,  I  experi- 
mented with  the  viola  by  itself,  still  giving  it  in  in- 
fusion. This  method  of  administering  it,  however, 
was  troublesome;  with  women  and  children  the 
"pansy  tea"  could  be  managed  without  great  diffi- 
culty, but  with  men,  especially  those  not  surrounded 
by  home  comforts,  or  ready  access  to  a  tea-kettle, 
this  plan  of  giving  it  proved  very  inconvenient.  I 
next  experimented  with  the  honiiceopathic  mother 
tincture.'-  This  preparation  did  not  api^ear  to  give 
as  good  therapeutic  results  as  the  infusion,  and  after 
fair  trial  was  abandoned,  and  the  latter  preparation 
returned  to,  despite  its  inconveniences.  Still  later, 
I  obtained  a  quantity  of  the  solid  aqueous  extract, 
kindly  prepared  for  me  by  Dr.  Chas.  Eice  at  the 
ph.'irmaceutical  laboratory  of  Bellevue  Hospital. 
This  preparation  would  not  keep,  the  .summer's  heat 
causing  it  to  ferment. 

Up  to  this  time  the  results  obtained  from  viola 
tricolor  varied  greatly.  Sometimes  they  were  un- 
rnistakably  brilliant,  at  other  times,  in  'apparently 
similar  cases,  they  were  negative.  Suspecting  that 
the  quality  of  the  drug  furnished  on  prescription 
might  have  something  to  do  with  this,  I  procured 
samples  from  a  number  of  drug  stores.  Of  these 
four  were  found  to  be  genuine  viola  tricolor— one  of 
good  quality  and  three  old  and  deteriorated. '=     One 


Lei;ons  sur  les  maladies  de  la  pean.  Piiris-,  ISDO-'i. 

Prepared  by  macerating  the  fresh  herb  with  two  parts  by  weight 


of  f-trong  alcohol. 

'3  Apropos  of  thi-s  the  expcrici 
be  cited.  This  eminent  phyiiician 
Avzneikitnde   u.    Wimdarziieikunst. 


recorded  by  Hiifcland  may 
1  writer  says  (Jnur.  d.  pract, 
.   XI.,  St.  4.,  p.  l:«):  "It  has 


450 


THE  MEDICAL  RECORD. 


sample  was  viola  odorata,  two  were  viola  pedata,  and 
three  were  nnrecognized.  This  experience  induced 
me  to  make  a  special  importation  of  the  dmg, 
which,  on  trial,  I  found  to  give  much  more  uniform 
and  very  satisfactory  results.  Since  then  I  have 
depended  almost  entirely  on  such  importations  for 
the  necessary  supplies. 

The  use  of  the  herb  in  infusion  sHll  proving  in- 
convenient, I  sought  some  better  way  of  emj^loying 
it.  This  I  found  in  a  fluid  extract  made  for  me  by 
Dr.  Squibb,  according  to  his  "repercolation  "  pro- 
cess, using  very  dilute  (twenty-five  percent.)  alco- 
hol as  the  menstruum,  and  during  the  past  eighteen 
months  I  have  prescribed  about  twenty  pounds 
made  by  Dr.  Sijuibb,  and  an  equal  quantity  prepared 
in  the  same  manner  by  Messrs.  Caswell,  Hazard  & 
Co.  These  preparations  have  proved  in  every  way 
satisfactory. 

ChemiMrii. — The  older  chemical  researches  into 
the  constitution  of  viola  tricolor  yielded  almost 
negative  results,  nothing  being  found  in  the  plant 
to  account  for  its  ajsparent  activity.  Within  the 
last  two  years,  however,  Maudelin  has  subjected  the 
herb  to  very  thorough  and  careful  analy.sis,  and 
the  results  have  been  recently  published." 

This  experimenter  succeeded  in  isolating  an  or- 
ganic crystalline  substance,  which  was  found  to 
possess  the  i>liysical  properties,  and  chemical  char- 
acteristics of  ordinary  salici/Kc  acid,  thus  showing 
that  the  humble  herb,  despised  by  modern  German 
dermatologists  as  inert,  in  reality  contains  as  an  in- 
gredient a  substance,  which  a  German  experimenter 
(Kolbe)  brought  to  the  fi-ont  as  an  active  and  useful 
drug,  and  which  physicians  generally  would  be  sorry 
to  be  dejjrived  of. 

Physiological  action. — Observations  relative  to  the 
pure  physiological  effects  of  viola  tricolor,  that  is,  its 
effects  on  the  healthy,  are  almost  entirely  wanting  ; 
but  its  effects  on  organs  other  than  the  skin,  in  those 
suffering  from  cutaneous  disease,  have  been  recorded 
by  several,  commencing  with  Strack.  This  observer 
states  that,  given  in  medicinal  doses,  it  neither 
pukes  nor  purges ;  in  fact,  causes  little  systemic  dis- 
turbance other  than  increased  diuresis,  and  a  de- 
cided alteration  in  the  odor  of  the  urine.  This  is 
confirmed  by  the  personal  observations  of  Hufeland 
and  others,  and  has  also  been  observed  by  the  pres- 
ent writer.  Little  has  been  added  to  this,  except  a 
so-called  proving,  pul)lished,  in  1828,  by  Stapf,  in  the 
Archiv  f.  d.  homonp.  Heilk.,  B.  VII.,  H.  2,  p.  17.3,  in 
which  effects,  presiimably  observed  on  the  healthy, 
arc  inextricably  mixed  up  with  those  occurring  in 
patients.  Stapf's  collection  appears  to  be  based  on 
the  observations  of  Gutmann,  Hahnemann,  Franz, 
Wislicenus,  Lmghamnier,  Hufeland,  and  Haase,"' 
the  first  five  of  whom  were  adherents  of  the  Homoeo- 
pathic sect,  and  the  etlects  recorded  by  tliem  were 
probably  observed  after  tlie  administration  of  large 
doses  of  a  mixtm-e  of  the  expressed  juice  of  the  plant 
with  an  equal  quantity  of  alcohol.  This  iiro\  iiig,  to- 
gether with  a  few  additional  observations,  will  be 
found  in  .VUen's  "Encyclopedia,"  vol.  x. 

Tlie   recent    discovery   by  Maudelin  of  salicylic 


several  timc^  happennri  timt  I  have  piven  this  dnig  to  children  for  two 
or  three  weelcs  at  a  time  without  the  sli^litent  effect  (ffertiif/.tteti 
■Br/oly),  and  the  cause  wax  clear  when  I  asccrtaiiieil  that  tlic  drug  wan 
impaired  l>y  age  or  improper  preservation.  ...  I  specially  ob- 
served that  the  fresher  the  herb,  the  more  active  it  appeared  to  be 
(^Veherhaupt je frUc/ter  dun  Kraut  warje  wUrkauvier  scltien  es  mir  su 

'*  Untersuchuntfen  i'lber  das  Vorkommen  n.  iiber  die  Verbreitung  der 
Salicylsiittre  in  der  Pllanxenpattung  Viola.    Dorpat,  18^1. 

'*  In  17^■2  Haa^e  published  a  dissertation  on  viola  tricolor.  I  regret 
that  I  have  not  been  able  to  gain  access  to  a  copy  of  the  work. 


acid  in  viola  tricolor  lends  an  additional  interest  to 
the  question  of  its  physiological  effects,  and  induced 
the   writer  to  institute  a  comparison   between  the 
crude  viola  and  its  presumed  active  principle.'* 
The  result  is  here  given  : 


Head, — Confusion  and  dulness ; 
heavines-s  of  the  head  ;  headache ; 
burning  sensation  in  the  scalp 
above  the  forehead. 

Eye. — Stitches  in  the  eyes :_  lids 
droop  ;  pupils  contracted  ;  vision 
obscured. 

Nose. — Itching  pressure  toward 
the  left  fide  of  the  nose. 

J/ow<//.— T..iii;uc  white  and  cov- 
ered with  mucus  having  a  hitter 
taste  ;  much  saliva,  with  sensation 
of  dryness  of  the  month. 

Abdomen. — Sticking    and  grip- 

Vriitari/  orgnnx.  —  Tenesmus 
and  frequent  desire  to  urinate ; 
profuse  urination;  urine  turbid, 
offensive,  smells  like  cat's  unne. 


Temperature.— K^e.\>  over  the 
whole  body — night-sweats. 

Wd!.  — Nettle-rash  over  the 
whole  body  ;  itching  and  burning 
sensation. 


FJfects  of  SallC!/lic  Add.  > 


iVose.  —Sneezing. 

Mouth. — Dryness  and  bnmiui: 
ifl  the  mouth  ;  excreme'y  disgust 
ing  taste. 

Abdomen. — Vomiting. 

Urinary/  orffann. — Urine  of  a 
greenish  tinge,  filled  with  floatin.: 
crystals  that,  on  stiinding,  settlr 
to  the  bottom  of  the  vessel.  If 
the  crysL-ils  are  filtered  off,  tli. 
urine  soon  becomes  pntrid.  but  ;  i 
not  removed,  the  urine  will  rr 
main  fresh  for  a  week.'' 

Temperature.  —  Increased 
warmth  of  the  skin  ;  sweats. 

i.kiii. — Petechite  and  ecchymo- 
ses ;  burning,  itching,  and  dc8 
qunmation.2*' 

I  Effects  from  Salicylate  of  Soditnn. 

1  SH-in.  —  Severe    pmritus,    red- 

■  ness,  and  urticarial  eruption  i  Heio- 

I  lein).*i   Lichenoid  eruption. *■'' 

The  foregoing  observations,  taken  for  what  they 
may  be  worth,  certainly  exhibit  a  striking  corre- 
spondence between  the  effects  of  viola  tricolor,  as 
recorded  fifty  years  ago,  and  those  of  salicylic  acid 
of  more  recent  date ;  and  when  it  is  remembered 
that  they  were  made  and  recorded  before  the  j^res- 
ence  of  salicylic  acid  in  the  viola  was  suspecttil, 
their  significance  should  not  be  overlooked. 

Therapeutic  observations  and  uses. — Beturning  now 
to  Strack,  we  find  in  his  essay  records  of  several 
cases  of  eczema  of  the  scalp  and  face  treated  with 
viola  tricolor  in  the  doses  we  have  already  men- 
tioned (  3  j.,  mane  nocteque).  He  notes  at  the  veiy 
start  that  when  thus  given  the  eruption  at  first 
becomes  worse,  and  the  exudation  anil  crusting  more 
exuberant ;  this  condition  persists  for  some  days, 
when  a  change  for  the  better  occurs,  and  the  patitnt 
then  makes  rapid  progress  toward  recovery.-'  Tl"' 
following  case  recorded  by  Hufeland  eighty  yeai - 
ago,-'  exhibits  so  graphically  the  eombineil  effects  d 

1"  Until  some  other  physiologically  active  substance  is  diseovere<l  in 
viola  tricolor,  it  is  a  fair  presumption  that  its  therapentic  activity  de- 
pends in  piirt,  if  not  wholly,  on  salicylic  acid. 

"  Extracted  and  condensed  from  Allen's  Encyclopicdia  (1-  c.) ;  most 
of  it  originally  from  Stapfs  Archiv  (18^6). 

'"  From  Alien's  Encyclopicdia.  Effects  of  the  dmg  from  ndministra 
tion  of  doses  of  fcnr  to  twelve  grammes  (60-180  pmins)  in  jwuieni-. 
collected  by  Allen  from  numerous  authorities.  It  is  to  be  regnnti^l  t!i:i' 
the  authorities  are  not  mentioned,  as  abstracts  and  quotations  au . 
through  clerical  errors,  frequently  found  to  be  at  variance  with  ilu- 
originals. 

"  ncported  by  Dr.  J.  A.  E.  Stuart  as  the  result  of  an  experiment  on 
himself  with  nine  grammes  of  salicylic  acid.  Practitioner,  June,  ISfiT, 
p.  4a5. 

»»  Freudcnberg.    Berl.  Klin.  Wochcnschrift,  October  21,  1,'!7S. 

2'  .Tahresbericht  lib.  d.  Leist.  u.  Fort-sch.  u.  s,  w.,  IST'.I,  B.  1.,  p.  40(1, 

''  C.  S. :  Roston  Itedical  and  Surj:icj>l  .lournal,  June  1,  IfSO. 

53  strack's  first  two  cases  arc  recorded  as  follows  :  "  Fllla  mercnlori< 
U.  rfr«v(W  cru-'.las  lacle'ift  tliu,  eliam  iitritis  dirersi.^  remediix.  retinvti. 
Afisumta  octiduo  Jacea,  cru.^tar  vefiemetttur  eniniperunt  iuttiw  r 
unique;  altera  sepUmana  deaderuut ;  tirtta  nlliUKr  m^-rlio  nui'^r 
full,  utut  vctiemrnit  fdernfuerit.  SimlU  ratlone  intra  duox  *etniTnai"<-< 
ftanata  entfllta  Domino'  R.  qua*  totam  faciem  cl'unla  ante  abductam 
Aafteftfli." 

"  Ueber  den  Milchschorf  (CrtisJen  iMctea^  nnd  desscn  Zimiekheli.i 
Jour.  d.  proct.  Arr.neykundo  u.b.w.,  18U0,  B.  II.,  tt.  4.  i).  I'i6-'.i'.l. 


THE  MEDICAL  EECORD. 


451 


eczema  and  full  doses  of  viola,  that  I  quote  it  freely. 
Hufeland  savs :  "  I  once  saw  the  disease  in  a  fifteen- 
year-old  child,  who  had  also  suffered  from  it  in  in- 
fancy, and  at  the  eighth  year,  and  now,  for  the  third 
time,  was  suffering  severely.     The  worthy  motlier  of 
the  child  drew  from  her   pocket  the   prescrii^tion 
which  she  said  had  already  twice  cured  her  son  of 
his  eruption.      It   proved  to  be  the  Flos  trmitads 
offic.  sett  Jncea.     When  the  eruption  appeared  for 
the  third  time  with  little  vesicles  {Blntlerchm)  on 
the  foreLead  and  cheek,  she  believed  that  the  old 
evil  had  returned,  and  forthwith  administered  two 
enpfuls  of  strong  Jacea  tea  {Satnirten  Thee  vcm  der 
Jacea)  morning  and  night.     The  vesicles  began  to 
dry  up,  the  eruption  became  less  evident,  and  the 
tea  was  discontinued.     After  eight  or  ten  days  how- 
ever the  eruption  again  came  to  the  front.     The  tea 
was   resumed,  but  its  effects  were  quite  dififerent. 
The  skin  of  the  face  became  tense  and  swollen,  and 
the  emptiou  broke  out  on  fresh  spots  and  spread 
over  the  whole  face,  and  even  behind  the  ears.     Th« 
glands  in  the  neck  were  swollen,  and  the  patient,  in 
consequence  of  the  severe  tension  of  the  skin,  could 
hardly   turn   his   head.     The   eyes   alone  remained 
clear.     .     .     .     Now,  after  several  days,  the  entire 
face  became  covered  with  a  thick  crust,  which  here 
and  there  cracked   and   gave  issue  to  a  yellowish 
viscid  matter  that  thickened  and  hardened  like  gum. 
Owing  to  the  overhanging  crust,  the  patient  could 
with  difficulty  open  the  eyelids.     Together  with  the 
eruption  there  was  an   insufferable  itching,  which 
caused  the  youth  to  scratch  and  tear  the  crusts  even 
in  his  slec]!,  and  when  morning  came  it  was  found 
necessary  to  tie  his  hands  to  the  bed  to  keep  him 
from  scratching.     .     .     .     The   urine   increased   to 
an  unusual  amount,  and  stank  horrilily,  pervading 
the  entire  room  with  an  odor  like  that  of'cat's  urine." 
The  increase  of  the  eruption  after  full  doses  of 
the  drug,  as  described  by  Strack  and  Hufeland,  I 
have   personally   witnessed   almost    times    without 
number,  and  it  may  be  stated  as  a  i^roposition  ea.sy 
of  verification,  that  if  viola  tricolor  be  given  to  a 
child    suffering    from   acute    eczema,   in    doses    of 
thirty  to  sixty  grains,  or  to  adialts  in  proportionately 
larger  doses,  the  most  prominent  early  elfects  will 
be  decided  aggravation  of  the  eruption  and  increase 
of  area  invaded  by  it,  together  with  increase  of  local 
heat  and  pruritus.     This  condition  may  be  expected 
within  from  three  to  six  days  after  cornmencing  the 
use  of  the  drug,  and  reaches  its  height  in  about  a 
week  later.     After  this  it  sometimes  .subsides,  even 
during  a  continuance  of  the  medicine,  and  recovery 
rapidly  ensues.     At  other  times  the  patient  protests 
against  the  continuance  of  the  remedy  which  he  very 
properly  credits  with  the  aggravation  of  his  suffer- 
ings._    If  it  be  now  stopped,  the  eruption  decreases, 
and  in  a  short  time  he  tinds  himself  either  entirely 
well,   or  somewhat   Iietter   than   before   he   began 
treatment.     A  second  or  a  tliird  course  often  com- 
pletes the  cure.     In  this  manner  I  formerly  used  the 
viola,  and  these  were  the  results  I  observed,  when 
by  lucky  chance  my  patient  was  fortunate  enough 
to  obtain  a  good  quality  of  the  herb.     Since  I  have 
•aken  pains  to  secure  such  a  quality  these  results 
have  been  much  more  constant.     The  very  decided 
primary  aggravation  of  the  eruiition  which  usually 
'ollowed  the  above  described  method  of  admini.stra'- 
ion  was  by  no  means  an  agi-eeable  addition  to  the 
patient's  sufferings,  and  was  one  to  be  avoided  if 
possible.     Reffection  and  increased  experience  have 
n  great  measure  enabled  me  to  obviate  this  diihculty. 
-  refer  to  the  use  of  the  drug  in  the  acute  form  of 


the  disease.  It  was  simply  a  question  of  dose,  of 
the  dose  best  adapted  to  the  individual  case  in  hand. 
For  young  childien  the  proper  quantitv  to  begin 
with  IS  from  one  to  five  drop.s  of  the  fluid  extract 
(made  as  described  above)  once  or  twice  a  day.  If 
the  case  progi-ess  favorably  the  dose  should  be 
maintained ;  if  no  effects  appear  it  should  be  in- 
creased ;  if  aggravation  occurs  the  medicine  should 
be  discontinued  for  a  few  days  and  afterward 
resumed  in  smaller  doses  than  at  first.  In  subacute 
and  chronic  eczemata,  the  commencing  dose  should 
be  much  larger,  ten  or  fifteen  drops  at  lea.st ;  this,  I 
continue,  or  increase,  if  necessary,  until  theeiuption 
begins  to  show  signs  of  activity,  that  is  until  a  de- 
cided aggravation  is  imminent.  At  this  point  the 
do.se  should  be  discontinued,  as  before  mentioned, 
and  resumed  in  less  quantity.  In  adults  the  com- 
mencing dose  may  be  placed  at  from  five  to  ten 
minims  in  acute,  and  from  half  a  drachm  to  two 
drachms  in  subacute  cases. 

The  dose  having  been  selected,  it  is  my  custom  to 
direct  that  it  be  taken  in  a  small  quantity  of  water, 
once,  twice,  or  three  times  a  day,  alwavs  on  an 
empty  stomach,  and  when  possible  about  half  an 
hour  before  meals. 

The  question  of  dosage  and  admnistration  being 
settled,  it  may  properly  be  asked  under  what  cir- 
cumstances and  in  what  forms  of  eczema  viola 
tricolor  will  prove  most  useful.  The  best  and  most 
striking  results  that  I  have  obtained,  have  been  in 
thesecond  stage,  with  serous  or  sero-imiulent  (xu- 
dation  and  crusting.  In  the  first  .stage  I  rarely  have 
an  opportunity  of  using  this  or  any  other  medica- 
tion, and  in  the  third  or  scaly  stage  other  remtdit s 
appear  to  answer  as  well  if  not  better.  In  a  ceilain 
proportion  of  cases,  I  precede  its  administration 
with  a  single  full  mercurial,  either  blue  pill  or  cal- 
omel and  jalap,  and  in  perhaps  one-third  of  the 
ca.'-es  appropriate  local  treatment  is  conjoined. 

Theoretica/.~To  those  fond  of  theoiizing  on  the 
action  of  medicines,  and  to  those  who  are  contin- 
ually searching  for  explanations  of  observed  facts, 
this  article  would  hardly  seem  complete  without 
some  attempt  to  ex])lain  the  manner  in  which  viola 
acts  in  the  relief  of  eczema.  In  other  words,  is  its 
action  antii^athic,  homoeopathic,  allopathic,  or,  if 
not,  what  ? 

Is  it  antipathic?  The  fact  that  viola  taken  in 
medicinal  doses  aggravates  the  eruption  at  the  be- 
ginning negatives  the  view  that  its  action  is  anti- 
pathic. 

Is  it  homoeoi^athic  ?  It  was  so  claimed  by  Hahne- 
mann in  his  first  essay  on  Homceopathv,  in  the  fol- 
lowing words:  "The  panzy  violet  (viola  tricolor j 
at  first  increases  cutaneous  eruptions,  and  thus 
shows  its  power  to  produce  skin  diseases,  and  con- 
.sequentJy  to  cure  the  same  efl'ectually  and  perma- 
nently." ■'=  In  this  sentence  we  have  a"  premise  that 
is  con-ect,  and  two  conclusions  that  are  neither 
logical  sequences  nor  warrantable  inferences  from 
the  premise.  The  Hahnemanuian  claim,  it  seems 
to  me,  is  not  substantiated.  If  now  we  refer  to  the 
physiological  action  of  the  drug  in  support  of  the  ho- 
nxeopathicity,  so-called,  of  viola  tricolor  to  eczema, 
we  find  nothing  therein  to  sustain  this  view.  Urti- 
caria, it  is  stated,  may  follow  the  ingestion  of  viola  ; 
but  urticaria  can  hardly  be  considered  a  disease  in 
any  way  similar  to  eczema,  and  hence  the  successful 
use  of  viola  in  eczema  cannot  be  brought  forward 
as  an  exemplification  of  homoeopathic  action.     Ur- 

="  Dudgeon's  Translation. 


THE  MEDICAL  RECORD. 


»ria,  moreover,  may  follow  the  ingestion  of  crabs, 

Asters,  oysters,  chloral  hydrate,  and  a  variety  of 
Aer  substances,  which  no  one,  so  far  as  I  am  aware. 
As  yet  brought  forward  as  8i)eciaUy  useful  in  the 
treatment  of  eczema.  Further,  if  viola  tricolor 
were  homceopathic  to  eczema,  it  should  prove,  ac- 
cording to  the  Hahnemannian  doctrine,  most  useful 
when  given  in  iutinitesimal  doses.  Such,  I  have  no 
hesitation  in  stating,  is  not  the  case,  and  I  base  this 
statement  on  the  results  of  personal  experiment.  A 
recent  homoeopathic  writer,  in  recommending  the  use 
of  viola  in  eczema,  says  :  "I  usually  have  about  one 
drachm  of  the  dried  herb  boiled  in  half  a  |iint  of  water, 
and  of  this  tea  prescribe  one  drachm  two,  three,  or 
four  times  a  day  in  milk  slightly  sweetened.  .  .  . 
Frequently,  in  alternation  with  the  tea,  I  have  given 
the  first  or  second  dilution  or  the  thirtieth,  but  have 
not  been  able  to  discover  any  marked  difference  in 
the  course  of  the  disease  produced  thereby.""" 

Baehr,  another  homceopathic  writer,  who  evi- 
dently experimented  with  viola  tricolor  in  dilutions, 
speaks  of  it  as  of  little  or  no  use  in  eczema.'-' 

If  neither  antipathic  nor  homceopathic,  is  the 
action  allopathic?  Allopathic  treatment  consists 
essentially  in  treatment  by  derivation,  or  counter- 
irritation,  whereby  irritation  is  set  up  in  some  organ 
other  than  the  one  which  we  hojie  to  relieve.  Now, 
it  is  a  well-known  fact  that  eczemata  will  sometimes 
disappear  during  the  existence  of  a  free  purgation, 
whether  the  result  of  cathartics  or  occurring  spon- 
taneously. In  these  instances  the  cure,  if  such  it 
be  called,  is  allopathic.  Viola  tricolor,  however,  in 
mediciaal  doses  does  not  produce  catharsis  or  irrita- 
tion of  other  organs,  the  only  alteration  of  the  bodily 
functions  being  slightly  increased  diuresis.  This 
treatment  cannot,  therefore,  be  properly  termed  allo- 
pathic. 

Is  it  specific?  As  we  have  already  seen,  Strack, 
DUlenius  and  others,  and,  I  may  adil,  Hufeland,'-*  so 
regarded  it.  If  they  used  the  term  "  specific  "  in 
the  sense  that  we  often  see  it  applied  to  cinchona  in 
connection  with  malaria,  and  to  mercuiy  in  relation 
to  syphilis,  namely,  as  the  be.st  single  remedies 
yet  known  for  the  diseases  mentioned,  I  think  they 
were  fully  justified  in  .so  doing.  I  know  of  no  other 
drug  that  singly  and  alone  is  capable  of  affording  so 
much  relief  to  that  frequent  and  frequently  obsti- 
nate disease,  eczema,  as  the  viola  tricolor. 

It  will  thus  be  seen  that  antipathy,  homoeopathy, 
and  allopathy,  using  these  words  in  their  correct 
sigaifij.itions,  alike  fail  to  explain  the  action  of  the 
drug  we  are  considering ;  and,  if  the  same  examina- 
tion be  made  of  cinchona  and  mercury  in  the  con- 
nections referred  to,  it  will  be  found  that  they  also 
fall  into  the  category  of  drugs  for  the  successful 
action  of  which  no  systematic  explanation  has  yet 
boea  offered.  The  term  "  specific  "  has  no  scientific 
dafluition,  and  hence  cannot  be  used  with  pi'opriety 
except  as  a  provisional  cover  for  our  own  ignorance. 
For  this  reason  I  offer  no  objection  to  its  use  as 
above. 

Ooiichttioti. — It  m\y  not  be  out  of  place  to  allude 
to  certain  views  advanced  by  me  some  years  ago 
relative  to  the  nature  and  causation  of  eczema  and 
its  dependence  on  u  diathesis  closoly  allied  to  that 


">B!elor,  Ilnhn.  Mooth..  Jnminry,  1880. 

a'  •'  Von  viula  tricolor  Imbcn  wlr  dnbci  nicma^n  oinc  nnch  nnr  pcrinfje 
H'-Mlwirkimjc  gcschen.    Bio  Theraplo  u.  8.  w.,  B.  11..  p.  Gil).    Leipzig, 

a"  "Mir  hnt  dio  Jacea  in  dor  Crwtta  lacten  immor  vortrodiche. 
DionnUi  ^ctoiHtct>  HO.  ilaHH  ich  vollkomincn  bore  -iitifft  bin.  wio  Hen- 
Prof.  Slrai  Bio  filr  ein  Spectftcum  in  ciictor  Kmnl(tioit  zn  Imlten.'' 
■Juur.  d.  pract.  Arz:n;ylc.,B.  11.,  St.  ■).,  p.  120. 


which  underlies  rheumatism.  The  facts  connecting 
salicylic  acid  with  viola  tricolor  must,  I  think,  be 
taken  as  corroborative  of  the  inductions  then  made. 
Two  problems  yet  remain  to  be  investigated. 
Will  salicylic  acid  itself  prove  as  useful  in  eczema 
as  viola  ?  Will  viola  prove  u.seful  in  rheumatism  ? 
The  first  of  these  I  have  under  present  study,  the 
second  I  leave  to  the  investigation  of  others. 


OBSEEVATIONS  ON  HElVIIPLEGLi., 

Based    on     Eighty  one     Kecordkd    Cases,    -with 
Special  Reference  to  Cerebral  Localization. 


By  a.  D.  ROCKWELL,  A.M.,  M.D., 


ELECTRO-THEB 


TO  '. 


'.  N.  Y.  STATE   WCMA 


rAL,  ET  ■ 


TYPICAL  CASE  OF  HEMIPLEGIA — LESIONS  OF  THE  COKPI,-S 
STRIATUM — RELATIVE  FKEyUENCY  OF  RIGHT  AND  LEFT 
HEMlPLECilA — ORGANIC  APHASIA — FUNCTIONAL  APHA- 
SIA— ACUTE  SLOUGHING — INCKEASED  TEJIPERATDBE 
AND  SWELLING  OF  PARALYZED  MEMBERS — LESIONS  OP 
THE  OPTIC  THALAMUS,  CRUS  CEREBRI,  AND  PONS  VABO- 
LU — "  PULSUS  DEFERENS  " — LESIONS  OF  THE  CORTICAL 
SUBSTANCE — ffiREGULAR  FORMS  OF  ANiESTHESLi — UNI- 
LATERAL HYPEEJiSIHESIA — SPASM  OF  VESSELS — IN- 
TERMITTENT  HEMIPLEGIA — SUDDEN  LOSS  OF  SIGHT, 
FOLLOWED   BY   RECOVERY. 

I  H.AVE  records  of  eighty-one  cases  of  hemiplegia 
that  have  been  under  my  care  during  the  past  four- 
teen years,  and  it  has  occurred  to  me  that  some  sort 
of  an  analysis  of  them  might  be  not  allogetber 
valueless,  both  in  a  statistical  point  of  view  and  as 
a  clinical  contribution  to  cerebral  localization.  The 
symptoms  and  the  grouping  of  symptoms  in  many 
cases  of  hemiplegia  vary  very  widely,  and  this  varia- 
tion, it  is  hardly  necessary-  to  say,  is  due  to  the 
special  part  or  parts  of  the  brain-substance  that  are 
damaged.  Every  disease  and  evei-y  pathological 
condition,  however,  has  its  common  and  readi' 
recognized  type,  and  the  typical  hemiplegic  fiii 
his  counterpart  in  the  following  case : 

Mr.  X ;  aged  sixty-two,  suddenly,  and  without 

marked  premonitory  symptoms,  became  partially 
unconscious,  and  on  recovery  found  that  his  right 
leg  and  arm  were  completely  paralyzed. 

The   face   was    drawn   sharply  toward    the   non- 
pai-alyzed  side,  and  the  tip  of  the  tongue  when  pro- 
truded deviated  to  the  paralyzed  side.  '  There  was 
some  aphasia,  and  the  utterance  was  thick,  but  the 
intellect  was  undisturbed.     Some  anicsthesia  of  tlic 
extremities  was   present,  but  the  electro-mnsculaii 
iiTitability  was  normal.     In  the  course  of  two  weekd 
the  patient  was  able  to  articulate  with  almost  lii' 
usual  clearness,  and  the  aphasia  had  entirely  disaj' 
peared.     He   could   take   a  few   steps   around  tin 
room,  while    the  paralysis  of   the  face  and  tongm 
had  improved  in  a  considerably  greater  degree,     li 
three  months'  time   the  jiatieut  was  able  to  wnll 
about  at  will,  although  the  toe   pointed  somcwl 
downward,  with   a  tendency  to  drag.     The  ohni: 
teristic  and  almost  pathognomonic  circumdnotioii 
the  leg  had,  however,  almost  entirely  disappear! 
As  is  usual  in  those  cases,  the  arm  recovered  much  !■ 
rapidly  than  the  leg,  and  it  was  many  montlis  bcl' 
he  could  raise  it  over  his  head  or  utilize  it  in  n 
considerable  degree.     The   regional  or  anatonii. 
diagnosis   in   this   case  was   ofVusion   of   raoder;' 
quantity  into  or  in  the  immediate  neighborhood 
the  corpus  striatum.     This  patient  finally  so  far  i 
covered  that  he  could  walk  with  hardly  a  jierceptil 


THE  MEDICAL  RECORD. 


453 


limp,  while  the  facial  muscles  and  tongue  were  quite 
restored  to  their  normal  condition. 

The  arm,  however,  remained  decidedly  weaker 
than  its  fellow  until  the  occurrence  of  death,  some 
two  years  subsequently — from  a  second  and  more 
profuse  hemorrhai^e.  In  addition  to  this  case,  I 
iiud  a  sufficiently  detailed  record  of  eighteen  others, 
the  symptoms  of  which  were  enough  in  accord  with 
the  one  just  given  as  to  justify  a  similar  diagnosis 
as  to  the  probable  seat  of  the  lesion.  In  thirteen  of 
these  nineteen  cases  the  paralysis  was  on  the  right 
side,  and  in  the  remaining  six  upon  the  left  side.  Of 
these  thirteen  cases,  involving  lesions  of  the  left 
hemisphere,  nine  were  in  a  greater  or  less  degree 
amnesic  or  aphasic,  while  of  the  six  cases  involving 
lesions  of  the  right  hemisphere,  not  one  was  com- 
plicated with  aphasia  or  its  kindred  symptoms. 

This  experience  is  in  accord  with  the  generally 
accepted  view  that  aphasic  symptoms  follow  lesions 
of  the  left  cerebral  hemisphere  rather  than  tlie 
right,  and  that  the  posterior  portion  of  the  third 
oonvolution  is  the  most  frequent  seat  of  structural 
change. 

In  analyzing  all  my  cases — 81  in  number — with 
reference  to  the  side  affected,  I  find  that  right  hemi- 
plegia prejionderated  in  about  the  same  proportion 
as  in  the  19  typical  cases  (lesions  in  or  about  the 
corpus  striatum)  just  referred  to.  Right  hemiplegia 
occurred  49  times ;  left  hemiplegia,  30  times,  and 
double  hemiplegia  twice.  While  it  is  evident  that 
complete  and  persistent  hemiplegia  with  aphasic 
symptoms  depends  upon  positive  lesion  of  the  left 
hemisphere,  as  a  matter  of  fact,  the  aphasia  very 
frequently  disappears,  almost  entirely,  while  yet  the 
paralysis  of  motion  remains.  This  could  not  well 
be  explained  if  it  were  true,  as  M.  Broca  long  ago 
declared  that  the  faculty  of  articulate  language  was 
located  in  the  third  left  frontal  convolution.  On  the 
contrary,  the  experiments  of  Fritsch,  Hitzig,  and 
Farrier  show  that  in  every  essential  point  the  brain 
is  symmetrical. 

It  is  rational  to  believe,  therefore,  that  the  reason 
why  loss  of  the  co-ordinating  power  of  speech  is  so 
universally  associated  with  left  cerebral  lesion  is, 
that  as  most  people  are  right-handed,  po  are  they 
left-brained,  and  in  lesions  of  the  left  hemisphere 
with  aphasic  symptoms  the  memory  of  words  is  not 
totally  destroyed,  but  the  victim  is  without  the 
power  of  articulate  speech,  because  the  right  side  of 
the  brain  has  been  so  little  exercised  as  to  be  in- 
capable of  at  once  acting  alone.  When  aphasic 
symptoms  disappear,  therefore,  it  may  be  said  that 
the  right  side  of  the  brain  becomes  educated,  in  the 
same  way  that  the  left  hand  is  educated  when  its  fel- 
low becomes  disabled. 

In  regard  to  the  side  of  the  lesion  in  aphasia,  it 
may  l)e  remarked  that  Trousseau,  in  a  most  exten- 
sive hospital  experience,  met  with  but  one  case  of 
left  hemiplegia  associated  with  aphasic  sym]itoms, 
which,  at  the  time,  he  asserted  to  l>e  the  only  one 
on  record.  It  would  be  interesting  if  it  were  known 
whether  Trousseau's  case  was  left-h;inded  as  well. 

Aphasia  may  undoubtedly  occur  without  coincident 
piralysis,  and  dependent  upon  no  serious  structural 
changes.  The  single  case  of  this  character  that  has 
come  under  my  observation  occiirred  during  conva- 
lescence from  a  severe  attack  of  typhoid  fever.  The 
patient  first  noticed  a  slight  impairment  of  the  co- 
ordinating power  of  expression,  which  day  by  day 
increased  in  degree  until  he  lost  almost  completely 
the  power  of  intelligible  converse.  Under  a  general 
tonic  treatment  this  patient  finally  recovered. 


Slight  disturbances  of  speech,  unasscciated  with 
paralysis,  generally  disappear  rapidly  and  without 
treatment,  and  if,  as  it  is  possible,  a  local  change 
takes  place,  it  can  hardly  be  more  than  some  slight 
so-called  molcculardi.sturbance.  Following  a  some- 
what graver  central  lesion,we  have  aphasia  associ- 
ated with  paralysis,  more  or  less  ijersistent,  but 
amenable  to  a  greater  or  less  extent  to  time  and 
treatment. 

As  illustrating  this  condition,  I  give  the  following 
case,  in  which  the  treatment  adopted  seemed  to  be 
immediately  and  jio.sitively  beneficial. 

I  was  consulted  December  7,  1873,  by  a  lawyer, 
aged  fifty-three.  One  morning,  about  eight  months 
prior,  he  arose  in  his  usual  health,  and  for  some 
hoiirs  attended  closely  in  his  oflice  to  a  press  of 
business  that  had  accumulated  during  a  few  days' 
absence  from  the  city.  While  thus  engaged,  he  ob- 
served that  his  right  leg  was  a  little  numb,  and  that 
there  was  a  disr.greeal)le  sensation  of  tingling  in  the 
fingers  of  the  right  hand. 

Almost  immediately  he  felt  that  his  whole  right 
side  was  paralyzed,  and  on  attempting  to  speak, 
found  that  he  could  not  do  so  intelligibly.  In  a  few 
days  the  patient  regained  almost  the  normal  power 
over  the  paralyzed  members,  but  his  .'■■peech  re- 
turned more  slowly,  and  for  three  months  before  I 
saw  him  there  had  beeu  little  progress. 

He  could  speak  short,  disconnected  sentences 
well  enough,  but  when  he  attempted  to  engage  in 
animated  conversation,  he  not  only  constantly  used 
woi-ds  that  utterly  failed  to  convey  his  ideas,  but 
frequently,  all  remembrance  and  power  of  expref  sicn 
seemed  to  forsake  him,  so  that  he  was  unable  to 
proceed  tmtil  reminded  of  the  proper  word,  and  the 
thought  that  he  had  been  expressing. 

The  patient  was  treated  for  about  a  month  by 
central  galvanization,  and  with  such  marked  benefit 
that  in  a  few  weeks  he  was  able  to  converse  with 
much  greater  readiness. 

While  ai^hasia  is  a  result  peculiar  to  injuries  to 
the  left,  it  is  claimed  that  there  are  certain  symptoms 
peculiar  to  injuries  of  the  right  cerebrum.  Tonic 
f;23asms  of  the  limbs  and  conjugated  deviation  of  the 
eyes,  are  said  to  occur  in  the  proportion  of  aboiit 
two-thirds  of  the  ca^es  for  left  hemiplegia,  and  it 
has  been  found  by  Brown-Sfquard  that  the  .=ame 
proportion  of  the  "  recorded  cases  of  bed-sores, 
or  acute  sloughing  in  cases  of  hemiplegia,  have  oc- 
curred where  the  paralysis  of  the  limbs  has  been 
on  the  left  side."*  My  exi^erience  tends  to  confirm 
this  statement,  since  of  two  cases  of  acute  slough- 
ing that  I  have  seen,  both  were  associated  with 
lesions  of  the  right  hemisphere. 

This  symptom  is  regarded  as  indicative  of  speedy 
dissolution,  and  is  believed  to  depend  on  trophic 
rather  than  on  vaso-motor  changes.  In  my  own 
cases  the  patients  died  within  a  few  weeks  of  the 
appearance  of  the  sloughing. 

In  a  certain  rather  limited  proportion  of  cases 
of  hemiplegia,  we  find  that  the  paralyzed  limbs 
become  hot  and  swollen,  and  remain  in  this  con- 
dition for  an  indefinite  length  of  time.  Out  of  the 
whole  number  of  my  cases,  these  symptoms  were 
associated  with  five,'  and  were  especially  maiked  in 
the  following  : 

The  patient,  a  man  aged  sixty,  became  ."-uddenly 
numb  throughout  his  right  side,  but  speedily  re- 
covered. Soon  after  the  attack  was  repeated,  and 
with  a  similar  result.     The  third  attack  resulted  in 

•  Bn^tiaD  :  Pnralysia  froir  "?  :&m  D''  mRfl 


454 


THE  MEDICAL  RECORD. 


complete  paralysis  of  the  right  side,  followed  by 
swelling  and  increased  temperature. 

Six  months  subsequently  when  I  saw  him  the 
symptoms  were  typical  of  an  ordinary  lesion  of  the 
corpus  striatum  and  neighboring  parts,  with  the  ex- 
ception of  the  heat  and  swelling  referred  to. 

It  was  evident  in  this,  as  in  other  cases  associated 
with  this  special  symptom,  that  the  lesion,  wliatever 
or  wherever  it  was,  exerted  an  inhibitory  influence, 
either  directly  or  reflexly,  on  the  vaso-motor  centre. 

The  pons  varolii  is  regarded  as  especially  a  regu- 
lative centre  for  vaso-motor  nerves,  but  the  symji- 
toms  were  manifestly  not  those  that  follow  damage 
to  that  sensitive  body.  It  was  hardly  possible  to 
locate  the  lesion  in  the  crus  cerebri,  as  in  such  a 
case  there  would  probably  be  a  concurrent  paralysis 
of  the  third  nerve. 

Injuries  to  the  optic  thalamus,  however,  owing 
to  its  close  proximity  to  the  principal  vaso-motor 
centre,  have  so  frequently  been  found  associated 
with  these  symptoms  of  increased  temperature  and 
swelling,  that  in  the  case  related,  this  part  was  be- 
lieved to  be  seriously  involved. 

Of  two  cases  that  have  fallen  under  my  observa- 
tion, where  the  lesion  was  supposed  to  involve  both 
the  pons  varolii  and  the  crus  cerebri,  I  give  here  the 
history  of  one.  The  attack  occurred  suddenly  in  the 
person  of  a  working  man  aged  fifty-five,  who,  for 
years  before  had  not  been  detained  at  home  even  for 
a  day  by  reason  of  illness.  The  character  of  the 
paralysis  relating  to  the  extremities,  the  face,  and 
the  tongue  was  of  the  usual  character.  Beyond 
this,  however,  there  was  some  difficulty  of  degluti- 
tion, with  painful  hyperiesthesia  of  the  paralyzed 
side  of  the  face,  due  probably  to  injury  to  the  fifth 
nerve.  The  patient  also  became  exceedingly  emo- 
tional, bursting  into  tears  at  the  slightest  cause,  and 
frequently  without  cause.  These  symptoms  pointed 
undoubtedly  to  lesion  of  the  pons  in  its  upper  lateral 
portion.  The  symptom  that  indicated  damage  to 
the  crus  (ferebri  was  paralysis  of  the  third  nerve,  on 
the  same  side  as  the  brain  lesion.  The  results  of 
this  condition  are  well  known,  being  ptosis  of  the 
evelid,  dilatation  of  the  pupil,  and  external  squint. 
This  last  symptom  is  due  to  the  fact  that  all  the 
muscles  of  the  eyeball  become  paralyzed,  except  the 
external  rectus  and  superior  oblique.  The  tempera- 
ture of  the  paralyzed  limbs  was  decidedly  higher 
than  normal,  as  has  been  frequently  observed  in 
demonstrated  cases  of  lesions  of  the  pons  varolii. 

In  a  speedily  fatal  case  that  I  saw  a  few  weeks  ago, 
in  consultation  with  Dr.  A.  R.  Carman,  in  addition 
to  the  difficulty  of  deglutition,  paralTsis  of  the 
tongue,  an  1  other  symptoms  indicative  of  damage  to 
the  pons  varolii, we  noted  a  rare  symi^tom,  designated 
by  the  term  "pulsus  deferens."  The  ymlso  in  the 
right  radial  artery  would  repeatedly  disajjpear  and 
reappear,  and  was  suggestive  as  indicating  injury  to 
the  vaso-motor  nerve-tracts  and  consequent  inter- 
ference with  the  contractile  power  of  the  arterial 
walls. 

Severe  injiiries  to  the  pons  in  its  central  part  give 
rise  to  profound  coma  with  double  liemiplegia. 
These  cases  are,  as  a  rule,  rapidly  fatal.  If  the 
damage  to  this  central  part  is  slight,  tlie  patient  may 
regain  consciousness,  but  with  a  more  or  less  marked 
bilateral  paralysis.  When  the  lower  half  of  one 
lateral  region  is  involved,  the  facial  paralysis  is  on 
the  side  of  the  brain  lesion,  while  the  limbs  of  tlie 
opposite  side  are  atlected  in  tlie  usual  manner.  It 
is  readily  understood  that  this  so  (tailed  alternate 
paralysis  occurs  because  the  fibres  of  the  facial  are 


damaged  below,  instead  of  above  their  decussation 
in  the  pons,  while  the  motor  fibres  supplying  the 
extremities  become  involved  above  their  decussa- 
tion in  the  medulla.  I  have  no  lecord  of  any  case 
in  which  this  irregular  complication  existed. 

The  cortical  substance  of  the  brain  is  very  fre- 
quently the  seat  of  efl'usion,  and  the  comliinations  of 
symptoms  following  damage  to  this  part  are  many. 

A  very  interesting  case,  in  which  I  was  led  to  be- 
lieve that  this  was  the  damaged  portion,  came  under 
my  care  a  few  weeks  since  in  the  person  of  a  phy- 
sician in  an  adjoining  city.  Four  years  ago,  after 
sufl'ering  for  some  time  from  intense  pain  in  the 
head,  associated  with  a  tendency  to  sleep,  he  became 
suddenly  unconscious  and  fell  to  the  ground.  The 
resultant  hemiplegia,  at  first  incomplete,  soon  be- 
came complete.  In  five  days  he  began  gradually 
to  regain  the  power  of  motion,  until  in  this  respect 
he  had  quite  recovered.  At  no  time  was  there 
marked  an;esthesia,  and  but  very  slight,  if  any,  de- 
viation of  the  tongue  or  face.  The  sphincters  were 
at  first  relaxed,  but  power  was  speedily  regained 
over  these  muscles.  There  was  temporary  ptosis, 
and  also  pronounced  aphasia  from  the  beginning. 

Whether  at  the  time  of,  or  shortly  after  the  attack 
there  were  tonic  or  clonic  spasms  of  the  limbs, 
.symptoms  often  observed  in  lesions  of  the  cortical 
gray  matter,  I  did  not  ascertain.  At  the  present 
time,  four- years  after  the  attack,  the  patimt  pre- 
sents the  appearance  of  perfect  health.  Theie  is 
no  paralysis  of  any  kind,  and  aphasia  is  notice- 
able only  in  an  occasional  inability  to  remember 
a  word ;  but  there  exists  marked  amnesic  defects 
in  writing,  and  what  is  far  more  serious,  he  can  un- 
derstand hardly  anything  he  reads,  although  it  be- 
comes perfectly  plain  when  read  to  him.  The  char- 
acter of  the  onset  of  the  attack  in  this  case,  the 
final  and  somewhat  rapid  disappearance  of  the  hemi- 
plegia, the  exem])tion  of  the  face  and  tongue,  the 
absence  of  ansesthesia,  and  the  presence  of  aphasia, 
all  pointed  to  the  cortex  as  the  location  of  the 
lesion. 

Amesthesia,  it  is  unnecessaiy  to  say,  is  a  very  com- 
mon symptom  in  hemiplegia,  but  occasionally  we 
meet  with  irregular  forms  of  it,  where  it  is  out  of 
all  proportion  to  the  motor  paralysis,  and  persists 
after  the  power  of  motion  is  fully  regained.  I  have 
no  records  of  this  condition,  but  the  post-mortems 
of  Turck  and  the  investigations  of  Veyssitre  "go  to 
show  that  coni])lete  hemi-an;esthesia  may  be  pro- 
duced by  a  considerable  lesion  just  outside  of  the 
optic  thalamus,  involving  the  peduncular  expansion 
(internal  capsule)  just  at  the  part  where  it  begins  to 
unfold  into  the  foot  of  the  radiating  crown  of  Keil. 

In  Turck's  cases,  injuries  in  and  about  this  region 
gave  rise  to  a  hcmi-anjosthesia  which  persisted  for 
many  months,  and  even  for  one  or  two  years  after 
the  motor  paralysis  liad  almost  wholly  disappeared." 
Unilateral  hyperiesthesia,  on  the  contrary,  is  some- 
what more  common,  and  in  a  case  of  especial  inter- 
est, that  I  saw  with  Dr.  J.  W.  Greene,  it  was  a 
prominent  symptom.  The  patient  was  a  cashier  in 
one  of  our  banks,  and  a  hard  drinker.  His  right 
side  became  euddeirfy  and  completely  paralyzed, 
followed  by  such  an  acutely  sensitive  condition  of 
the  limbs,  that  the  slighest  touch  caused  great  i)ain. 

Taking  into  consideration  the  completeness  of  the 
paralysis,  and  the  severity  of  the  other  .symptoms, 
the  case  seemed  about  as  unjiromising  as  ])ossible, 
yet  in  a  few  months  recovery  was  approximate  if  not 
complete.  The  treatment  was  almost  entirely  elec- 
trical, by  the  methods  of  general  faradization  and 


THE  MEDICAL  RECORD. 


455 


central  galvanization.  I  have  frequently  met  him 
on  Broadway,  walking  with  all  his  former  vigor. 
We  do  not  positively  know  the  cause  of  this  symp- 
tom, but  it  has  been  suggested  that  as  destruction 
of  one  of  the  sense-centres  for  commoa  sensibility 
results  in  hemi-an;esthesia,  so  a  neighboring  lesion, 
resulting  merely  in  a  reflex  irritation  of  this  sense- 
centre,  may  be  followed  by  hemihyperitsthesia. 

In  all  the  foregoing  cases  it  is  to  be  presumed 
that  the  pathological  condition  was  either  rui^ture 
or  occlusion  of  vessels.  I  have  made  no  attempt  in 
this  paper  to  discriminate  between  the  two  ;  indeed, 
it  is  no  easy  matter  to  do  this  in  many  cases,  and 
the  differential  diagnosis  in  this  respect  is,  by  no 
means,  so  important  as  the  regional  diagnosis,  which 
has  mostly  engaged  my  attention. 

There  is  a  third  cause  of  hemiplegia,  however, 
which  we  understand  very  little  about,  but  which 
ma^*  be  perhaps  not  quite  so  infrequent  as  is  gen- 
erally supposed.  I  refer  to  a  spasm  of  the  vessels. 
In  the  case  that  came  under  my  observation  the 
attacks  were  intermittent  in  character,  resulting  in 
partial  hemiplegia,  which  would  soon  pass  away. 
These  attacks  extended  over  several  months,  and 
finally  resulted  in  the  death  of  the  patient.  A  post- 
mortem made  at  my  request  by  Dr.  Heni-y  T.  Pierce 
revealed  various  abnormal  conditions  of  the  brain, 
but  neither  rupture  nor  occlusion  of  any  vessel,  and 
rendered  it  .probable  that  the  cause  was  functional 
and  spasmodic*  A  point  of  considerable  practical 
interest  in  the  consideration  of  this  case  lies  in  the 
fact  that  applications  of  electricity  for  the  purpose 
of  affecting  the  vasomotor  system  resulted  in  an 
immediate  cessation  of  these  attacks,  which  con- 
tinued from  the  25th  of  September  to  the  4th  of 
December,  when  a  most  violent  attack  canded  him 
off. 

The  infrequeacy  with  which  we  meet  serious  im- 
pairment of  the  function  of  the  nerves  of  special 
sense  in  cases  of  hemii^lpgia  following  brain  lesions, 
renders  the  subject  perhaps  of  secondary  impor- 
tance. The  exj)lanation  for  this  exemption  is  vei-y 
much  the  same  as  has  been  offered  by  Broadbent  in 
the  case  of  motor  phenomena,  and  is  perhaps  even 
more  conclusive ;  for  the  researches  of  Lockhart 
Clarke  certainly  show  that  the  nuclei  of  the  two  optic 
and  two  auditory  nerves  respectively  are  very  inti- 
mately connected.  Ai  a  matter  of  fact  we  know 
that  not  only  do  ordinary  lesions  of  one  hemisphere 
fail  to  impiir  sight,  but  that  almost  complete  de- 
struction of  one  hemisphere  may  leave  these  func- 
tions intact,  through  the  power  of  the  opposite 
hemisphere  to  take  cognizance  of  visual  im):)res- 
sions.  In  regard  to  sight  there  are  some  exceptions 
to  this  rule  of  exemption  in  damage  to  the  hemi- 
spheres, but  none  probably  as  regards  hearing,  since 
the  nuclei  of  the  two  auditory  nerves  lie  near  the 
junction  of  the  pons  with  the  medulla,  and  hearing 
can  hardly  be  impaired  without  there  is  either  a 
lesion  at  this  point,  an  injury  near  the  origin  of  the 
nerve  trunk,  or  an  incomplete  thrombosis  of  the 
basilar  artery.  Sight,  on  the  other  hand,  may  not 
only  be  occasionally  affected  by  damage  to  one 
hemisphere,  but  the  extent  of  the  optic  tract  within 
the  cranium,  and  its  varied  blood-supply,  render  it 
more  liable  to  injury  in  any  form  of  intracranial  dis- 
ease than  the  sense  of  hearing. 

Various  local  lesions,  resulting  not  only  in  hemi- 
plegia, but  also  in  total  or  partial  blindness,  might 

•  Thisj  case  will  be  found  in  the  New  York  Mediail  Journal,  Septem- 


be  enumerated ;  but  I  desire  at  this  time  to  consider 
an  occasional  loss  of  this  function  which  is  only 
temporary  and  due  i^robably  to  indirect  or  reflex 
efl'ects  of  injuries  to  brain-substance  in  close  prox- 
imity to  the  corpora  quadrigtmina. 

As  a  parallel  to  the  above  we  may  have,  as  a  re- 
sult of  an  epileptic  seizure,  temporary  paralysis  of 
the  limbs.  One  case  of  this  kind,  where  the  para- 
plegia was  complete,  and  lastiLg  for  over  twenty- 
four  hours,  I  have  myself  seen.  In  the  seme  way, 
then,  either  with  or  without  an  epileptic  attack,  we 
may  have  comjilete  loss  of  sight.  It  is  said  that 
hemiplegia,  when  associated  with  this  anomaly  of 
temporary  blindness,  is  apt  to  be  preceded  by  ei^i- 
leptiform  convulsions,  and  in  the  illustrative  case 
which  I  have  to  relate,  this  was  undoubtedly  the 
mode  of  onset.  This  case  came  under  my  observa- 
tion some  years  ago,  in  the  practice  of  a  Dr.  William 
Miller,  now  deceased,  who,  although  not  a  regular 
physician,  had,  in  certain  directions,  an  immense, 
and  perhaps  an  unparalleled  experience.  Until  with- 
in a  few  years  since,  I  had  never  reported  it,*  from 
the  fact  that  at  the  time  it  seemed  to  me  to  be  en- 
tirely exceptional  and  unexplainable.  In  the  light 
of  subsequent  experience,  however,  the  result  then 
noted  would  seem  to  be  not  altogether  exceptional, 
nor  devoid  of  the  possibility  of  rational  explanation. 
Some  years  previous  the  patient,  a  man  in  middle 
life,  had  suffered  from  a  convulsive  seiziiie,  which 
was,  I  suppose,  epUeptic  in  character,  and  these  at 
long  intervals  had  been  repeated.  Two  months 
before  he  came  under  my  observation,  he  was  pros- 
trated by  an  epilejjtiform  attack  of  unusual  severity, 
resulting  not  only  in  incomplete  laaralysis  of  cne 
side  of  the  body,  but  a  condition  also  of  total  blind- 
ness. There  was  in  this  case  a  reversal  in  the  order 
of  recovery,  for  two  months  after  the  attack— while 
the  arm  had  almost  wholly  regained  its  normal  power, 
the  strength  of  the  leg  was  stUl  impaired  to  a  con- 
siderable degree.  An  induction  current,  as  power- 
ful as  could  be  well  borne,  was  applied  simulta- 
neously to  both  eyes  of  the  patient  for  about  two 
minutes,  and  was  followed  by  an  immediate  restora- 
tion of  sight.  This  result,  surprising  as  it  seemed 
at  the  time,  and  almost  incredible  as  it  may  appear 
to  those  who  have  given  the  subject  no  thought,  or 
who  have  never  heard  of  cases  analogous,  is,  in 
truth,  not  so  astonishing  as  it  would  seem,  neither 
indicating  any  mysterious  power  nor  novel  therapeu- 
tic action  of  the  current.  Judging  from  reports  of 
otlier  cases,  and  the  probability  of  the  purely  func- 
tional or  indirect  cause  of  the  blindness,  recovery 
would  probably  have  taken  place  spontaneously,  and 
was  only  hastened  by  the  reflex  stimulation  of  the 
electricity. 

The  length  of  time  during  which  sight  was  lost 
in  this  instance  would  seem  to  be  exceedingly 
rare,  for  among  a  number  of  cases  mentioned  by 
Bastian.t  he  refers  to  one  in  which  the  blindness 
"lasted  for  an  unusual  time — as  long  as  six  weeks." 
This  patient,  while  in  apparently  perfect  health,  had 
several  attacks  of  numbness  in  the  left  arm,  which 
finally  resulted  in  almost  cortplete  loss  of  power, 
and  at  the  same  time  left  him  so  totally  blind  that 
he  was  unable  to  see  daylight. 

The  recovery  of  sight  was  rapid,  and  continued 
jiermanent.  If  we  attempt  to  explain  the  interest- 
ing phenomena  of  the  sudden  and  total  loss  of  sight 
and  its  sudden  recovery  on  the  theory  of  indirect  or 


456 


THE  MEDICAL  RECORD. 


reflex  influences,  some  might  suggest  that,  in  the 
light  of  a  better  knowledge  of  cerebral  physiology 
and  jjathology,  these  views  are  not  received  with  the 
same  favor  as  formerly.  It  must  not  be  forgotten, 
however,  that  morbid  anatomy  is  as  yet  far  from  be- 
ing co-extensive  with  pathology.  The  most  pro- 
found derangements  of  the  functional  activity  of  the 
nerve-centres  may  exist,  and  yet  by  none  of  our  ad- 
vanced methods  of  investigation  has  it  been  possi- 
ble to  discover  any  appreciable  lesion  ;  and  until 
we  have  more  accurate  knowledge  in  this  direction, 
the  theory  of  reflex  influences,  on  which  we  must 
fall  back  for  explanation,  although  beyond  the 
sphere  of  absolute  verification,  is,  at  all  events, 
plausible  and,  to  a  certain  extent,  rational. 


THE  DELIRIUM  OF  SALICYLIC  ACID. 
By  CHAS.  0.  BABEOWS,  M.D., 


There  are  few  writers  on  salicylic  acid  who  fail  to 
give  an  account  of  the  milder  cerebral  symptoms 
which  accompany  its  administration,  such  as  tinni- 
tus aurium,  headache,  deafness,  etc. ;  and  the  num- 
ber is  equally  small  of  those  who  do  mention  the 
moi'e  serious  cerebral  complication,  namely  delirium, 
more  or  less  active  and  violent.  Ewald,  quoted  by 
Still(i  and  Maisch  in  The  National  m^punsatoi-y 
(1879),  gives  the  best  account  of  it  that  I  have  been 
able  to  find. 

That  in  a  large  proportion  of  cases  of  acute 
articular  rheumatism  the  pain,  heat,  and  swelling 
of  the  joints  will  completely  disappear  within  forty- 
eight  hours,  or  soon  thereafter,  under  the  free  use 
of  salicylic  acid  or  its  salts,  is  a  fact  in  therapeutics 
now  well  established.  But  that  this  drug,  in  ex- 
actly .similar  cases,  may  set  up  a  violent  and  alarm- 
ing form  of  delirium,  does  not  seem  to  be  so 
generally  known,  at  least  to  the  average  practi- 
tioner. The  meagreness  of  our  cun-ent  literature 
on  this  subject,  as  well  as  the  want  of  information 
in  regard  to  it  in  those  books  on  theraj^eutics  which 
have  come  under  my  notice,  has  led  me  to  report 
the  following  cases  which  were  under  my  care  while 
recently  house  physician  to  Bellevue  Hospital.  To 
my  associates  in  the  hospital  there  will  be  nothing 
new  in  this  piper,  for  such  cases  wore  as  common 
in  their  wards  as  in  those  of  which  I  had  charge ; 
but  to  the  average  general  practitioner  I  trust  it 
may  contain  something  of  interest. 

Case  I. — Mary  Brennan,  aged  thirty,  a  native  of 
England,  married,  was  admitted  to  Ward  50,  Belle- 
vne  Hospital,  May  24,  1881,  sutfering  from  an  attack 
of  acute  articular  rheumatism  of  two  weeks'  standing. 
No  cardiac  complications.  Patient  is  six  months 
advanced  in  her  sixth  pregnancy.  Ordered  acidi 
salicylici,  gr.  xx.,  q.  2  h. 

May  26th. — Patient  became  wildly  delirious  last 
night,  in  consequence  of  whicli  all  treatment  was 
stopped.  Is  rational  this  morning,  but  very  deaf 
and  stupid.     Ordered  alkaline  treatment. 

May  ;iOth. — The  rheumatic  symptoms  increased  so 
markedly  when  the  salicylic  acid  was  stopped,  that 
it  was  renewed  yesterday,  and  opiates  given,  with 
the  hope  of  preventing  a  return  of  the  delirium. 

June  1st. — Patient  is  very  deaf,  but  not  delirious. 
Joints  are  not  so  jjainful. 

Juno  3d. — Patient  vomited  the  salicylic  acid  mix- 
ture yesterday,  and  it  was  stopped.  It  is  begun 
again"  this  morning. 


June  6th. — Again  delirious  last  night.  Salicylic 
acid  discontinued.     No  delirium  this  morning. 

August  22d. — This  patient,  after  having  tried  every 
form  of  treatment  with  but  little  benefit,  was  to-day 
discharged  at  her  own  request,  both  wrists  and  one 
knee  being  still  swollen,  painful,  and  so  etiil  as 
scarcely  to  admit  of  motion  cf  the  leg  or  hands. 
The  salicylic  acid  has  been  tried  again  several  times 
since  the  last  note,  and  was  each  time  followed  by 
delirium,  which  subsided  as  soon  as  it  was  discon- 
tinued. Between  June  11th  and  14th  she  sufiered 
from  a  vei-y  severe  acute  laryngitis,  a  complication 
which  is  by  no  means  rare  with  these  cases.  This 
was  relieved  by  inhalations  of  steam  with  vinegar. 
On  July  14th  she  began  to  have  labor  pains,  and 
examination  revealed  a  transverse  presentation. 
The  child,  which  had  been  dead  for  a  week  or  more, 
was  delivered  by  turning  without  difficulty. 

Case  II. — Mary  Boylan,  aged  forty  four,  a  native 
of  Ireland,  married,  was  admitted  to  Ward  .50,  Belle- 
vue Hospital,  September  20,  1881,  with  acute  ar- 
ticular rheumatism  of  several  days'  standing.  Sec- 
ond attack.  No  cardiac  complications.  Ordered 
acidi  salicylici,  gr.  xx.,  q.  2  h. 

September  21st. — Pain  much  less  severe ;  some 
dizziness  and  tinnitus  aurium.  Ordered  potassii 
bromidi,  gr.  xx.,  q.  4  h.,  and  acidi  salicylici,  gr.  xv., 
q.  2  h.,  continued. 

September  23d. — Patient  is  very  cross  and  is  de-  J 
lirious.  Salicylic  acid  stopped  and  potassium  bro-  I 
mide  continued.  ■ 

September  27th. — Delirium  has  subsided.  Pa-  11 
tient  still  complains  of  some  pain  in  one  knee,  but  'I 
is  able  to  be  up  and  about.  She  was  subpequently  ' 
discharged  cured,  without  farther  treatment. 

Case  III. — John  Sullivan,  aged  eleven,  a  native  of 
Ireland,  was  admitted  to  Ward  50,  Bellevue  Hospi- 
tal, .lune  18,  1881.  The  boy,  a  weUnouri.shed, 
bright,  healthy-looking  little  fellow,  states,  on  ad- 
mission, that  he  had  rheumatism  several  years  ago, 
from  which  he  soon  recovered,  and  that  he  has  been 
well  from  that  time  until  four  days  ago.  when  he  be- 
gan to  suffer  from  pain  and  swelling  in  his  ankles 
and  knees.  He  thinks  he  has  had  some  fever,  and 
has,  since  the  beginning  of  his  illness,  suflered  from 
shortness  of  breath.  He  has  had  no  pain  in  liis 
chest.  Examination  shows  heat,  tenderness,  and 
swelling  of  both  knees.  Auscultation  reveals  a  soft, 
blowing,  systolic  murmur  at  the  apex  of  the  heart, 
not  transmitted  in  any  direction.  Ordered  aciili 
salicylici,  gr.  x.,  q.  3  h. 

June  lOtli. — After  six  doses  (3  j.)  of  the  acid  Lad 
been  given,  the  patient  became  delirious.  Tlii^ 
morning  the  rheumatic  symptoms  have  entirely  di^ 
appeared,  but  the  j^atient  is  wildly  delirious.  11 
insists  that  his  bed  is  filled  with  cockroaches,  ari! 
that  the  floor  around  it  is  covered  with  fire-cracker.s 
which  are  continually  exploding.  His  efforts  to  es- 
cape both  imaginary  sources  of  annoyance  are  ex- 
tremely ludicrous.  Ordered  salicylic  acid  stopped, 
and  potassii  bromidi,  gi'.  x.,  to  be  given  every  three 
hoiirs,  until  the  delirium  shall  cease. 

June  20th. — Patient  is  rational  and  quiet  this 
morning,  and  has  very  little  pain.  The  swelling  is 
subsiding.     The  heart-murmur  is  still  heard. 

July  3d. — The  boy  has  convalesced  satisfactorily 
since  last  note,  and  is  to-day  discharged  cured,  the 
heart-murmur  having  disappeared. 

Case  IV. — MaryAbrey,  aged  thirty-seven,  a  native  | 
of  Oermanv,  single,  was  admitted  to  Ward  50,  Belle-  1 
vue  Hospital,  May  28,  1881,  with  her  fifth  attack  of 
acute  articular  rheumatism,  from  which  attack  she  ! 


THE  MEDICAL  RECORD. 


457 


had  beeu  sufferiug  two  weeks.  Ordered  acidi  sali- 
cylici,  gr.  xv.,  q.  2  b. 

May  30th. — \o  improvement.  A  pericardial  fric- 
tion-sound is  heard  over  the  base  of  the  heart. 

June  1st. — Patient  says  she  feels  worse,  and  has 
more  pain.  Is  very  deaf.  Pericardial  friction-sound 
is  very  loud. 

June  3d. — Patient  has  not  improved  at  all  Tinder 
the  salicylic  acid.  She  is  wildly  delii-ious,  and  is 
laboring  under  the  delusion  that  some  operation  is 
to  be  pel-formed  on  her.  As  she  threatens  the 
nurses  and  patients  around  her,  she  has  to  be  re- 
strained forcibly.     Salicylic  acid  stopped. 

June  6th. — Patient  has  become  very  quiet,  and 
makes  very  little  complaint.  She  is  dull  and  stupid, 
and  will  not  answer  questions. 

July  17th. — Under  the  use  of  potassium  iodide 
the  patient  recovered  within  a  few  days  after  the 
last  note,  and  worked  about  the  ward  until  to-day, 
.  when  she  eloped. 

Case  V. — Susan  Maswell,  aged  thirty-one,  a  native 
of  Ireland,  was  admitted  to  "Ward  50,  Bellevue  Hos- 
pital, June  8,  1881.  She  gives,  on  admission,  a  his- 
tory of  acute  rheumatism,  dating  back  two  weeks, 
and  affecting  almost  all  the  large  joints.  Exami- 
nation shows  tenderness,  swelling,  heat,  and  redness 
of  the  left  elbow  and  wrist.  Xo  cardiac  complica- 
tions found.     Ordered  acidi  salicylici,  gr.  xx. ,  q.  2  h. 

June  11th. — Patient  was  actively  delirious  last 
night.     Salicylic  acid  stopped. 

June  17th. — Delirium  has  disappeared,  and  pa- 
tient has  improved  rapidly  since  last  note,  and  is 
to-day  discharged  cured. 

Case  VI. — .\nna  Ricaumandis,  aged  thirty-tive,  a 
native  of  the  United  States,  mari-ied,  was  admitted 
to  Ward  50,  Bellevue  Hospital,  May  5,  1881.  Has 
suffered  from  acute  rheumatism  of  the  knees, 
ankles,  elbows,  and  wrists  for  three  weeks.  No  car- 
diac complication  can  be  made  out.  Ordered  acidi 
salicylici,  gr.  xx.,  q.  2  h. 

May  6th. — This  evening  the  patient  became  vio- 
lently delirious,  and  so  noisy  that  she  had  to  be 
removed  from  the  ward  to  a  room  in  the  Pavilion 
for  the  Insane  attached  to  the  hospital.  Salicylic 
acid  stopped. 

May  7th. — Patient  is  quiet  and  rational  this  morn- 
ing. She  complains  of  pain  in  her  lower  limbs,  but 
the  joints  are  not  swollen  nor  tender. 

She  was  transferred  to  Ward  23,  and  subsequently 
left  the  hospital  cured. 

Ca.se  VII. — Timothy  Mc.\uliffe,  aged  fifty,  a  na- 
tive of  Ireland,  married,  was  admitted  to  Ward  6, 
Bellevue  Hospital,  August  2-t.  1881.  The  patient 
has  been  suffering  from  acute  rheumatism  of  several 
joints  for  the  past  month.  This  is  his  third  attack. 
He  has  no  cardiac  symptoms.  Ordered  acidi  sali- 
cylici, gr.  XX.,  q.  2  h. 

August  26th. — Pains  have  disappeared,  but  the 
patient  is  deaf  and  has  some  tinnitus  aurium. 

August  27th. — Patient  was  delirious  last  night,  and 
is  excitable  and  very  deaf  to-day.  Has  no  pain. 
Salicylic  acid  stopped. 

September  10th. — Patient  has  had  several  returns 
of  the  pain  and  swelling,  which  were  relieved  by  the 
salicylic  acid  combined  with  potassium  bromide. 
He  has  had  no  return  of  the  delirium,  and  is  now 
well  of  his  rheumatism.  t" '" 

Case  VIII. — Henry  Seymour,  aged  twenty-eisht, 
a  native  of  the  United  States,  was  admitted  to  Ward 
6,  Bellevue  Hospital,  August  11,  1881,  suffering  from 
acute  rheumatism  of  one  week's  standing.  No  cardiac 
symptoms.     Ordered  acidi  salicylici,  gr.  xx.,  q.  2  h. 


August  15th. — Patient  has  no  more  pain  in  his 
joints,  but  complains  of  deafness  and  "confusion  in 
his  head."     He  has  been  delirious. 

August  16th. — Patient  has  a  severe  laryngitis. 
Salicylic  acid  stopi^ed  and  potassium  bromide  and 
chloral  hydrate  ordered,  as  the  patient  is  still 
delirious. 

August  19th. — Patient  is  no  longer  delirious. 

August  25th. — Patient  has  improved  steadily  since 
the  last  note,  and  is  to-day  discharged  cured. 

In  my  case-books  I  have  recorded  the  histories  of 
twenty-eight  cases  of  acute  rheumatis ni  treated  with 
salicylic  acid,  with  tlie  development  of  delirium  in 
the  eight  cases  which  I  have  presented  above.  This 
large  proportion — almost  one-third  of  the  cases  so 
treated — may  perhaps  be  accounted  for  by  the 
liberal,  some  may  say  heroic,  manner  in  which  the 
drug  was  administered.  The  following  combina- 
tion, which  I  find  agrees  with  the  stomach  better 
than  any  other  I  have  seen,  was  used  in  every  case  : 

B  Acidi  salicylici r  ss. 

Sodii  bicarbonatis q.  s. 

Syi-.  zingiberis J  ij. 

Aqu* q.  s.  ad.  §  vi. 

M. — S.   z  ss.  =  gr.  XX. 

In  Case  III.,  that  of  the  boy,  3  ij.  of  the  mixture 
(=  gr.  X.  of  the  acid)  yrere  given  every  three  hours. 

The  delirium  in  all  of  these  cases  resembled  very 
closely  that  of  acute  alcoholismus.  This  resem- 
blance is  particularly  well  illustrated  in  the  case  of 
the  boy  (III.),  whose  illusions  and  hallucinations 
were  strikingly  similar  to  those  of  delirium  tremens. 
In  every  case  the  delirium  subsided  quickly  when 
the  exciting  cause  was  removed — in  some  without 
further  medication,  in  others  under  the  use  of 
opiates  or  the  bromides.  Since  I  am  free  to  confess 
that  I  am  ignorant  as  to  the  manner  of  action  of 
salicylic  acid,  I  shall  not  attempt  to  speculate  or 
theorize  on  the  reason  why  it  produces  delirium, 
the  only  object  of  this  paper  being  to  bear  testi- 
mony to  the  fact  that  it  is  the  direct  cause  of  the 
delirium  which  at  times  accompanies  its  adm'nis- 
tration. 

Willet's  Poikt,  JT.  y.  B..  March  27.  1SS2. 


Resection  op  the  Stomach. — The  operation  for 
resection  of  the  stomach  is  one  at  once  so  bold  and 
raelical,  that  a  certain  fascination  attaches  to  it. 
Surgeons  seem  loath  to  give  it  up,  however  unfavor- 
able the  results  so  far  have  been.  In  Culm,  Dr. 
Rydygier,  on  November  21st,  operated  upon  a 
woman  who  was  suffering  from  cancerous  stiicture 
of  the  pylorus.  The  iiatient  has,  up  to  the  present 
time,  done  well.  This,  according  to  the  Allgemeive 
medicinischen  Central- Zeitinig,  makes  eight  cases  in 
all  of  this  operation.  Five  of  these  were  oijerations 
performed  by  Billroth.  Three  of  the  cases  died  al- 
most immediately ;  one  died  three  months  later, 
from  a  return  of  the  growth.  One  has  now  been 
living  for  three  months,  and  appears  to  be  in  good 
health.  Dr.Wiilfer's  patient  was  operated  on  in  April, 
1881,  and  at  last  accounts  was  doing  well.  In  July, 
1881,  Kitajewsky  operated  upon  a  woman  with  can- 
cerous stomach.  She  was  very  weak  at  the  time, 
and  died  six  hours  after  the  operation. 

The  operation  for  resection  was  first  proposed  snd 
described  by  Merrem  in  1810,  but  no  one  ventured 
to  adojjt  his  .suggestion.  .\s  the  result  of  experi- 
ments upon  lower  animals  by  Pean,  Rydygier,  and 
others,  Billroth  ventured  to  extirjjate  the  pylorus  in 
January,  1881. 


458 


THE  MEDICAL  RECORD. 


Hqjorts  0f  i^ospitals. 


aiANHATTAN   EYE    A^"D   EXR  HOSPIT.^. 

The  following  interesting  cases  were  seen  in  the  ser- 
vice of  Dr.  D.  B.  Bt.  John  Roosa,  one  of  the  visit- 
ing surgeons : 

SENILE  CATAJRACT — INFLAMMATORY  DEPOSIT  IN  THE 
PUPIL. — COKNEAIi  SECTION — AN.ESTHETICS — DATE  OP 
OPENING   THE   EYE. 

Miss  H ,   seventy-two   j-ears   of  age,  came  in 

with  ordinary  senile  cataract  in  both  eyes.  Eight 
weeks  ago  Dr.  lioosa  operated  upon  the  right  eye, 
performing  the  ordinary  cataract  operation  known 
as  Graefe's,  making  an  upward  section  of  the  cor- 
nea and  an  iridectomy.  When  the  eye  was  oj^ened 
late,  from  four  to  six  days  after  the  operation  being 
the  rule,  he  found  that  the  pupil  was  entirely  ob- 
scured, although  there  was  nothing  in  either  the 
operation  or  the  subsequent  history  of  the  case  to 
account  for  it.  There  had  been  no  jjain,  thei'e  was 
no  undue  tenderness,  and  yet  the  pupil  was  blocked 
up  with  inflammatory  material,  which  remained  so 
long  that  he  thought  it  better  to  operate  on  the 
other  eye  than  to  wait  until  the  eye  already  oper- 
ated upon  was  ready  for  needling.  The  left  eye  was 
accordingly  operated  ui)on,  and,  when  opened,  the 
history  of  the  right  eye  was  repeated,  as  this  j^upil 
also  was  blocked  up  with  inflammatory  deposit.  But 
in  a  few  days  the  right  eye, began  to  clear  up,  soon 
afterward  the  left,  and  she  had  finally  very  comfortable 
vision,  and  was  ready  to  be  discharged.  Before  the 
operation  she  was  myopic,  and  now  wears  glasses 
with  6a  inch  focal  distance,  which  give  her  vision  of 
-fi?ii  +.  She  had  sight  enough  to  read  coarse  type. 
No.  4  Jaeger.  There  was  nothing  special  concern- 
ing the  management  of  the  case,  except  that  Di-. 
Koosa  agreed  with  Dr.  Derby,  of  Boston,  and  did 
not  open  eyes  early  upon  which  cataract  opei-ation 
had  been  performed.  He  did  not  agree  with  Dr. 
Derby,  however,  concerning  the  non-use  of  anaes- 
thetics when  the  operation  was  performed.  He 
makes  no  incision  in  the  sclerotica.  He  thinks,  and 
has  always  thought,  that  a  wound  of  the  sclerotic  is 
much  more  serious  than  a  corneal  wound,  and  there- 
fore made  the  incision  in  the  cornea  entirely,  even 
when  the  Graefe  ojjeration  was  first  suggested. 

SENILE  CAT.AJiACT — ESCAPE  OF  THE  LENS  IN  ITS  CAPSULE 
— THE  FLANNEL  BANDAGE — LIGHT  IN  OPHTHALMIC 
DISEASE. 

iVIrs.  Q ,  sixty-five  years  of  age,  had  senile  cat- 
aract fully  developed  in  the  right  eye,  and  in  the 
left  eye  only  partially  developed,  looking,  under 
atropin,  like  a  wheel  with  a  good  hid)  and  short 
spokes.  Dr.  Roosa  ojierated  upon  the  right  eye  ten 
days  ago.  After  making  the  ordinary  section  he 
found  that  tlio  lens  was  ready  to  escajie  in  its  cap- 
sule, and  therefore  he  did  not  divide  the  cap.sule ; 
that  is,  the  entire  lens  came  without  opening  into 
the  capsule.  He  regarded  that  as  a  great  desider- 
atum, and  could  he  devise  a  method  which  was  not 
dangerous,  he  would  remove  every  lens  in  its  cap- 
sale. 

He  regarded  the  loss  of  vitreous  as  one  of  the  worst 
things  which  could  occur,  as  choroiditis  andhyalitis 
were  apt  to  follow  and  destroy  the  eye  mouths  after 
it  was  thought  that  a  cure  had  been  etTected.  In 
this  case  the  lens  came  out  without  the  escape  of 


vitreous.  Afterward  an  iridectomy  was  performed. 
The  jjatient  has  done  veiy  well.  She  had  not  had 
the  subjective  symptoms  of  iritis,  although  the  dis- 
ease was  present  as  indicated  by  the  watery  condi- 
tion of  the  eye  and  the  slight  tenderntbs  of  the 
globe.  Dr.  Koosa  still  clings  to  the  use  of  the  flan- 
nel bandage,  suggested  by  Graefe,  for  ten  to  four- 
teen days  after  the  operation,  and  then  he  applies  a 
shade,  and  glasses  if  the  condition  of  the  pa  e  admits. 

There  has  been  a  gi-eat  advance  made  in  ophthal- 
mology in  one  respect.  In  former  times  the  great- 
est pains  were  taken  nol  to  admit  a  ray  of  light  to 
the  patient's  room,  but  nowadays  the  surgeon  is 
contented  with  a  moderate  darkness  and  the  protec- 
tive bandage  is  considered  as  sufficient.  The  pop- 
ular opinion  is  exaggerated  concerning  the  neces- 
sity of  darkness  in  the  management  of  ophthalmic 
disease. 

On  examination  of  the  eye,  a  good  black  pupil 
was  found,  the  wound  had  healed  perfectly  and' 
smoothly,  and  the  eye  was  a  Little  watery  and  there 
was  slight  redness.  Her  vision  was  sufficient  to 
count  fingers,  and  she  saw  objects  well.  Vision  was 
tested  only  sufficient  to  determine  what  was  going 
on  inside  of  the  eye. 

SENILE  CATARACT — DELAYED  UNION  OF  THE  COKNEAIi 
FLAP — .SECONDARY  OPERATION — FAII.URE. 

Nancy    ,   seventy-five   years    of  age,  had  an 

operation  upon  her  right  eye  well  performed  by 
an  ophthalmic  surgeon,  but  unsuccessfully.  Dr. 
Roosa  operated  ujjon  the  left  eye  but  the  pa- 
tient had  not  recovered  any  great  amount  of 
vision.  The  ujjward  section  was  made,  the  flap 
was  small,  and,  the  first  time  the  eye  was  opened, 
it  was  found  that  it  had  not  united  and  there  was 
bulging  which  continued  for  some  time.  Union 
finally  occurred,  but  it  did  not  leave  the  pupil 
thoroughly  black.  She  had  blepharitis  of  the  most 
marked  kind  at  the  beginning  of  the  operation,  and 
that  had  been  one  of  the  factors  which  had  con- 
tributed to  lack  of  success  in  both  eyes.  Ten  days 
ago  he  performed  iridectomy  in  order  to  see  if  some  ■ 
sight  could  not  be  obtained  from  this,  and  he  finally 
succeeded  with  difficulty  in  removing  a  piece  of  the 
iris. 

The  blepharitis  was  nearly  cured,  and  there  was 
excellent  percei^tion  as  the  result.  Improvement 
probably  would  occur,  and  there  was  yet  a  chance 
that  the  jjatient  might  get  sight  sufficient  to  enable 
her  to  go  about  the  room  alone. 

IRIDECTOMY — SYMPATHETIC   INFLAMMATION. 

A  young  woman  who  had  lost  one  eye  by  supi)ura- 
tion  of  the  globe,  had  had  a  perforating  ulcer  of  the 
cornea  of  the  fellow,  with  a  scar  so  situated  as  to 
prevent  vision.  Dr.  Koosa  made  an  opening  in  the 
iris  below,  and  with  good  result.  But  she  was  having 
pain  in  the  atrophic  eye,  and  there  was  sensitiveness 
in  the  eye  operated  upon,  accompanied  by  lach- 
rymation.  Unless  improvement  began  very  soon, 
extirpation  of  the  atrophied  globe  would  be  per- 
formed. In  the  meantime  hot  water,  long  used  in 
ophthalmic  practice,  was  to  be  applied  every  hour, 
until  the  pain  and  sensitiveness  had  had  time  to  sub- 
side. 

OONaENITAL   CATARACT — GOOD   PERCEPTION  OP  LIGHT — 
NEEDLING — ABtLrTY  TO   RECOGNIZE   OBJECTS. 

Gilbert ,  eleven  years  of  age  ;  born  bUnd  ;  was 

brought  to  the  hospital  two  weeks  ago.    Both  lenses 
wei'e  opaque.    The  iris  in  each  eye  was  of  good  color. 


THE  MEDICAL  RECORD. 


459 


movable,  and  he  has  excellent  perception  of  light. 
Both  lenses  were  very  white,  but  the  left  whiter  than 
the  right.  While  it  was  thought  that  the  lenses  were 
still  undergoing  degeneration,  it  was  not  supj)osed 
that  they  were  mere  shells.  Ten  days  ago  the  right 
eye  was  operated  upon  by  needling,  the  proposition 
being  to  make  a  hole  in  the  lens,  break  it  up  some- 
what, and  leave  it  to  be  absorbed.  The  moment, 
however,  the  needle  was  introduced,  it  was  found 
that  it  entered  a  material  like  syllabub.  There  was 
not  much  reaction  after  the  operation,  such  as  may 
arise  (1)  from  iritis,  and  (2)  irritation  produced  liy 
swollen  lens-material,  the  latter  being  the  most  dan- 
gerous. 

On  examination,  it  was  seen  that  he  had  nystag- 
mus, which  came  from  never  having  had  any  good 
point  of  fixation  from  which  he  could  see  well.  A 
black  pupil  could  be  seen  in  the  right  eye,  with  some 
white  material  in  the  lower  part  of  it.  His  central 
development  was  of  the  average  character,  and  it  re- 
mained to  be  determined  whether  or  not  he  had  a 
sound  retina,  optic  nerve,  etc.  It  was  inferred  that 
they  were  in  good  condition,  because  the  boy's  per- 
ception of  light  was  so  good,  and  still  further,  that 
since  the  operation  he  could  recognize  objects. 

An  ophthalmoscopic  examination  would  he  made 
as  soon  as  the  condition  of  the  eye  would  admit. 
The  patient,  of  course,  was  like  an  infant,  did  not 
know  how  to  see,  and  it  was  with  great  difficulty 
that  it  could  be  positively  ascertained  that  he  did 
actually  see  objects.  To  teach  him  to  see  would  be 
a  work  of  patient  training  continued  for  montlis, 
perhaps  years.  He  should  have  been  operated  upon 
under  two  years  of  age,  from  then  to  six  months  old, 
being  the  time  usually  selected  as  that  which  gives 
the  most  favorable  fesults.  This  patient  is  learning 
colors.  He  now  recognizes  black,  white,  blue,  and 
red. 

TBAUMATIt:    CAT.4.RACT — CLOSED    PCPIIi — INFLAMJIATIOX 
OP    THE   VITREOUS — LORINg'S  METHOD   OF    IRIDOTOMY 
-RESTORATION  OF  VISION. 

This  young  woman,  twenty-two  years  of  age,  came 
to  the  hospital  three  years  ago.  When  admitted  she 
came  for  an  operation  for  closed  pupil,  the  result  of 
iritis  not  ti-eated  by  atropine,  as  was  found  out  by 
Dr.  John  H.  Hinton,  who  sent  the  patient  for  treat- 
ment. The  pupil  was  closed,  the  iris  was  glued  to 
the  capsule,  and  she  had  secondai-j'  cataract.  With 
great  difficulty  a  piece  of  the  iris  was  removed  by 
cutting  into  it  and  tearing  it  out,  and  that  operation 
was  repeated  seven  times.  At  first,  as  well  described 
by  Stellwag,  the  space  made  by  removing  the  por- 
tion of  iris  was  quickly  tilled  up  with  new  products, 
and  apparently  the  eyes  were  no  better  off  than  at 
the  beginning.  But  in  this  ease  they  were  improved, 
and  in  October,  1881,  Dr.  Eoosa  jierformed  the 
seventh  operation.  It  consisted  in  usingDr.  Loring's 
knife — having  gotten  rid  of  most  of  the  lens  by  the 
six  previous  operations  and  its  place  having  been 
taken  by  new  plastic  material — introducing  it  as  Dr. 
L.  had  recommended,  passing  it  through  the  an- 
terior chamber  as  for  Graefe's  operation,  and  then 
lifting  it  verv  high  so  that  it  stood  almost  vertical, 
and  cutting  through  the  entire  vitreous  humor  witli 
one  broad  sweep.  It  is  an  operation  applicable 
only  to  desperate  cases,  in  which  the  lens  has  given 
place  to  connective  tissue  and  the  vitreous  is  prob- 
ably inflamed,  and  there  remains  perception  of  light. 
The  object,  then,  is  to  get  through  this  connective 
tissue,  .and  if  the  vitreous  cells  are  not  opaque 
all  the  way  down  a  result  may  be  obtained,  because 


the  vitreous  will  ooze  between  the  edges  of  the 
opening.  Keep  them  separate,  and  after  the  first 
inflammatory  reaction  has  passed  away,  there  will 
remain  a  clear  layer  of  material  to  the  rods  and  cone, 
which,  in  this  case,  were  sound.  From  the  beginning, 
the  prognosis  was  bad  in  the  case  before  us,  but  the 
patient  urged  operation  after  operation,  and  the 
final  result  was  a  vision  of  t.^ j;  for  distance,  ability  to 
read  Jaeger's  number  14,  to  go  about  alone,  to  dis- 
tinguish men  from  women  ;  in  short,  had  been  res- 
cued from  blindness.  The  ease  was  interesting  and 
remarkable  on  account  of  the  yeai-s  during  which 
seven  operations  were  performed,  and  instructive  as 
showing  the  advantage  of  Dr.  Loring's  method  of 
iridotomy,  which,  though  bold,  was  regarded  as  the 
only  one  that  would  do  any  good  in  advanced  cases. 
The  after-treatment  was  simply  the  apjilication  of 
cold,  sometimes  the  bandage,  sometimes  not,  and 
moderate  exclusion  of  light.  After  several  of  the 
operations  the  reaction  was  very  severe.  More  than 
all,  the  case  was  interesting  as  showing  a  good  result 
obtained  under  the  most  unfavorable  conditions,  so 
far  as  the  eye  was  concerned,  the  surgeon  being 
aided  by  the  great  faith  and  persistent  fortitude  of 
the  patient. 


|)ro0W02i  of  iHctiical  Science. 


OsLER  ON  THE  Brains  OF  Cbiminaxs. — ProfessoT 
William  Osier,  of  Montreal,  has  been  examining  a 
number  of  bi-ains  with  the  view  of  seeing  whether 
or  not  he  could  confirm  the  statements  of  Benedikt 
that  in  criminals  the  brain  is  atypical  and  to  be  re- 
garded as  different  from  the  average  human  species 
in  the  cultured  races,  the  special  points  of  variation 
being  in  the  conformation  of  certain  gyri  and  fis- 
sures. Thus,  he  claims  for  the  criminal  brain  a  con- 
fluence of  many  primary  fissures,  and  also  the  exist- 
ence of  foTir  horizontal  convolutions.  He  bases  his 
studies  upon  thirty-eight  hemispheres  taken  from 
twenty-two  criminals.  Dr.  Osier  has  carefully  ex- 
amined .sixty-three  hemispheres  from  thirty-four  in- 
dividuals, all  of  whom  were  patients  in  the  Mon- 
treal General  Hospital,  and  probably  good  examples 
of  the  class  from  which  the  hospital  wards  are 
regularly  recruited.  In  addition,  he  obtained  the 
brains  of  two  murderers  and  studied  them  with 
reference  to  the  same  points.  Giacomini's  method 
of  preservation  was  employed. 

His  conclusions  are  interesting  as  bearing  on  the 
question  in  both  respects.  Thus  while  in  one  of 
the  criminals,  and  in  nine  of  the  hospital  cases, 
he  found  four  frontal  gyri  as  saibdivisions  of  the 
fir.st  frontal  convolutions,  in  the  hospital  cases  an 
eqiial  proi^ortion  exhibited  the  confluent  fissure 
type,  though  there  was  a  less  number  of  unions  be- 
tween typical  fissures  than  in  Benedikt's  cases.  He 
accordinglv  thinks  it  more  reasonable  not  to  as.sign 
any  special  significance  to  these  conditions  until  the 
arrangement  of  the  convolutions  in  the  various  races 
has  been  more  thoroughly  studied,  since  it  may 
prove  that  the  race  rather  than  the  cerebral  organi- 
zation goveras  the  jieculiar  conformation.  —  Can. 
Med.  and  Surt/.  Jour.,  February,  1882. 

Hart  on  the  Peopagation  op  TTPHoro,  Scarla- 
tina, AND  DrPHTHEBiA  BY  MiLK. — Mr.  EiTiest  Hart, 
of  London,  has  recently  given  a  tabular  review  of 
seventy-one  epidemics  that  have  been  attributed  to 


460 


THE  MEDICAL  RECORD. 


infected  milk.  Three  diseases  he  recognizes  as 
capable  of  being  so  propagated,  and  they  are  typhoid 
fever,  scarlatina,  and  diphtheria.  At  the  same  time 
that  he  limits  the  agency  of  milk  to  this  small  num- 
ber of  diseases,  the  probability  of  others,  that  are 
cognate,  being  conveyed  by  the  same  medium  is 
thought  to  be  strongly  indicated.  The  total  num- 
ber of  cases  in  the  epidemics  is  stated  to  have  been 
in  round  numbers :  for  typhoid,  35,000 ;  for  scarlet 
fever,  800 ;  and  for  diphtheria,  500.  Though  at 
first  mueh  scepticism  prevailed  about  this  peculiar 
method  of  disseminating  infection,  Mr.  Hart  thinks 
that  now  its  acceptance  as  a  fact  is  practically  de- 
monsti-ated.  He  freely  admits  that  the  proof  of  the 
contamination  could  not  be  shown  in  every  epi- 
demic, but  this  is  iield  to  be  iramatei'al,  the  records 
showing  unmistakably  that  there  was  an  incidence 
of  disease  upon  the  customers  of  a  particular  dairy, 
where  their  neighbors  in  the  vicinity,  living  under 
otherwise  similar  conditions,  escaped  wholly  or  in 
great  part. 

As  regards  typhoid  fever,  the  milk  was  more  com- 
monly poisoned  by  the  soakage  of  the  specific  matter 
of  typhoid  excrement  into  the  well-water  used  for 
washing  the  milk  cans,  perhaps  by  the  actual  dilu- 
tion of  the  milk  with  the  tainted  water.  Other  ways 
in  which  the  careless  or  filthy  habits  of  the  milkers, 
who  at  the  same  time  were  attendants  at  the  sick-bed 
of  typhoid  patients,  could  accidentally  soil  the  cans, 
the  milk,  or  the  water,  naturally  suggest  themselves. 
In  the  matter  of  scarlatina,  it  was  found  that  in  the 
majority  of  instances  persons  employed  about  the 
dairy  were  at  the  same  time  caring  for  per.sons  ill 
of  scarlatina,  and  the  ease  with  which  the  branny 
dust  of  the  disease  could  find  access  to  the  milk  is 
readily  recognized.  In  diphtheria  the  matter  was 
wrapped  in  some  obscurity.  Prior  to  1878,  it  had 
not  been  suspected  that  the  infection  could  be 
communicated  by  milk,  but  since  that  time  Mr. 
Power  had  traced  sis  epidemics  to  this  source,  and 
yet  in  each  instance  the  exciting  cause  was  never 
made  clear.  As  a  deduction  from  this  very  impor- 
tant jvs«/«',  the  regulation  and  inspection  of  milk 
farms  and  depots  are  strongly  urged  upon  the  notice 
of  legislative  bodies. — Trims,  of  Inlernat.  Med.  Con- 
gress, vol.  iv„  1881. 

.\cDrK  Traumatic  Tetanus  Successfully  Treat- 
ed  HY    ClILORAIi   AND   loDIDE    OP   PoTASSIUM. — Mr.   J. 

H.  Salter  contributes  another  case  to  the  increasing 
list  of  successes  by  the  combined  use  of  the  bromide 
and  chloral.  A  laborer,  aged  fifty-one,  smashed  the 
little  finger  of  his  right  hand,  and  subsequently 
treated  it  first  by  poultices,  and  later  by  water 
dressings.  After  a  period  of  some  seven  weeks  gen- 
eral spasms  began  to  manifest  themselves  at  short 
intervals,  the  flexors  of  his  trunk  and  extremities 
being  involved,  while  the  jaw  became  fixed.  Tem- 
perature normal.  Chloral  and  bromide  of  potassium 
were  then  given  him  every  two  hours,  the  former  in 
ten-grain,  the  latter  in  fifteen-grain  doses,  with,  in 
addition,  from  fifteen  to  thirty  grains  of  diloral  hy- 
padermically,  this  latter  procedure  having  a  very 
marked  effuct.  Decided  improvement  was  not  noted 
for  twenty  days,  but  from  that  period  on  was  .satis- 
factory. The  man  is  now  entirely  well  and  working 
daily.  During  the  period  of  twenty  days  he  took 
two  hundred  and  forty  grains  of  the  bromide  and 
one  hundred  and  eighty  of  chloral  per  day,  the  total 
amount  given  during  the  time  being  of  chloral  sixty 
drachms,  and  of  the  bromide  eiglity  drachms  or 
thereabouts. — The  PracUlioner,  Februai-y,  1882. 


Papillaby  Growths  in  the  Bladder  Scraped 
Off  by  the  Finger. — Dr.  W.  F.  Atlee,  of  Phila- 
delphia, has  reported  a  rare  case  of  excrescences  in 
the  female  bladder  which  he  has  successfully  re- 
moved in  a  very  simple  way.  An  unmarried  lady, 
nineteen  years  of  age,  consulted  him  in  the  summer 
of  1880,  describing  symptoms  of  pain  in  passing 
water,  which,  originating  in  early  life,  had  increased 
with  her  yeai's,  until  at  seventeen  she  suffered  se- 
verely during  each  act  of  micturition.  At  eighteen 
she  had  pus  in  the  urine,  and  sometimes  blood,  and 
often  was  confined  to  her  bed  for  some  months.  Dr. 
A.,  having  anicsthetized  his  patient,  dilated  the 
urethra  with  dressing  forceps  and  then  passed  his 
fingers  into  the  bladder.  He  found  no  foreign 
bodies,  but  at  the  fundus  a  collection  of  papillary 
growths,  some  more  than  half  an  inch  in  length  and 
about  a  line  in  thickness.  Finding  them  soft  and 
yielding,  he  used  his  finger  and  finger  nail,  and  re- 
moved them  all  thoroughly-  Since  that  time  the 
patient  has  had  no  untoward  symptoms,  and  the 
case  is  reported  as  one  of  radical  cure.  Attention  is 
called  to  the  fact  that  in  the  systematic  text- books 
the  treatment  recommended  is  usually  palliative, 
whereas  a  permanent  cure  can  be  easily  accom- 
plished with  comparativelv  little  risk  to  the  patient. 
—Bost.  Med.  and  Surff.  Journal,  March  30,  1882. 

NiTRO- Glycerine  in  the  Treatment  of  Heart 
Disease. — Mr.  W.  E.  Green,  of  the  Isle  of  Wight, 
finds  that  this  comparatively  new  remedy  has  a  field 
of  usefulness  that  is  hardly  less  extensive  than  digi- 
talis. He  uses  it  in  the  form  of  a  one  per  cent,  so- 
lution in  alcohol,  one  minim  being  the  initial  dose, 
though  occasionally  a  less  quantity  may  be  sufficient 
to  produce  the  physiological  eSect.  This  consists  in 
a  paralysis  of  the  vaso-motor  nerves.  In  consequence 
the  face  flushes,  the  temples  throb,  and  the  pulse 
becomes  dicrotic  and  much  quickened.  In  some 
cases  the  head  aches  violently,  but  in  others  there 
is  merely  a  sense  of  fulness  and  pain  across  the  fore- 
head, which  lessens  with  each  subsequent  dose  until 
ultimately  there  is  no  unpleasant  effect,  but  rather 
a  sensation  of  warmth  all  over  the  body.  At  first 
there  may  be  even  a  little  nausea.  Rarely  the  quan- 
tity may  be  increased,  so  that  fifteen  or  twenty 
minims  will  be  administered  every  four  hours.  This 
peculiar  efl"ect  is  not  so  rapid  in  its  development  as 
in  the  case  of  amyl  nitrite,  but  it  continues  fi'om  four 
to  six  hours.  Mr.  Green  finds  it  specially  indicated 
in  angina  pectoris  and  in  weak,  fatty,  and  dilated 
hearts,  and  cites  a  number  of  illustrative  instances 
from  his  individual  experience. —  T7ie  PradiUoner, 
Februai7,  1882. 

Diphtheria  in  Calves  Communicated  to  Pigs. — 
Mr.  Cole,  a  veterinary  surgeon,  of  Hinckley,  in  Aus- 
tralia, has  published  the  following  illustration  of 
the  way  in  which  diphtheria  may  be  communicated 
from  one  of  the  domestic  animals  to  another  of  a 
different  species,  thus  indicating  special  sources 
from  which  the  human  disease  may  at  times  be  con- 
tracted. 

A  calf,  about  five  months  old,  was  found  to  be 
dying  with  some  symptoms  of  a  throat  disorder,  and 
instructions  were  given  to  have  the  body  buried, 
which  through  some  neglect  was  not  done  immedi- 
ately, so  that  a  sow  which  managed  to  get  access  to 
the  enclosure,  attacked  the  diseased  meat  and  ate 
some  of  it.  This  circumstance  came  to  be  kno\»Ti 
when,  a  few  days  later,  some  of  the  pigs  were  taken 
down  with  throat  disease.  Eventually  the  sow  and 
her  young  pigs  were  also  victims.    These  latter  died 


THE  MEDICAL  RECORD. 


461 


within  twenty-four  hours,  while  the  others,  includ- 
ing a  boar,  recovered  entirely.  Apropos  of  this  out- 
break among  domestic  animals  an  account  is  given 
of  an  epidemic  that  occurred  in  the  Oakleigh  police 
station,  the  disease  being,  on  this  occasion,  traced 
to  a  diseased  cow,  whose  milk  had  been  used  by  the 
inmates  of  tlie  station. — Australian  Veterinari/  Join-- 
nal,  Febi-uary,  1882. 

Statistics  as  to  Penetrating  Wounds  op  the 
Chest. — Dr.  de  Santi,  in  studying  the  medical  rec- 
ords of  great  campaigns,  particularly  during  this 
century,  and  utilizing  the  figures  of  Guthrie,  Men- 
iere, Chenu,  Laeffler,  Stromeyer,  Otis  and  Beck 
more  especially,  has  found  that  the  numerical  rela- 
tions between  wounds  of  the  chest  and  other  parts 
of  the  body  has  not  altered  since  1814,  but  that 
the  ratio  between  penetrating  and  non-penetrating 
wounds  of  the  chest  has  constantly  increased.  Still 
at  the  same  time  there  has  been  a  notable  diminu- 
tion in  the  gravity  of  chest  wounds,  which  latter 
circumstance  he  would  ascribe  to  the  alterations 
which  tire-arms  have  latterlv  undergone. — Archives 
Gen.  de  Med.,  March,  1882. 

The  Phtsiological  Action  of  the  Rattlesnake- 
Vntrs  AND  ITS  Antagonists. — Dr.  Isaac  Ott,  follow- 
ing out  a  line  of  investigation  instituted  by  Drs. 
8.  Weir  Mitchell,  of  this  country,  and  Sir  Joseph 
Fahrer,  of  England,  has  studied  the  circulatory  phe- 
nomena to  be  observed  after  an  animal  has  been  the 
victim  of  snake-bite.  He  emjiloyed  four  rabbits  for 
his  tirst  series  of  experiments,  and  having  applied 
Ludwig's  kymographion  as  soon  as  possible  after 
the  virus  had  been  instilled,  made  notes  of  the  ar- 
terial pressure  and  pulse-rate.  He  concluded  from 
these  observations  that  the  rattlesnake-poison  kills 
by  producing  a  failure  of  the  heart,  and  by  diminish- 
ing arterial  tension.  Subsequently,  in  a  second 
series  of  seven  cases,  ammonia,  alcohol,  and  digitalis 
were  given  to  counteract  the  poison,  and  they  were 
found  to  exalt  arterial  tension.  Ammonia  and  alco- 
hol also  increased  the  pulse-rate,  while  on  the  other 
hand  digitalis  slowed  it.  Toward  the  close  of  life 
excessive  stimulation  by  these  same  reagents  rapidly 
exhausted  the  cardiac  irritabilitv. — Ai-chives  of  Medi- 
cine, April,  1882. 

Simultaneous  OccrTSKENCE  or  Measles  and  Scar- 
latina in  the  Same  Indfvidual. — During  the  last 
ten  years  a  number  of  instances  have  been  rei^orted 
in  which  two  or  more  infective  diseases  have  ap- 
peared in  conjunction,  Barthiez  Eilliet  being  cred- 
ited with  first  recording  the  combination  of  measles 
and  scarlatina,  while  Klein,  in  1877,  reported  a  case 
of  the  triple  combination,  scarlatina,  measles,  and 
varicella.     Of  the  first  category  an  instance  is  now 

furnished   by  Herzog,   of  Gratz.     H.  K ,   a   lad 

eight  years  of  age,  experienced  the  usual  prodromal 
malaise  of  the  exanthematic  fevers  and  then  com- 
plained of  sore  throat,  nausea,  and  had  some  fever. 
Within  twenty-four  hours  an  eruption  appeared  upon 
the  head  and  neck,  and  the  temperature  rose  to  102' 
F.  ;  pulse,  120.  Slight  bronchitis  and  conjunctivi- 
tis. On  the  second  day  this  eniption  began  to  fade, 
but  on  the  following  a  new  scarlatinal  efflorescence 
was  manifested  on  the  body.  The  spleen  was  now 
somewhat  enlarged  and  the  sore  throat  became 
worse,  while  the  bronchitis  diminished.  The  throat 
difficulty  increased  to  such  a  degi'ee  that  there  was 
great  difficulty  in  swallowing.  There  was  also  severe 
thii-st.  Temperature,  104°  ;  pulse,  130.  The  eruj> 
tion  continue  1  to  spread  over  the  lower  extremities. 


while  the  measly  eruption  above  was  scaling.  On 
the  next  day  the  scarlatinal  efflorescence  becan  to 
fade.  The  treatment  was  chiefly  by  quinine,  and 
convalescence  occurred  withoiit  anv  seiious  draw- 
back.—iJer/.  Klin.  Woch.,  1,  1882. 

Two  Cases  of  Poisoning  by  Boeacic  Acid.. — 
Boracic  acid  solutions  are  now  used  so  often,  that 
the  following  cases,  reported  by  Dr.  Molodenkofl' 
( Vratsch,  No.  3),  are  of  especial  interest,  in  so  far  as 
they  demonstrate  a  possible  danger  that  is  not 
generally  known.  In  the  first,  a  chest  had  been 
taliped  for  pleuritic  exudation  and  the  cavity  iiri- 
gated  for  nearly  an  hour  with  a  five  jier  cent,  solu- 
tion of  boracic  acid,  until  the  returning  fluid  became 
perfectly  clear ;  it  was  then  discontinued,  but  a 
little  of  the  solution  was  intentionally  left  within  the 
body.  Shortly  after  this,  the  patient  began  to  sufl'er 
from  nausea,  which  developed  toward  night  into 
severe  vomiting.  On  the  following  day  the  pulse 
became  very  rapid,  easily  compressible,  vomiting 
continued,  and  the  patient  had  hiccough.  During 
the  night  the  patient's  face  was  sufl'used  by  an  ery- 
thematous rash,  which  extended  on  the  next  day 
all  over  the  trunk.  The  vomiting  and  hiccough  con- 
tinued and  the  pulse  was  hardly  perce]>tib]e  ;  prostra- 
tion became  extreme,  though  the  mind  remained 
clear.  On  the  following  day  (the  fourth)  the  rash 
extended  to  the  extremities  and  the  vomiting  con- 
tinued. There  was  hardly  any  pulse,  though  the 
respirations  were  normal.  Obscured  vision  was  an- 
other symptom.  Toward  evening  he  became  coma- 
tose and  died.  In  the  second  case  the  poisoning 
became  ai^parent  after  the  washing  out  of  a  cold 
abscess,  and,  as  in  the  iirevious  case,  some  of 
the  solution  was  left  in  the  cavity.  The  symptoms 
were  essentially  the  same,  viz.,  nausea,  vomiting, 
hiccough,  cardiac  paresis,  and  prostration.  There 
was  also  some  rise  of  temperature,  but  the  erythe- 
matous rash  affected  the  eyelids  only.  The  patient 
died  in  collajise  on  the  third  day.  An  autopsy  re- 
vealed nothing  of  .special  interest,  except  small  ex- 
travasations in  the  pericardium  and  on  the  surface 
of  the  left  ventricle  and  auricle.  Stimulants  were 
freely  used,  but  without  any  benefit.  As  a  natural 
inference  from  the  history  of  these  cases,  solutions 
of  the  acid  used  for  irrigation  should  not  be  left  in 
the  cavities  of  the  body,  as  toxic  symptoms  are  said 
to  have  never  manifested  themselves  except  under 
these  circumstances. 

The  Use  or  Continued  Tepid  Baths  in  Ttphoid 
Fevee. — Dr.  Afanassiefl",  following  the  example  of 
Riess,  has  adopted  this  mode  of  .treatment  in  seven 
cases  of  fvphoid  fever,  of  which  two  were  quite  se- 
vere. Each  jjatient  received  two  baths  daily  of  three 
hours'  duration,  the  temperature  of  the  water  vary- 
ing from  88"  F.  to  06^  F.  Their  action  on  the  course 
of  the  disease  was  thought  to  be  beneficial.  Kone 
of  the  patients  developed  the  typhoid  state,  but 
their  minds  remained  clear.  There  was  either  no 
headache  or  it  was  very  slight,  and  the  patients  slept 
well,  and  their  appetites  were  retained  during  the 
entire  sickness.  Pain  in  the  iliac  fossa  and  tympan- 
ites were  present,  but  they  did  not  call  for  any  ac- 
tive interference.  The  fever  in  most  cases  was  ma- 
terially influenced  by  these  baths,  the  temperature 
falling  from  3'  to  6'  F.  The  effects  were  more 
marked  toward  the  close  of  the  disease,  and  in  the 
evening  more  than  in  the  morning.  The  pulse  in- 
variably grew  stronger  and  fuller,  its  frequency  di- 
minishine  by  twenty  to  thirty  beats  per  minute. — 
Vratsch,  No.  61. 


462 


THE  MEDICAL  RECORD. 


The  Medical  Record: 

%  lUwIxlg  JJournal  of  fllcbicinc  anb  Smgerg 


'JEORGE  F.  SHRADY,  A.M.,  M.D„  Editor. 


PUBLISHED   BY 
Win.  \rOOD  &  CO.,  no.  27  Creat  Jones  St.,  N.  If, 


New  York,  April  29,  1882. 

THE   TREATMENT    OF    TYPHOID    FEVER 
IN  THE  PAST  FOUR  YEARS. 

A  BEViETv  of  the  literature  covering  the  subject  of 
typhoid  fever  since  1878  is  communicated  to 
Schmidt's  Jahrhncher  bj'  Dr.  Arthur  Geissler.  It  is 
interesting  to  note  that  a  very  large  proportion  of 
this  literature  is  devoted  to  the  subject  of  etiology 
and  prophylaxis.  Too  much,  indeed,  is  said  to  per- 
mit of  any  adequate  criticism  of  it  here.  The  sub- 
ject of  therapeutics  of  the  disease  occupies  a  much 
less  space.  Indeed,  considering  the  extensive  preva- 
lence of  the  disease  and  the  mortality  therefrom 
(four  per  100,000  inhabitants  in  German  cities),  the 
question  as  to  how  it  is  best  to  be  dealt  with  by  the 
physician  has  received  surprisingly  little  attention. 

In  the  articles  that  have  been  contributed  we  find 
that  the  measures  recommended  may  be  classed 
under  three  heads — the  antipyretic  treatment,  the 
antiseptic  treatment,  and  miscellaneous  methods. 
The  antipyretic  treatment  still  excites  the  most  dis- 
cussion. In  Germany  it  means  the  use  of  baths,  of 
quinine,  and  of  salicylic  acid.  In  this  country  other 
means  of  cooling  the  body  than  baths  are  often 
resorted  to,  the  Inost  frequent  being  •  probably 
sponge-bathing.  It  is  noticeable  that  there  is  very 
little  literature  regarding  the  efficacy  of  baths,  and 
Geissler  states  that  in  German  hospitals  the  mor- 
tality from  typhoid  fever  has  considerably  increased 
since  eight  years  ago.  In  1877  it  was  12.8  joer  cent, 
among  10,901  cases ;  in  1878  it  was  13.5  per  cent, 
among  12,100.  In  the  years  1879-81  the  figures  are 
still  more  iinfavorable.  In  D^-esden,  between  the 
years  1850  and  1870,  before  the  antipyretic  treat- 
ment was  introduced,  the  mortality  was  12. G  per 
cent,  among  3,387. 

Those  authors  who  have  written  recently  upon 
this  subject  continue  for  the  most  i)art  still  to 
recommend  it,  but  not  with  the  exaggerated  praise 
heard  eight  yeare  ago.     A.  Vogel  had  a  mortality  of 


one  in  seventy  cases  treated  with  baths ;  Morf 
speaks  guardedly  regarding  their  employment; 
Henoch  and  Asby  all  caution  against  frequent  cold 
baths  fDr  children ;  Keulich  is  enthusiastic  over 
wet-packs  combined  with  systematic  high  feeding; 
Steffin  was  only  moderately  successful  with  wet- 
packs  ;  Zenotti  advocates  Ziemssen's  treatment  with 
calomel,  baths,  and  quinine. 

One  finds  little  said  about  the  antipyretic  value  of 
quinine.  There  has  been  a  tendency  to  substitute 
salicylic  acid  for  it,  but  the  results  obtained  seem 
discouraging.  Of  five  authors  who  report  their  ex- 
perience only  one  advocates  its  use.  The  drug  in 
large  doses  reduces  temjierature,  but  its  action  is 
temporary,  and  it  is  likely  to  weaken  the  heart  and 
disturb  digestion.  Hallopeau  and  a  few  others 
think  that  by  alternating  salicylic  acid  with  quinine 
better  results  are  obtained. 

A  survey  of  the  recent  literature  collected  Ijy 
Geissler  ujjon  the  antipyretic  treatment  of  typhoid 
fever  leads  to  the  impression  that  the  roseate  views 
once  entertained  for  it  are  not  being  justified.  Cer- 
tainly no  American  statistics  have  been  collected 
which  show  positively  that  the  treatment  by  baths 
or  by  large  doses  of  quinine  has  any  real  influence 
upon  the  mortality  in  American  typhoid.  The 
measure  seems  to  Ije  helpful  in  some  cases.  Tliat 
is  all  that  can  be  said. 

We  referred  some  time  ago  to  the  antiseptic  treat- 
ment of  typhoid  fever  advocated  by  Roth.  Dr.  B. 
Bell  claims  good  results  from  a  similar  method,  in 
which  he  uses  eucalyptus.  But  the  antiseptic  treat- 
ment, as  a  special  remedial  method,  has  as  yet  no 
solid  basis. 

The  "water-diet"  treatment,  strenuously  advo- 
cated by  Dr.  Luton,  of  Rheims,  has  a  curious 
interest  only.  He  gives  his  patients  only  cold 
water,  bait  this  in  lai-ge  quantity,  for  the  first  four  or 
eight  days.  In  this  way  he  "washes  out"  all  the 
disease-germs  from  the  bowels  and  the  blood. 
Whether  he  cures  his  patients  may  be  considered 
doubtful. 

The  medical  profession  cannot  be  said  to  have 
yet  formulated  a  treatment  for  enteric  fever  which 
receives  any  unanimous  adoption.  This  is  not  to 
our  credit,  for  it  is  very  largely  due  to  the  fact  that 
we  do  not  work  as  a  body,  and  our  individual 
experiences  are  not  therefore  utilized. 


THE   MURDER   OF   JENNIE   OBAJIER. 

The  trial  for  the  supposed  murder  of  Jennie  Cramer 
was  begun  last  week.  The  case  jjromises  to  be 
of  some  medico  legal  interest.  The  unfortunate 
girl,  it  will  be  remembered,  was  found  lying  dead 
near  the  water  last  summer.  It  was  thought  at 
first  that  she  was  drowned,  but  this  was  disproved. 
It  is  now  claimed  by  the  prosecution  that  she  was 
killed  bj"  ilio  administration  of  arsenic.  This  view 
when  first  advanced  seemed  to  be  entirely  conti-a- 


THE   MEDICAL  RECORD. 


463 


dieted  by  the  fact  that  there  was  no  evidence  of 
corrosion  or  irritation  of  the  stomach,  and  by  the 
fact  that  only  a  very  small  amount  of  arsenic  was 
found  in  the  body.  Recently  the  tissues  have  been 
re-examined,  and  a  larger  amount  of  arsenic  is  said 
to  have  been  found.  We  are  told,  also,  that  the 
prosecution  has  engaged  an  expert  who  will  testify 
that  a  fatal  dose  of  arsenic  can  be  taken  without  its 
seriously  affecting  the  stomach  mucous  membrane. 
We  cannot  say  that  such  a  thing  is  impossible. 
But  it  would  be  outrageous  to  hang  a  man  upon  any- 
thing so  improbable.  The  prosecution  may,  how- 
ever, be  able  to  produce  other  corroborative  evidence. 


THE     COMMUNICATION     OP     CONT.<.GIOUS    DISEASES   BT 
BOVINE   VIRUS. 

The  widesj^read  use  of  bovine  virus  in  this  and 
other  countries  makes  the  question  of  its  safety  and 
efSeiency  a  most  important  one.  The  National 
Board  of  Health  has  had  a  number  of  the  large  vac- 
cine farms  examined  and  reported  upon  by  in- 
spectors. As  a  rule,  the  vaccinations  seem  to  be 
done  with  care  upon  healthy  cattle,  and  in  clean 
stables.     But  this  is  not  uniformly  the  case. 

It  is  noticeable,  furthermore,  that  if  the  vac- 
cinated surface  of  the  calf  gets  dirty,  inflammation 
is  liable  to  set  in.  A  clean  skin  seems  to  be  neces- 
sary for  a  typically  good  course  of  the  disease 
in  the  cow  as  well  as  in  man.  To  secure  this,  a 
piece  of  canvas,  to  protect  the  vaccinated  surface, 
is  used  at  some  establishments. 

A  point  of  no  little  importance,  dwelt  upon  by 
Dr.  James  Law,  is  whether  the  vaccine  lymph  should 
be  gathered  on  the  seventh  or  eighth  day.  At  Dr. 
Grifiith's  establishment,  in  Brooklyn,  the  lymph  is 
taken  on  the  seventh  day,  altliough  it  is  believed  that 
more  could  be  obtained  on  the  eighth.  But  in  mi- 
croscopic examinations  of  the  lymph  it  is  claimed 
that  up  to  the  end  of  the  former  period  the  fluid  con- 
tains merely  the  minute  granules  or  micrococci 
supposed  to  characterize  vaccine  virus.  On  the 
other  hand,  from  the  eighth  day  onward  there  are 
superadded  granule  corpuscles,  granules,  pus-cells 
and,  in  cases  where  the  vesicle  has  burst,  aerial 
bacteria,  etc.  The  early  lymph  is,  therefore,  be- 
lieved to  be  purest,  although  there  is  a  temptation 
to  wait  a  day  longer. 

In  most  of  the  establishments  quills  are  used.  It 
is  claimed  that  these  absorb  less  lymph,  dry  better, 
and  keep  longer  than  bone  or  ivory  jjoints,  which 
.  are  too  porous. 

Attention  is  called  by  Dr.  Law  to  the  possibility 
of  conveying  any  other  disease  than  vaccinia  from 
the  cow  to  man.  It  has  generally  been  considered  im- 
possible with  any  ordinary  precautions.  The  subject 
has  not  been  carefully  studied,  however.  Foot- 
and-montli  disease  (an  epizootic  eczema),  anthrax  in 
its  various  forms,  and  tuberculosis  are  the  three  dis- 
eases from  which  infection  is  possible.      The  ejii- 


zootic  eczema  is  very  contagious  indeed,  but  is  not 
dangerous,  and,  fortunately,  does  not  now  exist  in 
this  country,  though  liable  to  be  imported  at  any 
time.  Malignant  anthrax  in  cattle  can  easily  infect 
man,  though  it  has  never  been  known  to  do  so  by 
vaccination.  It  is  not  of  frequent  occurrence,  and 
its  presence  so  markedly  affects  the  animal  that 
no  one  could  fail  to  observe  the  disease.  The  pos- 
sibility that  a  calf  with  malignant  anthrax  could  be 
used  for  vaccine  purjjoses  implies  more  than  igno- 
rance on  the  part  of  the  vaccinator.  He  would 
have  to  be  a  deliberate  criminal.  There  is  no  fear 
from  this  disease. 

The  danger  from  tuberculosis  is  also  remote 
enough  ;  but  in  these  days  of  polemical  pathology 
there  is  room  for  alignments  on  each  side.  Dr.  Law 
thinks  that  vaccinia  may  bring  out  a  latent  tuber- 
cular tendency  in  a  cow,  just  as,  in  his  opinion, 
small-pox  does  in  human  beings.  He  also  thinks 
that  Jersey  cows,  which  are  preferred  by  vaccin- 
ators on  account  of  their  soft  skins,  are  much  more 
consumptive  than  other  breeds.  *In  these  two 
points  others  have  had  a  different  experience.  It 
has  never  been  shown  that  tuberculosis  could  be 
conveyed  by  vaccination.  It  is  highly  improbable 
that,  even  if  a  diseased  calf  were  used,  such  a  thing 
would  occur. 

On  the  whole,  therefore,  we  may  consider  the 
dangers  from  disease  in  lower  animal^  as  practi- 
cally non-existent,  provided  any  reasonable  care  be 
used  in  selecting  the  calves  for  vaccination. 


OFFICE   SWTNDLEBS. 

The  city  physician  is  reminded  several  times  a  year 
that  eternal  vigilance  is  the  price  of  his  personal 
property.  The  office  swindler  has  become  almost  an 
establi.shed  institution  among  us.  He  has  to  be 
provided  against  by  the  careful  physician  just  as  the 
truly  ethical  guard  against  the  debauched  followers  of 
Hahnemann.  His  methods  gi'ow  more  ingenious  or 
audacious  every  year.  We  recently  received  a  letter 
from  a  distinguished  gynecologist  of  this  city  recit- 
ing his  exjierience.  A  gentlemanly  individual  called 
upon  our  correspondent  and  announced  himself  as 
the  brother  of  Dr.  Eobert  Battey,  of  Georgia.  After 
some  conversation,  in  which  the  stranger  showed 
himself  to  be  an  intelligent  and  educated  man,  he 
requested  the  favor  of  a  blank  check,  tilled  it  out 
for  a  considerable  sum,  and  desired  the  doctor  to 
endorse  it.  This  being  refused,  he  ajiologized,  and 
said  he  would  return  in  a  short  time  with  evidences 
of  his  identity,  but   of  course   he   never  appeared 


This  was  one  of  the  bolder  operators.  The  petty 
swindlers  and  sneak-thieves  who  prey  on  the  doctor 
are  more  numerous.  The  estimable  but  invalid  phy- 
sician who  wants  just  money  enough  to  join  his  be- 
reaved family  in  Australia ;  the  deaf  and-dumb  man 
whose  uncle  was  a  physician  ;  the  man  just  out  of  the 


464 


THE   MEDICAL  RECORD. 


hospital  who  wants  a  night's  lodging;  the  itinerant 
case  of  extroverted  bladder,  or  other  anomalies,  and 
the  irrepressible  agent  of  incomparable  ledgers  and 
day-boolis ;  these  are  all,  more  or  less,  familiar  to 
the  city  physician.  Nor  is  our  country  brother  en- 
tirely neglected. 

The  practice  of  medicine  is  believed  to  make  us 
charitable  and  humane.  We  are  so  often  swindled 
in  our  bills  that  it  becomes  rather  a  matter  of 
course  to  have  some  advantage  taken  of  us.  We 
are  suspicious  enough,  but  are  disinclined  to  act 
promptly  on  our  suspicions.  The  doctor  is  rather 
easy  in  his  dealings  with  his  fellow-men,  though  he 
may  be  sharp  enough  when  it  comes  to  interjjreting 
symptoms.  That  is  why  the  peddler  of  an  unspeak- 
able mucilage  made  his  largest  sales  among  our 
most  distinguished  practitioners.  An  eminent  sur- 
geon, of  our  acquaintance,  looks  sadly  into  bis  upper 
drawer  where  lie  twenty-four  cakes  of  an  inferior 
quality  of  putty,  which  he  bought,  thinking  he  was 
heljjing  the  poor  and  getting  something  witli  su- 
perior plastic  properties. 

Every  doctor  must  expect  to  lose  an  overcoat,  or 
a  few  books,  or  a  surgical  instrument.  The  suffer- 
ing patient  who  "  will  wait  until  he  gets  through 
dioiier"  is  liard  to  guard  against.  We  have  heard 
of  ii  patent  enfolding  chair  for  such  parties  which, 
being  sat  in,  at  once  puts  a  splint  about  the  limbs 
of  the  occftpant.  It  never  became  popular,  how- 
ever. The  doctor,  we  repeat,  must  expect  to  lose 
something,  and  it  is  well  enough  that  he  should. 
When  a  thief  runs  off  with  yonr  overcoat  and  a  set 
of  obstetrical  forceps,  the  world  seems  dark  for  a 
while.  But  later  there  comes  by  contrast  a  sense  of 
moral  elevation.  You  feel  as  though  you  could  see 
a  ITurald  reporter  or  endorse  a  mineral  water  with- 
out being  a  really  bad  man.  You  collect  bills  more 
rigidly  for  the  next  few  weeks,  and  find  some  sweet- 
ness in  the  uses  of  adversity. 

As  a  preventive  to  office  swindlers,  therefore, 
we  recommend  all  due  precautions,  but  no  extraor- 
dinary and  burdensome  vigilance.  We  have  always 
been  pleased  with  the  simple  practice  of  instructing 
the  servant  to  give  the  waiting  but  suspicions  pa- 
tient a  copy  of  the  "  American  Code  of  Medical 
Ethics,"  and  to  watch  till  he  reads  it.  In  nine  oases 
out  of  ten  ho  leaves  in  a  softened  and  penitent  mood, 
and  we  have  reason  to  think  subsequently  confines 
his  operations  to  homoeopaths. 


(l.VIL  HA.1IILT0N  ON  THE  SPENT  BULLET. 

It  is  always  painful  to  our  sense  of  gallantry  to 
have  to  mention  the  fact  that  the  brain  of  woman 
weighs  only  forty-four  ounces.  But  a  talented  lady, 
who  uses  the  pseudonym  of  Gail  Hamilton,  has 
recently  shown  so  strikingly  the  quantitative  and 
qualitative  limitations  of  the  female  intellect,  that  it 
rather  compels  our  bringing  to  light  tlio  above  ana- 


tomical figures.  This  distinguished  authoress  has 
written  an  article  in  the  North  American  Review 
upon  the  subject  of  the  "Spent  Bullet,"  meaning 
the  bullet  fired  by  Guiteau.  The  line  of  thought,  or 
perhaps  we  should  say  of  intuitions,  is  somewhat  as 
follows  :  Modern  science  has  been  for  some  years 
arrogating  to  itself  certainty,  and  denying  the  value 
or  truth  of  religion.  The  buUet  shot  by  Guiteau 
was  found,  after  eighty  days  of  careful  application 
of  the  best  scientific  methods,  not  where  it  was 
supposed  to  be,  but  —  in  the  wash-basin.  Hence 
modern  science  should  hereafter  acknowledge  with 
humiliation  that  it  is  fallible,  and  should  bow  to  the 
dictates  of  revelation.  It  is  hardly  necessary  to  dis- 
cuss the  merits  of  this  extraordinary  syllogism. 
We  might  inform  the  worthy  lady,  however,  that 
the  principles  and  practice  of  modern  surgery  have 
no  connection  whatever  with  the  spirit  of  modem 
science.  A  man  can  be  a  good  Christian  and  a  good 
surgeon  also,  if  he  wishes.  We  would  like  to  have 
our  eminent  contemporary.  Dr.  Post,  expound  the 
Scriptures  to  Miss  Dodge,  and  think  .she  could  leam 
a  gi'eat  deal  from  him. 

It  is  not  the  syllogism,  however,  which  is  only 
amusing,  that  we  wished  to  criticise.  But  the  fair 
authoress  takes  the  opportunity  to  say  many  unjust 
things  about  the  medical  profession  generally,  and 
that  part  of  it  which  treated  President  Gai-field  in 
particular.  There  lias  been  a  great  deal  of  gossip 
among  the  ladies  of  Washington  over  our  lamented 
President's  treatment.  Several  in  high  authority 
were  not  pleased  with  the  i^hysicians,  and  in  the 
cosy  and  confident  way  with  which  women  discuss 
medical  matters  and  men,  they  have  settled  that  a 
great  deal  of  the  treatment  was  wi'ong.  Gail  Ham- 
ilton has  evidently  given  vent  to  much  hitherto 
pent-up  feeling,  and  no  doubt  she,  as  well  as  her 
many  Washington  acquaintances,  will  now  experi- 
ence relief.  We  can  only  say  that  the  subject  is  one 
which  deserves  calm  and  candid  treatment  rather 
than  the  cantankerous  criticism  given  it  in  the 
Revietc.  The  judgment  of  the  great  body  of  the 
profession  is,  that  the  President's  physicians  did  all 
that  could  be  done  for  him,  and  no  doubt  consider- 
ably prolonged  his  life.  The  lady  who  tries  to 
prove  otherwise  must  adopt  more  powerful  and  dig- 
nified metliods  than  are  em])loyed  in  moralizing 
over  "The  Spent  Bullet." 


THE   DEATH   OF   DAK  WIN. 

The  deatli  of  Cbarles  Darwin  justly  excites  deep 
regret  among  men  of  science  everywhere.  No 
naturalist  or  biologist  ever  achieved  so  wide  a  rep- 
utation or  earned  it  by  better  work.  Darwin  lived 
to  see  his  views  corroborated  in  the  main  by  his 
fellow-workers,  while  among  all  intelligent  people 
early  ridicido  had  already  given  way  to  profouiul 
respect. 


THE  MEDICAL  RECORD. 


465 


Medical  science  is  not  without  its  indebtedness 
to  Darwin,  and  it  should  contribute  due  homage  to 
his  memory.  The  many  luminous  contributions  to 
biological  subjects  made  by  the  deceased  scientist 
have  elevated  and  excited  a  wider  interest  in  those 
fundamental  sciences  which  underlie  medicine.  Dar- 
win's views  regarding  the  variation  of  species  have 
been  richly  suggestive  to  pathologists,  especially  in 
these  later  times.  Darwin  created  an  epoch  in 
natural  eoience.  He  turned  the  currents  of  scien- 
tific thought  and  work  into  new  and  broader  chan- 
nels. It  is  perhaps  hardly  true  to  say  that  his  in- 
fluence upon  our  especial  science  has  been  as  yet 
great,  since  it  has  only  been  an  indirect  one.  But 
it  has  certainly  not  yet  ended. 


THE   LAMSON    CASE. 

There  has  been  a  great  deal  of  idle  talk  and  maud- 
lin sympathy  over  the  case  of  Dr.  Lamson.  In  no 
trial  was  it  ever  shown  more  clearly  that  a  deliber- 
ate and  cold-blooded  murder  was  performed.  It 
may  be  that  Lamson  was  an  opium-eater,  and  was 
morbidly  fond  of  prescribing  aconite.  But  it  seems 
equally  sure  that  he  was  a  dissipated  and  unprin- 
cipled medical  tramp,  who  murdered  his  brother- 
in-law  to  relieve  himself  of  pecuniary  troTibles. 

The  medical  interest  in  the  case,  apart  from  the 
unhappy  fact  that  the  prisoner  is  a  physician  of 
American  birth,  is  chiefly  a  psychological  one.  One 
learns  how  easy  it  is  to  excite  the  interest  of  two 
great  nations  over  a  man  about  to  be  justly  hanged 
— if  hanging  be  ever  just. 

The  history  of  the  murdered  boy  and  of  the  .symp- 
toms produced  by  the  aconite,  furnishes  little  that 
is  new  to  medico-legal  .science.  The  doses  of  aconite 
given  were  so  large  that  it  took  no  extraordinary 
skill  to  detect  its  presence  in  lethal  amount. 


Much  Misekx,  Many  BniTHS,  is  the  heading  of 
an  article  in  a  Socialist  paper  of  this  city,  giving 
some  recent  population  statistics.  According  to 
the  official  Russian  year-book,  the  population  of 
Russia  increases  more  rapidly  in  proportion  than  in 
any  other  country  except  Denmark  and  Holland. 
The  annual  number  of  births  per  1,000  inhabit- 
ants, is  in  Russia,  id  ;  in  Germany,  43  ;  in  France, 
26.  The  population  of  Russia  doubles  itself  in  58 
years,  that  of  France  in  165  years,  Germany  68,  and 
Italy  lil  years. 

On  the  other  hand,  the  mortality  rate  is  higher  in 
Russia  than  in  any  other  European  country,  being 
37  per  1,000.  The  mortality  is  also  greater,  propor- 
tionately, among  young  children  than  it  should  be. 
The  ratio  of  deaths  among  children  under  one  year 
of  age  to  the  deaths  among  other  children,  is  in 
Russia  1  to  4 ;  in  France  it  is  1  to  6 ;  and  in  Eng- 
land 1  to  7.  Illegitimate  births  seem  to  be  the  least 
frequent  of  any  country. 

Th»  conclusion  drawn  from  the  above  is,  that 
where  there  is  the  most  misery  there  are  the  most 
births. 


tilcuinug  ftntr  ItoticesJ  of  doolie. 


Lectures  on  Diseases  of  Children.  By  Edward 
Henoch,  M.D.,  Berlin.  New  York:  William  Wood 

&  Company.  1882. 
This  work  embodies  the  record  of  cases  seen  and 
carefully  studied  during  an  experience  of  thirty- 
seven  years  in  the  field  of  diseases  of  children. 
There  is  an  introductory  chapter  on  methods  of  ex- 
amination of  infants,  showing  how  the  physician 
may  acquaint  himself  with  those  factors  by  which 
certain  aijpearances  in  childhood,  which  are  found 
under  normal  conditions,  are  differentiated  from 
those  present  in  the  adult,  so  that  the  mistake  may 
not  be  made  of  considering  normal  conditions  as 
pathological.  The  author  then  describes  the  dis- 
eases common  to  all  periods  of  childhood,  bringing 
in  the  important  points  in  question  without  dwell- 
ing at  too  great  length  upon  clinical  histories.  The 
last  chapter  is  devoted  to  such  affections  of  tlie  skin 
as  are  characterized  by  certain  peculiarities  in  chil- 
dren, reference  being  made  to  metasta.sis  of  skin 
diseases.  On  account  of  the  great  amount  of  prac- 
tical clinical  information  contained  in  this  volume, 
it  is  a  very  useful  book  for  the  general  practitioner. 

An  Index  op  Surgery.  By  C.  B.  Keeixet,  F.R.C.S. 
New  York  :  William  Wood  >t  Company.     1882. 

This  work  is,  as  stated  on  its  title-page,  "  a  concise 
classification  of  the  main  facts  and  theories  of  sur- 
gery," and  as  a  brief  compendium  of  the  existing 
knowledge  in  this  department  it  meets  a  recognized 
want  of  the  advanced  student  as  well  as  the  busy 
practitioner. 

Under  the  modest  title  of  index  the  author  has 
arranged  in  alphabetical  order  the  most  important 
of  the  affections  the  surgeon  is  called  upon  to  treat. 
Each  heading  is  followed  by  an  outline  embracing 
history,  pathology,  and  treatment,  together  with  the 
various  tlieories  and  operations.  These  sketches  are 
more  or  less  full,  in  proportion  to  the  imj^ortance 
of  the  subject,  the  sections  on  diseases  of  bones, 
fractures,  dislocations,  syphilis,  and  tumors  being 
worthy  of  special  notice.  The  veiy  comprehensive 
notes  on  ophthalmic  surgery,  by  Henry  Jules, 
F.R.C.S.,  which  form  part  of  the  appendix,  are  alone 
worth  more  than  the  merely  nominal  price  of  the  book. 

We  commend  it  to  all  students  and  others  whose 
knowledge  of  surgery  is  either  confused  or  riisty.  It 
will  be  found  esj^ecir  Uy  valuable  as  a  final  remem- 
brancer, to  be  read  just  before  examinations,  either 
for  hospital  or  degree. 

A  Handbook  on  the  Diseases  or  Women.  By.  W. 
Symington  Brot\-m,  M.D.  8vo,  240  pp.  Illus- 
trated. New  York  :  Wm.  Wood  A:  Company.  1882. 

This  work  has  the  merit  of  being  a  more  complete 
practical  elucidation  of  this  much  written  subject 
than  any  we  have  seen  in  a  book  of  such  moderate 
size. 

To  say  that  great  advances  have  been  made  in  the 
diagnosis  and  treatment  of  women's  diseases  would 
be  telling  no  news.  Perhajjs  no  deiMrtment  of  medi- 
cine has  developed  so  rapidly.  To  every  thinking 
man  it  must  be  evident  that  the  more  rapid  this  pro- 
gress the  more  frequent  must  be  the  publications 
representing  the  latest  facts  and  ideas.  The  author 
of  the  present  work,  though  making  no  attemjit  to 
go  into  details,  or  even  mention  the  more  obscure 


466 


THE  MEDICAL  RECORD. 


and  recondite  divisions  of  his  subject,  has  furnished 
a  handbook  of  undoubted  value. 

A  confused  mass  of  facts  and  theories  usually  ob- 
tains in  the  mind  of  the  student  after  perusing  the 
larger  works,  and  liearing  one  or  two  courses  of  lec- 
tures on  the  subject.  A  careful  reading  of  Dr. 
Brown's  book  will  certainly  do  much  toward  bring- 
ing order  from  this  state  of  chaos. 

Introductory  chapters  on  the  anatomy  of  the  fe- 
male organs  and  the  use  of  instruments,  together 
with  a  dictionary  of  the  terms  employed,  justify  the 
title  of  "  handbook." 

Lectuees  on  the  Pathologt  and  Tkbatment  of 
Lateral  and  other  Forms  op  Cubvatdbe  of 
THE  Spine.  By  William  Adams,  F.R.C.S.  Sec- 
ond Edition.    London  :  J.  &  A.  Churchill.     1882. 

These  lectures  were  delivered  in  1860 -(31,  and  were 
published  in  book  form  four  or  five  years  later. 
This,  the  second  edition,  seems  to  have  been  brought 
out  chiefly  through  the  instrumentality  of  Mr.  F.  K. 
Fisher,  a  young  and  industrious  orthopfedic  surgeon 
of  London.  Whatever  Mr.  Adams  writes  must  be 
good,  for  he  is  a  painstaking,  honest  investigator, 
and  one  need  not  expect  to  find  anything  but  what 
will  bear  the  test  of  criticism.  The  book  he  has 
given  now  to  the  profession  is  a  careful  7-rxHmr  of 
all  important  theories  as  to  the  causation  of  lateral 
curvature,  candidly  discussed  on  anatomical  and 
physiological  grounds.  The  mechanism  is  now  un- 
derstood by  all  as  rotation  of  the  bodies  on  the  hori- 
zontal axis,  with  a  combination  of  a  general  twist- 
ing. Just  what  produces  this  is  a  question  which 
has  led  to  the  publication  of  books  since  the  time 
of  Dr.  Dods,  who  wrote  in  182-1.  Mr.  Adams  recog- 
nizes, first,  predisposing  causes,  which  are  essential- 
ly constitutional,  and  second,  pi-oximate  causes,  such 
as  long  continuance  of  certain  bad  positions  in  stand- 
ing or  sitting,  short  limbs,  etc.,  etc. 

After  giving  quotations  from  Dr.  Judson's  paper, 
which  was  presented  at  the  Academy  of  Medicine  in 
182(3,  he  states  that,  "it  will  be  seen  that  Dr.  Jud- 
son's view  of  the  cause  and  mode  of  production  of 
rotation  does  not  niateriilly  differ  from  that  of  Mr. 
A.  Shaw ;  although  the  influence  of  the  muscles  in 
preventing  or  limiting  the  deviation  of  the  spinous 
processes  appears  to  be  an  original  observation  in 
the  accuracy  of  which  I  concur."  The  views  of  Mr. 
A.  Shaw,  wiio  wrote  in  1832,  and  to  which  our  au- 
thor subscribes,  are  as  follows  . 

"  In  lateral  curvature  of  the  spine  we  have  a  distinct 
demonstration  that  the  articulating  processes  give 
way  more  extensively  than  any  of  the  other  parts  of 
the  column.  This  is  evinced  by  the  rotation  which 
the  spine  makes  in  its  perpendicular  axis,  at  the 
same  time  that  it  inclines  laterally.  The  joints  of 
the  articulating  processes  being  situated  posteriorly 
as  well  as  laterally,  the  spinal  column  cannot  yield 
in  their  direction  without  wheeling  partially  round  ; 
and  it  is  owing  to  this  rotation  that  the  transverse 
processes  and  the  ribs  are  directed  obliquely  back- 
ward upon  the  convex  side  of  the  curvature,  thus 
giving  rise  to  a  fulness  or  swelling  on  the  one  hand 
and  a  depression  or  sinking  in  on  the  other." 

If  any  one  reads  this  book  witli  the  hope  of  find- 
ing out  just  what  cases  of  lateral  curvature  do  not 
require  apparatus,  he  will  lie  disappointed.  That  is 
the  great  want  whieli  IMr.  Adams  and  all  other 
writers  have  not  met.  The  practitioner  is  often 
consulted  by  jjatients  with  what  is  called  "  incipi- 
ent rotary  lateral  curvature,"  and  ho  has  no  means 
of  satisfying  himself  whether  this  is  a  case  that  has 


undergone  spontaneous  arrest  or  whether  it  will  go 
on  to  hunchback.  He  does  not  know  whether  to 
apply  a  brace  which  may  lower  the  muscular  tone, 
or  to  prescribe  a  course  of  exercise.  In  either  case 
he  will  incur  more  or  less  censure.  Now,  works  on 
curvature  of  the  spine  should  teach  this  one  thing 
above  all  others.  If  there  are  many  cases  of  sponta- 
neous arrest  in  all  ages  and  at  all  stages,  we  should 
very  much  like  to  know  how  we  shall  say  positively 
of  a  given  case,  "This  is  fully  arrested  and  no  appa- 
ratus whatever  is  required." 

Again,  Mr.  Adams  is  convinced  that  many  of  these 
old  cases  of  spinal  irritation,  wherein  such  great  suf- 
fering is  experienced,  are  nothing  more  than  rotary 
curvature  of  the  spine,  and  he  cites  a  few  cases  that 
are  by  no  manner  of  means  conclusive.  One  won- 
ders how  a  man  ordinarily  so  unbiassed  in  opinion 
and  so  close  in  observation,  could  be  so  far  misled 
by  the  very  cases  he  selects  for  conviction.  Space 
does  not  permit  an  analysis  here  of  these  eases,  but 
a  close  study  even  by  a  specialist  will  enable  one  to 
see  wherein  Mr.  A.  has  fallen  into  error. 

He  takes  good  grounil  in  tlierapeutics.  Improve- 
ment of  the  general  health,  precautionary  measures 
in  view  of  the  great  influence  heredity  bears  in  the 
etiology,  correction  of  bad  position,  systematic  ex- 
ercises adapted  to  the  case  in  hand,  apparatus  so 
constructed  as  to  prevent  an  increase  in  the  deform- 
ity— such  is  the  substance  of  that  portion  which 
deals  with  the  treatment. 

The  book,  notwithstanding  its  few  glaring  defects, 
is  really  a  good  one,  and  is  valuable,  not  only  to  the 
specialist,  but  to  the  medical  man  who  practises  no 
specialty. 

Spectacles  ;  and  How  to  Choose  Them.     An  Ele- 
mentaiy  Monograph.    By  C.  H.  Vilas.  M.A.,  M.D., 
Professor   of  Diseases   of  the    Eye  and    Ear   in 
the   Hahnemann   Medical  College  and  Hospital, 
Chicago,  111.;  President  of  the  Western  Academy 
of  Homi^opathy,  etc.     Small  Svo,  jip.  158.     Chi- 
cago:  Duncan  Bros.     1881. 
The  Ophthalmoscope  :  Its  Theory  and  Practical 
Uses.     Same  Author.    Small  Svo,  pp.  150.    Chica- 
go :  Duncan  Bros.     1882. 
The   first   of  these   monographs   gives   useful    ad- 
vice to  those  who  choose  to  select  their  own  glasses 
at  the  ojitical  store.      It  teaches  the   qualities    of 
crown,  pebble,  periscopic,  meniscal,  and  other  lenses, 
and  gives  the  tourmaline  test  for  pelibles,  while  it 
properly  inveighs  against  the  practice  of  seeking  the 
first  advice  as  to  glasses  from  other  than  a  compe- 
tent oculist.     The  "distinguished  Eu.ssian  "  (from 
New  York  ?),  or  "  celebrated  Pole  "  (from  Chicago ?), 
who,  at  the  sacrifice  of  time  and  health  and  in  con- 
sideration of  his  love  for  his  fellow-men,  and  from 
ten  to  twenty  times  the  commercial  price,  is  jire- 
vailed  on  to  i)art  with  the  last  few  pairs  of  "  Brazil- 
ian pebbles  "  in  his  stock,  is  sIioa^ti  up  to  the  satis- 
faction   of  non-metropolitan   oculists.      The    book 
reproduces  a  large  nundier  of  admirable  wood-cuts 
of  spectacles,  eye-glasses,  and  coipiilles  from  Meyro- 
witz  Bros.'  (New  York)  catalogiie  of  optical  instru- 
ments. 

The  second  monogi-aph  portrays  the  optical  pos- 
sibilities of  convex,  concave,  and  prismatic  lenses, 
with  well-selected  diagrams  in  black.  The  histoiy 
of  the  modern  ophthalmoscope,  dating  from  the 
Kekoss  revolving  disc,  and  its  theory,  as  shown  by 
the  simjile  instnimcnt  of  Helmholtz,  are  concisely 
put  together.  The  instruments  of  Knapp  and  Lov- 
ing arc  regarded  as  the  standard  ones  ;  the  descri]'- 


THE   MEDICAL  EECORD. 


407 


tion  of  the  former  is  taken  fi-om  his  own  (K.'s) 
account  of  it  in  the  Archives  of  Opldhalmolof/i/  and 
Ololorjil,  that  of  Loring's  from  the  "  Transactions  of  the 
American Oijhthalmological Society,  1878."  Thereare 
the  usual  chapters  on  the  healthy  and  diseased  fun- 
dus of  the  eye,  and  a  brief  chapter  on  ophthalmo- 
scopic optometi-y,  the  original  credit  of  which  is 
assigned  to  Knapp,  and  whose  mathematical  for- 
mula; may  be  found  in  Helmholtz's  "  Physiologische 
Optik."  Practical  tables  for  the  measui'ement  of 
elevations  and  depressions  within  the  eyeball  are  re- 
produced. 

The  book  is  a  concise  essay  on  the  subject,  and 
admirably  written.  The  dioptrical  behavior  of  the 
eye  is  made  very  clear  to  the  I'eader,  while  at  the 
same  time  there  is  little  in  the  line  of  new  investiga- 
tion ;  and  we  can  hardly  apjireciate  the  statement  in 
the  preface  that  it  is  publi.shed  "  to  occupy  a  place 
hitherto  vacant  in  medical  literatui'e,  and  sujiply  a 
want,"  etc. 

One  must  forget  Schweigger,  Loring,  Carter,  and 
many  otiiers,  in  order  to  coincide  with  the  author  in 
this  ubiquitous  statement.  This,  however,  does  not 
interfere  with  its  truthfulness  as  a  guide  to  the  ele- 
mentary student  of  the  ophthalmoscope. 

A    M.iXU.u:   OF    MlDW-IFERY.      Bv   ALFRED   Me.UJOWS, 

M.D.,  Lond.,  F.K.C.P..  as.s'isted  bv  Albekt  J. 
Venx,  M.D.,  ME.C.P.  The  Fourth  Edition,  re- 
vised and  enlarged,  and  illustrated  with  one 
hundred  and  thirty-seven  wood  engravings.  12mo, 
pp.  xxiv,  498.  New  York :  G.  P.  Putnam's  Sons. 
1882. 

Wh.wevbr  was  wanting  in  former  issues  of  Dr.  Mead- 
ows' work  seems  to  have  been  added  in  the  jaresent 
edition,  and  whatever  was  superfluous  removed. 
The  text  is  elucidated  by  ample,  though  not  too  pro- 
fuse illustration,  the  language  is  clear  and  concise, 
and  the  scope  of  the  volume  thorough.  Besides 
stating  his  own  opinions  and  the  results  of  his  own 
experience  the  author  presents,  in  an  impartial  man- 
ner, the  teaching.^  of  different  obstetrical  schools.  In 
dealing  with  puerperal  fever.  Dr.  Priestley's  classi- 
fication, as  adojjted  by  the  London  Obstetrical  So- 
ciety, is  generally  obsei-ved.  The  book  is  published 
in  a  very  convenient  form,  is  neat  in  appearance, 
and  does  credit  to  the  printer.  It  is  tiseful  as  a 
handbook  for  the  student,  and  as  a  book  of  refer- 
ence for  the  busy   practitioner. 


Reports  of  Socirtic«. 


British  and  AMEP.ic.iN  Physicians  in  Paris. — 
With  a  view  to  promote  social  intercoui'se  and  main- 
tain good  fellowship  between  British  and  American 
physicians,  a  society  has  been  formed  under  the 
name  of  the  "  Britisli  and  American  Medical  Society 
of  Paris."  Membership  is  limited  to  British  sub- 
jects and  citizens  of  the  United  States  of  America 
legally  entitled  to  practise  as  physicians  in  Paris, 
and  actually  doing  so.  A  certain  number  of  dinners 
are  appointed  to  be  held  annually  ;  the  first  took 
place  on  February  1st.  Among  the  members  who 
form  this  society  are  Dr.  McCarthy,  Sir  John  Pvose 
Cormack,  Dr.  Thomas  Bishop,  Dr.  the  Hon.  Alan 
Herbert,  Dr.  Pratt,  Dr.  Marion  Sims,  Dr.  Johnson, 
Dr.  Faure-MiUer,  Dr.  Jennings,  Dr.  Murray,  Dr. 
Pepper,  Dr.  Kowlatt,  and  Dr.  Loughnam,  etc'  The 
President  for  1S82  is  Sir  John  Bose  Cormack,  and 
the  Vice-President  Dr.  Bishop. 

Professor  Klebs,  of  micrococcus  fame,  is  not 
popular  in  Prague,  and  it  is  thought  that  he  will 
go  to  Zurich,  to  which  place  he  has  received  a  call. 


MATERIA  MEDICA  SOCIETY. 

Stated  Meeting,  Thursday,  March  23,  1882. 
Db.  Faknhaji,  Chairman,  pro  tern. 
The  paper  of  the  evening,  entitled 

VIOLA   TRICOLOR  AND  ITS   USES  IN  ECZEMA  (See  p.  449), 

was  read  by  the  author.  Dr.  Henry  G.  Piffard. 

The  discussion  was  opened  by  Dr.  Johnson,  who 
remarked  that  the  effects  of  siilicylic  acid  or  salicy- 
late of  soda  upon  the  eyes  were  much  more  severe 
than  those  of  viola  tricolor.  He  had  recently  had  a 
case  of  rheumatism  under  treatment  by  salicylic 
acid,  in  which  he  had  to  suspend  the  drag  chiefly  on 
account  of  the  severe  lachrymation  which  it  pro- 
duced. There  was  a  flooding  of  tears  and  the  eye- 
lids became  intensely  red,  causing  great  suffering 
on  the  i^art  of  the  patient,  who  refused  to  take  the 
drug  any  longer. 

Db.  Beonson  was  exceedingly  interested  in  the 
paper,  and  wanted  to  know  whether  the  therapeutic 
action  of  viola  tricolor  was  attributed  in  any  degree 
to  the  salicylic  acid  which  it  contained. 

Dr.  Piffabd  replied  that  salicylic  acid  was  the 
only  active  substance  yet  found  in  viola  tricolor, 
and  until  some  other  active  jirinciple  was  found  it 
was  fair  to  presume  that  the  therapeutic  action  was 
due  to  that,  in  view  of  the  fact  that  there  is  a  close 
correspondence  between  the  physiological  action  of 
the  salicylic  acid  and  viola  tricolor. 

Dr.  Bronson  then  inquii'ed  if  by  any  possibility 
the  salicylic  acid  could  explain  the  therapeutic 
action  of  the  viola  tricolor.  It  occurred  to  him 
that,  as  the  older  wTiters  employed  the  drug  more 
particularly  for  the  crusted  forms  of  eczema,  the 
salicylic  acid  which  the  drug  contained  might  act 
as  an  antiseptic,  perhaps  as  an  anti-suppurating 
remedy.  His  own  exjierience  with  viola  tricolor 
was  in  a  single  case  of  a  child,  suffering  from  eiT- 
thematous  eczema.  He  tried  the  infusion  for  two 
weeks  till  he  produced  a  laxative  effect,  and  then 
stopped  the  drug.  When  the  bowels  were  not  freely 
open  he  used  it  again.  In  that  case  he  discovered 
no  other  effect  than  what  he  should  obtain  from  any 
laxative  remedy.  He  was  pursuing  local  treatment 
at  the  same  time,  and  the  case  improved  rapidly. 
At  the  time  he  attributed  this  simply  to  the  deriva- 
tive effect  of  the  remedy  ;  the  derived  action  being 
created  on  the  intestines,  the  external  imtation  was 
of  course  diminished.  He  also  attributed  a  good  deal 
of  the  cure  to  the  local  measures.  At  the  end  of  a 
fortnight  he  abandoned  the  drug  entirely,  and  con- 
tinued to  treat  the  case  by  simj^le  local  measures 
and  tonics.  Ultimately  it  made  a  good  recovery. 
The  remedy  at  that  time  seemed  to  him  to  have  the 
ordinary  effect  of  any  laxative.  The  drug  varies 
largely  in  quality. 

Dr.  Piffard  stated  that  every  medicinal  herb 
when  ofl'ered  for  dispensing  should  present  char- 
acters which  enable  it  to  be  identified.  The  offici- 
nal portion  of  this  drug  is  the  entire  plant.  The 
root  is  a  very  active  portion  of  it ;  it  contains  twice 
the  percentage  of  salicylic  acid  as  the  herb;  the 
flowers  contain  a  less  proportion  than  the  other 
parts. 

Dr.  Johnson  remarked  that  those  plants  which 
have  a  perennial  root  have  a   larger  proportion  of 


468 


THE  MEDICAL  EECORD. 


medicinal  properties  in  the  latter  than  in  the  parts 
appearing  above  ground.  Thus  in  belladonna,  the 
root  is  medicinally  more  powerful  than  the  leaves. 

Dr.  Pipp,\kd  had  used  viola  tricolor  in  all  sorts  of 
eczemas.  He  found  it  most  useful  in  eczemas  in 
the  second  stage,  where  there  is  exudation  and 
crusting,  both  when  that  is  taking  on  the  acute  and 
subacute  forms.  The  crusta  lactea  of  infants  will 
last  three  and  six  months,  and  even  longer,  when 
inefficiently  treated.  In  that  subaciite  condition 
there  is  not  a  great  deal  of  discharge,  but  some- 
times a  greenish  dry  crust,  and  sometimes  a 
yeUowi.sh  green  one,  especially  on  the  head  and 
face.  Most  writers  confine  the  term'crusta  lactea 
to  eczema  of  the  scalp.  Strack  in  his  original 
article,  however,  speaks  of  crusta  lactea  occurring 
on  other  parts  of  the  body,  showing  that  in  his 
mind  the  term  was  synonymous  with  the  word 
eczema  of  to-day.  The  cases  of  eezema  in  which 
this  drug  has  been  found  most  useful  are  those  in 
which  the  vesicles  or  primary  lesions  have  already 
disappeared,  and  there  is  exudation  and  crusting. 
When,  however,  the  eczema  has  i-eached  the  third 
stage  and  becomes  dry,  and  there  is  an  attempt  at 
the  formation  of  a  new  epithelium,  the  viola  tricolor 
does  not  prove  as  useful  as  some  other  drugs. 

As  regards  the  laxative  effect  of  the  drug,  Dr. 
Pittard  had  not  observed  that  property  in  using  the 
viola  tricolor.  In  the  very  great  proportion  of  cases, 
even  where  he  had  made  iuquiry,the  patient  said  there 
were  no  eft'ects  on  the  bowels.  In  the  majority  of 
instances  patients  remarked  that  there  was  some  in- 
crease in  the  quantity  of  urine.  In  a  few  cases  he 
had  learned  on  inquiry  that  the  urine  had  a  di.sagree- 
able  odor.  One  man  said  that  it  smelled  as  bad  as 
asparagus  urine,  but  not  the  same  kind  of  a  smell. 
It  is  judicious  always  to  warn  a  patient  in  adminis- 
tering this  medicine  that  it  may  possibly  excite  an 
aggravation  of  sniferings  and  an  increase  of  erup- 
tion. As  examples  of  this  temporary  aggi'avation, 
witness  the  effect  of  nitrate  of  silver  on  a  conjuncti- 
vitis, or  of  an  ordinary  injection  in  gonorrhoea.  There 
is  a  temporary  increase  of  pain  and  irritation,  which, 
when  it  subsides,  carries  with  it  some  of  the  original 
cause  of  the  complaint.  If  just  the  effect  needed 
can  be  obtained  without  aggravation  so  much  the 
better ;  but  doses  cannot  always  be  so  adjusted  as  to 
accomplish  this  result.  Dr.  Piffard  further  stated 
that  in  all  cases  where  viola  tricolor  is  employed 
medicine  enough  should  be  given  to  produce  the 
effect  of  the  drug.  In  the  treatment  of  syphilis,  he 
would  not  be  content  in  treating  a  case  at  the  start, 
until  he  had  pushed  the  mercury  up  to  the  point  at 
which  he  could  tell  it  was  working,  as  evidenced  by 
the  uncomfortableness  about  the  mouth,  etc.  In 
like  manner,  in  the  use  of  arsenic  in  sub-acute  cases 
of  eczema,  he  would  push  the  drug  until  its  physio- 
logical effects  had  liecome  apparent,  and  would  then 
diminish  the  amount.  In  the  various  forms  of  ex- 
ternal indolent  disease,  a  stimulant  of  some  sort,  as 
nitrate  of  silver,  sulphate  of  copper,  and  acetate  of 
zinc,  is  used.  Those  preparations  bring  blood  tem- 
porarily to  the  part,  and  that  blood  when  it  goes  away 
carries  off  some  of  the  infiltration  with  it.  In  the 
infiltrated  eczema  green  soap  acts  as  a  stimxilant  and 
irritant,  producing  temporarily  an  increase  of  red- 
ness, heat,  and  swelling;  when  the  effects  of  the 
application  have  passed  off,  there  is  a  diminution  of 
these  features — in  other  words,  an  improved  condi- 
tion of  the  part.  He  believed  that  viola  tricolor 
and  arsenic  produced  a  congestive  efVect  on  the  af- 
fected part ;    after  the  congestion   passed   off,   the 


same  result  followed  that  was  obtained  from  local 

stimulants. 

The  discussion  being  closed.  Dr.  Piffard  called  the 
attention  of  the  society  to  some  remarks  on 

THE    SYSTEMATIC    EXPL.iN.VriON     OF     THE     ACTIONS     OF 
DRroS. 

He  said :  There  are  some  drugs,  the  action  of 
which  we  can  explain  pretty  satisfactorily.  For  in- 
stance, we  will  take  an  illustration  of  the  allopathic 
application  of  drugs.  If  a  man  has  a  congestion  of 
the  brain  and  you  give  him  on  the  one  hand  a  pur- 
gative, you  are  producing  a  derivation  to  the  intes- 
tinal canal.  If  you  put  a  blister  on  the  back,  face, 
or  neck  you  are  producing  a  derivation  to  the  skin. 
There  you  have  a  typical  instance,  properly  speak- 
ing, of  allojiathic  practice.  If  you  give  a  man  with 
congestion  of  the  brain  bromide  of  potassium,  you 
are  not  producing  a  derivative  effect.  You  are  not 
treating  the  man  allopathically  but  anti-pathically ; 
in  other  words,  you  are  giving  a  drug  which  acts 
upon  the  part  affected  in  a  manner  the  opposite  to 
that  which  the  disease  is  pursuing.  Now,  what  a 
homa'Opath  would  recommend  would  be  a  drug  like 
belladonna,  in  that  same  condition  of  congestion  of 
the  brain.  He  would  say  that  belladonna  congested 
the  brain  and  therefore  was  the  projier  remedy. 
Here  are  three  .systems  by  which  a  certain  diseased 
condition,  viz.,  congestion  of  the  brain,  would  be 
treated.  First,  the  old  plan,  which  was  allopathic  ; 
second,  the  modern  plan,  which  is  anti-pathic,  or 
commonly  known  as  physiological  therapeutics; 
and  thii-dly,  the  so-called  homoeopathic.  The  case 
of  mercury  in  syphilis  we  cannot  bring  imder  either 
of  those  three  categories.  Homceopaths  claim  that 
mercury  is  homwopathic  to  syphilis.  It  certainly 
is  not  anti-pathic,  nor  is  it  allopathic,  and  there  is 
no  sound  evidence  that  it  is  homrfopathic.  The 
older  practitioners  sought  to  cure  syphilis  with 
mercury  by  producing  an  increased  action  of  the 
salivary  glands.  Now  we  cure  it  more  effectively 
and  pleasantly  by  giving  the  drug  in  doses  that  will 
not  produce  this  effect.  There  is  no  explanation  in 
harmony  witli  any  of  these  Si/slemis  to  account  for 
the  action  of  mercury  in  syphilis  ;  neither  is  there 
any  systematic  explanation  of  the  eft'ects  of  cin- 
chona in  intermittent  fevers.  Hahnemann  claimed 
that  cinchona  was  homceopathic  to  intermittent 
fever.  In  fact,  some  experiments  with  that  dnig 
led  him  to  the  adoption  of  the  theories  that  he 
advanced,  and  the  promulgation  of  his  system  of  the- 
rapeutics. When  you  examine  closely  the  effects  of 
cinchona  and  the  records  made  by  Hahnemann  as 
to  the  effects  that  he  observed,  you  will  i,i'l  find  the 
"  similarity  "  which  is  essential  to  the  maintenance 
of  his  doctrine. 

The  prominent  and  distinctive  feature  of  intermit- 
tent fever  is  the  intermittent  recurrence  of  several 
paroxysms  of  fever  following  a  single  dose  of  the 
malarial  poison.  A  man  passes  a  single  night  in  a 
malarious  district,  and  he  may  have  for  months  a 
succession  of  quotidian  and  tertian  attacks.  But 
there  is  nothing  in  the  physiological  action  of  cin- 
chona that  has  been  brought  forward  thus  far  to 
show  that  this  periodicity  is  a  feature  of  the  action 
of  the  drug.  Hahnemann  himself  stated  that  the 
renewal  of  the  artificial  quinine  fever  only  occui-red 
after  adilitional  doses  of  the  drug.  It  will  be  seen, 
therefore,  that  cinchona  is  not  homoMpathic  to  the 
periodical  fcatureof  the  disease,  though  it  may  some- 
times proilu<(>  symptoms  that  closely  counterfeit  an 
individual  paroxvsm. 


THE  MEDICAL  RECORD. 


469 


Dr.  Bronson  stated  that  he  supposed  that  the 
usual  explanation  of  the  action  of  cinchona  in  ma- 
laria was  that  it  acted  as  a  nervous  stimulant,  and 
thus  tided  the  patient  over  the  disease. 

Dr.  Pifpard  continued :  There  have  been  before 
the  world  these  three  systems  of  therapeutics,  viz., 
allopathic,  anti-pathic  or  physiological,  and  homtfio- 
pathic.  Neither  of  these  systems  explains  the  ac- 
tion of  mereui'v  and  cinchona  in  diseases  in  which 
they  are  found  especially  useful.  That  does  not 
deny  that  there  may  be  some  other  explanation  out- 
side of  these  systems  which  will  prove  satisfactorv. 

Dr.  Farnham  tliought  that  Dr.  Bronson's  remarks 
with  reference  to  the  tiding  over  would  apply  just 
as  well  to  other  drugs  which  were  not  found  eqiially 
useful  in  curing  malaria  as  cinchona. 

In  conclusion.  Dr.  Fuller  exhibited  a  specimen  of 
his  hypodermic  tablets  of  morphia,  containing  one- 
sixth  of  a  grain.  Dr.  Pift'ird  stated  that  at  the  last 
meeting  a  discussion  was  held  on  the  subject  of 
comparative  solubility  of  the  Wyeth  and  Fuller 
tablets,  intended  for  hypodermic  injection.  It  w.is 
the  result  of  experiment  that  evening  -ndth  Dr  Ful- 
ler's preparations  that,  while  much  more  soluble 
than  those  of  Wyeth  Brothers,  they  were  still  not 
sufficiently  soluble  for  hypodermic  use.  Since  then 
the  tablets  of  Dr.  Fuller  had  been  made  so  that 
they  posses.sed  all  the .  solubility  that  could  be  de- 
sired. Further  experimentation  at  the  present 
meeting  demonstrated  this  fact.  Dr.  Fuller's  speci- 
mens dissolved  in  the  short  period  of  thirty  seconds. 

The  societv  then  went  into  executive  session. 


NEW  YORK  ACADEMY  OF  jMEDICIlSrB. 


FoRDTCB  Barker,  M.D.,  LL.D.,  President,  in  the 
Chair. 


Staled  Meeting,  April  20,  1882. 

Barker,  M.D.,  LL.D.,  Preside: 
Chair. 

Dr.  W.  M.  Chamberlain  spote  concerning  some  of 

THE   USES  OF  RUBBER    TUBING    IN     THE    THER.APEDTICS 
OP   REDUCTION   OP  BODT-TEMPERATURE. 

About  a  year  ago  Leiter's  tubes,  made  of  com- 
posite metal,  and  arranged  so  as  to  form  disks  of 
various  shapes  and  sizes,  were  introduced  into  Xew 
York  from  Vienna  as  a  novelty.  They  were  pre- 
sented at  the  International  Congress  in  1881,  pro- 
tected by  patent  obtained  in  Austria.  It  was  the 
purpose  of  the  inventor  to  obtain  a  patent  in  the 
United  States,  but  he  found  that  the  principles  of 
the  appliances  had  already  been  given  to  the  med- 
ical 7)rofession  several  years  ago.  In  the  year  lS7i 
Dr.  Chamberlain  presented  to  the  New  York  3Iedi- 
cal  Journal  and  Library  Association  the  subject  of 
the  various  ends  which  could  be  accomplished  by 
extemporized  appliances  made  from  rubber  tubing 
and  used  for  circulating  water  over  the  surface  of 
the  body  for  the  purpose  of  reducing  temperature. 
But  he  had  been  unable  to  find  any  publication  of 
the  communication.  At  that  time  he  supposed  it 
was  his  own  device,  but  subsequently  ascertained 
that  the  same  idea  had  been  presented  bv  Dr.  Rob- 
erts, of  London,  in  1871,  and  Dr.  Ashhur'st,  of  Phil- 
adelphia, in  1872.  Although  the  appliances  were 
original  to  himself,  they  were  not  unprecedented  ; 
but  certainly  they  antedated  by  several  years  the 
supposed  novelties  designated  as  Leiter's  tubes. 

Dr.  Chamberlain  then  spoke  of  cold  as  an  antipy- 
retic, and  remarked  that  the  best  single  monograph 
in  the  use  of  cold  in  surgical  afTections  had  been 


written  by  Esmarch.  He  quoted  the  following  sen- 
tence to  show  the  high  estimation  in  which  the  use 
of  cold  was  held  Viy  that  writer  :  "  Of  all  the  means 
which  we  possess  for  limiting  the  inflammatory 
process,  I  regard  cold  as  the  most  available  and  most 
efficient,  and  without  it  I  would  rather  not  be  a 
surgeon." 

The  essential  feature  of  Dr.  Chamberlain's  ap- 
pliances was  the  circulation  of  water  through  coils 
of  rubber  tubing,  availing  himself  of  the  siphon 
pressure.  Coil  the  tubing  and  make  disks  of  varying 
size,  and  attach  one  end  to  a  piece  of  tubing  con- 
nected with  a  fountain  placed  at  sucii  height  as 
may  be  desirable.  He  had  apjilied  cold  by  this 
means  in  a  number  of  local  afl'ections  with  satis- 
factory results.  The  coils  possessed  a  certain  de- 
gree of  usefulness  in  the  treatment  of  the  heat  ff 
fever,  and  perhaps  might  be  available  in  cases  in 
which  objections  were  made  to  the  use  of  baths  or 
packs  or  Kibbee's  cot.  The  rapid  return  of  the 
heat,  after  the  use  of  the  cold  bath,  might  be  pre- 
vented by  the  use  of  the  coiLs.  He  had  found  the 
syjihon  principle  especially  serviceable  in  imgating 
the  internal  cavities,  such  as  the  stomach  and  blad- 
der. He  thought  that  the  coils  would  be  of  service 
in  the  application  of  cold  to  the  eye.  When  the 
coils  were  fastened  together  with  wire  tape  used  by 
milliners,  the  disk  or  plate  could  be  bent  so  as  to  fit 
•  any  portion  of  the  Iwdy. 

Dr.  Leale  said  that  he  was  present  at  the  meeting 
of  the  Medical  Journal  and  Library  Association  in 
1874,  when  Dr.  Chamberlain  made  his  demonstra- 
tions. 

Dr.  Vanderpoel  recollected  well  when  Dr.  Cham- 
berlain presented  the  same  subject  to  the  Medical 
Society  of  the  State  of  New  York.  [See  Transac- 
tions of  that  society  for  1873-74,  p.  16,  of  the  sec- 
ond part,  "  The  Application  of  Hydrostatic  Laws 
to  Therapeutics,"  by  Dr.  Chamberlain,  of  New  York. 
"  The  apparatus  consisted  of  rubber  tubing,  with  a 
nozzle  and  stop-cock  attached,  so  aiTanged  that  it 
will  conduct  fluid  from  a  vessel  above  upon  an  ob- 
ject below  its  level.  The  ajiparntus  can  be  used 
for  the  treatment  of  almost  all  forms  of  disease 
.  .  .  removal  of  foreign  bodies  from  the  ear ; 
treatment  of  diseases  of  the  eye ;  irrigation  of  the 
stomach,  etc."  Kep.]  He  sjjoke  of  the. superiority  of 
a  snft  mbber  tube  over  the  ordinary  stomach  tube  in 
irrigation  of  the  stomach.  It  needed  to  be  about 
five  feet  long,  could  be  introduced  with  the  gi-eatest 
ease,  and  with  it  there  was  no  danger  of  injuring 
the  mucous  membrane. 

The  President  regarded  this  method  of  applying 
cold  as  a  therapeutic  resource  that  could  be  made 
available  in  a  very  large  number  of  cases. 
Dr.  J.  D.  Brtant  then  read  a  paper,  entitled 

PERIOSTEAIi   PRESFRVATION  IN  AMPUr.VTION    OF   THE  LEG 
— ILLUSTRATED   BT   SPECIMENS. 

The  term  "periosteal  preservation"  was  used 
synonymously  with  "  periosteal  flaps,"  and  the  lead- 
ing feature  of  the  paper  related  to  the  question  of 
the  ability  of  healthy  periosteum,  when  separated 
from  healthy  bone,  to  produce  bone  having,  practi- 
cally, a  normal  texture.  Can  healthy  periosteum  be 
separated  from  healthy  bone  of  the  human  subject 
and  its  integrity  .so  preserved  that  it  will  produce 
bone?  Experiments  upon  the  lower  animals  answer 
in  the  affirmative.  In  the  human  subject,  however, 
operations  performed  with  this  question  in  mind 
have  not  proved  as  satisfactory.  That  bone  has 
been  found  connected  with  detached  periosteum  in 


470 


THE  MEDICAL  RECORD. 


the  human  subject  is  unquestionable,  but  it  has  not 
been  determined  positively  whether  it  was  removed 
with  the  periosteum  or  developed  from  it  subse- 
quently. Dr.  Bryant  then  directed  attention  to  the 
anatomy  of  the  periosteum,  and  its  ajiplication  to 
the  suViject  of  surgical  interference  in  cases  of  in- 
jury or  disease  of  bones.  He  reached  the  conclu- 
sion that  the  periosteum  can  be  detached  and  lione 
developed  from  its  inner  surface  sufficient  to  entitle 
the  fact  to  consideration  in  operative  surgery. 

In  the  second  place,  "  Is  this  secondary  growth 
of  bone  constant  in  its  occurrence,  durable  in  its  ex- 
istence, and  useful  to  the  patient?"  It  is  not  con- 
stant in  its  appearance  ;  although  the  rule  is  that 
production  of  bone  does  take  place.  If  proper 
precautions  hive  been  observed  new  bone  will  be 
produced  within  from  five  to  eight  months.  But  it 
is  not,  under  all  circumstances,  permanent.  It  is 
useful  to  the  patient,  as  shown  by  the  advantages  to 
be  gained,  such  as  preventing  necrosis,  atfording 
protection  from  the  discharges,  and  preventing  the 
adhesion  of  the  cicatrix  to  the  end  of  the  bone  after 
amputation.  After  considering  the  objections  urged 
against  psriosteal  flaps.  Dr.  Bryant  presented  speci- 
mens and  gave  the  history  of  two  cases.  In  one  the 
Hood,  in  the  other  the  circular,  flap  was  made.  The 
periosteum  was  raised  in  conjunction  with  the  soft 
p  irts  from  the  subcutaneous  surface  of  the  tibia. 
But  in  the  second  case  the  coaptation  of  tlie  flaps 
was  made  obliquely :  that  is.  in  a  line  parallel  with 
the  subcutaneous  surface  of  the  tibia,  and  therefore 
in  a  line  parallel  with  the  line  of  detachment  of  the 
periosteum  flaps  of  the  bone  from  which  it  had  been 
raised.  This  deviation  allowed  the  upper  portion 
of  the  flip  to  fall,  by  its  own  weight,  evenly  over  the 
divided  end  of  the  bone,  and  brought  the  cicatrix 
between  the  ends  of  the  two  bones.  The  patient 
was  able  to  wear  an  artificial  limb  at  the  end  of 
five  weeks  without  annoyaiice,  and  the  cicatrix  re- 
mained soft  and  movable.  On  examination  of  the 
specimen  the  periosteum  was  seen  to  be  evenly  at- 
t  iched  to  the  end  of  the  tibia.  There  was  no  tangi- 
ble evidence  of  the  production  of  bone.  The  end  of 
the  fibula  was  covered  with  fibrous  tissue  continu- 
ous with  its  structure. 

Db.  Stephek  Smith  described  his  method  of  form- 
ing the  periosteal  flaps,  which  consisted  in  making 
a  long  incision  tipon  the  posterior  part  of  the  leg, 
making  flaps  laterally,  throwing  them  back  about 
one  inch,  or  as  far  as  the  normal  curve  allows  them 
to  turn  back,  and  then  making  complete  circular 
section  of  muscle  and  bone,  ligate  all  the  ves- 
sels, and  then  turning  the  periosteal  flap  back  with 
the  entire  mass,  so  that  the  periosteum  and  the 
tissues  between  it  and  the  skin  are  entirely  undis- 
turbed. .Vfter  turning  the  periosteum  back  evenly 
to  the  point  whore  the  bone  is  to  be  divided,  the 
division  is  made  by  means  of  a  very  tine  saw,  in 
order  to  avoid,  to  the  greatest  extent  jiossible, 
injury  to  the  bono.  In  his  cases  he  had  never  used 
a  drainage-tube,  because  drainage  was  so  complete 
as  to  render  it  unnecessary.  Even  without  the  use 
of  anti.septics  less  suppuration  had  occurred  than 
after  amputation  by  the  ordinaiy  method.  The  ad- 
vantages of  the  operation  mentioned  by  Dr.  Biyant 
he  had  seen  very  decidedly,  especially  the  movable, 
soft  cicatrix,  which  will  boar  artiflci  1  limbs  without 
trouble,  and  very  early.  One  advantage,  not  men- 
tioned by  the  author  of  the  paper,  was  tliat  the  bone 
did  ii')t  atrnj)hy  and  become  spindle-shapod.  as  after 
an  amputation  by  thi'  old  inotliod.  .\  shinip  was  ob- 
tained which  had  a  great  deal  of  breadth  and  firm- 


ness. In  twenty  or  thirty  cases  he  had  seen  only 
two  accidents,  one  being  the  formation  of  a  spicula 
of  bone,  which  was  of  but  little  consequence,  and  the 
other  a  small  necrosis.  The  advantages,  immediate 
and  remote,  attending  the  saving  of  the  periosteum 
exceeded  by  at  least  fifty  per  cent,  any  results  he 
had  seen  olitained  by  the  old  operation. 
The  Academy  then  adjourned. 


NEW  YORK  SURGICAL  SOCIETY. 

Stated  Meeting,  February  14,  1882. 
(Coutinued  from  page  446.) 

Dr.  .T.  C.  Hutchison,  Vice-President,  in  the  Chair. 

Dr.  R.  F.  Weir  presented  a  urethra  which  illus- 
trated the  results  of 

INTERNAL   URETHROTOMY 

as  performed  by  Maissoneuve's  instrument.  The 
stricture  was  of  gonorrhoeal  origin,  and  was  a  close 
one,  admitting  originally  No.  5  Chanifere,  situated  in 
the  deep  portion  of  the  urethra,  just  anterior  to  the 
triangular  ligament.  It  was  divided  superiorly  with 
a  blade  11  mm.  in  breadth,  which  would  cut,  as  had 
been  determined  experimentally,  so  as  to  admit  a 
No.  2G  sound,  but  by  twisting.the  instrument  slight- 
ly, so  as  to  make  a  second  cut  in  withdrawing  it, 
the  opening  in  the  urethra  was  satisfactorily  en- 
larged. In  this  case  a  No.  34  sound  was  subsequently 
introduced,  after  all  inflammatory  action  had  sub- 
sided, as  tested  by  the  thermometer.  The  patient 
was  forty  years  of  age.  The  operation  was  performed 
January  19th,  and  he  died  February  12th.  from  peri- 
tonitis following  a  strangulated  hernia.  The  speci- 
men showed  the  two  cuts  in  the  roof  of  the  iirethra, 
one  larger  than  the  other,  and  each  nearly  entirely 
covered  by  a  delicate  cicatrix. 
Dr.  Weir  also  presented  a  specimen  of 

TRAUUATIC    ABSCESS   OP   THE   LIVER, 

with  the  following  history. 

William  O ,  thirty-four  years  of  age,  single, 

was  admitted  to  Bellevue  Hospital,  Januaiy  16,  1^82. 
Twelve  days  before  admission  he  slipped  on  ice 
and  feU,  striking  on  his  buttocks,  and  six  days  later 
was  obliged  to  quit  work  and  take  to  his  bed. 

On  entering  the  hospital  his  general  condition 
seemed  quite  good.  He  became,  however,  giadu- 
ally  weaker,  and  during  the  first  night  was  slightly 
delirious.  The  delirium  continued  constantly  after 
the  first  night,  though  he  could  be  aroused  suffici- 
ently to  answer  questions.  Temperature,  when  ad- 
mitted, 101^    F. 

On  the  afternoon  of  the  10th,  and  again  on  the 
17th,  a  hypodcmiic  needle  was  introduced  into  a 
tumor  which  he  had  in  the  hepatic  region,  and  a 
bloody  looking  fluid  evacuated,  which,  upon  micro- 
scopic examination,  was  found  to  contain  few  or  no 
blood-globnles,  but  ipnte  a  number  of  pus-ceUs  and 
some  granular  material. 

On  January  18th  tumor  was  aspirated  and  sixteen 
ounces  of  fluid  extracted,  which  was  very  viscid  and  of 
reddish  brown  color.  Microscopic  examination 
showed  large  polygonal  cells,  which  contained  fat  and 
yellow-looking  granules,  bacteria,  no  well-formed 
cells  of  any  description,  blood-globules,  and  dctiilus. 

Dr.  Welch,  who  made  the  examination,  suj)i)osed 
the  patient's  trouble  to  be  from  an  abscess  of  the 
liver. 

On  January  19th  Dr.  Weir  introduced  a  trocar,  and 


THE  MEDICAL  RECORD. 


471 


the  camila  was  left  in  the  cavity  to  secure  maximum 
freedom  of  drainage.  Some  twenty  or  twenty-five 
ounces  of  fluid  were  removed.  The  operation  was 
done  under  the  carbolic  acid  spray ;  and  the  aVido- 
men  was  covered  with  an  antiseptic  dressing.  Tlie 
dressings  were  changed  three  times  during  the 
night,  and  subsequently  as  often  as  any  sign  of  dis- 
charge was  discovered  about  the  edges. 

On  January  21st  the  canula  was  removed,  and  a 
drainage-tube  of  large  size  substituted. 

The  patient  died  of  heart  failure  and  pulmonaiy 
oedema,  at  8.50  p.m.,  January  2'2. 

Dr.  Weir  also  presented  a  specimen  of 

LACERATION     OF     THE     CESOPHAGUS,     ABSCESS     OF     THE 
NECK   AND  MEDIASTINUM, 

with  the  following  history,  furnished  by  Dr.  F.  M. 
Towuseud,  house  surgeon  at  the  New  York  Hospital: 

J.  A.  H ,  thirty-five  years  of  age,  while  eating  meat 

felt  some  foreign  substance,  which  he  believed  to 
be  bone,  lodge  in  his  thi-oat.  He  was  unable  to  dis- 
lodge it,  and  pain  and  difficulty  of  swallowing  soon 
developed,  with  tenderness  upon  the  right  side  of 
the  neck.  He  was  unable  to  swallow  solids,  and 
fluids  only  with  more  or  less  difficulty.  Ou  the  fol- 
lowing day  a  physician  was  called,  who  explored  the 
throat  with  his  finger,  but  was  unable  to  detect  any 
foreign  body.  An  emetic  was  given  but  nothing  was 
dislodged  from  the  throat.  The  throat  was  then 
explored  with  a  sponge  prohang,  but  with  negative 
results.  On  the  third  day  the  symptoms  had  some- 
what subsided,  and  the  patient  could  again  take 
fluid  food.  Ou  the  fourth  day  the  patient  felt  as 
though  the  body  had  disapj^eared  from  hi.s  throat, 
but  he  was  still  unable  to  swallow  solids  ;  and  on  the 
evening  of  that  day  a  swelling  of  the  neck  was 
noticed,  which  increased  on  the  fifth  day,  and  most 
of  the  previous  symptoms  returned.  The  pain  and 
tenderness  increased  ;  the  swelling  increased  in  size, 
and  on  the  sixth  day  the  patient  had  a  well-marked 
chill,  followed  by  fever  and  sweating.  Difficulty  of 
breathing  became  a  prominent  symptom.  On  the 
seventh  day  the  patient  had  the  second  chUl,  and 
the  severity  of  all  the  symptoms  was  increased.  On 
the  evening  of  the  seventh  day,  the  dyspnoea  became 
extreme,  and  several  laryngeal  spasms  occurred.  On 
admission,  seven  days  after  the  accident,  he  com- 
plained of  severe  pain,  refeiTed  to  the  right  side  of 
the  neck,  had  marked  dvsimiiea  ;  respirations,  40  ; 
pulse,  130;  and  temperature,  102i'ii°  F.  Breathing 
laryngeal.  He  was  unable  to  swallow  either  solids 
or  fluids.  There  was  a  sen,sation  of  general  pres- 
sure upon  both  the  wind]>ipe  and  throat.  There 
was  marked  swelling  of  the  tissues  of  the  neck, 
especially  upon  the  right  side ;  enlargement  of 
glands  under  the  jaw  ;  the  head  was  thrown  back  ; 
the  mouth  was  held  ojien.  The  integument  was 
tense,  and  the  tissues  beneath  it  boggy  and  red- 
dened, and  the  parts  were  very  tender.  Laryngo- 
scopic  examination  negative,  except  that  the  tissues 
of  the  pharynx  and  larvnx  were  (edematous  and  red. 
The  dvspnoea  increased  in  severity  ;  cyanosis  was 
marked  ;  respirations  were  50  ;  temperature,  103^," 
P.;  swelling  increasing,  and  several  laryngeal 
spasms  occurred. 

At  4  P.M.  February  11th  ether  was  administered, 
the  neck  extended  and  the  head  turned  to  the  right, 
and  an  incision  was  made  by  Dr.  Weir,  beginning 
opposite  the  thvroid  cartilage — left  side — midway 
between  it  and  the  sterno-mastoid  mu.scle,  extending 
parallel  with  that  muscle  for  about  three  inches  to 
the  sternum,  and  dividing  the  skin,  superficial  fas- 


cia, and  platysma.  The  dissection  was  continued 
through  the  swollen,  dark-colored  tissues  until  the 
gi'eat  vessels  of  the  neck  were  reached,  which  were 
drawn  to  the  outer  side  with  retractors,  while  the 
tissues  on  the  inner  side  were  drawn  in  an  opposite 
direction.  The  anterior  jugular  vein  was  divided 
in  the  dissection  and  ligated.  A  small  artei-y  was 
also  cut  and  ligated.  The  deeper  tissues  of  the 
neck  were  found  to  be  infiltrated  with  pus,  having 
a  very  fetid  odor,  and  several  small  pus-cavities 
were  opened.  The  dissection  was  continued  tbicugh 
the  sloughing  cellular  tisfue,  until  the  asophfigus 
was  reached,  when  a  search  was  made  for  the  for- 
eign body,  but  it  was  not  to  be  felt.  A  stomach- 
tube  was  introduced  through  the  pharynx  and  car- 
ried to  the  stomach,  but  no  foreign  substance  was 
encountered,  nor  could  anything  abnormal  be  felt 
in  the  o'sojihageal  wall  while  the  tube  was  in  situ. 
Further  interference  was  deemed  inadvisable,  the 
I^atient's  breathing  having  become  easier.  A  fenes- 
trated drainage-tube  of  large  ^ize  was  inserted  to 
the  bottom  of  the  wound,  and  the  parts  left  open. 
The  patient  rallied  from  the  ether  slowly,  remain- 
ing semi-unconscious  for  .several  hours.  During 
the  early  part  of  the  evening  he  breathed  easier,  the 
relief  being  apparently  due  to  removal  of  pressure. 
The  pulse,  temperature,  and  respiration  were  not 
materially  changed.  Laryngeal  spasms,  however, 
occurred  later  in  the  evening,  ard  incressed  in  se- 
verity and  frequency,  the  general  condition  of  the 
patient  became  markedly  worse,  and  at  11  p.m.  the 
patient  was  again  etherized  and  laryrgctrmy  was 
performed.  After  a  somewhat  tedious  dissection 
through  oedematous  tissues,  the  thyrohyoid  mem- 
brane was  reached  and  the  larynx  opened,  the  pa- 
tient in  the  meantime  having  had  a  laryngeal  spasm, 
and  death  from  asphyxia  was  imminent.  Artificial 
respiration  was  performed,  and  brepthirg  rgain  es- 
tablished. The  hemonhage  was  quite  profuse,  the 
blood  finding  its  way  into  the  larynx  atd  causing 
mTich  irritation.  It  was  not  readily  controlled  by 
pressure.  The  patient  rallied  from  the  ether  more 
promptly  than  after  the  previoais  operation,  and 
for  twelve  hours  afterward  decidedly  imjiroved,  but 
after  that  time  grew  steadily  worse,  and  died  on 
Febiiiary  13th,  at  1.30  p.m.,  with  a  temperature  of 
106°,  which  reached  afterward  107 ,-,1°  F. 

At  the  autop.sy  there  was  found  a  small  quantity 
ofpus  at  the  upper  part  of  the  anterior  mediastinum. 
There  was  marked  oedema  of  the  right  side  of  the 
epiglottis.  Just  below  the  cricoid  cartilage  were 
two  small  openings  in  the  anterior  wall  of  the  oeso- 
phagus, which  communicated  with  the  deep  fascia 
of  the  neck,  and  through  it  to  the  external  wound. 
There  was  pus  in  the  intermuscular  planes  on  both 
sides  of  this  region.  The  trachea  contained  foul 
pus  opposite  the  site  of  the  openings  in  the  oesopha- 
gus, its  mucous  membrane  was  red,  but  there  was 
no  opening,  and  no  foreign  body  w.as  found. 

The  left  lung  contained  a  cavity  at  its  apex  as 
large  as  a  walnut,  and  had  thick  walls,  with  patches 
of  peribronchial  thickening  in  the  neighborhood. 

The  society  then  proceeded  to  the  transaction  of 
miscellaneous  business. 


BEQrEST  TO  DAETMOrTH  Medical  Coi.lege. — The 
late  Edwin  Btoughton  left  a  bequest  of  .?2,000  to  the 
7iathological  museum  of  Dartmouth  College.  He 
had  previously  given  about  ?12,000  to  this  museum, 
which  goes  by  his  name. 


472 


THE  MEDICAL  RECORD. 


MEDICAL  SOCIETY  OF  THE  COUNTY  OF 
NEW  YOEK. 

Stated  Meeting,  April  24,  1882. 
Dr.  F.  K.  SiuRGia,  Pbbsident,  in  the  CHArR. 
Dr.  a.  D.  Rockwell  read  a  paper,  entitled, 

OBSERVATIONS  ON  HEMTPLEGIA,  BASED  ON  EIGHTY- 
ONE  RECORDED  CASES,  WITH  SPECIAL  REFERENCE  TO 
CEREBRAL  LOCALIZATION  (868  p.  452). 

Dr.  E.  C.  Sequin  remarked,  with  reference  to 
blindness  with  hemiplegia,  in  which  recovery  took 
place  after  treatment,  that  it  seemed  to  him  the 
cases  were  more  important  for  clinical  study  than 
for  a  scientific  discussion  of  the  question  of  local- 
ization, because  of  the  lack  of  ophthalmoscopic  ex- 
amination. 

Another  point  was  with  reference  to  Dr.  Kock- 
■wsll's  statement  that  the  special  senses  were  not 
connected  with  the  hemispheres. 

At  the  present  time  it  seemed  that  there  was  cu- 
mulative evidence  to  show  that  a  connection  did 
exist.  Experiments  upon  animals,  at  least,  were 
very  conchisive  that  destruction  of  certain  portions 
of  the  parietal  and  occipital  lobes  will  produce  bi- 
lateral nearsightedness  and  blindness,  and  also  deaf- 
ness. 

With  reference  to  audition  in  man,  there  were 
exceedingly  few  cases  in  favor  of  the  existence  of 
any  such  connection.  One  was  that  reported  by  Dr. 
A.  B.  Ball  and  himself,  where  there  was  a  peculiar 
form  of  aphasia.  At  one  time  the  aphasia  was  com- 
plete ;  btit  after  a  while  the  ataxic  element  passed 
away,  and  in  a  great  measure  the  patient  recovered 
his  capacity  to  read  and  understand,  but  never  re- 
covered the  power  of  hearing.  He  could  hear  single 
words,  and  even  a  simple  sentence,  but  continuous 
remarks  were  a  meaningless  jumble  to  him. 

Autopsy  sliowed  the  only  lesion  of  the  brain  to 
be  in  the  inferior  part  of  the  parietal  lobe,  extend- 
ing well  down  toward  the  occipital  and  sphenoidal 
lobes,  and  consisted  of  a  patch  of  softening  which 
destroyed  a  considerable  area  of  gray  matter  and 
some  adjacent  white  matter,  approximating  very 
closely  the  area  of  special  senses. 

With  reference  to  the  cortex,  the  evidence  was 
simply  growing,  and  just  now  it  was  impossible  to 
make  any  correct  statement  with  regard  to  man. 

CALCItlM   SULPHIDB   AS   AN   ASTISUPPDRATIVE. 

Dr.  A.  H.  Smith,  President  of  the  Therapeutical*  So- 
ciety, then  presented  the  report  of  the  Committee  on 
Restoratives  on  the  above  subject.  The  report  was 
based  upon  fiftv-one  cases  in  which  the  drug  had 
been  used  by  Drs.  W.  T.  Alexander,  Geo.  Baylis, 
H.  T.  Hanks,  D.  M.  Cammann,  Austin  Flint,  V.  P. 
Gibney,  T.  H.  Burch,  Robert  Amory,  of  Brookliue, 
Mass.,  and  communications  from  Drs.  G.  H.  Swasey, 
E.  C.  Seguin,  and  Binsham,  of  Burlington,  Vermont. 
A  sketch  of  the  history  of  the  drug  had  been  fur- 
nished by  Dr.  John  C.  Peters.  The  afToctions  in 
which  it  had  been  employed  wore  pustular  acno, 
chanchroidal  bubo,  furuncle,  purulent  o|ihthalmia, 
otorrhoea,  tonsillitis,  8U])purative  endometritis,  ax- 
illary abscess,  mammary  abscess,  phlegmonous  peri- 
arthritis, phlegmon  of  the  neck,  hordeolum,  bromic 
acne. 

The  report  contained  the  following  conclusions  : 
First. — Tn  many  cases  of  suppurative  aftbctions 
ranging  from  simple  pustules  of  acne  to  extensive 
suppuration  certainly  an  appreciable,  often  a  marked 


benefit  is  derived  from  the  use  of  calcium  sulphide. 
At  the  same  time  its  action  is  not  uniform. 

Second. — The  drug  is  somewhat  prone  to  irritate  the 
stomach,  therefore,  small  doses,  frequently  repeated, 
should  be  used,  and  one-tenth  grain  every  two  hours 
in  acute  cases,  is  an  average  dose,  although  larger 
doses  may  be  required.  Some  patients  may  bear 
well  one  grain  three  times  a  day.  Patients  are  more 
or  less  annoyed  with  emctations  of  sulphuretted  hy- 
drogen while  taking  the  drug. 

The  report  being  before  the  society.  Dr.  David 
Webster  said  that  he  had  used  calciiim  sulphide  in 
two  cases  of  suppurative  disease  of  the  ear,  and,  as 
he  thouglit,  with  marked  benefit.  He  gave  it  in 
one-fourth  to  one-half  grain  doses  four  times  a  day. 
One  was  a  case  of  acute  otitis  media  occurring  dur- 
ing recovery  from  typhoid  fever.  The  other  was  a 
case  of  suppurative  inflammation  of  the  middle  ear, 
with  considerable  swelling  over  the  mastoid  region, 
constant  pain  in  the  ear,  and  such  a  condition,  as,  a 
few  years  ago  at  least,  would  have  almost  demanded 
Wilde's  incision.  The  patient  was  a  badly  nourished 
girl,  and  was  seen  in  consultation  with  Dr.  Lough- 
lin.  The  calcium  sulphide  was  recommended  and 
the  benefit  was  veiy  marked  and  rapid  in  both  cases. 
He  had  used  the  drug  in  other  cases  without  bene- 
fit. 

Dr.  a.  W.  Waeden  had  used  the  drug  in  middle- 
ear  disease  with  some  benefit,  but  had  obtained  the 
best  results  in  adenitis.  He  asked  conceraing  the 
physiological  effects  of  the  drug,  and  with  reference 
to  its  administration  to  the  old  or  the  young. 

Dr.  Sexton  had  been  specially  interested,  while 
listening  to  the  reports  of  some  of  the  speakers, 
particularly  his  friend  Dr.  WeVister,  who  at  onetime 
had  no  faith  in  the  efiicacy  of  the  drug.  As  to  the 
age  of  the  patient,  he  had  given  it  to  children  as 
young  as  one  and  two  months  old,  and  without  any 
evidence  whatever  of  deleterious  effects.  He  had 
employed  the  drug  six  or  seven  years  in  aural  prac- 
tice, and  the  preparation  which  he  preferreil  for 
children  was  the  trituration  of  the  hepar  sulphur 
with  sugar  of  milk.  Fuller's  tablets  reduced  to 
powder  might  be  used.  Dr.  Sexton  then  referred 
briefly  to  cases  in  which  the  drug  had  afforded 
prompt  and  marked  relief;  for  example,  abscesses 
over  the  mastoid  process,  middle-ear  disease,  and 
quinsy.  In  some  cases  he  had  thought  that  too 
large  doses  had  been  given,  and  he  had  frequently 
reduced  the  size  from  one-half  to  one-fourtli  of  a 
grain.  He  had  not  always  obtained  the  best  results 
in  acute  eases,  but  in  general  the  subacute  cases 
had  yielded  the  most  satisfactory  results. 

Dr.  H.  G.  Pipfabd  referred  to  the  fact  that  prob- 
ably pure  sulphide  of  calcium  had  not  been  used,  a 
fact  which  wis  readily  explained  by  the  im|)uritie8 
present  in  the  substances  used  in  its  preparation, 
and  the  instability  of  the  compound  when  made 
pure.  The  fact  that  there  is  such  a  difference  in  the 
preparations  sold  under  the  name  calcium  sulphide 
doubtless  explains  some  of  the  failures  eiu'onnt- 
ered  in  its  use.  The  antidotal  acticm  upon  mercury 
was  the  first  therapeutic  etTect  of  the  drug  noticed, 
and  at  one  time  it  had  an  extensive  reputation 
as  an  anti-merourial.  Its  use  in  furuncle  was 
first  mentioned  probably  hy  the  homoeopaths.  Sub- 
sequentlv  Ringer  brought  the  siilphides  forward 
as  remedies  to  be  used  for  the  arrest  of  suppuration. 
In  this  citv  Dr.  Sexton  was  the  first  to  use  the  cal- 
cium sulphide  in  suppurative  otitis,  and  he  himself 
was  the  first  to  use  it  in  suppurative  luibo.  He 
thought  there  was  no  doubt  that,  in  acute  inflam- 


THE  MEDICAL  RECORD. 


473 


matory  processes,  the  drug  was  efficacious  in  abort- 
ing aad  arresting  suppuration. 

Dr.  O.  B.  Douglas  reported  two  cases — one  of 
submaxillary  abscess  following  scarlet  fever,  in  which 
the  remedy  was  used  with  benefit ;  the  other,  pus- 
tules upon  various  parts  of  the  body  following  vac- 
cination, in  which  the  drug  was  taken  without 
result.  Dr.  Douglas  also  read  a  letter  received 
from  Dr.  Robert  Amory,  of  Brooklme,  Mass.,  in 
which  was  given  some  evidence  that  esi:)osure  to  the 
fumes  of  the  bisulphide  of  carbon  was  liable  to  be 
followed  by  the  occurrence  of  fm-uncles. 

Dr.  Piff.\kd  remarked  that  the  physiological 
effect  of  the  drug  in  large  doses,  mentioned  in 
"Hahnemann's  Materia  Medica,"  was  the  produc- 
tion of  furuncles ;  but  the  evidence  was  so  discon- 
nected as  to  seem  to  be  unreliable.  While  experi- 
menting with  sulphide  of  potassium  and  other 
sulphides,  for  the  purpose  of  ascertaining  what  the 
active  agent  was  in  the  comi>ound,  he  had  seen 
some  evidence  which  pointed  toward  the  same  con- 
clusion ;  and  it  would  seem  that  Dr.  Amory's  observa- 
tions had  carried  him  in  the  same  direction. 

The  discussion  being  closed,  the  Secretary  was 
empowered  to  furnish  credentials  to  members  who 
are  qualified  to  hold  office,  and  desire  to  attend  the 
American  Medical  Association  as  delegates. 

The  Secretary  requested  the  members  to  notify 
him  at  once  of  change  of  address,  in  order  that  his 
report  to  the  Secretary  of  the  State  Medical  Society 
might  be  completed  immediately. 

The  society  then  adjourned. 


Corrcspontraicc. 


LACERATION  OF  CERVIX  UTEEI. 

To  THE  Editor  of  The  Medical  RECono. 
Deab  Sir  :  I  herewith  enclose  you  the  paper  which 
I  read  at  the  London  Medical  Congress  on  "  Lace- 
ration of  the  CerVix  Uteri,"  extracted  from  the 
British  Medical  Journal  of  No<-ember  26,  1881,  and 
would  beg  you  to  publish  it  in  extenso,  as  soon 
as  possible  It  is  the  best  reply  I  can  give  to 
the  untruthful  and  therefore  unjustifiable  state- 
ments made  by  Dr.  Fallen  in  your  number  of  Feb- 
ruary 25th,  which  my  friend,  Dr.  Marion  Sims,  has 
jint  pl.iced  in  my  hands.  I  have  read  this  letter 
with  feelings  of  amazement  and  indignation.  To 
utter  the  drivelling  idioms  which  Dr.  Fallen  im- 
putes to  me  in  the  discussion  that  followed  the 
reading  of  my  paper,  I  must  have  been  laboring 
under  senile  softening  of  the  brain,  an  imputation 
that  the  writing  of  the  paper  itself  negatives.  Not 
one  of  Dr.  Fallen's  statements  respecting  my  utter- 
ances in  the  debate  is  true,  and  I  appeal  to  the  very 
physicians  present  whom  he  names  as  corroborative 
witnesses  of  what  I  assert.  In  commenting  on  my 
paper.  Dr.  Fallen  commenced  by  speaking  in  eulo- 
gistic terms  of  my  early  gynecological  writings, 
thereby  much  moliifying  me,  and  making  me  very 
anxious  to  show  even  more  forbearance  and  cour- 
tesy than  I  had  done  before.  He  went  on  to  state 
that  I  had,  however,  neglected  to  follow  the  recent 
progress  of  uterine  surgei'v,  and  that  if  I  would 
come  to  his  hospital  in  New  York  he  would  show 
me  his  operations  and  prove  to  me  the  correctness  of 
his  opinions.  As  far  as  my  memory  serves  me,  these 
were  the  only  "  arguments "  he  used — arguments 
not  very  likely  to  convert  the  author  of  such  a  paper 


as  the  one  I  had  just  read,  founded  on  the  personal 
experience  of  forty  years.  In  my  reply  1  stated  that 
I  had  not  condemned  or  negatived  the  new  opera- 
tion for  cervical  laceration ;  that  1  admitted  that  it 
might  be  a  desirable  one  in  some  extreme  cases  of 
deep  laceration,  with  lobular  segments,  such  as  Dr. 
Emmet  had  figured  in  his  work.  I  maintained, 
however,  that  this  operation  was  not  a  scientific 
progress  presented  as  Dr.  Fallen  had  presented  it 
m  his  paper  read  at  Cambridge  in  1881.  Such  an 
operation  was,  I  considered,  totally  unjustifiable  in 
the  immense  majority  of  cases  in  which  Dr.  Fallen 
advised  it  and  said  he  had  periormed  it.  As  I  no 
longer  practice  operative  surgery  1  left  it,  however, 
to  my  juniors  to  fix  the  legitimate  limits  of  the 
operation.  I  added  that  it  was  true,  as  all  who 
knew  my  works  were  aware,  that  my  time  and 
thoughts  had  been  thrown  by  invalidism,  for  many 
years,  into  other  channels.  At  the  same  time  I  had 
always  continued  to  take  the  liveliest  interest  in 
gynecology,  and  continued  to  practice  it  actively, 
until  a  few  years  ago,  in  London  in  the  summer,  and 
was  still  practicing  as  a  gynecologist,  much  con- 
sulted, at  Mentone,  on  the  Genoese  Kiviera,  in  the 
winter.  I  remember  well  that  1  concluded  my  reply 
by  stating  that  Dr.  Fallen  need  not  be  so  angry  with 
me  for  criticizing  his  doctrines,  as  I  thereby  gave 
him  the  opportiinity  of  ventilating  them,  but  that 
to  establish  them  in  Great  Britain  he  would  have 
not  only  to  convert  me,  but  every  gynecologist  in 
the  country. 

In  this  reply  there  was  no  recanting,  no  contri- 
tion, no  expression  of  regret — in  a  word,  no  drivel- 
ling. So  far  from  retracting  the  opinion  embodied 
in  my  paper,  I  now  endorse  every  word  therein 
contained.  Moreover,  I  now  add  that  my  ojunions 
on  the  subject  are  more  decided  than  those  ex- 
pressed in  my  paper,  in  which  they  are  toned 
down — softened  by  a  feeling  of  courtesy  which  I 
now  perceive  was  lost  on  Dr.  Fallen.  I  now  state 
emphatically  that  I  consider  his  doctrines,  as  con- 
tained in  the  paper  read  at  the  Cambridge  meeting 
of  the  British  Medical  Association,  as  adding  new 
terrors  to  the  natural  pangs  of  parturition,  as  an 
outrage  on  uterine  surgery,  utterly  unfounded  on 
pathological  facts. 

That  I  am  not  alone  in  this  opinion  will  be  shown 
by  an  extract  from  the  Faris  Journal  de  Medhine  et 
de  Chirxtrgie  Pratiques,  a  much-esteemed  journal 
edited  by  M.  Lucas  Champonnifcre,  a  young  and 
rising  hospital  surgeon.  In  the  number  for  Sep- 
tember, 1881,  giving  an  account  of  the  London 
Medical  Congress,  the  editor  says,  p.  387  : 

"  In  the  obstetrical  section  the  discussion  was  on 
modern  surgical  interferences,  the  total  ablation  of 
the  cancerous  uterus  (Freund's  operation),  the  abla- 
tion of  the  healthy  ovaries  (Battey's  operation),  the 
suture  of  the  lacerated  uterine  neck  (Emmet  s  ope- 
ration); we  only  speak  of  the  last  known  surgical 
voperations.  Gynecology  is  the  field  of  an  oijerating 
debauch  (d'une  debauchf  oi:)eratoire)  which,  fortu- 
nately, now  and  then  finds  opponents.  An  excel- 
lent paper  of  Dr.  Henry  Bonnet's  has  beaten  a  breach 
in  a  most  serious  manner  in  this  oj^eration  of  Em- 
met's, which  is  so  abused  that  in  fifty  women  on 
whom  it  is  performed  there  is  scarcely  one  that  wants 
it.  This  does  not  mean  that  it  should  never  be 
practiced." 

I  remain,  sir. 

Very  truly  yours, 

J.  Henrt  Bennet. 
Mentoke,  France. 


474 


THE  MEDICAL  RECORD. 


PHAJRMACODYNAMICS. 

To  THE  Editor  of  The  Medical  BEconD. 
Sm :  The  action  of  drugs  and  their  uses  is  one  of 
the  most  important  subjects  to  which  the  attention 
of  the  medical  practitioner  of  the  present  day  can 
be  directed.  Whatever  may  be  our  theories  con- 
cerning a  given  pathological  condition,  however 
varied  the  opinions  of  physicians  as  to  either  im- 
mediate or  remote  causes,  we  must  find  some  com- 
mon ground  on  which  to  fix  our  principles  of  treat- 
ment ;  and  he  to  whose  good  judgment  is  superadded 
the  most  general  and  exhaustive  knowiedg3  of  drugs 
in  all  their  uses,  whether  given  in  large  or  small 
doses,  will  be  sure  to  meet  with  the  greatest  success 
in  the  treatment  of  disease. 

All  medicines  hare  a  positive  and  a  negative  ac- 
tion. As  the  amount  given  is  either  much  or  little, 
so  its  ojieratiou,  positive  or  negative,  will  be  found 
to  correspond  to  this  variation  in  strength  of  dose. 

Opium  in  large  doses  is  a  powerful  narcotic — when 
given  in  small  doses  it  becomes  a  valuable  stimulant. 
Mercury  is  a  cholagogue  cathartic  when  given  in 
large  doses,  while  very  small  doses  of  this  drug  re- 
lieve a  similar  condition  of  the  "  prima  via  "  aris- 
ing from  other  causes.  Large  do.ses  of  ijjecac  vriW 
produce  vomiting  and  dysenteric  diarrhoea.  This 
condition,  Dr.  Kinger  tells  us,  will  generally  yield 
to  hourly  drop  doses  of  ijiecacuanha  wine. 

"  Tartar-emetic  "  and  veratrum  viride,  in  like  man- 
ner, when  given  in  very  small  doses  will  relieve 
those  pithological  conditions  which  most  nearly 
correspond  to  their  toxic  effects. 

The  same  theraj^eutic  principle  prevails  in  refer- 
ence to  all  drugs  whose  action  has  been  carefully 
and  thoroughly  investigated  and  ascertained.  To 
no  single  school  of  medicine  are  we  wholly  indebted 
for  whatever  of  knowledge  we  possess  concerning 
this  subject  of  pharmacodynamics ;  and  the  result 
of  this  long-continued  and  thoughtful  research  on 
the  part  of  unprejudiced  minds  seeking  only  to  find 
a  truth,  has  l^een  to  bring  all  such  investigators 
nearer  the  same  conclusions. 
....  As  all  streams  finally  pour  their  waters  into  one 
common  ocean,  so  the  tendency  of  all  intelligent 
and  unsellish  thought  concerning  a  con-ect  knowl- 
edge of  drags  and  their  uses  is  toward  the  common 
ground  of  the  co-worker  in  the  grand  scheme  of 
how  to  best  mitigate  or  relieve  the  suS'erings  of  hu- 
manity. Headland,  in  his  introductory  remarks 
upon  the  science  of  therapeutics,  thus  emphasizes  the 
importance  of  united  effort :  "  While  other  sciences 
are  moving  and  other  inquiries  progressing  fast, 
this  subject,  so  momentous  in  its  ajjplicatious,  has, 
in  spite  of  the  earnest  labors  of  a  few  talented  in- 
vestigators, made  after  all  but  small  progress.  Let 
but  those  who  feel  this  want  bestir  themselves  to 
remove  it,  and  it  will  soon  be  done.  Those  doubts 
and  difficulties,  which  are  now  slowly  clearing  away 
before  the  efforts  of  a  few,  will  then  be  linally  dis- 
pelled by  the  united  energies  of  all  :  and  instead  of 
our  present  indecision  and  uncertainty  on  nmny 
points,  we  shall  find  ourselves  eminently  iiualitied  to 
wage  the  conflict  with  disease,  being  skilled  in  that 
science  whose  name  bespeaks  its  peculiar  impor- 
tance." 

For  want  of  a  better  term,  I  have  denominated  as 
positive  and  negative  the  action  and  effect  of  medi- 
cines when  administered  in  comparatively  large  or 
small  dose.i ;  and  the  lesson  w-hich  we  must  surely 
sDoner  or  later  learn  from  that  infallible  source  of 
facts,  experieuce,  will  teach  us  that,  to  be  true  to 


our  high  calling  as  members  of  one  of  the  noblest 
professions,  we  must  not  be  indifferent  to  the  truth, 
though,  at  times,  it  may  seem  to  have  its  origin  in  a 
professional  Nazai-eth. 

The  recognition  of  a  positive  and  negative  princi- 
ple in  therapeutics  is  not  of  recent  date.  We  find 
in  the  writings  of  Gregory  the  Great,  the  following 
proposition  :  "Mos  medicinte  est  ut  aliquando  simi- 
lia  similibus,  aliquando  contraria  contrariis  curet." 
And  he  further  adds:  "Nam  s;«pe  calida  calidis, 
fiigida  frigidis,  sse]^©  autem  frigida  calidis,  calida 
frigidis  sanare  consuevit." 

The  two  most  important  factors  in  the  solution  of 
this  problem  of  pharmacodynamics  are  found,  the 
one  in  the  course  of  investigation  pursued  by  so- 
called  "  allopathists,"  the  other  in  the  "provings" 
of  Hahnemann  and  his  followers ;  and  so  zealous 
have  been  these  workers  in  their  search  for  hidden 
treasure,  and  so  closely  have  their  courses  run  that 
they  have  at  times  occasionally  labored  on  the  same 
vein,  and  each  in  their  turn  considered  themselves 
the  discoverers  of  that  which  was  already  known  to 
the  other,  though  called  by  a  different  name. 

Finally,  a  careful  review  of  the  past,  and  an  hon- 
est, thoughtful  consideration  of  present  methods  of 
medical  theory  and  practice,  must  convince  us  that 
only  by  unity  of  effort  can  we  possibly  attain  to  that 
strength  of  knowledge  coneemingthe  various  actions 
and  uses  of  medicines,  so  necessary  to  the  judicious 
and  successful  treatment  of  all  forms  of  disease. 

Almon  S.  Allen,  M.D. 
40  Lee  Avenue,  Brooklyn,  N.  T. 


ARMY  NEWS. 

Official  List  of  Chavges  of  Statioyis  and  Duties  of  Offi- 
cers of  the  Medical  Departmetit.  United  States  Army, 
from  April  16,  1882,  to  A2>ril  22,  1882. 

Greenleaf,  Chas.  B.,  Major  and  Surgeon.  In 
accordance  with  Par.  12,  S.  O.  78,  0.  S.,  from  head- 
quarters of  the  army,  relieved  from  duty  in  this  De- 
partment. S.  O.  57,  Department  of  Dakota,  April 
11,  18S2. 

Gardner,  W.  H.,  Captain  and  Assistant-Surgeon. 
His  assignment  to  duty  at  Fort  McKavett,  to  relieve 
Surgeon  ^^'ate^s,  revoked,  and  to  report  to  the  Com- 
manding OlKcer,  Fort  Davis,  Texas,  for  duty  as 
Post  Surgeon.  S.  O.  38,  Department  of  Texas, 
April  14,  1882. 

Lauderdale,  J.  V.,  Captain  and  Assistant-Sur- 
geon. Par.  1,  S.  O.  47,  C.  S.,  from  these  headquar- 
ters, in  regard  to  him,  revoked  ;  and  he  will  i)roceed 
to  Fort  Sully,  D.  T.,  and  report  to  the  Commanding 
GiBcer  of  that  post  for  duty.  S.  O.  59,  Department 
of  Dakota,  April  l.^,  1882. 

Brown,  P.  K.,  Captain  and  Assistant-Surgeon.  To 
be  relieved  from  duty  in  Department  of  Texas.  On 
receipt  of  this  order  to  proceed  to  Now  York  City, 
and  on  an-ival  report  bv  letter  to  the  Surgeon- 
General.     S.  O.  88,  A.  G.'O.,  April  17,  1882. 

FiNiiET,  J.  A.,  Captain  and  .\ssistant-Surgeon. 
Relieved  from  duty  at  Fort  Concho,  Texas,  and  as- 
signed to  duty  as  Post  Surgeon  at  Fort  McKavett, 
Texas,  relieving  Surgeon  Walters.  .  S.  O.  38,  C.  S., 
Department  of  Texas. 

KiLBOuuNE,  H.  S.,  Captain  and  .\ssistant-Surgeon, 
having  reported  in  person  at  these  headquarters, 


THE  MEDICAL  RECORD. 


475 


will  proceed  to  Fort  Sbaw,  Mont.  T.,  and  report  to 
the  Commanding  Officer  of  tliat  post  for  duty.  S.O. 
60,  Department  of  Dakota,  April  li,  1882. 

CoRBUsiER,  Wm.  H.,  Captain  and  Assistant-Sur- 
geon. Assigned  to  duty  as  Post  Surgeon  at  Fort 
MacKinac,  Mich.  S.  O.  67,  Department  of  the  East, 
April  15,  1882. 

DA^^s,  Wm.  B.,  Captain  and  Assistant-Surgeon. 
So  much  of  Par.  12,  S.  O.  78,  April  5,  1882,  from 
A.  G.  O.,  as  directs  him  to  report  for  duty  to  the 
Commanding  General,  Department  of  the  Platte,  is 
amended  as  to  direct  him  to  report  in  person  for 
duty  to  the  Commanding  General  Department  of 
Dakota.     S.  O.  87,  A.  G.  O.,  April  15,  1882. 


iHciical  Jtems  anlj  Utvos. 


Contagious  Diseases  —  Weekly  Statement.  — 
Comparative  statement  of  cases  of  contagious  diseases 
reported  to  the  Sanitary  Bureau,  Health  Department, 
for  the  two  weeks  endiiig  April  22,  1882. 


A 

i 

$ 

1.- 

Week  BndlBg 

li 

b 

II 

■^9 

i 

1 

i 

$ 

4 

321 

is 
o 

4 

s 

150 

97 

20 

April    15,  1882. 

16 

0 

April    23,  1883 

7 

7 

2.36 

3 

137 

93 

21 

0 

Some  Curious  Things  that  Happen  to  cub  Do- 
mestic Animals. — Chronic  Vomiling  in  nyi  Ox. — A 
fitteen-mouths-old  ox  vomited  regularly  its  food. 
Being  put  on  bran-mash,  it  stopi>ed ;  but  began 
again  with  a  return  to  hay.  Post-mortem  showed  a 
diverticulum  in  the  cesophagus  the  size  of  a  child's 
head,  tilled  with  dry  hay  and  straw. 

A  similar  direrticxhim,  with  almost  complete  sten- 
osis of  the  cardia,  was  found  in  an  old  cow  which 
had  also  suffered  from  chronic  vomiting. 

Slenosif  of  the  ossopli-agus  in  a  horse  was  brought 
about  by  an  inflammatory  hypertrophy  (?)  of  the 
muscular  wall. 

^•1  Lung-Stomach  Fistula. — A  cow  suffered  from 
chronic  indigestion  and  intermittent  tympanites. 
Post-mortem  showed  a  fistula  between  the  first  stom- 
ach, the  diaphragm  and  the  lung,  jji-oduced  by  a 
rusty  nail. 

Hair-pin  in  the  Soft  Palate. — A  horse  neither  drank 
nor  ate  for  six  days.  He  was  othei'wise  healthy.  A 
hair-pin  was  at  last  found  in  his  soft  palate.  Upon 
removal,  the  animal  took  nourishment  as  usual. 

A  Fatli/  Liver.— In  a  fine  old  English  stallion, 
which  had  only  been  fed  on  hay  and  oats,  a  very 
large  and  fatty  Hver  was  found,  weighing  over  fifty 
pounds.     There  were  hemorrhagic  spots  on  it. 

Litti-tsusceptinn  in  a  Horse. — A  horse  had  for  sev- 
eral weeks  suffered  from  constant  indigestion  and 
intermittent  colic.  Post-mortem  showed  that  the 
ccecum  had  been  forced  down  into  the  colon. 

Tetanus  from  unskilful  castration  was  observed 
several  times  in  young  steers  by  Dr.  Heizmann,  of 
Messkirch. 

The  Result  of  Clipping.— k  fine  horse  was  clipped 
in  the  fall  of  the  year.      Immediately  after,  a  well- 


marked  attack  of  pleurosthotonos  was  obseiwed, 
which  lasted  for  four  weeks. 

A  fbro-garcoma  within  the  skull  pressed  upon  the 
trigeminus,  causing  paralysis  and  complete  atrophy 
of  the  muscles  of  mastication  upon  that  side.  The 
horse  had  to  be  killed. — Jo-urnal  of  Comparative 
Medicine. 

Vaccination  After  Small-pox. — Dr.  Archibald 
Mercer,  of  Newark,  N.  J.,  writes  :  "  Having  twice 
lately  obsers-ed  a  reference  made  to  the  s^^bject  of 
'  Vaccination  alter  Small-pox '  in  the  columns  of 
the  Kecord,  the  following  may  be  of  interest :  Dur- 
ing January  I  was  called  ui^on  to  vaccinate  one 
hundred  and  six  men  in  a  factory  in  this  city.  I 
made  a  careful  note  in  each  case  of  the  date  of  the 
last  vaccination,  and  later  examined  each  arm.  The 
men  had  all  been  vaccinated  at  least  once  before, 
and  some  of  them  several  times.  Of  the  number, 
seven  (7)  had  had  smaU-pox,  and  in  each  the  vac- 
cination was  successful;  two  had  had  varioloid,  the 
vaccination  taking  m  one  instance,  and  of  two,  '  inoc- 
ulated' in  infancy,  the  vaccination  was  successful 
in  each.  Of  the  total  number  vaccinated,  sixty-five 
(65)  had  perfect  vaccine  pustules.  The  quills  used 
were  from  the  Xew  York  Health  Department." 

Inefpecttve  Vaccine  Vmrs. — Dr.  S.  M.  Mouser, 
of  San  Francisco,  Cal.,  vn-ites  :  "  In  your  number  of 
the  1st  inst.  is  an  article  by  H.  J.  Gifrrigues,  M.D.,  on 
'  Ineflective  Vaccine  Virus,'  in  which  he  says  he 
vaccinated  sixteen  babies  who  were  from  a  few  hours 
to  a  few  weeks  old,  and  that  vaccination  failed  in 
fourteen.  Is  it  certain  that  this  was  because  of 
inertness  of  the  vaccine,  or  is  it,  rather,  the  rule 
that  vaccination  is  much  more  likely  to  fail  in 
children  so  young?  The  latter  has  been  my  ex- 
perience, so  much  so  that  for  many  years  I  have 
not  vaccinated  a  baby  under  four  or  six  months 
old,  unless  there  was  danger  of  being  exposed  to 
contact  with  small-pox,  in  which  event  I  would  vac- 
cinate even  at  birth. 

"I  believe— and  suppose  medical  men  generally 
do — that  there  is  a  happy  provision  of  nature  which 
exempts  these  tender  beings  from  susceptibility  to 
contagious  diseases  generally,  and  with  the  rest, 
small-pox  and  vaccine.  There  are,  however,  some 
exceptions  to  this  rule,  if  it  is  a  rule.  Such  has 
been  my  experience  during  nearly  forty  years  of 
practice. 

"In  regard  to  bovine  virus,  my  experience  with 
such  as  I  have  been  able  to  obtain — mostly  from  New 
York  and  Wisconsin — has  not  been  satisfactory,  and 
fuUy  corroborates  Dr.  Garrigues'  statement  that  it 
is  not  reliable.  Whether  it  has  come  to  me  in  a  suf- 
ficiently fresh  condition  or  not,  I  am  unable  to  say ; 
but  it  has  gonerally  failed  in  my  hands,  while  the 
arm-to-arm  process  with  humanized  virus  has  seldom 
done  so.  I  also  prefer  ijuncture  to  scraping  the  sur- 
face, which  latter  operation  sometimes  misleads  the 
inexperienced  by  the  formation  of  a  scab,  the  result 
of  mechanical  irritation." 

The  St.  Louis  Mebic.\l  Society  and  the  New 
Code. — The  following  resolutions  were  adopted  by 
the  St.  Louis  Medical  Society  April  1,  1882  : 

Resolved,  That  the  St.  Louis  Medical  Society, 
while  it  desires  to  accord  the  broadest  freedom  to 
medical  investigation,  and  recognizes  fully  the  right 
of  individuals  to  form  and  hold  private  opinions, 
hereby  declares  that  it  regards  with  disfavor  any 
steps  taken  to  lessen  or  obliterate  the  distinctions 
and  safeguards  between  an  honorable  practice  of 
medicine  founded  upon  science  and  that  founded 


476 


THE   MEDICAL  EECORD. 


upon   any  of  the  current  delusions   and  exclusive 
medical  systems  of  the  day. 

Resolved,  That  a  copy  of  this  resolution  be  for- 
warded by  the  Corresponding  Secretary  to  the 
New  York  State  Medical  Society,  to  the  Permanent 
Secretary  of  the  American  Medical  Association,  and 
to  several  si^ecified  medical  journals. — Wm.  Dickin- 
son, M.D.,  President:  A.  H.  Ohjiann-Dumesnii., 
M.D.,  Recording  Secretary. 

Chicago  MbdicaIi  Societt. — At  the  annual  meet- 
ing of  the  Chicago  Medical  Society  the  following 
officers  were  elected  for  the  current  year :  Dr.  J.  H. 
HoUister,  President;  Dr.  D.  W.  Graham,  Vice- 
President;  Dr.  L.  H.  Montgomery,  Secretary;  Dr. 
E.  F.  Ingals,  Treasurer. 

Medical  Association  of  Geoegia. — The  thirty- 
third  annual  session  convened  in  the  city  of  Atlanta, 
at  eleven  oclock  a.m.,  on  Wednesday,  April  19,  1882, 
and  continued  in  session  for  three  days. 

Dr.  Wm.  H.  Parish  has  been  elected  Professor  of 
Anatomy  in  the  Philadelphia  Women's  Medical 
College. 

The  New  York  Hospital  will  not,  it  is  said,  buUd 
a  new  receiving  hospital  in  Chambers  Street.  It  is 
more  likely  to  leduce  the  present  one  to  a  smaller 
size.  . 

Sir  Robert  Christison  and  Digitaij3ib. — At  one 
of  the  trials  in  which  Sir  Robert  Christison  was  en- 
gaged, one  of  the  points  for  the  defence  was  that 
there  was  no  truce  of  the  poison  (sti-ychnia)  found 
in  the  body.  In  answer.  Sir  Robert  said  he  knew 
of  a  substance  so  deadly  that  a  minute  dose  of  it 
would  infallibly  i^rove  fatal  and  yet  so  subtle  that 
the  most  careful  examination  would  fail  to  detect 
its  presence  in  any  of  the  tissues.  He  was  about  to 
name  the  substance  when  the  presiding  judge  begged 
him  to  keep  so  important  a  secret  to  himself,  lest  it 
should  be  used  successfully  for  criminal  purposes. 
Sir  Robert  used  to  tell  in  after  years  how  for  days 
his  breakfast-table  was  loaded  with  letters  begging 
to  know  the  secret.  It  is  now  well  known,  and  there 
is  no  need  for  concealing  it,  that  he  referred  to  digi- 
taline,  a  substance  which  is  not  at  all  likely  to  be 
obtained  by  any  but  scientific  men. — Edin.  Cor.  jV". 
E.  Medical  Monthly. 

An  Electric  Excitability  of  the  Brain  Cor- 
tex in  hypnotic  or  trance  patients  has  recently  been 
shown  by  Charcot  to  exist.  He  puts  his  subjects 
into  a  hypnotic  sleep.  A  galvanic  current  is  then 
made  to  pass  along  one  side  of  the  cranium,  when 
muscular  movements  are  excited  on  the  opposite 
side  of  the  body.  The  cortical  motor  areas  seem  to 
be  in  a  state  of  hyperexcitability. 

Niiw  Dentists. — At  the  Pennsylvania  Dental  Col- 
lege Commencement,  February  25th,  there  were 
fifty  graduates.  Six  of  them  came  from  Germany, 
one  each  from  Switzerland  and  Italy,  five  from  New 
York,  and  the  remainder  from  various  other  States 
in  the  Union. 

Ergot  and  Ergotine  in  Pharyngitis. — The  value 
of  the  topical  use  of  ergot  in  chronic  pharyngitis  has 
be!u  almitted  for  some  years.  Recently  a  writer  in 
the  Revue  MensuelU  de  Laryngolojie  gives  some  in- 
dependent testimony  as  to  ergotine.  He  recom- 
mends the  following  mixture : 

IJ .  Ergotine gr.  xv. 

Tinot.  iodine 3  j. 

Glycerine 3  j. 


Medical  Journalism  in  Japan. — Dr.  Stuart  El- 
dridge,  of  Y'okohama,  Jajjan,  writes  :  "  I  notice  that 
in  your  issue  of  August  6th  you  acknowledge  the  re- 
ception of  the  first  number  of  Idzo  Shin  Bun,  a  med- 
ical journal  in  Japanese,  and  speak  of  it  as  the  first 
of  its  kind  published  in  the  empire.  For  the  credit 
of  the  native  profession,  I  am  glad  to  say  that  the 
latter  statement  is  inconect,  whether  intended  to 
ap2)ly  to  medical  periodicals  in  general  or  to  those 
of  fortnightly  issue  only.  I,  myself,  established  in 
187y,  and  for  a  considerable  time  conducted  the 
Kin  Se  J  Setzu,  or  '  Modern  Medical  News,'  which 
was  the  pioneer  of  medical  journalism  in  Jajian  and 
was  quickly  followed  by  others,  so  that  there  are  at 
present  at  least  six  periodicals  devoted  to  medical 
science,  issued  regularly,  exclusive  of  the  new  enter- 
prise, the  advent  of  which  you  have  clironicled,  two  of 
them  appearing  fortnightly,  the  others  being  week- 
lies, monthlies,  or  bi-monthlies.  Those  curious  in 
the  matter  can  find  files  of  four  Jajjanese  journals 
of  medicine  on  the  shelves  of  the  National  Medical 
Library  at  Washington,  as  well  as  a  number  of 
treatises  upon  medicine  and  surgery  by  Japanese 
authors.  The  six  periodicals  above  mentioned  are 
at  present  under  management  exclusively  native,  and, 
though  chiefly  made  up  of  translations  and  compila- 
tions from  foreign  sources,  contain  occasional  origi- 
nal articles  of  vei-y  creditable  character.  The  excej)- 
tional  progress  of  Western  medical  science  amoig 
the  Japanese,  a  progress  greater  and  resting  on  a 
more  solid  basis  than  that  made  in  any  other  mod- 
ern science,  has  created  a  demand  for  medical  litera- 
ture in  the  vernacular  which  ensures  the  success  of 
any  fairly  executed  work,  be  it  journal,  translated 
text-book,  or  original  treatise.  Many  of  the  leading 
text-books,  both  German  and  English,  have  been 
translated  and  published,  and  a  much  larger  num- 
ber will  apiiear  within  the  coming  year  or  two.  I 
hope  at  an  early  date  to  publish  a  review  of  Japa- 
nese medicine,  past  and  present,  believing  that  the 
history  of  a  reformation,  almost  complete,  occuning 
within  a  few  years,  will  not  be  without  interest  else- 
where than  in  Japan." 

Medical  Department  of  the  Universitt  or  the 
City  of  New  Y'ork. — Prof.  Herman  Knapp  has  ac- 
cepted the  Chair  of  Ophthalmology,  and  will  fill  the 
vacancy  caused  by  the  resignation  of  Prof.  D.  B.  St. 
John  Roosa. 

The  Prophylactic  Value  of  Salicylic  Acid  ik 
Yellow  Fever. — Dr.  Walls  White  instructed  the  cap- 
tain of  a  BrazUian-bound  vessel  to  give  salicylic  acid 
to  his  men  when  he  reaced  his  destination.  On  ar- 
riving at  Rio  Janeiro,  it  was  found  that  the  yellow 
fever  was  prevailing.  Among  the  one  hundred  and 
fifty  ships  in  the  harbor,  there  was  not  one  that  had 
not  had  from  two  to  four  deaths  on  board.  The 
captain  in  question  gave  his  men  from  five  to  ten 
grains  of  salicylic  acid  daily,  for  fifteen  days,  during 
which  time  all  the  crew  remained  well.  The  medi- 
cine was  then  stopped  for  a  few  days,  but  as  some 
of  the  men  began  to  show  prodromal  symptoms  they 
were  i>ut  upon  it  again.  The  vessel  soon  after  left 
the  port,  having  had  no  case  of  yellow  fever. — El 
Sigh  Med. 

The  Siceleton  op  a  Prehistorto  Man,  at  least 
four  thousand  years  old,  is  said  to  have  been  discov- 
ered in  the  Province  of  Maranho,  Brazil.  The  skel- 
eton measures  eight  feet  two  inches,  and  the  back- 
bone is  jirolonged  in  tlie  form  of  a  tail  for  nearly  two 
feet.  The  fossil  in  (piestion  probably  belongs  to  the 
order  of  the  Cardiff  giant. 


Vol.  XXI.-No.  li 
May  6.  1882. 


THE  MEDICAL  RECORD. 


477 


©riginal  Communications. 

HYDEONEPHEOSIS.* 
Br  GEOEGE  A.  PETERS,  M.D., 

O.isE  I. — JolinK.  Wallace,  nineteen  years  of  age,  sin- 
gle, dentist,  and  a  native  of  the  United  States,  was 
admitted  to  tiie  New  York  Hospital  October  1,  1S78. 
The  following  history  was  furnished  by  G.  Lee 
Knapp,  general  as.sistant-surgeon  : 

About  eight  weeks  ago  he  was  taken  with  a  severe 
<".hill,  which  was  followed  by  cramps  in  the  stomach. 
The  abdominal  pain  lasted  two  weeks,  and  then  dis- 
apjieared,  but  there  remained  a  pain  in  the  left  lum- 
bar region  which  has  lasted,  with  varied  intensity, 
Tip  to  present  time.  One  week  after  the  severe 
attack  had  subsided  he  was  taken  with  pain  again  in 
precisely  the  same  manner  as  before.  This  time, 
however,  the  symptoms  only  lasted  two  days.  For 
three  weeks  following  there  was  no  return  of  pain, 
but  at  the  end  of  that  time  it  returned  with  all  its 
former  intensity,  and  has  lasted  uji  to  this  date.  He 
attributes  his  present  condition  to  the  following  : 
Several  weeks  before  admission,  while  lifting  a  hea\"y 
weight,  he  felt  a  most  excruciating  pain  in  the  back, 
extending  from  the  lower  dorsal  to  third  lumbar 
vertebra.  This,  however,  only  lasted  a  short  time, 
and  he  was  able  to  be  about  his  work  as  usual.  At 
the  end  of  live  days  he  was  obliged  to  take  to  his 
bed,  from  which  he  has  not  as  yet  risen. 

The  pain  now  appears  to  be  a  severe  one  in  the 
lumbar  region,  and  is  without  intermission.  The 
left  leg  is  di-awn  uj)  in  a  semi-flexed  position  and 
cannot  be  fully  extended.  At  time  of  admission  the 
symptoms  pointed  toward  the  formation  of  a  j^soas 
abscess — the  pain,  extreme  tenderness,  etc.  On 
standing,  which  is  accomplished  with  great  diffi- 
culty, the  entire  weight  is  thrown  on  the  right  leg, 
and  the  position  of  the  other  is  similar  to  that  taken 
in  morbus  coxarius.  There  is  a  lateral  curvature  ot 
the  spine  in  the  dorsal  region,  but  no  pain  on  pres- 
sure, except  at  one  point,  and  that  is  at  the  eleventh 
dorsal  vertebra.  Ordered  rest  in  bed  and  bowels 
to  be  kept  open  ;  plaster- jacket. 

October  4th. — General  condition  improved,  and 
pain  less  marked. 

October  6th. — AVjle  to  straighten  left  leg ;  can 
stand  much  easier  than  before ;  general  health 
good.  It  has  been  deemed  prudent  to  omit  the 
plaster-jacket  for  a  few  days  longer  in  order  to  see 
how  much  improvement  there  will  be  without  it. 

October  8th. — Allowed  to  get  up.  Is  able  to  walk, 
but  not  without  considerable  trouble.  General 
health  improving  ;  appetite  good. 

October  12th. — Severe  pain  in  left  gluteal  region, 
■which  was  modified  by  the  administration  of  quinine. 

October  25th. — General  condition  improved ; 
quinine  continued.  Stall  some  pain  in  hip,  but  only 
at  night,  and  then  not  at  all  severe. 

November  1st. — Has  noticed  for  a  few  days  past  a 
swelling  in  left  ilio-hypogastric  region.  On  examin- 
ation a  hard  tumor  is  found  there,  but  slightly  mov- 
able and  perfectly  painless.  It  is  distinctly  sepa- 
rable from  the  spleen. 

November  10th. — General  health  improving  daily. 
Tumor  still  observed,  no  change  whatever  being 
noticed  in  it. 

*  Read  before  the  New  "York  Snrgica!  Society,  February  28,  1882. 


November  20th. — Tumor  seems  to  have  increased 
slightly  in  size ;  no  pain  however,  riuctuation 
made  out.  Patient  kejit  in  bed.  There  is  thought 
to  be  fluid  in  the  peritoneal  cavity. 

November  21st. — The  tumor  was  outlined  as  fol- 
lows :  "  Beginning  about  one  half-inch  above  ante- 
rior superior  spine  of  ilium,  it  could  be  traced  in  a 
direction  inward  and  downward  as  far  as  within 
one-half  inch  of  median  line,  where  its  edge  could 
be  distinctly  made  out  to  form  a  curve  in  a 
direction  upward  to  within  one-half  inch  of  um- 
bilicus, and  thence  outward  and  upward  almost 
as  high  as  the  twelfth  rib.  It  could  be  made  out 
as  far  back  as  the  edge  of  quadratus  lumboium 
muscle,  and  thence  in  a  direction  downward  to 
the  point  of  commencement.  There  was  flatness 
upon  percussion  over  this  area,  and  a  feeling  of 
deep  fluctuation.  A  small  aspirating  needle  (No. 
1),  with  asjiirator  attached,  was  inserted  one-half 
inch,  the  puncture  being  made  almost  one  inch 
above  anterior  superior  spine  of  ilium  and  one 
ounce  of  a  clear  serous  fluid  drawn  oft',  which  was 
alkaline,  had  a  specific  gravity  of  10.08,  contained 
twenty-five  per  cent,  of  albumen,  and  also  leuco- 
cytes, but  no  urea.  Aspirator  did  not  work  well, 
and  over  an  hour  was  occupied  in  obtaining  the 
above  fluid.  The  result  was  a  total  disajipearance 
of  the  tumor  both  to  feel  and  sight,  and  where 
before  there  was  marked  flatness  normal  abdominal 
resonance  returned. 

November  22d. — No  bad  efl'ects  due  to  the  asjji- 
ration  ajsparently,  and  patient  only  complains  of 
being  kej^t  in  bed. 

November  23d. — Slight  tenderness  on  pressure 
over  site  of  aspiration  ;  countenance  flushed  and  left 
thigh  flexed  on  pelvis.  Temperature,  98.5°  F. ; 
pulse,  90  and  full. 

November  24th. — Febrile  symptoms  and  pain  have 
disajJi^eared.  Keaccumulation  of  fluid ;  abdominal 
resonance  becoming  flat.  There  is  nothing  definite, 
however,  about  the  shape  that  the  new  tumor  is 
taking.     Temperature,  98.5='  F.,  and  feels  well. 

November  25th. — The  tumor  has  obtained  the  same 
size  as  before,  and  is  again  aspirated. 

December  4th. — No  special  change  in  patient  up  to 
this  date.  He  was  placed  on  the  right  side,  and  twelve 
ounces  of  fluid,  having  the  same  color  as  before,  were 
drawn  off.  It  was  thought  best  not  to  draw  ofl'  any 
more.  Examination  of  fluid  revealed  the  same  as 
before,  except  that  urea  was  found,  which  points 
toward  hydronephrosis. 

December  5th. — No  bad  results  following  the  aspi- 
ration, the  patient  was  allowed  to  go  out  for  a  ride. 

December  16th. — Has  been  up  and  about  ward  as 
usual.  Feels  well ;  appetite  good ;  bowels  regular. 
Tumor  as  large,  if  not  larger,  than  heretofore. 
Commences  at  anterior  superior  spine  of  ilium, 
outline  made  out  to  extend  along  Poupart's  ligament 
as  far  as  inner  one-third,  then  up  abdomen  in  me- 
dian line  two  inches  above  umbilicus,  where  it  comes 
out  and  ujjward  nearly  to  free  border  of  ribs,  and 
extends  behind  almost  to  vertebral  column,  thence 
curves  down,  and  then  in  to  point  of  starting  (an- 
terior superior  spine  of  ilium).  Patient  placed  uj5on 
left  side,  and  aspirating  needle  (No.  1)  introduced  in 
left  lumbar  region  to  depth  of  two  and  one-half 
inches,  forty-six  ounces  of  fluid  drawn  ;  same  in  ap- 
pearance as  that  heretofore  obtained.  Some  slight 
pain  experienced  by  patient  during  the  aspiration,  but 
none  after  the  fluid  was  withdrawn.  After  the 
evacuation  of  the  fltiid,  the  hand  could  be  made  to 
press  as  deeply  down  into  iliac  fossa  of  that  side  as  on 


478 


THE  MEDICAL  RECORD. 


the  other.  No  appearance  of  any  tumor  present, 
and  where  flatness  existed  before  percussion  gave 
normal  resonance. 

December  ITtli. — Patient  up  and  about  ward.  No 
appearance  of  filling  up  of  tumor. 

December  18th. — Patient  complains  of  slight  pain 
in  the  back,  extending  down  to  the  thigh.  On  ex- 
amination, it  is  seen  that  the  tumor  is  again  rapidly 
filling,  and  the  hand  cannot  be  made  to  press  deeply 
into  the  iliac  fo.ssa. 

December  2.3d.— Operation  2..30  p.  ii.  by  Dr.  K.  F. 
Weir.  The  patient  was  etherized  and  laid  upon  the 
operating-table  on  the  right  side ;  carbolic-acid 
spray  was  directed  over  parts,  which  were  also 
washed  thoroughly  with  a  carbolized  solution  (1  to 
20)  ;  an  incision  was  made,  commencing  at  lower  bor- 
der of  twelfth  rib,  and  extending  in  an  oblique  direc- 
tion downward  and  backward  to  the  crest  of  the  ilium. 
The  tissues  wei-e  rapidly  divided  and  the  quadratus 
lumborum  exposed.  An  incision  was  made  in  this 
muscle,  transversely  cutting  across  its  fibres  for 
about  one  inch.  The  left  kidney  was  exposed,  and 
recognized  by  the  bluish-gray  color  presented.  A 
smaU  trocar  was  introduced,  and  fluid  of  same  nat- 
ure as  that  drawn  ofl"  by  the  aspirator  was  obtained. 
A  free  incision  was  then  made  into  the  sac,  and  it 
evacuated  about  forty  ounces  of  thin  serous  fluid. 
The  finger  of  the  operator  was  then  introduced  into 
the  sac,  and  made  to  pass  for  several  inches  in  an 
upward  and  downward  direction  in  what  appeared 
to  be  the  distended  capsule  of  the  kidney.  A  large- 
sized  drainage-tube  (carbolized),  fenestrated  for  the 
first  two  inches  of  its  extent,  was  introduced  into 
the  opening,  and  made  to  pass  into  the  cavity  sev- 
eral inches.  To  the  free  end  was  attached  a  large 
rubber  bag  filled  with  sponges  (carbolized  by  pre- 
vious immersion  in  carbolic,  1  to  20),  which  is  to  be 
contained  within  the  dressing.  Another  drainage- 
tube  was  placed  through  the  entii-e  length  of  the 
wound,  and  the  edges  brought  together  by  car- 
bolized sutures  ;  a  full  Lister  dressing  was  applied, 
jute  being  used  instead  of  gauze.  During  opera- 
tion the  pulse  remained  good,  and  half  an  hour  later 
pulse,  80 ;  respiration,  24 ;  temperature,  98°  F. 

6  P.M. — Ether  sickness  slight.  Pulse,  70  and 
feeble ;  respiration,  26  ;  temperature,  99°  F.  Com- 
plains of  cold.  Ordered  heaters  to  feet  and  sjjt.  tiin. 
gall.  3  ss.  every  two  hours,  milk  and  beef  tea  ad  lib. 

10  P.M. — Pulse,  75  ;  respiration,  21 ;  temperature, 
101°  P.  Patient  restless,  but  suffers  no  pain.  Or- 
dered ten  minims  of  Magendie's  solution  of  morphia. 

December  24th. — The  patient  passed  a  very  good 
night.  No  pain,  but  a  feeling  of  discomfort  about 
left  side.  Takes  fluid  nourishment  and  in  sufficient 
quantity.     No  difliculty  in  passing  urine. 

4  P.M. — The  dressing  was  changed  on  account  of 
discharge,  and  done  under  spray.  On  opening  the 
bag  attached  to  tube,  only  about  four  ounces  of  a 
bloody  fluid  wore  found,  and  pressure  over  site  of 
former  tumor  did  not  increase  the  quantity.  The 
wound  looks  well ;  dressing  same  as  before.  Passes 
one-third  less  urine  than  before,  but  color  much 
darker,  almost  black,  sp.  gr.,  1010 ;  albumen  50  per 
cent.     No  vomiting  nor  gastric  disturbance  present. 

December  25th. — No  pain  ;  passed  a  good  night. 
No  vomiting,  face  clear,  although  slightly  flushed. 
Bowels  constipated.  Passes  normal  amount  of  urine 
same  in  character  as  on  24th.  Dressing  changed  on 
account  of  discharge.  Wound  free  from  appear- 
ances of  inflammation  ;  union  by  first  intention,  ex- 
cept at  opening,  caused  liy  drainage-tubes  ;  slight 
amount  of  serous  fluid  had  escaped  with  the  nibber 


bag,  and  a  slight  amount,  two  ounces,  at  time  of 
dressing,  escaped  from  flee  end  of  tube.  No  pain 
on  pressure  in  iliac  region,  and  evidently  no  reaccu- 
mulation  of  fluid  in  that  locality ;  dressed  as  before. 

December  26th. — Passed  a  good  night.  Urine 
still  continues  dark,  which  seems  to  point  toward 
carbolic  acid  poisoning,  but  no  other  symptoms  are 
present,  and  BaCVj  test  negative.  No  pain  in  side, 
but  simply  a  feeling  of  soreness  on  motion.  Bowels 
still  constipated  ;  appetite  good. 

4  P.M. — Dressings  changed.  Wound  perfectly  asep- 
tic in  appearance,  several  sutures  removed,  union 
firm.  Discharge  of  serous  fiuid,  two  ounces,  from 
tube.     Dressed  as  before. 

December  27th. — Passed  poor  night,  very  restless, 
but  complained  of  no  pain  in  parts.  Pulse,  100 ; 
respiration,  20  ;  temperature,  101  \  Dressed  as  be- 
fore, line  of  union  good.  No  fluid  escapes.  No 
inflammation  about  wound,  sutures  removed. 

December  28th.— Pulse,  99  ;  respiration,  20  ;  tem- 
perature, 100  .  Dressed  as  before;  about  sixteen 
ounces  of  clear  serous  fluid  escaped  from  end  of 
tube  on  removal  of  dressing,  which  was  examined 
and  found  to  contain  urea. 

January  3,  1879. — Wound  dressed  as  before.  There 
appears  to  be  a  separation  of  tlie  edges  which  had 
already  united.  Union  by  granulation  going  on. 
Small  amount  of  clear  fluid  escapes.  General  con- 
dition good  ;  i^ulse,  100 ;  respiration,  20  ;  tempera- 
ture, 99   F. 

January  4th. — Pulse,  100  ;  respiration,  21 ;  tem- 
perature, 99J°.  Dressed  as  usual.  Good  union 
taking  place  by  granulation.  Drainage  tube  of 
wound  projjer  removed.  Free  escape  of  clear  fluid 
as  heretofore. 

From  this  date  to  January  10th  there  were  no 
special  symptoms  developed,  and  then  a  small 
amount  of  sero-pus  escaped  from  the  tube,  and  about 
two  ounces  of  the  same  fluid  were  found  in  rubber 
bag.     Antiseptic  dressing  continued. 

January  11th. — Pulse,  100  ;  respiration,  22  ;  tem- 
perature, 99.2°  F.  Slight  discharge  from  wound, 
which  is  rapidly  cicatrizing.  Total  amount  of  urine 
in  twenty-four  hours  about  twenty-four  ounces. 

Januai-y  13th. — Pulse,  99  ;  respiration,  20  ;  tem- 
perature, 99.4°  F.  Dressing  renewed  under  spray. 
About  four  ounces  of  fluid,  sero-punilent,  found  in 
bag.  Weir's  flexible  silver  probe  (wet  with  1  to  20) 
introduced  into  wound  and  made  to  pass  in  a  direc- 
tion downward,  forward,  and  inward,  below  the  Virim 
of  the  pelvis.  A  grating  sensation  was  imparted  to 
the  hand  of  the  operator  by  the  instrument.  A  flexi- 
ble bougie  (No.  8  F.)  likewise  introduced,  but  only 
passed  to  about  eight  inches,  where  it  was  firmly 
grasped  as  though  in  the  bite  of  a  stricture.  A 
steel  sound,  15  and  21  F.,  introduced  through  the 
wound,  but  could  di.scoverno  obstruction.  No  pain 
experienced  by  patient  during  above  examination, 
and  no  bad  eff'ects  followed.     Dressed  as  before. 

January  14th. — Pulse,  89  ;  respiration,  20  ;  tem- 
perature, 99  F.  Passed  a  good  night.  No  bad  ef- 
fects fi'om  exploration  of  yesterday.  Slept  well,  and 
wants  to  get  up.  Dressed  as  before.  No  notable 
change, 

January  15th. — Allowed  to  sit  up  in  a  chair. 

Januaiy  18th. — No  special  change  since  last  note. 
About  four  otinces  of  turbid  fluid  found  in  nibber 
bag.  Wound  apparently  healing.  Tube  left  in  situ. 
Dressed  as  before.  Tendency  to  diarrhoea  ;  ordered 
pil.  opii  after  each  movement. 

January  21st. — Pnl.se,  85  ;  respiration,  20  ;  tem- 
perature, 99.4°  F.   Considerable  discharge.    Dressed 


THE  MEDICAL  RECORD. 


479 


as  before.  About  two  ounces  milky  fluid  found  in 
bag.  Wound  doing  well.  Tube  shortened  about 
two  inches. 

January  •'iOth. — Drainage-tube  and  rubber  bag 
discontinued. 

January  31st. — Temperature,  99.4°  F.  Dressed 
as  usual ;  dressing  is  saturated  with  discharge, 
which  is  very  profuse.  Passes  in  twenty-four  hours 
about  twenty  ounces  of  urine. 

February  3d. — Dressed  every  day  up  to  date. 
Doing  well.  Discharge  still  about  the  same.  Tem- 
perature varies  from  98°  to  99..5'  F.  Genei-al  condi- 
tion slowly  impro\'ing  ;  appetite  fair ;  sleeps  well. 
Only  occasional  tendency  to  diarrhcea. 

February  10th. — Dressed  everyday.  Doing  well. 
Still  discharge.  General  health  daily  improving. 
Has  gained  ten  pounds  in  last  three  weeks  ;  appe- 
tite good ;  allowed  to  go  out  and  take  short  walks. 

February  12th. — Dressed  as  usual.  Ordered  cav- 
itv  to  be  washed  out  with  weak  solution  of  carbolic 
(1  to  100).  1 40  P.M.  :  Taken  with  severe  chill. 
Temperature,  103.2"  F.  during  chill ;  after  chill, 
temperature  103°  F. 

February  13th. — Pulse,  89  ;  respiration,  22 ;  tem- 
perature, 100°  F.  Feels  periectly  well.  Dressed  as 
usual. 

February  20th. — Dressed  every  other  day.  Granu- 
lating surface  has  entirely  healed,  leaving  a  small 
fistulous  opening,  from  which  fluid  escapes  as  be- 
fore. No  diminution  in  amount  noted.  Patient's 
general  health  excellent ;  eats  and  sleeps  well,  and 
goes  out  occasionally  for  a  walk. 

February  22d. — Oi^ening  entirely  closed.  Coin- 
cident with  cessation  of  discharge  was  a  great  in- 
crease in  the  quantity  of  urine  passed — in  twenty- 
four  hours  forty-six  to  fifty  ounces.  Dressing  re- 
applied. 

February  26th. — Opening  still  closed.  Dressing 
discontinued.  Urine  still  increased  in  amount — 
about  fifty  ounces  in  twenty -four  hours.  Feels  per- 
fectly well. 

Februarv  27th. — Discharged  cured. 

Note  of  Dr.  Weir  (.Januaiy  10,  1880). —Sinus 
closed  entirely  June,  1879,  and  has  since  remained 
so. 

Case  II. — Margaret  Hallman,  born  in  Germany, 
aged  fortv-even,  married.  Was  admitted  into  St. 
Luke's  Hospital,  August  19,  1880. 

Patient's  previous  history  good,  with  exception  of 
prolapsus  uteri  after  birth  of  her  last  child.  About 
four  years  ago  patient  noticed  for  the  first  time  "a 
lump  "  about  the  .size  of  a  hen's  egg  in  the  median 
line  of  the  abdomen,  about  two  inches  below  the 
umbilicus.  This  has  continued  to  increase  in  size 
since  that  time,  but  has  grown  more  rapidly  for  the 
past  two  months,  during  which  time  it  has  increased 
to  double  its  previous  measurements.  The  abdo- 
men is  very  much  distended  in  the  hypogastric,  in- 
guinal, and  lower  part  of  the  umbilical  regions. 
The  tumor  is  somewhat  ovoid  in  shape,  measuring 
sixteen  inches  in  its  transverse,  and  twelve  and  one- 
half  inches  in  its  vertical  diameter.  On  the  surface 
of  this  abdominal  enlargement  can  be  made  out  the 
transverse  colon  and  a  coil  of  small  intestines  lying 
just  beneath  the  abdominal  wall,  and  freely  mov- 
able over  the  surface  of  the  tumor.  The  left  upper 
half  of  the  swelling  is  occupied  by  a  globular  mass, 
measuring  about  seven  inches  in  diameter.  To  the 
touch  it  is  tense,  but  distinct  fluctuation  can  be 
made  out,  and  it  is  somewhat  movable.  She  has  oc- 
casional pains  in  this  region,  but  not  very  severe 
in  character ;  also  has  "  dragging  pains  "  through 


the  groins,  but  her  principal  pain  is  in  the  small  of 
her  back.  The  bowels  are  habitually  constipated, 
apjietite  fair,  and  she  sleeps  well.  Patient  was  seen 
in  consultation  by  my  colleagues,  Drs.  Little,  Mc- 
Burney,  Sabine,  and  Bull :  also  by  Drs.  Sands,  Em- 
met, and  others.  It  may  be  well  to  state  here  that 
the  patient  was  sent  to  the  hospital  as  a  case  of 
ovarian  tumor,  favorable  for  operation.  A  careful 
examination  with  the  finger  in  the  vagina  and  con- 
joined maniijulation,  revealed  the  fact  that  the 
tumor  had  no  connection  with  either  the  uterus  or 
ovaries. 

The  finger  introduced  into  the  rectum  would  just 
reach  the  lower  border  of  the  tumor,  on  a  level  with 
the  promontory  of  the  sacrum. 

In  order  to  make  diagnosis  more  clear,  I  deter- 
mined to  explore  the  cavity  with  the  hand  introdiiced 
into  the  rectum.  On  October  19th,  my  friend  and 
colleague  at  the  hospital.  Dr.  T.  T.  Sabine  (who  has 
a  hand  iieculiarly  well  adapted  for  such  an  explora- 
tion), the  patient  being  etherized,  passed  his  hand 
into  the  bowel,  and  by  conjoined  manipTilation 
could  distinctly  feel  both  ovaries.  He  was  enabled 
to  move  his  left  hand  freely  about  in  the  renal  region, 
and  in  that  situation  recognized  a  large  movable 
mass,  which  seemed  to  be  a  cyst  connected  with  the 
left  kidney. 

I  determined  to  operate  by  cutting  down  in  the 
himbar  region,  open  the  sack,  and  stitch  it  to  sur- 
rotinding  skin,  hoping  by' this  means  to  procure  a 
final  obliteration  of  the  sac. 

On  the  12th  of  November,  1880,  I  operated,  Drs. 
Sabine  and  McBurney  assisting,  in  the  presence  of 
Drs.  E.  Mason,  Weir,  Post,  Little,  Emmet,  Otis, 
Sands,  Briddon,  Fallen,  and  others.  An  oblique  in- 
cision about  four  inches  long  was  made  in  the  left 
lumbar  region,  extending  from  border  of  rib  to  crest 
of  ilium,  about  three  inches  from  the  line  of  spinous 
pi-ocesses  of  lumbar  vertebr;e,  and  parallel  with  bor- 
der of  quadratus  lumborum  muscle.  The  dissection 
was  carried  down  carefully  behind,  and  to  outside 
of  the  peritoneal  cavity,  until  the  surface  of  the  tu- 
mor was  reached.  It  was  not  determined  that  there 
was  any  kidney-structure  in  the  exjicsed  wall  of  sac. 
With  a  hypodermic  needle  I  punctured  and  drew 
oft'  a  small  quantity  of  clear  fluid,  thus  demon- 
strating that  the  sac  had  been  i-eached.  With  a 
sharp,  curved  bistoury  I  made  a  free  opening,  which 
was  immediately  followed  by  a  flow  of  bloody  fluid, 
welling  up  into  the  wound.  The  edges  of  the 
wound  in  walls  of  the  sac  were  then  brought  out  and 
secured  by  fine  carbolized  silk  sutures  to  the  edges 
of  surrounding  skin.  A  rubber  drainage-tube  was 
then  introduced  some  six  inches  into  the  sac,  one 
end  being  left  free  at  the  opening ;  also  a  smaller 
and  shorter  one  in  the  external  wound,  both  ends  of 
which  projected,  one  at  the  ujiper,  the  other  at  the 
lower  angle  of  the  wound.  The  edges  of  the  cut 
were  then  brought  together  with  fine  carbolized  silk 
sutures.  Wound  well  washed  out  with  carbolic  so- 
lution, 1  to  60,  covered  with  "  protective,"  a  mass 
of  carbolized  jute,  to  absorb  the  discharge,  and  over 
all  a  Lister  dressing. 

The  fluid  which  came  from  the  opening  made  in 
the  sac  was  very  considerable  in  quantity.  Only 
about  six  pints  were  saved  :  the  remainder  was  lost. 
The  fluid  contained  a  quantity  of  blood,  as  evidenced 
l-iy  large  clots  after  it  had  stood  a  while.  Before  the 
dressing  of  the  wound  was  completed  the  patient 
became  very  much  exhausted ;  pulse  small  and 
rapid,  respiration  sip-hing,  and  temperature  fell  to 
much  below  the  normal  standard.     Brandv  was  ad- 


480 


THE  MEDICAL  RECORD. 


ministered  hypodermically,  and  she  was  left  upon 
the  operating-table  until  she  should  rally  sufficiently 
to  make  it  safe  to  remove  her  to  the  ward.  By  8 
o'clock  P.M.  patient  had  rallied  considerably,  being 
able  to  take  brandy  and  milk  by  the  mouth.  Tem- 
perature, d5i°;  pulse,  8i. 

November  13th. — Patient  a  little  stronger.  No 
vomiting  during  the  day.  The  discharge  having 
oozed  through  the  dressing,  it  was  reapplied.  Morn- 
ing temperature,  103^  ;  pulse,  136.  Quinine  and 
morphine  were  administered.  Evening  tempera- 
ture, 99J'.  Dressings  were  changed  daily,  and  the 
cavity  of  the  cyst  was  washed  out  with  weak  solu- 
tion of  carbolic  acid  by  means  of  a  syringe. 

November  15th. — The  belly  became  vei'y  tym- 
panitic, evidently  caused  by  the  decomposition  of 
blood  clots  in  the  cyst  cavity,  and  not  by  peri- 
tonitis. 

November  29th. — All  sutures  were  removed  and 
the  drainage-tube  taken  out  from  the  sac.  Several 
large  pieces  of  a  cheesy  material,  with  a  very  often- 
sive  odor,  were  found  adhering  to  it. 

December  14th. — The  washing  out  of  the  sac  was 
discontinued.  A  small  pad  and  compress  were  ap- 
plied over  the  opening,  and  the  patient  allowed  to 
sit  up. 

Patient  remained  in  the  hospital  until  January  27, 
1881,  when  she  was  discharged.  During  all  this 
time  she  had  a  Huctuating  tempei-ature,  ranging 
from  normal  to  104'.  Her  pulse,  however,  did  not 
correspond  with  the  temperature.  Her  appetite 
was  good,  and  she  gained  in  health  and  strength. 
When  discharged  there  was  an  opening  only  suffi- 
cient in  size  to  admit  a  small  silver  jjrobe,  which 
could  be  passed  in  for  an  inch  or  two,  and  could  not 
be  moved  about,  showing  only  a  nan-ow  sinus. 

The  fluid  which  escaped  during  the  operation 
yielded,  to  microscopic  examination  made  by  Dr. 
Satterthwaite,  "  small,  round  bodies  like  fat  glob- 
ules, biomatoiden  and  flab  cells  with  large,  dark, 
opaque  nuclei."     It  also  contained  urea. 

February  24,  1882. — The  imtient  called  upon  me  a 
few  days  ago  to  report.  Since  leaving  the  hospital 
she  has  been  able  to  do  her  daily  work,  and  is  in 
good  health  and  strength.  The  sinus  still  remains, 
through  which  a  little  urine  continually  dribbles, 
and  keeps  the  pad  which  she  wears  over  the  orifice 
moist,  but  gives  her  no  serious  inconvenience. 

Remark:^. — Hydronephrosis  is  a  disease  not  fre- 
quently observed,  as  I  am  enabled  to  recall  to  mind 
but  few  eases  in  a  hospital  experience  of  over  thirty 
years.  Operative  interference  is  but  seldom  resort- 
ed to.  The  greater  mimber  of  the  cases  which  we  see 
are  treated  for  a  time,  and  are  either  relieved  or  be- 
come chronic,  and  pass  from  under  observation. 
Here  are  two  cases  presented,  occurring  one  clo.se 
upon  the  other,  which  liave  been  cured  by  operation 
and  the  patients  saved  from  a  probably  fatal  termi- 
nation in  rupture  and  peritonitis.  The  operation  in 
both  cases  was  performed  in  the  same  way  with  but 
slight  difForence  in  tlio  methods  of  procedure.  In 
Case  I.  (John  II.  Wallace),  the  treatment  by  simply 
tapping  and  emptying  the  sac  by  aspiration  was 
tried,  but  without  permanent  good.  I'rom  Novem- 
ber 21st  to  the  day  of  final  operation,  aspiration 
was  done  five  times,  and  fiuid  was  drawn  off,  in 
quantities  varying  from  one  ounce  to  forty-six 
ounces.    The  sac  rapidly  refilled  after  each  tapping. 

In  this  ca.se  of  Dr.  Weir's  the  opening  was  made 
through  the  lumbar  region  into  the  distended  sac, 
and  drainage  was  secui'ed  l)y  the  introduction  of  a 
rubber  tube  through   the  wound,  whic^h   tube  was 


worn  for  nearly  six  weeks,  while  in  my  case  the 
edges  of  the  sac  were  secured  by  sutures  to  the 
edges  of  the  skin  cut,  where  it  healed  and  enabled 
me  to  withdraw  the  tube  at  end  of  the  tliird  day. 
In  Dr.  Weir's  case  the  wound  healed  entirely  in  six     | 
months,  and  had  remained  closed  up  to   Janiiary     j 
10,  1880,  at  which  time  the  patient  presented  hin,- 
self  for  inspection,  a  period  of  over  six  months,  and     I 
for  aught  we  know  to  the  contrary  is  stiU  closed.  | 

In  my  case  tlie  sinus  remained  open  from  the  time     li 
of  the  ojieration  until  a  short  time  ago,  when  she     3 
presented  herself  at  my  office,  a  period  of  over  a     I 
year.     The  sinus  is  very  shallow  and  the  discharge 
is  simply  an  oozing,  and  it  may  fairly  be  expected  to 
improve  still  more.     The   advice  given  by  some  of 
my  surgical  friends,  who  had  had  much  experience 
in  laparotomy,   w'as  to  attack  the  tumor  from  the     i 
front  by  free  incision  in  median  line.     This  advice    i 
was  founded  on  the  fact  that  tlie  tumor  was  very 
large,   was  well  defined,  and  could  be  more  easily 
reached  through  that  incision,  and  that  the  opening 
through  its  wall  could  be  easily  stitched  to  the  sur-    i. 
rounding  skin.     My  reason  for  preferring  to  attack    i 
it  from  liehind  was  that  I  could  reach  it  with  suffi- 
cient ease  through  such  a  cut,  and  should  thus  avoid 
the  danger  of  having  at  some  future  time  strangula- 
tion of  any  j^ortion  of  the  intestines  which  might 
possibly  become  entangled  in  the  bauds  of  adliesion 
which  must  necessarily  exist  between  the  cut  edges 
of  the  sac  and  the  anterior  abdominal  wall.     I  sec 
no  reason  to  withdraw  my  preference  for  the  poste- 
rior incision. 

In  Case  II.  (Margaret  Hallman),  the  opening  of 
the  sac  was  followed  by  a  hemon-hage  so  profuse  as  to  i 
reduce  the  patient's  strength  to  a  very  low  ebb.  ' 
This  hemorrhage  was  not  from  any  vessel  divided 
by  the  knife,  but  apparently  a  passive  oozing  from 
the  sac  wall,  such  as  sometimes  occurs  from  drawing 
off  suddenly  the  contents  of  a  large  abscess  or  from 
tapping  in  ascites,  and  is  an  accident  for  which  the 
operator  should  be  prepared.  There  is  one  little 
point  of  practice  to  which  I  wish  to  call  the  atten- 
tion of  any  one  who  desires  to  repeat  my  operation. 
After  the  incision  through  the  skin  had  brought  me 
down  upon  the  surface  of  the  tumor,  I  introduced 
a  small  hypodermic  needle  in  search  of  fluid,  having 
found  which  I  passed  the  Itlade  of  a  bistoury  beside 
the  needle  and  made  my  incision  into  the  sac. 
This  inci-sion  slijiped  easily  away,  and  it  was  with 
considerable  difficulty  that  I  was  enabled  to  find  it. 
Had  I  thrust  a  curved  needle  armed  with  a  di.ublo 
ligature  through  the  sac  wall,  as  we  do  in  lumbar 
colotomy,  I  should  have  escaped  that  annoyance. 

The  method  of  securing  the  drainage  from  tin 
sac  into  a  sponge  secured  in  an  india-rubber  baj;, 
practised  by  Dr.  Weir,  was  ingenious,  but  the 
method  which  I  adopted  was  just  as  effectual,  and 
much  less  troublesome.  I  used  the  Lister  dressing 
but  a  few  days,  nor  would  my  past  ex]iericnoe  lead 
me  to  lay  much  stress  upon  its  employment  for  a 
longer  time. 

C.vsE  III. — Sophia  Koskey,  twenty-seven  years  of 
age,  a  native  of  Denmark,  was  admitted  to  tlio  ser- 
vice of  Dr.  George  A.  Peters,  at  the  New  York  Hos- 
pital, December  24,  1881.  The  notes  of  the  history 
are  furnished  by  Dr.  Vanderpo'el,  senior  assistant- 
surgeon.  She  applied  in  jierson  for  admission.  No 
s))eeific,  alcoholic,  or  rheumatic  history.  Family 
history  good.  Four  and  oneluvlf  years  ago  the 
patient  was  married  ;  previous  to  that  time  had  al- 
ways been  perfectly  healthy  and  courses  regular. 
Six  months  after  marriage,  signs  of  pregnancy  de- 


THE  MEDICAL  KECORD. 


481 


veloped  ;  menstruation  ceased,  was  salivated,  had 
morning  vomiting,  breasts  enlarged  slightly,  and 
primary  areola  appeared.  AVhen  pregnant  three 
months,  she  sustained  a  fall  of  about  four  feet,  strik- 
ing the  right  side  of  the  abdomen  against  some 
prominent  object.  Was  taken  immediately  with  in- 
tense pain,  nausea,  and  vomiting,  and  in  about  one 
hour  a  profuse,  bloody  discharge  appeared  from  the 
vagina.  No  membranes  or  evidence  of  a  foetus  were 
observed,  although  the  patient  had  well-marked  labor 
pains. 

Discharge  and  pain  gradually  oeased,  and  two 
weeks  after  the  accident  she  was  up  and  about  again. 

Two  weeks  later  the  patient  had  another  attack  of 
pain,  with  vomiting  and  a  bloody  discharge,  whieli 
lasted  but  a  few  days.  After,  she  was  pei-fectly  well 
for  about  eight  months,  menstruation  being  quite 
regular.  Breasts  had  become  smaller,  and  all  signs 
of  pregnancy  had  ceased.  Pains  then,  however,  be- 
gan again,  and  on  examination  a  mass  was  detected 
on  the  right  side,  about  half  the  size  of  the  present 
tumor.  This  slowly  grew,  occasioning  periodical 
attacks  of  pain,  which  occurred  at  about  the  time  of 
her  monthly  illness.  Her  condition  continued  about 
the  same  for  several  years,  until  eight  months  ago 
the  patient  came  to  America,  when  the  pains  in- 
creased in  frequency,  and  became  more  active,  espe- 
cially at  night,  lasting  for  several  days. 

For  the  j^ast  month  or  so  the  attacks  have  oc- 
curred daily,  with  more  or  less  vomiting,  which,  dur- 
ing the  three  or  four  days  previous  to  admission,  was 
streaked  more  or  less  with  blood.  Since  the  tumor 
appeared  it  has  slowly,  steadily,  and  uninterrupt- 
edly increased  in  size,  and  extended  towai-d  the  me- 
dian line  in  front.  She  has  lost  no  flesb,  and  her 
bowels  have  been  regular.  Xo  urinary  symptoms, 
no  pain  during  intercourse,  and  no  signs  of  preg- 
nancy since  the  accident.  Suffers  no  backache,  or 
headache,  and  no  oedema  of  the  feet.  Jaundice  has 
never  occurred,  and  patient  is  not  hysterical. 

On  admission,  she  was  fairly  nourished  ;  her  gen- 
eral condition  good.  The  above-mentioned  symp- 
toms were  present,  occurring  every  night  ;  but  she 
has  no  fever,  and  her  pulse  is  good. 

Examination  showed  an  ill-defined  mass  situated 
in  the  right  ilio-lumbar  region,  giving  no  marked 
fulness  or  swelling,  and  extending  from  within  one 
inch  of  the  umbilicus,  where  dulness  began,  almost 
as  far  down  as  the  crest  of  the  ilium  below,  and  to 
the  free  border  of  the  ribs  above,  where  the  dulness 
emerged  into  that  of  the  liver.  The  lower  limit 
corresponded  with  a  line  just  above  the  anterior 
iliac  spines,  and  the  posterior  with  the  axillaiw  line. 
The  size  of  mass  from  behind  forward,  six  and  one- 
half  inches  ;  and  from  above  downward,  four  and 
one-half  inches  ;  the  greatest  breadth  being  anterior 
near  the  median  line,  giving  a  somewhat  pyriform 
shape  with  the  base  forward.  On  manipulation, 
much  pain  and  tenderness  were  experienced,  and 
deep  palpation  gave  an  obscure  sense  of  fluctuation. 

When  the  patient  was  upon  the  left  side,  the  mass 
falls  somewhat  in  that  direction,  percussion  then 
giving  a  somewhat  tympanitic  note  from  the  inter- 
vention of  the  gut. 

Since  admission,  the  pains  have  continued  and  in- 
creased somewhat,  and  the  amount  of  blood  in  the 
vomited  material  has  also  increased.  She  sleeps 
but  little,  although  anodynes  are  administered  in 
large  quantities  nightly.  Patient  is  losing  flesh. 
Bowels  have  been  regular,  and  movements  well 
formed.  Urine  is  acid  ;  its  average  specific  gravity 
is  1016  ;  its  color  is  amber  ;  it  contains  no  albumen. 


but  a  slight  amount  of  mucus.  Average  amount 
passed  daily  twenty-seven  ounces. 

Treatment. — The  patient  was  etherized,  and  an 
operation  performed  January  7.  Patient  laid  upon 
the  left  side,  and  an  oblique  incision  made,  extend- 
ing from  three  inches  external  to  the  spinous  pro- 
cesses on  a  level  with  the  last  rib,  downward  and 
outward  to  the  middle  of  the  crest  of  the  ilium  on 
the  right  side.  The  superficial  fascia  and  tissues 
were  then  cut  thi-ough  down  to  the  margin  of  quad- 
ratus  lumborum,  and  the  layers  of  the  abdominal 
wall  divided  as  they  presented  themselves.  The 
dissection  was  then  carried  through  the  fine  layers 
of  areolar  adipose  tissue  which  lay  immediately  be- 
low, when  a  fold  of  what  was  supposed  to  be  intes- 
tine, with  its  covering  of  peritoneum,  presented 
itself ;  this  was  pushed  one  side,  and  another  sup- 
posed layer  of  areolar  tissue  cut  up  on  a  director. 
The  finger  was  then  introduced  into  the  cut,  and  a 
large,  firm,  solid  mass  detected,  apparently  about 
the  size  of  a  fist,  but  nothing  that  gave  a  sense  of 
fluctuation  could  be  felt.*  The  mass  was  grasped 
by  vnlsellum  forceps,  and  drawn  toward  the  edge 
of  the  wound,  the  finger  introduced,  and  surround- 
ing tissues  separated. 

Traction  was  now  made,  but  the  mass  seemed  im- 
movable. The  whole  hand  was  introduced,  and 
found  to  be  in  the  general  i^eritoneal  cavity,  whence 
the  anterior  free  border  of  the  liver  could  be  felt 
adjacent  to  the  part  operated  upon.  Further  inter- 
ference was  now  deemed  unadvisable. 


A  fenestrated  drainage-tube  was  inserted  for 
about  four  inches  into  the  wound,  and  the  surround- 
ing parts  were  washed  freely  with  1  to  4  car- 
bolic  acid,  none,   however,  being   admitted    inter- 

*This  was  determined,  by  the  con.sent  of  Drs.  Markoe  and  Weir,  to  be 
the  kidney,  and  it  was  deemed  best  to  pursue  the  tiissectioii,  with  the 
removal  of  the  kidney  in  view. 


482 


THE  MEDICAL  RECORD. 


nally.  The  wound  was  sutured  with  fine  carbolic 
silk  sutures,  and  full  Lister  dressing  applied.  The 
operation  was  done  under  the  spray,  and  hemorrhage 
was  very  slight.  The  patient  was  returned  to  the 
ward  and  stimulated  hypodermically. 

The  pulse  during  the  operation  was  very  good, 
but  afterward  became  very  weak,  and  temperature 
fell  to  95^  F.  The  patient  died  Januaiy  8,  at  6.30 
A.  M.,  of  shock  and  heart  failure. 

Autopsy. — January  8, 1882, 11  a.m. — At  the  autopsy 
the  body  was  anjemic,  though  fairly  nourished,  and 
rigor  mortis  was  well  marked.  Very  .slight  ledema 
in  both  lower  extremities.  In  the  right  lumbar  re- 
gion there  is  an  incision  three  inches  anteriorly  to 
spinous  processes  of  vertebriB,  and  running  in  a 
diagonal  direction  from  the  free  border  of  the  ribs 
to  the  crest  of  the  ilium. 

Brain  and  niembrnnes  not  examined. 

Abdomen. — The  right  lobe  of  the  liver  extends  in 
the  mammary  line,  12  ctm.  below  free  border  of  ribs. 
Lower  border  of  liver  is  on  a  level  with  anterior 
superior  spine  of  ilium.  Lower  border  of  right 
lobe  of  liver  is  lacerated  and  hemorrhagic ;  re- 
mainder of  surface  that  can  be  viewed  without  dis- 
turbing organ  is  anaimic.  The  transver.se  colon 
with  its  omentum  lies  two  inches  below  umbilicus. 
The  fundus  of  stomach  occupies  the  left  hypochon- 
driac region  ;  the  most  dependent  portion  (two  and  a 
half  inches  above  pylorus)  is  on  a  level  with  the 
umbilicus.  The  left  kidney  is  about  in  the  normal 
situation,  its  upper  border  being  on  a  level  with  the 
plane  of  the  fifth  intercostal  interspace  on  the  an- 
terior surface  of  the  thorax,  its  lower  border  reach- 
ing to  the  plane  occupied  by  lower  border  of  ribs 
in  the  axillary  line.  The  right  kidney  extends  be- 
tween the  .same  limits,  but  is  half  an  inch  nearer  the 
median  line.  Peritoneal  cavity  contained  about  six 
ounces  of  blood.  There  were  no  evidences  of 
peritonitis,  but  peritoneum  in  front  of  internal 
opening  of  above-mentioned  incision  was  stripped 
up  for  an  area  of  about  four  square  inches  toward 
the  median  line,  and  the  mesocolon  of  the  caput 
coli  and  the  ascending  colon  are  hemorrhagic. 

Ovaries. — Both  ovaries  enlarged.  Right  ovai-y, 
five  inches  by  three  and  one-third  inches ;  left  ovary, 
three  and  one-half  inches  by  three  and  one-half 
inches. 

Liver. — Weight,  1,500  grammes.  Breadth  at 
broadest  part,  21  ctm.,  of  which  lower  lobe  occupies 
9.  Length  :  Right  lobe,  from  coronary  ligament  to 
lower  extremity  of  lobe,  27  ctm.;  of  left  lobe  be- 
tween the  same  limits,  IGJ  ctm.  Liver  presents  on 
its  anterior  surface  a  marked  transverse  constric- 
tion. Lacerations  are  all  at  lower  extremity  of  right 
lobe,  and  penetrate  in  places  to  a  depth  of  two 
inches.  On  section  the  liver  appears  to  the  naked 
eye  to  contain  a  slight  excess  of  connective  tissue. 

Kidneys,  intestines,  s])Ieen,  stomach,  and  uterus 
normal.  Heart  markedly  fatty,  as  determined  by 
microscopic  examination. 

Remarks. — Our  failures  as  well  as  our  successes 
should  be  published.  Indeed,  statistics  are  of  little 
value,  where  only  successful  cases  are  recorded.  The 
case  of  Sophia  Roskey,  which  I  liave  just  read, 
teaches  that  accuracy  in  diagnosis  is  exceedingly 
difficult  to  secure.  I  was  very  confident  that  I  had  a 
case  of  hrdronephrosis  to  deal  witli,  in  most  par- 
ticulars closely  resembling  the  two  cases  which  I 
have  reported  this  evening.  The  history  and  tlie 
physical  geography  of  the  patient  pointed  in  that 
one  direction.  She  was  examined  by  all  my  col- 
leagues— Drs.  Markoe,  Sands,  Weir— and  by  many 


other  surgical  friends.  After  careful  inspection,  we 
all  reached  the  conclusion  that  it  was  a  case  of 
hydronephrosis,  and  a  proper  one  for  operation.  In 
particular  did  all  agree  as  to  the  existence  of  distinct 
fluctuation.  In  this  case  I  omitted  to  make  manual 
examination  by  the  rectum  for  the  reason  that  my 
patient  was  small  and  delicate,  and  complained  of 
much  pain  after  but  slight  handling  of  the  abdo- 
men. This  led  me  to  think  that  the  walls  of  the 
cyst  might  be  thin,  and  in  danger  of  rupture  from 
such  an  examination.  In  this  view  I  was  supported 
by  mj'  associates.  Had  the  examination  been  made, 
I  very  much  doubt  that  it  would  have  saved  me 
from  the  eiTor  into  which  I  fell.  The  hand,  on  being 
pushed  up  into  the  renal  region,  would  immediately 
have  come  in  contact  with  a  body  in  that  region  in 
all  respects,  in  so  far  as  I  can  appreciate,  resembling 
in  feel  and  position  an  enlarged  kidney.  Possibly 
the  absence  of  fluctuation  might  have  been  deter- 
mined, in  which  case  it  is  possible  that  the  opera- 
tion might  have  been  done  more  in  view  of  that  fact. 
When  the  incision  let  me  down  upon  what  was  sup- 
posed to  be  the  kidney,  not  one  of  us  engaged  had 
a  doubt  that  it  was  that  organ  which  presented  at 
the  V)ottom  of  the  wound.  Color,  feel,  and  aU.  The 
apparent  increase  in  size  seemed  to  be  due  to  some 
diseased  action.  Up  to  this  time  we  were  all  confi- 
dent that  the  wound  had  not  penetrated  the  perito- 
neal cavity,  and  it  was  only  on  pursuing  the  manipu- 
lation still  further,  with  the  intention  of  getting  the 
entire  kidney  in  my  grasp,  and,  if  necessary,  remov- 
ing the  organ,  that  I  found  myself  in  the  cavity  and 
ujion  the  surface  of  tlie  liver. 

Up  to  this  time  no  portion  of  intestine  was  in 
view,  although  I  must  have  entered  the  cavity  early. 
When  it  was  evident  that  it  was  the  liver  which  pre- 
sented, the  kidney  was  found  with  some  difliculty, 
apparently  crowded  up  under  the  ribs,  and  not  pre- 
senting in  the  usual  jjosition.  Had  I  recognized  the 
liver  earlier,  I  should  have  handled  it  less  roughly, 
and  sooner  have  closed  the  wound.  The  amount  of 
displacement  and  malposition  of  liver  and  stomach 
revealed  by  the  autopsy  was  such  as  I  had  never 
seen  before,  and  was  possibly  occasioned  by  con- 
stant tight-lacing  from  early  youth. 

Tlie  drawing  which  accompanies  this  was  made 
by  Dr.  Thompson,  Junior  Walker  on  the  medical 
side,  and  very  faithfully  represents  the  aijpearanceB 
of  those  organs.  I  wish  that  the  teachings  of  this 
case  made  me  feel  that  it  would  be  impossible 
to  make  the  same  mistake  again.  I  much  fear  that 
under  the  same  circumstances  and  surrounding  I 
might  repeat  the  same  error. 


DEFEf'TIVE  HeaRINi}  IN'  ClirLDREN. — Dr.  Weil,  of 
Stuttgart,  has  during  the  last  two  years  ex;!mined 
4,.'500  school  cliildren  in  i-eforence  to  their  hearing. 
The  examination,  which  included  boys  and  girls  of 
all  social  classes,  yielded  the  following  results  :  (1/ 
defects  of  hearing  are  exceedingly  common  ;  in  the 
public  schools,  thirty  per  cent,  of  the  children  were 
found  to  have  imperfect  hearing  in  one  ear,  while  a 
still  larger  percentage  were  lound  not  normal  ;  (2) 
among  the  children  of  well-to-do-jiareuts.  the  figures 
are  more  favorable  than  among  those  of  the  ]>oor ; 
(3)  the  percentage  of  defective  hearing  increases 
with  age ;  (-1)  country  schools  yield  relatively  better 
results  than  city  schools. 

Reichard,  of  Riga,  has  examined  1,{)5,")  children, 
using  the  water-test,  and  found  22.2  per  cent,  with 
defective  hearing  in  one  or  both  ears. 


THE  MEDICAL  RECORD. 


483 


ON  THE  LIMIT   OF   SKIN   VITALITY. 
By  E.  p.  brewer,  M.D.,  PH.D., 


NORWICH,  CONN. 


Sparsely  scattered  through  the  medical  literature 
of  the  past  century  are  found  details  of  crude  ex- 
periment in  transplantation.  Though  it  seems  to 
have  been  established  that  the  ejiidermis  might  be 
wholly  severed  from  its  organic  supporters  and  re- 
acquire its  connections  if  placed  immediately  in 
situ  or  upon  a  healthy  granulating  surface,  yet 
the  results  of  the  operation  were  so  indefinite  and 
unsatisfactory  that  prior  to  the  experiments  of  M. 
Reverdin  at  La  Charitf  in  18l!9,  it  was  regarded  of 
little  value  beyond  an  interesting  physiological  de- 
monstration. However,  his  practical  method  and 
splendid  results  gave  the  subject  new  impetus,  which 
now,  after  the  expiration  of  nearly  thirteen  years,  is 
still  unimpaired  and  echoes  in  clear  harmony  the 
tones  disseminated  from  La  Charite. 

In  general  hospital  practice  very  few  surgical  pro- 
cedures are  more  frequently  used  or  of  greater  value 
than  transplanting.  It  forms  a  royal  pathway,  as  it 
were,  to  the  correction  of  the  accidents  of  slough- 
ing which  are  so  embarrassing  in  surgical  practice. 
Our  unfortunate  skLn-sloughings  in  flap  amputations 
are  replaced  with  wonderful  rapidity  ;  the  immense 
ulcers  incident  to  superficial  gangrene  are  healed  in 
weeks,  where  otherwise,  if  they  healed  at  all,  months 
would  surely  be  required  ;  our  healthy  gi-anulatins; 
ulcers  close  as  if  touched  by  the  magician's  wand. 
Hence  skin-grafting  becomes  a  justifiable  and  suc- 
•cessful  routine  practice. 

One  of  the  main  elements  of  success  was  formerly 
regarded  to  reside  in  the  immediate  application  of 
the  fresh  skin,  but  more  recent  experiment  seems  to 
fairly  establish  that  this  view  is  erroneous ;  in  truth 
it  is  a  matter  of  common  observation  that  the  skin 
obtained  from  amputated  members  four  or  five  hours 
after  the  operation  is  equally  successful  as  the  fresh 
graft.  Later,  however,  experimenters  have  utilized 
skin  obtained  from  the  dead  body,  and,  strangely, 
with  good  success. 

As  a  legitimate  offspring  of  these  observations  the 
inquiry  has  arisen,  What  is  the  extreme  duration  of 
vitalitv  in  the  skin  ?  or.  What  is  the  limit  of  skin 
vitaHty  ? 

To  determine  this  mooted  question  to  our  own 
satisfaction,  we  entered  upon  this  series  of  observa- 
tions, in  which  we  have  exercised  much  care  to  select 
cases  that  would  serve  as  unequivocal  criterion. 

Arranging  our  cases  to  exhibit  jjrogressive  elapse 
in  time  from  the  removal  to  the  application  of  the 
graft,  we  will  invite  your  attention  to  the  lirst  one. 

Case  I. — An  L-ishman,  aged  forty-five  years,  of  in- 
temperate habit  and  free  from  specific  taint.  Upon 
his  left  leg  over  the  anterior  tifcial  muscle  is  a  pale 
glistening  ulcer  about  two  inches  square,  covered 
with  a  thin  and  scanty  secretion.  This  he  states  has 
existed  ten  months,  and  owed  its  origin  to  a  sevei-e 
bruise.  Submitted  to  the  iodoform  dressing,  gran- 
ulations sprung  up  abundantly,  and  the  discharge 
became  purulent. 

Now  carefully  dissecting  a  piece  of  skin  from  a  re- 
cently amputated  leg,  we  folded  it  in  a  piece  of  pa- 
per and  laid  it  away  in  our  commode  for  eighteen 
hours.  Then,  placing  no  restraint  upon  the  patient's 
movements,  we  gi-atted  after  the  usual  manner. 

After  the  expiration  of  four  days  we  removed  the 
dressings  and  irrigated  cautiously  with  carbolized 
water  (1-100) .     Changing  the  dressings  every  second 


day,  we  watched  for  the  radii  from  the  grafts.  Upon 
the  eighth  day  they  were  distinctly  visible  to  the  eye. 
Knowing  the  number  of  the  giafts  used  and  enume- 
rating the  number  of  grafts  presenting  radii,  we 
found  that  the  proportion  of  four  out  of  five  grafts 
survived,  a  twenty  per  cent,  mortality.  Repair  pro- 
gressed favorably,  and  on  the  fifteenth  day  the  iilcer 
was  closed. 

Case  II. — Our  next  case  presents  no  interesting 
peculiai-ities.  He  is  of  Irish  parentage,  aged  thirty- 
eight  years,  intemperate  and  of  good  physique.  His 
ulcer,  which  is  on  the  right  leg,  near  tuberosity  of 
the  tibia,  is  a  healthy  granulating  sore,  one  and  one- 
half  inch  long  and  one  inch  wide.  Contrariwise 
our  gi-afting  material  has  a  verv-  peculiar  history, 
which  is  briefly  as  follows  :  About  9  o'clock  one  even- 
ing we  were  called  in  haste  to  visit  a  patient  with 
hipmoptysis ;  our  efforts  were  useless  and  he  died  soon 
after  our  arrival. 

The  following  day  at  2  o'clock  we  held  an  autopsy 
(both  lungs  contained  cavities,  and  tubercle  was 
found  in  the  mesentery,  lungs,  and  liver).  Before 
closing  the  abdomen,  I  cut  from  it  some  of  the  in- 
tegument, and  carefully  rolling  it  in  paper,  put  it  in 
my  pocket.  Entering  at  once  upon  urgent  duties, 
it  "was  forgotten  until  the  following  morning. 

Then,  between  9  and  10  o'clock,  thirty-six  to 
thirty-seven  hours  after  death — nineteen  hours  of 
which  it  was  earned  in  my  pocket — I  proceeded  to 
graft  case  Xo.  2.  Following  the  method  adopted  in 
our  previous  case,  I  found  that  on  the  eighth  day 
the  fila  were  very  abundant.  On  counting  the  grafts, 
three  out  of  five  had  survived.  Rej^aration  was 
complete  on  the  fifteenth  day. 

The  result  obtained  in  the  face  of  such  glaring 
disadvantages  exceeded  my  expectations,  and  en- 
couraged me  to  further  investigations. 

Selecting  uninjured  integument  from  the  dorsum 
of  a  recently  amputated  foot,  I  wrapped  it  in  moist 
cloth  and  laid  it  in  a  cool  place.  At  the  expiration 
of  thirty-five  hours  I  grafted  a  healthy  ulcer  three 
inches  long  by  one  inch  wide,  occurring  on  the  per- 
son of  an  Englishman  (Case  No.  3),  forty  two  years 
of  age,  and  in  perfect  health  and  constitution.  The 
mortality  among  the  grafts  suri>assed  all  my  pre- 
vious cases,  reaching  50  per  cent.  Notwithstanding, 
healing  seemed  unimpaired,  the  thirteenth  day  find- 
ing the  ulcer  closed. 

From  the  same  integument,  at  the  end  of  forty-five 
hours,  I  laid  grafts  upon  an  eminently  promising 
surface  left  by  the  separation  of  the  slough  of  super- 
ficial gangrene. 

The  patient,  a  Swede  (Case  No.  4),  thirty-eight 
vears  of  age,  temperate,  and  of  good  health  and 
habits,  received  a  severe  and  extensive  contusion  on 
the  left  leg.  Erysipelas  developed,  on  which  super- 
ficial gangrene  supervened.  The  slough  left  an 
ulcer  ten  inches  long  and  five  inches  wide,  copiously 
granular  and  bathed  in  laudable  pus. 

Three  days  after  transplantation  the  gi-afts  were 
in  place  and  seemingly  normal.  Removing  one,  I 
carefully  washed  it  in  water,  to  remove  extraneous 
matter,' placed  it  on  a  glass  slide,  and  divided 
it  with  a  scalpel.  With  a  i-inch  objective,  we  dis- 
cerned infiltration  and  gi-anular  cells  j,/,.,t  inch 
in  diameter,  gifted  with  unmistakable  ama?boid 
movements.  Acetic  acid  made  the  cells  more  dia- 
phanous, thus  rendering  the  granular  condition 
more  distinct,  but  otherwise  no  change  was  appar- 
ent. On  the  fifth  day  the  macro-  and  microscopic 
phenomena  were  unchanged.  Examining  the  case 
on  alternate  days,  it  was  not  until  the  ninth  that  fila 


484 


THE  MEDICAL  RECOKD. 


appeared,  and  then  from  only  twelve  grafts ;  devel- 
opment proceeded  slowly  for  four  days,  then  ceased, 
the  fila  disappeared,  and  the  last  graft  fell  oft'  on  the 
twentieth  day.  Although  these  twelve  grafts  stood 
with  indubitable  evidences  of  vitality,  the  vast  ma- 
jority implanted  showed  a  singular  disposition  to 
adhere,  and,  had  it  not  been  for  the  searching  in- 
quiry on  the  ninth  day  with  a  powerful  hand  magni- 
ling  glass,  we  would  not  have  hesitated  to  have 
looked  upon  the  case  .with  a  fair  hope  of  success. 
The  results,  negative  in  total,  confirmed  the  sus- 
picion. 

The  ulcers  in  both  oases  were  unquestionably  well 
adapted  to  support  the  life  of  the  grafts  ;  both  cases 
received  equal  care  and  the  same  grafting  material. 

The  first  healed,  the  second  remained  open  ;  the 
first  prospered  on  grafting  material  thirty-fivp 
hours  old,  the  second  failed  to  nourish  material 
forty-five  hours  old.  Conceding  the  limit  of  via- 
bility in  this  specific  specimen  narrowed  to  ten 
hours,  the  objection  of  grafting  upon  two  individuals 
is  pertinent,  and  must  in  justice  be  considered. 

To  this  end,  we  selected  a  chronic  ulcer,  four 
inches  long  and  two  and  one-half  inches  wide  (the 
result  of  a  burn),  on  the  arm  of  a  healthy  Irishman 
(Case  No.  5),  thirty-six  years  of  age.  Taking  in- 
tegument from  a  still-born  babe  at  full  term,  we 
grafted  the  lower  lialf  in  thirty-six  hours  and  the 
upper  in  forty  hours  respectively.  Dressing  ac- 
cording to  our  usual  custom  for  the  first  time  on  the 
fourth  day,  and  afterward  on  every  second  day, 
nothing  distinctive  occurred  until  the  eighth  day. 
Now  threadlike  fila  branched  from  the  lower  grafts : 
the  upper  remained  unchanged.  On  the  tenth  and 
twelfth  days  on  the  lower  half  the  tila  increased  and 
became  confluent,  while  on  the  upper  the  grafts  fell 
oft' one  by  one.  In  eighteen  days  the  lower  half  of  the 
ulcer  was  entirely  healed,  the  upper  half  being  open 
and  devoid  of  grafts. 

The  objection  of  grafting  upon  different  indi- 
viduals is  no  longer  available.  Responsibility  of 
viability  is  transferred  from  the  person  to  the  graft 
itself,  and  in  tui-n  is  credited  to  the  time-element  of 
the  graft. 

A  thirty-six-hour  graft  framed  a  successful  career, 
the  forty-hour  graft  died  and  was  exfoliated. 

Purporting  to  draw  the  limit  still  closer,  we  re- 
grafted  the  surface  with  healthy  integument  thirty- 
eight  hours  old.  The  result  proved  disastrous.  In 
eight  days  not  a  single  graft  remained  to  tell  the 
tale.  Obtaining  from  the  same  source  another 
specimen,  I  again  regrafted  in  the  same  manner  as 
before,  using  a  thirty-live  hour  graft.  From  these 
fifty  per  cent,  survived,  development  progressed 
noriually,  and  in  fourteen  days  the  ulcer  was  totally 
healed. 

Formulating  our  cases  for  comparison,  we  have 
the  following  statement : 

Experiment.  Affe  nf  graftx.  Result. 

Hours. 

1 18 Successful. 

2 36 Successful. 

3 35 Successful. 

•t 45 Unsuccessful. 

5 36 Successful. 

(■> 40 Unsuccessful. 

7 38 Unsucces.sful. 

8 3.") Successful. 

Of  the  eight  experiments,  five  were  .successful  and 
three  unsuccessful.  In  the  successful  cases  the 
time  elapsed  was  in  one  case  eighteen  hours,  in  two 


thirty-five  hours,  and  two  thirty-six  hours ;  in  the 
unsuccessful,  one  each  of  thirty-eight,  forty,  and 
forty-five  hours.  Although  in  three  instances  the 
grafts  were  removed  from  the  dead  body,  yet,  in 
consequence  of  dissolution  being  the  result  of  acci- 
dent, they  may  with  perfect  propriety  be  classed 
and  discussed  with  those  removed  from  the  living 
body. 

In  presenting  these  cases,  that  so  favorably  com- 
pare even  to  the  published  statistics  of  transplanta- 
tion with  the  fresh  graft,  I  am  well  aware  that  few 
surgeons  regard  the  procedure  as  trustworthy.  But 
from  our  own  experience  we  are  inclined  to  refer 
the  failure  to  lack  of  care  in  selecting  the  cases  ;  for 
whenever  we  have  grafted  upon  a  surface  of  free 
granulations,  bathed  with  laudable  piis,  success  haa 
been  uniform  ;  on  the  contrary,  our  grafting  upon 
surfaces  of  other  character  has  credited  variable  and 
generally  unsuccessful  results.  Confessedly  the 
most  striking  feature  in  our  cases  is  the  long  main- 
tenance of  vitality  in  the  gi-afts.  Comparing  their 
course  of  development  with  a  typical  case,  no  devia- 
tion in  time  of  development  nor  permanency  of  cure 
is  determined.  It  is  established,  if  a  graft  lives,  it 
develops  after  a  given  ratio,  varying  only  with  the 
idiosyncrasies  of  the  individuals  on  which  it  i» 
placed. 

In  the  forty-five-hour  experiment  (Case  No.  4),  aa 
previously  explained,  twelve  grafts  developed  fila  on 
the  ninth  day,  retained  them  four  days,  and  then 
fell  victims  to  degeneration.  The  explanation  of 
this  phenomenon  is  not  altogether  plain.  From  ex- 
tensive observation  I  have  determined  that  tila  ar& 
not  (tere/iiped  until  hlood-ressels  adually  penetrate  the- 
(jrafl.  Hence,  by  these  grafts  developing  fila,  we  are 
constrained  to  believe  that  blood-vessels  actually 
penetrated  the  grafts ;  and  if  blood-vessels  pene- 
trated the  gi'afts,  they  must  have  been  encouraged 
thereto  by  at  least  a  few  live  cells.  Then  followed 
the  degeneration.  Possibly  the  predominance  of 
dead  cells  so  affected  the  blood-vessels  that  their 
growth  was  paralyzed.  Be  that  as  it  may,  the  ob- 
servation remains  a  stubborn  fact. 

Each  and  every  experiment  with  grafts  thirty- six 
hours  or  less  in  age,  when  placed  upon  a  faronihle 
surface,  have  been  wholly  successful ;  beyond  this 
period  the  ultimate  result  has  been  a  failure.  While 
awaiting  the  results  of  cases  complementary  to  the 
above,  we  consider  thirty-six  hours  as  the  estab- 
lished duration  of  vitality  of  the  skin,  with  a  possi- 
bility of  its  being  extended  under  auspicious  cir- 
cumstances to  fortv-five  hours. 


Do  SouTiiEitN  Hogs  have  Teichina  Si'Iualis? — 
In  response  to  an  inquii-y  of  tlie  above  nature  quoted 
from  the  Journal  of  Comparath-e  Medicine,  Dr.  A.  G. 
Smythe,  Sanitary  Commissioner  of  Mississi})])i,  in- 
forms us  that  he  has  found  trichina^  in  the  flesh  of 
a  hog  in  that  State.  Our  correspondent  reports 
only  one  case,  however,  and  adds:  "In  a  practice 
of  nearly  half  a  century  among  swine-eating  people 
I  have  not  met  with  a  single  case  of  what  there  was 
any  reason  to  KU))pose  was  trichiiiiasi.s  cau.«ed  by  the 
use  of  swine's  tlesli  which  had  been  raised  and 
slaughtered  in  the  Southern  .\tlantic  or  Gulf  States^ 
but  have  seen  several  cases  su))posed  to  hnve  been 
caused  by  the  use  of  dried  salted  meats  from  St. 
Louis,  Mo.  But  in  no  case  did  it  jjrove  fatal,  and 
there  was  no  post-mortem,  and  therefore  no  ]iositive 
proof  that  any  case  was  true  trichiniasis." 


THE  MEDICAL  RECORD. 


485 


CEIiLULO-CUTANEOUS    EEYSIPELAS     IN 
THE   CEE\7CAL    EEGION, 

With   Subcutaneous   Slough   of  Vein — KEC0\-EBy. 

By  H.  J.  RAYMOND, 

ASSISTANT  SCKGEON,   r.  S.  ARMY. 

An  Italian,  aged  thirty-eight  years,  of  debilitated 
constitution,  came  under  my  care  in  July,  1881, 
while  in  charge  of  the  erysipelas  tent  connected  with 
Bellevue  Hospital.  Patient,  who  was  brought  in  on 
a  stretcher,  gave  a  history  of  an  attack  of  cervico- 
facial erysipelas  of  six.  days'  standing,  and  the  sud- 
den development  of  a  swelling  just  below  the  angle 
of  the  jaw.  This  abruptly  appearing  tumor  made 
its  advent  the  night  previous  to  admission,  and  had 
gradually  increased  from  the  size  of  a  goose-egg  to  a 
medium-sized  gourd,  measuring  eight  inches  in  its 
long  diameter  and  extending  from  lobe  of  right 
ear  to  the  left  sterno-clavicular  articulation,  making 
pressure  upon  the  pharynx  and  trachea,  thus  embar- 
rassing respiration  and  rendering  deglutition  diffi- 
cult. To  insure  mechanical  rest  to  the  injured  part, 
nutrition  was  kept  up  per  rectum,  and  the  head  was 
couched  snugly  on  a  pillow,  the  patient  being  strictly 
enjoined  to  keep  the  head  in  statn  quo. 

The  strict  compliance  with  this  injunction  on  the 
part  of  the  patient  for  almost  a  fortnight  seemed  the 
working  out  of  his  own  salvation. 

The  muriated  tincture  of  iron,  quinia,  and  brandy 
were  administered  in  libei-al  quantities. 

The  case  seeming  desperate,  Dr.  Frank  H.  Ham- 
ilton, at  my  solicitation,  kindly  consented  to  see  the 
patient  and  give  me  the  benefit  of  his  own  exjjerience 
and  judgment.  After  an  inspection  of  the  tumor 
and  a  few  interrogatories  to  the  patient,  the  Doctor 
gave  as  his  opinion  that  a  sulicutaneous  slough  of  a 
vein  in  the  cervical  region  had  taken  place  subse- 
quent to  and  caused  by  the  erysij^elatous  process ; 
that  only  a  ghost  of  a  chance  was  held  out  to  the 
patient  for  his  life,  namely,  that  the  skin  would  not 
ulcerate  too  soon  for  the  formation  of  proper  clots 
in  one  or  more  of  the  subcutaneous  patulous  veins. 
Thirty-six  hours  subsequently  the  skin  ulcerated 
through  and  a  pint  of  dark  grumous  blood  oozed 
out,  the  tumor  disappearing.  Dried  sulphate  of 
iron  was  used  as  a  hemostatic  by  being  sprinkled 
over  the  ulcerated  surface,  which  within  twelve 
hours  gradually  increased  in  area  to  the  size  of  a 
man's  hand. 

To  prevent  sepsis,  the  cavity  was  gently  packed 
with  carbolized  lint,  moistened  in  a  two  and  one-half 
per  cent,  solution  of  carbolic  acid,  and  all  precautions 
taken  to  keep  the  wound  clean  that  were  permissilile 
under  the  circumstances.  The  slough  was  so  deep 
as  to  lay  bare  the  common  carotid  artery,  which 
could  be  felt  to  pulsate  immediately  under  the 
finger. 

Ten  days  later,  small,  bright  red  granulations  be- 
gan to  spring  up  in  the  bottom  of  the  wound,  and 
its  surface  took  on  a  healthful  appearance. 

After  the  lapse  of  three  months,  the  tilling  up  with 
grranulation  tissue  was  completed,  and  the  super- 
ficies skinned  over. 

It  is  important  to  observe  that  rest — "absolute, 
unconditional,  and  complete  " — of  the  disorganizing 
tissuee  of  the  cervical  region  was  secured  by  sus- 
pending deglutition,  allaying  cough,  prohibiting 
articulation,  and  enjoining  the  maintenance  of  tlie 
head  in  a  comparatively  fixed  position,  and  that  ul- 
ceration of  the  skin  was  retarded  bv  the   removal 


and  exclusion  of  all  dressings  causing  the  slightest 
pressure  upon  the  tensely  stretched  skin. 

On  the  other  hand,  as  between  Scylla  and  Charyb- 
dis,  while  warding  off  exhaustion  by  hemorrhage,  the 
non-evacuation  by  the  bistoury  of  the  pent-up  ad- 
mixture of  jjutrefying  blood  and  ichorous  pus,  and 
the  possible  existence  of  a  suppurative  phlebitis 
portended  a  fatal  is.siae  in  the  probable  putrid  sys- 
temic infection  through  the  open  mouths  of  the 
veins,  and  the  sui)purative  action  going  on  in  their 
interior. 

This  issue  was  happily  averted,  as  was  also  a  fatal 
termination  from  hemorrhage,  inanition,  asthenia, 
or  other  untoward  consequences  of  a  deep-seated 
phlegmonous  process  in  so  vital  a  region  of  anatom- 
ical relations. 

Alcatuaz  Islaxd,  Cal. 


OSTEITIS  OF  THE  FE.MUK— SUBCUTA- 
NFiOUS  PEPtIOSTOTO:\lY— RECOVERY  BY 
RESOLUTION,  WITR  RE:\[ARKS. 

By  J.  BLOCK,  M.D., 

KANSAS    CITT,    MO. 

The  following  history  presents  a  case  suggesting  the 

above  title.     Infant  W was  bom  in  December, 

1880,  and  is  the  sixth  child  of  healthy  parents  whose 
family  history  does  not  reveal  anything  of  import- 
ance referable  to  heredity.  From  the  statement  of  its 
mother  I  learned  that  the  child,  although  deprived 
of  breast- milk  from  birth,  enjoyed  remarkably  fine 
health,  being  plump,  well  developed  and  nourished 
up  to  the  fifth  or  sixth  month  of  its  existence.  These 
exceptions  to  the  previous  remark  were  however  ob- 
served. At  intervals  it  seemed  distressed  on  void- 
ing urine,  the  quantity  being  reduced  and  high  in 
color,  yielding,  however,  to  the  administration  of 
domestic  remedies.  After  having  attained  the  age 
of  three  months,  it  was  remarked  that  it  did  not  dis- 
play the  active  mobility  usually  observed  in  young 
infants  at  this  period,  and  that  it  was  intolerant  of 
pressure  to  the  plantar  surfaces  of  either  foot,  seem- 
ingly avoiding  play-tapping  of  these  regions,  with  a 
marked  degree  of  aversion. 

During  May  and  June  of  1881  it  suffered  fi'om 
dysentery,  after  having  been  removed  from  Kansas  to 
this  city,  for  which  it  was  treated  by  a  prominent 
practitioner  of  this  city.  At  this  time  its  lower 
middle  incisors  made  their  appearance.  Although 
it  made  a  fair  recovery  from  its  enteric  trouble,  the 
child  progressed  biit  slowly,  and  I  first  saw  it  when 
suffering  from  a  diarrhcea  in  July.  Subsequently,  it 
again  came  under  my  observation  for  what  seemed 
to  be  a  dysuria.  It  was  at  this  time  that  my  atten- 
tion was  called  to  its  inferior  extremities. 

Upon  tapping  the  sole  of  the  left  foot,  the  infant 
would  cry  and  sometimes  shriek  with  pain.  Al- 
though a  similar  distress  was  manifested  on  repeat- 
ing the  process  on  the  right  foot,  it  was  decidedly 
less  in  degree. 

A  thorough  examination  of  the  ankle,  knee,  and 
hip-joints  found  nothing  abnormal  presenting  in 
or  about  these  articulations.  The  vertebrre  were 
free  from  evidences  of  disease,  and  the  long  bones 
of  the  extremities  did  not  seem  to  be  undergoing 
any  pathological  change.  No  evidences  of  trauma- 
tism was  elicited. 

Late  in  September  of  the  same  year  the  infant 
suffiered  from  a  ]3yrexia  that  was  intermittent  in  its 
course,  terminating  in  a  profuse  diaphoresis.  It 
would  not  yield  to  aconite,  but  a  tolerably  liberal 


ISiJ 


THE  MEDICAL  RECOKD. 


exhibition  of  quinine  seemed  to  cut  it  short.  Its 
duration  was  three  days.  It  might  be  added  that 
some  time  previous  to  this  fever,  the  upper  incisors 
made  their  appeai'ance. 

On  October  «,  18S1,  the  left  thigh  began  to 
swell,  and  the  next  day,  on  being  called  to  the 
little  patient,  I  found  it  with  an  anxious  counte- 
nance and  an  accelerated  i>ulse,  but  no  elevation  of 
temjierature  marked  the  onset  of  this  condition  at 
the  time.  The  left  lower  extremity,  notwithstand- 
ing the  restlessness  of  the  little  sufferer,  appeared 
instinctively  immobile.  The  left  thigh  presented  a 
pusiform  appearance,  the  tumefaction  being  greatest 
at  the  centre  of  the  shaft  of  the  femur,  gradually  ap- 
proaching the  normal  level  as  it  encroached  upon 
the  epiphyses.  The  surface  was  neither  reddened 
or  liot,  but  presented  a  mottled  appearance,  lirmly 
resistant  and  exquisitely  tender  to  touch.  At  its 
centre  the  tumor  was  about  twice  the  circumference 
of  the  opposite  thigh,  although  the  swelling  had 
made  its  appearance  in  the  short  space  of  a  few 
hours.  The  surface  of  the  thigh  was  uniformly 
smooth,  with  an  absence  of  fluctuation  evei-ywhere. 

The  next  morning,  the  10th  iust.,  after  deliberat- 
ing in  consultation  with  Dr.  Halley,  it  was  deter- 
mined— having  concluded  that  the  case  was  an  osteo- 
2ieriostitis — to  relieve  tension  by  a  periostotomy. 
Owing  to  the  frail  and  unpromising  condition  of  the 
little  sulf^rer,  we  agreed  to  limit  the  operation  to  a 
subcutaneous  incision.  This  was  also  looked  upon 
as  an  exploratory  measure.  After  the  administration 
of  chloroform  the  puncture  was  made  immediately 
internal  to  the  external  hamstring  and  over  the  ex- 
ternal condyle  down  through  the  periosteum  upon 
the  surface  of  the  femur  the  entire  length  of  its  dia- 
physis.  The  operation  was  dmie  under  the  spray,  a 
tenetome  being  the  instrument  emplo3-ed.  Nothing 
but  a  little  bloody  serum  exuded  from  the  wound. 
The  shaft  was  felt  roughened  as  though  covered  with 
osseous  stalactites.  We  then  closed  the  wound  with 
absorbent  cotton  and  applied  a  bandage.  Iodide  of 
potassium  in  three-grain  doses  was  ordered  in  its 
feeding-bottle  three  times  a  day,  and  a  mixture  of 
cod-liver  oil  and  pancreatic  emulsion  to  be  given  in 
teaspoonful-doses  between,  meals.  Tincture  of  opium 
to  relieve  pain  in  such  doses  and  as  frequently  as 
required. 

The  next  day  our  patient  seemed  no  worse  for  the 
operation  and  no  elevation  of  temperature  followed 
the  procedure,  but  the  suffering  still  continued. 
The  wound  was  kept  open  by  introducing  a  probe 
every  other  day  and  redressed  under  the  spray.  As 
this  operative  interference  seemed  fmitless  in  re- 
sults after  the  lapse  of  a  week,  we  permitted  the 
wound  to  close,  the  exceedingly  bad  aspect  of  the 
case  not  warranting  the  more  formidable  operation 
of  linear  osteotomy  or  trei>hining. 

Continuc'l  application  of  hot  flaxseed  poiiltices 
were  now  ordered,  and  tincture  of  o])inm  given  as 
often  as  required.  The  cataplasms  afforded  some 
relief,  but  at  night  the  pain  was  so  great  as  to  in- 
terfere almost  entirely  with  sleep.  Although  the 
suffering  spomed  constant,  there  ap])eared  to  be 
paroxysms  of  intense  aggravation. 

The  case  now  proceeded  from  bad  to  worse  ;  the 
swelling  increasing,  obliterating  all  the  furrows  on 
the  cutaneous  surface  of  the  thigh,  even  the  gluteo- 
femoral  fold,  s.nd  tlin  thickening  began  to  invade  the 
condyles,  so  that  the  limb  presented  almost  a  cylin- 
drical tumefaction  from  one  end  to  the  other,  and 
when  viewed  in  contrast  witli  the  op])osite — which 
serimed  shrivelled  into  a  little  pipe-stem   from  the 


general  atrophy — it  was  about  threefold  in  circum- 
ference, so  sensitive  to  touch  that  it  lay  in  the 
supine  position  upon  the  lap  of  its  devoted  mother 
almost  continually  for  six  weeks,  being  unable  to  sit 
and  shrieking  with  pain  upon  the  least  movement. 
A  severe  bronchitis  now  added  to  its  anguish,  and 
the  gums  over  the  tapper  central  incisors  became 
very  much  swollen,  ulcerous,  and  sloughy,  bleeding 
upon  touch  and  concealing  the  teeth.  This  increased 
the  distress  by  interfering  with  sucking.  The  appe- 
tite became  so  poor  that  it  took  but  two  bottles  in 
the  twenty-four  hoiu's.  The  quantity  of  anodyne 
was  gradually  increased  from  two  drojjs  of  the  tinc- 
ture of  opium  to  twelve  and  even  fifteen,  and  finally 
so  excruciating  became  the  pain,  that  I  began  to 
resoi't  to  morphia  for  relief,  giving  as  much  as  one- 
fifth  and  sometimes  three-tenths  of  a  grain  before  a 
disturbed  slumber  afforded  partial  resjnte.  The 
picture  was  truly  appalling.  So  wasted  and  wan 
was  the  little  sufferer  that  almost  eveiy  bone  became 
visible.  The  bronchitis  continued,  the  cough  being 
accompanied  by  pitiful  shrieks.  Grasjjing  the  infant 
beneath  the  armj^it  so  increased  its  suffering  that  it 
was  permitted  to  remain  in  the  recumbent  position. 
Ablution  and  change  of  apparel  performed  with 
greatest  caution  and  tolerated  only  under  protest. 
Dentition  was  also  aggravating  the  general  condi- 
tion so  that  incisions  into  the  gums  over  the  ap- 
Ijroaching  teeth  was  j^resumed  to  partially  alleviate 
the  distress. 

The  long-looked-for  pointing  and  fluctuation  fail- 
ing to  put  in  an  appearance,  fears  of  a  malignant 
growth  were  now  entertained,  despite  the  extreme 
youthfulness  of  the  patient.  Occasionally  a  .slight 
oedema  about  the  face  suggested  an  impending  com- 
plication to  terminate  the  case  in  dissolution.  At 
times  we  thought  that  a  diminution  in  the  swelling 
at  some  points  was  discernible,  but  it  was  more  ap- 
parent than  real.  The  cod-liver  oil  being  illy  toler- 
ated, eggs  and  wine  were  substituted. 

About  the  beginning  of  December  I  was  suddenly 
called  east.  Two  days  previous  to  my  departure, 
looking  upon  the  case  as  hopeless,  I  ordered  three- 
fourth  grain  doses  of  mercury  and  chalk  three 
times  a  day,  and  all  other  medication  to  be  sus- 
pended excejitiug  the  anodyne  to  relieve  jiain,  and 
the  limbs  to  be  wrapjied  in  cotton  batting.  U))on 
my  return,  ten  days  subsequently,  I  was  surprised  to 
find  my  little  patient  still  alive,  and  the  picture 
of  suffering  metamorphosed  into  one  of  ap])arent 
comfort  and  gaiety.  The  limb  was  decidedly  re- 
duced in  thickness,  more  at  some  points  than  others, 
so  that  shallow  folds  began  to  present  themselves. 
The  appetite  had  remarkably  improved,  four  to  five 
bottles  of  food  being  eagerly  accepted  in  twenty-four 
hours.  Sleep  was  undisturbed  and  of  considerable 
duration  and  so  reduced  the  sensitiveness  that  it  sat 
upon  its  mother's  lap. 

Gradually  the  enlaigement  presented  a  process 
of  liquefaction  and  the  scrawny  form  began  to  cover 
itself  with  adipose.  One  week  after  my  return,  the 
mother,  to  secure  a  week  of  much  needed  recreation, 
departed  for  the  East.  The  nurse  who  assumed 
charge  of  the  infant,  through  some  misapprehension 
and  at  the  solicitation  of  friends,  discontiniied  the 
use  of  the  mercury.  In  a  few  days  the  old  state  of 
affairs  threatened  to  return,  all  the"  past  sym]itoms 
again  manifesting  themselves.  At  this  juncture  I 
had  the  mother  telegraphed  for,  and  on  her  return 
the  mercury  was  continued,  when  it  again  reverted  ij 
to  a  convalescence  like  a  charm.  The  scorbutic 
gums  gradually  receded,  first  under  the  application 


ic     II 


THE  MEDICAL  RECORD. 


487 


of  iodoform,  then  of  alum,  and  in  about  four  weeks 
the  case  was  discharged  as  cured,  but  slight  osseous 
hypertrophy  remaining  to  mark  the  pathological 
process. 

The  child  plays  with  one  limb  as  miioh  as  with 
the  other,  moving  it  about  in  every  direction  with 
as  much  celerity.  It  has  grown  fat  and  large,  and 
teeth  are  rapidly  tilling  its  mouth.  Its  noirrishmeat 
now  consists  mostly  of  solid  food. 

In  January,  1882,  however,  previous  to  its  com- 
plete recovery,  the  tibia  of  the  same  side  assiimed  a 
slight  enlargement  in  its  entire  length,  disappearing, 
however,  in  a  few  days  under  the  continued  admin- 
istration of  hydrarg.  cum  creta?. 

On  reviewing  the  history  of  this  case  a  number  of 
interesting  points  are  offered  for  consideration. 
The  absence  of  specificity,  which  was  pretty  thor- 
oughly searched  for  ;  the  want  of  preceding  dyscra- 
sia,  none  of  the  exanthemata,  struma,  or  injury 
entering  into  its  etiology,  presents  a  striking  example 
of  the  well-remarked  expression  that  age  does  not 
preclude  the  possibility  of  any  malady,  referring 
here,  of  course,  to  the  exitremely  early  period  of  life 
for  this  disease  without  apparent  cause.  Its  evident 
subacute  or  chronic  course,  as  elicited  by  the  early 
history,  dating  back  almost  to  birth  in  its  insidious- 
ness,  and  the  sudden  engrafting  of  an  acute  process 
by  the  remarkable  rapidity  with  which  the  swelling 
appeared  is  also  worthy  of  notice. 

That  so  aggravated  an  example  of  formidable  dis- 
ease— when  one  considers  the  compactness  of  this 
type  of  connective  tissue— should  terminate  in  reso- 
lution is  also  a  marvel,  experienced  observers  record- 
ing it  an  exception  to  the  rule,  necrosis  and  caries, 
often  destroying  the  life  of  patient,  being  the  usual 
result.  In  addition  should  be  remembered  the  dis- 
advantages against  which  Nature  labored,  the  infant 
being  artificially  reared  from  the  beginning. 

The  extreme  tolerance  of  opium  at  so  early  a 
period  of  life  suggests  the  propriety  of  an  assertion 
that  the  extent  of  pain  and  suffering  should  be  the 
measure  of  its  indication  rather  than  the  age  of  the 
subject.  That  no  deleterious  after-effects  are  now 
to  be  seen  also  warrants  this  conclusion.  Impaired 
nutrition  was  rather  to  be  attributed  to  the  disease 
than  the  anodyne. 

The  absorbent  or  altei'ative  effects  of  mercury 
were  here  beautifully  illustrated.  Nor  can  the  result 
be  entirely  attributed  to  the  vis  medicatrix  natura; 
when  you  will  recollect  that  upon  suspension  of  the 
mercurial  all  the  symptoms  began  to  return,  followed 
by  relief  upon  its  readmini.stration. 

The  time  during  which  this  bony  structure  must 
have  been  subjected  to  the  pressure  of  effused  in- 
flammatory products  without  destraction  of  tissue, 
impairment  of  function,  or  diminished  usefulne-ss  is 
certainly  marvellous — from  October  8th  to  Decem- 
ber 5th,  fifty-eight  days  having  elapsed  before  the 
subsidence  of  the  acute  stage. 


The  Ajiericu?  Acadejix  of  Medicine,  accord- 
ing to  a  recently  published  list,  has  nearly  two  hun- 
dred members.  It  is  a  cui-ious  fact  that  all  the 
members  except  nine  live  in  the  Enst.  Ohio,  Illi- 
nois, and  Michigan  are  the  only  Western  States  that 
possess  membership,  the  latter  State  Ijeing  repre- 
sented by  Dr.  Connor  alone.  The  natural  inference 
is  that  college-bred  physicians  will  not  go  West. 

TRicfirxosis. — More  cases  of  trichinosis  have  been 
discovered  in  Brooklyn,  and  in  Hoboken,  N.  J. 


|Jr00re«fii  of  iJleliical  Science. 


Influence  of  Ptuetic  Disease.s  on  the  Cofrse 
OF  Syphilis. — It  is  well  Ivnown  that  the  gi-ave  py- 
retic diseases  can  materially  modify  the  course  of 
constitutional  syphilis,  so  that  its  manifestations 
may  temporarily  subside  or  be  moderated.  In  cor- 
roboration of  these  views.  Dr.  Petrowsky  (I'l-utfch, 
No.  22)  relates  the  histories  of  three  patients  who 
appear  to  have  been  entirely  cured  of  it  in  conse- 
quence of  an  intercurrent  fever.  The  following  case 
illustrates  his  claim.  The  jjatient,  male,  aged  thirty, 
contracted  syphilis  six  months  previous  to  his  en- 
tering the  hospital.  He  had  an  indurated  ulcer  on  the 
I^repuce,  balanitis,  a  number  of  flat  condylomata  on 
the  head  of  the  penis,  discharging  papules  thickly 
covering  the  scrotum,  and  large  mucous  patches  on 
the  fauces,  while  the  scalp  was  covered  with  the  des- 
tjuamating  j^apular  syphilides,  and  on  the  face  were 
numerous  tubercles.  A  mercurial  treatment  of  .six 
weeks'  duration  had  but  a  very  slight  effect,  though 
the  Hunterian  induration  grew  smaller  and  the  syj^h- 
ilides  on  the  scrotum  became  drier  and  smaller  in 
size;  the  remaining  manifestations  were  unaltered. 
Toward  the  close  of  the  second  month  of  his  stay  in 
the  hospital,  he  contracted  small-pox.  The  disease 
was  very  severe,  but  he  recovered  entirely,  and  when 
the  scabs  fell  oft'  not  the  slightest  trace  of  his  for- 
mer s^qihilitic  manifestations  could  be  discovered. 
This  patient  was  under  observation  for  a  number  of 
years,  remaining  free  fi'om  the  syphilitic  symptoms. 
The  second  case,  also  in  the  early  stage  of  syphilitic 
intoxication,  recovered  in  consequence  of  a  grave 
attack  of  facial  erysipelas  lasting  two  weeks.  Here 
mercury  was  not  used  at  all.  The  subsequent  his- 
tory was  the  same  as  in  the  preceding  case.  The 
history  of  the  last  patient  is  less  striking.  After 
recovei-y  from  typhoid  fever  a  gummy  tumor  situ- 
ated at  the  angle  of  the  jaw  suppurated  and  healed 
of  itself,  leaving  a  cicatrix  that  was  free  from  all  ap- 
pearances of  disease. 

An  Inst.\nce  of  SDn"iiTA>'Eous  Infection  with 
Recitrrent  Fea-er,  Measles,  and  Tyi'hus  Fe-^-er. — 
In  Eussia,  where  all  infectious  diseases  rage  uncon- 
trolled and  in  their  most  malignant  forms,  it  is 
claimed  that  there  are  frequent  instances  where  the 
system  can  he  the  seat  of  comliined  infection.  While 
this  fact  has  been  notoriously  a  matter  of  observa- 
tion in  certain  diseases  of  a  particular  gi'oup  (ty- 
phoid, typhus,  and  recurrent  fevers)  the  same  sort  of 
combination  has  been  described  in  some  others  of 
the  eruptive,  miasmatic,  and  contagious  fevers.  Such 
a  complex  infection  is  called  in  Russia  mixed  ty 
phus.  As  a  rale,  it  is  possible  to  recognize  the 
characteristic  features  of  the  elementary  disease,  but 
in  some  cases  the  picture  is  too  confused  to  permit 
any  intelligent  interpretation  of  the  symptoms.  In 
connection  with  this  subject  the  case  reported  by 
Dr.  Pasternatzky  ( T  i-atsch.  No.  .36)  is  very  interest- 
ing, as  it  shows  the  possibility  of  a  trii:)le  infection 
(reciuTent  fever,  measles,  and  typhus  fever).  The 
patient,  a  boy,  fourteen  years  old,  was  under  treat- 
ment in  one  of  the  temporary  hospitals  for  infec- 
tious diseases,  under  the  management  of  Professor 
Tschudnowsky  (St.  Petersburg).  The  day  of  ad- 
mission was  the  fourth  day  of  the  first  paroxysm  of 
recurrent  fever.  It  lasted  in  all  seven  days,  and  was 
followed,  after  four  days  of  apyrexia,  by  the  second 
attack,  lasting  four  days.     During  the  last  day  of 


488 


THE  MEDICAL  RECOED. 


his  first  paroxysm,  and  three  days  after  his  admis- 
sion, the  first  case  of  measles  entered  the  hospital, 
from  which  the  patient  very  probably  contracted 
this  disease.  It  manifested  itself  after  two  days  of 
apyrexia,  following  the  second  attack  of  recurrent 
fever,  and  ran  a  very  typical  course.  On  the  sev- 
enth day  the  eruption  disappeared.  On  the  eighth 
the  temperature  returned  to  normal  and  desqua- 
mation commenced.  The  ajij'rexia  lasted  thirty- 
six  hours,  when  the  third  attack  of  recuiTent  fever 
made  its  appearance,  lasting  three  days.  The  poi- 
son of  typhus  fever  entered  the  system  of  our  pa- 
tient most  likely  during  the  attack  of  measles,  and 
the  disease  broke  out  immediately  after  the  third 
paroxysm  of  recurrent  fever,  reaching  its  intensity 
on  the  sixth  day  with  the  aj^pearance  of  erujitiou, 
bronchitis,  catarrh,  lachi-ymation,  etc.  Typhus  fever 
followed  its  usual  course  until  the  eleventh  day, 
when  the  fever  suddenly  went  down,  the  patient  was 
attacked  with  diarrhcea  and  vomiting,  the  spleen 
and  liver  became  enlarged  and  painful,  for  four  days 
there  was  present  mild  pyrexia,  when  finally  the 
convalescence  was  fully  established.  This  unusual 
termination  of  typhiis  fever  is  interpreted  by  the  re- 
porter as  being  due  to  the  appearance  of  the  fourth 
paroxysm  of  recurrent  fever,  which  closed  this  strange 
and  complicated  illness. 

HoUB-GlASS  CoNTR.iCTION   OF   THE   UtERDS   TkEAT- 

BD  WITH  Amyii  Nitrite. — Dr.  Fancourt  Barnes  re- 
lates a  case  in  which  the  nitrite  of  amyl  was  success- 
fully used  by  him  to  counteract  the  uterine  sj^asm 
produced  by  ergot.  Being  called  to  a  patient  who 
had  been  attended  by  a  midwife,  he  found  that  ergot 
had  been  given  after  the  birth  of  the  child,  to  expel 
the  placenta.  Expulsion  had  not  been  accompli.shed, 
however,  and  the  umbilical  cord  had  been  torn  off. 
The  OS  internum  and  Bandl's  ring  were  firmly  con- 
tracted and  the  uterus  admitted  the  finger  only. 
Bearing  in  mind  the  power  possessed  by  amyl  ni- 
trite to  relax  muscular  tension,  three  drops  were 
given  upon  a  handkerchief.  During  the  inhalation 
the  uterus  was  found  to  steadily  yield,  so  that  the 
hand  was  introduced  and  the  jilacenta  detached.  It 
was  found  to  possess  a  remarkably  exsanguinated 
appearance.  Dr.  B.  was  not  aware  that  this  reagent 
had  been  used  before  for  this  purpose,  although  it 
had  been  recommended  theoretically  in  his  father's 
"Obstetric  Operations." — Brit.  Med.  Journal,  March 
18,  1882. 

Experiences  of  Thiebsoh  in  Nbr^te-Stretchtno 
FOR  Disease  op  the  Spinad  Cord. — In  the  Boston 
Medical  and  Surgical  Journal  for  March  2,  1882,  Dr. 
G.  L.  Walton  reports  four  cases  of  nerve  stretching 
from  the  clinic  of  Professor  Thiersch  (Leipsic).  In 
one,  a  temporary  improvement  was  noted,  but  in 
the  others  none  at  all  could  be  recognized,  these 
results  coinciding  therefore  with  many  others  that 
are  being  published  from  the  experience  of  surgeons 
in  various  quarters.  The  following  instance  is  given 
as  showing  the  best  result  he  obtained  :  A.  varni.sher, 
thirty-five  years  of  age,  the  subject  of  spastic  spinal 
paralysis  of  six  years'  standing,  following  typhoid 
fever,  gave  the  following  symptoms  :  Numbness  and 
weakness  of  the  lower  extremities,  with  a  band-like 
constriction  abo\it  the  body,  lateral  distortion  of 
the  spine,  convexity  to  the  right  between  the  first 
and  twelfth  dorsal  vertebric,  to  the  left  Ijelow  the 
twelfth,  but  with  no  apparent  inflammation  of  tlie 
cord  or  membranes.  Upper  extremities  normal,  but 
in  lower,  movements  impaired,  though  neither  ataxic 
phenomena  nor  abnormal  sensibility  were  apparent. 


The  operation  consisted  in  putting  the  patient  in 
the  prone  position  nnder  chloroform,  when  after 
exposure  of  the  sciatics  they  were  stretched  to  such 
an  e.xtent  that  the  buttocks  were  lifted  from  the 
table  during  the  eiibrt.  Lister's  antiseptic  method 
was  rigidly  followed  and  the  wound  closed  by  su- 
tures, after  the  introduction  of  drainage-tubes. 

For  a  few  days  there  was  increase  of  mobility,  but 
soon  prickling  and  burning  of  the  feet  were  felt,  and 
then  the  old  symptoms  gradually  returned,  and  on 
the  fourteenth  day  it  was  generally  conceded  by 
those  in  attendance  that  no  permanent  advantage 
had  been  gained.  Of  the  three  remaining  cases, 
where  no  improvement  ensued  after  stretching,  one 
was  of  locomotor  ataxia,  thought  to  be  of  syphilitic 
origin. 

Paroxysmal  Oocubrence  of  H^aEaioGLoniNniiA. — 
Dr.  Robert  Saundby,  of  Birmingham,  has  just  pub- 
lished the  results  of  his  personal  observations  upon 
an  affection  which  was  formerly  known  under  the 
name  of  intermittent,  paroxysmal,  or  winter  h;ema- 
turia.  It  was  first  described  by  Dressier,  in  1854. 
Subsequently  the  same  disease  was  called  h.'cmati- 
nuria,  but  in  1872,  when  Lebert  called  attention  to 
the  fact  that  Gschleiden  had  proved  the  spectro- 
scopic appearances  to  be  those  of  ha^maglobin  or 
met-hsemaglobin,  and  not  hiematin,  the  new  term, 
hiemoglobinuria,  came  into  use.  The  disease  may 
occur  at  any  age,  but  the  young  are  most  frequently 
attacked,  and  the  male  sex  by  preference.  Though 
in  some  cases  hereditary,  it  is  almost  invariably  pre- 
cipitated by  a  rigor  of  some  kind ;  in  rarer  cases  it 
has  been  induced  by  a  blow  or  exposure  to  cold. 
The  relation  it  bears  to  ague  is  not  clear,  nor  is  it 
specially  related  to  any  diathetic  tendency  or  spe- 
cific disease.  Functional  disturbance  of  the  liver  is 
often  an  associated  condition,  and  excei^tionally  the 
spleen  is  found  to  be  enlarged.  During  an  attack 
the  temperature-range  may  be  variable,  from  the 
subnormal  to  even  a  high  degi'ee  of  fever.  The  mi- 
croscopic characters  of  the  blood  are  those  of  slight 
aniemia.  The  urine  contains  hajmaglobin  or  met- 
hwmaglobin,  serum  albumen,  paraglobulin,  granular 
and  hyaline  casts,  and  urates. 

The  prognosis  is  good,  but  while  spontaneous 
cures  are  rej^orted,  there  is  a  tendency  to  relapse — 
not  modified  by  the  use  of  any  drug.  Quinine  ap- 
pears to  be  useful  during  the  paroxysm,  but  resi- 
dence in  a  tropical  climate  is  recommended  as  af- 
fording the  best  prospect  of  permanent  restoration 
to  health. 

The  Dental  Enoine  Modified  for  Surgical  Use. 
— Dr.  Garretson,  of  Philadelphia,  in  an  illustrated 
article  (Annals  of  Anatmni/  and  Snri/er;/,  March, 
1882),  descrilies  a  new  mechanical  adjuvant  for  sur- 
gical operations,  which  seems  calculated  to  give 
gi"eat  assistance  in  a  certain  class  of  operations, 
where  the  parts  are  difficult  of  access  or  a  special 
nicety  is  recjuired  that  is  hardly  to  be  obtained  with 
the  ordinary  instniments  of  the  surgeon's  armamen- 
tarium. This  appliance  is  in  reality  nothing  but  a 
modified  dental  engine,  and  those  who  have  seen 
the  latter  in  use  can  readily  understand  the  mechan- 
ism of  the  former.  For  the  wire  cable  of  the  dental 
engine  is  substituted  a  steel  arm.  An  assistant  tuins 
the  crank  of  the  surgical  engine,  while  in  the  dental 
the  foot  \ipon  a  treadle  gives  the  propelling  jiower. 
The  engine,  of  which  the  best  is  Bonwill's,  of  Phila- 
del])hia,  is  supplied  with  instruments  of  various 
forms,  such  as  circular  saws,  rose  ilrills,  bits,  etc. 
The  rapidity  with  which  it  accomplishes  the  object 


THE  MEDICAL  RECORD. 


489 


may  be  appreciated  from  the  fact  that  an  instni- 
ment  can  be  made  to  make  fifteen  thousand  revolu- 
tions in  the  minute.  Dr.  G.  finds  the  engine  is 
specially  suited  for  removing  necrosed  bone,  exos- 
toses, carious  portions  of  shafts,  segments  of  the 
coccyx,  in  exposing  the  zygomatic  and  sphenomaxil- 
lary foss.ie,  and  for  trephining. 

Tendon-  Reflexes. — Dr.  Byers,  of  Belfast,  has 
published  some  cases  illustrating  the  importance  of 
the  patellar  tendon  reflex  symptoms  in  the  diagnosis 
of  certain  nervous  lesions.  Though  not  strictly  a 
pathological  condition,  he  has  only  once  found  it 
absent  in  a  healthy  person  ;  and  yet  he  observes 
that  under  certain  normal  conditions  it  may  not 
be  produced,  as  for  example,  when  the  individual 
happens  to  be  very  fleshy,  or  when  the  tendon  is  un- 
usually short.  Berger  is  also  quoted  to  show  that 
the  reflex  may  occasionally  be  absent  without  ner- 
vous disease  (in  about  one  per  cent.).  To  deter- 
mine whether  the  reaction  be  present,  he  places  the 
patient  on  a  chair,  lets  the  foot  be  planted  firmly 
upon  the  floor  at  a  little  more  than  a  right  angle. 
He  then  rests  his  left  hand  on  the  quadriceps  mus- 
cle and  with  the  other  hand  strikes  the  tendon  below 
the  patella.  The  muscle  is  then  felt  to  contract  if 
the  reaction  ensue.  Should  this  fail,  however,  the 
patella  may  be  struck,  or  even  the  tendon  above  the 
patella.  This  is  Buzzard's  method.  Cases  of  tabes 
dorsalis  and  of  diphtheritic  paralysis  are  given  where 
the  absence  of  the  reflex  was  noteworthy,  while  in  a 
case  of  acute  anterior  polio-myelitis  the  absence  of 
the  patellar  reflex  enabled  him  to  diSerentiate  the 
disease  from  a  cerebi-al  disease,  there  being  in  this 
case  either  exaggerated  reflex  or  none  at  all.  In  his 
fourth  history,  one  of  right  hemiplegia,  there  was 
increased  patellar  reflex  of  the  right  leg  and  ex- 
aggerated supinator  reflex  of  the  right  arm. — Dublin 
Journal  nf  the  Medical  Science^-:,  March,  1882. 

The  EAPrDiTY  of  Amyloid  Deuenekatiox. — Ed- 
ward Bull,  in  several  of  his  works  on  Bright's  dis- 
ease, has  endeavored  to  demonstrate  that  the  de- 
velopment and  course  of  amyloid  degeneration  are, 
as  a  rtde,  vastly  more  rapid  than  has  been  hither- 
to admitted.  In  the  present  article  he  cites  a  case 
of  amyloid  kidney  in  which  favorable  ci]-cumstan- 
ces  have,  as  he  considei-s,  permitted  him  to  deter- 
mine the  space  of  time  that  separated  the  causal 
moment  from  the  first  trace  of  the  albuminuria. 
This  period  of  time  did  not  exceed  thirty  hours. 
The  subject,  a  sickly  man,  twenty-two  years  of  age. 
was  attacked  by  a  severe  phlegmonous  aSection  of 
the  right  lumbar  region.  An  incision  made  on  Xo- 
vember  12th.  at  noon,  revealed  the  presence  of  a  con- 
siderable abscess,  which  was  treated  by  the  antiseptic 
method.  For  a  long  time  previous  to  and  also  on  the 
day  of  the  incision,  the  urine  had  been  examined  for 
traces  of  albumen,  but  always  with  a  negative  result. 
On  Xovember  13tli,  in  the  evening,  traces  of  albumen 
were  discovered  for  the  first  time.  After  a  continuous 
increase  of  albuminuria,  collapse  and  death  oceuned 
on  Xovember  30th.  At  autopsy  the  left  kidney  was 
found  to  be  pale,  swollen,  and  amyloid  :  the  right 
kidney  was  implicated  in  the  surrounding  phleg- 
monous process,  and  was  atrophied,  sclerotic,  but 
not  amyloid :  the  liver  and  the  spleen  were  not 
amyloid.  The  accession  of  air  to  a  sui^purative 
centre  being  considered  bv  him  to  be  necessary 
to  induce  waxy  change,  a  degeneration  of  the  left 
kidney  could  not  probably  have  existed  prior  to  the 
incision,  a  circumstance  still  better  corroborated, 
according  to  the  author,  by  the  previous  absence  of 


albumen  from  the  urine  as  well  as  by.  the  insignifi- 
cant extension  of  the  amylaceous  deposit.  Hence, 
the  author  considers  that  the  case  in  question  is 
strongly  in  favor  of  his  opinions  as  to  the  rapid  devel- 
opment of  amyloid  degeneration.  It  also  agiees  with 
his  experience  that  the  kidneys  are  in  general  the 
first  organs  attacked  by  this  degeueration,  or,  at 
least,  that  they  are  in  all  cases  aft'ected  at  a  very 
early  period. — Nbrdiskt  Medicinskt  Ark-ir,  Bd.  XII., 
No.  0. 

Resuscitation  of  Animals  after  Exposure  to 
Extreme  Cold. — F.  F.  Loptschinski  says  ( VrnUvh, 
Xo.  5-7)  there  is  a  remarkable  disagi-eement  be- 
tween experimenters  and  clinical  observers  as  to  the 
manner  of  treating  individuals  that  have  been  ex- 
posed to  extreme  cold.  'SMiile  nearly  all  of  the  latter 
hold  that  the  application  of  heat  should  be  gradual, 
the  former  (Beck,  Hon\at,  Jacoby)  advise  that  it 
should  be  rapid.  The  author  has  experimented  with 
dogs  in  order  to  solve  this  question.  Some  of  the 
animals  were  exposed  to  cold  air  (  —  17°  C,  two 
above  zero  F.),  others  were  packed  in  freezing  mix- 
tiu-es  (  —  1.3-1.5°  C,  5-8°  F.).  After  freezing,  one  of 
the  animals  (twenty  esioeriments  were  made,  each 
with  three  dogs)  was  immediately  i^laced  in  a  warm 
bath  of  37°  R.  (115°  F.);  the  second  was  placed  in  a 
room  the  temperature  of  which  was  22-24°  R.  (81- 
86°  F.) ;  the  third  was  first  placed  in  a  temperature 
of  0°  (32°  F. ),  and  then,  as  the  temperature  of  the 
rectum  arose  and  manifestations  of  life  were  shown, 
the  bodily  temperature  increased.  Friction  with 
bmshes  and  dry  cloths  was  used  in  all  three  cases. 

The  experiments,  which  were  made  with  great 
care,  throw  light  on  various  conditions  which  will 
not  be  referred  to  here  (blood  examinations,  micro- 
scopic examinations  of  the  muscular  tissue,  con- 
ditions of  temperature,  etc.).  But  there  were  other 
results  which  have  a  practical  significance  for  physi- 
cians. Of  20  animals  that  were  exposed  to  a  low 
temperature  which  was  gi-adually  elevated,  14  died  ; 
of  20  animals  that  were  immediately  brought  into 
a  warm  apartment,  8  died  ;  of  20  animals  that  were 
immediately  placed  in  a  warm  bath,  >inne  died. 

Prolapse  of  the  Urethra  in  a  Yot-xg  Girl.  — Dr. 
V.  Ingerslev  reports  the  case  of  a  girl,  ten  years  of 
age,  who  attempted  to  stop  laughing  by  stn fling  a 
handkerchief  into  her  mouth.  She  immediately  had 
a  sensation  as  if  something  had  broken  between  her 
thighs,  and  soon  afterward  felt  something  which 
was  not  there  before.  The  labia  were  separated  by 
a  reddish  blue  tumor,  the  thickness  of  the  end  of 
the  index  finger,  about  a  centimetre  in  length,  with 
an  opening  at  its  free  end.  There  wa»  a  frecjuent 
desire  to  urinate.  The  mucous  membrane  was  easily 
reduced  under  chloroform,  but  gradually  repro- 
ti-uded.  Reposition  was  ettected,  tannin  was  ap- 
plied and  the  vagina  was  tamponed.  Prolapse 
again  occurred.  A  soft  catheter  was  then  intro- 
duced, passed  through  a  cork  which  was  secured 
close  to  the  urethral  orifice.  The  prolapse  still  re- 
cuiTed.  The  protruded  portion  was  then  cut  ofland 
four  sutures  were  passed,  so  as  to  sew  the  urethral 
orifice  to  the  mucous  membrane  of  the  vulva,  and  a 
soft  catheter  introduced.  The  sutures  were  removed 
in  eight  days,  at  which  time  there  was  no  prolapse. 
Ten  days  later,  another  prolapse,  1  ctm.  in  length, 
occuri'ed.  This  was  cut  oflf  without  suturing,  and 
no  catheter  was  introduced.  Eight  days  later  the 
wound  had  healed  and  the  prolapse  has  not  re- 
curred.— Hospitiils-tidende  and  ybi-disit  Medicinskt 
Arkic,  Bd.  XIII.,  Xo.  29. 


490 


THE  MEDICAL  RECOED. 


The  Medical  Record: 


51  InceklD  jlouvnal  of  fllebicinc  anb  Suvgcrn 


GEORGE  F.  SHRADY,  A.M.,  M.D.,  Editor. 


PUBLISHED   BY 
Wifl.  WOOD  &  CO.,  No.  27  Oreat  Joues  St.,  N.  li°. 


New  York,  May  6,  1882. 


POST-GEiiDUATE  STUDIES. 

The  remarks  recently  made  regarding  the  utility  of 
establisliing  post-graduate  courses  have  given  rise  to 
considerable  discussion  in  many  quarters.  There  is 
a  strong  sentiment  in  the  profession  in  favor  of  any 
movement  which  would  utilize  in  a  proper  and  sys- 
tematic manner  for  the  working  practitioner  the 
clinical  resources  of  medical  centres.  No  man  enters 
the  practice  of  his  profession  without  being  painfully 
aware  of  the  fact  that  there  are  many  things  which 
were  left  undone  in  his  college  curriculum  which 
should  have  been  done.  "With  the  best  of  intentions 
on  the  part  of  the  most  industrious  student,  there 
is  an  impossibility  of  doing  more  than  laying  the 
ground-work  for  future  study.  The  time  is  comj^ara- 
tively  short  for  this  purpose  in  any  event,  even  allow- 
ing that  his  powers  of  mental  assimilation  are  more 
than  ordinarily  active.  He  is  at  best  a  crammed  in- 
dividual, who  can  pass  a  faculty  or  hospital  examin- 
ation, but  who  has  little  or  no  clinical  experience. 
It  is  true  he  has  occasionally  attended  clinicjues  at 
the  larger  hospitals,  and  has  witnessed  most  of  the 
major  operations,  but  of  actual  clinical  instniction 
in  the  commoner  matters  pertaining  to  practical 
medicine  he  has  next  to  nothing.  Of  his  evei-y-day 
duties,  which  are  expected  of  him  in  his  commen- 
cing practice,  he  knows  very  little  indeed.  This  is 
due  in  part  to  the  mistaken  idea  that  cases  are  not 
interesting  or  valuable  for  him  unless  they  demand 
some  surgical  ojieration,  or  are  perhaps  uniijue  as  to 
the  lesion  presented.  Consequently  almost  every 
student  will  go  to  the  hospital  to  see  the  most  ordi- 
nary case  of  amputation,  when  he  would  have  no  pos- 
sible interest  in  visiting  a  fever  ward  or  in  clinically 
studying  a  case  of  infantile  diarrhcea.  When  he  gets 
into  practice,  however,  he  finds  where  he  has  missed 
his  opportunities,  and  yearns  to  enjoy  them  again  in 
some  shape  or  other. 


And  this  is  precisely  the  condition  in  which  &ie 

many  of  the  working  practitioners  over  the  country, 
who,  during  their  medical  puiiilage,  have  had  the 
oi-dinary  clinical  privileges  connected  with  the 
larger  metropolitan  colleges.  "With  the  best  of  in- 
tentions they  have  made  the  worst  possible  selec- 
tion of  their  cases  for  clinical  study.  In  this  respect 
they  have  been  in  no  small  degree  aided  and  abet- 
ted by  their  clinical  professors,  who  would,  of 
course,  much  sooner  operate  for  stone  than  dress  a 
fracture,  or  would  be  more  intent  upon  describing 
a  rare  pathological  lesion  than  prescribing  for  a 
case  of  ordinai-y  colic. 

And  yet  the  every-day  man  in  the  country  often 
wishes  that  the  tables  had  been  turned  in  his  favor 
when  he  is  called  to  apply  his  first  bandage  or  to 
treat  his  first  case  of  measles. 

"We  have  repeatedly  said  that  if  there  is  one  thing 
in  the  supplementarv-  education  of  the  younger 
practitioners,  which  is  needed  by  them  more  than 
anything  else,  it  is  the  opportunity  of  the  clinical 
experience  and  clinical  study  which  shall  minister 
to  the  pressing  necessities  of  ordinary  counti-y  prac- 
tice. That  he  does  not  obtain  it,  as  a  rale,  in  the 
college  clinic  or  in  the  hospital  ward,  is  quite  gen-  ! 
eraUy  admitted.  This  can  be  said  without  any  dis-  M 
position  to  reflect  upon  the  good  intentions  of  the  ' 
clinical  professors,  or  the  usual  discrimination  of 
the  ordinary  student.  The  student  knows  nothing 
practically  concerning  what  is  required  of  him  in 
his  future  practice,  and  naturally  loses  what  good 
opportunities  for  usefid  clinical  experience  he  might 
otherwise  obtain.  There  is  nothing  that  gives  him 
a  keener  relish  for  this  sort  of  knowledge  than  a 
five  or  ten  years'  j^ractice  in  some  remote  district 
where  he  must  from  necessity  depend  abeohitely 
upon  his  own  resources  and  rely  almost  entirely  upon 
his  own  judgment.  Such  men  are  so  much  in  favor 
ofpost-graduate  studies,  in  which  clinical  teaching 
in  our  hospitals  shall  be  a  leading  feature,  that  they 
are  inquiring  how  a  system  can  be  inaugurated 
which  shall  make  such  a  thing  possible. 

The  material  for  the  purpose  is  at  hand  in  all  our 
larger  cities,  supplied  as  they  are  by  well-equipped 
hospitals,  and  it  is  possible  that  the  necessary  de- 
tails of  management  may  be  made  under  some  central 
organization,  which  shall  realize  in  a  practical  man- 
ner the  main  necessities  of  jjost-graduate  courses. 
The  first  step  in  this  direction  would  be  a  general 
agreement  among  the  hospitals  as  to  the  regular  days 
and  hours  during  which,  beside  instruction,  would 
be  given  to  the  members  of  the  profession  desiring  it. 
The  next  move  would  be  in  the  direction  of  estab- 
lishing special  courses  of  instruction  in  the  wards 
to  limited  classes  ;  and  finally,  the  arrangement  of 
courses  in  the  different  hospitals  so  as  not  to  conflict 
with  one  another,  and  allow  the  practitioner  to  map 
out  a  plan  of  attendance  to  suit  himself. 


THE   MEDICAL  RECORD. 


491 


THE  NEW  YORK  CODE  AND  THE  NEW  YORK  MEDICAL 
JOURNAL. 

Dk.  Frank  P.  Foster,  editor  of  The  yew  York 
Medical  Journal  and  Obstetrical  Eerieir,  writes  :  "In 
your  issue  of  the  22d  inst.,  speaking  of  the  con- 
sultation section  of  the  new  State  Code  of  Ethics, 
in  an  article  headed  '  Freedom  in  Consultations,' 
you  say :  'Already  we  are  enjoying  the  proud  dis- 
tinction of  being  the  only  journal  that  has  assumed 
the  responsibility  of  being  oiitspoken  on  this  ([Ues- 
tion.'  By  referring  Ivo  the  March  uiimber  of  this 
journal  you  will  see  that  the  Eeoord  is  not  the  only 
journal  that  has  been  '  outspoken  on  this  question.' ' 
At  the  time  the  article  to  which  reference  was 
made  was  written,  we  had  not  read  tlie  editorial  in 
the  columns  of  our  esteemed  contemporary.  We 
are  glad  now  to  call  attention  to  the  subject,  and 
take  this  opportunity  of  congratulating  Dr.  Foster 
on  the  forcible  manner  in  which  he  has  supported 
the  principles  of  the  New  York  Code. 


AN    ANTHROPOMETRICAL   LAI50RAT0KY. 

Mr.  Francis  Galton  has  offered  to  the  public  a 
novel  suggestion,  but  one  which  is  the  logical  result 
of  the  scientific  tendency  of  the  times.  He  urges 
the  establishment  in  our  large  cities  of  anthropomet- 
rical  laboratories.  By  these  he  means  places  where 
as  accurate  as  possible  an  appraisement  of  a  person's 
physical  condition  and  powers  can  be  made.  Mr. 
Galton  suggested,  some  time  ago,  that  parents  should 
keep  a  life  history  of  the  physical  and  mental  prog- 
ress of  their  children,  which  should  be  supj^le- 
mented  by  photographs  taken  at  stated  intervals. 
By  means  of  well-equiisped  laboratories  such  histo- 
ries could  be  made  much  more  complete. 

The  special  objects  of  investigation  in  these  labo- 
ratories would  be  numerous.  The  height,  weight, 
dimensions  of  different  parts,  any  facial  or  other  an- 
atomical characteristics,  the  color  of  the  hair,  con- 
dition of  the  skin,  lungs,  heart,  kidneys,  etc.,  would 
all  be  estimated  with  every  possible  exactness.  Still 
further,  there  would  be  tests  applied  to  determine  the 
delicacy  of  the  touch,  the  acuteness  and  range  of  sight 
and  hearing,  and  of  the  other  senses.  Even  the  sim- 
pler mental  faculties  would  be  gauged  ;  for  examjjle, 
the  memory  and  judgment.  The  rapidity  in  form- 
ing judgments,  as  is  now  known,  can  be  easily  and 
quite  accurately  determined.  Two  diflerent  signals 
are  described,  and  the  j^ierson  to  be  tested  is  told  to 
make  a  different  response  for  each.  One  of  the  signals 
is  then  suddenly  displayed.  The  interval  between 
this  display  and  the  response  made  by  the  individual 
experimented  upon,  indicates  the  time  required  in 
forming  his  judgment.  This  is  found  to  vary  in  dif- 
ferent individuals. 

To  supplement  the  work  of  these  laboratories,  it 
is  recommended  that  a  medical  history  be  kept. 
Physicians  should  make  careful  notes  of  the  histoid 
of  their  j^rivate  patients,  and  these  notes  should  be 


given  to  thfe  patient  for  preservation  and  future  ref- 
erence. 

Thus,  when  a  person  reaches  old  age  he  will  have 
the  complete  history,  not  of  his  life,  but  rather  of 
his  body,  a  sort  of  physiological  and  pathological 
annal.  The  benefits  to  be  derived  from  such  docu- 
ments would  be,  first,  that  of  having  an  authentic 
history,  which  would  be  of  personal  and  family  in- 
terest ;  second,  that  of  furnishing  data  upon  which 
calculations  as  to  probable  dangers  to  his  descend- 
ants could  be  made  ;  third,  an  accumulation  of  such 
documents  would  give  a  solid  basis  for  the  study  of 
many  questions  in  anthropology  at  present  unsettled. 

The  project  of  Mr.  Galton  will  not  be  a  jjoi^ular 
one  to  the  masses,  and  will  no  doubt  receive  some 
ridicule.  There  are  many  physicians,  however,  who 
can  appreciate  the  benefit  to  science,  and  eventually 
to  humanity,  contained  in  such  a  scheme. 


NEW   REMEDIES    FROM   MAD.\GASCAR. 

At  a  meeting  of  the  London  Pharmaceutical  Society 
in  February  last.  Dr.  Parker,  physician  to  the  Queen 
of  Madagascar,  exhibited  a  very  large  collection  of 
the  materia  medica  of  that  island.  He  made  some 
statements  which  shoidd  excite  to  activity  some  of 
the  enterprising  firms  of  this  country  who  have  now 
quite  thoroughly  ransacked  the  flora  of  America  for 
new  remedies. 

Madagascar,  we  are  told,  is  exceedingly  rich  in 
plants  of  aU  kinds.  More  than  one-half  of  the  natu- 
ral orders  of  plants  known  to  botanists  are  found 
there.  Furthermore  aboiit  sixty-five  per  cent,  of  the 
native  species  are  peculiar  to  the  island.  In  other 
words,  it  contains  at  least  3,000  jalants  not  found 
anywhere  else  in  the  world.  Here  is  truly  a  rich 
field  for  the  jihysiologist  and  pharmacist. 

Dr.  Parker's  accounts  of  the  specimens  which  he 
exhibited  are  somewhat  meagre ;  at  least,  as  we  find 
them  reported  in  the  British  Medical  Journal.  He 
knew  nothing  regarding  the  medicinal  value  of  many 
of  the  plants.  Of  others,  his  information  was  not 
very  positive. 

The  Malagasy  have  classified  their  drugs  according 
to  their  most  prominent  clinical  effects.  They  have 
several  remedies  for  bronchial  diseases.  The  most 
curious  is  a  fungus  called  Hola-tafa,  which  is  given 
in  the  form  of  an  infusion  or  decoction. 

Drugs  for  urinary  diseases  are  quite  numerous  and 
well  patronized,  since,  says  Dr.  Parker,  aboiit  one 
man  o\it  of  every  thi'ee  has  a  stricture  caused  by 
venereal  disease  and  hard  drinking. 

The  drugs  for  intestinal  worms  are  quite  popular 
also.  Among  these  is  one  which  acts  quite  as  well 
as  santonin.  Two  dmgs  are  mentioned  as  being 
efficacious  for  tape-worm.  There  is  a  native  castor- 
oil  which  is  of  inferior  quality.  The  natives  also  use 
one  of  the  Eubiaceic  as  an  astringent  and  haemo- 
static. They  have  a  remedy  for  headache  which  is 
called  Fisava  or  "  the  disperser,"  one  which  would 


492 


THE  MEDICAL  RECORD. 


certainly  be  popular  in  this  country  if  it  were  as 
good  as  is  claimed.  The  remedies  used  for  rheuma- 
tism are  not  much  recommended.  A  drug  of  more 
interest  is  the  seeds  of  Viito-hTlaka.  An  infu.sion  of 
these  seeds  is  used  to  expel  the  placenta,  and  as  we 
need  an  efficacious  oxytoxic,  it  might  be  worth  while 
to  investigate  this  one.  There  are  very  good  aloes 
in  Madagascar,  also  aconite,  and  possibly  nux- 
vomica.  The  Fangena  or  ordeal  beans  are  de- 
scribed as  very  poisonous,  but  their  exact  physio- 
logical eflfeot  is  not  known. 

From  the  brief  notes  given  by  Dr.  Parker,  it  seems 
probable  that  Madagascar  may  furnish  something  of 
importance  to  our  materia  medica.  We  have  plenty  of 
new  drugs  now,  but  new  remedies  are  pitifully  scarce. 


THE  BREEDING    AND   DISEASES   OF   ELEPHAMTS. 

The  birth  of  a  baby-elephant  and  the  importation 
of  Jumbo  have  greatly  excited  the  popular  interest. 
Taking  advantage  of  this,  the  Journal  of  Cowjidriitive 
Medicine  publishes  in  its  current  issue  an  article 
upon  the  breeding  of  elephants,  as  well  as  an  editoral 
note  upon  the  di.seases  of  this  animal. 

The  subject  of  elephant-breeding  is  treated  by  Mr. 
Arstiugstall,  Barnum's  traiuer,  who  was  present  at 
the  birth  of  the  only  two  elephants  ever  born  in 
this  country.  The  elephant,  he  says,  rarely  breeds 
in  captivity,  largely  because  he  is  kept  on  a  low  diet. 
If  properly  fed,  the  male  and  female  can  hardly  lie 
prevented  from  copulating.  The  evidences  of  heat 
are  a  slight  swelling  and  congestion  of  the  vulva. 
The  period  of  pregnancy  is  between  twenty  and 
twenty-one  months.  Within  three  months  the 
mammary  glands  begin  to  swell,  and  by  the  end  of 
pregnancy  they  are  as  large  as  those  of  a  cow.  An 
elephant  may  conceive  when  it  it  is  only  fifteen  years 
old.  In  that  case  it  will  often  grow  very  rapidly 
during  its  pregnancy. 

The  elephant,  Queen,  which  gave  birth  to  a  "  baby  " 
at  Bridgeport  this  spring,  exhibited  no  signs  of  dis- 
turbance up  to  a  few  hours  before  the  act  of  partui-i- 
tion.  There  was  then  some  uneasiness  shown,  and 
the  animal  was  isolated  and  chained.  The  infant 
was  delivered  rapidly  and  without  any  apparent  suf- 
fering on  the  part  of  the  mother,  who  stood  with  the 
posterior  extremities  somewhat  separated.  The 
foetus  came  out  head  and  feet  foremost,  enclosed  in 
its  membranes.  As  soon  as  it  was  drojiped  the 
mother  crossed  the  hind  legs,  and  by  rubbing  them 
together  severed  the  cord.  Her  subsequent  pro- 
ceeding showed  a  remarkable  instinctive  sagacity. 
The  little  one  lay  quietly  in  its  sac — not  breathing, 
and  api)arently  lifeless.  The  mother  as  soon  as  the 
cord  was  broken  turned  around,  and  with  one  of  her 
fore-feet  struck  the  membranous  sac  quite  forcibly. 
It  broke  with  a  loud  report  (so  says  the  trainer). 
.\tter  rupturing  the  membranes  she  placed  her  foot 
on  the  thorax  and  preHsed  it  with  the  appearance  of 
much  force,  raised  it  and  pressed  it  again  until  the 


baby  began  to  breath  and  show  signs  of  life.  The 
elephant  mother  appeared  to  understand  the  princi- 
ples of  Sylvester's  method  as  well  as  if  she  had  taken 
a  course  at  the  First-Aid-to-the-Injured  Society. 
The  placenta  was  delivered  in  about  two  hours,  the 
animal  suffering  considerably  meanwhile.  Five 
hours  after  birth  the  baby  was  able  to  stand  on  its 
feet.  It  walked  to  the  mother,  turned  its  trunk  up 
over  its  head  and  began  to  nurse. 

Some  facts  given  editorially  regarding  the  diseases 
of  elephants  are  of  interest.  There  are  eighty-eight 
elephants  in  this  country,  valued  at  about  .§.500, 000. 
The  diseases  to  which  they  are  subject  are  a  matter 
of  some  practical  importance.  A  list  is  given  and 
it  is  quite  a  long  one.  The  more  prominent  affec- 
tions are  meningitis  and  apoplexy,  vomiting,  colic, 
and  enteritis,  hiematuria,  tetanus,  pneumonia,  foot 
and  mouth  disease,  and  anthrax.  A  work  on  the 
diseases  of  the  elephant  is  now  being  wi-itten. 


FABBICATED   WINES. 

We  are  accustomed  to  think  with  complacency  of 
the  results  of  scientific  research,  and  to  feel  sure 
that  an  extension  of  knowledge  must,  of  course, 
eventually  benefit  the  race.  Occasionally  such  optim- 
ism receives  a  shock,  and  it  is  chemistry  which 
furnishes  our  latest  disappointment.  To  be  .sure  we 
have  never  had  very  high  an  opinion  of  this  occiilt 
science,  being  still  in  the  penumbra  of  that  darkness 
which  it  shed  over  our  college  career.  But  it  was 
hardly  expected  that  chemists  would  attempt  to 
supplant  the  grape.  We  have,  though  this  is  what 
they  have  done  for  a  long  time,  asked  of  them  a 
cheap  artificial  quinine,  and  they  gave  us  a  synthet- 
ical claret  which  cheats  the  palate  even  of  experts. 

Since-  the  phylloxera  made  such  ravages  in  France 
and  Switzerland,  much  attention  has  been  paid,  first 
to  the  adulteration,  and  then  to  the  fabrication  of 
light  wines.  This  latter  process  has  finally  become 
so  perfect  and  so  widely  extended  as  to  threaten 
the  destruction  of  many  of  the  vineyards.  Tlie 
vinegrowers  of  the  <-anton  of  Geneva,  for  example, 
have  petitioned  the  government  to  do  something 
for  their  protection. 

This  is  a  difficult  thing  to  attempt.  The  new  wine 
is  not  adulterated,  but  is  fabricated.  It  contains 
everything  that  a  grape-wine  does  and  nothing  more. 
It  is  made  out  of  water,  with  alcohol,  tannin,  and 
sugar.  The  latter  ingredients  are  obtained  from 
raisins.  A  hoqio;/  is  also  given  to  it.  It  costs  the 
retailer  only  thirty  cents  a  gallon.  Light  wini'^ 
(clarets,  etc.)  made  in  this  way  are  sent  to  England, 
and  presumably  to  this  country.  And  so  perfect 
are  they  that  detection  of  the  fraud  is  impossible  to 
the  chemist  and  not  easy  to  the  wine-taster. 

There  may  be  no  harm  in  these  artificial  mixtures, 
but  the  medical  man  prefers  and  ought  to  know 
where  and  by  whom  the  alcohol,  tannin,  and  water 
that  he  prescribes  is  manufactured. 


THE  MEDICAL  RECORD. 


493 


NEW  YOEK  ACADEIIY  OF  THEDICINE. 

SECTION  IN  PRACTICE  OF  MEniCINE. 
Slated  Meeting,  Ajn-il  18,  1882. 
Dk.  Andeew  H.  Smith,  Chaikman. 
Db.  a.  D.  Rockwell  reported 

CASES  rLLtrSTBATING  SOME  PRACTICAL  POINTS  IN  THE 
USE  OF  THE  ACTUAL  CAUTEKT,  AND  IN  ELECTKO- 
THERAPEDTICS. 

Case  I. — A  woman,  sixty-four  years  of  age,  in  No- 
vember, 1881,  swallowed  by  mistake  a  quantity  of 
caustic  liniment.  About  a  week  afterward  she  had 
some  impediment  in  swallowing  food,  which  gradu- 
ally increased  until  finally  only  small  quantities  of 
liquids  could  be  taken.  Dr.  Rockwell  then  saw  the 
patient,  in  consultation  with  Dr.  N.  Perry,  of  Kidge- 
ville.  Conn.,  and  found  her  emaciated  and  weak  and 
complaining  of  an  oppressive  feeling  in  the  region 
of  the  ccsoi:)hagus,  a  few  inches  above  the  cardiac 
extremity.  Occasionally  whatever  was  swallowed 
was  ejected  before  reaching  the  stomach.  The  case 
was  diagnosticated  as  one  of  probable 

STEICTDRE   OF   THE   CESOPHAGUS, 

due  to  the  effect  produced  by  the  caustic.  On  the  fol- 
lowing day  the  patient,  with  her  family  jjhysician,  saw 
Dr.  Willard  Parker,  who  explored  the  oesophagus, 
and  decided  that  no  organic  stricture  existed.  Pain 
along  the  dorsal  jjortion  of  the  spine  was  excessive. 
Acting  on  the  suggestion  that  the  stricture  was 
probably  spasmodic,  Dr.  Rockwell  slightly  cauter- 
ized the  spine  over  the  .seat  of  the  severe  pain,  and 
on  the  following  morning  the  patient  swallowed 
solids  without  difficulty.  Although  the  stomach  was 
somewhat  ii-ritable  for  a  time,  complete  recovery 
finally  took  place.  The  case  was  interesting  because 
of  the  fact  that  the  first  apijlication  of  the  actual 
cautery  removed  permanently  what  seemed  to  be  a 
tonic  spasm  which,  on  account  of  its  persistency, 
was  giving  rise  to  very  grave  apprehensions. 

Case  II. — This  illustrated  the  good  effect  of  the 
actual  cautery  in  the  treatment  of  some  of  the 

SEQUEL.S:  OF   CEBEBRO-SPINAL   MENTNGITIS. 

The  patient  was  seen  in  consultation  with  Dr.  Ed- 
gerton,  of  Middletown,  and  was  a  woman  who,  some 
years  before,  had  been  under  his  care  for  severe  and 
persistent  symptoms  following  this  disease.  From 
those  symptoms  she  recovered,  but,  as  the  result 
of  a  fall,  they  returned  in  full  vigor,  and  when  Dr. 
Rockwell  saw  the  patient  she  was  suffering  from  a 
generally  diffused  hypenesthesia,  con.stant  and  se- 
vere pain  in  the  basilai-  region,  some  nausea,  and 
partial  motor  paralysis.  She  was  thoroughly  cau- 
terized, two  days  in  succession,  along  the  whole 
length  of  the  spine,  and  two  days  after  the  last  ap 
plication  the  patient  was  able"  to  get  out  of  bed, 
dress  herself,  and  come  to  New  York  for  a  repetition 
of  the  treatment,  under  which  she  rapidly  recov- 
ered. 

Case. III. — A  patient,  bed-ridden  for  many  weeks — 
the  prominent  symptoms  being  sj^inal  imtation, 
insomnia,  and  violent  attacks  of  cephalalgia— was 
seen,  in  consultation  with  Dr.  A.  R.  Carman,  of  New 
York.-^The  cautery  speedily  relieved  her;  and,  un- 


der further  treatment,  she  recovered  so  that  she  was 
able  to  resume  her  occupation  of  teaching. 

These  were  a  few  of  the  many  ca-ses  that  might  be 
cited  in  illustration  of  the  benefit  sometimes  de- 
rived from  the  use  of  the  actual  cautery.  The 
ai)plication  of  the  remedy  is  ea.sy,  causes  but  little 
actual  discomfort  to  the  patient,  although  it  is 
sometimes  difficult  to  convince  a  timid  person  that 
it  is  not  a  terrible  iJiocedure. 

LOC.Ui   paralysis — A    COMMON   MISTAKE   IN   THE   SELEC- 
TION  OF   THE   PROPER   ELECTRIC    CURRENT. 

Dr.  Rockwell  thought  that  the  mistake  could 
be  best  pointed  out  by  reporting  a  few-  illustrative 
cases,  from  a  score  or  more  that  might  be  narrated  : 

Mrs. ,  an  opera  singer,  thirty  years  of  age, 

was  sent  to  him  by  Dr.  .1.  B.  Read.  Several  months 
before,  while  singing  in  public,  she  was  suddenly 
attacked  with  left  facia!  i:)aralysis.  The  eye  refused 
to  close  ;  she  subsequently  suffered  from  severe  ceph- 
alalgia and  marked  vertigo.  The  physician  to 
whom  the  patient  first  applied  prescribed  elec- 
tricity, used  it  a  few  times,  and  then  directed  her  to 
buy  a  small  faradic  apparatu.s,  and  apply  the  cur- 
rent along  the  course  of  the  affected  nerve.  This 
was  done  faithfully  for  many  weeks,  but  with  nega- 
tive results.  On  examination,  no  resj^on-se,  as 
miglit  have  been  expected,  could  be  obtained  by  the 
use  of  the  faradic  current.  Galvanism,  however,  at 
once  produced  faint  contractions,  and  three  weeks 
after  the  jjrojier  treatment  was  begun,  farado-mus- 
cular  contractility  returned,  and  recovery  to  a  good 
extent  had  taken  place. 

Case  II. — A  boy,  four  years  of  age,  suffered  from 
cerebro-spinal  meningitis,  which  was  followed  by 
complete  parah/sis  of  the  right  leg.  The  patient  was 
sent  to  Dr.  Rockwell  by  Dr.  Chauveau.  Before  Dr. 
Chauveau  saw  him  a  physician  had  recommended  the 
faradic  current,  and  it  had  been  used  faithfully,  but 
without  benefit.  On  examination  there  was  no  re- 
sponse to  faradism,  and  only  slight  reaction  to  gal- 
vanism. Under  the  systematic  use  of  the  galvanic 
current,  however,  improvement  began,  and  farado- 
muscular  contractility  was  finally  restored.  The 
improvement  in  the  power  of  locomotion  was  coin- 
cident with  that  of  the  electro-muscular  contractility. 
Dr.  Rockwell  thought  there  could  be  no  doubt  that 
in  both  these  cases  the  failure  to  correctly  differen- 
tiate in  the  selection  of  the  method  of" treatment 
not  only  interfered  with  the  rapidity  of  recoveiy, 
but  in  one  instance,  at  least,  might  be  the  cause  of 
some  permanent  disability. 

ELECTRICAL    CONDITION    OF    THE     MUSC'LES     IN    FACIAi 
PARAIYSIS. 

In  facial  jjaralysis  the  farado-muscular  contractility 
is  either  normal  or  decreased,  but  the  galvano- 
muscular  contractility  may  in  addition,  in  certain 
cases,  be  increased,  while  the  reaction  to  the  faradic 
current  in  the  same  cases  is  either  wanting  or  very 
much  diminished.  In  these  cases  the  galvanic  cur- 
rent must  be  used  with  increasing  strength,  at  each 
sitting,  in  order  to  keep  up  the  vigor  of  the  muscular 
contractions  when  galvano-muscular  contractility  is 
reduced  to  normal,  or  sometimes  before  farado- 
muscular  contractility  becomes  manifest,  and  a  rapid 
recovery  usually  follows. 

Dr.  E.  C.  Seguin  said,  with  regard  to  the  use  of 
the  actual  cautery,  that  his  experience  was  very  much 
in  accord  with  that  given  by  Dr.  Rockwell.  Occa- 
sionally remarkable  results  were  obtained  from  one 
or  two  applications.     He  had  found  it  very  service- 


494 


THE  MEDICAL  RECORD. 


able  in  exceedingly  painful  cases,  as  well  as  those  of 
the  character  described. 

With  regard  to  the  simplicity  and  painlessness  of 
the  application,  lie  entirely  agreed  with  Dr.  B. 
Sometimes  considerable  argument  was  necessary  to 
induce  a  patient  to  submit  to  the  first  application, 
but  he  had  not  had  any  trouble  whatever  concerning 
the  second  operation  ;  indeed  most  patients  retvirned 
of  their  own  accord  and  asked  for  the  use  of  the 
cautery.  The  question  of  the  ulili/i/  of  the  tn-o  elec- 
tric currents  he  regarded  as  a  very  important  one. 
But  he  thought  it  possible  that  in  one  of  Dr.  Kock- 
well's  cases  at  least,  if  it  had  been  left  to  Nature,  the 
patient  might  have  recovered  without  electricity. 
It  was  probably  a  case  of  paralysis  from  lesion  of 
the  nerve,  whether  fi-om  superficial  pressure  or  from 
reflex  action  upon  the  nucleus  of  the  nerve  was 
uncertain,  but  there  were  good  reasons,  from  clinical 
history  and  from  electrical  reactions  to  assimilate  it 
with  cases  of  ordinary  nerve  injury.  In  such  cases 
he  thought  there  was  a  fatality  in  the  degeneration 
and  regeneration  of  the  nerve,  and  he  doulited  very 
much  whether  measures  commonly  used  had  greatly 
to  do  with  recovery.  The  process  of  regeneration  is 
much  slower  than  that  of  degeneration,  but  it  takes 
place  with  a  great  deal  of  certainty,  and  in  a  major- 
ity of  cases  of  facial  paralysis  the  recovery  was 
through  the  process  of  repair  of  the  nerve,  and  the 
consequent  repair  of  the  muscular  tissue.  He  agreed 
entirely  with  Dr.  Eockwell  that  the  faradic  current 
was  next  to  useless  for  several  weeks  or  mouths,  and 
he  also  doubted  whether  galvanic  applications  had 
much  to  do  with  recovery.  The  changes  in  the 
electrical  and  nutritive  state  of  the  muscular  fibres 
produced  by  the  application  might  do  something 
toward  keeping  uj)  the  nutrition  of  the  muscle,  and 
preserve  it  in  a  condition  fit  for  action  when  the 
nerve  had  improved.  He  did  not,  however,  believe 
that  electrical  currents  could  hasten  cell  growths. 

The  inutility  of  the  faradic  current  in  facial  paral- 
ysis was  a  point  worth  directing  attention  to,  and 
nndoubtedly  ignorance  with  reference  to  it  had 
many  times  brought  discredit  upon  the  profession. 

Dr.  Janeway  said  he  had  long  believed  that  the 
great  value  of  the  galvanic  current  in  facial  paraly- 
sis was  twofold. 

In  the  first  place,  it  gave  a  means  of  making  a 
prognosis  with  regard  to  the  probable  time  required 
for  recovery.  If  the  faradic  reaction  was  destroyed 
and  the  galvanic  preserved,  the  great  jirobabilities 
were  that  it  would  require  more  than  two  months 
for  recovery  to  occur,  probably  from  three  to  six 
months. 

In  the  second  place,  it  was  valuable  in  keeping  tiji 
the  nutrition  of  the  muscles.  The  faradic  cuiTent 
he  regarded  as  totally  useless  in  these  cases,  to  say 
the  least.  Dr.  Janeway  then  referred  to  a  case  of 
facial  parali/xlx  of  the  peripheral  type,  due  to  expo- 
sure to  cold  and  occurring  in  a  child  night  months  old. 

With  reference  to  the  actual  caiitery,  ho  had  to 
admit  the  same  doubt  that  Dr.  Seguin  had  ex- 
pressed concerning  the  utility  of  the  galvanic  cur- 
rent. He  was  sometimes  in  great  doubt  as  to 
■  whether  the  good  results  wore  due  to  the  mental 
effect  or  to  the  actual  infinence  of  the  cautery.  It 
was  very  frequently  difticult  to  .separate  effects  pro- 
duced by  an  agent  itself  from  those  produced  by 
the  imagination. 

In  connection  with  the  sequehv  of  cerebro-spinal 
meningitis  he  had  used,  with  benefit,  the  actual 
cautery  along  the  side  of  the  sjiine,  in  addition  to 
blistering  in  the  upper  cervical  and  occipital  regions. 


Db.  Eockwell  said  he  was  very  nearly  in  accord 
with  the  views  expressed  by  Dr.  Janeway  and  Dr. 
Seguin  concerning  the  use  of  the  two  electric  cur- 
rents in  the  peripheral  form  of  facial  paralysis. 
The  aid  attbrded  to  nutrition  by  the  use  of  the  gal- 
vanic current  was  very  important.  His  chief  object 
in  reporting  the  cases  was  to  direct  attention  to  the 
necessity  of  correctly  difierentiating  between  the 
two  currents. 

Dr.  Pdtzel  referred  to  a  case  in  which  the  faradic 
cuiTent  used  in  facial  paralysis  produced  actual 
harm.  The  paralysis  was  due  to  exposure  to  cold, 
and  the  degenerative  reaction  was  well  marked. 
The  result  was  twitchings,  followed  by  contracture, 
which  was  persistent. 

Dr.  Seguln  wished  to  put  upon  record  his  ex- 
perience with  reference.to  an 

UNDESCRIBED    SEQUEL    OF    FACIAL    PABALl'SIS    DIE   TO 
COLD, 

namely,  a  condition  of  marked  twitchings  corre- 
sponding precisely  with  post-hemiplegic  chorea. 
Within  the  last  eight  years  he  had  seen  four  or 
five  recovered  cases  of  facial  paralysis  in  which, 
during  the  period  of  actual  recovery,  there  occurred 
clonic  twitchings,  short,  lightning-like  jerks  of  mus- 
cles formerly  paralyzed  ;  and  this  phenomenon  oc- 
curred witbout  mislaid  treatment  or  contracture. 

De.  PiTZEL  thought  there  was  a  difierence  be- 
tween this  condition  and  posthemiplegic  chorea, 
because  in  the  latter  there  was  a  slow  movement  of 
one  muscular  fibre  after  another,  while  in  these 
cases  the  muscle  twitches  as  a  whole  and  then  sub- 
sides. 

Dr.  Sbgdin  remarked  that  the  point  brought  out 
by  Dr.  Putzel  was  an  interesting  one.  He  had 
shown  to  his  class  a  graded  series  of  cases  in  which 
there  were  post- paralytic  movements,  and  had  been 
able  to  show  two  or  three  varieties  in  a  single  lec- 
ture. He  had  classified  the  cases  into  (1)  those  in 
which  atheboid  movements  occun-ed,  ("2)  those  in 
which  the  movements  were  more  marked,  and  (3) 
the  ataxic  cases.  The  shading  oft"  from  one  condi- 
tion to  the  other  is  sometimes  exceedingly  delicate. 

Dr.  Eoberts,  as  illustrating  liow  widespread  the 
oijinion  was  that  the  difierentiating  of  the  two  cur- 
rents was  not  a  matter  of  much  practical  importance, 
said  that  not  long  since  he  heard  a  college  pro- 
fessor explain  to  his  class  the  feasibility  of  treating 
all  cases  with  an  ordinary  faradic  battery. 

Dr.  BiiiiiSALL  referred  to  two  oases  of  facial  paral- 
ysis of  ijeripheral  origin,  in  which  there  were  con- 
tracture after  a  number  of  months  and  muscular 
movements  of  the  quick  variety.  He  hud  used  the 
galvanic  current  in  facial  paralysis  with  the  result 
of  giving  the  patient  relief  from  the  feeling  of  ten- 
sion. 

recent     C.VSE.S     ILLUSTRATIVE     OP     LOCALIZATION     AND 
ITS   DIFFICULTIES. 

Dr.  E.  G.  JANKn'AV  reported  cases  as  follows : 
Case  I. — Blow  in  the  fronio-temporal  rer/ion — Un- 
conscioiixnesx — Aphasia    and    agrnphia — Hecoren/. — 

Patrick  Q ,  forty-seven   years  of  ago,  native  of 

the  United  States,  and  a  silversmith,  was  admitted 
to  Bellevue  Hospital  February  10,  188'J.  He  was 
perfectly  healthy  iip  to  three  days  before  admission, 
when  he  was  struck  with  a  billiard-cue  on  the  left 
fronto-temporal  region.  He  fell  and  remained  mo- 
tionless and  Tinconscious  about  twenty  minutes. 
When  he  came  to  himself  he  was  unalilo  to  speak, 
and  on  attemjiting  to  swallow  water   it  flowed  out 


THE  MEDICAL  RECORD. 


495 


between  his  lips.      There  was  severe   pain   at  the 
seat  of  the  blow,  and  considerable  swelling.     There 
was  no  loss  of  power  in  the  arms  or  legs.     On  ad- 
mission, there  was  a  swelling  in  the  left  temporal 
region,  but   the  skin   was  neither   broken   nor  dis-   ' 
colored.     No  fracture  was  made  out.     He  had    se- 
vere pain  in  the  head  ;  there  was  diminished  power 
of  the  muscles  of  the  right  side  of  the  tongue  and 
of  the  right  side  of    the  face  below  the  eye.     The 
muscles  about  the  eyes  and  of  the  limbs  were  un- 
aflfected.     The  tongue  was  deviated,  as  in  cerebral  ' 
paralysis,  toward  the  i^aralyzed  side.     He  was  un-   ! 
able  to  speak  his  own  name   or  the  name   of  any  j 
object  shown  him  or  repeat  a  word  spoken  to  him. 
Aphasia  as  well  as  paralysis  of  the  lips  and  tongue. 

On  attempting  to  write  his  name  or  the  name  of 
an  object,  he  made  some  of  the  letters  correctly,  but 
transposed  some  or  omitted  or  put  in  wrong  letters,  \ 
and  could  not  write  in  a  straight  line  (agrajihia).  I 
He  was  able  to  tell  when  a  wovd  was  written  or 
spoken  correctly.  The  treatment  consisted  in  the 
application  of  cold  to  the  swelling,  a  blister  to  the 
nape  of  the  neck,  keeping  the  bowels  open,  and 
the  internal  use  of  iron  and  iodide  of  jiotassium. 

February  1.5th,  five  days  after  admission,  the  pain 
had  nearly  disappeared,  but  he  had  marked  vertigo. 

February  18th. — Xo  pain.    Dizzy.    The  aphasia  is   l 
slowly  improving.     He  can,  with  much  hesitation 
and   stammering  and   thickness  of   speech,  finally 
utter    almost    any   word    he   tries.     Amnesic   with 
ataxic  aphasia. 

February  20th. — More  pain,  i^articularly  at  night, 
and  especially  if  he  lies  upon  the  left  side.  Speech 
and  movements  of  the  face  improving.  He  has  but 
little  trouble  in  writing. 

February  24th. — Pain  better,  but  still  disturbs 
him  at  night. 

March  25th. — The  pain  and  dizziness  gradually 
disappeared.  The  facial  paresis  has  gone  entirely. 
The  aphasia  and  agraphia  are  hardly  noticeable,  but 
he  says  that  lie  forgets  names  and  the  spelling  of 
some  words.     Discharged. 

Dr.  Janeway  thought  the  lesion  consisted  prob- 
ably in  laceration  of  superficial  vessels,  a  certain 
amount  of  laceration  of  brain  tis-sue,  and  the  hem- 
orrhage must  have  spread  into  the  neighborhood  of 
the  third  frontal,  the  posterior  and  lower  part  of  the 
ascending  convolution  of  the  frontal  lobe. 

Case  II. — Tubercular  meningitix — Conjugate  devia- 
tion of  the  eyes — Intermittent  paralysis  and  ancFsihesia 
— Pathological  lesions  e<jual  upon  both  sides — Curies  of 
the  spine. — John  C ,  thirty-five  years  of  age,  na- 
tive of  Switzerland,  was  admitted  to  Bellevue  Hos- 
pital March  31,  1882.  On  admission  he  was  in  a 
stupid  and  irritable  condition,  and  seemed  to  be 
somewhat  delirious.  The  head  and  eyes  most  of  the 
time  were  turned  to  the  right.  The  left  arm  and 
leg  were  rigid  and  almost  devoid  of  sensation. 
Three  of  the  vertebrse  in  the  middle  of  the  dorsal 
region  were  prominent,  and  the  middle  one  of  these 
displaced  laterally.  Urine  acid,  urates  in  abun- 
dance, specific  gi-avity  1039,  no  albumen,  no  sugar. 

April  1st. — The  rigiditv  has  disappeared.  Tem- 
perature A.  M.,  lOOi"  F  ;  p.  M.,  101°  F. 

April  2d. — Last  night  he  was  so  delirious  that  it 
was  necessary  to  tie  him  in  bed.  The  bowels 
moved,  but  there  was  no  diarrhoea.  Temperature 
A.  M.,  100°  F. ;  p.  M.,  100°  F. 

April  3d. — It  was  necessary  to  tie  the  patient  in 
bed  again  last  night.  This  morning  he  is  less  ob- 
stinate and  talks  more  intelligibly.  The  whole  sur- 
face of  the  body  is  hyperEe.sthetic.     Sensation  and 


motion  have  returned  to  the  left  arm  and  leg.  Tem- 
perature morning  and  evening,  100J°  F. 

April  4th. — Last  night  he  was  very  delirious  and 
had  a  con\T.ilsion.  This  morning  he  lies  in  a  state 
oi  coma  vigil,  groaning,  staring,  and  picking  at  ob- 
jects about  him.  Face  and  eyes  congested.  The 
juipils  are  dilated  equally ;  eyes  turned  toward  the 
right.  Opisthotonos.  Sensation  is  much  impaired 
in  the  left  arm  and  leg,  and  he  does  not  move  either 
of  them,  although  he  did  last  night.  He  passes 
his  faeces  in  bed.  Temperature,  a.m.,  9!U  F.  ;  M., 
102°  F.;  pulse,  140  ;  respiration,  40;  death.  At  no 
time  was  there  choked  disk. 

Autopsy. — At  a  point  corresponding  to  the  lump 
on  the  back  there  was  absence  of  the  intervertebral 
cartilage  between  the  third  and  fourth  dorsal  verte- 
br;e,  the  bodies  of  which  were  carious.  Within  the 
chest  this  portion  of  the  spinal  column  was  covered 
by  a  tumor,  which  proved  to  be  a  sac  filled  with 
cheesy  pus — a  carious  abscess. 

The  peritoneum  was  thickly  studded  with  tuber- 
cles. The  upper  jjortion  of  both  lungs  contained 
numerous  tubercles. 

The  meninges  of  the  brain  were  markedly  con- 
gested. About  the  fissure  of  Sylvius  and  the  medulla 
— less  at  other  parts  of  the  pia  mater — were  found  a 
thin  layer  of  pus  and  a  few  tubercles.  The  brain 
tissue  was  soft,  and  the  ventricles  contained  a  very 
small  quantity  of  fluid.  The  meninges  of  the  cord 
contained  many  tubercles.  The  dura  mater,  on  its 
inner  surface,  was  quite  vascular  and  covered  with  a 
thin  layer  of  false  membrane. 

The  special  points  of  interest  in  this  case  were 
the  conjugate  deviation  of  the  eyes,  the  intermittent 
paralysis  and  antesthesia  upon  the  left  side,  but  no 
difference  in  the  pathological  conditions  found  at 
autopsy  upon  the  two  sides.  If  there  was  any  ditler- 
ence  at  all,  the  lesion  was  mo.st  marked  upon  the 
side  opposite  to  where  it  was  expected  to  be  found. 

Case  III. —  Cerebro-.yjincd  meningitis — Onset  sudden 
— Symptoms  chiefly  unilateral — Pathological  lesions 
the  same  upon  both  sides. — The  patient  was  a  girl, 
fourteen  years  of  age,  who  was  attacked  suddenly 
with  con^Tilsions,  imconsciousness,  and  a  high  fever. 
There  was  severe  j^ain  upon  the  left  side  of  the  neck, 
beneath  the  external  auditory  meatus,  paralysis 
upon  the  02iposite  side  of  the  body,  with  persistent 
loss  of  sensation,  but  the  least  touch  or  irritation 
beyond  the  median  line  upon  the  left  side  produced 
movements.  Dr.  Janeway  supposed  that  the  symp- 
toms were  associated  with  disease  of  the  left  hemi- 
sphere, but  at  the  autop.sy  thei-e  tras  no  ^perceptible 
diffi'vnice  in.  the  condition  of  the  hemispheres. 

Db.  Jan'Ew.w  also  referred  to  a  case  in  W'hich  the 
symptoms  2Jointed  distinctly  toward  cerebro-spinal 
meningitis.  Choked  disk  was  exceedingly  well 
marked.  At  the  autopsy  the  only  lesion  found  was 
hemorrhage  into  the  left  ventricle. 

The  special  point  of  interest  in  the  cases  was  that 
with  meningial  symptoms,  although  there  might  be 
23ersistent  hemiplegia  and  hemiauiesthesia,  the  lesion 
was  not  necessarily  localized  upon  the  opposite  side 
of  the  brain  or  confined  to  one  side,  but  might  be 
equal  ujion  both  sides. 

Dk.  Seouin  remarked  that  Dr.  Janeway's  first  case 
was  one  for  admiration  and  not  for  criticism. 

With  regard  to  meningitis,  he  thought  cases  of 
that  disease  were  not  of  very  gieat  value  in  studying 
localization.  In  several  of  his  cases  there  had  been 
hemiplegic  symjitoms  with  undoubted  lesion  ujion 
both  sides,  and  the  explanation  was  not  in  accord- 
ance with  the  appearances   ujion   the  surface,  but 


496 


THE  MEDICAL  RECORD. 


in  accordance  with  the  general  changes  beneath,  as 
had  already  been  suggested  by  Dr.  .Taneway. 

Db.  Janeway  remarked  that  he  had  noticed  in 
several  cases  where  hemianesthesia  had  existed,  no 
evidence  of  special  lesion  had  been  found  in  the 
occipital  lobe  ;  the  lesion  had  been  expended  chiefly 
over  the  central  portion  of  the  brain. 

Dr.  SectUIN  had  seen  hemianfesthesia  without 
lesion. 

Dr.  W.  B.  Birdsall  then  reported  a  case  of 

BRACHIAL   MONOSPASM   AND  MONOPLEGIA  WITH  SABCOMA 
OP  THE  ASCENDING  FRONTAL  CONVOLUTION. 

The  patient  was  one  whom  he  saw,  in  consultation 
with  Dr.  Macgregor.  The  original  tumor  was  a 
sarcoma  of  the  thigh.  The  principal  interest  in  the 
case,  in  this  connection,  was  with  reference  to  the 
centres  for  localization  of  lesion.  There  were  four 
small  tumors  in  the  brain,  but  the  one  believed  to 
be  that  which  gave  rise  to  motor  symptoms  chiefly, 
if  not  entirely,  was  situated  in  the  motor  area  for  the 
upper  extremity,  the  portion  of  the  ascending  frontal 
and  the  parietal  convolutions,  the  so-called  centres 
for  the  lower  extremity  being  free.  There  was  pa- 
ralysis of  the  arm  and  face. 

Dr.  Seguin  thought  that  the  existence  of  the 
other  tumors  rendered  the  case  puzzling. 

Dr.  W.  H.  Thomson  thought  it  was  difhcult  to 
locate  pathological  lesions  according  to  results  ob- 
tained by  physiological  experiments,  because  of  so 
many  elements  entering  to  disturb  symptomatology. 
Symptoms,  due  to  pressure  from  any  cause,  trau- 
matic, inflammatory,  etc.,  are  entirely  absent  when 
the  physiologist  experiments  upon  a  healthy  ani- 
mal. It  cannot  be  denied  that  physiology  has 
demonstrated  pretty  closely  the  limits  of  the  motor 
area  in  the  brain,  and  he  thought  that  very  often 
pathological  facts  were  obtained  which  bore  out 
such  localization.  But  even  in  a  case  where  a  tu- 
mor is  exactly  defined,  and  has  removed  a  neatly 
circumscribed  jjortion  of  cerebral  tissue,  we  do  not 
know  to  what  extent  it  may  have  interfered  with 
or  come  in  contact  with  connections  which  are 
motor  or  sensory,  or  both,  in  other  portions  of  the 
brain.  Yet,  in  some  chronic  cases,  he  believed  we 
have  very  valuable  hints  concerning  localized  irri- 
tations of  the  cortex.  At  least  he  had  thought  so 
in  some  cases  of  traumatic  epilepsy  which  he  had 
treated.  With  a  certain  degree  of  deflniteness,  he 
thought  it  was  allowable  to  reason  in  chronic  cases 
upon  the  facts  of  physiology.  In  acute  cases  there 
was  embarrassment  in  reaching  conclusions,  partic- 
ularly where  there  are  symptoms  of  a  meningial 
charactsr. 

Dr.  Putzel  thought  that  in  Dr.  Birdsall's  case 
there  were  too  many  tumors  for  purposes  of  local- 
ization. He  referred  to  a  case  where  there  were 
convulsions  affecting  the  right  side,  followed  by 
hemiplegia  of  the  ordinary  cerebral  type.  There 
was  no  distui'bance  of  sensation.  The  child  died 
of  marasmus.  At  the  autopsy,  nine  or  ten  tuber- 
cular tumors  were  found,  one  as  large  as  a  good- 
sized  hicltory  nut  taking  up  the  middle  part  of  the 
ascending  frontal  and  parietal  convolutions,  but  upon 
the  same  side  as  the  paralysis.  It  was  diiiicult  to 
reason  from  the  existence  of  tumor  with  regard  to 
localization,  ospeciallv  where  there  were  several  and 
scattered  through  ditTerent  parts  of  the  brain. 

Dr.  Sikjuim  thouvfht  that  Dr.  Birdsall's  ca.se 
should  not  be  rejected  entirely,  but  should  be  taken 
in  association  with  other  cases.  He  thought  the 
tumor,  specially  mentioned,  was  within  the  motor 


centre  for  the  arm.  With  reference  to  Dr.  Ptitzel's 
case,  he  asked  if  the  decussation  in  the  pyramids 
was  examined  ? 

Dr.  Putzel  believed  it  was,  and  found  normal. 

Dr.  Janeway  had  seen  enotigh  cases  to  lead  him 
to  believe  that,  very  frequently  at  least,  the  lesion, 
when  ujion  the  same  side  with  the  hemiplegia,  was 
surface  hemorrhage.  He  referred  to  a  case  in 
which  there  was  hemiplegia  of  the  arm  and  leg, 
afterward  convulsions  in  the  arm  and  leg,  followed 
by  general  convulsions.  At  the  autopsy,  a  clot  was 
found  in  the  cavity  of  the  arachnoid  over  the  upper 
pai't  of  the  central  convolutions,  in  connection  with 
this  thrombus  of  the  veins  from  the  fissure  of  Ro- 
lando, with  softening  of  the  upper  extremities  of 
two  central  convolutions,  but  not  extending  deeply. 

The  Section  then  adjourned. 


NEW  YORK   SURGICAL   SOCIETY. 

Slated  Meeting,  February  28,  1882. 
Dr.  J.  C.  Hutchison,  Vice-Pbesident,  in  the  Chaib. 
Dr.  a.  C.  Post  read  a  paper  (see  p.  281)  on 

THE  LOCAL  TREATMENT  OP  CIRCUMSCRIBED  GANGKENOUS 
INFLAMMATIONS  OF  THE  SKIN  AND  CELLULAB  TISSUE, 
COMMONLY  KNOWN  AS  CARBUNCLES  AND  FURUNCLES. 

Dr.  Post,  as  bearing  upon  the  arterial  hemor- 
rhage which  occurred  in  the  last  case  reported  in 
his  paper,  referred  to  a  case  which  appeared  at  his 
clinic  two  weeks  ago.  It  was  one  of  large  carbuncle 
upon  the  neck,  and  while  he  was  examining  it  a  con- 
siderable flow  of  bright  arterial  blood  occurred 
through  one  of  the  openings  made  by  ulceration. 
The  carliuncle  had  been  incised  several  days  before, 
but  not  very  thoroughly,  and  he  made  a  free  incision, 
and  the  bleeding  ceased  as  soon  as  the  tension  was 
removed.  The  spontaneous  occurrence  of  arterial 
hemorrhage  in  two  cases,  and  the  prompt  cessation 
of  the  bleeding  after  making  a  free  incision,  which 
removed  the  tension,  suggested  that  one  of  the  ob- 
jections urged  against  incisions  because  of  their 
liability  to  troublesome  hemorrhage,  had  no  real 
foundation. 

Dr.  George  A.  Peters  then  read  a  paper  (see  p. 
477)  on 

HYDBONEPHBOSIS. 

Db.  Weir,  in  his  case  of  hydronephrosis,  referred 
to  the  absence  of  urea  in  the  fluid  drawn  early  by 
aspiration.  He  had  found  that  this  had  occasion- 
ally been  observed,  and  the  explanation  given  had 
been  that  jiressure  of  the  contained  fluid  upon  the 
kidney  caused  the  diminution  of  urea,  and  that  view 
was  supported  by  the  fact  that  immediately  subse- 
quent to  the  operation  the  fluids  discliarged  through 
the  wound  contained  a  nearly  normal  quantity  of 
urea. 

Another  interesting  feature  was  the  result  of  the 
exploration  of  the  ureter,  which  was  made  after  the 
inflammatoi-y  process  had  subsided,  with  the  hope 
of  finding  the  cause  of  the  obstruction  to  be  a  cal- 
cuhis,  when  its  removal  would  have  been  attemiited. 

He  was  able  to  jiass  a  flexible  metallic  probe  down 
to  the  brim  of  the  true  pelvis,  but  was  unable  to 
find  any  foreign  body,  although  a  soft  cervical  bou' 
gie  was  grasped  at  .some  eight  inches  from  the  wound, 
as  if  in  a  stricture.  Furthermore,  it  miglit  be  noted 
that  immodiately  after  tlie  final  closure  of  the  wound, 
the  patient  noticed  an  increase  in  the  quantity  of 
urine  discharged  by  the  natural  passages.     He  also 


THE  MEDICAL  RECORD. 


497 


thought  these  twocases  were  instructive  from  another 
point  of  view.  In  a  recent  article  on  nephrectomy,  bv 
Korner,  it  is  advised  that,  in  cases  of  hydronephrosis, 
the  kidney  should  be  removed,  because  that,  although 
the  hydronephrosis  might  be  relieved  by  an  opera- 
tion, a  troul)lesome  fistula  remained,  and  therefore 
it  was  wiser  to  remove  the  kidney.  Korner  stated 
that  he  was  unable  to  find  any  case  on  record  of  a 
cure  after  an  incised  hydronephrosis.  This  ease,  and 
probably  the  other  also,  disj^roved  such  a  remark. 

Dk.  Peters  said  that  his  own  case  showed  that  it 
was  not  always  so,  and  that  we  may  hope  for  a  cure. 

Dk.  Weir  remarked,  with  regard  to  the  fat-al  case 
reported  by  Dr.  Peters,  that  one  thing  which  led 
him  to  believe  that  he  had  to  deal  with  a  large  float- 
ing or  wandering  kidney  was  the  mobility  of  the  tu- 
mor. Pressure  caused  it  to  disappear  upward  al- 
most entirely.  Several  such  enlargements  of  the 
liver  are  depicted  in  Frerich's  work  on  diseases  of 
the  liver. 

Though  not  recognizing  any  cystic  condition  in 
the  case,  the  success  obtained  in  nephrectomy  for 
movable  kidney — only  two  deaths  in  nine  cases — war- 
ranted the  removal  of  the  organ,  the  expedient  of 
Hahn  of  securing  it  in  the  loin  by  anchoring  sutures 
being  somewhat  uncertain  as  well  as  too  novel  to  be 
entertained. 

Dr.  Laxoe  asked  if  intestine  could  be  recognized 
in  front  of  the  tumor. 

Dr.  Peter.s  said  that  there  was  sometimes  what 
seemed  to  be  a  thin  layer  of  resonant  tissue. 

Dr.  Lange  remarked  that  in  the  majority  of  cases 
of  tumor  of  the  kidney,  manual  examination  had 
showed  the  presence  of  intestine  in  front  of  the 
tumor. 

Dr.  Peters  said  that  it  was  so  in  his  real  case  ; 
and  in  the  fatal  case  there  was  at  times  what  was  re- 
garded as  slight  tymi^anitic  sound  over  the  anterior 
surface  of  the  tumor. 

Dr.  Lan'Ge  referred  to  two  cases,  which,  although 
not  belonging  exactly  under  the  title  of  Dr.  Peters' 
communication,  he  thought  worthy  of  being  men- 
tioned.    They  were  cases  of 

PYONEPHROSIS. 

The  first  came  under  his  observation  in  1878,  and 
the  hiftory  of  it  was  presented  to  the  New  Yoi-k 
Pathological  Society. 

In  that  case  a  fistula  was  made,  the  tumor  dimin- 
ished in  size  gradually,  and  two  yeais  afterward 
there  was  only  a  slight  watery  discharge.  The  fel- 
low kidney  was  also  enlarged  and  not  in  the  normal 
linsition. 

The  second  was  the  case  of  a  man  fifty-one  years 
ot  age,  who  had  had  a  fistula  made  in  the  side  by 
Dr.  Lellmann,  at  St.  Francis  Hospital.  The  tumor,- 
which  was  about  the  size  of  a  man's  head,  gradually 
diminished  in  size,  and  when  the  jiatient  was  dis- 
charged from  the  hospital,  a  number  of  months 
later,  he  was  in  comparatively  good  health.  There 
was  a  discharge  of  urine  continually,  but  the  patient 
wore  a  rubber  bag  into  which  the  drainage-tube 
emptied.  The  incision  was  made  in  continuation 
of  the  anterior  axillary  line.  The  patient  had  several 
attacks  in  which  a  mild  pysemic  condition  was  de- 
veloped in  oon.sequence  of  decomposition  of  the  con- 
tents of  the  sac  ;  he  had  numei'ous  chills  and  his 
general  strength  and  condition  dejweciated  very 
much,  and  the  symptoms  lasteil  for  weeks  at  each 
attack.  Last  summer  he  came  under  the  care  of 
Dr.  Lange,  who  enlarged  the  opening  by  burning  a 
large  hole  into  the  substance  of  the  kidnev  sufficient 


to  admit  two  fingers.  The  patient  did  well  after 
this  operation,  excepting  that  a  severe  secondary 
hemorrhage  occurred  at  the  time  the  slou^s  sejja- 
rated.  But  that  was  controlled  and  not  long  after- 
ward the  opening  began  to  diminish  in  size,  and 
pus  accumulated  again.  .Vfter  about  two  months  had 
passed,  Dr.  Lange  decided  to  remove  the  kidney,  and 
the  operation  was  performed  five  weeks  ago.  It  was 
exceedingly  diflicult,  on  account  of  the  kidney  being 
imbedded  in  a  mass  of  cicatricial  tissue,  and  it  was 
impossible  to  remove  the  organ  without  injuring  the 
peritoneum.  The  operation,  however,  went  on  fairly 
well,  although  there  was  rather  free  hemorrhage 
from  numerous  small  vessel.s,  until — being  obliged 
to  work  entirely  by  touch — finally  he  encountered  a 
firm,  cord-like  structure,  which,  from  its  feel,  he  re- 
garded as  a  band  of  cicatricial  tissue  and  divided  it 
with  scissors.  Although  situated  at  the  upper  end 
of  the  kidney,  near  the  supra-renal  capsule,  it  proved 
to  be  the  renal  artery  arid  a  profuse  hemorrhage  at 
once  occurred.  The  finger  was  immediately  placed 
over  the  mouth  of  the  open  vessel,  and  then  a  pair  of 
forceps,  such  as  are  used  in  ovariotomy  for  seizing  the 
sac,  were  applied.  It  was  not  advisable  to  apply  a 
ligature.  The  same  would  ]3robably  have  slipped. 
On  account  of  the  loss  of  blood  he  was  unable  to 
thoroughly  disinfect  the  large  wound — several  small 
cysts  filled  with  oifensive  pus  had  burst  and  emptied 
into  it — but  was  compelled  to  clean  it  as  quickly  as 
possible,  and  powder  it  completely  with  iodoform. 
The  forceps  were  left  in  situ.  The  patient  rallied 
and  during  the  first  twenty-four  hours  did  quite 
well.  The  wound  was  left  open,  except  being 
loosely  filled  with  borated  cotton  and  covered  with 
antiseptic  gauze. 

On  the  second  day  it  was  very  evident  that  the 
patient  was  losing  ground,  and  he  died  on  the  third 
day. 

At  the  autopsy  it  was  found  that  the  other  kidney 
was  the  seat  of  fatty  degeneration,  as  was  also  the 
liver.  There  was  peritonitis,  but  not  extensive. 
There  was  septic  infiltration  of  the  cellular  tissue 
along  the  spine.  The  renal  arteiT  had  been  divided 
about  half  an  inch  from  its  origin  in  the  aorta. 
Badenheuer  had  reported  a  case  in  which  there  was 
hemorrhage,  and  he  drained  the  peritoneal  cavity 
and  the  patient  recovered.  In  that  case  there  was 
some  difficulty  in  loosening  the  kidney,  until  he  cut 
directly  through  the  capsule,  and  then  he  was  alile 
to  puU  it  out  easily.  To  remove  the  organ  in  that 
way  in  Dr.  Lange's  case  was  impossible,  and  such  a 
separation  could  not  be  made  even  in  the  post- 
mortem specimen. 

Dr.  Peters  asked  if  any  of  the  members  thought 
it  possible  to  have  made  the  diagnosis  more  com- 
plete by  means  of  manual  examination  through  the 
rectum.  It  seeme'd  to  him,  from  the  little  experi- 
ence he  had  had  in  examination  by  means  of  the 
hand  can-ied  into  the  rectum,  that  very  likely  it 
would  not  have  been. 

Dr.  Briddon  thought  that  not  much  information 
was  to  be  gained  by  the  procedure,  and  certainly  it 
was  not  unattended  by  danger. 

He  once  examined  a  patient,  several  years  ago, 
who  was  an  inmate  of  the  Presbyterian  Hospital,  and 
had  an  abdominal  tumor,  the  character  of  which  was 
doubtful.  There  was  no  diificulty  in  manipulating, 
V)ut  he  was  unable  to  distinguish  between  different 
organs  with  the  precision  neces.sary  for  diagnosis. 
He  thought  he  recognized  an  enlarged  spleen.  The 
patient  died  twenty-four  hours  afterward,  and  at  the 
aiitopsy  there  was  found  a  splenic  tumor,  which  had 


498 


THE  MEDICAL  RECORD. 


.  large  cvst,  the  walls  of  which  were  agglutinated  to 
the  omentum,  and  at  that  point  the  cyst,  which  was 
thin  as  lissue  paper,  had  ruptured,  and  poured  its 
contents  into  the  peritoneal  cavity.  He  should  hesi- 
tate very  much  before  resorting  to  the  method  in  any 
case. 

Dr.  Hutchison  thought  that  the  liability  to  do 
damage  depended  somewhat  upon  the  size  of  the 
hand.  Simon  limited  the  size  to  ten  and  one-half 
inches  in  circumference. 

Dr.  Peters  said  that  the  reason  he  did  not  make 
the  examination  in  his  case  was  because  ordinary 
examination  gave  a  great  deal  of  pain,  and  he  was 
afraid  of  the  existence  of  a  thin  cyst  wall,  and  dared 
not  interfere. 

Dr.  Brtodon  thought  the  great  danger  was  the 
liability  to  encounter  cysts  with  thin  walls  and  rup- 
ture them. 

Db.  Weir  said  that,  prior  to  the  opeia-tion,  lie 
thought  tliey  had  sufficient  data  ujjon  which  to 
base  a  diagnosis  without  resorting  to  a  rectal  exaiu- 
ination,  which,  in  his  opinion,  was  not  altogethei 
free  from  risk.  But  he  had  since  concluded  that 
probably  a  better  appreciation  of  the  tumor  would 
have  been  obtained  by  resorting  to  Simon's  method. 
Although  the  upper  border  of  the  tumor  probably 
could  not  have  been  reached,  yet  the  hand  quite 
likely  would  have  passed  behind  the  elongated  liver, 
and  thus  it  would  have  been  known  that  it  was  not  a 
kidnev  tumor.  .  ,  .    , 

Dr."  Peters  thought  that  that  view  might  have 
been  corroborated  bv  the  autopsy.  At  all  events,  he 
would  not  be  willing  in  another  case  to  regard  the 
diagnosis  complete  unless  Simon's  method  had  been 
practised. 

Dr.  Weir  remarked  that  Dr.  Lange  s  cases  sup- 
plemented one  which  he  had  had  in  the  Roosevelt 
Hospital,  about  six  years  ago.  For  the  relief  of  a 
'  pvouephrosis,  he  made  an  incision  m  the  loin, 
which  evacuated  the  matter  and  revealed  a  much 
disorganized  tubercular  kidney,  which  he  wished  to 
remove,  but  the  proposition  was  overruled  by  his 
colleagues  in  consultation,  and  a  drainage-tube  was 
inserted  and  the  case  left  to  the  processes  of  natiire. 
The  man  went  on  very  well  for  six  weeks,  and  then 
unfavorable  symptoms  developed  and  he  died  of 
peritonitis.  .  .     .   „  ,. 

The  autopsy  showed  peri-nephritic  mtlammation, 
with  suppuration  in  places,  and  peritonitis.  At  the 
time  the  nephrectomy  was  proposed  the  kidney 
could  have  easilv  been  removed.  At  the  tinie  of 
death  however,  it  was  so  firmly  fastened  by  mflam- 
matorv  processes  that  it  could  not  have  been  re- 
moved, except  with  very  gi-eat  difficulty  and  with 
great  risk  to  the  peritoneum.  .   ■,     ,  , 

Pvouephrosis,  with  and  without  calculi,  had  been 
a  csiuse  for  nephrectomy  in  seventeen  cases  with 
seven  deaths. 

Dr.  Post  presented  a  portion  of  dead  bone  re- 
moved in  a  case  of 

NECROSIS  OP  THE  UPPER  PART  OP  TUB  SHAFT  OF  THE 
HUMERUS. 

The  patient  was  a  bov,  fifteen  years  of  age,  who 
came  to  his  clinic  three  weeks  ago.  Seven  months 
before,  he  had  injured  his  arm,  and  infiaramation  fol- 
lowed. After  two  or  three  months,  an  opening  was 
made  about  a  hand's  breadth  below  the  shoulder  and 
pus  evacuated,  and  the  discharge  continued.  A  re- 
cent abscess  had  formed  higher  up  toward  the  ax- 
illa, upon  the  inner  si.lo,  not  far  from  the  axillary 
vessels.     Fluctuation  existed,  and  Dr.  Post  opened 


the  abscess,  which  evacuated  a  quantity  of  pus,  and 
then  injected  a  carbolized  solution  {1  to  40)  when  he 
found  that  it  communicated  with  another  sinus  that 
had  existed  for  some  time.  Carbolized  dressings 
were  applied.  At  the  end  of  a  week  the  intlammation 
had  subsided,  and  he  then  went  through  the  deltoid 
with  a  longitudinal  incision,  exposed  the  upper  part 
of  the  shaft  of  the  humerus  and  removed  the  portion 
of  dead  bone  presented.  The  necrosis  was  limited  by 
the  epiphyseal  cartOage.  He  had  observed  the  sann^ 
thing,  in  "persons  of  that  age,  in  a  number  of  in- 
stances, the  head  of  the  bone  being  apparently  sound, 
the  necro.sis  extending  no  farther  than  the  cartilage. 
He  asked  if  necrosis  of  the  humerus,  in  persons  of 
that  age,  was  not  apt  to  be  limited  by  the  epiphyseal 
cartilage.  He  was  inclined  to  think  that  it  was  a 
pretty  general  fact. 

Dr.  Post  also  presented  a  conical  pistol-ball 
which  he  had  removed  from  the  outer  side  of  the 
lower  jaw. 

The  society  then  proceeded  to  the  transaction  of 
miscellaneous  business. 


Corresponticnce. 


THE    MEDIC.VL    MSSIONAEY    HOSPITAL 
AT  C! ANTON,  CHINA. 

To  THE  Edit>r  of  The  Medical  Record. 
SrR  :  It  has  occurrea  to  me  that  a  few  items  from 
vour  antipodes  might  ->ot  be  without  interest,  and 
coming  directly  from  th.  field  it  may  also  increase 
interest  in  that  vital  sub>ct  of  medical  missions. 
Did  space  permit,  we  wouH  like  to  give  some  sta- 
tistics from  a  number  of  sim,'ar  institutions  on  hea- 
then soil,  but  can  only  give  th^  salient  points  of  the 
work  as  found  here  in  Canton. 

The  Medical  Missionary  Hosntal  of  Canton  was 
begun  in  1834  by  Dr.  Peter  Parker,  of  Yale  College, 
now  in  Washington,  D.  C.  He  wvs  under  commis- 
sion of  the  American  Board  of  Missions,  and  was 
the  first  medical  missionary  in  Chna.  As  early  as 
180.5,  however.  Dr.  Pearson,  surgeonof  the  old  East 
India  Company,  at  Canton,  began  thtgood  work  by 
introducing  vaccination,  and  superinteuled  the  prac- 
tice in  the  hands  of  a  native  vaccinaor  for  many 
vears.  And  at  Macao,  about  ninety  miles  south 
from  here.  Dr.  T.  E.  CoUedge,  also  of  tin  East  India 
Company.'conducted  a  dispensary  from  827  to  1832, 
treatingli.OOO  cases. 

Notwithstanding  the  restrictions  on  fo-eign  inter- 
course and  the  prohibition  of  missionary  ipnrations, 
■Dr.  Parker  was  able  to  open  this  hosptal,  which 
was  resorted  to  bv  hundreds  of  patients,  ^orne  even 
spending  the  night  in  the  street  to  be  sui,  of  an  en- 
trance in  the  morning.  The  important  of  such 
work  being  seen,  the  Medical  ^lissionnry  •Society  in 
China  was  organized  in  18:iS,  and  Dr.  Colledge 
elected  president,  which  connection  was  only  sev- 
ered last  vear  bvhis  death,  when  Hon.  Pete,-  Parker, 
M  D  ,  was  chosen  in  his  stead,  and  Prof.S.  Wells 
WilliaiiLS,  IjL.D.,  now  of  Yale  College,  Iw  long  a 
resident  of  China,  elected  senior  vice-presi.ent.  In 
1,S40  during  the  first  war  between  Eng\ml  and 
China,  the  hospital  Work  was  suspended,, nd  Dr. 
Parker,  returning  to  the  TInited  States,  lecired  in 
the  interest  of  medi<-al  missions,  and  was  tU  cause, 
while  passing  through  Scotland,  of  the  ori  jnation 
of  the  Edinburgh  Medical  Missionary  Scciev. 


THE  MEDICAL  RECORD. 


499 


In  1843,  peace  being  restored,  he  reopened  the 
hospital,  and  oamed  it  on  till  1855,  up  to  which  time 
over  53,000  cases  were  treated,  and  numerous  surgi- 
cal operations  performed. 

Dr.  Parker  again  returning  to  America,  Dr.  J.  G. 
Kerr,  of  Jefferson  Medical  College,  Philadelphia,  as- 
sumed the  care  of  the  hospital,  under  the  Presbyte- 
rian Board  of  Missions. 

Under  this  same  management  now  the  hospital  is 
in  a  flourishing  condition.  During  the  past  year 
there  were  1,034  in-patients,  19,33'2  out-patients, 
and  1.115  surgical  operations,  many  of  them  minor, 
but  none  the  less  important  here.  During  1879 
eighty-one  patients  were  admitted  with  urinary  cal- 
culi ;  during  1880,  sixty-six  ;  and  more  this  year,  we 
understand,  though  we  have  not  the  exact  figures. 
Most  of  these  were  removed  by  lithotomy,  while 
Bigelow's  instrument  for  crushing  was  used  \\-ith 
success  in  a  number  of  cases.  The  collection  of  jire- 
putial  calculi  is  a  marked  feature  of  the  hospital. 
'There  were  two  successful  cases  of  ovariotomy  last 
jear. 

There  is  in  connection  with  the  hospital  a  class 
■of  a  dozen  or  more  native  students,  who  pay  a  small 
iee,  and  constitute  the  Canton  Medical  College. 
Becoming  expert  in  the  use  of  the  knife,  for  which 
there  is  so  much  call  here — there  being  no  surgery 
in  the  native  Chinese  practice — a  numlier  have  gone 
forth  to  play  an  important  part.  One  is  employed 
at  coal  mines  near  Tientsin,  at  a  salary  of  81,000  a 
year.  The  reputation  of  Drs.  Wong,  Kwan  To,  Tien 
Hee,  and  others,  declares  their  ability. 

The  publication  of  medical  works  in  Chinese  was 
begun  by  Dr.  Benjamin  Hobson,  his  fii'st  work,  on 
anatomy  and  physiology,  being  issued  from  Canton 
in  1850.  It  was  followed  by  other  treatises,  as  "  The 
Principles  and  Practice  of  Surgery,"  "  Practice  of 
Medicine,"  and  a  "  Manual  of  Midwifery,"  which 
volumes,  Dr.  Lockhart  says,  will  be  of  incalculable 
benefit  to  the  Chinese ;  and  were  this  all  that  Dr. 
Hobson  had  done  it  would  be  worth  the  labor  of  a 
lifetime.  To  these  Dr.  Ken-  has  added  a  "  Chemis- 
try," in  four  volumes;  a  "Materia  Medica,"  in  two 
volumes;  "  Manuals  of  Skin  and  Eye  Diseases  ;"  bro- 
chures on  "Diagnosis,"  "  Sy^jhilis,"  and  "Banda- 
ging;" a  treatise  on  "Fevers  and  the  Digestive  Or- 
gans ;  "  and  has  an  "  Operative  Surgery  "  in  print, 
containing  many  excellent  illustrations.  A  medical 
journal  in  the  Chinese  language — the  Said  San  Po — 
has  also  been  begun. 

Dr.  Kerr  has  been  making  his  iniiuence  felt  through 
all  the  province,  while  in  the  city  there  have  sprung 
up — more  or  less  directly  the  result  of  this  hospital 
— two  other  hospitals,  two  dispensaries,  two  drug 
stores,  a  number  of  offices  for  the  practice  of  foreign 
dentistry,  several  missionary  dispensaries  outside 
the  city,  and  a  "vaccination  hall"  lately  opened. 
Accompanying  Dr.  Kerr  thither  recently,  we  found 
extensive  and  finely  furnished  Chinese  apartments, 
where  he  has  been  rerpiested  to  teach  a  class  of  some 
five  hundred  Chinese  in  the  art  of  vaccination.  An- 
other feature  of  this  new  establishment  is  the  pur- 
chase and  care  of  female  infants  aliout  to  be  de- 
stroyed by  their  parents.  Female  infanticide  is  one 
of  the  crimes  of  China,  as  is  well  known. 

Dr.  Kerr  last  year  attended  upon  His  Excellency 
ihe  Viceroy,  and  gave  him  chloroform  for  a  minor 
operation  of  the  foot.  He  was  greatly  pleased  with 
the  wonderful  medicine.  Their  Excellencies  the 
Viceroy  and  Hoi-kwan  each  make  an  annual  contri- 
bution of  two  hundred  dollars  to  the  support  of  the 
hospital. 


We  note  also  by  the  China  mail  that  Dr.  Macken- 
zie, in  much  favor  with  Viceroy  Li  Hung  Chang,  has 
lieen  called  to  Peking  to  attend  H.  E.  Kwang,  lately 
appointed  First  President  of  the  Board  of  Civil  Of- 
fice. Thus  are  important  avenues  to  a  lasting  good 
influence  opening  up  on  eveiy  hand  and  inviting 
entrance,  and  the  finest  field  for  medical  missions, 
as  Dr.  Henderson  has  declared,  is  China.  Of  five 
medical  missionaries  sent  out  by  the  Presbyterian 
Foreign  Board  last  year,  three  are  come  to  China. 
Jos.  C.  Thomson. 

CiiTON,  CHI23A,  February  11,  1SS2. 

]siee\:e-stketching. 


To  THE  Editor  of  The  Me 

SiE :  The  lively  interest  manifested  by  the  profes- 
sion upon  the  subject  of  nerve-stretching  will  doubt- 
less be  enhanced  by  the  interesting  and  timely 
paper  by  Dr.  Morton,  read  before  the  New  York 
Neurological  Society,  a  synopsis  of  which  appeared 
in  the  Kecoed  of  March  4th,  and  your  editorial 
upon  the  same  subject.  It  should  he  a  matter  of 
pride  that  not  a  little  of  the  knowledge  already 
acquired  is  due  to  investigations  made  by  American 
physicians.  The  subject,  however,  appears  to  have 
been  studied  wholly  with  reference  to  its  bearings 
upon  surgery,  or  to  the  anatomical  changes  which 
ensue  to  the  brain,  the  spinal  cord,  and  the  nerve 
itself,  as  a  result  of  stretching. 

Thus  far  investigations  appear  to  show  : 

First. — That  jjaralysis  of  sensation  is  more  pro- 
nounced than  paralysis  of  motion,  while  the  latter 
is  more  persistent  than  the  former. 

Second. — That  the  effect  upon  the  cord  from 
stretching  is  negative. 

Third. — That  the  irritability  of  the  nerve-trunk  is 
modified,  or  may  be  temporarily  destroyed. 

Fourth. — That  stretching  a  nerve  not  only  acts 
upon  itself,  but  likewise  has  an  action  upon  the 
nerve  of  the  opposite  side. 

Fifth. — That  the  cohesion  of  the  nerve- sheath  or 
nerve-fibrils  is  affected  by  the  nerve  sliding  within 
its  sheath,  thus  breaking  up  the  adhesions  and 
relieving  the  nerve  of  pressure. 

Si.rth. — "That  there  may  be  a  rapid  coagulability 
of  the  medullary  sheath,  a  separation  of  the  sheath 
from  the  neurilemma,  or  a  solution  in  the  con- 
tinuity of  the  axis-cylinder  and  medulla,  as  a  result 
of  the  violence  done." 

Seventh.— Tlh&t  the  best  results  from  nerve-stretch- 
ing are  obtained  not  by  feeble  and  sudden,  but  by 
vigorous  and  prolonged,  stretching. 

Thus  far  the  physiology  of  nerve-stretching  has 
either  been  overlooked  or  completely  ignored.  The 
knowledge  of  nerve-stretching,  now  in  its  transition 
state,  is  merely  empirical  knowledge,  and  cannot 
become  scientific  until  more  attention  is  given  to 
the  physiology  of  the  subject. 

There  are  many  interesting  problems  relating  to 
physiology  connected  with  the  procedure  of  nei've- 
stretching.     Space  forbids  a  mention  of  but  two  : 

(a)  What  influence  upon  the  nutrition  of  the  cord 
follows  stretching  a  nerve  ? 

(h)  What  influence  does  stretching  a  nerve  have 
upon  the  vascular  mechanism  ;  and  if  any.  through 
what  kind  of  nerve-fibres  and  in  what  way  is  this 
influence  manifested  ? 

Division  of  a  nerve  supi^lying  a  muscle  quickly 
and  greatly  increases  the  venous  flow  of  blood, 
showing  a  dilatation  of  the  muscular  arteries.  Does 
stretching  a  nene  produce  the  same  phenomenon? 


500 


THE  MEDICAL  RECORD. 


If  this  be  answered  affirmatively,  the  following 
question  naturally  arises :  Does  this  condition 
obtain  in  nerves  only  whose  irritability  has  been 
destroyed?  Again,  when  an  animal — a  kitten — ^is 
warmed  in  a  heated  chamber  till  the  feet  become 
red  from  dilatation  of  blood-vessels,  division  of  the 
sciatic  nerve  causes  the  foot  of  the  same  side  to  be- 
come paler  (Schiflf).  Has  a  similar  change  in  the 
vascular  mechanism  followed  the  stretching  of  the 
sciatic  nerve  in  man  V 

If  Mrelclunrj  the  sciatic  nei-ve  in  man  produces 
modified  aniemia  (observed  in  the  kitten  after  divi- 
sion), does  the  nerve  stretching  act  as  a  stimulus  to 
the  dilator-fibres  of  the  blood-vessels,  or  is  it  due  to 
loss  of  central  tonicity,  or  both  ?  I  think  these  and 
other  questions  relating  to  the  physiology  of  nerve- 
stretching  are  sufficiently  important  to  receive  care- 
ful investigation  at  the  hands  of  Dr.  Morton  or  some 
other  American  neurologist. 

Talbot  Jones. 

St.  Padl.  Minn. 


SEVrULTANEOUS    FKACTUEE    OF    BOTH 
CLAVICLES. 

To  THE  Editor  of  The  Medical  Record. 
Dear  Sib  :  In  looking  over  Professor  F.  H.  Hamil- 
ton's last  edition  of  his  "  Treatise  on  Fractures  and 
Dislocations,"  I  notice  that  under  the' heading  of 
"  Fractures  of  the  cla%'icle,"  he  remarks  that  "a  dou- 
ble fracture  or  a  simultaneous  fracture  occurring  in 
both  clavicles  seldom  occurs."  He  records  but  two 
cases,  both  occurring  in  young  boys,  while  Mal- 
gaigne,  at  the  Hotel  Dieu,  saw  but  one  instance  in 
two  thousand  three  hundred  and  fifty-eight  cases, 
and  recollects  only  five  other  examples.  Professor 
H.  thinks  these  double  fractures  "  occur  more  often 
in  children  than  in  adults,  and  are  of  the  character 
of  partial  fractures  without  usually  much  displace- 
ment." This  may  be  the  rule  in  general.  I  am, 
however,  enabled  to  contribute  one  case  where  a 
fracture  of  both  clavicles  occurred  in  an  adult. 

P.  R.  P ,  aged  about  fifty,  by  the  upsetting  of 

^  load  of  hay  upon  which  he  was  riding,  was  thrown 
into  an  angle  of  an  old-fashioned  rail  fence,  striking 
in  such  a  manner  against  the  rails  that  both  clavi- 
cles were  broken.  I  was  called  to  attend  the  case. 
Both  fractures  were  complete.  The  usual  dressings 
were  applied  in  order  to  keep  the  shoulders  drawn 
back  and  the  broken  ends  as  near  in  ofjposition  as 
possible.  The  patient  was  quite  restive  under  the 
dressings,  and  would  not  submit  to  the  necessary 
confinement,  but  insisted  on  using  his  right  arm. 
The  left  clavicle  had  a  good  union  ;  in  the  right  no 
union  took  place,  and  a  false  joint  was  the  conse- 
quence. A  few  yeai-s  later  he  was  thrown  from  a 
wagon  and  killed,  and  thus  the  case  terminated. 

I  forward  you  this  report  that  it  may  bo  added  to 
the  list  of  this  unusual  accident. 
Yours,  etc., 

(teokhe  Btitu,  M.D. 

BlNaHAMTOM,  X.  Y. 

ARMY   NEWS. 
Offlcidl  Lial  of  Changes  of  Slations  and  Duties  of  Offi.- 
cers  of  the  Medical  Department,  United  Stdtes  A  rmy, 
from  April  23,  1882.  to  April  29,  1882. 
Jaquett,    (t.   p..    Major   and   Surgeon.     Granted 
leave  of  absence  for  six  months  on  stirgeon's  cer- 
tificate of  disability.    G.  O.  97,  A.  G.  O.,  April  27, 
1882. 


Maus,  L.  M.,  Capt.  and  Asst.  Surgeon.  Having 
reported  at  these  headquarters,  will  proceed  to  Forfc 
Lewis,  Col.,  and  report  to  the  commanding  officer 
for  dutv.  S.  O.  86,  Dept.  of  the  Missouri,  April 
24,  1882. 

Pouter,  .Joseph  Y.,  Capt.  and  Asst.  Surgeon. 
His  leave  of  absence  for  one  month,  granted  him  in 
S.  O.  .32,  Dept.  of  the  South,  March  14,  1882,  ex- 
tended one  month,  with  permission  to  apply  for  a 
farther  extension  of  twentv  davs.  S.  O.  17,  Mil. 
Div.  of  the  Atlantic,  April  25,  1882. 

Gardiner,  J.  de  B.  W.,  Capt.  and  Asst.  Surgeon. 
Telegraphic  instructions  of  this  date,  assigning  him 
to  duty  at  Fort  Huachuca,  A.  T.,  confirmed.  S.  O. 
57,  Dept.  of  Arizona,  April  19,  1882. 

Gardner,  Ed^vin  B.,  Capt.  and  .\sst.  Surgeon. 
Having  reported  at  these  headquarters,  is  assigned 
to  temporai-v  dutv  at  Vancouver  Barracks,  Wash. 
Ter.  S.  O.  'SO,  Dept.  of  the  Columbia,  April  14, 
1882. 

Shupeldt,  E.  W.,  Capt.  and  Assistant  Surgeon. 
Granted  leave  of  absence  for  three  months  from 
May  1,  1882.  Relieved  from  duty  in  the  office  of 
the  Surgeon-General,  to  take  efl'ect  May  1,  1882,  and 
upon  expiration  of  his  leave  to  report  by  letter  to 
the  Surgeon-General.  S.  O.  92,  \.  G.  O.,  April  21, 
1882. 

Robinson,  S.  Q.,  Capt.  and  Asst.  Surgeon.  Hav- 
ing reported  at  these  headciuarters,  is  assigned  to 
duty  at  Fort  Spokane,  Wash.  Ter.  S.  O.  50,  0. 
S.,  Dept.  of  the  Columbia. 


iHrtical  3tcms   antr  news. 


CoNTAGio0s  Diseases  —  Weekly  Statement.  — 
Oomparative  statement  of  cases  of  contagious  diseases 
reported  to  the  Sanitary  Bureau,  Health  Depai-tment, 
for  the  two  weeks  ending  April  29,  1882. 


Week  Boding 

si 

•Is 

« 

•a  . 

II 
la 

i 

•s 
1 

i 

1 

& 

B 

1 

o 

s 

5 

DQ 

fi 

April    22,  1882. 

7 

7 

2.36 

2 

137 

93 

21 

0 

AprU    29,  1882. 

4 

9 

201 

3 

137 

81 

14 

0 

Kentucky  State  Medic.vl  Society. — The  twenty- 
seventh  annual  session  was  held  at  Louisville, 
April  5th.  tSth,  and  7th,  1882.  The  society  convened 
in  the  i-ooms  of  the  Polytechnic  Society  of  Ken- 
tucky in  the  City  of  Louisville,  at  2.30  r.sr.  on  .\pril 
5th.  The  reports  of  Committees  and  the  annual 
address  by  the  President,  Dr.  J.  W.  Holland,  of 
Louisville,  occupied  the  session  of  the  first  day. 
The  annual  address  of  tlie  President  was  entitled 
"  Our  Thirtieth  Year,"  and  abounds  in  interesting 
discussions  relating  to  the  society  and  its  work,  both 
retrospective  and  prospective.  Dr.  Holland  took 
up  in  detail  the  subject  of  State  medicine  :  vital 
statistics  ;  medical  education  :  the  regulation  of  the 
practice  of  medicine  and  medical  ethics,  especially 
as  relating  to  the  profession  in  the  State  of  Ken- 
tucky. The  address  is  published  in  full  in  the 
Louisville  Mediad  Xeirs. 


THE  MEDICAL  RECORD. 


.")U1 


On  the  second  day  Dr.  W.  O.  Roberts,  of  Louis- 
ville, made  an  elaborate  report  on  the  progi'ess  of 
surgery.  Dr.  W.  H.  Wathen,  of  LouisviUe,  followed 
with  a  paper  on  abdominal  section  versus  crani- 
otomy, when  Dr.  Comes,  of  Louisville,  discoursed 
on  color-blindness,  exhibiting  and  describing  an  in- 
genious instrument  for  its  detection.  Dr.  Lunsford 
P.  Yandell,  also  of  Louisville,  made  an  elaborate  re- 
port on  dermatology,  after  which  Dr.  Mathews,  of 
Louisville,  read  a  paper  on  stricture  of  the  rectum 
and  its  treatment  by  divulsion.  Dr.  Ap  Morgan 
Vance,  of  Louisville,  reported  a  successful  case  of 
double  osteotomy  (supra-condyloid  method)  for  the 
cure  of  genu  valgum,  and  also  read  an  interesting 
and  instructive  paper  on  the  treatment  of  spinal  de- 
formities. The  following  papers  were  also  read  : 
"  Cerebro-Sijinal  Meningitis,"  by  Dr.  J.  A.  Lara- 
bee  ;  "  Obscure  Brain  Lesions,"  by  Dr.  A.  H.  Kelch  ; 
"Acute  Bromism,"  by  Dr.  A.  M.  Carlbige  ;  "  On  the 
Deteriorated  Quality  of  Spectacle  Glasses,"  by  Dr. 
Dudley  S.  Reynolds  ;  on  "  Ovariotomy,  with  a  Report 
of  eight  cases,"  by  Dr.  D.  W.  Yandell.  Previous  to 
adjournment,  the  Committee  on  Ethics  made  the 
following  report  : 

"  Whereas,  The  Medical  Society  of  the  State  of 
New  York  has  departed  from  the  Code  of  Ethics  of 
the  American  JNIedical  Association,  and  adopted  a  re- 
■vised  system  of  ethics,  it  seems  projjer  that  this 
society  should  give  expression  to  its  views  ujaon 
this  important  subject.     Therefore,  be  it 

"  Resnlred,  That  the  Kentucky  State  Medical 
Society  regards  the  Code  of  Ethics  of  the  Amer- 
ican Medical  Association  the  best  system  of  ethics 
for  the  guidance  of  honorable  medical  men  now 
in  existence,  and  that  we  hereby  declai-e  our  un- 
faltering and  firm  adherence  to  its  principles,  and 
must  dei>reeate  any  alteration  at  this  time  in  its 
honored  teachings. 

"  Sesoh-ed,  That  our  representatives  at  the  aji- 
proaching  meeting  of  the  American  Medical  Associ- 
ation be,  and  are  hereby,  instructed  to  give  their 
vote  and  influence  in  favor  of  unqualified  adherence 
and  fidelity  to  the  code  as  it  now  stands." 

On  motion,  the  society  then  adjourned. 

American  Medicaij  Association. — The  Thirty- 
third  Annual  Session  will  be  held  in  St.  Paul,  Minn., 
on  Tuesday,  Wednesday,  Thursday,  and  Friday, 
June  6,  7,  8,  9,  1882,   commencing   on  Tuesday  at 

11  A.M. 

"  The  delegates  shall  receive  their  appointment 
from  permanently  organized  State  medical  societies 
and  such  county  and  district  medical  societies  as 
are  recognized  by  representation  in  their  respective 
Stale  societies,  and  from  the  Medical  Dej)artment  of 
the  Army  and  Xavy,  and  the  Marine  Hospital  Ser- 
vice of  the  United  States." 

"Each  State,  county,  and  district  medical  society 
entitled  to  representation  shall  have  the  privilege  of 
sending  to  the  Association  one  delegate  for  every  ten 
of  its  regular  resident  members,  and  one  for  every 
additional  fraction  of  more  than  half  that  number  : 
Provided,  however,  that  the  number  of  delegates  for 
any  particular  State,  territory,  county,  city,  or  town 
shall  not  exceed  the  ratio  of  one  in  ten  of  the  resi- 
dent physicians  who  may  have  signed  the  Code  of 
Ethics  of  the  Association." 

Secretaries  of  medical  societies  as  above  desig- 
nated are  earnestly  requested  to  forward  at  once  lists 
of  their  delegates. 

Sections. — "  The  chaii'men  of  the  several  sections 
shall  prepare  and  read  in  the  general  sessions  of  the  | 


Association  papers  on  the  advances  and  discoveries 
of  the  past  year  in  the  branches  of  science  included 

in  their  respective  sections " — Bi/-l<m-s, 

Art.  n..  Section  4. 

Practice  of  Medicine,  Materia  Medica,  and  IViysi- 
ology. — Dr.  J.  A.  Octerloney,  Louisville,  Ky.,  Chair- 
man; Dr.  D.  J.  Roberts,  Kashville,  Tenn.,  Secre- 
tary. 

Obstetrics  and  Diseases  of  Women  and  Children. — 
Dr.  H.  O.  Marcy,  Boston,  Mass.,  Chairman;  Dr.  C. 
V.  Mottram,  Lawi-ence,  Kan.,  Secretary. 

Surgery  and  Anatomy. — Dr. ,  Chairman; 

Dr.  W.  A.  Byrd,  Quincy,  El.,  Secretary. 

Slate  Medicine. — Dr.  A.  L.  Gihon,  U.  S.  Na\'y, 
Chairman  ;  Dr.  J.  H.  Sears,  Waco,  Texas,  Sea-etary. 

Ophthalmology,  Otology,  and  Laryngology. — Dr. 
,  Chairman  ;  Dr.  J.  Solis  Cohen,  Philadel- 
phia, Secretary. 

Diseases  of  Cliildren. — Dr.  S.  C.  Bnsey,  Washing- 
ton, D.  C,  Chairman  ;  Dr.  W^illiam  Lee,  Baltimore, 
Md.,  Secretary. 

Denlisti-y. — Dr.  D.  H.  Goodwillie,  New  York  city. 
Chairman  ;  Dr.  T.  W.  Brophy,  Illinois,  Secretary. 

A  member  desiring  to  read  a  j^aper  before  any 
Section  should  forward  the  jiaper,  or  its  title  and 
length,  (not  to  exceed  twenty  minutes  in  reading),  to 
the  Chairman  of  the  Committee  of  Arrangements  at 
least  one  month  before  the  meeting. — By-luus. 

Committee  of  Arrangements. — Di\  A.  J.Stone,  St. 
Paul,  Minn.,  Chairman. 

Amendments  to  the  By-laws. — Oflered  by  Dr.  D.  H. 
Goodwillie,  Ai't.  II.,  Section  8.  Permanent  Mem- 
bers :  strike  out  the  words  "  but  without  the  right 
of  voting." 

Offered  by  Dr.  J.  H.  Packard,  Regulation  II.,  par. 
I.,  to  read  "  as  permanent  members  or  members  by 
application." 

Regulation  VI.,  line  4,  strike  out  5  and  insert  10. 
Second  paragraph,  lines  4  and  5,  strike  out  all  after 
"  jjublication  "  to  and  includiug  "Association,"  and 
insert  "  publication." 

Regulation  IX.  Add  new  paragi-aph  :  "Members 
by  application  shall  consist  of  such  members  of 
State  and  county  societies,  in  good  standing,  as  shall 
make  application  in  writing  for  admission.  They 
shall  simply  have  the  right  to  receive  the  Journal  on 
the  same  terms  as  other  members." 

Regulation  TV.,  par.  6,  strike  out  all  from  "see," 
in  line  7,  to  "  and  "  in  line  9. 

Regulation  V.,  par.  3,  after  "  jjublished "  insert 
"  in  such  manner  as  the  Association  may  direct." 
William  B.  Atkinson,  M.D., 

Permanent  Secretary. 

Medical  Societt  of  New  Jekset.- — The  One  Hun- 
dred and  Sixteenth  Annual  Meeting  of  the  Medical 
Society  of  New  .Jersey,  will  be  held  in  Educational 
Hall,  at  Asbury  Park,  on  Tuesday  23d  instant,  at 
four  o'clock  P.M.,  and  will  continue  in  session  the 
following  day.  The  Grand  Avenue  House  will  be  in 
readiness  for  guests. 

Quackery. — A  sharp  discussion  upon  this  rather 
trite  subject  took  place  at  one  of  the  South  London 
Branches  of  the  British  Medical  Association.  Mr. 
Nelson  Hardy  read  a  paper  on  "Quackery,  Ancient 
and  Modern,"  ooncluding  it  with  the  following  pro- 
positions :  1.  Quackery  is  moi'e  profitable  pecuni- 
arily than  scientific  medicine,  but  not  so  profitable 
mentally  or  morally.  2.  Quackery  most  readily  finds 
its  victims  among  the  highest  and  lowest  social  strata, 
not  among  the  more  intelligent  middle  classes ; 
readily  also  among  religious  people,  hence  certain 


502 


THE  MEDICAL  RECORD. 


quacks  always  advertise  largely  in  the  (so-called)  re- 
ligious periodicals.  3.  Quackery  in  various  forms 
has  always  been  intimately  connected  with  the  prac- 
tice of  medicine,  and  has  always  impeded  scientific 
progress.  Dr.  Dowse,  who  followed  the  speaker, 
wanted  to  hear  more  about  the  sly  advertising  done 
by  members  of  the  profession,  which  was  really  a 
kind  of  quackery.  He  also  wanted  a  definition  of  a 
quack.  He  thought  Mr.  Hardy  had  been  too  severe 
on  certain  forms  of  cures.  So  long  as  a  medical  man 
cured  his  case  and  did  not  resort  to  villany.  it  was 
of  no  consequence  what  method  he  took.  Mr.  Bar- 
well  said  that  any  medical  man  who  cheated  was  a 
quack,  while  he  who  believed  in  the  efficacy  of  a  de- 
cillionth  of  a  grain  was  only  a  lunatic.  Mr.  Hardy 
asserted  the  claims  of  scientific  and  rational  med- 
icine. He  thought  it  quackery  to  use  patent  med- 
icines, even  if  they  cured. 

A  Question  on  Ethics. — A  correspondent  asks  the 
following  : 

"  Mr.  Editor  :  Will  you  kindly  answer  a  few  ques- 
tions on  the  Code  through  the  columns  of  the  Rec- 
ord.    First,  a  statement  of  facts. 

"Mr.  A i-emoves  with  his  family  into  a  town 

where  there  is  no  near  physician  in  active  practice, 
and  having  occasion  for  the  services  of  a  physician, 

Dr.  B ,  who   resides  in  a  neighboring   town,  is 

consulted   and  is  employed  until  a  physician.  Dr. 

C ,  removes  to  town,  after  which   event,  about 

three  years,  they  have  employed  Dr.  C . 

"  Becently  Mr.  A met  with  an  accident.  A  mes- 
senger was  dispatched  for  Dr.  O ,  who  at  the  time 

was  out  of  town  and  was  not  expected  for  two  or 
three  hours  ;  consequently  a  messenger  was  sent  for 

Dr.  B who  dressed  the  wound,  etc.,  and  made 

ajjpointment  to  see  the  case  again.  Now,  which  of 
these  physicians  can  claim  to  be  the  '  family  physi- 
cian '  of  the  Code — see  Art  V.,  Sec.  6  ;  and  wliat  were 

the  individual  duties  of  both  Dr.   B and   Dr. 

C in  the  case  V  " 

[Dr.  C having  been  called  in  an  emergency, 

should  consider  the  case  as  belonging  to  Dr  B 

who  is  evidently  the  family  physician,  and  should 
resign  the  case  to  him,  unless  he.  Dr.  C ,  is  spe- 
cially requested  by  the  patient  to  continue  his  at- 
tendance.— Ed.] 

English  Undertakers  are  enterprising,  to  use 
the  mildest  term.  They  send  around  circulars  to 
the  medical  men,  offering  a  per  cent,  on  the  busi- 
ness sent  them ! 

Eating  Before  Sleeping. — Man  is  the  only  ani- 
mal that  can  be  taught  to  sleep  qiiiotly  on  an  empty 
stomach.  The  brute  creation  resent  all  efl'orts  to 
coax  them  to  such  a  violation  of  the  laws  of  nature. 
The  lion  roars  in  the  forest  until  he  has  found  his 
prey,  and  when  he  has  devoured  it  he  sleeps  over 
until  he  needs  another  meal.  The  horse  will  paw 
all  night  in  the  stable  and  the  isig  will  squeal  in  the 
pen,  refusing  all  rest  of  sleep  until  they  are  fed. 
The  animals  which  chew  the  cud  have  their  own 
provision  for  a  late  meal  just  brfore  dropping  off  to 
their  nightly  slumbers. 

Man  can  train  himself  to  the  habit  of  sleeping 
without  a  preceding  meal,  but  only  after  long  years 
of  practice.  As  he  comes  into  the  world  nature  is 
too  strong  for  him,  and  he  nuist  be  fed  before  lie 
will  sleep.  A  child's  stomach  is  small,  and  when 
perfectly  filled,  if  no  sickness  disturbs  it,  sleep  fol- 
lows naturally  and  inevitably.  As  digestion  goes  on 
the  stomach  begins  to  empty.     A  single  fold  in  it 


makes  the  little  sleejier  restless  ;  two  will  waken  it ; 
and  if  it  is  hushed  again  to  repose  the  nap  is  short. 
Paregoric  or  other  narcotic  may  close  its  eyes  again, 
but  without  either  food  or  some  stupefying  drug  it 
will  not  sleep,  no  matter  how  healthy  it  may  be. 
Not  even  an  angel  who  learned  the  act  of  minstrelsy 
in  a  celestial  choir  can  sing  a  babe  to  sleep  upon  an 
empty  stomach. 

We  use  the  oft-quoted  illu.stration,  "  sleeping  as 
sweetly  as  an  infant,"  because  this  slumber  of  a 
child  follows  immediately  after  its  stomach  is  com- 
pletely filled  with  wholesome  food.  The  sleep  which 
comes  to  adults  long  after  partaking  of  food,  and 
when  the  stomach  is  nearly  or  quite  empty,  is  not 
after  the  type  of  infantile  repose.  There  is  all  the 
difference  in  the  world  between  the  sleep  of  refresh- 
ment and  the  sleep  of  exhaustion. 

To  sleep  well  the  blood  that  swells  the  veins  in 
the  head  during  our  busy  hours  must  flow  back, 
leaving  a  greatly  diminished  volume  behind  the 
brow  that  lately  throbbed  with  such  vehemence.  To 
digest  well,  this  blood  is  needed  at  the  stomach  and 
nearer  the  fountains  of  life.  It  is  a  fact  established 
beyond  the  possibility  of  contradiction  that  sleep 
aids  this  digestion,  and  that  process  of  digestion  is 
conducive  of  refreshing  sleep.  It  needs  no  argu- 
ment to  convince  us  of  this  mutual  relation.  The- 
drowsiness  which  always  follows  the  well-ordered 
meal  is  itself  a  testimony  of  nature  to  this  inter- 
dependence.-— Neio  York  Jorimal  of  Ccmimerce. 

Fahrenheit  and  Centiobade. — 

From  CentigriKle  to  Fahrenheit, 

'Tifi  easy  to,  divine — 

You  first  must  use  nrlthmetic 

And  nmltiplv  bv  nine. 

The  answer  now  divide  by  five,! 

And  then  you  have  in  view 

The  very  number  that  you  seek. 

By  adding  thirty-two. 

From  Fahrenheit  to  Centigrade, 

However,  it  is  plain— 

You  first  must  talve  the  thirty-two 

And  multiply  again. 

But  this  time  only  by  the  five. 

And  then  you  draw  a  line 

Straight  up  and  down,  in  order  that 

You  may  divide  by  nine. 

The  Sale  of  Milk.— A  bill  has  recently  passed 
the  Legislature  of  New  Jersey  prohibiting  the  sale- 
of  skimmed  milk  without  "letting  the  customer- 
know  that  it  is  such.  The  cans  are  to  be  labelled 
"skimmed  milk."  The  law  is  very  radical  in  its  at- 
tempt to  compel  the  furnishing  of  pure  milk.  It 
forbids  feeding  the  cows  upon  the  distillery  waste 
known  as  "  swill,"  or  upon  any  substance  known  as 
unwholesome. 

Ague  and  the  Spots  on  the  Sun. — According  to 
the  humorous  editor  of  the  Xeit-  York  Times,  a  Dr. 
Merritt,  of  Chicago,  defends  with  great  ingenuity 
the  theory  that  chills  and  fever  are  caused  by  the 
spots  on  the  sun.  This  is  tpiite  as  good  a  view  as 
some  already  current. 

The  Jitjiuo  of  all  Recent  Pathological  Aggre- 
gations was  a  tumorweighing  forty-two  pounds,  and 
removed  from  the  scrotum  of  a  patient  living  in 
Bombay.  It  was  of  course  a  case  of  elephantiasis 
Arabrum. 

Small-Pox  in  CiNcrxNATi  had  at  last  reports  lieen 
increasing  very  rapidly,  and  cases  were  being  re- 
ported at  the  rate  of  tliirty  or  forty  per  day.  The 
trouble  has  been  largely  due,  it  is  said,  to  a  failure 
of  the  German  pojiulation  to  get  vaccinated. 


THE  MEDICAL  RECORD. 


503 


Wax  in  the  Extbrnax,  Meatus. — Weil  found,  in 
examining  5,905  children,  wax  in  the  ear  in  eleven 
per  cent,  of  the  boys,  and  fifteen  per  cent,  of  the 
girls. 

Fined  fob  Practising  WirHOUT  a  License. — 
"  Dr."  Richard  C.  Flower,  of  No.  439  Fifth  Av- 
enue, indicted  on  complaint  of  Frederick  E.  Stur- 
gis  for  practising  medicine  without  a  license,  pleaded 
guilty  in  the  General  Sessions  Court.  Judge  Cow- 
ing imposed  a  fine  of  S2U0,  which  was  promptly  paid 
by  Dr.  Flower,  who  will  probably  soon  resume  his 
practice. 

Uselessness  of  Antiseptics  in  OcrL.\R  SuRCiERr. 
— In  a  report  of  his  seven  hundredth  case  of  cataract 
extractions,  Dr.  H.  Knapp  {Arch,  of  OjJithulmologij, 
September  1,  1881)  says  :  "  I  freely  confess  that  the 
advocates  of  antisejisis  in  eye-surgery  have  thus  far 
failed  to  convince  me  of  the  utility  of  their  varied 
procedure,  and  I  do  not  think  it  incumbent  upon 
me  to  waste  time  by  what  I  consider  to  be  super- 
fluous complications  of  treatment.  For  two  years 
and  a  half  I  had  ao  case  of  suppuration  after  any 
operation  on  the  eyeball,  but  three  occurred  lately. 
I  think  the  statistics  of  those  who  use  antisejitic 
means  are  no  better." 

Dr.  Lamson's  Mental  Condition. — Sixteen  affi- 
davits in  Dr.  Lamson's  behalf  were  sent  to  London 
by  the  Attorney- General.  The  affidavit  of  Irving 
McElroy  sets  forth  that  Lamson,  in  1877-78,  was  ad- 
dicted to  the  extravagant  use  of  opium  and  atro- 
pine, from  which  his  mental  and  physical  condition 
was  seriously  affected.  Others  make  similar  affida- 
vits. Dr.  Winston,  of  the  New  York  Life  Insurance 
Company,  affirms  that  he  had  Lamson  under  treat- 
ment last  year,  and  found  his  mind  to  be  greatly  im- 
paired from  an  excessive  use  of  opium.  The  other 
affidavits  are  from  Dr.  H.  H.  Kane,  of  this  city  ;  Dr. 
John  Swinburne,  of  Albany ;  Dr.  D.  Murray,  Hol- 
land Porter,  and  others.  They  all  tend  to  show  that 
Lamson's  mind  was  impaired  from  an  intemiJerate 
use  of  drugs.  As  early  as  187.7,  according  to  one 
affidavit,  Lamson  showed  a  marked  tendency  toward 
insanity. 

*  The  evidence,  on  the  other  side,  to  the  effect  that 
Lamson  was  a  cheat  and  a  scamp,  is  very  consider- 
able. 

M.  Pasteur's  Discoveries  Applied. — An  applica- 
tion to  man  of  M.  Pasteur's  researches  on  the  pres- 
ervation of  animals  from  malignant  pustule  has 
been  reported  by  M.  Casson,  in  a  note  read  at  a 
meeting  of  the  Academic  des  Sciences.  He  de- 
scribed the  case  of  a  farmer  who  had  been  twice  at- 
tacked by  charbon.  The  first  attack  was  slight :  the 
second  was  very  serious,  and  expected  to  be  fatal. 
However,  the  dangerous  symptoms  speedily  disap- 
peared, leaving  two  deep  ulcers  on  the  back  of  the 
hand.  M.  Casson  considers  that  the  rapid  improve- 
ment indicates  an  actual  vaccination  resulting  from 
the  first  attack  of  charbon,  and  suggests  that  the 
case  contii-ms  the  facts  established  by  M.  Pasteur's 
researches  on  the  preservation  of  animals  by  the  in- 
oculation of  attenuated  virus. 

The  St.  Louis  IMedical  Society  and  the  Code. 
— This  society  recently  received  a  majority  report 
on  the  Code  recommending  inaction,  and  a  minority 
report  recommending  the  changes  recently  adopted 
by  the  St.  Louis  Medical  Society,  and  also  recom- 
mending that  the  provision  in  the  Code  against  ad- 
vertising be  abolished.  ^ 


The  Khedive  of  Egypt  has  created  Dr.  Warren 
Bey,  the  well-known  American  physician  of  Paris,  a 
commander  of  the  order  of  Osmanie,  as  a  further  rec- 
ognition of  his  brilliant  professional  career  in  Cairo 
and  in  Paris. 

The  College  op  Physicians  and  Surgeons  of 
Chicago  announces  that  thirteen  of  its  chairs  have 
been  filled. 

Dr.  Reuben  A.  Vance  has  been  appointed  to  the 
professorship  of  Operative  and  Clinical  Surgei-y  in 
the  medical  department  of  Wooster  University,  at 
Cleveland,  O. 

The  Tennessee  State  Medical  Society. — The 
next  meeting  of  the  Medical  Society  of  the  State  of 
Tennessee  will  be  held  in  Memphis,  commencing 
the  second  Tuesday  in  May. 

A  New  Remedy  for  Asthma. — From  more  than 
one  quarter  it  is  reported  that  Australia  posseses  a 
valuable  remedy  for  asthma,  which  might  with  ad- 
vantage be  more  generally  known.  A  species  of 
Eitphorhia  indigenous  to  Queensland,  and  desigTiated 
K.  pilulifei-a,  is  used  locally  with  the  best  results  in 
asthmatic  and  bronchial  affections.  An  ounce  of 
the  leaves  of  the  plant  placed  in  two  quarts  of 
water,  and  allowed  to  simmer  until  tlio  quantity  is 
reduced  to  one-half,  affords  a  medicine  which,  taken 
a  wineglassful  at  a  time  twice  or  thrice  a  day,  is 
credited  witli  the  power  of  relieving  the  most  obsti- 
nate case  of  asthma,  as  well  as  coughs  and  ordinai'y 
chest  affections.  The  leaves  may  easily  be  gathered 
and  dried,  and  wiU  keep  for  a  considerable  length 
of  time.  Other  species  of  the  Eiqihorhia  have  al- 
ready acquired  some  reputation  for  their  medicinal 
virtues  ;  thus  the  leaves  of  the  E.  nereifdUri  are  pre- 
scribed as  a  purgative  by  the  native  jjractitioners  in 
India,  while  the  root  of  the  E.  ipecacuanha  is  said 
to  be  equal  in  all  respects  to  the  true  ipecacuanha. 
— Medical  Times  and  Gazette. 

Relief  of  the  Pain  in  Lead  Colic — A  Novel 
^Iethod  of  Getting  Poisoned. — Dr.  Geneuil,  in  a 
note  to  the  Bulletin  de  Therapeutique,  after  alluding 
to  the  various  means  adopted  for  the  relief  of  the 
terrible  pains  of  lead  colic,  as  rubefaction  by  syna- 
pisms,  chloroform,  electricity,  and  hypodermic  in- 
jections of  morphia,  relates  a  case  to  which  he  was 
called  in  the  country,  where  none  of  these  means 
were  at  hand,  and  in  which  he  succeeded  in  giving 
complete  and  permanent  relief  by  a  very  simple 
procedure.  Having  dii'ected  a  napkin  to  be  heated 
at  the  fii-e,  he  first  applied  a  towel  wetted  with  al- 
most ice-cold  water  to  the  whole  surface  of  the  ab- 
domen, while  the  patient  was  shrieking  with  pain, 
and  having  retained  it  there  for  four  or  five  seconds, 
rapidly  replaced  it  by  the  almost  burning  napkin. 
The  effect  was  like  enchantment,  the  pain  instantly 
disappearing  and  sleep  following,  without  any  re- 
turn of  suffering.  The  cause  of  the  colic  was  at  first 
obscure,  but  was  found  to  depend  upon  the  patient, 
who  was  an  inveterate  smoker,  and  had  very  often 
in  the  day  to  relight  his  pipe,  which  he  did  by  means 
of  matches  colored  with  chromate  of  lead. 5 

Secret  AND  Proprietary  Medicines. — Dr.  Joi-dan, 
in  the  Chicago  Medical  Times,  closes  a  well-written 
article  on  certificates  given  in  favor  of  nostrums  as 
follows;  "What  a  blessing  secret  and  proprietary 
medicinesare  !  In  summary,  these  blessings  may  be 
briefly  told  :  1.  The  use  of  them  destroys  the  confi- 
dence and  respect  of  the  patient.  2.  They  lead  to  a 
routine  practice  highly  beneficial  to  the  undertaker. 


504 


THE  MEDICAL  RECORD. 


3.  They  lessen  the  labors  of  the  physician  by  ena- 
bling the  patient  to  do  his  own  prescribing.  4. 
They  lead  to  fatal  delays  in  calling  in  the  physician, 
thus  improving  the  marble  business.  5.  They  sup- 
port medical  journals  and  induce  editors  to  put  to 
shame  the  exploits  of  Munchausen.  6.  They  in- 
crease the  rate  of  mortality,  and  thus  aid  in  prevent- 
ing the  overcrowdiog  of  population.  7.  They  ena- 
ble our  distinguished  professors  to  advertise  them- 
selves both  to  the  medical  and  non-medical  world, 
and  very  nicely  enable  the  laity  to  find  out  the  ex- 
alted merit  of  our  professors  and  other  great  men. 
8.  They  bring  the  medical  profession  to  the  level 
with  patent-medicine  men,  and  exalt  the  latter  to 
.the  position  of  dictators  to  the  medical  profession." 

The  Phil.ujelphia  Cottntt  Medical  Society  and 
THE  New  Code. — At  the  stated  meeting  of  the  Phila- 
delphia County  Medical  Society,  held  April  19,  1882, 
the  following  resolutions  were  adopted  : 

"Resolved,  Tliat  this  Society  reaffirms  its  adhe- 
rence to  the  principles  of  the  Code  of  Ethics  of  the 
American  Medical  Association,  and  declares  that, 
in  its  opinion,  for  a  physician  to  extend  professional 
recognition  to  irregular  practitioners,  is  to  patron- 
ize and  encoui'age  irregular  practice  ;  and  is  alike 
inconsistent  with  honesty  of  purpose  and  the  pursuit 
of  medicine  as  a  science. 

"  Reaolved,  That  this  resolution  be  referred  to  the 
Pennsylvania  State  Medical  Society  at  its  next  an- 
nual meeting." 

CojJ%-ULSioNS  IN  Besuscitated  Childken. — Dr.  C. 
H.  Preston,  of  Davenport,  Iowa,  writes:  "In  the 
proceedings  of  the  New  York  Academy 'of  Medicine, 
reported  in  your  number  for  April  15th,  just  at 
hand.  Dr.  Post,  in  the  coui'se  of  a  discussion  on  the 
subject  of  still-births,  refers  '  to  the  tendency  to  the 
occurrence  of  convulsions  within  twenty-four  or  thir- 
ty-six hours  in  resuscitated  children.'  Having  just 
seen  an  ajjropos  case,  I  send  you  a  note  of  it,  hojiing 
it  may  contribute  to  a  solution  of  the  pathological 
problem  involved  in  the  occurrence  of  these  con- 
vulsions which  are  so  apt  to  make  the  labor  of  re- 
suscitation vain.  Excluding  mechanical  injury,  is 
not  the  cause  of  death  probably  a  carbonic  acid 
poisoning  of  the  nervous  centres  from  long  reten- 
tion of  the  natural  pulmonai-y  excreta  ? 

"On  the  17th  inst.,  at  12.30  a.m.,  I  delivered  a 
lady  of  her  second  child,  a  well-developed  male, 
breech  presentation.  The  child  was  still-born, 
white,  cold  and  pulseless,  with  flaccid  lids  and  lips. 
On  au.scultation,  however,  an  occasional  heart-beat 
could  bo  detected,  and  after  more  than  an  hour's 
persistent  effort  with  hot-wrung  flannel  wraps  and 
artificial  respiration  after  the  manner  recommended 
by  Dr.  Shrady  in  the  discussion  alluded  to — a 
method  which  insures  inflation  of  the  lungs — I  suc- 
ceeded in  restoring  vitality. 

"  About  half  an  lionr  afterward,  respiration  was 
again  suspended  for  a  few  moments  during  a  slight 
spasm,  chiefly  noticeable  in  the  muscles  of  th^  lower 
jaw.  Afterward  the  little  patientrested  quietly,  nui-s- 
ing  at  intervals,  and  being  apparently  all  right,  with 
the  important  exception  of  an  occasional  setting  of 
the  jaw,  and  a  constant  tendency  to  flexion  of  the 
forearms  upon  tlie  arms.  Death  occurred  suddenly 
in  a  convulsion  at  1.30  a.m.  of  the  18th,  a  little  less 
than  twenty-four  hours  from  the  time  of  resuscita- 
tion." 

DiiAw.v  OR  Unurawn  Fowls. — Dr.  H.  K.  Porter, 
of  Bismarck,  D.  T.,  writes:  "You    say  that  'there 


seem  to  be  no  definite  facts  as  to  which  "  will 
keep  longer,  drawn  or  undrawn  fowl."  F(n:ts  de- 
monstrate in  this  part  of  the  country  that  drawn 
fowl  keep  longer.  Hunting  parties  here,  who  go 
out  in  the  fall  and  kill  immense  numbers  of  prairie- 
chickens,  ducks,  geese,  etc.,  always  take  out  the  en- 
trails of  all  they  bring  home  for  use  or  to  ship, 
for  the  reason  that  they  keep  longer.  I  know  from 
actual  experience  that  birds  shot  the  same  hour  and 
drawn  will  keep  and  remain  sweet  three  days  longer 
than  the  undrawn.  Have  also  noticed  that  where 
the  viscei'a  is  allowed  to  remain  for  any  length  of 
time  the  flesh  has  a  decided  intestinal  flavor,  not 
at  all  agreeable,  except  to  very  gamy  ptusoris." 

The  Okigin  of  Hospitals. — We  do  not  know  why 
Mr.  Huxley  is  interested  in  tlie  origin  of  hospitals, 
or  what  they  have  to  do  with  zoology.  He  has,  how- 
ever, been  investigating  the  subject,  and  announces, 
with  a  kind  of  "  hoop-la,"  that  hospitals  are  not 
Christian  institutions,  but  were  first  estaUished  by 
the  .Esculapian  priests.  This  may  be  a  new  thing  to 
zoologists,  but  it  can  hardly  be  so  to  any  one  hav- 
ing the  slightest  acquaintance  with  the  origin  of 
medical  science.  In  the  descriptions  of  the  tem- 
ples of  iEsculapius  they  are  always  referred  to  as  a 
kind  of  hospital.  They  were  not  liospitals  according 
to  the  modern  or  Christian  idea,  howevei',  since  faith 
was  more  than  works  in  therapeutics,  and  payment 
in  some  form  was  expected.  These  institutions  died 
out  finally,  and  then  hospitals  were  established  by 
Christian  Europe,  being  then  entirely  new  things, 
neither  modelled  after  nor  suggested  by  the  .Escu- 
lapian  temples. 

Tcbeeculosis  in  the  Centbaij  Nervous  System  of 
Cows. — Some  interesting  cases  in  which  the  above 
disease  occurs  are  related  by  a  German  veterinarian. 
The  symptoms  are  characteristic  :  "In  all  cases  the 
head  is  held  high  up  (corresponding  to  the  boring 
movement  of  the  head  in  children),  and  in  some 
cares  twisted  to  one  side.  The  eyes  have  a  changed 
appearance.  They  are  either  staring  or  else  are 
directed  forward,  or  there  is  some  form  of  strabis- 
mus. Often  the  pupils  are  uneijual.  The  limbs 
become  stiff".  The  hind  legs  may  be  paralyzed,  or  the* 
animal  falls  down,  and  remains  on  its  side,  with 
stiffened  extremities. 

Generally  the  lungs  are  affected  at  the  same  time, 
and  tliis  fact  will  gieatly  help  the  diagnosis. 

There  may,  perhaps,  be  a  few  tubercles  in  the 
meninges  of  the  brain  or  cord  for  months  ;  but  the 
disease  is  essentially  an  acute  one,  just  as  it  is  in 
human  beings. 

That  the  tubercles  are  the  true  tubercles  of  bovine 
tuberculosis  is  sho\<'n  by  theu-  developing,  in  some 
cases,  directly  on  the  dura  mater  of  the  brain  in 
the  form  of  little  peduncuhited  tumors  :  so  that  the 
German  name  of  "pearl  disease"  applies  to  it  still 
when  situated  in  this  region.  They  also  show  a 
tendency  to  calcify,  peculiar  to  the  pearl  disease. 

The  Test  op  Civilization,  according  to  Lord 
Derby,  is  the  death-rate.  According  to  that,  Isew 
York  is  considerably  behind  in  the  scramble. 

The  German  Coni;kess  for  Internal  MumciNE 
met  at  Wiesbaden  April  20th,  21st,  and  22d.  It  was 
opened  by  Professor  Frorichs,  of  Berlin.  Two  of 
the  most  important  discussions  were  that  on  the 
Pathology  of  Bright's  Disease,  opened  by  Dr.  Ley- 
den  and  Dr.  Rosenstein,  and  that  on  the  Antipyretic 
Treatment,  opened  by  Dr.  Liebermeister  and  Dr. 
Beiss. 


Vol.  XXI.-No.  1  9.  ( 
May  13.  1883.     i 


THE  MEDICAL  RECORD. 


fOo 


©rigtnal  Cffmmiinicaturn©.  ^ 


CASES   OF    TiIONOHYPOCHONDEIA  AND 

MONOMANL\. 

II. 

By  GEOBGE  M.  BEAliD,  A.M.,  M.l)., 

NEW    YORK. 

(Continued  from  page  .317.) 

A  YorxG  lady  was  courted  by  a  young  man,  in 
the  usual  way,  and  with  quite  as  good  opportunities 
for  becoming  acquainted  with  liim,  in  his  freipient 
calls  and  visits  in  the  long  winter  evenings,  as  is  cu.s- 
tomary  in  our  city  life.  The  courting  and  engage- 
ment lasted  for  a  year,  jiossibly  more  than  a  yeai\ 
During  the  intimacy  of  this  courtship  she  learned 
from  him  that  he  was  nervous — not  perfectly  well 
— but  saw  nothing  and  heard  nothing  to  lead  her 
to  suppose  that  there  was  anything  more  than  ner- 
vousness. Xot  long  after  marriage  she  learned  that 
he  had  some  most  remarkable  symptoms  :  he  was  a 
monohypochondriac,  to  u.se  the  term  that  I  employ. 
The  peculiar  form  that  this  monohypochondria 
assumed  in  him  was  a  love  of  taking  medicine,  and 
a  morhid  fear  thai  he  should  not  take  it  e-ractb/  an 
ordered. 

Cases  somewhat  like  this  perhaps  almost  all  of  us 
have  seen  ;  but  a  ease  so  remarkable  as  this,  where 
the  monohypochondria  was  carried  to  such  a 
degree,  is  without  precedent  in  my  observation,  and, 
so  far  as  I  know,  in  literature. 

His  fear  was  that  he  might  omit  a  dose  of  medi- 
cine that  had  been  ordered,  or  might  take  one  dose 
more  than  was  ordered,  might  take  one  drop  more 
or  less  than  the  prescribed  quantity,  or  might  forget 
to  take  it  at  the  precise  moment  when  he  should 
take  it,  or  that  he  might  take  too  much  or  too  little 
exercise,  or  might  not  observe  accurately  the  diet 
enjoined. 

Not  until  he  had  been  for  some  time  under  my 
care  did  I  learn  what  the  matter  really  was  with 
him.  The  ordinary  diagnosis  in  such  cases  is  that  the 
man  is  a  fool  ;  patients  of  this  kind  are  usually  al- 
most kicked  out  of  tha  office  ;  Xnxt  this  man  was  not  a 
fool,  he  was  intelligent,  well  educated,  a  man  of 
good  sense  and  judgment  in  matters  where  his  weak- 
ness did  not  enter.  He  .served — is  serving  now — as 
book-keeper  in  a  large  house,  wliere  accuracy  and 
faithfulness  are  needed.  He  can  talk  and  act  as 
sensibly  as  any  other  man,  except  where  his  special 
hypochondria  is  concerned. 

The  first  week  of  marriage  was  a  sad  one  to  his 
wife,  as  was  unfolded  to  her  the  weakness  of  her 
husband,  which  she  interpreted  as  insanity,  though 
it  is  not  insanity,  but  would  often  be  classed  as 
such.  When  he  first  came  to  see  me,  he  told  me  he 
had  been  doctoring  eleven  years,  with  a  firm  of  char- 
latans in  this  city. 

When  he  came  to  see  me  he  would  go  over  in 
detail  just  what  he  had  been  doing  during  the 
week,  what  exercise  he  had  taken,  how  many  min- 
utes, how  many  times  he  had  i-ubbed  himself,  what 
he  had  eaten  and  drank,  just  what  medicine  he  had 
taken;  and  if  he  had  omitted  taking  anything  he  was 
directed  to  take,  he  would  speak  of  it  in  the  most 
humble,  ajjologetic,  and  terrified  manner,  as  though 
he  had  committed  the  sin  for  which  there  is  no  re- 
mission, and  most  pitiable  was  the  jieculiar  expres- 
sion of  his  eye  and  countenance  as  he  told  the  stoiy 


of  his  failures  and  omissions;  his  appearance  changed 
at  once  as  he  touched  upon  the  doses  of  medi- 
cine, the  exercise,  and  the  hygiene.  He  who  would 
work  all  day,  and  whom  no  one  would  suspect  of 
weakness,  became  as  a  little  child  in  the  presence 
of  this  special,  limited,  and  most  peculiar  of  mental 
impairment.  He  would  laugh  about  his  trouble 
sometimes,  would  joke  about  it,  and  talk  of  it  as 
though  he  understood  it,  but  could  not  emancipate 
himself  from  it. 

He  would  ask  me  such  questions  as  these  :  "  Shall 
I  drink  water  at  meals,  or  shall  I  di'ink  milk  ?  Shall 
I  wash  my  hands  in  hot  or  in  cold  water  ?  plain  wa- 
ter, or  with  soap  and  water?  What  shall  I  drink? 
What  shall  I  drink  between  meals?  Milk?  or  wa- 
ter ?  Shall  I  drink  beer?  Shall  I  shave  myself? 
if  so,  shall  I  use  hot  water  or  cold?  How  often 
shall  I  shave?  every  day?  Shall  I  eat  oysters? 
What  else  shall  I  eat  ?  How  often  shall  I  eat  ?  three 
times  a  day?  How  often  shall  I  bathe?  how  many 
minutes  at  a  time?  What  temperature  shall  I  have 
the  water  ?  " 

Many  times  he  has  come  back,  after  leaving  my 
office,  with  a  repetition  of  these  questions,  having 
either  not  quite  understood  the  answers  or  forgot- 
ten what  the  answer  was.  At  one  time  I  sent  for 
his  wife,  whom  I  found  to  be  a  vei-y  intelligent,  well- 
informed  and  sensilile  lady,  and  who  quite  well  un- 
derstood his  case.  She  told  me  that  his  mother  had 
the  same  peculiarity,  and  that  one  of  their  childien 
— five  years  of  age — manifested  the  same  symptoms. 
She  begged  of  me  to  give  him  orders  to  omit  the 
treatment  on  certain  evenings  of  each  week,  so  that 
they  might  sometimes  attend  a  tiieatre  or  other 
places  of  amusement,  as  it  took  him  all  the  even- 
ing, nearly,  to  get  through  with  the  rubbing 
and  bathing  and  exercising  ;  for  he  claimed  that  it 
was  impossible  for  him  to  go  out  at  all  if  he  did  all 
that  was  ordered.  The  next  time  he  came  to  see 
me,  I  accordingly  told  him  to  omit  the  baths  and 
other  treatments  two  evenings  of  the  week,  and  that 
I  would  like  to  have  him  forget  them  entirely  ;  that 
forgetting  was  really  an  important  jiart  of  the 
treatment.  With  this  he  seemed  quite  pleased,  and 
said  he  and  his  wife  would  be  able  to  go  out  to- 
gether sometimes.  After  this  he  would  occasionally 
omit  the  treatment  at  other  times — when  he  found 
it  convenient  to  forget  it — and  thought  he  was  car- 
rying out  my  orders  in  so  doing. 

This  man  had  other  physical  symptoms,  for  there 
was  a  real  ])hysical  basis  for  his  troubles.  He  had 
lumbar  jjains,  very  sensitive  urethra,  extreme  con- 
stipation, bearing-down  .sensation  in  the  genital  or- 
gans, and  occasional  emissions.  He  was  so  sensitive 
that  ice-cream  woiild  keep  him  awake  at  night,  and 
wearing  false  teeth  gave  him  emissions  ;  any  men- 
tal shock  was  felt  in  the  perineum,  just  as  it  often 
is  in  the  head  or  stomach. 

This  man  is  not  a  fool  or  a  lunatic,  and  probably 
never  will  become  a  lunatic  ;  rather  he  has  switched 
off  into  this  milder  phase  of  mental  impairment 
which,  while  it  suggests  insanity,  is  not  insanity  : 
he  skirts  the  border-line,  but  will  probably  never 
cross  it. 

In  this  case  there  is  seen  what  I  have  observed 
in  many  other  cases  of  functional  nerve-disorder,  a 
peculiar  and  hard-to-be  described  expression  of  the 
eye  at  the  moment  irhen  the  morliidfear  in  active. 

Thus,  when  he  touched  upon  the  subject  of  taking 
medicine,  after  having  been  talking  of  other  matters, 
the  eye  showed  instantly  a  change  in  expression — a 
change  that  takes  place  in  the  eye  itself  independent 


506 


THE  MEDICAL  RECORD. 


of  the  muscles  of  the  lids.  This  feature  often  sug- 
gests the  expression  that  is  noticed  in  the  eye  ii| 
trance,  natural  and  artificial,  and  which  is  familiar 
to  all  students  of  trance,  but  it  is  not  as  profound  ; 
it  is  suggestive  oi  painful  seriousness,  and  it  appears 
in  anticipation  of  the  words,  for  thought  moves  more 
([uickly  than  the  articular  expression  of  thought. 

This"  eye-peculiarity  is  noticed  also  in  some  of  those 
who  have  morbid  fear  of  places  or  of  being  alone. 
Thus  the  monophobiac  previously  described  (p.  316) 
— the  body-guard  patient  who  must  have  two  or  three 
persons  always  with  her  while  travelling— showed  in 
her  eyes  wheu  she  even  feared  or  suspected  that 
she  might  be  left  alone. 

Very  important  also  in  the  above  case  is  the  con- 
cealment of  the  special  morbid  symptom  from  a 
.sn-eetheart  tlirough  a  tolerably  long  courtship.  Our 
most  intimate  friend  may  be  a  severe  sufferer  from 
some  one  of  these  morbid  fears,  and  wo  never  know 
or  suspect  it.  In  this  case  the  wife  soon  learned 
what  the  lover  had  no  means  of  learning.  But  wives 
do  not  always  know  their  husbands  iu  this  respect 
— on  one  side  or  the  other,  or  perhaps  on  both  there 
may  be  intentional  or  unintentional  deception  :  or  the 
suti'erer  may  fail  to  make  his  companion  compre- 
hend this  ill"-understood  psychological  phenomenon. 

Very  recently  a  gentleman  from  the  west  consulted 
me  for  morbid  fear  of  travelling  alone,  so  persistent 
and  fixed  that  he  could  not  go  from  his  home  be- 
yond Chicago,  eastward,  to  New  York  unless 
his  wife  were  with  him,  although  he  could  go  more 
than  a  hundred  miles  alone.  As  with  many  of  these 
cases,  he  carried  with  him  on  his  travels  a  small 
bottle  of  hrandif,  thoroughly  stopped,  to  use  in  case 
of  emergency,  which  emergency  never  came,  and 
conse(iuently  the  bottle  was  never  opened. 

For  nine  years  he  had  been  married,  but  up  to  the 
moment  when  I  was  consulted  his  wife  did  not  know 
of  the  existence  of  this  fear  of  travelling  alone  in 
her  husband,  but  supposed  that  he  took  her  always 
on  his  long  journeys  because  he  enjoi/ed  her  society. 
Sd  she  again  and  again  assured  me.  I  regretted  to 
1)8  obliged  to  break  so  sweet  a  delusion,  but  feeling 
it  to  be  necessary  that  she  should  understand  her 
husband's  real  condition,  I  introduced  husband  and 
wife  to  each  other,  explaining  to  her  in  his  presence 
that  any  friend  iu  whom  he  had  confidence  would 
answer  as  a  travelling  companion  nearly,  if  not  quite 
as  well  as  she.  It  is  doulitfiil  whether  the  wife  be- 
lieved me;  it  is  probable  that  .she  preferred  the 
pleasing  deception  ;  but  at  that  very  time  the  hus- 
band was  so  bad  that,  as  he  confessed  to  me,  he 
could  not  have  remained  in  New  York  but  for  the 
consciousness  that  his  wife,  or  some  one,  was  in  the 
city  with  him. 

The  two  following  cases  con.sulted  me  almost 
simultaneously : 

A  lady,  about  fifty  years  of  age,  had  this  peculiar 
symptoin  ;  she  worried  constantly  about  growing 
old.  So  miich  was  she  troubled  by  this  fear  of  ap- 
proaching old  age  that  she  hardly  dared  look  in  the 
glass.  She  became  very  much  depressed  in  spirits. 
This  was  the  third  attack  of  this  symptom  from 
which  she  had  suffered  ;  she  had  recovered  from  the 
two  previous  attacks. 

For  several  weeks  she  had  not  seen  her  husband, 
who  iinderstood  her  case  and  was  v«ry  kind  and  at- 
tentive to  her.  Shu  left  Iiim  and  went  away  on  ac- 
count of  her  miserable  and  unhappy  condition;  she 
was  so  despondent  tliat  she  could  not  stay  near 
him  ;  slie  was  perfectly  wretched  over  her  fear  that 
she  was  growing  old.     There  were  other  symptoms 


connected  with  this  morbid  fear ;  there  was  dis- 
tress in  the  stomach,  symptoms  of  dyspepsia,  cold 
hands  and  feet,  insomnia,  fear  of  society,  and  for  a 
long  time  there  had  been  uterine  ulceration. 

From  the  other  attacks  this  lady  had  recovered 
spontaneously  ;  and,  under  treatment,  she  is  rapidly 
recovering  from  the  present  attack. 

Is  this  lady  crazy  ?  Is  it  a  case  of  melancholia  ? 
AU  physician's  who"  classified  it  at  all  would  prob- 
ably call  it  melancholia,  although  they  might  not 
use'  so  strong  a  term  as  insanity,  of  which  melan- 
cholia is  but  a  variety. 

To  me  it  seems  a  border-line  case,  that  occasion- 
ally crosses  the  border,  for  this  reason,  that  she  does 
not  always  respond  to  tests  of  insanity ;  she  is  not 
always  out  of  harmony  with  her  environment ;  her 
instinct  of  self-preservation  is  yet  active  ;  and,  while 
she  cannot  control  her  feelings,  she  can  and  does,  in 
a  measure,  at  times,  control  the  means  of  control- 
ling her  feelings. 

The  other  case,  whfch  came  to  me  about  the  same 
time,  was  a  lady,  between  thirty  and  forty  years  of 
age.  In  this  case,  the  hysteria  had  gone  on  toward, 
and  very  near,  the  border  of  insanity,  but  had  not 
quite  c'ros.sed  the  border-line.  She  said  she  was 
crazy,  but  I  did  not  regard  her  as  such,  although  I 
saw  her  when  she  was  very  bad  indeed.  Her  worst 
symptom  was  a  desire  to  choke  her  only  child,  whom 
s'he  loved  with  her  whole  nature,  and  to  whom  she 
was  perfectlv  devoted  ;  and  she  also  desired  to  choke 
her  husband,  whom  she  fondly  loved.  She  con- 
fessed her  desire  freely,  earnestly,  and  sorrcwfully, 
and  said  it  was  hard,  almost  impossilde  for  her  to 
resist  the  inclination  when  these  attacks  came  on 
her.  I  do  not  think  she  had  any  desire  to  choke  me, 
or  any  one  who  was  not  especially  dear  to  her  ;  and 
I  do  not  believe  she  will  ever  choke  any  one.  I  told 
her  husband  I  believed  both  he  and  the  child  were 
entirely  safe.  Morbid  impulses  are  not,  as  all  the  au- 
thorities teach,  necessary  signs  of  insanity.  Lilt 
mm-bid  fears,  they  occur  in  the  sane  as  veil  as  in  th- 
insane.  Those  who  study  thoroughly  their  cases  of 
neurasthenia,  cerebral  congestion,  hypochondria  ami 
hi/stena  u-illfind,  or  have  found,  that  only  in  a  limited 
number  of  instances  do  these  moo-bid  impidses  go  inin 
actual  insanity.  In  this  respect  each  case  is  its  oini 
study. 

In  this  case,  no  doubt,  hysteria  had  gone  about 
as  far  as  it  could  go  withou't  becoming  absolute  in- 
sanity ;  but  there  is  no  certainty  that  she  will  ever 
become  insane  ;  there  is  strong  probability  that  she 
will  be  relieved.  She  was  troubled— as  these  cases 
always  are—  before  and  during  the  time  of  the  men 
ses,  with  accompanying  symptoms,  such  as  attacks 
of  spinal  irritation",  insomnia,  catarrh,  and  piles  ; 
she  was  so  nervous  that  she  could  not  even  write  a 
postal-card  without  great  distress;  after  writing  a 
few  words  her  neck  would  become  so  stiff  that  she 
could  not  write  another  line. 

In  this  case,  as  in  most  teases,  there  had  been  a 
historv  of  uterine  troubles. 

One  of  my  patients  has  given  me  the  history  of  an 
acquaintance,  a  lady  over  thirty  years  of  age,  who 
just  before  and  during  the  nienstnial  period  has 
an  irresistible  desire  to  destroy  her  clothing.  If 
she  does  not  find  an  old  garment  that  she  can  rip 
or  cut,  she  will  attack  a  new  one.  no  matter  how  val- 
uable. 

Puring  these  periods  she  sometimes  takes  licr 
drosses,  one  after  another,  and  rips  thern  entirely 
apart,  with  the  apparent  intention  of  altering  them  ; 
after  the  menstrual  jxniod  has  passed,  she  will  spend 


THE  MEDICAL  RECORD. 


507 


a  week  inputting  a  .Iress  together  precisely  as  it 
was  before  she  commenced  the  work  of  destruction. 

This  lady  is  not  generally  sick  ;  she  has  always 
enjoyed  good  health  ;  but  she  is  at  times  very  ner- 
vous. As  she  grows  older,  she  seems  to  be  gradu- 
ally overcoming  this  symptom  without  any  special 
treatment. 

The  following  case  is  a  most  remarkable  and  most 
intei'estiug  one.    It  is  a  border-liner. 

A  teacher,  lietween  thii'ty  and  forty  years  of  age, 
gives  the  following  history  : 

Fii-sl. — She  has  an  attack  of  insomnia  which  lasts 
several  weeks  at  a  time.  The.se  attacks  are  period- 
ical, lasting  about  three  months,  and  are  accom- 
panied by  great  excitability  or  exaltation  :  she  also 
loses  flesh  considerably. 

S-'cond. — She  then  has  an  attack  of  depression,  also 
lasting  about  tliree  months  :  she  is  then  well  for  a 
yi-ar,  then  goes  the  round  again.  She  says  these 
attacks  of  insomnia  and  depression  with  iilters'als  of 
one  year  of  health  have  gone  on  for  twenty  years  or 
more. 

Third. — There  is  mental  irritability,  which  is 
common  in  cases  of  this  kind. 

Fouiili. — Localized  flushing  on  excitement,  of  a 
limited  and  circumscribed  character.  These  symp- 
toms are  common  enough  in  both  sexes. 

Fifth. — Uterine  displacement. 

Si.dh. — Lumbar  pain. 

This  patient  \\Tote  out  for  me  in  elaborate  detail 
her  symptoms  and  histoiT,  which  I  publish  withotit 
any  changes.  It  is  a  remarkably  well-written  docu- 
ment, and  is  an  extraordinarily  good  analysis.  I 
therefore  publish  it  just  as  it  is  written,  and  it  is 
well  worth  the  study  of  students  of  this  class  of  ner- 
vous diseases. 

.4.S  a  border  liner  this  patient  is  a  type  ;  she  is  not 
insane,  she  has  not  been  insane,  but  she  is  sick,  and 
has  been  sick,  seriously  sick  at  times,  as  this  ac- 
count makes  clear ;  but  at  no  time  has  her  mental 
responsibility  been  so  seriouslj'impaired  as  to  take 
away  her  force  of  will.  While  she  thinks  of  poison, 
and  thinks  of  suicide,  and  glfiats  on  the  idea,  she 
does  not  commit  suicide,  and  is  not  likely  to  do  so. 

"  FKrut  Stage — Biioyanci/  or  Exaltation.  By  exal- 
tation I  mean  a  feeling  of  being  lifted  up,  a  buoy- 
ancy, but  not  a  feeling  of  exaltation — I  think  per- 
haps you  misunderstood  and  thought  that  was  the 
word  I  used.  I  cannot  explain  the  general  feeling 
any  better,  but  in  very  bad  attacks,  after  the 
sleeplessness  has  been  running  on  for  two  or  three 
months,  I  have  fancied  myself  inspired  by  God  to 
do  or  say,  or  more  especially  to  write  certain  things 
to  certain  persons  for  their  good.  I  happened  upon 
one  of  these  long  letters,  that  by  some  mistake  had 
not  been  sent,  among  some  of  my  papers  in  my 
desk,  one  day  after  I  had  entirely  recovered  from 
one  of  these  attacks  and  was  quite  myself  again, 
and  upon  reading  it  over  could  scarcely  believe  that 
I  had  written  it,  and  was  only  too  thankful  that  it  had 
never  reached  its  destination.  Since  then  I  have 
guarded  myself  too  closely  to  allow  myself,  when 
under  the  influence  of  these  attacks,  to  wi-ite  to  any 
one  except  those  who  know  well  enough  what  the  mat- 
ter is  with  me,  to  make  allowances.  It  is  a  relief  to 
me  to  write  things  down  in  this  way,  and  there  is  a 
fascination  about  it — I  suppose  because  it  feeds  the 
inordinate  egotism  that  seems  a  part  of  the  disease  : 
besides,  it  is  much  easier  to  ^mte  things  than  to  say 
them,  because  my  ideas  are  clearer  when  I  am  alone 
and  do  not  get  confused,  but  the  act  of  writing  them 
brings  that  flushed  spot  under  the  eyes  that  you 


noticed.     Ordinarily,  I  have  no  color  n-halerer  in  my 
face." 

"  A  much  more  prominent  element  than  that  of  ex- 
altation is  a  feeling  of  hurry  that  is  always  a  part  of 
the  insomnia  from  beginning  to  end — an  element  of 
fierceness  and  haste.  Whatever  I  am  doing,  I  feel 
as  if  I  must  hurry  through  with  it.  I  lay  plans  rap- 
idly, and  they  must  be  carried  out  in  eveiw  detail  at 
once.  I  must  do  it  all,  no  matter  who  or  what  I 
trample  on  in  the  way.  I  used  to  fancy  that  I  could 
not  swallow  during  these  attacks,  and  so  was  veiy 
irregular  in  the  matter  of  eating,  but  I  have  found 
that  I  can  eat  everything,  if  I  do  it  unconsciously 
and  mechanically.  For  instance,  during  my  last 
attacks  I  used  to  feel  vei^  much  exhausted  after  I 
dismissed  my  pupils  at  one  o'clock,  but  I  was  not 
in  the  roused  state,  which  is  fatal  to  sleep  ;  but  if  I 
had  gone  to  the  lunch-table,  or  even  if  I  had  gone 
to  any  place  in  the  house  where  food  was  kept.  I  ran 
the  risk  of  coming  in  contact  with  some  members  of 
the  family  with  an  almost  certainty  of  being  thrown 
into  what  I  call  a  roused  state.  And  so  my  way  was 
to  take  before  school  began  something — it  was  gen- 
erally a  piece  of  bread  of  a  snflioient  size — to  my 
bedroom,  and  as  soon  as  my  pujiils  left  me  I  would 
go  directly  there  and  read  some  interesting  book, 
meanwhile  breaking  i^ieces  of  bread  and  eating  them, 
without  any  consciousness  of  swallowing  them  ;  if 
that  did  not  succeed,  I  could  always  pace  up  and  down 
and  eat.  About  coming  in  contact  with  people — I  get 
gi-adually  so  irritable  that  I  not  only  cannot  .stand 
having  the  people  who  live  in  the  same  house 
speak  to  me  or  look  at  me,  but  cannot  endure  that 
they  should  think  about  me  ;  it  seems  as  if  I  could 
feel  the  fiiction  of  theii'  thoughts  touching  me.  If 
during  my  lonely  meal  in  my  bedroom  it  came  into 
my  head  that  the  rest  of  the  family  were  noticing 
(in  their  thoughts  merely)  my  absence  from  the 
lunch-table,  it  would  ii-ritate  and  rouse  me  so  that 
I  could  not — as  I  always,  at  least,  tried  to  do — lie 
down  directly  after  eating  and  sleep  for  an  hour  or 
jjerhaps  half  an  hour.  At  the  very  earliest  stage,  even 
before  insomnia  begins,  I  mind  the  contact  of 
people's  eyes.  I  mind  some  people's  eyes  a  great 
deal  more  than  others,  and  some  eyes  I  do  not  mind 
at  all.  Children  I  never  mind  at  all ;  they  never  an- 
noy me  in  any  way.  You  spoke  of  bereavement, 
trouble,  etc.  I  have  not  the  kind  of  nature  that 
broods  over  such  things,  or  over  anything  that  is 
fixed  and  decided.  Susjsense,  doubt,  uncertainty — 
such  things  come  and  go,  I  suppose,  in  all  lives — 
wear  upon  me,  but  I  cannot  trace  any  of  these  at- 
tacks directly  to  anything  of  the  sort,  except  per- 
haps once  when  an  attack  was  brought  on  out  of  its 
regular  course,  that  is,  only  a  few  months  after  the 
recovei-y  from  a  former  one,  by  something  of  that 
natirre.  I  am  never  worried  alDout  myself,  that  is 
physically  about  my  health,  I  mean.  I  analyze  my- 
self and  pull  myself  to  pieces,  not  exactly  in  a  dis- 
])assionate  way,  but  at  least  without  any  anxiety  as 
to  the  future,  or  to  the  present  either,  for  that  matter. 
I  should  think  that  this  putting  myself  down  upon 
l^aper  were  bad  for  me;  my  brain  is  so  restless  and 
teeming  with  thought  this  Sunday  morning,  if  I  did 
not  know  from  long  exj^erience  that  if  it  were  not 
full  of  this,  which  is  vei-y  fascinating  work,  it  would 
be  full  of  something  else.  I  slept  well  last  night 
and  waked  up  in  a  perfectly  natural  and  healthful 
manner,  that  is,  with  an  inclination  to  turn  over 
and  so  go  to  sleep  again,  and  I  think,  perhaps,  I 
ought  to  have  yielded  to  that  inclination,  but  on 
Sunday  morning  I  am  in  the  habit  of  going  to  an 


508 


THE  MEDICAL  RECORD. 


early  service,  at  half  past  seven,  in  a  church  about 
a  mile  from  our  house.  Would  it  be  better  for  me 
to  give  up  going  to  it  for  the  pr&sent  ?  I  did  during 
my  last  attack,  but  it  seemed  to  make  little  dirt'er- 
ence.  The  little  argument  with  myself  as  to  whether 
I  should  get  up  this  morning  or  not  of  course  waked 
me  beyond  the  power  of  going  to  sleep  again,  and 
I  satisfied  myself  by  thinking  that  I  would  sleep  an 
hour  or  two  later  in  the  day,  but  I  am  as  far  as  pos- 
sible from  sleep  now,  and  probably  shall  be  aU  day. 
I  cannot  tell  how  it  will  be  to-night. 

"  I  have  asked  my  aunt  (my  father's  sister,  who 
took  my  mother's  ijlace  in  the  family  when  she  died)  if 
she  could  remember  any  decided  beginning  of  these 
attacks.  She  says  that  she  thinks  they  date  from 
my  return  from  boarding-school  when  I  was  sixteen 
years  old.  She  says  that  I  was  a  perfectly  healthy 
child,  of  exhaustless  energy,  '  dreadfully  energetic,' 
as  she  expresses  it,  brimming  over  with  plans  (gen- 
erally mischievous),  which  I  always  carried  out,  not 
only  rapidly,  but  daringly  and  unscrupulously,  lead- 
ing'all  the  other  children  after  me  and  making  no  end 
of  trouble  for  everybody.  She  said  it  was  with  many 
misgivings  that  she  allowed  my  relatives  to  send  me 
to  a  boarding-school;  it  seemed  to  her  that  restraint 
and  confinement  would  kill  a  child  so  active  and 
fond  of  the  freedom  of  an  outdoor  life.  It  was  just 
after  my  fourteenth  birthday  that  I  was  sent  away. 
The  menses  began  about  six  months  after,  and  when 
I  had  been  there  nearly  two  years  I  hack  something 
which  our  home  physician  thought  (she  says)  must 
have  been  diphtheria.  My  own  recollection  of  it  is 
that  I  went  up  to  the  matron's  room  with  half  a 
dozen  girls  who  were  having  their  throats  examined, 
and  just  for  fun  I  opened  my  mouth  and  suggested 
merrily  that  she  had  better  look  at  mine  too.  She 
looked  and  told  me  gravely  to  go  at  once  to  the  nur- 
sery. I  cannot  remember  whether  I  was  kept  ai5art 
from  the  other  girls.  If  it  had  been  for  any  length 
of  time,  for  a  week  even,  I  think  I  should  be  able  to 
i-ecall  it.  All  that  I  can  remember  is  that  I  was 
kept  away  from  the  schoolroom  in  the  nursery  for 
several  weeks  ;  that  the  matron  (toward  the  end) 
used  to  touch  my  palate  constantly  with  alum,  that 
the  physician  used  to  look  at  it,  I  supijose,  daily,  and 
sometimes  made  an  application.  I  remember  hear- 
ing him  say  once  that  there  was  honey  in  something 
he  applied,  and  once  he  said  to  the  matron  that  the 
inflammation  had  gone  back  to  the  nostrils,  and  I 
can  remember  that  what  seemed  to  me  like  pieces  of 
Hesh  about  the  size  of  a  pea  used  to  come  out  through 
my  nostrils.  My  aunt  says  that  I  came  home  for 
my  vacation  soon  after  that,  seemingly  very  much 
broken  down  in  health,  full  of  morbid  whims  and 
not  at  all  like  myself.  I  went  back  again  for  a  few 
months  and  then  came  home  again  with  chills  and 
fever.  I  don't  remember  how  long  they  lasted,  or 
much  about  myself  at  that  time,  but  my  aunt  says  I 
have  never  seemed  well  since,  although  she  cannot 
date  the  beginning  of  these  periodic  attacks. 

"  I  think  I  can  give  an  illustration  that  will  make 
you  understand  a  little  better  these  premonitory 
symptoms.  I  am  used  to  spending  about  an  hour 
every  morning  in  my  private  devotions,  going  through 
a  regular  formula,  which  consists  princi\)ally  of  the 
morning  service  of  the  Prayer-book.  It  takes  the 
clergyman  a  little  more  than  half  an  hour  to  go 
tlirough  with  it ;  it  takes  me  somewhat  longer  at  all 
times,  because  of  wandering  thoughts,  going  back  to 
repeat  over  again  things  that  I  have  said  mechan- 
ically, etc.,  which  pi-ovos  that  there  is  a  want  of 
power  of  concentration  at  all  times.     But  before  the 


beginning  of  these  attacks,  at  least  before  insomnia 
begins,  my  efforts  to  fix  my  thoughts  in  prayer  be- 
come an  all  day's  battle  with  myself  until  bedtime 
comes  before  I  have  got  through  (and  not  at  all  satis- 
factoi-ily  thenj  with  what  ought  not  to  take  an  hour. 
After  the  insomnia  sets  in  I  am  obliged  to  give  up 
prayer  in  anything  but  a  desultoi-y  and  irregidar 
way.  Altogether  I  think  my  brains  kick  more 
decidedly  against  that  than  against  anything  else. 

"Loss  of  flesh. 

"  Missionary  work. 

"  Restlessness. 

"  I  have  just  been  asking  my  aunt  how  these  attacks 
appear  to  her.  She  says  they  seem  to  change  my 
whole  nature ;  that  I  am  the  very  opposite  to  my- 
self;  that,  whereas  I  am  naturally  bright  and  .smil- 
ing, taking  life  easily  and  comfortably,  through 
these  attacks  I  never  smile  at  all,  and  seem  to  be 
filled  with  sorrow  and  anxiety  about  the  most  trifling 
things,  and  am  eternally  drawing  my  brows,  always 
preoccujned,  generally  very  silent,  biit  very  restless, 
always  pacing  uji  and  down,  or  moving  about  in  a 
distracted  sort  of  way,  as  if  I  were  looking  for  some 
indefinite  thing. 

"  Second  Stm/e — Dqrrcssiion.  About  the  depression 
that  comes  with  the  reaction.  If  I  could  have  believed 
that  it  were  possible  to  put  myself  asleep  and  never 
wake  again  in  any  state  of  being,  I  think  I  should 
have  committed  suicide  long  ago ;  but  I  have  never 
been  able  to  believe  it  for  a  moment,  and  so  have  never 
seriously  contemplated  anything  of  the  kind.  I  have 
only  taken  a  morbid  satisfaction  in  dwelling  upon  the 
subject.  The  depression  has  rather  taken  the  form 
of  praying  earnestly,  in  an  agony,  for  death ;  of 
always  lying  down  at  night  with  a  longing  that  .1 
might  never  wake  again  ;  of  earnestly  hoping,  when- 
ever I  got  on  a  railroad  tram,  that  there  might  be 
an  accident  which  would  kill  me,  etc.  I  pace  up 
and  down  a  room  wringing  my  hands  in  an  agony 
of — I  don't  know  ^^at ;  I  don't  luiow  in  the  least 
what  I  am  unhappy  about ;  at  the  very  moment  I 
coiald  not  tell  myself  much  less  any  one  else.  It  is 
not  a  fear  of  hell  or  anything  of  that  sort,  because, 
to  begin  with,  I  don't  believe  in  eternal  punishment, 
and  besides  it  is  not  in  any  sense  what  I  should  call 
a  religious  depression.  There  is  a  feeling  of  being 
forsaken  by  God,  which  does  not,  however,  enter 
into  it  largely.  It  does  not  make  the  least  dift'er- 
ence  what  I  do,  I  always  feel  as  if  it  were  the  wrong 
thing,  and  that  I  ought  to  be  doing  something  else. 
In  describing  it,  it  seems  as  if  there  were  very  little 
in  it,  at  least  as  if  it  would  seem  very  little  to  any 
one  else ;  yet  it  is  very  real  suffering  to  me.  I  can- 
not talk  about  it  to  any  one,  and  as  never  smiling 
is  a  part  of  this  stage  of  the  disease,  my  family 
always  fancy  that  I  am  unhappy  throughout  the 
whole,  and  see  very  little  difference  in  me  in  the  two 
stages,  which  are  as  unlike  as  possible  to  me. 
Action  and  reaction  express  it  iierfectly.  I  am  wor- 
ried, without  being  in  the  least  depres.sed,  all  throngh 
the  sleepless  part,  ami  worried — |iassively  worried —  i 
and  de]>ressed  thrcnigh  all  the  rest.  There  is  a  gi-eat 
deal  of  absent-mindedness  during  the  first  part,  ' 
which  does  not  characterize  the  second,  at  least  not 
to  any  extent.  There  is  a  good  deal  of  that  sort  of 
thing  about  me  at  any  time,  but  it  is  verv  much  ex- 
aggerated during  the  sleeplessness.  I  find  myself  | 
in  some  remote  part  of  the  house  without  having  i 
the  least  idea  of  how  I  got  there.  I  have  set  a  table  j 
for  dinner  perfectly,  and  then  have  left  the  room,  ; 
and  five  minutes  after  have  looked  in  at  the 
dining-room   door  and  wondered   who   has  set  it.  | 


THE  MEDICAL  RECORD. 


509 


(Naliti-al  triiiice.)  At  another  time,  -wiien  my  mind 
has  been  present,  it  has  been  only  with  the  greatest 
effort  that  I  coukl  remember  or  count  up  the  num- 
ber of  knives  and  forks,  etc.,  required.  It  seems 
to  me  that,  instead  of  being  changed  and  totally 
opposite  from  myself,  as  people  think,  that  it  is 
only  that  every  trait  of  character  is  very  much  ex- 
aggerated. I  am  very  fond  of  reading.  Books  are 
my  only  friends  and  companions,  but  after  the  first 
five  or  six  weeks  gradually  I  cannot  fix  my  thoughts 
on  any  book,  even  if  read  out  loud.  I  carry  on 
a  separate  train  of  thought.  There  is  never  veiy 
much  temptation  to  talk  about  myself  to  the  people 
who  live  in  the  house  with  me.  I  grow  into  such 
aversion  toward  them  that  I  cannot  bear  to  say  any- 
thing moi'e  to  them  than  is  absolutely  necessary.  They 
never  dare  to  ask  how  I  have  slept  or  how  I  feel,  or 
to  take  any  notice  of  me,  which  is  rather  a  difficult 
thing,  when  I  seem  so  unlike  myself.  I  think  they 
suffer  more  than  I  in  the  first  stage.  But  to  out- 
siders—people whom  I  don't  see  often  —  I  have 
always  to  fight  against  the  desire  to  talk  about 
myself. " 

The  patient  who  prepared  the  above  psychological 
analysis  of  her  experience  has  yet  other  peculiari- 
ties. She  morbidly  dislikes,  and  has  always  disliked, 
to  shake  hands  with  or  to  kiss  any  one.  This  dislike, 
which  is  a  part  of  her  organization,  applies  to  both 
sexes  and  all  ages.  It  is  painful,  or  at  least  very 
disagi'eeable,  to  feel  the  touch  of  the  lips  of  any  one 
against  her  own.  She  is  a  maiden,  and  of  course 
can  never  marry.  All  through,  her  organization  is  of 
the  finest  type.  The  attacks  of  natural  trmice  are 
very  interesting. 

Under  various  treatment,  the  state  of  insomnia 
with  exaltation,  for  which  she  consulted  me,  has 
been,  to  aU  apiaearance,  broken  up,  so  that  she  sleejas 
well  and  is  in  all  respects  far  better  than  in  any  pre- 
vious attack.  Indeed,  I  have  never  seen  a  case  so 
long  standing  and  so  severe  yield  so  rapidly  to 
therapeutical  procedures. 


AcQiTTRED  MoNOECHiDiSM. — Dr.  A.  C.  Graham,  of 
Dallas,  Texas,  writes :  "  Operating  for  fistula  in 
ano,  I  obtained  from  the  patient  the  following  his- 
tory :  W.  C.  W ,  thirty-six  years  of  age,  married, 

father  of  four  children.  AVhen  fourteen  years  of 
age,  he  attempted  to  climb  over  a  fence  with  a  sack 
of  wheat  on  his  shoulder ;  his  foot  slipping,  the 
right  testicle  was  caught  and  squeezed  between  the 
top  board  and  his  body.  He  suffered  intense  pain 
in  the  injured  organ  at  the  time,  but  did  not  notice 
till  the  next  day  that  the  scrotum  aontained  but  one 
testicle,  the  right  being  felt  much  enlarged  a  little 
below  the  external  abdominal  ring. 

"  He  assures  me  with  much  emphasis  (and  being 
an  intelligent  person  I  have  no  reason  to  doubt  the 
correctness  of  his  statement)  that  before  he  met 
with  this  accident  both  testicles  were  well  down  in 
the  scrotum,  the  left  hanging  a  little  lower  than  the 
right.  .4t  present  examination  the  latter  is  small, 
about  the  size  of  an  almond,  lies  over  the  external 
ring,  but  can  easily  be  pushed  along  Poupart's  liga- 
ment a  distance  of  two  inches  or  more.  It  never 
gave  him  any  trouble  till  last  October  ;  since  then, 
at  times,  it  swells  and  becomes  painful.  In  Holmes' 
'System  of  Surgery'  a  case  is  reported  in  which 
the  right  testicle  during  masturbation  was  drawn 
up  into  the  inguinal  canal.  Van  Bui'en,  in  his  work 
on  '  Genito-Urinary  Diseases,'  mentions  the  same 
case." 


THE  TKEAT^VEENT  OF  HEMORRHOIDS 
BY  THE  DILATATION  OF  THE  ANAL 
SPHINCTERS. 

Br  WILLIAM  BODENHAMEB,  A.M.,  M.D., 


The  treatment  of  hemorrhoids  by  the  dilatation  of 
the  sphincters  of  the  anus,  whether  gradual,  instan- 
taneous, or  forcible,  is  founded  upon  the  theory  that 
the  involuntary  contraction  of  one  or  both  of  these 
sphincters  is  an  exciting  or  an  efficient  cause  of  the 
hemorrhoidal  disease,  or  that  it,  at  least,  exerts 
great  influence  in  its  production  and  continuance  ; 
consequently  that  the  dilatation  of  the  analsi^hincters 
is  a  rational  method  of  cure,  doubtless  upon  the 
iu-incii>le  that  by  the  removal  of  the  cause  the  effect 
itself  will  cease.  But  the  efl'ect  of  a  certain  causs 
sometimes  becomes  itself  a  disease,  and  exists  inde- 
pendently of  the  cause  or  disease  which  first  pro- 
duced it ;  so  that  the  removal  of  the  original  cause 
in  such  a  case  will  not  remove  the  original  effect, 
which  has  now  itself  become  an  independent  entity. 
With  regard  to  the  hemorrhoidal  att'ection,  when 
accompanied  by  regular  organized  tumors,  if  caused 
by  involuntary  contraction  of  the  sjihincter  ani,  I 
hold  that  the  removal  of  the  contraction  alone  will 
not  remove  the  tumors,  one  of  the  original  efl'ects  of 
it.  Indeed,  if  ever  hemorrhoids  are  caused  by  in- 
voluntary contraction  of  the  anal  S25hincters,  dilata- 
tion of  these  nuiscles  can  only  act  efficiently  as  a 
therapeutic  remedy  in  the  early  stage  of  the  disease, 
before  extravasation  of  the  contents  of  the  turgid 
vessels  into  the  cellular  tissue  has  taken  place  and 
before  organized  tumors  have  formed.  It  will  be 
shown  hereafter  that  even  the  most  zealoufi  advo- 
cates of  forcible  dilatation  of  the  anal  sphincters  do 
not  rely  upon  this  remedy  alone  as  a  cure  of  hem- 
oiThoids,  when  organized  tumors  exist,  but  combine 
with  it  cauterization  by  the  galvano-cautery  or  by 
some  other  process.  In  such  a  case,  if  any  cure  at 
all  is  effected,  it  is  the  result  solely  of  the  cauteriza- 
tion, and  not  of  the  dilatation.  Why,  then,  combine 
the  two  methods?  I  would  obsei-ve,  however,  that 
it  is  the  practice  of  some  surgeons,  in  case  of  hem- 
orrhoids, to  employ  forcible  dilatation  or  nijiture  of 
the  anal  sphincters,  not  as  a  therapeutic,  but  merely 
as  a  diagnostic  measure,  to  enable  them  the  better 
to  explore  with  greater  ease  the  seat  of  the  aifection, 
and  to  operate  with  greater  facility. 

I  would  here  remark  that  the  generic  term,  fnrcihle 
(lilatafion,  coined  by  French  surgeons,  includes  two  or 
three  methods  of  dilatation,  which  difl'er  essentially 
from  each  other,  both  with  regard  to  the  modii^  op- 
ernndi,  and  the  amount  of  force  to  be  used  ;  hence 
the  meaning  of  the  term  is  understood  and  explained 
differently  by  different  French  authors.  Some  de- 
clare that  the  dilating  force  should  be  carried  to  the 
extent  of  forcibly  rupturing  or  lacerating  the  sphinc- 
ters ;  while  others,  again,  declare  that  the  dilating 
force  should  be  limited  to  a  point  short  of  any  injury 
whatever  to  the  dilatable  parts,  knowing  that  when 
the  limits  of  the  dilatability  of  the  anal  sphincters  is 
reached,  any  further  expansion  is  gained  only  at  the 
expense  of  the  continuity  of  the  membranes  and 
muscular  fibres.  The  term  forcible  dilatation,  then,  is 
not  specifical  enough  in  either  case,  inasmuch  as  it 
does  not  indicate  how  much  or  how  little  force 
should  be  employed  in  the  process  of  dilatation.  I 
would  therefore  suggest  to  those  who  explain  the 
term  to  mean  the  rupture  of  the  muscles,  to  em- 
ploy   the    word  overstrain  the  anal  sphincters,  in- 


510 


THE  MEDICAL  RECORD. 


stead  of  the  term  forcible  dUcrialion  of  them.  The 
woi'd  orerslrain  would  indicate  the  amount  of  force 
required  to  produce  what  ther  call/orc/i/c  ditalntioii. 
With  these  few  prefatory  remarks,  I  will  now  pro- 
ceed to  give  a  brief  history  of  the  dilatation  of  the 
anal  sphincters,  both  gradual  and  instantaneous  or 
forcible  ;  their  modus  operandi ;  the  anatomy  and 
physiology  of  the  sphincters  ani,  upon  which  the 
operation  is  performed  ;  the  effect  upon  these  mus- 
cles by  the  operation,  together  with  the  iuyoluntary 
contraction  of  them,  as  an  efficient  cause  of  hemor- 
rhoids. 

Gradual  dilatation— Ihe  treatment  of  hemor- 
rhoids by  the  dilatation  of  the  anus  and  anal  canal, 
by  means  of  bougies  gradually  increased  in  size,  was 
practised  many  years  before  instantaneous  or  forci- 
ble dilatation  was  thought  of  for  the  same  purpose. 
The  bougie  as  an  efficacious  local  remedy  in  dis- 
eases of  the  canal  and  orifice  of  the  anus  was  em- 
ployed a  century  ago  in  Italy.  Palletta  thus  briefly 
alludes  to  its  use  :  "  Ma  piu  direttamente  ojjereranno 
i  locali  remedii  introdotti  nell'  ano  :  tra  quali  trovai 
prontamente  effieaoe  una  candeletta  di  cera  spalmata 
di  burro  impastato  con  molta  polvere  di  galladi 
querela"  ("  Instituzioue  Ohirurgiche  di  Monteggia," 
parte  tezza,  sezione  seconda,  p.  521.  8vo.  ISIelauo, 
1805). 

In  our  own  country,  I  find  that  compression  and 
dilatation  were  successfully  practised  for  the  cure  of 
hemorrhoids  by  a  physician  of  the  State  of  Mai-y- 
land  in  1801  (""  The  Medical  Depository,"  I2d  Hex- 
ade,  vol.  1,  p.  339.     8yo.     New  York,  1804). 

Mr.  Copeland,  of  London,  ijreyious  to  1810  suc- 
cessfully employed  dilatation  of  the  anus  and  anal 
canal  by  means  of  bougies  in  the  treatment  of  nu- 
merous cases  of  hemorrhoids.  He  highly  recom- 
mended the  practice  ("Observations  on  the  Prin- 
cipal Diseases  of  the  Kectum  and  Anus,"  p.  67. 
Second  edition,  8vo.     London.  1814). 

ISIr.  Quain  also  speaks  in  high  terms  of  the  use  of 
dilatation  of  the  anal  canal  by  means  of  bougies  in 
certain  cases  of  hemorrhoids  ("  The  Diseases  of  the 
Rectum,"  p.  18.  Second  edition,  12mo.  New  York, 
1855). 

I  have  for  a  number  of  years  employed  dilatation 
of  the  anus  and  anal  canal  by  the  use  of  bougies  for 
the  treatment  of  the  incipient  stage  of  the  hemor- 
rhoidal disease,  with  good  results.  If  judiciously  em- 
ployed at  an  early  stage,  before  organized  tumors 
have  foi'med,  it  may  prove  the  means  of  destroying 
the  morbid  condition  of  the  yes.sels,  and  overcoming 
any  undue  contraction  of  the  anal  s])hincters,  and 
thus  preventing  the  further  progress  of  the  disease. 
The  influence  of  the  bougie  in  removing  the  morbid 
sensibility,  and  in  relaxing  the  rigidity  of  the  sphinc- 
ters, as  well  as  facilitating  the  return  of  the  blood 
from  the  turgid,  congested,  and  varicose  vessels,  is 
often  surprising ;  and  if  torpor  of  the  rectum  and 
ob.stinate  constipation  oV)tain,  which  are  not  unusual 
in  such  cases,  it  soon  induces  a  natural  action  of 
the  bowels,  an  object  so  very  desirable  in  such  iu- 
.stances. 

Inslanlaneoiis  or  forcible  dilatalioit. — It  is  known 
that  more  than  half  a  century  ago  the  able  and  dis- 
tinguished French  siirgeon,  1\I.  le  Baron  Boyer, 
maintained  the  theory  tliat  in  what  lie  called  a»al 
Jisxuri;  the  spasmodic  or  involuntary  contraction  of 
the  spliinctor  ani,  was  the  jirimary  as  well  as  the 
principal  morbid  condition.  He  considered  the 
spasmodic  or  arbitrary  contraction  of  the  anal 
sphincter  to  bo  tlio  real  substantive  disease  itself, 
while  the  lesion  of  the  mucous  membrane,  if  exist- 


ent, to  be  the  mere  result  or  eflfeet  of  it ;  so  that 
whenever  the  two  affections  coexisted,  they  stood  in 
the  relation  of  cause  and  effect.  His  treatment 
therefore  corresponded  with  his  theory,  that  is,  he 
practised  and  advised  the  complete  division  of  the 
anal  sphincter,  for  the  cure  not  only  of  the  spas- 
modic contraction  of  the  muscle,  but  for  the  cure  of 
the  fissure  also  {Journal  ('nnqilhnentaire  dii  Diclion- 
naire  des  Sciertces  Mrdical.s,  tome  ii..  p.  24.  8vo. 
Paris,  1818;  "  Traite  des  INIaladies  Chinirgicales." 
Cinquifme  edition,  tome  vi.,  p.  605.  Svo.  Paris, 
1849J. 

Some  considerable  time  after  the  introduction  of 
M.  Beyer's  operation  for  anal  constriction  and  fis- 
sure, it  was  generally  laid  aside  by  French  surgeons, 
and  forcible  dilatation  of  the  anal  sphincters  was 
gradually  substituted  for  it.  The  commencement  of 
this  radical  change  was  principally  brought  about 
by  the  aide  and  ingenious  M.  Rccamier,  of  the  Hotel 
Dieu  of  Paris,  who  was  the  first  French  surgeon  to 
apply  extension,  distention,  and  massage  in  the 
treatment  of  the  morbid  contractions  of  muscles. 
He  thoroughly  investigated  this  subject  in  a  very 
able  and  valuable  article,  published  in  the  Revue 
Medicale  de  Paris,  January,  1838.  In  this  produc- 
tion M.  Ili'camier  speaks  of  having,  for  the  first 
time  in  anal  fissure,  employed,  instead  of  Beyer's 
operation, massage  or  kneading  upon  the  anal  sphinc- 
ters, in  order  to  lessen  the  force  of  the  spasmodic 
muscular  contraction  which  obtains  in  that  disease, 
and  which  he  considered  to  be  the  real  cause  of  the 
suffering.  He  also  employed  dilatation  of  the  anal 
sphincters  by  the  use  of  bougies,  gradually  increased 
in  size.  A  iady  consulted  him  who  had  long  sufl'er- 
ed  severely  from  a  fissure  of  the  anus,  for  which  M. 
Boyer  had  divided  the  anal  sphincters.  The  opera- 
tion did  not  prevent  a  relapse,  and  the  patient  con- 
tinued to  suffer  dreadful  pain  in  the  rectum,  espe- 
cially when  stooKng.  M.  Kecamier  employed  dOata- 
tions  of  the  anal  sphincters,  and  inferior  portion  of 
the  rectum,  by  means  of  V)ougies,  and  idtimately 
succeeded  in  effecting  a  perfect  cure  in  this  inter- 
esting case.  He  reports  several  other  cases  of  anal 
fissure,  which  were  complicated  with  hemorrhoids, 
in  which  the  same  treatment  was  speedily  followed 
by  complete  recovery. 

It  is  very  e^•ident  from  the  obser\-ations  of  51.  Ri'- 
camier,  that  he  did  not  contemplate,  by  either  grad- 
ual, instantaneous,  or  forcible  dilatation  of  the  anal 
sphincters,  any  rupture  of  the  muscular  fibres,  or 
any  laceration  or  tearing  of  the  mucous  membrane 
of  the  rectum,  as  some  authors  have  attributed  to 
him.  M.  Monod,  when  discu-ssing  the  subject  of 
the  forcible  dilatation  of  the  anal  sphincters  in  anal 
fissure,  and  after  explaining  what  he  considered  the 
■modus  operandi  of  M.  Rfcamier's  process  to  be,  says 
that  "  in  it  there  occurs  no  rent  of  the  mucous 
membrane,  nor  rupture  of  tlie  fibres  of  the  sphinc- 
ters, but  simply  a  modification,  or  a  sudden  change 
in  the  nervous  state  of  the  muscles,  from  which  ii 
momentary  paraly.sis  results,  followed  by  the  return 
again  to  the  normal  state"  ('-De  la  Dilatation 
Forcc'e  comme  moyen  de  Traitement  de  la  Fissure 
de  I'.Vnus  avec  Constriction  du  Sidiincter."  Svo. 
Paris,  1840).  About  a  (juarti'r  of  a  ccnttiry  subse- 
quent to  the  introduction  of  ^f.  Rccamier's  process 
of  anal  dilatation,  which,  by  the  bye,  never  met  with 
any  favorable  reception,  "^l.  IMaisonneuve.  the  able 
successor  of  M.  liC'camier,  at  the  Hotel  Dieu,  re- 
vived, as  it  were,  this  long-neglected  method  of  his 
predecessor,  by  making  a  striking  change  in  its 
madns     (iperaii'dl.       Instead    of    dilating    the    anal 


THE  MEDICAL  RECOKD. 


511 


sphincters  by  means  of  botigies,  or  rapidly  dilating 
them  by  means  of  the  fingers,  as  practised  by  ]\r. 
Kecamier,  he  conceived  the  very  original  and  iinii]U(' 
idea  of  instantaneous  or  forcible  dilatation  of 
the  anal  sphincters.  This  he  etfected  by  gradually 
insinuating  his  right  hand,  finger  by  finger,  into  the 
anus,  and  up  into  the  ampoule  reclale,  then  firmly 
clenching  it,  and  forcibly  withdrawing  the  fist  ;  tlius 
producing  instantaneous  and  forcible  dilatation  of 
the  anns  and  anal  canal,  and  of  course,  inflicting 
more  or  less  injury  upon  the  mucous  and  muscular 
tissues  of  the  same.  This  repulsive  proceeding  of 
M.  Maisonneuve,  before  chloroform  was  introduced, 
met  with  no  favor  whatever,  and  was  soon  consigned 
to  oblivion.  He,  however,  some  years  subsequently, 
greatly  modified  it,  as  I  will  now  proceed  to 
show.  M.  Maisonneuve  in  1851  maintained  the 
theory  that  involuntary  contraction  of  the  anal 
sphincters,  besides  being  a  cause  of  anal  fissure,  was 
also  a  frequent  cause  of  hemorrhoids.  He  believed 
that  in  almost  all  cases  of  hemorrhoids  this  morbid 
contraction  played  a  most  con-spicuous  and  painful 
part  in  their  i)roduction  ;  hence,  his  remedy  ftr 
excellence  was  forcible  dilatation  of  the  anal  sphinc- 
ters, by  means  of  the  two  thumbs,  or  the  two  index 
fingers,  instead  of  the  fist.  He  was  the  first  sur- 
geon, so  far  as  my  reading  extends,  who  practised 
and  recommended  forcible  dilatation  of  the  anal 
sphincters,  as  a  therapeutic  remedy  in  hemorrhoids 
(^Cliniijue  Chirin-gicdle,  tome  ii.,  8vo.  Paris,  18(i4). 

M.  Lepelletier,  the  friend  and  intei-ne  of  M.  Mai- 
sonneuve, in  a  most  remarkably  able  thesis  on  this 
subject  reports  a  number  of  cases  of  hemorrhoids 
which  M.  IVIaisonneuve  had  successfully  treated  by 
forcible  dilatation  of  the  sphincter  ani  ("De  la 
Contracture  du  Sphincter  Anal,  et  de  son  Traitement 
par  la  Dilatation  ForcCe."     These  de  Paris,  1851). 

M.  Verneuil,  the  present  able  and  distinguished 
French  surgeon,  after  discarding,  like  many  of  his 
French  confrh-fn,  the  usually  accepted  theory  of  the 
etiology  of  the  hemoiThoidal  disease,  as  being  en- 
tirely too  inadequate  to  assign  the  true  origin  and 
cause  of  the  varicose  enlargements  of  the  hemor- 
rhoidal vessels,  proceeded  to  devote  his  attention  to 
a  diligent  search  for  the  true  predisposing  cause  of 
that  affection  in  the  anatomy  and  physiology  of  the 
rectum  itself.  He  declares  he  has  discovered 
the  true  and  only  predisposing  cause  of  hemorrhoids 
in  the  peculiar  distribution  of  the  hemorrhoidal 
veins,  and  the  course  they  pursue  in  the  coats  of 
the  rectum,  a  few  inches  above  the  anal  orifice;  and 
to  this  predisposing  cause,  together  with  involuntan- 
muscular  contraction,  he  attributes  all  the  varicose 
enlargements  which  take  place  in  the  hemorrhoidal 
veins.  According  to  M.  Verneuil,  then,  the  tnie  pre- 
disposing cause  and  the  eflicient  cause  of  all  hemor- 
rhoids are  solely  founded  in  the  anatomical  struc- 
ture and  physiological  action  of  the  rectum,  as 
he  has  demonstrated  by  dissection.  He  embodied 
his  views  upon  the  subject  of  these  causes,  es- 
pecially that  of  involuntai-y  muscular  contraction, 
in  the  pathogeny  of  hemorrhoids,  in  an  able  pro- 
duction, which  he  communicated  to  the  Anatomical 
Society  of  Paris  in  1855. 

M.  Verneuil  maintains  that  the  superior  hemor- 
rhoidal veins  are  only  in  connection  with  the  jiortal 
system,  and  form  only  internal  hemorrhoids,  while 
external  hemorrhoids  are  formed  from  the  middle 
and  inferior  hemorrhoidal  veins,  which  are  con- 
nected with  the  general  venous  system,  and  do  not, 
except  perhajis  in  the  most  remote  degree,  form 
connections  with  the  superior  hemorrhoidal  veins. 


thus,  in  effect,  cutting  oft'  all  communication  be- 
tween the  portal  and  general  venous  systems.  He 
further  maintains  that  the  superior  hemorrhoidal 
veins  commence  at  the  superior  border  of  the  ex- 
ternal sphincter  ani,  and  lie  under  the  mucous  mem- 
brane of  the  rectum,  and  at  the  height  of  ten  or 
eleven  centimetres  aliruptly  perforate,  as  it  were, 
tlie  muscular  coat  of  the  rectum.  At  this  particu- 
lar point  of  the  canal  M.  Verneuil  claims  to  have 
discovered  that  these  veins  pass  abruptly  through 
veritable  buttonhole  apertures  in  the  muscular 
coat,  and  in  consequence  of  these  muscular  aper- 
tures not  being  invested  by  any  protective  fibrous 
tissue,  have  the  .power  of  contracting,  and  thias 
causing  such  congestion  and  stasis  in  the  superior 
hemorrhoidal  veins  which  pass  through  them,  as  to 
constitute  the  primary  cause  in  the  formation  of  in- 
ternal hemorrhoids.  These  contractile  apertures, 
says  M.  Verneuil,  constitute  not  only  the  passive, 
but  also  the  active  cause  of  hemorrhoids.  Any  in- 
testinal irritation  will  produce  violent  and  spasmodic 
contractions  of  the  muscular  aiJertures,  and  these 
contractions  are  communicated  to  the  levator  and 
sphincter  ani  muscles,  and  a  rapid  development  of 
internal  hemorrhoids  is  the  consequence.  M.  Ver- 
neuil founded  his  peculiar  views  of  the  etiology  of 
hemorrhoids  upon  his  own  and  the  dissections  of 
MM.  Gosselin  in  1864,  Dubreuil  and  Richard  in 
1868,  and  Duret  in  1877.  Hence,  upon  this  plausi- 
ble theon',  as  demonstrated  by  the  dissections  of 
his  own,  and  those  of  his  able  coadjutors,  he  estab- 
lished his  favorite  treatment  of  hemorrhoids  by  the 
forcible  dilatation  of  the  anus  ("Du  Traitement 
des  Hemorroides  par  la  Dilatation  Forcee  de  I'Anus," 
8vo.     Paris,  1879). 

The  theory  deduced  from  these  important  and 
valuable  rectal  dissections  is  a  very  ingenious  and 
plausible  one,  yet  not  altogether  an  entirely  new 
one,  as  I  will  attempt  to  show ;  nor  is  it  any  less 
specious  than  that  on  the  same  subject,  advocated 
more  than  a  century  ago  by  many  of  the  old  sur- 
geons. Soon  after  the  illustrious  Harvey  had  de- 
monstrated the  circulation  of  the  blood,  great  im- 
portance was  attached  to  the  supposition  entertained 
by  some  surgeons  of  that  epoch  that  internal  hemor- 
rhoids were  in  immediate  communication  with  the 
splenic  and  great  mesenteric  branches  of  the  vena 
porta,  and  that  they  alone  depended  upon  this  source 
for  their  origin,  existence,  and  growth,  while  the  ex- 
ternal hemorrhoids  were  alone  the  result  and  pro- 
duction of  the  dilatation  and  engorgement  of  the 
terminating  hypogastric  branches  of  the  vena  cava. 
This  theory  finally  attracted  the  attention  of  the 
celebrated  T>e  Haen  of  the  eighteenth  century,  who 
established  XL\)on  it  the  following  axioms  :  namely, 
that  hemori-hage  from  the  external  hemorrhoidal 
vessels  directly  and  promptly  depleted  the  sanguin- 
eous system  in  general;  while,  on  the  contiary, 
bleeding  from  the  internal  hemorrhoidal  vessels  di- 
re'ctly  and  promptly  disgorged  the  vena  portal  sys- 
tem. De  Haen  says:  "Fluxu  hemorrhoidtim  ex- 
temaiiim  fit  directa.cita  ac  generalis  totius  systeniatis 
vasoiTtm  (prtfter  systema  vena;>-port.'e  quod  tunc  et 
lentius,  et  parcius  depletur),  depletio,  id  est  immi- 
nutio  plethorie  universalis.  Et  contra  fluxu  ha-m- 
orrhokium  internarum  fit  directa,  cita  et  copiosa 
depletio  systematis  vente-portic ;  lenta  vero,  ac 
parca  totius  reliqui  systematis  vasorum  ;  ut  proindfe 
hoc  fluxu,  plethora  totius  non  a  deo  imminuatur  " 
("Thtise  Pathologica3  de  HtemorrhoTdibus,"  cap, 
i.,  sec.  3.  8vo.  Vindobona=,  1759).  Alberti  main- 
tained  that   the   internal  hemorrhoidal  veins  were 


oia 


THE  MEDICAL  RECORD. 


derived  from  the  inferior  mesenteric,  while  the  ex- 
ternal hemorrhoidal  veins  were  branches  of  the  hy- 
pogastric ("  Tractatus  de  Ha-morrhoTdibus,"  cap.  v., 
p.  7-t.  -tto.  Hal;o,  1722).  M.  Gos.selin  declares  that 
internal  hemorrhoids  are  due  to  varices  of  the  su- 
perior hemorrhoidal  veins,  whilst  e.xternal  hemor- 
rhoids are  formed  by  the  inferior  hemorrhoidal  veins 
("Lemons  sur  les  Hcmorroides."     Paris,  1860j. 

The  plausible  theories  of  these  several  distin- 
guished authors,  however,  cannot  well  be  considered 
in  any  other  light  than  that  of  a  more  or  less  fanci- 
ful cUai'acter.  Indeed,  in  my  opinion,  they  cannot 
be  .satisfactorily  demonstrated,  either  by  dissection 
or  experiment,  in  consequence  of  the  in.superable 
barrier  presented  by  the  interminable  intersecting, 
interlacing,  and  the  innumerable  anastomosing  of  all 
the  hemorrhoidal  blood-vessels  which  abound  as  an 
intricate  plexus  in  the  middle  and  inferior  portions 
of  the  rectum.  It  therefore  seems  to  me  that  as 
yet  it  still  forms,  as  it  were,  a  comjilete  Chinese 
puzzle  to  determine  positively  what  particular 
hemorrhoidal  blood-vessels  produce  either  internal 
or  external  hemorrhoids,  or  what  particular  hemor- 
rhoidal blood-vessels  dejilete  the  system  in  gen- 
eral, or  the  vena  portal  system  in  particular. 

The  proceeding/  of  M.  Vernenil. — M.  Verneuil  was 
one  among  the  ablest  advocates  for  the  treatment  of 
hemorrhoids  by  the  foi-cible  dilatation  of  the  anus  ; 
but,  in  order  to  success,  lie  was  compelled,  in  the 
majority  of  cases,  to  combine  with  it  the  galvano- 
caustic  method.  The  proceeding  of  Verneuil,  in 
certain  cases,  comprises  two  distinct  processes : 
fir.st,  the  anal  dilatation ;  and  second,  the  interstitial 
cauterization  of  the  tumors.  I  am,  however,  only 
required  to  give  his  first  process.  On  the  evening 
of  the  day  previous  to  the  operation,  M.  Verneuil 
requires  the  patient  to  take  a  purgative,  and  on  the 
next  day,  just  before  the  operation,  an  enema  is  to 
be  administered.  After  the  rectum  is  completely 
emptied  by  these  means,  the  patient  should  be  put 
uader  the  iafiuence  of  an  anscsthetic,  and  placed  on 
his  left  side,  in  the  position  required  for  the  opera- 
tion of  fistula  in  ano,  and  a  bivalve  speculum  intro- 
duced into  the  rectum  fully  up  to  the  superior  border 
of  the  iaternal  sphincter  ani ;  then  the  blades,  forcibly 
opened,  should  be  slowly  withdrawn  from  the  rec- 
tum. Afterward  two  fingers  of  each  hand  may 
be  introduced  into  the  anus,  and  forcibly  stretching 
the  external  sphincter,  by  which  its  dilatation  will 
also  be  the  more  thoroughly  effected.  The  patient 
is  now  put  to  bed,  and  compresses,  dipped  in  cold 
water,  are  to  be  constantly  kept  applied  to  the 
anus. 

-V'^cording  to  M.  Verneuil,  this  operation  is  done 
in  a  minute,  and  does  not  give  place  to  any  serious 
complications.  There  is  no  fear  of  hemorrhage  nor 
of  purulent  infection,  nor  contraction  of  the  rectum. 
The  pain  that  follows  the  operation  is  not  severe, 
and  only  lasts  for  a  few  hours.  For  two  or  three 
days  the  dilated  sphincter  does  not  completely  close 
the  anal  orifice,  and  allows  the  mucous  membrane 
to  protrude  at  the  anus  in  the  form  of  a  hernia ; 
the  sphincter,  however,  gradually  regains  its  contrac- 
tile power,  and  at  the  end  of  five  or  six  days,  it  has 
again  resumed  its  normal  form  and  activity,  and  the 
patient  is  completely  ctired  (op.  cit.). 

M.  Durot,  a  former  hi/ernn  of  M.  Verneuil,  also 
very  ably  investigates  this  subject  by  plainly  show- 
ing the  manner  in  winch  the  involuntary  contraction 
of  the  anal  sphincters  acts  in  the  production  of  hem- 
orrhoids ("Sur  la  Pathogrnie  des  Hc'morro'ides " 
in  ]\I<^moire  pour  le  Concours  de  la  Mfdaille  d'Or). 


According  to  the  testimony  of  M.  Lartisien,  M. 
Verneuil  for  several  years  employed  forcible  dilata- 
tion of  the  anal  sjaliincters,  combined  with  the  gal- 
vano-cautery,  in  the  treatment  of  hemorrhoids. 
("  Du  Traitf  des  Hemon-oides,  et  de  la  Cauterisation 
intersti,  en  particulier."     ThiJse  de  Paris,  1873). 

M.  Gosselin  also  employed  forcible  dilatation  of 
the  anal  sphincters  in  the  treatment  of  hemorrhoids. 
The  cases,  however,  in  which  he  used  it,  were,  it 
seems,  complicated  with  anal  fissure ;  and  it  was 
doubtless  more  for  the  cure  of  the  fissure  than  for 
the  cure  of  the  hemorrhoids  that  he  employed  it 
(oj).  cit.). 

Hemorrhoids  and  anal  fissure  are  two  affections 
which  often  coexist,  and  the  theoiy  of  the  French 
surgeons  is,  that  when  such  is  the  case  forcible  dila- 
tation of  the  anal  sphincters  cures  both  diseases.  I 
have  shown,  however,  that  their  theory  and  their 
practice  do  not  correspond.  M.  Fontan,  a  distin- 
guished French  surgeon  of  Lyons,  commenced  treat- 
ing hemorrhoids  in  1875  by  the  forcible  dilatation 
alone  of  the  anal  sphincters,  by  means  of  the  fingers, 
carefully  guarding  against  any  injury  to  the  dilatable 
parts.  To  this  mild  oi^eration  of  M.  Fontan,  which 
will  prove  just  as  effectual  as  the  rupture  of  the 
anal  sphincters,  no  valid  objection  can  be  urged.  It 
is  the  same  operation  which  I  myself  practised  and 
recommended  previous  to  18G8,  in  certain  cases  of 
anal  fissure  ;  the  patient  always  being  first  placed 
under  profoiind  antesthesia  ;  for  the  anal  sphincters, 
in  consequence  of  their  functional  activity  in  such 
cases,  are,  as  a  general  rule,  the  last  to  relax  or  yield 
to  the  infiuence  of  anicsthetics.  I  then  said,  "In- 
stead of  the  thumbs,  I  introduce  into  the  anus  the 
index  finger  of  each  hand,  and  forcibly  dilate  the 
contracted  muscles,  first  antero-posteriorly  and  then 
laterally,  at  the  same  time  taking  care  to  preserve 
the  integritv  of  the  membranes"  ("  Anal  Fissure," 
p.  135.     Imp.  8vo.     New  York,  18(58). 

M.  Fontan,  in  his  valuable  productions  on  this 
subject,  refuses  to  give  credit  to  either  M.  Maison- 
neuve  or  to  M.  Lepelletier  for  priority  in  the  sugges- 
tion or  the  employment  of  forcible  dilatation  of  the 
anal  sphincters  as  an  especial  and  rational  treatment 
for  hemorrhoids.  He  says  that  this  is  a  }>ending 
question  (Moniteur  Tlurapeulique  de  Paris,  No- 
vembre,  1875;  "Du  Traitement  des  HemorrOuies 
par  la  Dilatation  Forcfe  des  Sphincters  de  I'Anus  " 
8vo.     Paris,  1877). 

M.  Cristofari,  a  recent  French  author  on  this  sub- 
ject, employs  forcible  dilatation  of  the  anal  sphinc- 
ters in  the  treatment  of  hemorrhoids,  and  he  very 
forcibly  advocates  this  fashionable  French  method 
("Du  Traitement  Chirurgical  des  Hi'morroides,  et 
en  particulier  de  la  Dilatation  ForcOe."  Svo.  Paris, 
1870). 

iTo  be  contimicil. ) 


An  In.s.vne  Asvlum  Investigated. — A  numVier  of 
charges  liaving  been  brought  against  tlie  Superin- 
tendent and  other  oiiicers  of  the  West  Virginia  State 
Asylum,  at  Weston,  a  Legislative  Conimittee  was 
appointed  to  investigate  tlio  matter.  It  was  found 
that  two  of  the  ilirectors  and  the  first  assistant  |diy- 
sician.  Dr.  Hullihen,  had  been  guilty  of  drunken- 
ness as  charged.  The  removal  of  Dr.  Hullilicn  was 
recommended.  The  charges  against  the  Superin- 
tendent, Dr.  Bland,  of  neglect,  extravagance,  and 
mismanagement,  were  entirely  unsupported.  The 
Committee  found  that  the  Asylum,  <uigina!ly  in- 
tended for  two  hundred  and  fifty  )iaticnts,  was 
crowded  with  six  hundred. 


THE  MEDICAL  RECORD. 


513 


Uc|Jort3  Of  Cjospitals. 


ST.  rRA]S,CIS  HOSPITAL,  N.  Y. 

Sekvice  of  Dr.  GEORGE  F.  SHRADY. 
LATERAL,  LIXHOTOMY — MrXtBEBRT  CALCULUS — RECO^"EEY. 

The  patient,  aged  nineteen,  had  suffered  from  symp- 
toms of  stone  for  several  months,  but  had  been 
treated  by  irregular  practitioners  for  simple  "  inflam- 
mation of  the  bladder."  Finally  he  consulted  Dr. 
Alex.  Hadden,  who  at  once  verified  the  suspicion 
of  the  existence  of  stone,  and  sent  him  to  Dr.  Shrady 
for  operation. 

On  sounding,  the  diagnosis  was  made  of  a  hard 
irregular-shaped  calculus,  of  about  one  inch  and 
a  half  in  diameter.  On  account  of  the  extreme 
irritability  of  the  bladder,  aggravated  by  a  recent 
attack  of  urethritis,  the  intolerance  of  instruments, 
the  size  and  character  of  the  stone,  and  the  small 
calibre  of  the  urethra,  the  operation  of  lateral  lithot- 
omy was  decided  upon,  in  preference  to  crushing, 
which,  under  other  circumstances  would  have  been 
indicated. 

The  operation  was  performed  April  22d,  at  St. 
Francis  Hospital,  with  the  assistance  of  Profs. 
Howe  and  Bryant.  The  stone,  on  being  reached  by 
the  finger,  was  found  to  have  an  exceedingly  rough 
surface,  and  resembled  a  lump  of  cinder  more  than 
anything  else.  It  was  readily  seized  with  the  for- 
ceps, but  before  extraction  could  be  safely  effected 
it  was  necessary  to  incise  the  right  lobe  of  the  pros- 
tate. 

The  stone,  which  was  of  the  mulberry  variety, 
weighed  two  hundred  and  eighty  grains,  was  oblong 
in  shape,  measui-ing  one  and  five  eighths  inch  in 
one  diameter  and  one  inch  in  the  other  ;  presented 
over  its  surface  large  and  widely  separated  dark 
brown  tuberculated  projections  (oxalate  of  lime), 
imbedded  in  a  white  crystalline  base  (phosphate  of 
lime),  was  of  flinty  hardness,  and  showed  more  than 
the  usual  irregularity  of  surface. 

The  patient  has  progressed  toward  recovery  with- 
out a  bad  symptom,  the  wound  has  nearly  healed, 
and  the  major  part  of  the  urine  is  voided  through 
the  penis. 

TRACHEOrOMT   FOR   STPHnilTIC   DISEASE   OF   LARYNX. 

A  mile  patient,  thirty  three  years  of  age,  was  sent 
by  Dr.  W.  C.  Jarvis,  with  the  diagnosis  of  syphilitic 
growth  on  the  left  side  of  larynx  involving  left  vocal 
cord.  There  was  such  extreme  difficulty  of  breath- 
ing, the  man  seemed  liable  to  become  asjjhyxiated  at 
any  moment.  He  had  been  getting  gradually  worse 
ha-  three  weeks  before,  and  in  desperation  begged 
that  he  be  relieved  by  tracheotomy.  The  operation 
was  performed  by  Dr.  Shrady  with  the  least  jjossible 
delay,  in  the  presence  of  and  with  the  assistance  of 
Drs.  Ripley  and  Satterthwaite.  Relief  was  immedi- 
ate. After  the  wound  had  been  closed  in  the  usual 
way  above  and  below  the  tube,  the  patient  was  seized 
with  a  severe  tit  of  vomiting  and  a  prolonged  par- 
oxysm of  coughing.  During  the  latter  act  the  tulie 
was  ejected  from  the  trachea,  and  emphysema  of 
the  head  and  neck  quickly  followed.  The  stitches 
were  promptly  removed  and  the  edges  of  the  tracheal 
wound  held  apart.  A  longer  tube  was  then  intro- 
duced, and  the  incision  in  the  integument  was  left 
open.  In  the  course  of  the  next  forty-eight  hours 
I  the  emphysema  had  disappeared,  but  the  tissues 
about  the  wound  had  become  much  infiltrated.    The 


latter  condition  increased  until  the  fourth  day,  when 
it  was  impossible  on  account  of  the  relatively  deep 
condition  of  the  tracheal  opening  to  keep  the  tube 
in  place.  During  tlie  five  days  following,  when  a 
longer  tube  was  being  made,  the  tracheal  wound  was 
simply  kept  open  by  the  occasional  introduction  of  a 
dilator.  Respiration  and  expectoration  were  carried 
on  through  the  aperture  without  the  slightest  incon- 
venience. The  larger  silver  tube  has  been  worn  for  the 
past  twc^weeks  with  comfort.  The  laryngeal  growth, 
which  is  irregular  and  warty  in  character,  is  appar- 
ently decreasing  under  anti-syphilitic  treatment. 

PEEINEAl   SECTION   FOR   TEArJlATlC   STRICTURE. 

This  was  the  case  of  a  laborer  who  fell  astride  a 
beam,  had  bloody  urine  for  three  weeks,  and  finally, 
at  the  end  of  a  month  longer,  almost  total  inability 
to  pass  his  water.  The  stricture  was  situated  at  the 
bulbo  membranous  portion  of  the  urethra,  where 
there  existed  for  an  inch  in  extent  an  irregular  tract 
of  cicatricial  tissue  of  cartilaginous  firmness.  The 
obstruction  was  practically  impassable  ;  even  after 
etherization  it  was  impossible  to  engage  the  finest  fili- 
form. Urethrotomy  was  performed  without  a  guide. 
The  strictured  portion  of  the  urethra  was  found 
deflected  sharply  to  the  right,  and  after  considerable 
search  an  oiiening  only  large  enough  to  admit  a  probe 
was  found  leading  to  the  bladder.  The  stricture 
was  then  freely  divided  in  the  usual  manner. 

IODOFORM   .is   A   DRESSING. 

Iodoform  has  been  used  quite  extensively  as  a  local 
dressing  for  indolent  granulating  surfaces,  and  in 
the  main  has  given  good  results.  It  is  not  em- 
jjloyed  at  present  as  a  di-essing  for  freshly  made 
stumps  and  recent  wounds. 

THE   INTERNAL   ADMINISTRATION   OF    CARBOLIC    ACID. 

In  several  cases  in  which  an  internal  antisei^tic 
seemed  to  be  indicated,  and  notably  in  such  as  were 
the  subjects  of  profuse  suppuration  with  attendant 
constitutional  disturbances,  Dr.  Shrady  has  used  the 
acid  phenique  (carbolic  acid )  internally  and  hypo- 
dermically,  according  to  the  method  of  Dr.  Declat  of 
Paris  with  quite  satisfactoiT  results.  He  has  em- 
ployed mostly  the  syr.  iodo-phenique  (Dtelat)  and 
the  nascent  acid  phenique  (Declat).  The  former 
in  doses  of  a  teaspoonful  every  two  hours,  and 
the  latter  in  quantities  of  eighty  minims  injected 
daily  in  the  cellular  tissue  of  the  abdominal  walls. 
In  two  cases  the  good  effects  were  quite  striking. 
One  was  a  woman  worn  down  by  suppurating  dis- 
organization of  the  knee-joint,  and  who  had  irregu- 
lar chills  and  high  temperature  and  other  symptoms 
pointing  toward  septic  infection.  The  thigh  was 
amputated  under  the  most  unfavorable  conditions, 
general  and  local,  with  hardly  a  hope  for  ultimate 
recovery,  and  after  the  first  forty-eight  hours  all  the 
l)ad  symptoms  disappeared  under  the  administration 
of  the  syr.  iodo-phenique  and  the  patient  ultimately 
left  the  hospital  cured. 

The  other  case  was  one  of  long-continued  and  ex- 
tensive supjjuration  from  an  open  and  burrowing 
iliac  absce.ss.  The  patient  has  been  bedridden  for 
months,  and  altogether  was  in  a  prostrated  and 
helpless  condition.  In  the  course  of  two  weeks  un- 
der antiseptic  treatment,  internally  and  bypodermi- 
cally,  his  general  condition  improved,  his  api)etite 
returned,  and  the  discharge  became  very  much  re- 
duced. At  the  end  of  six  weeks  he  is  able  to  hobb'e 
about  the  ward,  the  sinuses  are  healing,  and  He 
amount  of  pus  secreted  has  been  reduced  from  a 
pint  to  scarcely  half  an  ounce. 


514 


THE  MEDICAL  RECORD. 


progress  of  iHctiicol  Science. 


The  Use  of  Nitkous  Oxide  Gas  in  Labok. — Dr. 
KUkowitsch  [MediU.  Obozrenie,  xv.,  p.  7.39)  Las  used 
this  gas  iustead  of  chloroform  in  twenty  cases  of 
labor.  He  considers  it  much  superior  to  chloro- 
form or  ether.  Four  to  five  inhalations  are  sufficient 
to  abolish  sensation  without  affecting  consciousness, 
and  its  use  is  free  fi-om  the  objectionable  after-efi'ects 
peculiar  to  the  above-named  an;esthetics.  It  is  said 
that  the  inhalation  can  be  carried  out  under  the  di- 
rection of  an  intelligent  nurse,  so  that  the  inter- 
position of  the  physician  is  not  absolutely  necessary. 

The  Genesis  op  Certain  HEREDrrAET  Deformi- 
ties.— Dr.  Sigfred  Levy  has  investigated  the  hy- 
pothesis that  strong  pressure  on  the  walls  of  the 
uterus  may  cause  certain  deformities  in  the  f«tus. 

He  first  examined  the  conditions  existing  in 
twenty-one  cases  of  hereditary  talijies,  and,  by 
questioning  the  mothers  on  the  course  of  the  preg- 
nancy and  parturition,  found  indications  in  seven 
cases,  or  thirty-three  per  cent.,  that  there  was  but 
a  small  quantity  of  liquor  amnii. 

He  then  inquired  into  Prof.  Roser's  theoiyof  con- 
genital luxation,  which  was,  that  when  there  is  too 
small  a  space  for  the  fa^tus  iu  consequence  of  a  defi- 
ciency of  liquor  amnii,  the  result  will  be,  in  the  fe- 
male fietus,  congenital  luxation,  but  in  the  male, 
talipes.  In  eighteen  cases  of  congenital  luxation 
the  author  found  but  three  males,  while  in  congeni- 
tal pes  varus  there  were  but  22-,^r  per  cent,  females. 

As  patients  with  congenital  luxation  usually  ap- 
ply for  treatment  at  a  late  period,  information  as 
to  the  course  of  the  jjregnanoy  and  j^arturition  is 
thought  to  be  untrustworthy. 

Among  other  deformities,  the  author  mentions  a 
case  of  congenital  defect  of  the  left  radius  and  of 
the  fibula.  In  both  there  had  been  a  constant  loss  of 
liquor  amnii  during  pregnancy. — Ugeslcriftfur  Laeger 
and  Nbrdiskl  Medicinskt  Arkiv,  Bd.  xiii.,  No.  29. 

CONBmON  OF  THE  CoTANBOUS  NeRVES  IN  LOCO- 
MOTOR Ataxia. — M.  DPjCrnie  recently  announced  to 
the  Paris  Socifcte  de  Biologie  that  the  pathological 
condition  presented  by  the  cutaneous  sensory  nerves, 
in  ataxic  patients,  is,  essentially,  a  peripheral  neu- 
ritis. This  statement  M.  DCj'rnie  bases  upon  the 
fact  that,  in  a  case  recently  observed  by  himself,  the 
.spinal  ganglia  and  the  posterior  roots  below  the 
litter  were  perfectly  normal  in  appearance,  while 
the  cutaneous  nerves  were  the  seat  of  a  neuritis. — 
Progres  Medical,  March  25,  1882. 

Inoculation  as  a  Pkophyijactio  Measiuse  Ao.iiNST 
MAiiio.NANT  PnsTHLB. — In  a  communication  to  the 
Paris  Acaddmie  des  Sciences,  M.  E.  Corson  recently 
described  a  case  of  malignant  pustule,  occurring  in 
the  person  of  a  m  vn  who  had  experienced  one  attack 
of  that  disease  twenty-seven  years  before.  The 
symptoms  were  of  a  very  grave  character,  embracing 
severe  febrile  phenomena  and  deep  coma,  wliioli  per- 
sisted for  more  than  twonty-four  hours.  The  patient, 
however,  made  a  rapid  recovery  and,  at  the  end  of  a 
few  days,  bore  no  marks  of  the  disease  exoejit  two 
ulcerations  upon  the  back  of  the  liand.  M.  Corson 
advances  the  theory  that  the  rapid  recovery  of  the 
patient  may  have  been  due  to  the  pos.sil)le  modify- 
ing effect  exerted  by  the  former  upon  the  latter  at- 
tack.—i<lr««ce  Medicate,  March  25,  1882. 


Increase  of  H.emoglobine  in  the  Blood  of  Ani- 
mals Inhabiting  Elevated  Regions. — Le  Courrier 
Medical,  April  1,  1882,  gives  aresume  of  the  results  of 
M.  P.  Bert's  recent  experimental  investigation  regard- 
ing the  comparative  quantities  of  hicmoglobine  in  the 
blood  of  animals  residing  at  difl'erent  altitudes.  Men 
and  animals,  when  suddenly  removed  to  regions  six 
thousand  feet  above  the  sea,  experience  certain  well 
known  symptoms,  collectively  designated,  in  the 
Alps,  le  mat  des  monlngiies.  Dr.  Jourdanft.  long 
since  advanced  an  opinion  that  the  morbid  condi- 
tion is  referable  to  a  diminution  in  the  quantity  of 
oxygen  in  the  blood  and  suggested  for  it  the  desig- 
nation anoxylupmia.  M.  Bert's  experiments,  re- 
cently rejjorted  to  the  Paris  Acadi'mie  des  Sciences, 
seem  to  prove  the  accuracy  of  this  theory  and  to 
show  that  the  percentage  of  oxygen  in  the  blood 
diminishes  in  direct  ratio  to  the  reduction  of  atmos- 
pheric pressure.  Prolonged  residence  on  the  moun- 
tains secures  immunity  from  the  unpleasant  symp- 
toms alluded  to,  but  the  phenomena  of  anosyhamia 
show  themselves  even  in  the  acclimated,  whenever 
the  latter  suffer  from  any  acute  disease.  M.  Bert 
maintains  that  the  acclimation  in  question  is  due  to 
an  increase  in  the  h.'tmoglobine  of  the  blood,  basing 
his  hypothesis  upon  the  determination  of  the  per- 
centage composition  of  blood  taken  from  animals 
resident  at  different  altitudes.  While  the  blood  of 
animals  living  at  ordinary  elevations  absorbed  only 
ten  or  twelve  per  cent,  of  oxygen,  that  of  others 
which  had  been  transported  to  an  altitude  of  about 
ten  thousand  feet  above  the  sea  was  capable  of  ab- 
sorbing from  sixteen  to  twenty-one  per  cent. 

Treatment  of  Iebeducible  and  STRANorLATEi) 
Hernias  by  Morphia  HxpoDERmcALLY  ^Vdminis- 
tered. — Le  Gazette  des  Hopitaux,  March  25,  1882, 
presents  a  summary  of  the  results  obtained  by  Dr. 
Philippe  in  the  treatment  of  five  cases  of  irred\icible 
or  strangulated  hernia  by  means  of  hyijodermic  in- 
jections of  morphia,  and  concludes  that  this  method 
constitutes  a  potential  expedient  to  which  the  sur- 
geon should  resort  before  adopting  operative  meas- 
ures. Dr.  Philippe's  first  case  was  one  of  double 
iri-educible  inguinal  hernia.  Taxis  was  first  em- 
ployed, for  a  quarter  of  an  hour,  without  result. 
Five  drops  of  a  morphia  solution,  containing  about 
nine  and  one-half  grains  to  the  ounce,  was  then  in- 
jected, hypodermically,  after  which  the  volume  and 
the  tenderness  of  the  hernial  tumor  diminished. 
Fifteen  minutes  later  another  injection,  of  five 
drops,  was  administered,  and  the  reduction  of  the 
hernia  was  easily  efiected.  The  other  ca.<;es  only 
differed  from  the  first,  as  regards  treatment,  in  th(^ 
amount  of  morphia  used.  One  of  the  cases  was  an 
umbilical  hernia,  one  was  a  strangulated  femoral, 
and  another  a  strangulated  inguinal  hernia.  Re- 
duction was  easily  effected,  in  all  the  cases,  after 
the  employment  of  from  two  to  six  injections. 

Cerebr.vl  Sclerosis  in  Children. — M.  Jules  Si- 
mon describes,  in  tlie  Gazette  den  Hopitaux,  March 
21,  1882,  the  pathology  and  clinical  history  of  in- 
fantile cerebral  sclerosis,  as  studied  liy  himself  at 
the  Hopital  des  Enfants-Malades.  The  sclerosis  is 
more  frequently  sujierficial  than  deep,  and  affects, 
by  preference,  those  parts  of  the  cerebrum  ailjaoeiit 
to  the  fissure  of  Rolando.  It  occurs  in  isolated  nod- 
ules whicli  are  not  easily  enucleated,  are  dry  on  sec 
tion,  and  possess  hardly  any  vascularity.  .V  zone  of 
congestion  surrounds  tliem.  A  child  suffering  from 
this  disea.se  has  frequent  cephalalgia  and  marked 


THE  MEDICAL  RECORD. 


615 


iasomuia.  It  is  restless  and  cries  at  night.  Its  in- 
telligence may  or  may  not  be  affected.  It  has  oc- 
casional attacks  of  vertigo  and  emesis.  Limited, 
superdcial  sclerosis  causes  local  epileptiform  con- 
valsions,  involring  either  a  limited  number  of  mus- 
cles, as  those  of  the  hand  or  forearm,  or,  in  severe 
cases,  of  one  entire  ?ide  of  the  body.  The  convul- 
sive movements  may  aftect  only  one  cheek,  one 
eyelid,  or  one  side  of  the  face.  The  spasms  are 
sometimes  succeeded  by  coma.  The  most  charac- 
teristic symptom  consists,  however,  in  unsymmetrical 
local  paralysis.  Sensation  is  rarely  affected.  The 
differential  diagnosis  bL-tween  epilepsy  and  cerebral 
sclerosis  is  based  upon  the  greater  frequency  and 
severity  of  the  convulsions  in  the  latter  disease. 
The  general  health  of  the  patients  usually  remains 
good  and  febrile  movement  is  rare. 

ScTpntATrvE  Oirris  Media  follotving  the  Pldg- 
(rrsG  OP  THE  PosTERioK  Nares. — In  an  article  bear- 
ing the  above  title  (La  Tribune  Medicale,  March 
26,  1882),  Dr.  GelltS  first  explains  the  muscular 
mechanism  by  which  the  Eustachian  tube  is  nor- 
mally maintained  in  a  transient  patulous  state 
during  deglutition.  Dr.  Gelle  advances  a  theory 
that  the  tube  may  become  permanently  jiermo- 
able  to  air  and  fluids.  This  result  depends  upon 
the  sjiasmodic  contraction  of  the  dilators  of  the 
tube.  The  muscular  spasm  may  be  caused  by  the 
irritation  of  decomposing  blood  and  pus  when 
the  latter  come  in  contact  with  the  pharyngeal  ex- 
tremity of  the  Eustachian  tube.  This  causative  con- 
dition is  present  whenever  a  tampon,  applied  to  con- 
trol epistaxis,  is  left  in  the  posterior  nares  for  a  long 
time,  and  otitis  media  is  the  result.  Dr.  G.  refers 
to  two  cases  of  this  kind  which  have  fallen  under  his 
observation,  and  ascribes  to  Dr.  Crcquy  the  honor  of 
first  having  called  attention  to  the  accident  under 
consideration.  The  author  advocates  the  substitu- 
tion of  hypodermic  injections  of  ergotin  for  plugging 
of  the  posterior  nares  in  epistaxis. 

CnT.4.i{EOUs  Lymph.\dexitis. — Dr.  L.  Galliard,  pre- 
sents, in  the  Annales  de  Dermfitologie  et  de  St/j)///- 
ligraphie,  March  25,  1882,  an  outline  of  the  history 
and  of  the  pathological  changes  characterizing  this 
cutaneous  disease,  together  with  extended  notes  of 
a  case  observed  by  himself.  Kanvier  first  demon- 
strated the  origin  of  the  disease,  and  declared  it  to 
be  a  manifestation  of  the  lymphatic  diathesis, 
although  Albert  and  Bazin  studied  it  before  him.  The 
new  growth  is  often  preceded  by  areas  of  evanescent 
cutaneous  congestion,  by  erythema,  pi-ui-itus,  or  by 
lichen.  The  neoplasmata  grow  very  slowly,  may  be 
traasieatly  retrogressive,  often  occasion  no  visceral 
metastases,  and  do  not  end  in  leuoocythsemia.  They 
occupy  by  preference  the  internal  aspect  of  the 
limbs,  the  anterior  surface  of  the  trunk,  and  the 
frontal  region.  Their  size  varies  from  that  of  a  jiea  to 
that  of  a  large  nut.  Their  consistency  is  soft,  their 
color  gray,  and  their  surface  marked  by  capillaries 
of  large  calibre.  The  neoplasms  are  developed  in 
the  cutis,  and  cause  tension  and  projection  of  the 
epidermis.  They  soon  produce  ulceration  of  the 
latter,  and  discharge  sanious  and  fetid  jjus  upon 
the  surface.  Microscopical  examination  shows  the 
tumors  to  be  composed  of  reticulated  fibrous  tissue, 
the  interspaces  of  which  are  filled  with  lymphoid 
cells.  In  spite  of  the  slow  development  of  these 
new  growths,  a  cachectic  state  is  established,  the 
patient  suffers  from  grave  anajmia,  the  discharge 
from  the  tumors  is  exhaustive,  and  the  termination 
is  usually  lethal. 


Endocarditis  CoMPLicATrNG  Diabetes. — In  a  note 
presented  to  the  Paris  Acadfimie  des  Sciences  at  its 
session  of  March  0,  1882,  Dr.  LecorchC  called  atten- 
tion to  the  comparatively  frequent  occurrence  of 
endocarditis  as  a  complication  of  diabetes  mellitus. 
He  believes  it  to  be  occasioned  by  the  irritation  ex- 
erted upon  the  endocardium  by  blood  charged  with 
sugar.  In  eight  cases  o\it  of  fourteen  observed  by 
Dr.  Lecorche  the  patients  were  women.  Endocar- 
ditis appears  late  in  the  course  of  diabetes,  usually 
two  or  three  years  after  the  initial  symptoms.  It 
hastens  the  progress  of  the  disease  by  inducing 
anasarca  and  asthenia.  The  valves  usually  attacked 
are  the  mitral.  The  aortic  semi-lunar  valves  were 
affected  in  only  one  of  Dr.  L.'s  cases.  Atheroma  of 
the  arteries  was  observed  in  two  cases.  The  symp- 
toms are  those  of  endocarditis,  superadded  to  these 
referable  to  the  original  disease. — Gazette  des  Uo- 
pitaux,  March  U,  1882. 

The  Ocoureekce  op  Sugar  in  the  Seecm  op 
QSdematous  Tissues. — Dr.  Ottomar  Eosenbach,  of 
Breslau,  maintains  (Breslauer  Aerlzl.  Ztseh.,  No.  .5, 
1882)  that  sugar  is  an  almost  constant  ingredient  of 
those  cedematous  fluids  which  contain  only  small . 
amounts  of  albuminous  materials.  The  quantity  of 
sugar  present,  even  in  the  most  marked  cases, 
amounted  to  only  from  one-tenth  to  one-fifth  per 
cent,  of  the  trantuded  fluid.  The  transudations 
most  frequently  analyzed  by  Dr.  Eosenbach  were 
obtained  from  cedematous  subcutaneous  areolar  tis- 
sue, by  means  of  suitable  cnnuhe.  Sugar  was  also 
found,  however,  in  serum  withdrawn  from  the  pleu- 
ral and  peritoneal  cavities,  and  in  that  from  the 
cranium  of  a  hydrocephalic  child.  The  presence  of 
the  sugar  was  demonstrated  by  means  of  Trommcr's 
and  Fehling's  tests,  after  the  removal  of  all  albumin- 
ous ingredients  of  the  transudation  by  boiling  and 
filtration.  If  the  fluid  be  exposed  to  the  air  for  any 
length  of  time  the  quantity  of  sugar  rapidly  dimin- 
ishes, owing  to  the  occurrence  of  the  alcoholic  fer- 
mentation. Caretul  examinations  failed  to  detect 
sugar  in  the  urine  of  those  patients  from  whom  the 
saccharine  drop.sical  effusions  had  been  removed. 
The  author  was  unable  to  observe  any  difference  in 
the  relative  quantities  of  sugar  contained  in  transu- 
dations from  different  parts  of  the  body. — Allgemeine  ■ 
Med.  Central-Zeilung,  March  15,  1882. 

Treatment  of  Eabies  bt  Hoang-nan. — M.  Gin- 
geot  recently  reported,  to  the  SocietC  Mf  dicale  des  ■ 
Hopitaux,  a  case  of  rabies  treated  with  hoang-nan. 
His  experience,  in  this  case,  led  him  to  the  follow- 
ing conclusions  :  1.  There  is  reason  to  believe  that- 
this  drug  may  prove  etficacious  in  the  treatment  of  ' 
i-abies.     2.  It  should  not  be  administered  by  the 
mouth  because  it  is  apt  to  induce  dysphagia  and 
emesis.     3.  The  hypodermic  injection  of  a  ten  per 
cent,  aqueous  solution  of  the  alcoholic  extract  of ' 
hoang-nan  furnishes  the  best  method  of  administra- 
tion.    4.  The  injections  should  be  made  at  short  in- 
tervals.    5.  The  maximum  dose  cannot  be  defined 
beforehand,  in  any  individual  case.     The  injections, 
should  not  be  suspended  until  symptoms  of  intoler- 
ance, which  usually  appear  simultaneously  with  the 
therapeutical  efl'ects,  are  established. — Le  Coiirrier  ■ 
Medical,  February  25,  1882. 

Is  UHICiBMIA  A  PliEMONITORT  SYMPTOM .  OP  DIA- 
BETES?— Dr.  Coignard  publishes  in  the  Jotirnal  de 
Therapeutiijue,  certain  original  views  relating  to  the 
etiology  and  the  2Jrognosis  of  diabetes  mellitus.  Dr. 
C.  is  of  the  opinion  that  an  excess  of  uric  acid  in.. 


516 


THE  MEDICAL  RECORD. 


the  urine,  not  referable  to  other  causes,  is  a  pre- 
monitory symptom  of  diabetes.  This  theory  rests 
upon  extended  clinical  experience.  The  prognosis 
in  cises  of  diibates  characterized  by  the  excretion 
of  an  abnormally  large  quantity  of  urea,  but  by  an 
abnormally  small  amount  of  uric  acid,  is,  according 
to  Dr.  C,  comparatively  favorable. — Le  Gourrier 
Medical,  March  4,  1882. 

Spoxianeoos  Falling  op  the  Nails  in  Locomotor 
Ataxia. — Prof.  A.  Pitres,  of  Bordeaux,  reports  (Le 
Progres  Medical,  February  25,  1882)  two  cases  of 
locomotor  ataxia,  attended  by  spontaneous  and  in- 
termittent falling  of  the  nails  of  the  great  toes. 
Several  weeks  before  the  falling  of  the  nails,  there 
was  dull  pain  in  the  extremity  of  the  affected  toes, 
but  there  was  neither  suppuration  nor  ulceration  of 
the  matrix.  The  fallen  nails  were  rapidly  replaced 
by  newly  formed  normal  ones.  No  injury  had  been 
inflicted  upon  the  nails.  Prof.  Pitres  believes  that 
the  phenomenon  in  question  is  referable  to  deranged 
nutrition  of  the  matrix  dependent  upon  the  medul- 
lary lesions  attending  tabes  dorsalis. 

Nerve-Stbetchino. — -MM.  Duret  and  Bonnaire 
contribute  a  paper  to  La  Progres  Medical,  March  4, 
1882,  bearing  upon  the  history  and  the  results  of 
nerve-stretching.  They  contend  that  the  results  of 
the  operation  have  been  fairly  satisfactory.  Elon- 
gation of  the  nerves  impairs  their  sensory  but  not 
their  motor  functions,  producing  a  greater  or  less 
degree  of  anassthesia  according  to  the  force  em- 
ployed. The  operation  produces  marked  patholo- 
gic.ll  changes  in  the  vasa  vasorum  ;  the  vessels  of  the 
stretched  nerves  become  dilated  and  sinuous,  even 
the  capillaries  participating  in  this  change.  Eight 
or  ten  days  after  the  operation,  embryonic  connec- 
tive tissue  and  newly  formed  vessels  are  found  in 
tbe  nerve-trunks.  Capillary  hemorrhages  may  result 
from  the  elongation,  but  while  the  medullary  layer 
and  axis  cylinder  are  sometimes  divided,  the  sheath 
of  Schwann  remains  unbroken.  Certain  degen- 
erative changes  subsequently  occur.  The  degener- 
ated fibres  are  usually  situated  in  the  perijihery  of 
tlio  nerve  trunks,  and  extend  from  the  point  of  trac- 
tion almost  to  tlie  roots  of  the  nerves  concerned. 
In  the  cases  studied  by  the  authors,  the  degenera- 
tion consisted,  during  the  first  few  days,  in  the  dis- 
appearance of  the  myeline  and  of  the  axis  cylinder 
in  many  of  the  fibres.  Later  it  was  characterized 
by  hyperplasia  and  hypertrophy  of  the  fibres  and 
by  proliferation  of  the  nuclei  in  the  inter-annular 
segments.  Lesions  in  the  cord  and  tlie  medulla 
may  follow  nerve-stretching.  M.  Duval  observed 
ecchymoses  and  congestion  of  the  medulla  after 
elongation  of  the  pur  vitgiim.  Considerable  force 
may  be  applied  to  a  large  nervous  trunk  without 
rupturing  it,  l)ut  it  is  not  admissible  to  employ  more 
than  fifteen  kilogrammes  (thirty-two  pounds),  even 
in  elongating  the  sciatic  or  the  median. 

Artificial  CuKAUE. — At  the  session  of  the  Paris 
Socirti'  do  Biologic,  held  February  25,  1882,  M. 
Rabuteau  described  a  now  drug,  tlio  pliysical,  chemi- 
cal, anil  physiological  eflects  of  which  are  identical 
with  those  of  curai-e.  It  is  a  whiie  salt,  has  a  bitter 
taste,  and  issolublein  wateraml  alcohol.  Chemically 
considered,  it  is  the  iodide  of  mothyltriethyl  sti- 
bium. It  resembles  iodide  of  pota.ssium,  and  turns 
blue  in  the  presence  of  starch.  The  effect  of  the 
new  drug  is  to  annul  nervous  irritability  without 
impairing  muscular  contractility. — J^e  Progi-es  Medi- 
cal, March  4,  1882. 


Gbinbelia  Eobusta  in  Asthma  and  Bronchitis. — 
Some  time  ago  we  recounted  some  favorable  results 
from  the  use  of  grindelia  robusta,  reported  to  the 
King's  County  Medical  Society  by  Dr.  T.  M.  Eoches- 
ter.  Dr.  Rochester's  paper  was  referred  to  the 
therapeutic  committee,  which  has  recently  made  its 
report. 

This  is,  on  the  whole,  rather  against  the  drug, 
though  the  number  of  cases  is  extremely  small  for  a 
therapeutic  committee  to  base  an  opinion  upon. 

Dr.  A.  Segur,  of  this  committee,  gives  eases  of  the 
use  of  the  drug  in  bronchitis.     He  says  : 

"  Pirst. — No  ijurely  spasmodic  asthma  was  treated. 

"  Secoyid. — One  old  asthmatic  woman,  who  had 
marked  emjjhysema,  took  fifteen  minims  of  the  medi- 
cine every  two  hours  for  a  fortnight.  It  did  not  dis- 
turb the  stomach,  and  a  gradual  and  decided  reUef 
in  the  number  and  severity  of  the  paroxysms  was  ob- 
served. 

"  Third. — A  man,  with  chronic  bronchitis  for  four 
months,  and  severe  paroxysms  of  asthma,  who  had 
taken,  without  relief,  iodide  of  potassium  and  ano- 
dyne expectorants,  and  inhaled  the  fumes  of  nitre 
paper,  was  promptly  and  permanently  benefited  by 
the  grindelia  ;  fifteen  minims  every  three  hours. 

"  Fourth. — During  the  two  months  every  case  of 
bronchitis,  acute  or  chronic,  or  in  phthisical  patients, 
were  given  the  grindelia,  usually  fifteen  minims  every 
two  hours. 

"  Expectoration,  cough  and  respiration  were  usu- 
ally favorably  modified,  but  not  in  a  degree  markedly 
different  from  the  effects  of  various  other  treat- 
ments. 

"Frequently  the  medicine  would,  after  a  few  days, 
produce  headache,  and  would  have  to  be  suspended. 
It  was  usually  well  borne  by  the  stomach. 

"  Fifth. — In  two  cases  of  asthma,  in  private  prac- 
tice, I  have  used  grindelia.  In  one  with  marked 
benefit ;  in  one  with  none  at  all." 

Dr.  Charles  L.  De  La  Vergne  reports  that  in  three 
cases  of  spasmodic  asthma  there  was  much  improve- 
ment ;  in  four  others  there  was  none. 

Dr.  William  M.  Thallon  reported  two  classical  and 
obstinate  cases  of  spasmodic  asthma,  both  of  which 
were  rapidly  and  permanently  relieved  by  half- 
drachm  doses  of  fluid  extract  of  grindeli.'c  robust., 
q.  4  h.  to  q.  2  h. 

Dr.  J.  A.  McCorkle  reported  three  cases  of  spas- 
modic asthma,  in  which  grindelia  was  ineffectual. 
The  disease  was  relieved  by  potas.  iodid.  and  ar- 
senic. Dr.  McCorkle  says  (basing  his  opinion  ap- 
parently on  the  three  cases)  : 

"From  my  observation  of  grindelia  robusta,  I  am 
led  to  the  belief  that  in  pure  spasmodic  asthma  it  is 
of  little  value.  In  the  catarrhal  forms  we  might  ex- 
pect better  results,  on  account  of  the  oleo-resin  it 
contains,  and  its  demulcent  ])roperties.  In  my 
judgment  the  drug  has  no  special  medicinal  virtue 
to  recommend  it  above  many  other  and  better  known 
remedies  of  its  class. 

"  Its  action  is  that  of  a  nauseating  and  stimula- 
ting expectorant.  Its  high  pi'ice  and  nauseou.s  taste 
are  against  it,  when  compared  with  other  less  ex- 
pensive and  more  palatable  drugs. 

"  Certain  cases  of  asthma  arc  undoubtedly  re- 
lieved by  its  use  ;  also  many  by  that  very  depressing 
agent,  lobelia,  while  the  great  majority  will  yield 
kindly,  and  somewhat  jiernianently,  to  the  action  of 
potassium  iodide  and  arsenic." 

Dr.  Alex.  Hutchins  had  used  the  drug  in  a  num- 
ber of  cases  of  dyspmea.  He  did  not  find  it  effica- 
cious. 


THE  MEDICAL  RECORD. 


517 


The  Dangers  fbom  Cakui^i:  in  Tbachbotomy,  and 
THE  Proper  KiXD TO  Use.— In  the  Annahof  Anntmiu/ 
and  Sta-geiy  for  January,  Dr.  Henry  J.  Garrigiies 
gives  a  synopsis  of  an  elaborate  monograph  by  Dr. 
Oscar  Bloch,  of  Copenhagen,  on  the  above  subject. 
After  a  reriew  of  the  injuries  that  may  be  caused  by 
the  tracheotomy-tubes,  he  says:  "The  chief  point 
in  the  preventive  treatment  is  to  use  a  proj)er  canu- 
la.  After  giving  in  detail  the  measurements  of  the 
trachea,  as  found  by  different  surgeons,  and  the 
width  of  different  canuhe,  the  author  recommends 
the  following  dimensions  of  the  outer  canula  : 


Age. 

Circiiinference. 

Diameter. 

0-1  year. 

17      mm. 

^l 

mm. 

1-2  years. 

21 

7 

2-3     " 

24       " 

8 

" 

3-5     " 

27       " 

9 

5-7     " 

30       " 

10 

Above  7    " 

31^7  " 

lOi 

-155  " 

"  For  general  practitioners  he  advises  especially 
to  keep  the  three  sizes  designed  for  children  between 
one  and  five  years. 

"  The  length,  as  commonly  used,  is  ■l.S-S  ctm.,  and 
that  is  satisfactory.  As  to  shape,  he  gives  the  pref- 
erence to  Parker's  model,  with  the  open  angle  and 
sloping  lower  aperture.  The  canula  ought  to  be  of 
silver,  with  movable  neck-plate.  If  the  presence  of 
an  irlceration  in  the  trachea,  due  to  pressure,  has 
been  diagnosticated,  a  silver  canula  of  a  different 
length  may  be  used,  or  it  may  be  replaced  by  Mor- 
rant  Baker's  canula  of  red  vulcanized  rubber,  or  by 
a  simple  drainage-tube  of  the  same  material,  retained 
by  a  large  safety-pin  placed  transversely  to  the  di- 
rection of  the  wound  in  the  neck. 

"  If  no  canula  be  obtainable,  a  simple  drainage- 
tube  may  be  used,  or  the  lips  of  the  wouud  kejjt 
apart  by  a  couple  of  hair-pins. 

"Xine  cases  of  fatal,  hemorrhage  from  pressure  of 
the  trachea  are>elated.  In  eight  others  the  innom- 
inate artery  was  found  to  be  separated  from  the 
canula  by  a  thin,  fibrous  membrane,  which  would 
soon  have  given  way.  Still,  as  a  rule,  the  pressure 
of  the  canula  is  not  dangerous. 

DrPHTHERIA — SUBDEN    DeaTH   DJ    CoNTAIiESCENCE. 

— ^Dr.  W.  H.  Johnson,  of  Selma,  Ala.,  sends  us  the 
history  of  a  jjatient,  aged  seven,  sufl'ering  from  diph- 
theria. The  child  was  treated  with  a  mixture  of 
tinct.  ferri  mnriat.,  TI\  viij.,  and  potas.  chlorat.,  gr.  iv., 
in  glycerine  and  water,  every  two  hours,  night  and 
day.  The  nostrils  were  washed  out  with  a  solution 
of  boracic  acid  and  hyposuljihite  of  soda.  The 
throat  was  touched  three  times  daily  with  a  mixture 
of  tannic  acid  and  tincture  of  iron  in  glycerine. 
Abundant  food  and  stimulants  were  given.  At  the 
end  of  the  seventh  day,  evidences  of  great  imjjrove- 
ment  had  appeared  and  convalescence  was  nearly 
established.  Suddenly,  after  having  had  a  large 
movement  from  the  bowels,  the  patient  turned  on 
her  side  and  in  a  moment  was  dead. 
Dr.  Johnson  makes  the  following  remarks  : 
"  Until  the  last  morning  I  had  but  little,  if  any, 
doubt  of  the  ultimate  recovery  of  my  patient.  The 
swelling  in  her  neck  had  disappeared  and  only  a 
small  deposit  was  left  in  her  throat,  and  she  was 
taking  plenty  of  nourishment  up  to  twelve  or  four- 
teen hours  preceding  her  death.  The  only  symptom 
that  gave  me  any  anxiety,  after  the  vomiting  ceased, 
was  the  rapid  fall  in  the  pulse.  At  6  p.m.,  on  loth, 
pulse  was  117;  and  on  the  morning  of  16th,  at  8  a.m., 


pulse  was  84,  and  all  other  symptoms  favorable,  and 
I  considered  that  also  favorable.  The  same  after- 
noon, at  6  P.M.,  it  was  70  and  still  no  other  symp- 
toms to  account  for  this  rapid  and  steady  fall  in  the 
pvdse.  The  volume  was  good,  and  fair  strength  to 
the  beat.  On  the  morning  of  the  17th,  pulse  was  48, 
but  she  had  been  vomitting  most  of  the  night ;  at 
such  a  time  I  expect  to  find  a  frequent  and  feeble 
pulse.  This  pulse  reminded  me  very  much  of  one 
that  had  been  reduced  by  giving  veratrum.  Could 
the  chlorate  of  potash  in  the  doses  given  have  slowed 
her  pulse  ?  Never  in  any  other  case  has  it  so  acted 
with  me. 

"I  have  no  doubt  this  child  had  diphtheria  two  days 
before  treatment  was  commenced.  I  knew  of  no 
cases  in  town  and  did  not  examine  her  throat. 

"I  have  almost,  if  not  altogether,  absolute  faith  in 
the  iron  and  potash  treatment  rchen  ccmymenced  uiikin 
twenty-fonr  hours  from  the  onset  of  the  disease,  and 
when  the  patient  will  lake  the  medicine  and  nonrishment 
day  and  night,  and  as  given  ahote.  I  have  treatfd 
many  of  these  patients  before,  and  never  hod  one 
die  under  this  treatment,  when  seen  during  the  first 
twenty-four  hours.  I  know  there  are  mspy  mild 
cases  that  will  get  well  under  alrrost  any  kind  rf 
treatment.  But  even  in  this  case  the  swelling  in  the 
neck  (the  anterior  surface  of  neck  was  nearly  on  a 
level  with  her  chin)  had  disappeared,  and  the  de- 
posit had  all  gone  but  a  slight  patch.  The  note 
had  become  clear.  I  am  satisfied  this  was  due  alone 
to  the  ii'on  and  potash. 

"  I  did  not  at  any  time  examine  her  urine.  The 
kidneys  acted  throughout  the  disease  and  her  mind 
was  clear.  Fifteen  minutes  before  death  she  asked 
for  milk  and  drank  it.  She  was  not  permitted  to 
raise  herself  when  her  bowels  acted  the  last  time, 
and  she  died  without  a  struggle.  Her  attendants 
stated  everything  seemed  to  be  goirg  on  well  up  to 
the  time  of  the  movement  of  her  bowels.  Had  I 
been  sent  for  during  the  night  I  should  have  given 
stimulant  and  nutrient  enemas,  and  put  nothing  in 
the  stomach.  I  saw  her  in  the  morning,  noon,  and 
evening  throughout  the  disease.  Twenty-four  hours 
before  her  death  I  had  no  doulit  in  my  own  mind  of 
her  recovery.  I  thought  the  immediate  cause  of 
death  was  paralysis  of  the  heart." 

A  Hospital  fop.  the  Miners. — It  is  stated  that 
Mr.  Moses  Taylor  has  given  .S'i.oOjOOO  in  first  mort- 
gage bonds  of  the  New  York,  Lackawanna  A-  West- 
ern road  for  the  purjjose  of  founding  and  main- 
taining a  hospital  at  Scranton  for  the  benefit  of 
miners,  railroad  men,  iron-workers,  and  others.  The 
value  of  the  bonds  makes  the  gift  equal  to  §270,000. 
The  hospital  will  be  under  such  rules  and  regula- 
tions as  may  be  adopted  by  the  trustees.  President 
Hatfield,  of  the  Lackawanna  Iron  and  Coal  Com- 
pany, and  President  Sloan,  of  the  Delaware,  Lack- 
awanna k  Western  Company.  The  need  of  such 
a  hospital  is  very  great.  Last  year  alone,  forty-four 
men  were  killed  in  the  mines  of  this  valley,  and 
more  than  twice  that  number  were  maimed  at  their 
work.  Scarcely  a  day  passes  without  an  accident 
in  which  some  man  or  boy  is  injured. 

Work  of  the  Medical  Mission. — The  report  of 
the  New  York  Medical  Mission  for  the  first  quarter 
of  1882  shows  that  the  number  of  new  cases  apply- 
ing for  relief  was  740.  Attendance  has  been  given 
at  the  dispensary  to  1,782  persons,  and  .579  visits 
have  been  paid  to  sick  persons  at  their  homes.  The 
mission  will  remove  to  No.  81  Roosevelt  Street. 


5.8 


THE  MEDICAL  RECORD. 


The  Medical  Recoed: 

^  iDccklj)  lournal  of  fllcbicine  anb  Suvgeru 


GEORGE  F.  SHRADY,  A.M.,  M.D.,  Editor. 


PUBLISHED   BY 
Wm.  irOOD  &  CO.,  no.  27  Great  Jones  St.,  N.  ¥. 

New  York,  May  13,  1882. 

VEGETABLE  PATHOLOGY  AND 
TERATOLOGY. 

The  subject  of  vegetable  pathology  has  of  late  been 
urged  upon  the  attention  of  physicians.  It  is  a 
branch  of  science  as  yet  almost  unknown,  but  one 
which  might  well  broaden  the  doctor's  knowledge  as 
well  as  amuse  his  leisure  hours.  Since  Sir  James 
Paget,  two  years  ago,  so  eloquently  discussed  its 
merits,  there  have  been  a  few  short  contributions 
from  English  writers.  Recently,  Dr.  T.  J.  Burrell 
has  written  an  article  {Science),  showing  much  intel- 
ligence and  eai-nestness,  upon  the  subject  in  ques- 
tion. The  physician,  and  especially  the  rural  prac- 
titioner, can  learn  from  it  that  there  is  much  more 
in  the  phenomena  of  plant-life  about  him  than  he 
has  ever  suspected. 

Plants  are  not  subject  to  acute  diseases,  unless  we 
consider  their  occasional  rapid  destruction  by  cer- 
tain fungi  as  such.  When  a  limb  is  lopped  off,  it  is 
a  whole  year  in  healing  ;  great  injuries  to  one  part 
do  not  affect  the  rest,  unless  the  supply  of  nour- 
ishment is  cut  off.  This  sloimiess  of  change  and 
physiological  independence  of  parts  is  due  to  there 
being  no  nervous  system  in  plants  and  to  the  very 
moderate  rate  of  the  circulation.  The  sap  in  a  tree 
ascends,  at  its  best,  at  the  rate  of  only  a  foot  an 
hour.  The  circulation  is  but  a  kind  of  soaking. 
Vegetable  pathology  has  to  do  chiefly,  therefore, 
■with  chronic  and  generally  with  local  disease. 

Yet  this  is  not  all.  The  protoplasm  of  plants,  like 
that  of  animals,  is  plastic  and  susceptible  to  modifi- 
cations. New  varieties  can  be  quHe  readily  formed 
and  perpetuated  by  inheritance.  These  new  varie- 
ties have  an  independence  of  environment  peculiar  to 
vegetable  protoplasm.  This  is  seen  by  the  grafting 
of  good  fruit  on  bad.  In  this  way  one  can  almost 
g.ither  "  figs  from  thorns  and  grapes  from  thistles." 
Furthermore  a  careful  study  of  many  of  the  new 
forms  which  florists  and  gardeners  display  wiU  show 


that  they  are  really  monstrosities,  as  really  so  as 
the  armless  man  or  the  giant  Chang.  The  cabbage 
is  the  succulent  illustration  of  an  enormous  hyper- 
trophy. From  the  standpoint  of  the  normal  rose, 
the  Marshal  Niel  is  a  distorted  outcast.  Many 
other  beautiftil  flowers  and  leaves,  as  well  as  favorite 
vegetables,  are,  strictly  speaking,  morbid  specimens. 
Vegetable  pathology  is  therefore  linked  closely  to 
teratology. 

The  two  kinds  of  disease  referred  to  by  Dr.  Bun-eU 
as  being  most  prominent  are  those  produced  by 
certain  animal  poisons,  i.e.,  the  bites  of  insects,  and 
those  resulting  from  the  presence  of  parasites  and 
fungi.  The  bites  of  insects  produce  various  forms 
of  galls,  which  illustrate  remarkably  the  processes 
of  disease  in  plants.  Different  insects  produce  dif- 
ferent neoplasms,  and  there  seems  to  be  something 
truly  specific  in  the  animal  poison  which  excites 
their  growth.  There  are  hundreds  of  varieties  of 
galls  easily  distinguishable,  and  each  one  owes  its 
existence  to  a  different  agent.  There  are  also  in- 
sects whose  bites  produce  morbid  effects  different 
from  that  of  the  gall. 

The  number  of  parasites  which  infect  plants  is 
enormous.  There  is  hardly  a  flowering  plant  in  the 
country  which  is  not  injuriously  affected  by  one  or 
more  fungi  which  prey  upon  it.  The  gi'apevine 
alone  is  attacked  by  at  least  thirty  .species  of  fungi. 
In  some  cases  the  plant  must  be  first  injured,  per- 
haps its  epidermis  be  broken,  before  it  can  be  af- 
fected. But  this  is  not  always  necessaiy.  The  mor- 
bid changes  which  these  jiarasites  indiice  are  mani- 
fold, the  "rust"  on  wheat,  the  "scab"  on  apples, 
the  rot  in  potatoes  and  in  fruits,  all  represent  the 
activity  of  foreign  and  antagonistic  elements. 

There  is,  as  yet,  little  known  regarding  most  of 
the  deeper  changes  in  vegetable  pathology.  It  is  a 
fi-uitful  field  for  the  doctor  who  would  select  for 
himself  a  "hobbv." 


DOCTOBS    FEES   IN   liONDON  AST)   ON  THE  CONTrNENT. 

The  fees  of  the  London  consultant  are,  for  a  first 
visit  three  to  five  guineas,  for  a  first  office  consulta- 
tion two  guineas,  for  subsequent  calls  one  guinea. 
There  is  this  objection  to  the  system  in  London, 
which  does  not  hold  in  New  York  :  it  is  not  consid- 
ered etiquette  to  charge  loss  than  a  guinea ;  hence 
many  young  men  have  to  suffer,  as  well  as  many 
patients.  The  custom  is  a  bad  one,  since  it  tends 
to  help  the  big  men  and  injtire  young  physicians. 

On  the  Continent,  in  France  and  Germany,  there 
is,  according  to  the  Pall  Mall  Gmetle,  a  regular 
tariff  for  the  visits  of  medical  practitioners,  often — 
indeed  generally — exceeded  by  rich  patients,  but 
affording  a  guarantee  against  excessive  charge  for 
the  poorer.  It  is  also  a  satisfaction  to  the  public 
mind  generally  to  know  exactly  what  they  will  have 
to  pay  when  calling  in  a  doctor.    There  is  another 


THE  MEDICAL  RECORD. 


519 


point  of  medical  etiquette  in  North  Germany. 
Except  in  cases  of  severe  illness,  when  daily  attend- 
ance is  absolutely  necessary,  a  doctor  never  repeats 
a  visit.  He  must  be  requested  to  do  so.  This  cus- 
tom lias  its  advantages,  as  it  -svill  often  happen  in 
oases  of  slight  illness  that  a  single  visit  suflSces.  If 
medical  fees  are  too  high  in  England,  they  are  too 
low  in  Germany  and  France  (2  marks  and  2  francs 
visit),  excepting,  of  course,  in  the  fashionable 
watering-places,  whither  none  but  rich  folks  must 
betake  themselves. 


OHINOLIN   IN   THE   TREATMENT   OF   ^\-H0OPING-COTJGH. 

The  manufacture  of  chinolin,  a  substance  closely 
related  chemically  to  quinine,  has  excited  consider- 
able attention.  It  was  hoped  that  it  might  do  the 
work  of  quinine,  while  it  could  be  furnished  at  a 
much  less  price.  The  drug  can  be  made  in  several 
ways.  That  described  by  Dr.  G.  Koch,  of  Wies- 
baden, consists  in  the  addition  of  glycerine  and  sul- 
phuric acid  to  aniline,  or  nitro-benzole.  The  reac- 
tion is  as  follows:  CnHiNO^  (nitro-benzole) -t-CsH, 
O,  (glycerine)  =  C,H,N  (chinolin)  -l-H,0-)-Os.  The 
chinolin  is  then  turned  into  a  tartrate,  in  which 
form  it  keeps  well,  and  has  no  very  disagreeable 
taste. 

Chinolin  has  been  used  considerably  as  a  substi- 
tute for  quinine  in  ague  and  in  fevers,  but,  bo  far, 
with  poor  success.  Recently,  however.  Dr.  Koch 
has  announced  (Berlhier  Klinische  Wocheyisclirifl) 
that  it  acts  very  favoi'ably  in  whooping-cough. 

This  disease  is  one  for  which  a  long  list  of  reme- 
dies has  been  recommended.  No  drug  has  yet 
been  found,  however,  about  whose  value  there  is 
any  wide  agreement,  and  many  physicians  are  very 
sceptical  as  to  drugs  being  of  muoh  use.  Whooping- 
cough  is  a  self-limited  disease,  running  its  course  in 
ten,  twelve,  or  eighteen  weeks.  It  is  hard,  there- 
fore, to  tell  whether  a  medicine  has  really  helped  it. 

Dr.  Koch  claims  for  chinolin  that  it  shortens  the 
duration  of  this  malady,  and  makes  the  symptoms 
milder.  He  reports  eighty-five  cases  treated  with 
the  new  remedy.  The  patients  were  between  one 
and  ten  years  of  age.  In  thirteen  cases  the  symp- 
toms of  the  disease  stopped  within  two  weeks  ;  in 
twenty-one  cases  within  three  weeks  ;  in  nineteen 
cases  within  four  weeks.  The  average  duration  in 
the  eighty-five  oases  was  4.2  weeks.  In  many  of 
them,  where  the  symptoms  continued  for  seven, 
eight,  or  nine  weeks,  the  patients  had  an  intercur- 
rent disease,  or  did  not  take  the  medicine  regularly, 
or  else  were  feeble  and  unhealthy.  The  daily 
amount  used  was  from  gr.  iv.  to  gi-.  xv.,  given  usu- 
ally in  divided  doses,  every  three  hours.  It  is 
stated  that  the  effect  of  the  drug  was  to  make  the 
whooping  and  spasmodic  character  of  the  cough 
disappear  very  soon,  so  that  the  child  seemed  to 
suffer  only  from  a  bronchial  catarrh.     Our  author 


quotes  his   colleague,  Dr.  Slefeld,   as  stating  that 
chinolin  is  very  efficacious  in  bronchial  catarrh. 

Dr.  Koch's  statistics  should  carry  some  weight. 
Nevertheless  they  are  deficient,  in  that  he  does  not 
state  at  what  period  in  the  disease  he  began  to  use 
the  drug  he  recommends. 


THE   BRAINS   OF   CRIMINALS. 

Some  time  ago  Benedikt,  of  Vienna,  published  a 
work  on  the  brains  of  criminals.  As  a  result  of  his 
studies  he  concluded  that  "chronic"  evil-doers  had 
a  different  kind  of  brain  from  ordinal^  persons  and 
were,  in  fact,  an  anthropological  variety  of  their 
species.  The  distinguishing  characteristics  of  the 
criminal's  brain  are,  according  to  this  author,  1st, 
the  confluence  of  many  of  the  primaij  fissures  ;  2d, 
the  existence  of  four  instead  of  three  frontal  convo- 
lutions. A  typically  criminal  brain  is  one  in  which, 
"  if  we  imagine  the  fissures  to  be  watercourses,  a 
body  floating  in  any  one  of  them  could  enter  all  the 
others."  The  existence  of  an  extra  frontal  fissure  is 
thought  to  indicate  a  reversion  to  the  type  in  certain 
lower  animals,  i.e.,  carnivora. 

Since  Benedikt  first  announced  this  view  he  has 
made  further  researches  and  now  bases  his  conclu- 
sions upon  the  examination  of  eighty-seven  hemi- 
spheres from  forty-four  criminals.  In  somewhat  over 
half  of  these  cases  the  fissure  of  Eolando  communi- 
cated with  one  or  more  other  fissures.  In  about  two- 
thirds  of  the  hemispheres  the  fissure  of  Sylvius 
communicated  with  other  fissures,  especially  the  in- 
terparietal and  the  fissure  of  Rolando.  The  inter- 
parietal fissure  always  had  one  or  more  communi- 
cations with  its  lesser  neighbors. 

The  greater  preponderance  of  fissures  indicated, 
it  was  thought,  a  deficiency  in  the  associating  or 
connecting  fibres  of  the  convolutions  and  hence  a 
lower  structual  type. 

The  radical  conclusions  announced  by  Benedikt 
have  naturally  been  received  with  much  distrust,  a 
distrust  somewhat  heightened  by  the  peculiar  repu- 
tation of  this  author.  It  is  not  denied  that  his  spe- 
cial observations  are  in  the  main  correct,  but  it  must 
be  shown  that  the  peculiarities  which  he  found  were 
not  racial,  or  accidental,  or  were  not  found  in  other 
classes.     This  he  has  not  yet  shown. 

A  recent  contribution  by  an  American,  Dr.  Wm. 
Osier,  of  Montreal,  has  thrown  additional  light  upon 
the  matter.  He  has  examined  the  brains  of  two  ex- 
ecuted criminals  and  also  sixty-three  hemispheres 
from  thirty-four  individuals  who  died  in  the  Mon- 
treal General  Hospital.  He  found  that  the  brains  of 
the  two  criminals  showed  the  confluent  type  to  only 
a  slight  degree.  In  one  hemisphere  there  were  four 
frontal  convolutions.  Of  the  hospital  brains  he 
found  a  considerable  proportion  having  the  confluent 
fissure  type,  though  with  not  quite  so  marked  fissural 
connections  as  Benedikt  describes.    Hemispheres 


520 


THE  MEDICAL  RECORD. 


with  four  frontal  convolutions  were  found  in  a  few 
cases.  The  conclusion  drawn  is  that  we  cannot  yet 
tell  what  the  confluent  fissures  and  extra  frontal 
gyri  indicate.  Certainly  they  do  not  necessarily 
show  that  the  brain  is  an  inferior  one,  for  they  may 
exist  with  a  very  rich  convolution  system. 

The  collapse  (and  we  might  give  other  reasons  for 
considering  it  such)  of  Benedikt's  attempt  to  furnish 
an  anatomical  basis  for  crime  does  not  mean  that 
such  attempts  will  end.  It  is  the  tendency  of  mod- 
em physiological  science  to  make  mental  states  en- 
tirely dependent  on  material  structure.  The  doc- 
trine teaches  that  a  man's  mind  is  as  much  the  slave 
of  his  brain  cells  as  his  digestion  is  of  his  stomach. 
He  is  in  the  clutches  of  an  anatomical  fatalism.  His 
inherited  tissues  modified  somewhat  by  education 
alone,  shape  his  moral  character  and  destiny. 

Benedikt's  effort  to  formulate  this,  even  now, 
widely  entertained  view  of  man  should  at  least  call 
the  attention  of  students  to  the  jsroper  methods  of 
meeting  so  great  an  innovation  upon  the  older  theo- 
ries of  responsibility. 


FREEIDOM   IN    CONSTOTATIONS. 

The  opinion  of  the  learned  jurist,  Prof.  Theodore 
L.  Dwight,  upon  the  subject  of  freedom  in  consul- 
tations, published  in  another  column,  will  doubtless 
command  a  wide  reading.  Especially  will  this  be 
the  case  among  those  who  are  still  unsettled  in  their 
convictions  as  to  the  wisdom  of  the  State  Society  of 
New  York  in  making  such  a  provision  in  its  new 
code.  It  is  fair  to  presume  that  the  views  expressed 
in  his  communication  are  entirely  unprejudiced,  and 
are  based  on  those  general  principles  of  law,  equity, 
and  morality  which  should  govern  men  in  all  their 
varied  relations  to  the  community  and  to  each  other. 
As  such  they  will  doubtless  have  their  due  weight. 

Trichinosis  jn  American  Swine.— A  discussion 
was  recently  held  in  the  Paris  AcadCmie  des  Sciences, 
regarding  trichinosis  in  American  pigs  and  the  pro- 
hibition of  the  importation  of  pork  from  this  country 
(Le  Courrier  Medical,  March  4,  1882).  The  major- 
ity report  of  the  committee  charged  with  the  inves- 
tigation of  the  subject  embodied  the  resolutions 
here  briefly  subjoined  :  liesohe.d.  That  it  is  unne- 
cessary to  subject  pork  imported  from  America  to  a 
microscopical  examination,  with  a  view  to  ])revent- 
ing  the  development  of  tricliinosis  in  the  consumers 
of  this  meat,  because  the  culinary  ))rocesses  ii(lf>pted 
by  the  consumers  are  found  to  comi)l('teIv  f^'uard  them 
from  infection.  Kesolred,  That  special  circulars  be 
distributed  by  the  government  among  the  rural 
population,  for  the  purpose  of  warning  against  the 
danger  accruing  from  the  use  of  raw  or  uncooked 
pork.  Those  resolutions  were  adopted  by  an  im- 
mense majority,  and  forwarded  to  the  Minister  of 
Commerce. 

A  Bill  to  Reodlatb  Dentistry  is  before  the  Iowa 
Iiflgislature.  No  one  is  to  be  allowed  to  practise 
without  having  a  diploma  from  a  reputable  college. 


The  Human  Ear  and    its   Diseases.     A  Practical 
Treatise  upon  the  Examination,  Eecognition,  and 
Treatment  of  Affections  of  the  Ear  and  Associate 
Parts.     Prepared  for  the  instruction  of  Students 
and  the  Guidance  of  Physicians.     Bv  W.  H.  Wins- 
low,  M.  D.,  Ph.  D.     8vo,  pp.  ,'526.     New  York  and 
Philadelphia  :  Boericke  A-  Tafel.     1882. 
This   book   has   been  written  by  a  homceopathist, 
if  one  may  judge  by  the  names 'of  the  institutions 
and  the  society  with  which  his  name  is  associated 
on  the  title-page.     The  author  does  not  state  why 
he  thought  it  worth  while  to  write  a  book  on  the 
ear,  but  we  are  inclined  to  believe  that  he  wishes  to 
convey  the  idea  that  his  method  of  treatment  dif- 
fers from  that  of  the  regular  practitioner.     This,  on 
examination  of  the  book,  proves  to  be  true  to  a  cer- 
tain extent,  but  we  find  that  the  author  frequently 
runs  short  of  sectarian  remedies  and  has  to  resort 
to  the  time-honored  dnigs  of  the  "old  school."   But 
it  is  particularly  in  the  local  treatment  that  the  au- 
thor  seems   to   find   himself  very  much   at   home 
among   the  medical  and  surgical   methods  of  the 
"regular"  school.     In  some  instances  he  even  em- 
ploys means  that  are  no  longer  in  general  use.     If 
there  can  be  such  a  thing  as  over-treating  the  ear, 
as  has  been  hinted  in  some  quarters,  we  fear  the 
recommendations  of  the  author  would  render  him 
liable  to  such  a  charge. 

The  author's  experiments  with  the  nudiphone 
lead  him  to  agree  with  competent  authorities  as  to 
the  usefulness  of  such  aids  to  hearing  in  certain 
cases.  The  author  acknowledges  his  indebtedness 
to  Dr.  Charles  H.  Burnett's  standard  treatise  on  the 
ear,  and  he  has  also  made  liberal  use  of  Schwartze's 
work  on  the  pathological  anatomy  of  the  ear. 

The  book  is  well  printed,  and  the  type  is  com- 
mendably  large  and  clear. 

First  Aid  to  the  In.titred.     By  Peter   Shephebd, 
M.B.     American  revision  bv  Bowditch  Morton, 
M.D.     Ifimo,  pp.  88.    New  York  :  G.  P.  Putnam's 
Sons.     1882. 
There  are  many  emergency  books,  most  of  which 
are  addressed  to  the  profession.     In  this  little  work, 
however,  we  have  a  concise  manual,  wi-itten  with  the 
avowed  purpose  of  instructing  the  laity  as  to  what 
should  be  done  in  case  of  accident   before  the  ai^ 
rival  of  skilled  assistance.     It  is  prefaced  by  a  brief 
synopsis  of  the  points  in  anatomy  and  phvsiology, 
which   should  be   matters  of  common   knowledjje, 
none  but  the  simplest  of  technical  terms  being  in- 
troduced. 

The  Opitm  Habtt  and  Alcoholism.  By  Dr.  Fred. 
Theman  Hubbard.  8vo,  pp.  259.  New  York  :  A. 
S.  Barnes  .t  Co. 
This  work  is  conched  in  terms  calculated  to  render 
it  popular  with  the  laity  ratlier  tlian  with  the  medi- 
cal profession.  It  describes,  ipiite  accurntclv,  the 
train  of  morbid  jihenomena  induced  by  the  various 
drugs  concerning  the  aliuse  of  which  ittreats.  The 
curative  measures  proposed  are  partly  familiar  and 
partly  original  with  the  author.  He  recommends 
the  gradual  substitution  of  cannabis  indica  for 
opium  in  the  opium  habit.  His  treatment  of  dipso- 
mania consists  in  confining  the  ]iatient  to  foods 
thoroughly  flavored  with  a  mixture  of  various  li(|uors, 
until  a  disgust  for  all  spirituous  drinks  be  established,  j 
The  book  is  printed  with  worn  type  and  has  no  index. 


THE  MEDICAL  RECORD. 


521 


tHrports  of  Socirttc«. 


NEW  YORK  ACADE:\rY  OF  JIEDICINE. 

Stated  Meeting,  May  4,  1882. 

FoBDTCE  Barker,  M.D.,  LL.D.,  President,  in  the 
Chair. 

The  Librarian  acknowledged  the  reception  of  25!) 
bound  and  14  unbound  volumes,  160  pamphlets,  ami 
1,303  medical  journals.  Two  hundred  and  tifty-four 
bound  volumes  were  from  the  Hbrary  of  the  late  Dr. 
Bobert  A.  Barry. 

The  Statistical  Secretary,  Dr.  F.  V.  White,  an- 
nounced the  death  of  James  Rushmore  Wood,  M.D., 
LL.D.,  which  occurred  May  4,  1882,  in  the  sisty- 
fifth  year  of  his  age,  and  from  double  pneumonia. 

The  President  remarked  that  the  public,  the  pro- 
fession, the  Academy,  and  the  medical  institution  to 
which  he  belonged  had  met  with  a  great  loss  in  the 
death  of  Professor  Wood,  and  that  appropriate  action 
on  the  part  of  the  Academy  would  be  subsequently 
taken. 

Dr.  John  G.  Adams  then  read  a 

memoir  op   JAMES   OTIS   POND,  M.D., 

and  presented,  in  behalf  of  the  family,  a  crayon  por- 
trait of  the  deceased.  The  text  for  this  fitting 
tribute  was  "  The  faithful  steward." 

THE   EARLY   DIAGNOSIS   OP   CHRONIC   BRIGHT'S    DISEASE. 

The  discussion  on  Dr.  T.  A.  McBride's  paper  on 
the  above  subject  (see  vol.  xx.,  p.  607)  was  opened 
by  Dr.  W.  H.  Draper,  who  first  alluded  to  the  fact 
that  Bright  recognized  all  the  forms  of  kidney  dis- 
ease which,  since  his  time,  have  been  more  fully  de- 
scribed, although  he  offered  no  explanation  of  the 
morbid  conditions.  While  no  fixed  characteristic 
clinical  picture  of  the  diffei'ent  forms  of  the  disease 
had  been  established,  there  had  been  recognized  two 
varieties  of  chronic  nephritis :  1,  the  large  white 
kidney ;  2,  the  atrophied  kidney  ;  and  it  was  to  the 
latter  affection  that  special  reference  was  made  in 
Dr.  McBride's  paper  and  the  discussion  which  fol- 
lowed. It  was  that  insidious  form  of  the  malady 
which  never  began  with  any  symptoms  that  called 
attention  to  the  kidney  prominently  ;  in  which  alVm- 
minuria  might  never  be  a  prominent  symptom, 
might  never  be  detected,  and  in  which  dropsy  was 
never  an  initial  symptom,  etc. 

With  reference  to  this  affection — the  cirrhotic  kid- 
ney— Dr.  Draper  directed  attention  to  certain  points 
in  etiology. 

Firist — and  one  of  the  most  important  factors — 
keredit'/,  admitted  by  most  authorities  on  renal 
pathology.  In  this  connection  reference  was  made 
to  its  occasion.al  coexistence  with  glycosuria,  vascu- 
lar diseases,  as  cerebral  apoplexy,  and  with  ancestral 
cardiac  disease. 

Second. — The  existence  of  the  gouty  habit,  whether 
inherited  or  acquired.  There  was  a  pretty  general 
unanimity  of  opinion  among  clinical  observers  upon 
that  point.  Todd,  in  1846,  first  described  the  shriv- 
elled gouty  kidney. 

Although  a  frequent  complication,  it  was  regarded 
by  some  as  merely  a  coincident  associate  with  gout. 


Bartels  and  Dickinson  were  very  positive  in  their 
statomente  that  the  two  diseases  had  an  etiological 
relation.  Granger  Stewart  was  less  positive  in  his 
statements.  Garrod  distinctly  recognized  the  fre- 
ijuency  of  the  association  of  granular  kidney  with 
gout.  In  considering  gout  in  all  its  relations  Dr. 
Draper  regarded  it  as  essential  to  obsei-s'e  it  as  a 
general  disease,  of  which  lithaimia  and  trophic 
changes  were  important  factors. 

Third. — Senility. — The  cii-rhotic  kidney  was  a  dis- 
ease of  declining  years.  It  was  extremely  rare  under 
twenty  years  of  age  ;  the  largest  proportion  of  cases 
occurring  between  the  ages  of  thirty  and  sixty  years, 
a  period  in  which  the  general  failure  of  the  pro- 
cesses of  nutrition  occurred.  This  fact  pointed 
toward  the  conclusion  that  the  granwlar  kidney  was 
a  part  of  the  general  trophic  processes  induced 
either  by  the  limits  of  heredity  or  the  wear  and  tear 
of  life. 

All  these  factors  should  enter  into  the  study  of 
the  etiology  of  the  disease,  and  when  closely  anal- 
yzed pointed  strongly  toward  the  conclusion  that 
the  aflection  was  a  general  rather  than  local  one  ; 
and  that  renal  and  vascular  disease  have  a  common 
origin  in  blood  dyscrasia. 

The  theory  that  there  was  a  functional  stage  was 
one  which  the  observations  of  many  clinical  observ- 
ers tended  to  confirm.  For  example,  persistent  high 
specific  gravity  of  the  urine  had  been  regarded  as  an 
important  symptom  of  this  stage,  high  arterial  ten- 
sion, etc.  Dr.  Draper  believed  that  the  proper  ap- 
preciation of  the  functional  stage  of  the  granular 
kidney  was  to  be  found  only  in  the  proper  appre- 
ciation of  the  etiological  factors  considered  :  1, 
heredity,  2,  gouty  habit,  and,  3,  senility;  and,  prob- 
ably, then  only  a  conjectural  diagnosis  of  the  for- 
mative stage  would  be  reached. 

The  President  referred  to  the  fact  that  in  the 
discussion  of  the  subject  of  Bright's  disease,  which 
occurred  in  the  Academy  more  than  twenty  years 
ago,  the  relations  of  glycosuria  and  renal  disease 
were  set  forth  as  then  understood.  Since  that  time, 
however,  great  advance  had  been  made  in  etiology 
and  diagnosis,  but  the  subject  of  therapeutics  had 
not  received  the  attention  he  had  hoped  it  would, 
and  in  that  resjiect  he  asked  for  a  contribution  upon 
one  point — namely,  the  special  condition  of  the  heart 
in  which  digitalis'could  be  used  with  probable  bene- 
fit. With  discrimination,  he  had  found  it  an  exceed- 
ingly valuable  remedy  in  acute  albuminuria,  but  in  a 
certain  class  of  chronic  cases  it  had  seemed  to  him 
that  it  was  specially  contraindicated. 

Dr.  Andrew  H.  Smith,  in  reply  to  the  question 
put  by  the  President,  referred  to  the  quite  positive 
statement  made  by  FothergiU,  that  digitalis  acted  as 
a  diuretic  only  when  it  increased  arterial  tension. 
With  reference  to  the  general  therapeutics  of 
Bright's  disease,  he  had  found  that  the  milk  diet 
gave  very  satisfactory  results.  He  also  thought  it 
essential" that  the  patients  should  be  in  the  open  air 
as  much  as  possible.  He  asked  Dr.  Draper  if  gout, 
in  its  frank  condition,  occurring  among  those  who 
ride  and  hunt,  etc.,  was  as  liable  to  be  associated  with 
renal  disease  as  when  it  existed  in  persons  who  fol- 
lowed a  more  sedentary  course  of  life. 

Dr  S.  O.  Vander  Poel  referred  to  the  proposi- 
tions made  by  Dr.  Kinnicutt  in  his  paper  on  "  Tran- 
sient Albuminuria,"  and  mentioned  by  Dr.  Draper. 
The  propositions  were  :  "  First,  the  temporary  pres- 
ence of  a  large  amount  of  imperfectly  oxigenated 
matter  in  the  circulation.  Second,  di.sturbances  of 
the  general  nervous  system,  in  which  the  vaso- motor 


522 


THE  MEDICAL  RECORD. 


system  of  the  kidney  shares,  or  one  confined  to  the 
vdso-motor  system  of  the  kidney  in  its  elimination  of 
these  products  of  a  faulty  digestion.  Third,  a  tran- 
sient dilatation  of  blood-vessels  in  the  kidney,  and  a 
retardation  of  the  blood-cui-rent  in  the  glomerular 
vessels,  with  possibly  consequent  alteration  in  the 
fanctions  of  tUe  glomerular  epithelium,  also  of  a 
temporary  natui-e." 

To  the  rirst  proposition  he  could  accede,  but,  in 
his  mind,  the  lust  two  were  not  convincing.  He  rec- 
ognized fully  the  condition  of  low  arterial  tension 
as  being  almost  always  the  immediate  cause  of  albu- 
minuria. For  example,  the  first  urine  of  cholera  was 
albuiuinous,  also  the  first  with  suppression  in  yel- 
low ferer,  the  urine  in  pneumonia,  cardiac  disease 
in  the  later  stages,  pulmonary  emphysema,  etc. 
i'uese  cases,  howes'er,  hardly  came  under  either  of 
these  two  heads. 

rne  red  kidney,  to  which  allusion  had  incident- 
ally been  made  by  Dr.  Draper,  he  thought  was  not, 
pA)p9rly  speaking,  a  kidney  disease,  but  rather  an 
illustration  of  the  etfect  produced  by  a  general  dis- 
ease, probably  having  its  primary  seat  in  the  I'essels. 
With  reference  to  digitalis,  he  thought  that  it 
was  rarely  aiJplic.ible  until  the  latter  stages  of  the 
disease,  until  cardiac  dilatation  began  to  take  the 
place  of  the  hypertrophy. 

Dii.  KiNNicurr  said  that  he  did  not  advance  his 
propositions  with  the  view  to  explaining  all  cases  of 
temporary  albuminuria,  but  merely  as  api^licable  to 
a  certain  number. 

With  reference  to  the  topic  on  which  Dr.  McBride 
and  Dr.  Draper  had  written,  he  thought  it  would  be 
generally  adinitted  that  it  was  of  great  importance 
to  determine,  if  possible,  whether  any  of  the  com- 
monly accepted  cardinal  symptoms  of  granular  kid- 
ney, viz.,  polyuria,  albuminuria,  casts,  increased  ar- 
terial tension,  cardiac  hyiJertrophy  and  changes  in 
the  fundus  ocnli,  were  so  commonly  present  in  the 
early  stages  of  the  affection,  as  to  render  its  recog- 
nition at  each  time  possible.  Although  granting 
that  no  one  of  these  symptoms  was  constantly  pres- 
ent, nevertheless  it  had  seemed  to  him  that  certain 
ones  were  of  sutficiently  common  occurrence  to  de- 
mand es2)ecial  attention ;  namely,  increased  ar- 
terial tension,  polyuria,  and  the  presence  of  hyaline 
casts  in  the  urine.  The  existence  of  increased  arte- 
rial tension  iu  the  early  stages  of  granular  kidney,  in 
the  majority  of  cases,  was  at  the  jiresent  time,  he 
believed,  very  generally  admitted.  Its  importance 
as  a  symptom  had  been  very  fully  discussed  by  Dr. 
McBride  in  his  i^aper,  and  he  would  therefore  confine 
his  remarks  to  the  presence  of  hyaline  casts  (i.  e., 
casts,  homogeneous,  without  fibrillation  and  unaf- 
fected by  acetic  acid)  in  the  urinary  water. 

The  tendency  of  modern  English  pathologists  and 
clinicians,  and  also  American,  it  seemed  to  him,-  had 
been  to  underestimate  the  value  of  this  symptom. 
Dr.  George  Johnson  had  taught  that  little  value 
need  be  attached  to  their  presence.  Dr.  Saundby, 
on  the  contrary,  held  quite  an  opposite  opinion. 
Quite  recently  Aufrecht  had  apparently  demonstrated, 
by  a  series  of  experiments  on  animals,  that  hyaline 
casts  were  the  result  of  an  irritation  of  the  renal 
epithelium,  in  consequence  of  which  "it  secretes  a 
clear  fluid  in  drops,  wliich  subsequently  run  together 
into  cylinders,  taking  the  form  ot  the  tubuli."  These 
observations  have  been  confirmed  by  Oornil.  As 
Dr.  Saundby  had  suggested  the  production  of  casts 
of  this  typo  ])robal)ly  reprosoutcd  "  a  process  of 
minimum  intensity,  wliich  when  duo  to  a  transient 
cause  may  leave  no  traces  behind  it.     They  become 


significant  in  proportion  to  their  number  and  per- 
sistence." In  consideration  of  the  above  reasons, 
among  others,  it  seemed  to  him  that  the  ijresence 
of  hyaline  casts  alone,  and  particularly  when  asso- 
ciated with  high  arterial  tension,  might  be  regarded 
as  an  important  symptom  in  the  recognition  of  the 
early  stage  of  granular  kidney,  possibly  in  that  stage 
which  had  received  the  name  of  functional,  and 
which  was  now  admitted  by  many  pathologists  and 
cUnical  obser^'ers.  The  fact  of  theu-  common  occur- 
rence in  small  numbers  certainly,  in  aggravated 
cases  of  lith.iemia  in  adults,  was  at  least  suggestive. 
Dr.  F.  a.  Bdki!All  was  of  the  opinion  that  albu- 
minuria by  no  means  existed  as  a  frequent  concomi- 
tant of  lithiemia.  He  gave  the  results  of  two  hundred 
examinations  of  uiine,  in  eighteen  of  which  albumen 
was  found.  Of  these  eighteen,  in  but  one  did  uric 
acid  exist,  and  in  two  oxalate  of  lime.  In  three 
sijeoimens  the  specific  gravity  was  1010 ;  in  eight, 
1008  ;  and  in  seven,  loao, 

Db,  McBride  regarded  as  the  most  important 
point  in  the  discussion  the  ascertaining,  if  possible, 
whether  chronic  Bright's  disease  could  be  recognized 
by  a  suiiicient  number  of  early  symptoms  to  estab- 
lish a  clinical  picture  of  the  beginning  of  the  aflection. 
At  the  present,  our  diagnosis  was  based  mainly  upon 
the  low  specific  gravity  and  quantity  of  the  urine 
and  the  presence  of  certain  casts  and  epithelial 
cells,  etc.  If  it  could  be  said  that  the  disease  was 
present  before  these  symptoms,  constantly  observed, 
were  developed,  a  gi-eat  gain  would  be  made,  and 
with  tills  object  in  view  he  had  directed  attention 
to  persistent  high  specific  of  the  urine,  high  blood 
tension,  cardiac  hypertrophy,  and  diseased  arteries. 
He  was  well  aware  of  the  exceeding  difficulty  in 
reaching  a  correct  estimate  of  these  symptoms,  es- 
pecially high  blood  tension. 

He  thought  that  to  Dr.  Draper,  in  this  country,  we 
owed  the  most  intelligent  and  successful  regulation 
of  the  diet  in  the  treatment  of  the  diseases  of  sub- 
oxidation,  and  he  hoped  that  Dr,  Draper  would 
give  an  outline  of  the  plan. 

Dr  Draver,  in  closing  the  discussion,  disclaimed 
any  originality  in  the  plan  referred  to  by  Dr,  Mc- 
Bride, and  said  that  his  attention  was  first  called  to 
it  by  a  remarkal)le  book  "  On  the  Pathology  and 
Therapeutics  of  Suboxidation  Diseases,"  published 
by  Benoe  Jones  ia  1860,  and  in  which  the  views  of 
Liebig  were  applied  to  the  treatment  of  gout  and 
its  allied  disorders.  The  subject  was  too  large  to 
admit,  at  that  late  hour,  of  even  an  attempt  to  give 
an  outline,  as  suggested  by  Dr,  McBride,  but  he 
would  be  pleased  to  present  his  views  in  full  on 
some  future  occasion. 

With  regard  to  Dr.  Smith's  question,  lie  was  un- 
able to  answer  it,  and  thought  that  it  could  scarcely 
be  answered. 

As  to  the  use  of  digitalis,  he  regarded  it  as 
inapplicable  until  the  later  stages  of  the  granular 
kidney,  inasmuch  as  the  condition  during  all  the 
earlier  stages  was  just  that  sought  to  be  produced 
by  the  drug.  Wherever  cardiac  disease  complicated 
the  renal  affection,  if  the  lesion  was  mitral,  the 
digitalis  was  of  great  value,  as  it  was  ■whether  kid- 
ney lesion  existed  or  not ;  but  with  aortic  insufli- 
ciency  it  should  not  be  used,  as  it  would  lengthen 
the  diastole  and  increase  the  risk  of  fatal  syncope. 
For  the  dyspmea  of  cardiac  disease  iu  the  later 
stages,  morphia  was  the  most  efficient  remedy  that 
he  had  ever  employed,  being  far  better  than  digi- 
talis. 
The  Academy  then  adjourned. 


THE   MEDICAL  RECORD. 


523 


^oxxtspontftnct. 


CONCERNING  FREEDOM  IN  CONSULTA- 
TIONS. 

To  THE  Editor  of  The  Medical  Record. 

Sir  :  I  send  with  this  a  paper  bv  Profes.sor  Theo- 
dore W.  Dwight,  LL.D.,  Dean  of  the  Law  School, 
Columbia  College,  New  York,  containing  his  opinion 
on  the  "  New  Code."  I  asked  Dr.  Dwight  to  make 
a  stndy  of  the  subject.  I  gave  to  him  as  data  the 
"Old  Code,"  the  "New  Code,"  and  the  editorials 
and  excerpta  of  the  Medical  JVe?ps,  Philadelphia,  and 
The  Medical  Record.  He  was  therefore  provided 
witli  all  the  published  factors  in  the  case.  No  one 
in  America,  as  all  intelligent  critics  will  agi'ee,  is 
better  fitted  than  he  to  look  at  the  question  involved 
without  prejudice,  and  in  the  good  light  of  pure 
ethics.  He  ignores  entirely  in  his  discussion  the 
puerile  personalities  with  which  some  have  invested 
the  subject.  Such  decaying  elements  quickly  dis- 
appear, when  one  comes  to  consider  a  great  question 
away  from  the  atmosphere  of  partisanship  and  mere 
passion.  The  friends  and  advocartes  of  liberty  have 
always  been  harshly  dealt  with  in  their  day  and 
generation,  their  motives  suspected  and  denounced. 
They  have  been  gibbeted  from  time  beyond  mem- 
ory. It  is  refreshing  when  one  finds  himself  gib- 
beted, to  know  that  it  is  soon  over,  and  then  comes 
the  reward.  When  the  flames  of  unjust  criticism 
die  out  we  shall  then  gather  up  the  pure  results 
which  have  come  out  of  the  embers,  and  take  a  new 
departure,  which  will  make  ns  all,  I  trust,  worthier 
members  of  a  profession  deserving  the  name  of  lib- 
eral. Ever  yours  faithfully, 

C.  B.  Agnew. 

May  0.  1SS3. 

My  Dear  Dr.  Agnew  :  I  have  examined  the  papers 
which  you  submitted  to  me  a  few  days  ago  concern- 
ing the  recent  regulation  of  the  State  Medical  So- 
ciety of  New  York  governing  consultations.  The 
rule,  as  I  understand  it,  is  as  follows  :  "  Rules  gov- 
erning consultations.  Members  of  the  Medical  So- 
ciety oi'  the  State  of  New  York,  and  of  the  medical 
societies  in  affiliation  therewith,  may  meet  in  con- 
sultation legally  qualified  practitioners  of  medicine. 
Emergencies  may  occur  in  which  all  restrictions 
should,  in  the  judgment  of  the  practitioner,  yield  to 
the  demands  of  humanity."  I  find  this  section  in  a 
"  Code  of  Medical  Ethics"  laid  down  by  the  society 
for  the  guidance  of  the  action  of  its  members  in 
matters  of  morality  and  conscience.  One  of  the 
leading  divisions  of  this  concerns  the  relations  of 
physicians  to  the  public,  another  the  rules  concern- 
ing consultations,  while  the  third  division  apjilies  to 
the  relations  of  physicians  to  each  other.  All  of  the 
points,  as  far  as  I  can  obsene,  concern  moral  rela- 
tions, including  the  general  observance  of  the  rules 
of  kindness,  good  feeling,  and  humanity  toward  all 
men  suS'ering  jjain  and  disease  who  can  be  relieved 
by  medical  skill  and  attention,  as  well  as  the  duties 
of  courtesy  and  mutual  aid  toward  professional 
brethren. 

In  the  outset,  it  must  be  faiidy  presumed  that 
medical  ethics  are  but  a  branch  of  universal  ethics 
or  morality.  They  are  but  the  application  of  the 
general  rules  of  morality  to  special  cases.  All  intel- 
ligent men  who  have  a  cultivated  moral  sense  ai'e 
capable  of  judging  of  them.     They  ought,  then,  to 


square  with  the  rules  of  general  morality.  Any 
special  medical  rule  professing  to  be  "  ethical," 
which  is  based  on  a  ,-iolation  or  restriction  of  the 
great  rules  of  morality,  is  in  itself  "  unethical,"  op- 
posed to  public  policy,  and  fraught  with  evil  and 
disaster  to  the  non-medical  public  as  well  as  to  phy- 
sicians themselves. 

From  this  point  of  view,  the  rule  that  I  have 
quoted  above  must  be  interpreted.  There  is  another 
cardinal  rule  of  interpretation  to  be  stated.  This 
is,  tliat  the  whole  of  the  rule  of  the  society  must  be 
taken  into  account.  It  must  be  considered  with  its 
qualification.  Fairly  interpreted,  the  rule  has  the 
following  prominent  points  :  (1).  The  members  of 
the  State  Medical  Society  may  meet  in  special  cases 
in  consultation  "  legally  qualified  "  practitioners  of 
medicine,  not  members  of  the  society,  in  fftct  any 
and  aU  of  that  class,  notwithstanding  general  restric- 
tiiiiis  on  this  subject.  (2).  The  special  case  referred 
to  is  an  "  emergency."  An  emergency  is  a  matter  of 
pressing  necessity — an  unforeseen  casualty — a  sudden 
occasion  ("Worcester's  definition  of  Emergency"). 
(3).  The  object  of  giving  way  to  the  "emergency" 
is  "  to  yield  to  the  demands  of  humanity."  (See  the 
rule.)  Still  more,  the  niles,  as  I  observe,  apply 
equally  to  ijhysicians  and  surgeons.  All  through  the 
code,  medical  and  surgical  practice  is  referred  to. 
Under  this  rule,  the  question  might  arise  whether  a 
"  legally  qualified  practitioner  of  medicine  "  might 
call  in  consultation  an  eminent  surgical  ju-actitioner 
of  another  school.  The  question  might  be  as  to  the 
direction  of  a  gim-shot  wound,  whether  it  extends 
from  below  upward,  or  from  above  downward.  This 
may  be  vital  to  the  treatment,  and  his  opinion  may 
be  to  the  last  degree  important,  and  so  in  a  thousand 
other  cases  where  all  schools  of  medicine  act  in  com- 
mon. The  object  of  the  consultation,  I  repe'at,  is 
"  the  demands  of  humanity."  It  is  the  sufl'ering 
patient  who  requh-es  it,  and  who  may  have  no  other 
succor,  (i).  The  regulation  is  jjermissive.  No  one 
is  requii-cd  to  follow  it.  If  you  ask  how  shall  abuse 
be  avoided,  the  answer  is,  the  physician  who  is  called 
in  consultation  must  eL>:e7\'ise  liis  oun  judgmeyd.  To 
that  in  the  end  all  questions  of  ethics  must  come. 
Ethical  rules  are  established  only  to  guide  the  judg- 
ment. The  great  value  of  the  new  .rale,  if  it  have  a 
value,  as  I  am  sure  it  has,  is  that  it  substitutes  an 
elastic  for  an  iron-clad  nile.  The  Medical  Society 
says  in  substance  to  the  practitioner.  We  will  not 
I)lace  you  under  a  stem  rule  withoiit  any  exceptions. 
AVe  retain  the  general  rule  by  imjilication.  Humanity 
may  demand  its  relaxation.  Whether  it  does  so  or 
not  in  the  sijecial  case,  we,  as  a  society,  have  no 
means  of  determining ;  of  that  we  must  leave  you,  the 
practitioner,  in  possession  of  all  the  particular  facts 
in  the  case,  to  be  the  judge. 

Having  thus  considered  the  true  scope  and  pur- 
port of  the  rule,  the  remaining  question  is.  Is  it 
right?  Is  it  ethical?  Tlie  question  answers  itself: 
Shall  a  true  physician  hesitate  before  any  lawful 
acts  when  driven  to  it  by  the  "  demands  of  human- 
ity ?"  The  patient  does  not  exist  for  the  rule  of  the 
profession,  but  the  medical  profession  always  and 
everywhere  for  the  good  of  the  patient.  It  is  par 
excelleyice  the  profession  which  deals  with  man  in  a 
"matter  of  humanity."  Take  away  from  it  that  ele- 
ment, and  you  shear  from  it  its  royal  prerogative. 
If  this  rale  is  not  right,  then  it  should  be  put  in  this 
form  :  "  Members  of  this  society  shall  not  consult 
with  legally  qualified  practitioners  of  any  other  so- 
ciety than  our  own,  not  even  if  an  emergency  arises 
in  which  the  demands  of  humanity  require  it."     Can 


524 


THE  MEDICAL  RECORD. 


any  right-minded  physician  vote  for  such  a  resolu- 
tion? And  yet  is  not  that  the  position  that  the 
opponents  of  this  regulation  must  take?  I  should 
say  iinhesitiitingly  that  any  such  ground  taken  ex- 
pressly or  by  implication  is  contrary  to  public  policy 
and  worthy  of  public  reprobation. 

There  is  another  suggestion  which  may  not  he  out 
of  place.  The  State  Medical  Society  exercises  a 
right  conferred  on  it  by  the  statutes  of  the  State. 
It  is  not  a  mare  voluntary  society,  but  has  certain 
compulsory  powers  conferred  upon  it  by  law.  It 
profits  by  the  exclusion  of  unqualified  persons  from 
practice.  When  the  State  authorizes  practitioners 
of  other  schools  to  practise  medicine,  does  not  cour- 
tesy to  State  authority  dictate  recognition  of  their 
fitness  for  association?  How  can  the  State  Medical 
Society  consistently  demand  public  recognition  by 
reason  of  State  legislation,  and  yet  deny  it  to  others 
who  have  precisely  the  same  authoi-ity  ? 

I  cannot  but  think  that  the  rule  that  you  have 
brought  to  my  attention  is  sound  and  salutary,  and 
worthy  of  the  advancing  stage  of  medical  thought 
and  ethical  refinement.  Let  us  never  sacrifice  the 
demands  of  humanity  to  professional  etiquette,  nor 
imitate  the  poor  King  of  Spain,  who  is  reported  to 
have  lost  his  life  because,  by  the  laws  of  a  rigorous 
Spanish  ceremonial,  no  one  was  at  hand  who  was 
professionally  competent  to  move  his  chair  from  the 
fire  that  was  slowly  gnawing  at  his  vitals. 
Yours  very  respectfully, 

Theodore  W.  Dwight. 

COLTJMBIA  CoLLEnE  LAW  SCHOOL,  NEW  YORK,  April  24,  1882. 


OVARIOTOMY   ABROAD. 

To  TUB  Kditoh  of  The  Medical  Record. 
SrR :  Having  had  an  opportunity  of  studying  the 
methods  of  operating  followed  by  some  of  the  most 
eminent  ovariotomists  in  Europe,  I  thought  that 
perhaps  a  short  description  of  the  method  adopted 
by  each  individual  operator  might  not  prove  unin- 
teresting to  some  of  my  professional  brethren  in 
America. 

I  shall  commence  with  Monsieur  Pean,  the  dis- 
tinguished surgeon  of  the  Hopital  St.  Louis,  Paris. 
As  a  general  surgeon,  Pean  operates  neatly  and  dex- 
terously ;  and  his  appearance  is  decidedly  impres- 
sive, as  he  always  operates  in  full  dress.  His  method 
of  doing  ovariotomy,  however,  does  not  make  a  very 
favorable  impression  on  the  spectator.  The  i^atient 
lies  on  a  sort  of  double-inclined  plane,  her  arms  and 
legs  bsing  securely  fastened  to  the  operating-table 
by  straps  ;  and  a  mackintosh  sheet,  with  a  hole  in 
its  centre,  extends  from  her  chest  to  a  point  midway 
between  the  knees  and  ankles.  The  operator  is  at- 
tired in  a  long  mackintosh  apron,  and  having  sealed 
himself  in  front  of  the  patient,  between  her  legs,  he 
proceeds  to  make  the  iisual  abdominal  incision ; 
securing  all  bleeding  vessels  with  (P(?an's)  homo- 
sfcatio  forceps.  The  peritoneal  cavity  having  been 
opened  and  the  cyst  exposed,  it  is  punctured  with  a 
moderate-sized,  curved  trocar,  and  the  fluid  flows 
over  the  mackintosh  which  covers  the  patient,  and 
which  is  converted  into  a  gutter  between  her  leg.s, 
ioto  a  second  gutter  made  by  dojiressiug  the  mack- 
intosh apron  between  the  legs  of  the  operator,  and, 
finally,  into  a  large  basin  at  the  operator's  feet.  The 
cyst,  having  bnou  emptied,  is  extracted.  The  ped- 
icle is  tied  with  a  double  silk  ligature  (the  ends  of 
which  are  cut  off  short),  divided,  and  the  stump  re- 
turned into  the  abdomen.  The  "toilette  du  pfri- 
toino  "  is  not  made  with  sponges,  but  with  dry,  warm 


napkins,  which  are  allowed  to  remain  in  the  peri- 
toneal cavity  untU  all  the  silk  sutures  which  are 
used  for  closing  the  abdominal  wound  have  been  in- 
troduced.* 

The  napkins  are  then  withdrawn  and  the  abdom- 
inal wound  closed.  The  operation  is  done  strictly 
"a  la  Lister,"  even  the  protective  being  used.  The 
dressing  is  kept  in  place  by  long  strips  of  very  strong 
adhesive  plaster,  which  is  very  tiijhtly  applied.  The 
after-treatment  is  simple  :  for  the  first  twelve  or 
twenty-four  hours  but  little  is  given  except  sufficient 
ice  to  allay  thirst ;  then  milk,  or  broth,  in  small 
quantities,  frequently  repeated.  As  convalescence 
progresses,  a  little  solid  food  is  allowed.  Mr.  Pfian's 
hosijital  ovariotomies  are  done  in  a  "  maison  de 
santC,"  which  is  under  the  management  of  Sisters  of 
Charity,  who  act  as  nurses.  As  an  anesthetic,  Pean 
uses  sulphuric  ether  in  ovariotomy,  while  he  uses 
chloroform  in  general  surgery. 

I  had  not  the  pleasure  of  seeing  Mr.  Lawson  Tait 
do  a  "full-fledged"  ovariotomy,  birt  I  saw  him  per- 
form oophorectomy ;  and,  in  one  case,  I  saw  him 
make  an  abdominal  section,  and  i5uneture  two  ova- 
rian cysts,  each  the  size  of  an  orange,  and  universally 
adherent.  The  contents  of  the  cysts  having  been 
withdrawn,  the  abdominal  wound  was  closed.  The 
patient  made  a  good  recovery  from  the  operation. 
Mr.  Tait  does  all  his  operations  under  the  spray  of 
aqua  pura.  He  is  a  strong  opponent  of  Listerism. 
At  the  Birmingham  Hospital  for  Women,  Mr.  Tait 
operates  with  but  one  assistant,  who  jiossesses  the 
rare  quality  of  using  his  fingers  dexterously,  keep- 
ing his  eyes  open,  and — his  mouth  shut.  The  anses- 
thetic  (sulphuric  ether)  is  always  given  by  Sister 

,  a  bright-eyed,  intelligent,  active  little  sylph, 

who  keeps  the  patient  nicely  aniicsthetized  from  the 
beginning  to  the  end  of  the  operation.  In  fact,  it  is 
quite  a  treat  to  witness  the  ana-sthetizing  of  a  pa- 
tient by  Sister ,  after  having  seen  that  operation 

performed  by  certain  individuals  (of  the  masculine 
gender)  in  London,  who  are  supposed  to  make  their 
living  by  deadening  other  people's  sensibilities,  and 
are  pleased  to  call  themselves  "  specialists."  As  re- 
gards the  method  of  dealing  with  the  pedicle,  in 
ovariotomy,  Mr.  Tait  has,  for  many  years,  been  an 
ardent  advocate  of  the  intra-peritoneal  method.  At 
St.  Bartholomew's  Hospital,  London,  the  ovarioto- 
mies are  performed  l^y  Mr.  Willett.  The  ojierations 
are  done  in  a  small  amphitheatre  (generally  used  by 
Dr.  Matthews  Duncan  as  a  clinical  lecture  room)  on 
the  top  floor ;  and  the  number  of  spectators  is  lim- 
ited only  by  the  size  of  the  room.  Students  engaged 
in  dissecting  or  making  post-mortem  examinations 
are  invited — to  be  absent.  All  Mr.  Willett's  ovari- 
otomies are  done  under  the  carbolic  acid  spray  and 
Lister's  dressing  is  applied  to  the  wound.  The  in- 
tra-peritoneal method  of  dealing  with  the  jiediele  is 
always  adopted. f  After  the  operation  the  patient  is 
conveyed  to  a  small,  special  ward,  containing  three 
beds,  adjoining  the  operating-room.  She  remains  in 
this  ward  during  the  after-treatment.  The  results 
obtained  by  Mr.  Willett,  as  far  as  they  go.  are 
equally  as  good  as  those  obtained  by  many  surgeons 
in  this  country  whose  operations  are  performed  in 
hospitals  devoted  exclusively  to  the  treatment  of 
diseases  of  women. 

*  TIiP  number  of  impkiiiR  introduced  is  notod,  so  that  none  of  thcni 
may  In;  left  in  the  peritoneal  cavity. 

+  If  proof  wore  wiintlnR  of  the  innocuowsne<w  of  silk  Upatnres  in  the 
peritoneal  ctvity,  Mr.  Willett's  prnetiee  would  afford  strong  ovidcnco 
in  that  direction.  The  silk  which  ho  uses  to  seonrv  the  iieilicles  is 
almost  as  tliick  as  whipcoril,  and  yet  the  patients  do  not  seem  to  suffer 
any  inconvenienco  in  consequence. 


THE   MEDICAL  RECORD. 


5;;J5 


At  King's  College  Hospital,  Loudon,  the  ovari- 
otomies ai-e  performed  by  Mr.  John  Wood.  To  say 
that  Mr.  Wood's  ovariotoruies  are  done  with  the 
neatness,  dexterity,  and  skill  which  characterize  that 
distinguished  surgeon  in  the  performance  of  all 
other  surgical  operations,  would  lie  to  state  what  is 
not  true.  All  Sir.  Wood's  ovariotomies  are  done 
antiseptically. 

At  the  Hosjiital  for  Women,  Soho  Square,  London, 
the  ovariotomies  are  done  by  Dr.  Carter  and  Dr. 
Heywood  Smith.  Considering  that  this  is  the  olde.st, 
and  probably  the  largest  special  hospital  for  women 
in  the  United  Kingdom,  the  number  of  ovariotomies 
annually  performed  there  is  comparatively  small.  The 
operations  are  supposed  to  be  done  antiseptically. 
but  it  is  not  an  iinusual  thing  to  see  the  silk  which 
is  used  to  ligate  the  pedicle  hanging  on  a  string  be- 
hind the  operator,  who  proceeds  to  use  it  without 
even  dipping  it  in  the  antiseptic  solution.  In  the 
mind's  eye  one  sees  millions  of  bacteria,  which  have 
been  roosting  on  the  silk,  thus  carried  into  the  vul- 
nerable peritoneal  cavity  of  the  patient.  However, 
either  from  insuscejotibility  to  the  deleterious  in- 
fluence of  bacteria,  or  from  some  other  unexplained 
cause,  the  patients  recover  in  a  very  large  proportion 
of  the  ca.ses. 

At  the  Samaritan  Hospital  for  Women,  more  ova- 
riotomies are  performed  annually  than  in  all  the  other 
London  hospitals  put  together.  The  surgeons  are 
Dr.  George  Granville  Bautock  and  Mr.  J.  Knowlsley 
Thornton. 

Mr.  Thornton  is  a  straightforward,  orthodox,  an- 
tiseptic ritualist ;  while  Dr.  Bantock  is  decidedly 
heterodox,  so  far  as  the  Listerian  doctrine  is  con- 
cerned. It  is  evident  from  Dr.  Bantock's  practice 
that  he  believes  that  "  cleanliness  is  next  to  godli- 
ness ; "  but  he  evidently  does  not  think  that  carbolic 
acid  is  essential  to  the  process  of  purification,  or  to 
the  salvation  of  the  jiatient.  To  an  unprejudiced 
observer  there  is  much  to  interest  and  instruct  in 
the  practice  of  these  two  gentlemen,  holding,  as  they 
do,  opposite  views  as  to  the  value  of  antisejitics  in 
ovariotomy.  As  before  stated,  Mr.  Thornton  is  a 
faithful  disciple  of  Mr.  Lister,  and  does  all  his  ope- 
rations strictly  antiseptically ;  and  so  strong  is  his 
faith  in  antiseptics,  that  if  he  is  so  unfortunate  as  to 
lose  a  patient  from  septic.Tmia,  after  an  ovariotomy 
parformed  antiseptically,  he  attributes  the  bad  re- 
sult to  a  failure  on  his  part  to  carry  out  all  the  de- 
tails of  the  method. 

Dr.  Bantock,  on  the  other  hand,  maintains  that 
carbolic  acid  not  only  does  no  good,  but  that  it  does 
h.arm.  He  holds  that  h>/perjn/re.ria  is  much  more 
common  after  Listerian  ovariotomy,  than  after  ova- 
riotomy performed  under  what  he  terms  modified 
Listerism.* 

He  also  holds  that  there  is  danger  of  carbolic  acid 
poisoning  in  cases  in  which  the  peritoneum  is  ex- 
Ijosed  for  a  considerable  length  of  time  to  the  sjjrar 
of  the  ordinary  solution.  He  thinks  that  there  is 
danger,  in  a  prolonged  operation,  from  the  chilling 
of  the  peritoneum  by  the  spray,  especially  when  the 
apjmratus  is  placed  (as  it  generally  is)  at  the  foot 
of  the  patient,  and  the  spray  directed  into,  as  well  as 
over,  the  abdominal  incision. t 

There  is  one  point,  however,  on  which  Dr.  Ban- 
took  and  Mr.  Thornton  agree,  viz.,  the  necessity  of 

*  If  my  re.i4ers  would  like  an  explanation  of  the  meanint^  of  the  term 
*•  modified  Listerisra."  I  may  sjiy  that  it  consists  in  sub.stitiitin{;  a  \veal< 
BOlution  (from  one-half  to  one  );ei-  cent.)  of  carbolic  acid  for  the  strtjug. 
five  per  cent,  solution  used  by  Mr.  Lister  and  his  followers. 

+  Dr.  Bantock  adopts  Dr.  Keith's  plan,  and  jilaccs  the  spray  appa- 
tatas  at  the  head  of  the  patient. 


perfect  cleanliness.  Their  sponges  are  always  beauti- 
fully clean  and  white.  They  are  careful  to  have 
their  own  hands  and  those  of  their  assistants  and 
nurses  thoroughly  clean,  and  just  before  the  opera- 
tion the  operator  and  his  assistant  bathe  their  hands 
and  arms  in  a  warm  solution  of  thymol  or  carbolic 
acid,  the  strength  of  the  solution  varying  with  the 
iiliosi/nC7-as_i/  of  the  operator.  A  basin,  containing 
a  warm  solution  of  thymol  or  carbolic  acid,  is 
jilaced  in  a  convenient  position,  so  that,  during  the 
operation,  the  operator  may  cleanse  his  hands  of 
blood  or  ovarian  fluid,  previously  to  putting  them 
into  the  peritoneal  cavity.  Both  of  these  operators 
are  careful  to  thoroughly  cleanse  the  peritoneal  cav- 
itv  before  closing  the  alidonfinal  wound  ;  and  they 
both  treat  the  pedicle  by  the  intra-peritoneal 
method.  Mr.  Thornton  uses  silk  sutures  to  close 
the  abdominal  wound,  but  Dr.  Bantock  uses  silk- 
worm-gut. Mr.  Thornton  dispenses  with  the  "  pro- 
tective," and  uses  as  a  substitute  a  piece  of  thy- 
molized  gauze,  wrung  out  of  a  five  per  cent,  solution 
of  thymol,  and  over  this  he  places  the  ordinary  Lis- 
ter's dressing.  A  layer  of  cotton- wool  is  placed  over 
the  dressing,  a  folded  towel  is  placed  over  the  hy- 
pogastrium,  and  the  whole  is  retained  in  place  by 
strips  of  adhesive  plaster  and  a  bandage.* 

Dr.  Bantock's  dressing  is  more  simple :  a  few 
strips  of  dry  thymol-gauze  are  placed  over  the 
wound,  and  over  this  a  pad  made  of  absorbent  cot- 
ton wrapped  in  fine  gauze.  This  dressing  is  kept 
in  place  by  a  many-tailed  flannel  bandage.  In  or- 
dinary cases,  the  dressing  is  left  undisturbed  for<ten 
days,  when  the  wound  is  generally  found  com- 
pletely united.  In  cases  in  which  extensive  adhe- 
sions have  existed,  and  in  which  a  good  deal  of 
oozing  of  bloody  seram  continues,  even  after  the 
peritoneal  cavity  has  been  thoroughly  cleansed.  Dr. 
Bantock  uses  a  glass  drainage-tulie,  so  as  to  provide 
an  exit  for  this  fluid.  Mr.  Thornton,  however,  does 
not  consider  this  necessary.  He  believes  that,  if  the 
fluid  is  aseptic,  it  will  do  no  harm,  but,  on  the  con- 
trary, by  its  reabsorption  will  tend  to  nourish  the 
patient.t 

As  an  aujcsthetic.  Dr.  Bantock  uses  chloroform. 
Mr.  Thornton  uses  bichloride  of  methylene.  In  the 
after-treatment  of  their  cases  there  is  but  little  dif- 
ference in  the  practice  of  these  two  surgeons.  For 
the  first  twelve  hours  nothing  is  given  but  a  sip  of 
J/i)t  water,  from  time  to  time,  to  relieve  thirst.  After 
the  first  twelve  hours,  if  there  is  no  nausea,  small 
quantities  of  barley-water  are  given  at  regular  inter- 
vals. After  the  expiration  of  twenty-four  hours  a 
mixture  of  milk  and  liarley-water  in  equal  jiropor- 
tions  is  substituted  for  the  plain  barley-water.  On 
the  third  day  a  little  tea  and  toast  is  allowed  ;  on 
the  fifth,  a  little  fish  ;  and  gradually,  as  convales- 
cence progresses,  a  more  generous  diet  is  permitted. 
Ojoium  is  only  given  when  there  is  pain.  The  preji- 
aration  which  is  genei-ally  used  is  the  tincture,  and 
it  is  always  given  per  rectum.  On  the  sixth  or  sev- 
enth day  a  cathartic  is  administered,  and  its  opera- 
tion is  assisted,  if  the  rectum  is  loaded  with  faeces, 
by  an  enema.  The  stitches  in  the  abdominal  wound 
are  generally  removed  on  the  tenth  day. 

A    description   of  the   ovariotomists  of  London 


*  Mr.  Thornton  gives  as  a  reason  for  not  nsi 
the  peritoneal  surfaces  of  the  wound  are  sealed  i 
operation,  and.  therefore,  the  protective  is  useless. 

t  I  leave  my  readers  to  draw  their  own  concluBions  as  to  the  relative 
merits  of  these  two  opposite  lines  of  practice.  My  ovni  opinion  in  re- 
pard  to  the  matter  is  vei-y  decided,  aud,  at  some  future  time,  I  may 
feel  that  I  am  at  liberty  to  express  it ;  but,  at  present,  '•  Je  nicimte,  Je 
irejuf/e  jya«." 


526 


THE   MEDICAL  RECORD. 


without  a  reference  to  Mr.  T.  Spencer  WeUs  would 
be  like  the  play  of  "  Hamlet"  with  Hamlet  left  out. 
Mr.    Wells   now    only   operates   in   private,    liavmg 
given  up  his  connection  with  the  Samaritan  Hospi- 
tal,  except  as  consulting  surgeon,  some  five  years 
since.     Mr.  Wells  operates  under  the  thymol  spray, 
and  uses  the  antiseptic  dressing,  kept  in  place  by 
strips  of  adhesive  plaster.      As  an  anii'sthetic  Mr. 
Wells  prefers  bichloride  of  methylene.      There  is 
nothing  in  Mr.  Wells'  method  of  operating  which 
requires  special  description.    It  is  not  what  one  sees 
at  an  operation  by  Mr.  Wells  that  makes  an  impres- 
sion ;  it  is  the  consciousness  of  standing  in  the  pres- 
ence of  a  man  who  ha^done  more  ovariotomies  than 
anv  other  surgeon,  living  or  dead— a  man  with  an 
experience  of  ovkv  a  thousand  ovariotomies  stored 
away  in  the  cells  of  the  gi-ay  matter  of  his  cerebral 
convolutions,  ready  to  be  called  forth  at  an  instant's 
warning  in  the  event  of  an  unforeseen  complication. 
Last,  but  by  no  means  least,  comes  Dr.  Thomas 
Keith,  of  Edinburgh.    The  description  of  Dr.  Keith, 
and  his  method  of  operating,  given  by  Dr.  J.  Marion 
Sims  in  a  paper  entitled  "  Thomas  Keith  and  Ovari- 
otomv,'"  and  published  in  the  number  of  the  A  mer- 
ican  Journal  of  Obslelrics  for  April,  1880,  is  so  clear 
and  accurate  that  I  have  nothing  to  add  to  it,  and 
nothing  to  subtract  from  it.     I  shall  never  forget 
the  impression  made  on  me  by  Dr.  Keith  ;  so  quiet, 
mode.st,  and  unassuming,  that  I  forgot  I  was  in  the 
presence    of  the   most   sKccessful  ovariotomi.st  hi  the 
ii-orld.     After  describing  Dr.  Keith  and  his  method 
of  Operating,  Dr.  Sims  says:  "I  regret  to  say  that 
his  health  is  not  good,  and  that  he  is  often  com- 
pelled  to   leave   his  hard  work    and   the   rigorous 
climate  of  Edinburgh,  and  seek  recreation  in  the  more 
congenial  climate  of  the  South  of  France."   He  then 
adds,  "  Let  us  all  hope  that  the  life  of  this  great 
and  good  man  may  long  be  spared  to  relieve  sutfer- 
ing  humanity,  and  to  further  advance  the  progress 
of  our  science  for  which  he  has  abeady  achieved  such 
wonders." 

To  this  prayer  of  the  great  American  gynecologist, 
as  a  slight  tribute  of  respect  and  afl'ection  to  the 
great,  the  good,  the  noble  Thomas  Keith,  may  I  be 
allowed  to  add  a  fervent  Amen  ! 

[Note. — Since  the  above  article  was  written  I  have 
received  a  letter  from  Dr.  Bantook,  in  which  he  in- 
forms me  that  he  has  entirely  abandoned  the  use  of 
the  spray  ;  and  I  am  informed  that  Dr.  Keith  has 
done  likewise.]  O.  H.  Ballek.w,  M.D. 

Patkuson.  N.  .1. 


With  the  laudable  intention  of  enlightening  the 
ignorance  of  the  average  practitioner,  "  elderly  "  or 
otherwi.se,  both  these  specialists  proceed  to  give  us 
definite  rules  for  the  proper  employment  of  the  bo- 
vine virus,  from  which  I  extract  the  following  : 

"To  secure  the  best  results  from  the  bovine 
virus,  the  arm  mu.st  be  scarified,  and  not  denuded. 
....  Enough  blood  .should  be  drawn  to  well 
moisten  the  quill,  in  order  to  dissolve  the  virus  and 
render  it  capable  of  absorption.  Water  should 
never  be  used  for  this  purpose." 

Dr.  Taylor's  success  bv  this  method  in  primary 
vaccinations  is  stated  to  "be  82.66—94  per  cent.,  but 
"  it  is  not  claimed  that,  even  in  the  hands  of  experts, 
bovine  virus  is  quite  as  uniformly  reliable  as  hu- 
manized."    (!) 

On  the  other  hand  the  Drs.  Martin  say  : 
"  The  incisions  should  be  so  slight  as  barely  to 
result  in  the  faintest  possible  exudation  of  blood, 
and  that  only  after  the  lapse  of  a  second  or  two. 
....  The  best  mode  of  dissolving  the  dried 
albumen  and  virus  on  the  point  is  by  slightly  wet- 
ting a  part  of  it  with  the  point  of  a  cleon  finger,  dip- 
ped in  cold  or  tepid  water,  then  with  the  Hat  of  the 
clean  lancet,  or  of  another  ch-an  ivory  point,  rub  up 
the  water  with  the  dried  virus  till,  partly  mechani- 
cally and  partly  by  solution,  a  mucilaginous  mixture 
is  obtained." 

Their  success  is  still  more  enviable,  for 
"When  proper  care  is  taken,  invarinhh:  success 
follows  the  use  of  good  fresh  cowpox  virus  in  pri- 
mary vaccination."  • 
Now,  unless  there  is  a  physiological  difference  be- 
tween New  York  and  Boston  heifers,  one  of  these 
"  experts  "  has  yet  to  learn  the  proper  method  of 
using  the  bovine  virus. 

I  may  add  that,  in  recent  years,  my  own  success 
in  primary  vaccination  with  the  bovine  virus  has 
been  (pardon  the  liibernianism  !)  about  75  per  cent, 
of  failures.  Possiblv  I  may  have  confounded  the 
rules  of  the  eminent  "  experts  "  quoted,  and  used 
New  York  virus  under  Boston  niles,  or  rice  versa. 
But,  in  all  seriousness,  Mr.  Editor,  does  not  the 
wonderful  success  attained  by  the  authors  of  these 
two  contradictorv  rules  lead  to  the  fair  inference 
that  the  ill  success  of  the  profession  generally^  in  the 
use  of  bovine  virus,  is  due  more  to  the  inefficiency 
of  the  virus  employed,  than  to  the  method  of  vacci- 
nation ?  „ 

A  DisGnsTED  Vaccinator. 


THK  METHODS  OF  VACCINATIO.X. 

To   THE   KdiTOK  of  THE   MEDICAL  RECORD. 

Sir  :  Dr.  .T.  B.  Taylor,  Inspector  of  Vaccination  to 
the  Health  Department  of  this  city,  de(^lares  that 
"  the  reason  why  physicians  are  not  so  successful 
with  bovine  as  with  humanized  lymph  is  not  entirely 
due  to  the  ineffi(dency  of  the  virus,  but  partly,  also, 
to  the  wrong  method'  of  the  physician  in  using  it." 

Drs.  Henry  A.  and  Stephen  0.  Martin,  of  Boston, 
the  pioneer  cultivators  of  the  bovine  virus  in  this 
country,  write  : 

"  .  .  .  .  Others  (generally  elderly  physi- 
cians, who  often  seem  to  feel  insulted  at  any  attempt 
at  instruction),  whose  returned  points  indicate  an 
utter  failure  to  dissolve  virus,  are  continually  report- 
ing ill  su<'.coss,  and  it  is  to  be  feared  always  will. 
They  cannot  perceive  that  the  fault  is  not  in  the 
virus,  but  in  the  men  who  use  it,  and  the  manner  in 
which  it  is  used." 


WAS  IT  CURED  BY  CALCIUM  SULPHIDE  ? 

To  THE  EDiTon  Of  Thv.  Medioai.  Kecobo. 

Sir  :  In  the  spring  of  1880  an  intelligent  French- 
man near  this  jiost  took  me  to  see  a  middle  aged 
woman,  his  IMexican  mother-in-law,  whom  I  found 
suffering  from  extensive  suppuration  in  the  left  arm, 
chiefly  from  its  middle  down  to  the  elbow,  with  a 
historv  of  continuous  trouble  extending  back  at 
least  five  years,  and  formerly  involving  the  soft 
parts  over  the  scapula  and  shoulder.  There  were 
now  numerous  sinuses  and  openings  discharging 
pus,  and  the  woman  was  reduced  to  skeleton  pro- 
portions, except  at  the  swollen  arm  :  she  presented 
a  cachectic  appearance,  and  niiparently  was  a  prom- 
ising candidate  for  an  early  interment.  I  suspected 
periostitis  and  porhaiis  much  destruction  of  bone, 
but  having  no  probe  at  hand  I  did  not  explore  fur- 
ther, onlv  makinc;  an  appointment  with  the  woman  to 
meet  me  at  the  Tost  Hospital  later,  if  slie  was  able 
to  travel,  where  I  proposed  to  probe  the  sinuses  m 


THE   MEDICAL  RECORD. 


327 


detail  and  perhaps  cut  down  to  the  bone,  etc.  Mean- 
while, with  a  semi-placeboic  intent,  and  paitially  as 
a  possible  check  to  the  extensive  tendency  to  pus 
formation,  I  ordered  the  woman  one  quarter  of  a 
grain  of  calcium  sulphide  three  times  daOy,  giving 
her  one  hundred  of  Allaire,  Woodward  A:  Co.'s  pills. 
which  I  had  just  received  by  mail. 

I  heard  later  that  the  woman  was  better — even 
well,  but  was  rather  skeptical  about  it,  and  the  hos- 
pital appointment  was  left  uukept. 

A  few  weeks  ago  this  woman  came  to  me  to  have 
her  grandchildren  vaccinated,  and  she  assured  me 
that  she  had  made  an  immediate  and  complete  re- 
covery shortly  after  my  single  visit  to  her  two  years 
ago,  that  she  had  taken  the  pills  faithfully  and  no 
other  treatment  whatever.  She  is  now  a  blooming, 
hearty,  well-nourished  woman,  without  a  trace  of 
ill-healtli,  and  she  and  her  son-in-law  attribute  this 
happy-  change  wholly  to  the  intluence  of  those  cal- 
cium sulphide  pills.  My  inference  now  is  that  the 
bone  was  not  affected,  possibly  not  even  the  perios- 
teum, but  that  a  chronic  suppurative  tendency  ex- 
isted involving  only  the  soft  parts. 

I  may  add  that,  of  course,  being  an  ignorant 
Mexican  among  Mexicans,  not  the  slightest  aid  was 
likely  to  be  rendered  by  the  ordinary  dietetic  or 
other  hygienic  measures  people  of  more  intelligent 
races  would  have  resorted  to. 

When  I  asked  if  the  woman  had  had  syphilis  the 
Frenchman  responded  that  she  was  a  Mexican,  and 
that  I  knew  what  the  chances  therefore  were  in  favor 
of  that  taint,  but  there  was  no  direct  e\-idence. 
Francis  H.  Atkins, 
A.  A.  Surgeon,  U.  S.  Ai-my. 

Fort  Stanton,  New  JLexico. 


THE  HIGHEE  ]\IEDICAL  EDUCATION. 

To  THE  Editor  of  The  Medical  Record. 

Deak  Doctor  :  The  recent  deliverance  of  the  Phil- 
osophical Faculty  of  the  I'niversity  of  Berlin  will 
help  us  to  reach  a  correct  conclusion  as  to  the  value 
of  the  higher  education  to  the  prospective  student 
of  medicine,  and  to  all  is  an  impregnable  defence  of 
classical  studies.  The  paper  was  signed  by  all  the 
members  of  the  scientific,  as  well  as  by  all'  those  of 
the  classical  Faculty. 

By  the  decree  of  December  7,  1870,  students  of 
the  real  or  scientific  school  were  admitted  to  the 
University  to  study  mathematics,  natural  historv, 
and  modern  languages.  Before  this  time  none  were 
admitted  but  those  who  had  passed  through  the 
gymnasia  or  classical  .schools.  We  are  not  surprised 
that  the  facility  exjiressed  unanimously  their  views 
of  the  value  of  the  study  of  the  ancient  languages. 
By  a  trial  of  more  than  ten  years  they  reached  the 
conclusion  recently  published.  The  advocates  of 
the  scientific  course,  in  opposition  to  the  classical, 
tell  us  of  the  superiority  of  the  former  over  the 
latter.  Our  German  friends  testify  that  a  primary 
classical  training  gives  the  subject  of  it  great  advan- 
tage over  the  student  who  has  pursued  the  course  in 
science  to  the  neglect  of  classical  study. 

The  professor  of  chemistry  says,  "  That  students 
from  the  scientific  schools  cannot  in  this  branch  of 
study  l)e  ]ilaced  upon  the  same  2)lane  with  the  stu- 
dents of  the  gvmnasia." 

Professor  Hoft'man  observes,  "  That  the  matricu- 
lates from  the  non-classical  schools  often  show,  at 
the  beginning  of  their  chemical  studies  in  the  Uni- 
versity, a  more  rapid  progress,  in  acquiring  a  knowl- 


edge of  the  elementary  principles  of  the  science,  as 
well  as  a  greater  dexterity  in  the  early  practice  of 
chemical  manipulation  ;  but  that  before  their  studies 
have  advanced  veiy  far,  these  relations  are  reversed 
and  the  non-classical  students  are  left  behind." 

Professor  Kammelsberg  gives  similar  testimony  in 
regard  to  students  in  the  school  of  technology.  He 
remarks,  "  That  of  those  who  take  his  lectures  on 
chemistry  during  the  first  semester,  the  students 
trained  in  the  gymnasia,  though  without  any  pre- 
\-ious  knowledge  of  the  subject,  take  a  far  greater 
interest  in  the  instruction  than  that  shown  by  the 
students  from  the  non-classical  schools.  At  the 
final  examinations  the  work  of  the  non-classical 
students  is  generally  inferior  to  what  in  advance 
would  be  expected,  while  the  work  of  the  classical 
students  is  almost  invariably  better." 

Zupatza,  the  professor  of  English,  says:  "That 
the  attainment  of  the  non-classical  student  is  greatly 
inferior ;  and  what  is  of  still  gi'eater  importance, 
they  almost  invariably  show  a  want  of  keenness  of 
apprehension  and  independence  of  judgment  that 
prevents  them  from  taking  any  other  than  a  pre- 
scribed method."  He  also  testifies,  "  That,  as  a 
member  of  the  Examining  Committee  of  the  Gov- 
ernment, he  has  noticed  that,  althougli  the  students 
l^repared  in  the  scientific  schools  begin  their  studies 
of  English  before  they  go  to  the  I'niversity,  theii' 
knowledge  of  the  language  at  the  completion  of 
their  University  course  is  generally  much  inferior  to 
the  knowledge  shown  by  the  classical  students." 

HeiT  Miillenhoft',  one  of  the  professors  of  the  Ger- 
man language  and  literature,  uses  these  expressive 
words  :  "  According  to  my  experience,  it  is  hope- 
lessly imjiossible  for  a  student,  prepared  in  a  scien- 
tific school,  to  acquire  what  may  be  called  a  thor- 
oughly satisfactory  development.  No  one  ever 
acquires  it  through  the  study  of  the  modern  lan- 
guages, no  one  ever  wUl  without  the  soUd  founda- 
tion of  a  training  in  a  gymnasium." 

The  professors  of  mathematics  who  teach  the 
more  elementary  branches,  and  whose  lecture-rooms 
are  therefore  generally  sought  by  students  during 
the  first  year  of  residence  at  the  University,  testify 
that  they  have  discovered  no  important  diflerence 
between  the  two  classes  of  students.  But,  on  the 
other  hand,  both  of  the  jjrofessors  who  give  instruc- 
tion in  the  mathematics  of  a  more  advanced  giade 
certify  that  the  students  who  have  received  their 
preliminary  training  in  the  classical  schools,  al- 
though less  advanced  at  the  beginning,  show  a 
clearer  insight  into  the  subtleties  of  the  more  ab- 
struse mathematical  relations  ;  and,  before  they  have 
gone  very  far,  leave  the  non-classical  students  quite 
in  the  rear." 

The  testimony  of  the  professor  of  astronomy  is  of 
the  same  import.  Both  in  the  Observatoi-y  and  in 
the  Bureau  of  Weights  and  Measures  he  has  noticed 
a  marked  distinction  between  the  two  classes  of  stu- 
dents. He  has  observed  that  the  development  of 
the  non-classical  students  is  slower,  more  superficial, 
and  less  independent,  while  they  show  still  greater 
inferiority  in  point  of  ability  to  carry  on  the  more 
difflcult  processes  of  independent  research. 

"It  is  the  opinion  of  the  Faculty  that,  unless  the 
prevailing  tendency  is  arrested,  the  inevitable  result 
will  be  that  the  superior  excellence  of  scholarship, 
which  for  half  a  century  has  made  the  German  uni- 
versities famous  all  over  the  world,  will  be  a  thing 
of  the  past." 

We  have  in  this  paper  of  the  Berlin  Faculty  the 
clearest  testimony  as  to  the  course  to  be  pursued  by 


528 


THE  MEDICAL  RECORD. 


those  who  would  profitably  pursue  the  study  of 
medicine.  The  professors  of  the  Berlin  University 
are  competent  to  observe,  and  they  have  for  more 
than  ten  years  given  attention  to  the  progress  made 
by  those  who  have  pursued  the  scientific  course  as 
a  means  of  mental  discipline.  Some  of  the  studies 
are  those  which  belong  to  the  medical  course,  and 
all  are  closely  allied  to  them,  and  the  scientific  stii- 
dents  failed  remarkably  in  these  studies.  May  we 
not  say,  then,  that  the  degree  of  B.  S.,  or  M.  S.,  or 
Ph.  D.,  do  not  with  us  indicate  qualifications  equal  to 
those  belonging  to  the  degrees  of  A.B.  and  \.^l.  any 
more  than  the  certificates  held  by  the  students  of 
the  scientific  schools  of  Germany? 

An  abstract  of  the  report  of  the  Faculty  of  the 
University  of  Berlin  was  published  in  the  Xation, 
December  22,  1881,  and  in  other  places  ;  but  we  fear 
it  has  not  reached  as  many  of  the  members  of  the 
medical  profession  as  could  be  desired.  We  think 
so  much  of  it  as  prepared  above  will  prove  of  advan- 
tage to  the  readers  of  The  Medical  Record.  We  do 
not  suppose  that  any  of  our  teachers,  private  or  pub- 
lic, will  say  that  their  experience  differs  from  that 
of  the  Berlin  professors.  The  proverbial  dread 
which  so  many  medical  students  have  of  chemistry 
and  some  otlier  studies  in  the  cun-icula  of  our  med- 
ical schools,  is  easily  accounted  for  in  the  light  which 
has  come  to  us  from  Berlia.  Furtlier,  if  this  is  the 
condition  of  the  students  of  the  scientific  schools  of 
Germany,  may  we  not  ask  what  is  the  condition  of  a 
large  portion  of  our  medical  students  who  have  not 
any  scientific  or  literary  training? 

The  Berlin  teachers  are  not  alone  in  this  testi- 
mony. Professor  Liebig  some  years  before  his 
death'stated  that  he  frequently  observed  among  his 
own  students  in  chemistry,  that  although  those 
coming  from  technical  schools  appeared  at  first,  in 
all  that  related  to  natural  science,  as  giants  compared 
to  those  having  received  a  chiefly  classical  education, 
yet  that  the  latter,  in  most  cases,  not  only  soon 
made  up  their  deficiencies  in  this  respect,  but  in  the 
end  generally  outstripped  their  technically  educated 
rivals. 

Did  space  permit,  abundance  of  like  testimony 
could  be  furnished  from  teachers  in  Europe  and  our 
own  country. 

Very  truly  yours, 

Traill  Green. 


Northwestern  Dispensary. — The  twenty-ninth 
annual  report  of  the  Northwestern  Dispensary  an- 
nounces the  largest  work  for  1881  of  any  year  since 
its  establisliment. 

Twenty-five  thousand  and  five  hundred  (25,500) 
persons  were  treated,  being  an  increase  of  nearly 
twenty-one  hundred  (2,100)  over  the  number  for 
1880.  The  increase  in  the  last  decade  in  the  special 
classes  for  diseases  of  the  eye  and  ear  and  skin 
has  been  remarkable. 

In  1870  there  wore  treated  in  the  eye  and  ear  de- 
partment -t.'W  cases  ;  in  1881,  1,483  cases,  an  increase 
of  over  300  per  cent.;  in  1870  there  were  treated  in 
the  class  for  surgical  and  skin  diseases,  1,085  cases  ; 
while  in  1881,  the  surgical  class  treated  2,322  cases, 
and  the  class  for  skin  diseases  1,323  cases,  the  classes 
having  been  separated  a  few  years  ago.  All  these 
classes  have  been  attended  by  the  same  gentlemen 
for  a  number  of  years. 

Tlie  private  donations  for  1881  amount  to  ."^2,80(), 
while  the  city  gift  was  .SI, 000. 


©bitunri). 


JAMES  RUSHMOKE  WOOD,  M.  D.,  LL.D., 

NEW  TORE. 

This  journal  had  already  passed  the  printer's  hand, 
when  the  unexpected  death  of  this  eminent  .surgeon 
was  announced  by  the  secular  press.  Probably  no 
event  partook  more  of  the  character  of  a  startling 
bereavement,  inasmuch  as  the  fact  of  his  illness  was 
not  generally  known. 

Dr.  Wood,  whose  father  was  a  trader  in  moderate 
circumstances,  was  bom  in  Frankfort  Street,  this 
city,  September  11,  181(5,  and  in  his  early  life 
struggled  hard  against  adverse  circumstances  and 
the  disadvantages  of  interrupted  opportunities  for  a 
much-desired  education.  However,  he  profited  not 
a  little  by  his  training  in  the  "  Friends'  Semfnary," 
an  excellent  and  poiiular  institution  of  the  denomina- 
tion to  which  his  parents  belonged.  After  attending 
a  preliminary  course  of  lectures,  the  future  surgeon, 
whose  name  was  to  add  lustre  to  his  native  city, 
already  past  his  majority,  entered  the  office  of  Dr. 
Tulley,  of  New  Haven,  Conn.  Returning  to  this 
city  after  a  short  term,  he  became  a  pupil  of  Dr. 
David  L.  Rogers,  then  a  lecturer  in  the  College  of 
Physicians  and  Surgeons.  He  subse(iuently  gi-adu- 
ated  from  the  Castleton  (Vt.)  Medical  College  in 
1816,  and  was  at  once  appointed  its  Demonstrator  in 
Anatomy  by  the  late  Professor  Aldenmarch,  of  Al- 
bany. In  1817,  during  an  epidemic  of  typhus  fever, 
he  first  became  identified  with  Bellevue  Hospital,  as 
an  associate  of  Dr.  Wilson,  the  resident  physician, 
and  at  once  began  a  crusade  against  abuses  which 
had  grown  up  under  a  corrupt  political  manage- 
ment. Lunatics,  vagrants,  criminals,  and  small-pox 
patients  were  then  huddled  together  in  badly  ven- 
tilated apartments,  while  niu-ses  without  character 
were  expected  to  maintain  the  necessaiy  discipline. 
As  the  result  of  Dr.  Wood's  aggressive  movement, 
the  office  of  resident  physician  was  abolished  in 
1849,  and  the  medical  management  of  the  institu- 
tion was  vested  in  a  coips  of  visiting  physicians 
and  surgeons,  to  whom  the  house  staff  were  respon- 
sible, and  who  could  be  appointed  only  on  recom- 
mendation of  this  medical  board.  Within  three 
years  the  statistics  of  the  hospital  showed  an  annual 
reduction  of  mortality  equivalent  to  the  saving  of 
six  hundred  lives  per  year.  In  recognition  of  these 
services,  but  more  particularly  for  his  zeal  and  cour- 
age during  the  typhus  fever  epidemic,  when  the 
gi'ounds  about  the  hospital  were  crowded  with  tents 
containing  the  afflicted.  Dr.  Wood's  services  were  so 
highly  a])precinted  that  the  Alms-house  Commis- 
sioners offered  him  a  s])ecial  remuneration.  This,  in 
a  monetary  way,  he  declined,  but  asked  and  received 
permission  to  make  all  auto])sies  ordered  by  them. 
While  thus  actively  engaged  in  pathological  investi- 
gation, he  conceived  the  idea  of  what  is  known  as 
the  Anatomical  or  dissecting  bill,  which  after  a 
struggle  of  three  or  four  years  in  the  House  and 
Senate,  finally  became  a  law  l>y  a  majority  of  one. 
The  substance  of  the  bill  was  that  all  vagrants  dying 
unclaimed,  and  known  by  ]niblic  authorities  to  be 
such,  and  without  friends,  are  to  be  given  to  the  in- 
stitutions in  which  medicine  and  surgery  are  taught, 
for  dissection,  the  dilin's  to  be  buried  in  the  public 
cemetery.  The  clause  which  rescued  the  bill  was 
"  Any  unknown  person  found  dead  shall  be  buried." 
It  is  but  just,  however,  that  the  names  of  Professor 


THE  MEDICAL  RECORD. 


529 


Willaid  Parker  and  the  late  Dr.  AJexantler  F.  Vaclie, 
and  Professor  Martyn  Paine  should  also  be  men- 
tioned in  connection  with  this  valuable  boon  to  the 
profession.  Previous  to  the  passage  of  this  statute 
miiieriel  was  obtained  by  students  or  professional 
"body-snatchers"  from  the  Potter's  Field,  or  other 
burial  places  as  could  be  successfully  raided.  In 
October,  1856,  Dr.  Wood  established  the  Saturday 
surgical  clinics,  which  became  a  feature  of  Bellevue 
Ho.spital,  and  which  he  continued  down  to  the  last 
Saturday  of  his  life.  To  these  clinics  were  welcomed 
both  students  and  practitioners  :  such  of  the  opera- 
tions as  could  be  reserved  until  that  day  were  then 
performed  by  him,  with  descriptions  of  methods  and 
explanation  of  pathological  points.  It  was  mainly 
by  these  that  he  gained  the  title  of  "  the  Student's 
Friend." 

The  profession  honored  the  subject  of  this  sketch 
with  many  positions  in  recognition  of  his  merits.  He 
was  twice  elected  President  of  the  Pathological  So- 
ciety, and  was,  at  the  time  of  his  death.  Consulting 
Surgeon  to  Charity,  Woman's,  St.  Vincent's,  Rup- 
tured and  Crippled  Hospitals,  still  retaining  his  favor- 
ite position  on  the  Visiting  Stall'  of  Belle's'ue  Hospi- 
tal. His  honorary  membership  in  medical  societies 
outside  of  the  State  were  to  be  counted  by  scores,  as 
might  be  expected  in  so  busy  a  man.  Dr.  Wood 
contributed  but  little  to  the  medical  literatru-e  of  the 
day,  and  that  mainly  in  pamphlet  form — the  titles  of 
such  as  were  published  are  :  "Removal  of  the  Entire 
Lower  Jaw,"  "  Ligature  of  External  Iliac  Artery," 
"  Spontaneous  Dislocation  of  the  Head  of  the  Femiir 
into  the  Lschiatio  Notch  occurring  in  Morbid  Coxa- 
rius,"  and  '■  Early  History  of  the  Operation  of  Liga- 
ture of  the  Primitive  Carotid  Artery,"  which  last  is  a 
compendium  of  rare  interest. 

The  long-cherished  idea  of  a  medical  college  as  an 
outgrowth  of  the  hospital,  suggested  by  the  success  of 
the  Saturday  afternoon  clinics,  culminated,  in  18G1, 
in  the  present  Bellevue  Hospital  Medical  College,  and 
may  be  said  to  have  combined  the  bedside  with  the 
didactic  method  of  instruction.  The  collection  of 
anatomical,  surgical,  pathological,  and  histological 
specimens,  reputed  to  be  the  most  valuable  on  this 
continent,  was,  not  over  a  year  ago,  given  to  the 
city  on  condition  of  its  care  and  perpetuation.  In  it 
is  comprised  unique  and  exquisite  prize  dissections, 
duly  described  and  catalogued.  As  a  siu-geon,  Pro- 
fessor Wood  was  bold,  rapid,  and  anatomically  sure 
— eminently  judicious  and  successful.  His  fame 
gave  him  easy  access  to  the  medical  centres  of  such 
cities  of  Eui-ope  as  he  had  visited.  He  gained  no 
little  fcli'il  at  one  of  the  International  Medical  Ex- 
positions in  the  old  world  by  the  exhibition  of  a 
skull  demonstrating  the  reproduction  of  bone  from 
the  periosteum.  This  specimen,  so  well  known  to 
the  profession,  and  occupying  a  conspicuous  place 
in  the  museum,  shows  a  second  jaw  formed  after  the 
removal  of  the  first  for  phosphor-necrosis.  His  mode 
of  operating  was  very  simple,  and  consistecf  merely 
of  the  careful  separation,  in  sections,  at  different 
times,  of  the  necrosed  bone  from  its  membranous 
tunic  by  enucleation,  after  which  the  membrane  was 
replaced  in  position,  incisions  were  closed,  and  the 
proper  dressing  applied.  On  this  operation  it  was 
his  wont  to  dilate  with  a  pardonable  pride. 

As  a  man.  Dr.  Wood  exerted  a  magnetic  intluence, 
being  genial,  considerate,  and  scrupulous  regarding 
the  reputation  of  every  member  of  the  profession. 
To  merit  he  ever  extended  a  helping  hand.  Young 
men  speak  always  of  him  with  gratitude.  By  the 
'general  public  he  was  known  by  a  sobriquet  which 


designated  at  once  his  stature  and  slender  physique 
— this  came  to  be  a  synonym  for  enterprise,  cour- 
age, and  persistency.  At  length  the  spirit  which 
betrayed  him  into  the  belief,  as  he  more  than  once 
expressed  it,  "  that  there  was,  at  least,  ten  more 
yeai-s  of  work  in  him  yet,"  succumbed  to  its  over- 
taxed energies,  most  men  believing  his  age  to  have 
been  greater  from  the  work  already  done.  He  died 
on  the  4th  instant,  of  pneumonia,  despite  the  best 
efforts  of  his  friends.  Professors  Alonzo  Clark  and 
Austin  Flint ;  he  breathed  his  last  so  peacefully  that, 
in  the  words  of  a  physician  who  was  with  him  dur- 
ing his  last  moments,  one  could  not  tell  where  life 
ended  and  death  began. 

Few  there  are  in  this  city  who  knew  him  not — 
many  who  never  saw  him  exclaim,  "  Alas,  my 
brother \ " 


JOHX  T.  HODGEX,  M.D., 

ST.    LOUIS,    ilO. 

Ok  April  'iilth,  after  an  illness  of  only  twenty-four 
hours.  Professor  John  T.  Hodgen.  M.D.,  passed  away. 
He  had  been  giving  expert  testimony  in  the  courts 
on  the  day  before,  and  had  asked  to  be  excused  from 
completing  his  evidence  because  of  the  "'  intense 
agony  and  torture  "  he  was  undergoing.  When  he 
reached  his  home  he  could  not  walk,  but  crawled 
upstairs  upon  his  hands  and  knees.  Summoning 
his  colleagues,  Baumgarten,  E.  F.  Smith,  I.  B. 
Johnson,  and  E.  H.  Gregory,  to  his  bedside,  he  told 
them  to  save  him,  if  possible,  but  that  he  felt  his 
end  was  near.  He  died  next  morning,  and  a  post- 
mortem revealed  erosion  and  perforation  of  the  gall- 
bladder, which  i^roduced  the  fatal  shock  and  peri- 
tonitis. Professor  Hodgen  journeyed  to  the  Shadow- 
land  as  he  had  walked  the  earth — calm,  heroic, 
peaceful,  and  with  dignity. 

The  suddenness  of  his  demise  paralyzed  his  bro- 
ther-physicians with  grief,  and  no  man's  taking-off 
ever  created  profounder  soitow  in  the  city  of  St. 
Louis. 

Born  among  the  prairies  of  Illinois,  where  the 
simplicity  of  almost  pioneer  life,  and  the  known 
poverty  of  a  ministerial  career,  precluded  his  father 
from  giving  him  the  advantages  of  any  early  educa- 
tion, after  the  rude  hardships  of  a  Western  farmer's 
occupations,  John  T.  Hodgen,  in  18i4,  when  biit 
twenty  years  old,  determined  to  study  medicine. 
His  earnest  positiveness  and  quiet  dignity  soon 
made  him  the  leader  of  his  classmates  (a  position 
he  ever  occupied  among  men),  so  that,  when  he 
graduated,  he  was  appointed  prosector  to  the  Chair 
of  Surgery  in  the  Missouri  Medical  College,  under 
the  late  brilliant,  but  eccentric.  Prof.  Joseph  Nash 
McDowell.  A  journey  to  California  interrupted  this 
association  for  a  couple  of  years,  but  upon  his  return 
to  St.  Louis,  in  1850,  he  was  made  Demonstrator  of 
Anatomy,  then,  in  1852,  Professor  of  Anatomy  also, 
which  he  held  until  1861,  when  he  accepted  the 
same  chau-  in  the  St.  Louis  Medical  College.  In 
1872  he  was  appointed  Professor  of  Clinical  and 
MilitaiT  Surgery,  and  held  this  chau'  until  his 
death. 

Professor  Hodgen  was  particularly  known  for  his 
wonderful  readiness  and  adaptiveness  in  emergency. 
His  surgical  eai'eer  was  eminently  practical.  He  was 
too  busy  as  a  teacher  and  practitioner  to  be  an 
author,  although  he  made  most  valuable  contribu- 
tions to  current  literature  on  fractures,  amputations, 
hospitals,   and  sanitary  science.      His  last  literary 


530 


THE  MEDICAL  RECORD. 


effort  was  published  iu  the  North  American  Herieie, 
on  President  Gai-field's  case. 

As  a  man  he  was  exemijlary,  earnest,  silent, 
thoughtful,  courageous,  and  true  ;  as  a  friend  he  was 
steadfast,  loyal,  unswei-ving,  and  affectionate.  One 
who  knew  him  intimately  for  nearly  thirty  years — one 
who  had  been  associated  with  him  in  very  many 
operations — says  of  him  : 

"As  a  surgeon  proper  he  was  almost  without  a 
peer  in  the  land,  and  he  stood  unrivalled  with  those 
who  knew  his  excellence  and  readiness.  Hud  his 
lines  been  cast  in  London,  instead  of  the  wild  woods 
of  the  young  West,  he  would  have  carved  a  rei^uta- 
tion  in  men's  estimation  equal  to  Sir  Astley  Cooper's 
or  Sir  Benjamin  Brodie's.  Had  he  lived  under  the 
shadow  of  the  Parisian  school  he  would  have  stood 
alongside  Dupuytren,  Velpeau,  or  Xelaton.  .  .  . 
As  my  friend  I  weep  for  him ;  as  my  brother 
physician  I  mourn  for  him.  I  drop  the  immortelle 
wi-eatli  upon  his  grave,  and  I  feel  tliat  inanldud  is 
honored,  humanity  blessed,  and  the  world  benefited 
by  the  example  of  so  grand  and  noble  a  character 
as  John  T.  Hodgen's.  .  .  .  Great  .statesmen, 
brilliant  orators,  dashing  generals,  mitied  bishops, 
learned  judges,  wise  lawyers,  and  good  physicians 
stand  on  the  misty  shore  to  welcome  him.  In  all 
that  silent  throng  no  greater  soul,  no  kinder  heart, 
no  gentler  disposition  is  to  be  recalled  than  John 
T.  Hodgen's." 


ARMY   NEWS. 

Officinl  Lint  of  Changes  of  Staiions  mid  Duties  of  Offi- 
cers of  the  Medical  Department,  United  States  A rmy, 
from  April  .30,  1882,  to  Mni/  G,  1882. 

WiLi/iAJLS,  .John  W.,  Major  and  Surgeon,  (iranted 
leave  of  absence  for  six  months.  S.  O.  101,  A.  (i. 
O.,  May  2,  1882. 

CowDREY,  S.  G.,  Capt.  and  Asst.  Surgeon.  Now 
awaiting  orders,  to  report  to  Commanding  General, 
Dept.  of  the  East,  for  assignment  to  dutv  at  Fort 
Monroe,  Va.     S.  O.  108,  A.  G.  ().,  May  4,  1882. 

HoFF,  J.  V.  R.,  Capt.  and  .\sst.  Sui-geon.  To  be 
relieved  from  duty  in  Dept.  of  the  East,  and  report 
in  person  to  Commanding  General,  Dept.  of  Cali- 
fornia, for  assignment  to  dutv.  S.  O.  103,  C.  S., 
A.  G.  O. 

Porter,  Joseph  Y.,  Capt.  and  Asst.  Surgeon.  The. 
extension  of  his  leave  of  absence  granted  liim  in 
S.  O.  17,  C.  S.,  Mil.  Div.  of  the  Atlantic,  is  further 
extended  twenty  davs.  S.  O.  99,  A.  G.  O..  April  29. 
1882. 

Carter,  E.  C.,  First  Lieut,  and  .Vsst.  Surgeon. 
To  be  relieved  from  duty  in  Dept.  of  California,  and 
report  in  person  to  Commanding  General,  Dept.  of 
Arizona,  for  assignment  to  duty.  S.  O.  10:!,  C.  S., 
A.  G.  O. 

Raymonij,  H.  I.,  First  Lieut,  and  Asst.  Surgeon. 
To  be  relieved  from  duty  in  Dopt.  of  (lalifornia,  and 
report  in  person  to  (Commanding  (xeneral,  Dej)t.  of 
Arizona,  for  assignment  to  dutv.  S.  ().  lO.i,  ('.  S., 
A.  G.  O. 


Bellevie  Hospit.vx.  Medical  Coli/Eoe. — Dr.  F. 
H.  Bosworth  has  been  made  Professor  of  Diseases 
of  the  Throat,  and  Dr.  Beverly  Kobinson  Professor 
of  Clinical  Medicine,  in  this  institution. 


ittctiiral  Sterns   auli   Ucius. 


CoNTAaiocs  Diseases  —  Weekly  Statement.  — 
Comparative  statement  of  cases  of  contagious  diseases 
reported  to  the  Sanitary  Bureau,  Health  Department, 
for  the  two  weeks  ending  May  (i,  1882. 


Week  BndiiiK 

i 

3 

•Is 

1  . 

II 

« 

i 

1 

& 

^ 

I 

o 

•A 

0. 

1 

|S 

AprU  39,    1883. 

4 

9 

201 

3 

137 

81 

14 

0 

May     6,    1882. 

19 

8 

181 

(> 

14.) 

78 

19 

0 

Fctller's  TadijEts. — Dr.  H.  Lyle  Smith,  of  Hudson, 
N.  Y.,  writes  :  "  In  The  Medical  Kecord,  April  29, 
1882,  p.  469,  my  attention  was  called  to  the  use  of 
'Puller's  Tablets'  for  hypodermic  injection.  As  you 
are  aware,  since  1S78 1  have  made  my  own  tablets  and 
am  constantly  using  them.  I  have  made  and  used 
thousands  upon  thousands,  both  per  orem  and  hy- 
podermically.  Since  1878  I  do  not  believe  that  I 
have  given  a  hypodermic  injection  of  morphia,  ex- 
cept in  the  shape  of  a  Fuller  tablet,  and  I  use  my 
syringe  daily.  During  all  this  time  I  have  never 
had  the  least  trouble,  itei^n-  an  abscxs,  nor  any  lo- 
cal or  constitutional  trouble  from  them.  For  the 
last  two  years  I  have  made  ell  my  tablets  from  cane 
sugar.  I  buy  the  frof:! in ;j  sugar  of  the  confectioners, 
and  like  it  better  than  the  sugar  of  milk  ;  its  solu- 
bility is  far  greater.  Cane  sugar  used  hypodermi- 
eally  uerer  produces  the  least  irritJition.  I  have  seen 
Wyeth's  little  tablets,  but  in  solubility  they  bear  no 
comjaarison  to  Fuller's." 

Dr.  J.  Marion  Sims. — The  profession  of  this 
country  wUl  be  glad  to  learn  that  Dr.  Sims  has  been 
restored  to  health,  and  is  on  his  way  from  Paris  to 
this  city. 

State  Medical  Society  of  Wisconsin  held  its 
annual  session  for  1882,  at  IMineral  Point,  May  2d. 

The  late  Dr.  Ekski.ne  Mason. — The  Executive 
Committee  of  the  Board  of  Trustees  of  the  American 
Veterinary  College  issued  the  following  preamble 
and  resolutions  upon  the  death  of  Prof.  Erskine 
Mason,  A.M.,  M.D. 

Whereas,  By  the  death  of  Prof.  Erskine  Mason, 
A.M.,  M.b.,  the  Board  of  Trustees  of  the  American 
Veterinary  College  have  to  mourn  the  loss  of  an  as- 
sociate trustee,  but  just  reelected  to  his  second 
term  of  office  ;  therefore, 

Resolveil,  First,  that  by  his  death  we  lose  the  co- 
operation of  one  whom  we  have  learned  by  long 
associa*i.ion  to  regard  as  a  large-hearted,  liberal- 
minded,  and  conscientious  man. 

liesolred.  Second,  that  as  citizens  we  feel  that  the 
community  has  lost  one  whose  sterling  integrity, 
faithful  discharge  of  dvity,  and  professional  aliility 
had  rendered  his  life  an  ornament  to  his  profes- 
sion. 

Resolved,  Third,  that  we  tender  to  his  bereaved 
family  our  sincere  sympathy  in  their  atHiction. 

Resolved,  Fourth,  that  the  .\merican  VeterinaiT 
College  be  closed  on  the  day  of  the  funeral,  and  the 
Trustees  and  T'aculty  of  the  College  attend  the 
same. 


THE  MEDICAL  RECORD. 


531 


Resolri>d,  Fifth,  that  a  copy  of  these  resolutions  be 
forwarded  to  the  family  of  our  deceased  fellow- 
trustee,  and  that  the  same  be  printed  in  the  New 
York  Medical  Kecord  and  American  Veterinary 
Rerieic. 
By  order  of  the  Executive  Committee, 
SAJiTEii  ^Iarsh,  Esq., 

President  of  the  Board  of  Trirst'-es. 
Faneol  D.  Weisse,  M.D. 
Daniel  M.  Stiiison,  M.D. 
Hamiltox  BrsBEY,  Esq. 


IFAej-eas,  It  has  pleased  God  in  his  Providence 
to  remove  from  amongst  us  our  late  fi-iend  and  as- 
sociate, Dr.  Erskine  Mason  ;  and 

Whereas,  This  Board  has  for  many  successive 
years  profited  by  his  ad^dce  and  counsel ; 

Besolred,  That  the  Board  of  Trustees  of  the  Physi- 
cians' Mutual  Aid  Association  hereby  records  its 
sorrow  at  his  untimely  death,  in  the  midst  of  a  use- 
ful and  honorable  career,  in  a  profession  to  which 
he  had  devoted  the  best  years  of  his  life  with  ear- 
nestness and  fidelity ; 

Eesolred,  That  by  his  death  this  Board  loses  a 
member  who  was  always  prompt  and  faithful  in  his 
attention  to  his  duties,  fully  sensible  of  the  trust 
committed  to  him,  and  watchful  in  guarding  the  in- 
terests of  the  association,  kind  and  courteous  to  his 
fellow  members,  considerate  of  the  claims  of  the 
needy,  and  wise  in  his  suggestions  for  their  relief ; 

Resutred,  That  this  faithfulness  which  he  showed 
as  a  trustee  was  carried  into  all  the  associations  of 
his  medical  life,  with  the  same  zeal  and  conscien- 
tious devotion  to  whatever  he  undertook,  giving  us 
all  an  examj^le  worthy  of  imitation  ; 

Resolved.  That  these  resolutions  be  inserted  in  the 
medical  journals,  and  a  copy  of  them  transmitted  to 
his  bereaved  family,  with  the  sincere  sympathy  of 
the  Board. 

George  A.  Pctebs, 
George  G.  Wheelock, 
Daniel  LE-nxs,  _ 

Commillee.    ■ 

YruL.'^GE  DofTOR-s. — A  correspondent  of  the  British 
Medica!  Journal  defends  the  country  doctors.  He 
says  :  "  Is  it  remarkable  (as  has  been  alleged)  that  a 
village  doctor  should  have  arrived  in  1810  at  these 
conclusions,  which  anticipate  some  of  our  most  re- 
cent teachings,  WOl  he  inform  us  why  it  is  remark- 
able that  a  village  doctor  should  have  advanced  and 
independent  views  on  medicine  ?  Have  not  the  vil- 
lage doctors  fre(iueutly  and  strikingly  shown  that 
medical  intelligence  and  knowledge  is  not  to  be 
measured  by  the  jjopulation  with  which  it  is  sur- 
rounded? Village  doctors  want  to  thi-ow  aside  the 
superstitious  i-espect  shown  to  town  doctors,  and 
hold  to  and  record  the  results  of  their  own  observa- 
tion and  thought,  however  divergent  from  the  teach- 
ings of  town  doctors  ;  and  much  useful  knowledge 
would  be  recorded,  and  its  value,  years  afterward. 
accepted  by  the  town  doctors  who  assume  the  i)osi- 
tion  of  teachers." 

The  Effects  of  Medicines  in  S>lvll  Doses. — It 
has  for  some  time  now  become  a  recognized  princi- 
ple in  therapeutics  that  many  drags  have  an  eft'ect, 
when  given  in  minute  doses,  quite  ditlerent  from 
the  ordinary  massive  dose. 

Dr.  Ide  has  recently  contributed  some  observa- 
tions in  this  branch  of  therapeutics  to  the  Allge- 
meine  viedicinische  Cenlral-Zeitiing.     The  first  series 


of  facts  relate  to  arsenic  in  diarrhfea  and  in  ulcers. 
In  tlie  case  of  an  infant  aged  five  months,  with  en- 
tero-colitis,  two  drops  of  Fowler's  solution  were 
added  to  7'>  giammes  (  3ijss.)  of  water,  and  a  tea- 
spoonful  ordered  every  two  or  three  hours. 

The  next  day  the  child  was  better,  but  showing 
the  effects  of  the  arsenic  in  oedema  of  the  eyelids 
and  reddened  conjunctiva.  In  four  days  recovery 
had  taken  place.  This  use  of  arsenic  in  diari'hoea 
and  dysenteiw  is  not  a  new  one,  but  is  hardly 
applied  so  often  as  it  might  be. 

In  cases  of  old  leg  ulcers  which  are  painful  and 
obstinate.  Dr.  Ide  reports  good  results  as  regards 
relief  of  pain.  Thus,  he  gave  an  old  woman  with  a 
chronic  leg  ulcer  .a  teaspoonful  of  a  mixtui'e  con- 
taining three  drops  of  Fowler's  solution  in  100 
grammes  of  water,  the  dose  being  repeated  thrice 
daily.  Local  applications  of  carbolized  oil  were 
also  ordered.  Relief  from  severe  night- j)ains  was 
immediate. 

Tartar  emetic  in  doses  of  about  jj^^,  of  a  grain  re- 
lieved a  case  of  hay  fever. 

Two  cases  are  cited  which  the  author  thinks  show 
the  usefulness  of  silica  in  the  third  trituration,  in 
cases  of  injured  joints  or  ununited  fractures. 

The  occasional  usefulness  of  tinct.  cantharides 
iu  doses  of  a  fraction  of  a  drop,  for  h.'ematuria,  etc., 
is  well  known.  Dr.  Ide  cites  a  case  in  illustration. 
Calomel  and  corrosive  sulilimate  have  been  used  in 
diarrhteas  and  dysenteries  in  our  hospitals,  and  are 
recommended  by  Kinger.  In  a  case  of  dysentery, 
-'s  of  a  grain  of  coiTosive  sublimate  was  given  every 
two  hours,  with  the  most  marked  improvement 
within  twenty-four  hours ;  other  and  similar  cases 
are  given. 

A  case  of  stomatitis,  in  which  improvement  fol- 
lowed the  use  of  mercur.  solnt.  Hahn.  triturat.  iii.. 
gr.  ij.,  q.  3  h.,  after  other  treatment  failed,  is  thought 
to  illustrate  the  peculiar  power  of  mercui-y  iu  small 
doses.  In  another  case  a  dilute  solution  ( IT  j.  to 
;  j.)  of  nitric  acid  was  strongly  healing. 

The  powers  of  Pulsatilla  were  shown  in  a  case  of 
obstinate  trigeminal  neuralgia,  which  quickly  yielded 
to  that  drug  given  in  doses  of  about  half  a  drop  of 
the  third  dilution  every  three  hours. 

A  SociETr  FOR  Newly  Bokn  Infants  has  recently 
been  organized  in  Paris.  One  great  object  of  the 
society  is  to  prevent  infanticide.  It  has  a  "House 
for  Newly  Born  Infants,"  where  this  class  is  received 
and  brought  up  gratis  until  they  are  three  years  old. 
Mothers  are  encoui-aged  to  visit  their  children  here. 
Unfortunate  mothers  will  be  helped  in  securing 
employment. 

Utilizing  the  Brain  of  the  Cat  for  Anatomi- 
cal Stfuy. — Tlie  difficulty  of  pi-ocuring  the  human 
brain  in  a  snfficiently  fresh  state  for  the  observation 
of  the  finer  details  of  even  microscopic  anatomy  is 
weU  known.  Professor  Wilder,  of  Cornell  Univer- 
sity, has  recently  published  a  monograph  on  "  The 
Brain  of  the  Cat,"  and,  by  the  aid  of  elaborate  litho- 
graphic plates,  has  given  a  ven"  good  idea  of  how 
much  may  be  learned  from  the  encephalic  portion  of 
this  commonly  despised  animal.  He  has  chosen  the 
cat  as  being  generally  available  [in  countries  where 
anatomy  is  "  cultivated,"  and  better  than  the  dog  on 
account  of  breed  dili'erences  and  a  usually  complex 
fi.ssural  pattern  in  the  brain  of  the  latter.  Professor 
Wilder  has  added  several  new  names  to  this  already 
much-named  organ.  He  has  also  proposed  sev- 
eral changes  in  its  existing  nomenclature,  some  of 


532 


THE  MEDICAL  RECORD. 


which  will  undoubtedly  prove  of  value.  We  feel 
disposed  to  especially  endorse  his  recommendation 
for  the  more  general  adoption  of  such  terms  as  ceph- 
alic and  caudal,  dorsal  and  ventral,  in  place  of  supe- 
rior, inferior,  posterior,  and  anterior.  The  latter  are 
often  rendered  ambiguous  and  confusing  to  the  stu- 
dent on  account  of  the  natural  dift'erenee  in  jjosture 
between  man  and  other  mammals,  and  the  fact  that 
the  human  cadaver  is  usually  examined  in  a  supine 
position.  About  one  hundred  and  fifty  named  parts 
are  shown  in  the  plates.  Many  of  these  are  pointed 
out  by  the  author  as  subjects  calling  for  special 
elucidation.  The  paper  to  which  we  have  alluded 
is  the  first  of  a  series  on  the  same  subject,  promised 
by  this  indefatigable  worker.  It 'evidences  his  in- 
tention to  give  a  thorough  and  comprehensive  re- 
view of  the  brain  of  this  representative  mammal,  not 
only  as  to  its  gross  anatomy  but  also  its  histology, 
development,  and  taxonomic  relations.  The  series, 
when  completed,  will  serve  the  student  as  a  valu- 
able introduction  to  the  study  of  the  human  en- 
cephalon. 

Petroleum:  Pills  ik  Phthisis. — Dr.  M.  Milton, 
of  Branford,  Pa.,  sends  us  the  following  clinical  evi- 
dence of  the  value  of  petroleum  in  phthisis  : 

"C.\SE  I. — Mrs.   M ,  Irving,  N.  Y.,   German, 

widow,  occupation  housekeeper,  aged  thirty-seven  ; 
one  sister  died  of  consumption  at  the  age  of  thirty- 
five  ;  parents  both  dead,  cause  not  known.  This 
patient  has  had  a  cough  for  five  or  six  years — she 
says  'it  is  a  seven  years  cough ' — much  difficulty 
of  breathing  at  times.  Has  been  pronounced  a  con- 
sumptive by  several  physicians  and  given  up  as  an 
incurable  ;  had  dyspepsia ;  much  emaciated  ;  spent 
whole  nights  often  with  the  most  racking  cough  I 
ever  heard  :  expectoration  profuse ;  suppression  of 
the  menses ;  cavernous  respu'ation  in  apex  of  left 
lobe  of  the  lung  :  has  had  several  attacks  of  pneu- 
monia. She  came  under  my  observation  November, 
1879.  I  jjlaced  her  under  the  usual  treatment  of 
cod-liver  oil,  extract  of  malt,  whiskey,  etc.  These 
aijparently  having  no  appreciable  effect,  I  placed 
her  on  petroleiim  pills  —at  the  suggestion  of  Dr.  M. 
M.  Griffith,  then  residing  at  Irving,  N.  Y. — one  pill 
every  thi-ee  hours,  or  when  the  cough  was  trouble- 
some, also  as  a  tonic,  elixir  quinia,  iron,  and  strych- 
nia ter  die.  I  have  no  record  of  pulse,  temperature, 
etc.  The  cough  was  relieved,  expectoration  dimin- 
ished, and  the  difficiilty  of  breathing  disappeared. 
She  had  comfortable  night's  .sleep,  which  was  rare 
before.  The  improvement  was  slow,  but  apparent. 
She  occasionally  had  her  old  coughing  spells,  when 
she  committed  some  indiscretion  in  diet  or  exposure 
to  the  weather.  She  was  one  of  those  cases  whose 
house  one  would  prefer  to  pass  a  dozen  times  rather 
than  go  in  once,  and  rather  go  five  miles  around 
than  pass  the  house — she  was  a  regular  termagant. 

"  I  .saw  her  last  May.  She  was  then  under  the  care 
of  Dr.  Griffith,  who  reported  that  he  had  continued 
the  treatment,  only  varying  occasionally  as  indica- 
tions required.  She  had  gained  in  weight  twenty- 
five  or  thirty  pounds,  was  doing  all  her  household 
labor,  washing,  etc.,  which  she  had  not  done  for 
years.  I  think  this  may  V)e  called  a  case  of  '  con- 
sumption cured.'  It  luvl  boon  pronounced  so  by  my 
superiors  in  diagnosis,  tliough  lacking  tlie  evidence 
from  neglect  to  take  notes  at  the  time." 

"  Ca.se  II.— Noveml)er  lit,  187'.».     Mr.  B ,  aged 

twenty-nine  years,  weighs  117  jjounds  ;  temperature, 
9!)J°F.  ;  respiration,  21  per  minute.  Has  a  cough 
much  increased  upon  exertion,  and  attributed  to  an 


attack  of  pneumonia  two  years  ago.  He  has  not  been 
robust  since.  Nothing  hereditary  in  family.  Has 
been  gradually  losing  flesh  ;  night-sweats  at  inter- 
vals ;  no  appetite  ;  several  hemon'hages  during  the 
last  eight  months. 

"  Slight  dulness  at  apex  of  left  lung,  increase  of 
vocal  resonance,  increased  bronchial  whisper,  bron- 
cho-vesicular respiration  over  a  circumscribed  spot. 
Eight  lung  sound. 

"  Placed  upon  pills  of  petroleum  mass,  combined 
with  quinia  and  Dover's  powders  ;  one  every  three 
hoiu's,  or,  as  the  cough  was  troul)lesome,  also  elixir 
quinia,  iron,  and  strychnia  ter  in  die.  Did  not  see 
him  again  for  three  months.  He  liad  taken  the  pill.s 
faithfully,  the  elixir  occasionally.  I  scarcely  recog- 
nized him  as  the  same  person  ;  he  had  gained  thirty 
pounds  ;  appetite  good  ;  no  night-sweats,  and  to  all 
appearance  he  was  well.  December  17,  1880. — He 
reports  no  return  of  his  old  troubles. 

•'  CUsE  III. — Mr.  B ,  residence  Texas.    Phthisis 

hereditary ;  weighs  14.5  pounds  ;  color  good  ;  has 
nasal  catarrh ;  respiration,  "20  per  minute ;  tem- 
perature normal ;  has  had  night-sweats  occasionally, 
also  hemorrhages  ;  slight  infiltration  at  upper  lobe 
of  right  lung,  about  the  size  of  a  silver  dollar  ;  slight 
dulness  over  this  spot ;  diminished  respiratory  mur- 
mur ;  mucous  rfdes  ;  crackling  sound  over  the  spot. 
Was  placed  upon  the  pills  with  my  usiial  prescrip- 
tion— elixir  quinia,  iron,  and  strychnia.  He  has 
steadily  imj^roved,  gi'adually  gaining  in  weight  and 
strength.  He  returned  home  in  three  months,  and 
is  reported  by  his  physician  in  a  fair  state  of  health 
two  years  after  he  came  under  the  treatment. 

"  C.iSE  rV'. — Mrs.  M ,  residence  Svi-acuse,  N.  Y. 

Has  had  several  hemorrhages  ;  phthisis  hereditary 
in  the  family,  two  of  the  family  having  died  of  the 
disease  ;  weighs  110  pounds.  She  is  aniemic  in  ap- 
pearance ;  no  appetite.  Has  had  a  diy,  tickling 
cough  for  six  months  ;  now  raises  a  muco-purulent 
matter:  has  dyspeptic  troubles;  difficulty  in  breath- 
ing on  exertion  :  bronchial  breathing  in  a  small  area 
of  left  lung :  slight  involvement  of  the  apex  of 
right  lung ;  some  dulness,  upon  percussion,  of  the 
diseased  lung ;  pulse,  105  ;  temperature,  lOli".  Was 
given  my  usual  prescriptions,  also  to  use  a  plaster 
of  the  same,  to  be  used  and  worn  on  the  lung. 

"  In  one  month  much  improved  ;  appetite  fair. 
Menses  appeared,  which  had  been  suppressed  for 
three  months  ;  cough  and  expectoration  much  less  ; 
no  night-sweats ;  vesicular  murmur  in  both  lungs 
clear  and  distinct.  This  case  is  remarkable,  showing 
the  efficacy  of  the  treatment  when  applied  in  the 
early  stages."  • 

A  fourth  ease  is  related,  but  it  seems  to  carry  no 
evidence  of  tlie  value  of  petroleum.  Dr.  Milton  con- 
cludes with  the  following  judicious  .summing-up  of 
the  question  : 

"  5ly  number  of  cases  of  well-marked  phthisis 
have  not  been  large,  but  the  results  have  been  above 
the  average — fortv-three  eases  during  the  last  three 
years,  with  the  following  results  :  .\i>parently  cured, 
14 ;  improved,  18  :  no  improvement,  3  ;  died,  5  ;  no 
reports  from  :i.  The  apparently  cured  may  at  any 
day  break  forth  with  all  the  symptoms  of  the  disease 
in  its  worst  form.  I  am  inclined  to  the  belief  that 
we  are  no  nearer  a  cure  for  phthisis  tlian  ever  before. 

"  In  the  above  cases  I  did  not  rely  on  the  remedies 
exi'lusively,  but  treated  the  symptoms  as  they  arose; 
but  they  were  continued,  and  only  intermitted  when 
otlier  treatment  was  indicated.  I  never  use  cod-liver 
oil  in  phthisis,  the  petroleum  fulfilling  all  indications 
for  it." 


Vol.  XXI.-No.  20. 1 
May  80,  1882.     I 


THE  MEDICAL  RECORD. 


f33 


©rigiiml  Commumcations. 

PYREXLi    A    CONSEEVATI\'E    FORCE    IN 
rE\^E.* 

Bt  nelson  E.  JONES,  M.D., 

CIHCLEVILLE,    OHIO. 

This  may  seem  a  solecism.  The  difficulty  in  giving 
expression  to  the  proposition  in  a  few  words  leads  to 
the  adoption  of  the  present  heading.  It  expresses 
more  directly  what  is  really  meant  than  to  say  "  A 
conserrative  force  in  disease  ;"  for  the  latter  would 
make  the  subject  more  general  than  intended,  as  it 
would  embrace  all  diseases,  while  the  word  "fever" 
is  applied  to  a  certain  class  of  diseases,  which  col- 
lectively are  known  by  the  name  of  "fevers."  The 
word  "  pyrexia  "  is  employed  in  the  ordinary  sense 
— heat,  rise  of  temperature,  feverishness. 

According  to  present  jjathology,  increased  tem- 
perature, or  pvresia,  is  a  symptom  of  fever.  Some 
make  it  a  necessary  symptom,  and  claim  where  it  is 
absent  fever  does  not  exist.  True,  where  there  i.s 
no  preternatural  heat  it  may  be  said,  technically, 
there  is  no  fever  ;  still,  it  cannot  from  this  be  logic- 
ally asserted  there  is  no  disease,  for  grave  forms  of 
disease  sometimes  exist  without  fever,  or  even  with 
a  subnormal  temperature.  Also  a  high  tempera- 
ture may  be  present  without  fever  or  disease,  and 
there  may  be  fever  or  disease  with  a  low  tempera- 
ture ;  there  may  be  disease  without  fever,  but 
not  fever  without  disease.  Therefore,  "pyrexia," 
"  fever"  and  "  disease  "  are  not  exactly  the  represen- 
tatives of  the  same  idea,  neither  can  they  always  be 
interchanged  without  a  change  of  meaning ;  and 
confusion  in  representation  is  very  often  produced 
by  applying  entirely  different  meanings  at  diflerent 
times  to  these  substantives.  Very  frequently,  in- 
deed, both  writers  and  speakers  make  temperature 
the  synonym  for  "fever,"  and  speak  of  the  patient's 
having  a  great  fever,  a  high  fever,  etc.,  upon  the 
mere  indication  of  a  rise  in  the  temperature  point. 
And  at  another  time  no  relation  of  these  terms  is 
made  to  exist,  and  the  sick  are  described  as  having 
a  low  "  fever,"  a  malignant  "  fever,"  etc.,  with  a  nor- 
mal or  subnormal  temperature.  The  first  expression 
may  be  correct  or  may  be  incorrect,  for  temperatvire 
is  a  state,  and  fever,  in  the  sense  of  pyrexia,  is  but 
the  symptom  of  disease,  while  disease  is  an  entity, 
a  substance,  a  thing.  Increased  temperature,  bodily 
heat,  being  but  a  symptom  of  fever,  when  "fever" 
is  used  in  the  sense  of  disease,  it  may,  like  other 
symptoms,  be  absent  or  may  be  present,  and  still 
the  disease  may  be  called  a  fever ;  "  for  circum- 
stances may  arise,"  says  Virchow,  "  which  shall 
make  the  presence  of  one  or  another  symptom  im- 
possible." Webster  defines  "  fever,"  "  A  diseased 
state  of  the  system,  marked  by  increased  heat,  ac- 
celerated pulse,  and  general  derangement  of  the 
functions."  Fever  is  termed  a  "diseased  state  of 
the  system,"  and  as  such  it  is  but  reasonable  to  sup- 
pose it  may  be  accompanied  by  all  the  usual  symp- 
toms or  by  only  part  of  them  ;  and  this  diseased 
state  of  the  system  may  run  its  course  with  a  low 
temperature,  rapid  pulse,  and  general  derangement 
of  the  functions,  or  the  reverse,  and  no  one  can  pre- 
dict, in  an  expected  case  of  essential  fever,  which,  if 
any,  of  the  usual  symptoms  may  be  wanting  ;  neither 


one  nor  any  one  is  necessary  to  the  fever.  "  A  rise 
of  temperature,"  says  Senator,  "is  only  one  symp- 
tom, and  does  not  constitute  the  essence  of  'fever;' 
its  explanation  has  not  yet  furnished  any  theory  of 
fever,  because  underneath  this  symptom  very  dif- 
ferent morbid  processes  are  combined,  and  because 
there  are  in  fever  other  important  processes  inde- 
pendent of  temperature." 

"Everyone  is  sick,"  says  Dr.  Wagner,  "whose 
temperature  is  not  within  the  limits  of  health,  even 
if  he  should  feel  subjectively  well  and  healthy."  "A 
normal  temperatui'e  may  exist  in  disease."  .... 
"And  the  diagnostic  value  of  the  absolute  height  of 
a  certain  temperature  by  itself  is  very  slight." 
.  .  .  .  "  At  all  events,  it  Las  not  yet  been  j^ossi- 
ble  to  demonstrate  an  exact  relation  between  animal 
heat  and  tissue  metamorphosis,  and  a  conclusion 
cannot  be  drawn  from  the  height  of  the  tempera- 
ture as  to  the  severity  of  the  fever  nor  the  amount  of 
heat  production."  Opinions  difl'er  in  regard  to  the 
amount,  if  any,  of  increase  in  the  production  of  heat 
in  fever,  and  the  presumption  is  that,  if  any  increase 
exists,  it  is  indeed  veiy  small.  The  correctness  of 
this  supposition,  says  Dr.  Wagner,  seems  to  be 
justified  by  the  small,  even  to  a  certain  extent 
doubtful,  increase  of  the  consumption  in  fever  as 
compared  with  that  in  the  fasting  state.  With  the 
same  degree  of  heat,  the  heat-production  may  be 
much  or  little,  or  not  at  all  increased,  in  proportion 
to  the  amount  of  loss  of  heat,  and  for  this  reason 
the  febrile-waste  and  the  amount  of  febrile-products 
of  decomposition  may  in  one  case  be  small,  in  the 
other  large,  and  temperature  manifestations  may  be 
lirincipally  a  vaso-motor  j^henomenon,  whether  nor- 
mal, sui-iernormal  or  subnormal. 

Leibermeister,  the  great  philosopher  in  medicine, 
says  :  It  is  neither  heat-production  nor  increased- 
temperature,  nor  both  together,  that  constitutes 
fever.  The  manifest  heat  is  simply  the  regulation 
of  the  heat,  the  temperature  point  being  fixed  in 
fever  at  a  higher  degree  of  temperature.  And  it  is 
almost  a  matter  of  compulsion  to  look  for  and  to 
admit  a  governing  centre. 

Keichert  and  Bernard  have  shown  it  is  not  by  the 
variations  in  the  loss  of  heat,  nor  the  variations  in 
the  increase  of  heat-production,  nor  vascular  influ- 
ence, that  changes  are  jiroduced  or  constant  tem- 
perature is  maintained  at  any  given  point.  After 
dividing  the  cervical  sympathetic  on  one  side,  the 
side  operated  upon  assumed  a  temperature  several 
degrees  higher  than  that  of  the  other  side  without 
a  change  of  vascularity  ;  and  that  the  stimulation  of 
the  central  end  of  the  divided  auricular  nerve,  suffi- 
ciently intense  to  give  rise  to  pain,  occasioned,  on 
the  one  side  in  which  the  sympathetic  was  intact,  a 
fall  of  several  degrees  of  temjierature  in  the  ear,  x\n- 
aecomjianied  by  any  pallor,  whUe  on  the  side  on 
which  the  sympathetic  had  been  divided  a  rise  of 
temperature  was  at  the  same  time  observed.  "That 
is  to  say,  the  sensation  of  pain  gave  rise,  by  reflex 
action  through  the  intact  cei-vical  sympathetic,  to  a 
refrigeration  of  the  ear,  without  any  vascular  change 
in  the  ear  and  in  spite  of  an  increased  temperature 
of  other  parts  of  the  body." 

If  these  statements  are  admitted  as  true,  it  is  not 
saying  more  than  present  accumulated  facts  warrant 
in  saying,  that  this  regulating  vaso-motor  function 
may  so  direct  temperature  that  it  becomes  a  con- 
servative force  in  favor  of  the  well-being  of  the  or- 
ganism, and  that  there  is  a  want  of  clinical  evidence 
in  support  of  the  declarations  that  pyrexia  causes  a 
melting  away  of  the  nitrogenous  tissues  of  the  body, 


534 


THE  MEDICAL  RECORD. 


which  have  been  represented  as  wearing  out  quite 
slowly  under  ordinary  temperature,  but  oxidizing 
so  rapidly  at  an  elevation  of  a  few  degrees  only 
above  normal,  that  this  monster,  once  pyrexia,  now 
"hyper-pyrexia,"  has  been  described  without  real- 
ity asserted  without  doubt,  reiterated  without 
knowledge,  and  believed  without  evidence  as  de- 
stroyin"  cell-formation,  changing  the  character  ot 
the  'blood,  destroying  the  muscles  by  fatty,  granular, 
and  waxy  degenerations,  paralyzing  the  heart,  de- 
stroying the  liver,  kidneys,  and  lymphatics,  and  fanal- 
Iv— the  frightful  statement— "cooking  the  nerve- 
pulp"  and  turning  the  case  over  to  coma  and  death. 
Yes,  these  parrot  like  stories  of  pathological 
fiction,  so  often  told,  seem  almost  an  established 
reality,  and  it  is  with  difficulty  it  can  be  realized 
that  dupes  are  more  frequently  than  m  any  other 
way  dupes  of  opinions,  theories,  and  oft-repeated 
dogmatic  assertions. 

If  pyrexia  is  but  a  symptom  of  disease,  and  not 
always  a  true  measure  of  the  gravity  or  seventy  of 
the  attack,  and  even  when  disproportionately  high 
has  not  been  shown  to  be  especially  detrimental  to 
tissue  integritv,  or  seemingly  incompatible  with 
human  life,  but,  on  the  contrary,  that  even  extraor- 
dinary high  temperatures  may  be  endured  m  dis- 
ease for  lono-  periods,  without  detriment  or  danger, 
'and  that  such  cases,  as  a  rule,  end  in  recovery,  is 
there  not  reason  enough  in  all  this  to  call  for  a  care- 
ful investigation  of  the  part  taken  by  pyrexia  in 

The  clinical  histories  given  by  Dr.  Philopson, 
Davis  Little,  Teale,  Roddick,  Donkin  and  others, 
have  completely  overturned  all  suppositions  on  this 
subject,  especially  when  it  is  known  that  patients 
may  live  and  do  well  with  temperatures  ranging 
from  108°  to  122°  Fahr.  for  weeks  and  for  months, 
and  make  good  recoveries.*  . 

Temperature  high  or  temperature  low  i.s  not 
disease  Disease  is  chemical  change  produced 
in  the  organism  by  foreign  organic  or  inorganic 
matter;  and,  as  a  fact  worth  remembering,  m 
those  who  die  from  any  given  disease,  whether  ac- 
companied bv  a  normal,  subnormal  or  supernormal 
temperature, 'the  pathological  appearances  on  post- 
mortem are  the  same.  It  is  often  a  matter  of  sur- 
prise that  contributors  of  medical  literature  will  go 
so  far  as  they  sometimes  do  to  make  facts-m-form 
comport  with  preconceived  theories.  It  has  not 
only  been  assumed  that  temperature  produces  tissue- 
destruction,  but  of  late  that  bodily  heat  in  disease 
is  a  "complication"  as  well  as  a  symptom,  .and  an 
attempt  has  been  made  to  change  a  very  welldefaned 
matter  indeed,  by  calling  the  pyretic  state  ac^om- 
panvin"  fever  a  "  hvper-pyrexia,"  all  to  support  and 
iustifv  a  theoretical  and  empirical  plan  of  treatment. 
But  standard  authorities  on  this  subject  say  hyper- 
pvretic  temperatures  are  such  as  considerably  ex- 
ceed even  the  high-febrile,  and  which  are  by  no 
means  to  be  merely  received  as  an  expression  of 
very  inienxe  fevn:  And  when  pyrexia  is  named  it 
is  understood  to  mean  a  rise  in  temperature  as  may 
occur  in  disease,  including  inflammations  of  all 
kinds,  varying  in  height,  but  even  at  the  very 
highest  not  hyper-pyretic— even  at  the  very  highest 

not  disease.  .     , .  ^    ,  ,  i  * 

Microscopists  and  scientists  have  shown,  and  to 
the  belief  of  which  we  are  bound  by  facts  as  much 
as  we  are  bv  the  statements  of  Harvey  and  Galileo, 


»  BribiBh  Mea.c«l  Jonrnal.  .l«mmry  24  1880.    Lancet,  April  24, 18,-0. 
Mcrticnl  Time»  nncl  Gnicltc,  Apnl  24  anrt  .M»y  1,  1880. , 


that  both  animal  and  vegetable  micro-organisms  are 
developed  from  disease-germs- that  these  organisms 
produce  disturbances  we  call  disease.  And  it  has 
been  shown  that  these  micro-organisms  hye  and 
breathe  just  as  larger  animals  and  plants  live  and 
breathe.  So,  when  we  speak  of  disease,  we  but 
speak  of  animals  and  plants,  things  that  live  and 
move,  and  have  a  being,  a  substance,  a  solid. 

The  fungoid  mould  called  coprinus  domesticus  is 
a  well-known  sample  ot  these  organisms.  It  is  the 
cause  of  influenza,  a  most  infectious  disease,  so 
much  so,  at  least,  that  it  has  passed  into  a  common 
saying,  if  a  cat  begins  to  sneeze  from  this  cause, 
the  chances  are  it  will  spread  itself  to  eveiy  human 
member  of  the  household.  That  all  zymotic  dis- 
eases, or  the  classification  termed  such,  are  pro- 
duced bv  similar  specific  disease-organisms,  no  one 
can  at  present  successfully  refute.  The  relation  of 
some  of  these  organisms  to  disease  has  ab-eady  been 
established,  and  it  mav  be  inferred  that  a  similar 
relation  exists  among  other  diseases  of  the  class,  to 
organisms  vet  undiscovered.  For  when  the  law 
and  requirements  necessary  to  produce  one  ear 
of  corn  is  Imown,  it  is  conclusive  proof  of  the  re- 
quirements necessarv  to  the  production  of  every 
other  ear  of  corn  'and,  more,  the  whole  cereal 
family.  So  in  disease  ;  enough  has  been  absolutely 
proven  to  establish  the  natural  causes  that  develop 
and  perpetuate  all  diseases  we  term  zymotic,  specific, 
and  contagious. 

Although  many  of  the  classified  organisms  pro-. 
■  diicing  disease  are  said  to  resemble  each  other  so 
closely  that  it  is  difficult,  if  not  impossible,  to  dis- 
tinguish one  from  the  other,  yet  we  know  one 
produces  one  di.sease  and  another  similar  looking 
organism  produces  another  disease— one  brings  forth 
typhoid  fever,  another  small-pox,  another  measles, 
another  scarlet  fever,  etc.,  each  after  its  kind,  mak- 
ing, if  not  an  ocular,  a  clinical  difl'erence  quite  as 
important  as  a])parent.  An  inoculation  with  a 
small-pox  germ  never  produces  measles— never  pro- 
duces scarlet  fever,  nor  anv  other  disease  excepting 
the  one,  that  of  small-pox."  Each  germ  has  its  own 
manifestation  and  no  other ;  and  all  the  discussion 
of  identitv  and  similarity  in  appearance  is  made  to 
disappear'in  the  clinical  difference  in  their  develop- 
ment as  disease.  And  it  may  at  once  be  admitted 
there  is  a  close  resemblance,  but  still  a  difl'erence  ; 
and,  as  a  competent  observer  remarks,  no  closer  re- 
semblance perhaps,  even  in  those  which  have  con- 
formations  the  nearest  identical,  than  exists  between 
a  tiger  and  a  zebra— both  these  animals  having 
striped  skins,  four  legs  each,  and  each  a  tad,  yet 
having  entirely  difl"erent  constitutions,  one  subsist- 
ing only  upon  animal,  and  the  other  only  upon  veg- 
etable food.  . 

The  bacilli  in  the'saliva  of  persons  suftering  Irom 
syphilis,  rabies,  and  glanders,  have  a  close  resem- 
blance, yet  they  develop  entirely  difi'erent  conse- 
quences. And  it  has  been  shown  by  Buchner  that, 
while  the  bacillus  septicicmia  (the  bacillus  that  pro- 
duces metastatic  abscess,  septic  fever,  etc.)  resem- 
bles vcrv  closely  the  batullus  anthrasis  (the  micro- 
organism that  produces  splenic  fever,  anthrax,  or 
what  is  known  as  wool-sorter's  disease),  the  action 
as  well  as  the  subsistence  of  these  organisms  is 
entirelv  dilVerent,  one  flourishing  luxuriantly  in  a 
vegetable  infusion,  while  the  other  requires  an  ai.i- 
mal  sustenance —one  growing  and  proiiagating  in 
living  blood,  the  other  perishing  imniodiatolv  in 
this  menstruum.  One  produces  a  fever  with  a  high 
but  fluctuating  temperature,  and  is  a  disease  of  pro- 


THE  MEDICAL  RECORD. 


535 


longed  duration  ;  the  other  produces  a  fever  with  a 
low  temperature,  that  runs  a  rapid  and  fatal  comse 
Again,  the  bacillus  typhosis,  the  cause  of  tvphoid 
fever,  has  usually  a  definite,  self-limited  bourse 
with  an  elevated  temperature  and  small  rate  of 
mortality,  but  soon  destroys  the  patient  if  the 
temperature-point  does  not  rise  above  normal— at 
least  those  who  have  the  disease  without  pyrexia 
seldom  recover,  as  shown  by  Drs.  Broadbent  C4ib'- 
son,  .Tohnson,  Thompson,  Jones  and  others,  and 
verified  by  AVunderlich. 

I  might  go  on  and  enumerate  manv  important  and 
well-authenticated  discoveries  in  the  etiology  of 
fever  and  the  part  played  by  vibriones,  micrococci 
bacteria,  spirelli,  bacilli,  and  the  various  animals 
and  plants  which  in  embrvo  float  in  the  air  we 
breathe,  the  water  we  di-ink,  and  food  we  eat— ani- 
mals and  plants  that  do  not  come  into  existence  </,■ 
,  novo._  but  are  developed  from  eggs  and  seeds,  and 
require  the  necessary  surroundings  for  their  devel- 
opment. But  enough  is  here  given  for  mv  purpose, 
to  show  in  what  "fever"  consists;  to  "show  that 
"fever  "  in  the  usually  accepted  sense  is  not  Jteal  .- 
that  pyrexia  is  but  a  symptom  of  disease  ;  to  show 
that  a  rise  of  the  temperature-point  does  not  indi- 
cate an  increase  of  metamorphosis  or  heat-produc- 
tion, and  may  not  be  the  correct  index  to  the 
severity  of  the  disease  ;  to  show  a  high  temperature 
may  possibly  indicate  the  amount  of  reactive  force 
set  up  m  favor  of  health ;  to  show  that  zvmotic  dis- 
eases are  usually  dangerous  in  proportion  to  the 
absence  of  this  pyretic  force  ;  to  show  that  the  process  , 
caUed  specific  disease  is  the  destractive  work  of  liv- 
ing organized  matter :  to  show  that  these  organized 
beings  multiply  and  propagate  rapidlv,  in  and  out 
°;  J  '^ofly-  'it  a  temperature  near"  the  normal 
standard  ;  to  show  that  these  organisms  are  more  de- 
structive to  life  or  tissu«-integritv  in  a  temperature 
below  normal,  than  in  a  temperature  above  normal  • 
to  show  that  a  temperature  Init  little  above  normal 
IS  detrimental  to  all  forms  of  disease  organisms-  to 
show  that  an  obstruction  to  the  rise  of  the  tempera- 
ture-pomt  m  disease  forms  gi-ounds  for  an  unfavor- 
able prognosis. 

According  to  Leibei-meister,  the  post-mortem  ap- 
pearances revealing  changes  that  have  taken  place 
during  fever  are  in  many  cases  the  consequence  of 
the  increased  bodily  temperature,  and  frequentlv 
the  only  cause  of  death.  Leibermeister  attempts  to 
prove  these  statements  by  citing  to  the  constant  oc- 
currence of  albuminous  infiltrations :  to  which  Ur 
Wagner  replies:  To  this  a  number  of  important 
objections  can  be  made  ;  that  such  infiltrations  are 
entirely  ab.sent  in  some  cases  of  high  temperature, 
and  as  often  occur  under  conditions  in  whicli  verv 
slightor  no  fever  at  all  exi-sted.  "The  degenera- 
tion of  muscles  (says  Wagner)  is  also  believed  bv 
some  to  be  the  consequence  of  fever;  but  this  is 
present  under  such  various  circumstances  that  its 
cause  must  also  be  considered  as  unknown" 
Iherefore,  if  persons  die  of  these  poisonous  animals 
and  plants  with  a  high  temperature  throughout  the 
course  of  the  attack,  and  if  persons  with  the  same 
disease  also  die  more  certainlv  and  more  speedilv 
without  this  nse  of  temperature,  may  it  not  fairlv 
be  asked.  What  has  pyrexia  to  do  in  producing  or 
preventing  death  ?  r-  .-, 

Again,  if  in  persons  dying  from  the  diseases  pro- 
duced by  these  micro-organisms  are  found  the 
same  pathological  changes  after  death,  where  no 
rise  of  temperatm-e  existed,  as  are  found  where  higli 
temperature   exi.=ted   as   the    prominent   svmptom. 


may  it  not  be  asked,  What  has  temperature  to  do 

in  bringing  about  these  pathological  changes  ? 

Pasteur,  Klebs,  Buchner  and  others  have  shown 
that  disease-microbes  propagate  rapidlv,  in  a  proper 
menstruum,  at  a  temperature  above  85'  but  below 
100°  Fahr.,  and  that  a  higher  temperature  obstructs 
their  progress  and  development,  as  well  as  destroys 
their   existence.     This,  with    the   universal   clinical 
experience  that  a  grave  disease  with  a  low  tempera- 
ture IS  cause  for  an  unfavorable  prognosis,  points  at 
least  in  the  direction  of  cause  and  effect,  and  gives 
an  intimation  that  pyrexia  is  not  disease,  and  that 
high   temperature   may  do   more   than   gauge   the 
j   severity  of  the  symptoms  in  disease.     This  is,  to  a 
very  gi-eat  extent,  coiToborated    bv  many  physio- 
logical and  pathological  facts.     A  high  temperature 
!   can  exist  without  any  perceptible  disorder,  while 
with  a  very  slight  rise,  or  no  rise  at  all,  there  mav 
be  severe  manifestations  of  disease.     Yet  high  tem"- 
:   perature,  as  the  rule,  denotes  severity  of  the  affec- 
tion, and  Drs.  Wilson  and  Murchison  have  shown 
[   that  a  much  larger  per  cent,  die  in  tvphoid  fever 
with  a  temperature  over  lOi"  than  those  having  a 
pyrexial  run  less  than  this ;  but  they  failed  to  prove 
!   by  these  statistics  that  increased  temperature  makes 
I   the  difference,  for  this  eii-cumstance  meielv  points 
I   out  the  fact  that  persons  having  in  fever"  a  high 
temperature  have  one  of  the  symptoms  of  a  severe 
form  of  the  disease,  and  that  the  temperature-point 
has  come  to  tell  the  condition,  and  the  messenger 
that  gives  the  alarm  should  not  be  mistaken  and 
j   misused  for  the  offending  intruder. 

On  the  back  of  this  is  the  evidence  that  cases  of 
disease  which  abort  are  those  that  start  out  at  the 
I   very  onset   with   a   high   temperature.      This    was 
noticed  and  published  by  Dr.  Baumler,  Professor  of 
Clinical  Medicine  in  the  University  of  Freiburg,  in 
Baden,  that  the  mildness  of  an  attack  of  fever  does 
not  so  much  consi.st  in  the  slightness  of  the  symp- 
toms as  m  the  shortness  of  the  whole  attack-^the 
symptoms  may  set  in  very  grave  and  end  in  a  week, 
while,  on  the  other  hand,  they  may  begin  mild,  and 
last  four  weeks  or  more,  continuing  so  mild  that  the 
patient   can   with   difficulty  be   kept   in    bed.      In 
the  cases  of  a  short  duration,  the  abortive  cases,  the 
fever  at   the   onset  of   the  disease  is  always  very 
acute.     No  satisfactoiy  explanation  of  this  lias  eve'r 
been  offered.     It  may  be,  however,  that  the  absence 
of  high  temperature  favors  the  continuation,  multi- 
plication, and  even  reduplication  of  disease- organ- 
isms, while  an  elevated  temperature  at  the  onset,  or 
m  the-  early  stages  of  their  growth,  disturbs  their 
progi-ess  and  development  and  aborts  the  disease. 
The  abortive  cases  occur  under  circumstances  the 
reverse  of  relapses.     Relapses,  as  a  rule,  take  place 
m   the   milder   attacks  with   little    pyrexia,    or   in 
severer  cases  where  the  temperature  has  been  inter- 
fered with  and  has  been  kept  depressed  bv  the  use 
of    anti-pyretics.      Dr.    James   C.   Wilson,   in    his 
treatise  on  the  continued  fevers,  assigns  as  a  reason 
for  relapses,  as  probable,  that  some  portion  of  the 
poison  does  not  undergo  those  changes  in  the  body, 
which  are  neces.sary  to  its  destruction   or  elimina- 
tion, until  a  later  period  than   that  to  which   the 
primary  attack  is  due.  and  that  relapses  are  much 
more  apt  to  occur  where  the  temperature  is  sys- 
tematically kept  down  by  cold  baths  than  where  the 
fever  is  allowed  to  i-un  its  course  unchecked. 

Clinical  observations  are  not  silent  upon  this  sub- 
.iec_t.  Attacks  with  high  temperature  mav  suddenly 
end  and  speedily  recover,  and  mild  cases,  and 
severer  ones   when   treated   so   as    to    reduce   the 


536 


THE  MEDICAL  RECORD. 


pyrexia,  frequently  relapse,  and  undergo  a  sudden 
or  even  fatal  aggravation. 

All  other  things  being  equal,  it  would  appear  that 
severe  zymotic  diseases  with  a  high  temperature  are 
less  liable  to  complications  and  less  dangerous  than 
the  same  cases  would  be  with  a  depressed  tempera- 
ture. And  while  high  temperature  requires  a  cor- 
respondence of  other  symptoms  to  indicate  severe 
disease,  there  may  be  severe  disease  shown  by  all 
other  ordinary  symptoms,  excepting  pyrexia.  And 
the  question  "demanding  serious  consideration  is, 
Why  does  the  absence  of  this  one  symptom,  a  rise 
in  temperature,  add  gravity  to  the  prognosis  ?  In 
cholera,  yellow  fever,  typhoid  fever,  typhus  fever, 
scarlet  fever,  small-pox,  and  anthrax,  without  a 
change  of  temperature  above  normal,  attacks  are 
generally  and  immediately  fatal,  while  these  dis- 
eases, and  even  pyiemia  and  septiesemia,  with  a  high 
temperature  may'last  a  long  time  and  yet  recover. 

There  may  be  an  explanation  to  this,  for  Dr. 
Marchiafava,"  of  Rome,  found  the  bacillus  malarius, 
which  is  seen  in  the  blood  at  i.the  beginning  and 
during  the  chill  period,  disappeared  while  the  fever 
was  at  its  height,  and  left  nothing  to  be  seen  ex- 
cepting the  spores  ;  and  while  the  bacillus  is  readily 
destroyed  by  a  temperature  a  few  degrees  higher 
than  the  normal  temperature  of  the  body,  the  spores 
show  a  remarkable  resistance  to  destructive  agents. 
Although  not  actually  proven  that  t!ie  malarial 
bacilli  of  intermittent  fever  are  destroyed  by  the 
high  febrile  action,  their  sudden  and  regular  dis- 
appearance under  a  febrile  temperature  makes  it 
highly  possible  indeed  that  such  is  one  way  in  which 
the  system  reacts  against  these  organisms  in  favor 
of  health. 

I  am  aware  there  has  been  an  attempt  to  throw 
discredit  upon  Dr.  Marchiafava's  discoveries,  but  it 
has  only  added  undoubted  confirmation  of  the  truth 
of  ever'v  statement.  Since  the  publication,  many 
oases  have  been  examined  by  competent  scientists, 
and  have  gone  far  to  establish  his  announcement,  by 
showing  the  presence  of  bacilli  and  their  disappear- 
ance, as  described  by  Dr.  Marchiafava.  There  is 
good  authority  also  for  the  assertion  that  Professor 
Perroncito,  of'Turin,  one  of  the  leading  mycologists 
of  Italy,  has  recently  repeated  these  observations  in 
the  hospital  of  Vercelli  in  Piedmont,  and  found  the 
bacillus  in  the  blood  during  the  cold  stage  in  every 
instance,  and  that  they  disappeared  during  the  hot 
stage.  And  still  more  recently,  these  important 
discoveries  have  received  additional  confirmation 
by  Professor  Harley,  of  London. 

Another  fact  that  appears  well  settled  and  must 
not  be  lost  sight  of.  It  is  this  :  While  the  bacilli  or 
developed  animals  and  vegetable  organisms  are  ex- 
tremely detrimental  to  health  and  life,  the  spores 
are  entirelv  innocent. 

Bnt  of  all  the  collections  of  matter  pointing!  to 
pyrexia  as  a  conservative  force  in  disease,  no  one 
biidgot  has  contributed  more  and  of  greater  weight 
than  the  clinical  experience  based  upon  theories  of 
antagonistic  treatment.  The  present  antiiiyretic 
medication  of  a  symptom  in  disease  is  to  day  as 
universally  ])op«lar  all  over  the  world  as  was  ever 
that  of  blood-letting  and  the  spoliative  plan,  which 
ended  but  a  few  years  since.  With  unwavering  be- 
lief in  the  assertions  of  its  inventors,  it  has  been  per- 
aeveringly  followed,  with  the  motto,  "  Persist  in  the 
exhibition  of  tlio  remedies  until  success  crowns  the 
effort ;"  and  no  one  can  complain  that  effort  enough 
has  not  been  made.  Yet,  unfortunately,  success  has 
not  crowned  the  persistence,  and  the  best  observers 


all  over  the  world  are  constantly  announcing  their 
disappointment,  disbeUef,  and  condemnation  of  the 
practice.  ,     ,•  ,         j 

Hankel,  of  Leipsic,  a  pupil  of  Wunderlich,  and 
one  who  has  done  his  part  equal  to  any  other 
man  living  to  disseminate  the  antipyretic  theories, 
now  says  he  has  been  at  last  forced  to  admit  that 
although  antipvretics  may  lower  the  temperature, 
they  prolong  the  disease.  In  France  the  same  is 
asserted  by  Hirtz,  Cobberts,  and  others.  In  Eng- 
land Dr.  William  Jenner,  consulting  physician  to 
the  Universitv  College  Hospital,  says  of  the  anti- 
pyretic treatment:  "Neither  my  own  limited  ex- 
perience, nor  the  evidence  adduced  by  others  m 
its  favor,  has  carried  conviction  to  my  mind  of  its 
advantages."  And  of  quinine  and  salicylate  of  soda, 
he  has  been  disappointed  in  their  effects  as  reducers 
of  temperature,  while  he  has  seen  both  occasionally 
do  irreparable  damage  by  disturbing  the  stomach 
and  interfering  with  digestion.  Dr.  Bristow,  in  the 
British  Journal  of  Medical  Science,  says  of  quinine 
and  salicylate  of  soda:  "I  must  confess  that  my 
own  experience  of  their  use  has  not  impressed  me 
favorably."  ,    ■  -,   , 

Professor  Klebs  has  sho-mi  that  typhoid  fever  is 
dependent  upon  the  bacillus  typhosus,  and  con- 
cludes :  "  If  enteric  fever  really  depends  upon  the 
development  and  migi-ation  of  an  organism,  the 
therapeutic  indication  is  to  check  the  growth  of  this 
organism."  And  says  at  the  present  time  the  treat- 
ment is  mainlv  directed  toward  a  reduction  of  tem- 
perature, which  he  thinks  is  utterly  useless.  In 
support  of  these  views,  Prof.  Klebs  quotes  Straube, 
Praentzel,  and  others,  giving  epidemics  of  typhoid 
fever  with  unusual  gi-avity,  but  without  much  rise 
of  temperature,  and  insists  that  so  much  attention 
to  temperature  is  not  justifiable. 

Most  person.s  know  the  gi-eat  majority  of  cases 
of  disease  would  recover  without  any  treatment, 
and  that  it  is  to  the  small  per  cent,  of  those  which 
would  die  ivithout  treatment  that  medical  aid 
is  of  any  real  importance  ;  yet  no  statistics  or  col- 
lated facts  have  satisfied  the  sceptical  world  that  the 
antipyretic  treatment  has  stayed  the  hand  of  death 
in  a  single  instance.  In  fact  the  advocates  of  this 
theory  are  quite  careful  to  say  in  what  kind  of  pa- 
tients and  what  circumstances  the  treatment  is  to 
be  used,  and  that  it  is  not  adapted  to  the  naturally 
fatal  cases  ;  and  their  statistics  are  made  up  princi- 
pally from  subjects  whicli  would  get  well  without 
treatment ;  and  there  is  a  reason  for  their  mortality 

Leibermoister  admits  that  the  severe  eases  in 
which  there  is  every  probability  of  a  fatal  result 
from  bodily  weakness  and  severity  of  the  .lisense, 
are  not  eases  in  which  the  antipyretic  treatment  is 
admissible,  and  of  course  these  do  not  receive  antl- 
pyi-etic  attention,  and  consequently  are  not  made  to 
appear  in  the  formulation  of  his  statistics.  Why 
are  these  severe  cases,  in  which  there  is  every  reason 
to  anticipate  an  unfavorable  result,  not  treated  an' 
pyrotically.  if  not  that  the  answer  comes  with  *■ 
experience? 

Take  the  formerly  ]irescribed  treatment  of  fevi 
bv  blood-letting,  oi"  any  other  empirical  holiby  thi 
has  made  its  run  with  the  i)rofession,  and  eliminai_ 
the  theories  and  oi)inions.  and  there  will  be  mani- 
festly little  else  left  but  comiiarative  statistics  of  the 
most  unsatisfactory  character,  as  they  are  not  made 
to  compare  with  Nature's  own  effort  and  ability  to 
cure  unaided.  Statistics  can  show  but  littl<'  when 
collected  with  reference  to  other  modes  of  treatniont. 


vny 
ison_ 

.nt|L 

lat^H 


THE  MEDICAL  RECORD. 


537 


and  are  often  made  in  good  faith  to  establish  a  fa- 
vorite supposition,  or  to  give  the  ^author  the  credit 
of  a  discoverer. 

Some  years  since,  Dr.  Irving  W.  Lyon,  of  Bellevue 
Hospital,  New  York,  published  statistics  showing 
that  the  addition  of  sulphuric  acid  to  the  ordinarv 
treatment  of  fevers  reduced  the  rate  of  mortalitV 
one-half  over  fevers  treated  in  the  same  way  without 
the  acid.  Yet  Dr.  Lyon  failed  to  establish  anything, 
as  the  fallacy  of  his  reports  consisted  in  applying 
the  treatment  and  the  variations  in  the  treatment  to 
different  ejudemics,  in  different  years  and  different 
months  in  the  year.  Statistics  cannot  be  taken  as 
a  guide  to  successful  therapeutics,  although  they 
may  have  more  or  less  influence  in  giving  poi:)ularity 
to  certain  lines  of  empirical  practice. 

Dr.  Austin  Flint,  who  has  given  the  antipyretic 
treatment  no  small  amount  of  attention,  does  not 
speak  of  it  very  favorably,  as  far  as  his  experience 
goes.  "  It  neither  increased  nor  diminished  the 
fatality  over  the  ordinary  mode,"  is  the  most  he 
could  say  ;  those  that  would  die  without  antipyretic 
treatment,  died  with  antipyretic  treatment,  and  it 
neither  diminished  nor  increased  the  fatality  over 
the  ordinary  mode. 

I  have  thus  attempted  to  go  over  the  oft-trodden 
ground  called  fever,  and  have  endeavored  to  pick  up 
and  present  some  of  the  many  established  facts  that 
lie  scattered  here  and  there  over  the  uncultivated 
field  for  science — facts  which  show  disease  is  an 
entity,  a  substance,  an  organism,  the  result  of  an 
animal  or  vegetable  propagation  ;  facts  which  show 
that  pyrexia  is  but  a  symptom  of  disease  ;  that  it 
may  not  denote  increased  metamorphosis  or  in- 
creased heat  production  ;  that  it  may  indicate  the 
amount  of  reactive  force  in  favor  of  health ;  that  it 
checks  the  growth  and  multiplication  and  migration 
of  disease  organisms,  and  lessens  the  dangers  in 
zymotic  diseases :  that  temperature  and  its  regula- 
tion is  a  vaso-motor  pi'ocess,  and  that  an  obstruc- 
tion to  the  function  of  this  heat-regulating  centre  is 
detrimental,  if  not  dangerous,  in  disease. 

In  all  this  I  have  no  deductions  to  make,  no 
theories  to  advance,  no  hobby  to  pull  down.  I'^et 
inasmuch  as  the  field  of  preventive  medicine  has 
been  opened  up  with  discoveries  of  so  much  inter- 
est and  of  such  infinite  benefit  to  the  human  i-ace  : 
and  as  the  artisans  are  already  upon  the  ground  to 
change  the  etiology  of  disease  and  to  remodel  and 
rebuild  our  therapeutics ;  and  as  clinical  experience 
has  shown  treatment  based  upon  empirical  guessing 
has  ever  been  faulty  and  inefficient,  may  it  not  be 
well  to  submit  more  directly  to  the  light  of  science 
and  give  less  attention  to  the  treatment  of  symp- 
toms, and  more  to  Xatiire's  own  mysterious  ways, 
and  with  antiseptics,  antizymotics  and  germicides 
aid  in  the  suppression  or  destruction  of  the  organ- 
isms causing  the  disturbance?  "For  we  are  not 
yet  sure  but  what  a  high  temperature  is  one  of 
the  safeguards  and  efficient  means  employed  by 
Nature  to  rid  the  system  of  an  essential  poison  ; 
and  it  is  highly  possible,  indeed,  that  the  febrile 
heat  is  one  way  in  which  the  system  reacts  against  j 
the  organisms  that  produce  disease,  in  favor  of  j 
health." 


Death  OP  .4.N  Anti-Vaccinatob. — A  Chicago  paper 
reports  the  death,  by  small-pox,  in  that  city,  of  a  phy- 
sician quite  prominently  known  for  his  anti-vaccina- 
tion sentiments. 


THE  TEEATINIENT  OF  HEMORRHOIDS 
BY  THE  DH^ATATION  OF  THE  ANAL 
SPHDsCTEKS. 

By  WILLIAM  BODENHAMEE,  A.M.,  M.D., 

NEW^YOKK. 
(Continued  from  patre  512.) 

Anatomy  mid  physiology. — I  will  now  give  in  as 
brief  a  manner  as  possible  the  anatomical  disposi- 
tion and  the  physiological  and  pathological  action 
of  the  internal  and  external  sphincters  of  the  anus, 
the  only  sphincter  muscles  proper  to  the  terminal 
outlet  of  the  rectum.  I  use  the  designation  internal 
sphincter  with  a  full  understanding  and  conviction 
that  it  is  a  sphincter,  although  I  am  aware  that 
some  able  authors  who  are  anatomists,  and  some 
who  are  not,  deny  sphincteric  functions  to  it,  and 
some  even  deny  the  existence  of  such  a  muscle. 
These  authors  declare  that  no  such  property  or 
function  exists  in,  or  can  be  claimed  for,  the  aggi-e- 
gation  of  the  bundles  of  circular  muscular  fibres, 
which,  like  a  band,  encircles  the  inferior  eztremity 
of  the  rectal  pouch,  and  which  comi>rises  that  which 
has  been  denominated  spluncler  nni  inlervus.  They 
maintain  that  this  collection  of  circular  muscular 
fibres  differs  in  no  respect  whatever,  so  far  as  its 
function  is  concerned,  from  that  of  the  ordinary 
circular  fibres  of  the  intestinal  canal ;  that  it,  like 
they,  jserforms  the  office  merely  of  a  detrusor,  and 
not  that  of  a  sphincter.  There  can  be  no  dispute  as 
to  the  existence  of  this  collective  body  of  circular 
muscular  fibres,  and  that  it  is  normal  and  constant. 
The  only  controversy  is  in  relation  to  its  real  func- 
tion. I  therefore,  in  this  connection,  deem  the  sub- 
ject of  sufficient  importance,  anatomically,  physio- 
logically, and  surgically,  to  enter  into  it  somewhat 
in  detail. 

A  number  of  anatomists  neither  describe  nor  en- 
dorse the  internal  sphincter  ani.  and  many  confound 
the  two  sphincters  by  describing  them  as  one. 
Cniveilhier  says :  "  The  sphincter  interuus  of  authors 
is  nothing  more  than  the  last  ring  of  the  circular 
fibres  of  the  rectum"  ("The  Anatomy  of  the  Hu- 
man Bodv,"  p.  380.  American  edition,  bv  G.  S. 
Pattison,  M.D.  Imp.  8vo.  New  York,  18i4').  Clo- 
quet,  like  Cruveilhier,  neither  describes  nor  endorses 
the  internal  sphincter,  but  passes  it  over  by  saying 
that  "  many  anatomists  describe  around  the  lower 
part  of  the  rectum  a  fleshy  ring  under  the  name 
inner  sphincter^'  ("A  System  of  Human  Anatomy," 
p.  618.  English  version.  By  Robert  Knox,  M.D. 
Boston,  181.3).  It  is  in  this  brief  manner  that  these 
two  eminent  anatomists  dispose  of  the  internal 
sphincter  muscle — a  muscle  which,  with  its  col- 
league, the  external  sphincter,  performs  so  import- 
ant a  part  before,  during,  and  after  the  act  of 
defecation. 

This  very  distinct  sphincter  muscle  was  correctly 
described,  however,  at  an  early  date  by  several  able 
authors.  Albinus.  an  eminent  anatomist  of  the 
seventeenth  century,  denominates  the  bundle  of  cir- 
cular fibres  of  the  muscular  coat  of  the  rectum, 
which  encircles  the  inferior  extremity  of  the  rectal 
pouch,  sphincter  ani  intei-mis,  which  he  describes  as 
distinct  from  the  sphincter  ani  e:rtm~nus  ("  Tabid  as 
Sceleti  et  Musculonim  Corporis  Humani,"  lib.  ii., 
cap.  3.  Folio.  Lugduno-Batavonim,  17i7).  The 
celebrated  anatomist  Winslow,  of  the  eighteenth  cen- 
tury, when  speaking  of  the  internal  sphincter  of  the 
anus,  says :  "  The  intestinal  or  orbicular  sphincter 
of  the  anus  consists  merely  in  an  augmentation  of 


538 


THE  MEDICAL  RECORD. 


the  inferior  portion  of  the  circular  fieshy  liljres  of 
the  extremity  of  the  rectum  ("  An  Anatomical  Expo- 
sition of  the  Structure  of  the  Human  Bodv,"  vol.  ii., 
p.  U9.  English  Version.  By  G.  Doughxs,  M.D. 
London,  1732).  Mr.  Douglas,  another  able  and  dis- 
tinguished anatomist  of  the  eighteenth  century,  and 
the  translator  of  Winslow's  "Anatomy,"  says  that 
"  The  anus  has  two  sphincters.  The  first  may  be 
called  e.rterni/s,  or  cutaneous,  which  surrounds  the 
anus  about  the  breadth  of  an  inch,  being  placed  im- 
mediately below  the  integument.  The  second  is 
named  inlei-nal,  whose  fleshy  circular  fibres  encom- 
pass the  lower  end  of  the  intestintim  rectum.  Its  use 
is  to  i^revent  the  involuntary  excretion  of  the  fseces, 
by  shutting  up  or  closing  the  passage  of  the  rectum  " 
("  Descriptio  Comparata  Musculorum  Corporis  Hu- 
mani  et  Quadrupedis."  Versio  Latini.  Cap.  xxiii. 
8vo.  Lugduno-Batavonim,  1738).  Albinus,  Wins- 
low,  and  Douglas  were  the  first  anatomists,  so  far  as 
my  reading  extends,  who  correctly  described  and 
named  the  intei-nal  sphincter  as  a  distinct  muscle. 
Wilson  says,  with  regard  to  the  circular  fibres  of  the 
superior  and  central  i>ortions  of  the  rectum,  "  There 
are  no  circular  fibres  in  these  portions  of  the  rectum, 
they  appear  to  have  slipped  downward  to  the  lower 
end  of  the  intestine,  and  to  have  formed  there  a 
thick  muscular  ring,  the  internal  sjshincter  ani " 
(The  Dissector,  p.  56.  Edited  by  P.  B.  Goddard, 
M.D.  8vo.  Philadelphia,  18-14).  Professor  Horner 
says  that  "  the  circular  fibres  form  a  complete  coat, 
and  just  below  the  pouch  of  the  rectum  are  multi- 
plied so  much  for  eight  or  ten  lines  as  to  be  a  perfect 
internal  sphincter-muscle "  ("  Special  Anatomy  and 
Histology,"  vol.  ii.,  p.  iti  Eighth  edition.  Imp.  8vo. 
Philadelphia,  18.51).  I  will  now  briefly  describe  the 
internal  and  external  sphincters.  The  internal  sphinc- 
ter ani  is  a  flat  and  slightly  oval  muscular  ring,  com- 
posed of  numerous  bundles  of  the  circular  fibres  of 
the  rectum,  so  multiplied  and  so  closely  set  together 
as  to  form  a  complete  coat,  encircling  like  a  belt  the 
superior  extremity  of  the  anal  canal,  so  that  it  may 
be  regarded  as  an  aggregation  of  bundles  of  circular 
fibres.  It  bears  considerable  resemblance  to  the 
ring  of  fleshy  fibres  which  encircles  the  jiyloric  oi-i- 
fice  of  the  stomach,  denominated  by  some  authors 
the  pyloric  muscle.  It  is  situated  just  below  the 
terminal  pouch  of  the  rectum,  after  this  viscus  has 
left  the  level  of  the  prostate  gland,  and  it  varies 
from  seven  to  fifteen  lines  in  breadth,  and  from  one 
to  three  in  thickness.  At  its  superior  margin  it  is 
quite  thin,  being  continuous  with  the  corresponding 
plane  of  the  muscular  coat  of  the  rectum,  but  as  it  de- 
scends it  becomes  thicker,  more  distinct,  and  more 
fully  developed,  so  that  by  tlie  time  it  reaches  its  in- 
ferior border,  where  it  is  embraced  by  the  fibres  of 
the  superior  part  of  the  external  sjihincter,  it  becomes 
quite  strong  and  well-marked.  It  is  at  this  point 
where  its  greatest  power  of  contraction  resides,  and  it 
closes  the  catial  here  with  considerable  exactness  and 
firmness.  Wlien  tliis  muscle  is  examined  carefully  in 
xitu  it  is  infniidibuliform,  having  its  su])erior  open- 
ing, or  wide  mouth,  presenting  upward  toward  the 
prostate  gland  and  hasfond  of  the  bladder,  and  its  in- 
ferior opening,  or  neck,  presenting  downward,  vary- 
ing in  length  from  eight  to  fifteen  lines,  and  forming 
about  one-half  of  the  canal  of  the  anus.  Internally 
this  muscle  is  separated  from  the  mucous  coat  by  the 
hemorrhoidal  plexus  of  veins,  some  branches  of  which 
traverse  the  substance  of  it.  The  internal  sphincter 
ani  is  wholly  composed  of  circular  fibres,  which  are 
capable  of  themselves  alone  of  completely  closing  the 
anal  canal,  as  a  sphincter,  at  its  inferior  border. 


The  exteinal  cutaneous  sphincter  ani  is  composed 
of  elliptical  fibres,  which  form  a  broad  flat  band, 
about  ten  lines  in  breadth  and  aboiit  the  same  in 
thickness,  and  placed  immediately  beneath,  and  in- 
timately united  to  the  integument  of  the  anus,  the 
orifice  of  which  it  completely  circumscribes.  This 
muscle  originates  in  the  naiTow  fasciculus  of  tendi- 
nous fibres  attached  to  the  posterior  face  of  the  last 
bone  of  the  coccyx,  and  extends  to  the  anus.  From 
this  source,  passing  downward  and  forward,  it  sepa- 
rates into  two  semi-elliptical  fasciculi  of  concentric 
fibres,  whose  direction  is  outward  at  an  acute  angle, 
expanding  on  each  side  of  the  anus  into  the  ischio- 
rectal fossa,  nearly  as  far  out  as  the  tuberosity  of  the 
ischium  ;  then,  bending  forward,  they  jiroduce  the 
arch  of  a  circle,  and  in  front  of  the  anus  become 
blended  with  each  other,  and  are  attached  to  the 
tendinous  raphe  of  the  perineum,  at  the  point  where 
the  several  perineal  muscles  unite  ;  thus  forming 
anteriorly  an  angle  similar  to  that  at  which  they 
parted  posteriorly.  The  long  diameter  of  the  el- 
lipsis extends  from  the  os  coccygis  toward  the  sym- 
physis i^ubis,  having  its  angles  very  much  elongated. 
The  lateral  diameter  is  in  the  centre  of  the  interval, 
between  the  ischiatic  tuberosities,  and  occupies 
about  one-half  that  .space.  The  point  of  the  greatest 
contraction  of  the  external  sphincter  ani  is  near  its 
inferior  margin. 

The  interlacing  of  the  fibres  of  the  two  anal 
sphincters  which  sometimes,  though  rarely,  occurs, 
doubtless  gave  rise  to  the  erroneous  idea  entertained 
by  some  anatomists  that  these  two  sphincters  were 
in  reality  but  one.  Nothing,  however,  is  more  easily 
demonstrated  than  the  fallacy  of  this ;  the  one  con- 
sisting entirely  of  circular,  and  the  other  of  elliptical 
fibres,  and  diifeiing  anatomically  in  many  other  re- 
spects. 

M.  Velpeau,  in  his  description  of  what  he  caUs. 
the  external  sjihincter  ani,  makes  the  singular  decla- 
ration, if  I  understand  his  language,  that  this  single 
muscle  contains  within  itself  two  distinct  sphinctei's 
— one  composed  entirely  of  circular,  and  the  other 
of  elliptical  fibi-es — thus  coiTectly,  as  it  were,  de- 
scribing both  the  external  and  internal  sphincters  of 
the  anus,  but  apparently  under  the  impression  that 
these  two  siihincters  comjjose  bi;t  one  muscle.  I 
have  rendered  his  language  thus  :  "  If  we  carefully,"' 
says  M.  Velpeau,  '•  dissect  the  external  sphincter,  we 
find  that  it  is  composed  of  two  orders  of  fibres.  The 
one  forming  complete  and  regular  circles,  is  applied 
immediately  on  the  exterior  surface  of  the  intestine 
and  the  integuments  which  enter  the  cavity  of  the 
canal ;  the  other,  iinited  at  right  angles  in  front 
and  behind,  is  separated  into  two  fasciculi  by  the  anal 
orifice.  The  first,  being  a  continuation  of  the  fleshy 
tunic  of  the  organs  of  defecation,  is  alone  capable  of 
completely  closing  the  anal  opening  and  producing 
the  concentric  cutaneous  wrinkles  in  its  vicinity,  and 
at  the  same  time  preserving  its  annular  form  ;  the 
second,  composed  of  elliptical  fibres,  forming  the 
proper  sphincter,  can  only  circumscribe  an  elli)itical 
opening,  and  would  reduce  the  anus  permanently 
to  a  more  or  less  elongated  fissure  did  not  the 
circular  fibres  modify  its  action"  ("Traito  d'.\nat- 
omie  Chirurgicale  on  Anatomic  des  Ttcgions,"  tome 
ii.,  p.  272.  8vo.  Paris,  1S2()).  M.  Velpeau  again 
says,  "  The  fleshy  tunic  of  the  rectum  is  almost 
wholly  formed  of  longitudinal  fibres,  which  pre- 
dominate as  far  as  the  prostate  gland,  and  of  annular 
fibres,  gi'adually  increasing  in  number  from  this 
point  toward  tlie  skin,  where  they  form  that  which  I 
have  called  liilU-  splriitcter"  (op.  cit.,  tome  ii.,  p.  323). 


THE  MEDICAL  EECORD. 


589 


As  to  the  anus  itself,  I  would  remark  that  its  di- 
rection is  downward  and  backward,  and  when  in  the 
quiescent  state  it  has  the  appearance  externally  of  a 
linear  or  curvilinear  orifice,  with  its  long  diameter  in 
the  antero-posterior  direction,  and  its  edges  closelv 
approximated ;  but  when  it  is  distended  by  the  jjas- 
sage  of  hard  fieces,  or  by  the  linger  or  bougie,  it  be- 
comes what  its  name  imports,  ciroilar.  Indeed,  by 
inserting  the  linger  into  the  anus  and  dilating  it,  an 
elliptical  figure  may  be  converted  into  a  round  or 
circular  one. 

T/te  internal  sphincter  of  Lis/ranc. — Besides  the 
internal  s2ihincter  already  described,  M.  Lisfrauc,  a 
number  of  years  ago,  announced  the  existence  of 
another  internal  sjahincter-muscle,  about  four  inches 
above  the  verge  of  the  anus.  He,  however,  never 
demonstrated  or  described  such  a  sphincter,  but 
merely  imagined  its  existence  from  the  fact  that  he 
had  observed  tlie  power  of  contraction  and  retention 
possessed  by  the  rectum  at  that  height  without  in- 
continence of  fjeces  taking  place  after  he  had,  in 
several  instances,  removed  thi-ee  or  four  inches  of 
its  inferior  extremity  on  account  of  cancer  (Mal- 
aigne :  "  Traite  d'Anatomie  Ohirurgieale,  et  de 
Chirurgie  Experimentale,"  tome  ii.,  p.  34.3.  8vo. 
Paris,  1838).  I  would  observe,  however,  that  M. 
Amussat  explains  this  power  of  rectum  retention  of 
fseces  upon  a  very  different  principle  altogether.  He 
was  of  the  opinion  that  the  interior  outlet  of  the  body 
is  naturally  disposed  to  obey  the  will,  independ- 
ently of  its  muscular  ajiparatus,  so  as  to  favor  volun- 
tary retention  of  the  faeces ;  consequently  that  the 
power  of  retaining  and  controlling  the  discharge  of 
the  ffeces  does  not  .solely  de])end  upon  the  sphincter 
ani  muscles  ( Gazette  Malicahi  de  Paris,  -p.  753, 
Novembre  28,  183.5). 

The  internal  sphincter  announced  by  M.  Lisfrane 
was  subse(|uently  described  by  M.  Nelaton,  and 
verified  by  M.  Velpeau,  who  thus  speaks  of  it :  "I 
have  jiroved  the  existence  of  a  kind  of  sphincter  of 
the  rectum  described  by  M.  Nf-Iaton.  It  is  a  fleshy 
ring  placed  about  four  inches  above  the  anus, 
exactly  at  the  spot  where  stricture  of  the  rectum — 
above  the  anal  region — most  frequently  occurs.  If, 
after  having  everted  the  rectum  so  that  its  mucous 
surface  becomes  external,  we  slightly  inflate  it,  we 
see  this  muscle,  which  M.  Nelaton  proposed  to  name 
superior  sphincter,  is  formed  of  fibres  united  into  a 
fasciculus.  It  is  thickest  in  fi-ont,  where  the  fibres 
seem  collected  in  the  retiring  angle  corresponding 
to  the  union  of  the  first  with  the  second  cuiwe  of 
the  rectum  ;  whilst  ]50steriorly  they  are  disseminated 
over  its  convexity"  ("Anatomy  of  Kegions,"  p. 
515,  Hancock's  English  Version.  Imp.  8vo.  London, 
1838). 

Professor  Horner,  in  speaking  of  this  new  internal 
sphincter,  says  :  "  I  doubt  very  much  the  uniformity 
of  the  distinct  existence  of  such  a  muscle,  not  having 
been  able  to  find  it  in  the  dissections  which  I  have 
instituted  for  the  purpose,  unless  a  portion  of  the 
ordinary  circular  fibres  should  have  Iseen  collected 
for  that  designation,  in  which  case  several  other 
sphincter  muscles  may  bo  said  also  to  exist "  ('</'• 
cit.,  vol.  ii.,  p.  46).  A  number  of  years  ago,  I  also 
made  diligent  search  for  this  sphincter  muscle  at 
the  place  designated  by  Lisfrane.  Nelaton,  and  Vel- 
peau, but  failed  to  find  it.  I  therefore  concluded 
with  Professor  Horner  that  if  it  ever  exists,  it  does 
not  do  so  uniformly  ;  that  it  is  neither  normal  nor 
constant.  The  place  these  authors  point  out  as  the 
exact  locality  of  this  muscle  is  that  part  of  tlie 
rectum  just  above  its    pouch,  where,  according  to 


M.  Velpeau,  and  as  far  as  my  own  experience  goes, 
oi-ganic  stricture  of  the  rectum  most  commonly  oc- 
curs. 

In  my  dissections  of  the  rectum  and  colon,  I  have 
found  much  stronger  evidence  of  a  Kvperior  sphinc- 
ter at  the  juncture  of  the  colon  with  the  rectum  than 
at  the  place  so  nnich  lower  down  mentioned  by  these 
authors.  At  the  termination  of  the  colon,  there  al- 
ways exists  a  narrow  neck  or  contraction,  marked 
extenially  by  a  slight  circular  dejiression,  and  inter- 
nally in  the  same  situation  by  a  little  projection  of 
the  mucous  lining.  This  narrow  neck  or  annulus 
which  distinctly  marks  the  boundary  of  the  rectum 
and  the  colon,  and  which  has  been  described  by 
others,  seems  to  a  certain  extent  to  possess  the 
power  and  to  perform  the  office  of  a  sphincter ;  so 
that  the  description  which  Velpeaii  gives  of  Ne- 
laton's  superior  sphincter,  if  ajiplied  to  it,  would,  in 
several  respects,  quite  appropriately  describe  it.  I 
consider  this  fleshy  annulus  as  the  normal  condition 
of  this  jiart  of  the  intestine,  and  not  as  jjreternatural, 
or  as  a  congenital  malformation,  as  believed  by 
several  authors.  Indeed,  it  very  much  resembles  in 
character  and  in  function  the  pyloris  of  the  stomach, 
for  a  remora  of  the  contents  of  the  sigmoid  flexure 
of  the  colon  takes  place  at  this  point  previous  to 
their  entrance  into  the  rectum,  as  the  contents  of  the 
stomach  do  previous  to  their  entrance  into  the 
duodenum.  Mr.  O'Beirne  also  notices  this  peculiar 
contraction  at  the  inferior  extremity  of  the  colon, 
and  attributes  to  the  part  very  extraordinary 
"physiological  phenomena"  ("New  Views  of  the 
Process  of  Defecation,"  p.  31.    8vo.     Dublin,  1833). 

Hyrtl,  a  distinguished  German  anatomist,  has  of 
late  revived  the  subject  of  the  internal  sphincter  of 
Lisfrane,  by  devoting  much  time,  labor,  and  talent 
in  endeavoring  to  demonstrate  and  prove  the  uni- 
form existence  of  this  sphincter,  which  he  denomi- 
nates sphincter  ani  tertius  ("Topographical  'Anat- 
omy"). 

Is  the  sphincter  ani  inie/rmis  merely  a  detrusor? — 
The  number  of  bundles  of  the  circular  fibres,  which 
compose  the  internal  sphincter  ani,  and  which  im- 
part more  or  less  thickness  and  body  to  it,  is  a 
positive  evidence  that  it  is  intended  for  a  different 
purpose  than  that  merely  of  the  ordinary  circular 
fibres  of  the  intestinal  canal.  Indeed,  the  augmen- 
tation of  volume,  and  consequently  of  power,  proves 
that  this  aggi-egation  of  the  bundles  of  the  circular 
fibres  is  a  sphincter  or  constrictor  muscle,  and  fully 
corresponds  with  its  function,  being  especially  armed 
and  eqriipped  for  the  prirpose.  Furthermore,  there 
appears  to  be  an  obvious  necessity  for  a  sphincter 
muscle  immediately  at  the  termination  of  the  rectal 
ampulla  and  commencement  of  the  anal  canal,  or 
short  narrow  neck  of  the  rectum,  for  the  purpose 
of  arresting  and  retaining  the  fieces  in  that  deposi- 
tory for  tlae  time  being,  or  until  nature  calls  for 
their  evacuation.  Apparently  the  same  necessity 
exists  for  a  sphincter  at  the  commencement  of  the 
neck  of  the  bladder,  the  neck  of  the  uterus,  and  at 
the  pyloric  end  of  the  stomach. 

Now  it  is  not  necessary  that  the  circular  fibres  of 
the  rectum  should  always  completely  surround  it 
to  enable  them  to  perform  the  office  of  detrusors  or 
accelerators,  for  in  some  parts  of  it  they  are  arranged 
in  semicircles  or  in  segments  of  circles,  and  yet 
efficiently  perform  their  function  of  urging  on,  by 
their  peristaltic  motion,  the  contents  of  the  canal 
onward  and  outward.  It  is,  however,  essentially 
necessary  that  the  circular  fibres  of  the  rectum 
should  completely  surround  it  in  sufficiently  aggre- 


540 


THE  MEDICAL  RECORD. 


gated  bundles  to  enable  the  collection  thus  formed 
to  perform  efficiently  the  office  of  a  sphincter  or 
constrictor,  as  it  does  in  the  formation  of  the  inter- 
nal sphincter  ani,  which  possesses  the  power  of 
completely  closing  the  anal  canal  at  the  bottom  of 
the  rectal  pouch. 

Some  authors  consider  that  the  bundles  of  cir- 
cular fibres  composing  the  internal  sphincter  are 
wholly  of  the  involuntary  character ;  whereas  the 
elliptical  fibres  composing  its  colleague,  the  external 
sphincter,  are  entirely  of  the  voluntary  character. 
With  regard  to  the  character  of  the  internal  spliinc- 
ter,  they  reason  that,  inasmuch  as  it  is  connected 
with  the  common  intestinal  plane  of  arched  fibres, 
and  is  analogous  to  the  pyloris  and  the  cervical 
fibres  of  the  bladder  and  the  uterus,  that  it  therefore 
of  necessity  cannot  act  as  a  voluntary  muscle.  It  is 
true  that  from  analogy  one  would  naturally  be  in- 
clined to  consider  the  internal  .iphincter  as  immedi- 
ately under  the  control  of  the  splanchnic  and  the 
external  sphincter  under  that  of  the  cerebro-spinal 
centres.  But  the  truth  is,  and  it  has  been  verified, 
that  the  functions  of  these  two  sjihincters  are  of  a 
mixed  character,  partaking  in  part  both  of  voluntary 
and  involuntary  motion  ;  but  the  exact  proj^ortion, 
however,  in  which  each  possesses  the  power  or  the 
ability  of  voluntary  or  involuntary  motion  bestowed 
upon  it  by  the  two  classes  of  nerves  has  not  as  yet 
been  demonstrated.  I  therefore  consider  the  inter- 
nal sphincter  not  wholly  indei^endent  of  the  will,  as 
it  has  been  represented  to  be,  but  it,  with  its  col- 
league, is  one  of  those  muscles  which  acts  imper- 
ceptibly, yet  is  subjected  more  or  less  to  the  ■n"ill, 
as  the  miiscles  of  respiration.  The  tonic  contrac- 
tion of  the  two  anal  sphincters  which  is  intended 
to  close  the  canal  and  retain  the  fecal  matters  in  the 
intestine  is  always  involuntary,  and  not  under  the 
influence  of  the  will.  They,  however,  may  be  stimai- 
lated  to  act  directly  by  volition,  as  when  they  do  so 
to  prevent  a  strongly  imi^ending  evacuation  of  the 
bowels  ;  or  indirectly  by  reflex  irritation,  the  one 
action  being  voluntary  and  the  other  involuntary. 

Cause  of  the  involunlary  contrmiion. — As  to  the 
cause  of  the  involuntary  contraction  of  the  anal 
sphincters,  it  is  always  produced  by  reflex  nei've- 
action,  consequent  ui)on  sympathetic  hyper.tsthe- 
sia  of  the  inferior  extremity  of  the  rectum,  in- 
duced by  some  stimulating  or  irritating  agent 
operating  upon  the  mucous  membrane  or  muco-cu- 
taneous  tissue  of  the  canal  and  orifice  of  the  anus ; 
such  as  an  anal  fissure,  an  inflamed  or  irritable 
hemorrhoidal  tumor ;  or  irritation  or  inflammation 
of  the  mucous  membrane  of  the  canal  of  the  anus. 
This  arbitrary  contraction  is  also  sometimes  due  to 
reflected  irritation  from  some  of  the  genito-urinary 
organs,  being  consecutive  to  a  morbid  sonsiVulity,  or 
a  disease  in  some  one  of  them.  Tlie  rationale  of  the 
phenomenon  then  is  that  the  anal  sphincters  are 
brought  into  this  exalted  action  solely  in  conse- 
quence of  the  highly  sensitive  and  irritated  condi- 
tion of  tlie  tissues  in  their  vicinity,  through  reflex 
nerve-action.  Tlie  sensitive  nerves  being  shocked 
by  the  reflex  action,  from  whatever  cause,  an  invol- 
untary contraction  of  one  or  both  sphincters  takes 
place,  and  continues  in  proportion  to  the  intensity 
of  the  irritation  and  pain  of  the  primary  cause, 
the  contraction  thus  continiiing  and  vai-ying  in  de- 
gree with  the  nature  of  tlie  reflected  excitation. 
This  exalted  contraction  of  the  anal  sphincters  re- 
sembles that  of  the  orbicularis-jialpobrarnm  in 
strumous  ophthalmia,  provoked  by  the  stimulus  of 
the  strong  rays  of  light.     It  is  in  this  manner,  then, 


that  the  involuntary  contraction  of  the  anal  sphinc- 
ters may  be  provoked  by  the  stimulus  which  is  ex- 
ercised upon  the  mucous  membrane,  or  muco-cuta- 
neous  tissue  of  the  anal  canal,  by  any  preternatural 
exciting  cause  whatever. 

I  would  further  remark,  in  illustration  of  this 
intricate  subject,  that  physiology,  as  now  taught, 
satisfactorily  accounts  for  the  phenomenon  of  spas- 
modic or  involuntary  contraction  of  the  anal  sphinc- 
ters in  all  the  variable  degrees  of  irritation  or  exci- 
tation to  which  the  efferent  nerves,  which  have  their 
origin  at  the  seat  of  the  morbidly  sensitive  parts, 
are  subjected.  The  impression  eomnnmicated  to 
the  peripheral  distribution  of  the  nerves  of  sensa- 
tion is  tr.ansmitted  to  the  spinal  centres,  where,  ac- 
cording to  the  primary  laws  of  reflex  nerve-action,  a 
motor  impulse  is  produced,  and  the  fibres  of  the 
sphincter  muscles  in  the  immediate  vicinity  of  the 
source  of  the  irritation  are  impelled  to  contract 
spasmodically  to  a  greater  or  less  degree. 

"  Sphincternlgle." — Some  of  the  French  surgeons 
now  denominate  the  spasmodic  or  involuntary  con- 
traction of  one  or  both  anal  sphincters,  in  anal  fis- 
siire  or  hemorrhoids,  spliincferalgif,  and  treat  it  as 
an  entity — a  disease  in  itself.  But  I  ask,  is  the 
pain  or  disease  in  such  cases  really  in  the  sphinc- 
ters themselves  or  outside  of  them,  in  the  morbidly 
sensitive  and  painful  parts  so  violently  grasped  and 
compressed  by  them  ?  I  unhesitatingly  answer  that 
the  pain  in  such  cases  is  not  in  the  constricted 
sphincter  or  sphincters,  but  in  the  morbidly  sensi- 
tive and  painful  parts  themselves,  which  are  sub- 
jected to  this  mechanical  grasping  and  compressing, 
and  by  which  additional  and  most  agonizing  pain  is 
communicated  to  the  already  painful  parts.  As  an 
evidence  of  this,  the  involuntary  contraction  imme- 
diately ceases,  without  dividing  or  breaking  the  anal 
sphincters,  or  subjecting  them  to  any  treatment 
whatever,  on  simply  removing  or  allaying  by  proper 
or  judicious  measures,  the  morbid  sensibility  and 
irritability  of  the  constricted  parts,  which  are  in 
reality  the  primary  cause  of  the  sjiasmodic  contrac- 
tion. And,  furthermore,  this  spasmodic  contrac- 
tion of  the  anal  sphincters  also  spontaneously  ceases, 
on  the  subsidence,  sooner  or  later  after  the  act  of 
defecation,  of  the  pain  and  irritability  in  the  affected 
parts  themselves,  occasioned  by  the  passage  of  acrid 
and  stimulating  fajces,  and  the  straining  efforts  and 
tenesmus  attending  their  evacuation.  Now,  if  this 
theory,  in  such  cases,  is  true,  then  the  name,  sphinc- 
teralgie  is  a  misnomer. 

Spasmodic  contraction  of  the  anus  as  a  cavse  q^ 
hemorrhoids. — The  involuntary  contraction  of  the 
anal  sphincters  may  either  be  a  cause  or  an  effect 
of  hemorrhoids.  When  it  is  the  caiise  of  them, 
some  other  cause  than  hemorrhoids  must  first  pro- 
duce it.  When  the  contraction  is  the  effect  of  hemor- 
rhoids, they  themselves,  of  course,  produce  it  by 
their  own  morbid  sensibility  and  irritability,  through 
reflex  nerve  action. 

French  authors  generally  now  declare  that  this 
spasmodic  contraction  is  not  only  an  exciting 
or  an  efficient  cause  of  the  hemoiThoidnl  disease, 
but  that  it  is  almost  the  only  cause  of  that  ntloc- 
tion.  I  admit  that  it  is  sometimes  a  cause  of 
hemori'lioids,  but  tliat  it  is  a  frequent,  or  the  most 
frequent  cause  of  them  I  do  not  for  a  moment  be- 
lieve. In  my  judgment,  it  is  greatly  exaggerated  as 
a  cause  of  hemorrhoids  by  those  authors.  Indeed, 
instead  of  the  involuntary  contraction  of  the  anal 
s))hincters  being  a  primary  cause  of  hemon-hoids, 
it  is,  in  the  majority  of  instance.s,  only  the  effect  of 


THE  MEDICAL  RECORD, 


541 


them  ;  tor  it  cannot  be  denied  that  in  every  case  ot 
irritable  hemorrhoids  there  is  more  or  less  spas- 
modic contraction  of  the  anal  sphincters,  solely  in- 
duced by  the  irritation  of  the  hemorrhoids  them- 
selves, hemorrhoids  being  lirst  produced  by  some 
other  cause  than  siiasmodic  contraction  of  the  anal 
sphincters,  through  retlex  action,  as  the  result  of 
their  irritability  and  excitability. 

It  is  not  the  normal  condition  or  tonic  contraction 
of  the  anal  sphincters,  but  the  hyper  or  exalted 
contraction  of  them,  which,  under  the  stimulus  of 
reflex  nervous  imtatiou,  tends,  more  or  less,  to  in- 
terfere with  the  free  circulation  of  the  blood  in  the 
hemorrhoidal  vessels  within  the  grasp  of  the  active 
sphincters,  thus  tending  sometimes  to  the  produc- 
tion of  the  hemorrhoidal  disease  by  introducing 
tnrgescence,  hyperaimia,  congestion,  or  stasis  in 
Bome  of  those  vessels.  This  contraction  may  also 
sometimes  prove  an  efficient  cause  of  hemorrhoids, 
in  consequence  of  the  violent  straining  eflbrts  to 
evacuate  the  bowels  which  this  active  state  of  the 
sphincters  induces.  In  such  a  case,  a  part  of  the 
mucous  membrane  of  the  rectum,  together  with  the 
vessels  it  contains,  is  protnided  beyond  the  sphinc- 
ters at  each  time  of  the  exjjulsion  of  the  fteces,  and 
being  there  caught  by  the  spasmodic  contraction  of 
the  muscles,  its  vessels  become  engorged  or  strangu- 
lated. The  repeated  occurrence  of  this  circumstance, 
especially  when  assisted  by  constipation,  is  quite 
sufficient  to  produce  a  varicose  condition  of  the 
hemorrhoidal  vessels. 

I  would  observe  here  that  any  defect,  too,  of  the 
muscular  power  of  the  sphincters  may  also  prove  a 
cause  of  hemorrhoids  ;  perhaps  even  as  much  so  as 
the  too  powerful  action  of  them.  When  atony  of 
the  anal  sphincters  exists,  the  dilatations,  tnrges- 
cence, or  tumoi-s  form  on  those  parts  of  the  anal  canal 
invested  by  them.  For  the  want  of  the  natural  sup- 
port which  the  tonic  contraction  of  these  muscles 
affords,  the  hemorrhoidal  vessels  in  this  depending 
situation  become  relaxed,  and  allow  of  over-disten- 
tion,  by  undue  quantities  of  blood  entering  into 
them ;  hence  the  necessary  concomitants  of  this 
condition  are  dilatation,  hirgescence,  hyper:cmia, 
congestion,  stasis,  and  tumors.  Indeed," the  tonic 
contraction  and  compression  of  the  anal  sphincters, 
when  in  their  normal  condition,  uijon  the  parts  of  the 
canal  within  their  circumference  or  grasp,  prevent, 
to  a  great  extent,  any  undue  quantity  of  blood,  or  its 
elements,  from  entering  into  and  enlarging  the  ves- 
sels of  those  parts.  With  regard  to  the  spasmodic 
contraction  of  the  anal  sphincters,  more  or  less  in- 
flammation and  nervous  irritation  in  the  suiToimding 
parts  are  always  present ;  and  to  ascertain  to  a  cer- 
tainty that  involuntary  contraction  of  the  sphincters 
obtains,  it  is  only  neccssai-y  to  attempt  to  insert  the 
finger  into  the  anus,  when  it  will  at  once  encounter 
obstinate  resistance,  and  cause  more  or  less  pain. 
When  the  resistance,  however,  has  lieen  partially  over- 
come, and  the  finger  fairly  entered  into  the  anal  canal, 
it  will  be  (irmly  grasped  by  the  sphincters  as  by  a  vice. 
240  Madison  Avknue,  Nkw  ■\ork. 


VETERrNARY  MEniuiyE  IN  GERMANY. — I  was  read- 
ing, a  few  days  ago,  of  the  Veterinary  Department  of 
the  University  and  Horse  Hospital.  To  obtain  a 
diploma  from  this  school  one  must  attend  six  semes- 
ters, averaging  five  months  each,  or  twice,  nay  thrice 
even  the  amount  of  study  required  of  American  jihy- 
sicians.  Let  no  one  say  invidiously  that  the  Ger- 
mans value  their  horses  more  than  we  do  human 
beings  ! — Correspondi^nce  Buffalo  MinUcalJournal. 


A    CASE   OF   INTERMITTENT    EPISTAXIS, 

C0RED    m    QUINIA,    AFTER    FaILDKE    OF    USUAL    RE- 
MEDIES,   WITH    Re>UEKS    on    the    M.\NAGE5ni:NT     IN 

Genee-u.  of  Nose-Bleed. 

By  p.  F.  HAEVEY,  M.D., 

AB8I.-TAST-.SUEOE0N,  U.  fi.  A. 

Fdrst-Class  Private  A.  W.,  Engineer  Cor])s,  aged 
thirty-seven,  a]iplied  to  me  on  February  7,  1882, 
for  the  relief  of  a  severe  epistaxis  that  had  com- 
menced the  day  jirevious.  I  ordered  the  nostrils 
to  be  injected  with  a  cold  saturated  solution  of 
alum,  and  a  drachm  of  ergot  to  be  given  internally. 
This  arrested  the  bleeding  temijorarily,  but  in  a 
couple  of  hours  it  recommenced  with  all  its  initial 
severity.  The  patient  now  was  directed  to  seat  him- 
self in  a  cool  room  with  his  head  over  a  bucket,  and 
apply  a  cloth,  soaked  in  ice  water,  over  the  no.se. 
In  this  manner  a  clot  was  formed  and  the  bleeding 
again  stopped.  Having  enjoined  upon  him  the  ne- 
cessity of  avoiding  all  interference  with  the  clot,  the 
projecting  end  was  clipped  off  with  scissors  and  he 
was  directed  to  go  to  his  quarters  and  remain  per- 
fectly quiet  in  a  cool  room.  The  directions  not 
being  observed,  the  bleeding  recurred,  and  toward 
evening  the  patient  was  admitted  to  hospital.  When 
I  saw  him  on  this  occasion,  there  was  no  hemoirhage 
in  progi'ess.  To  guard  against  its  return,  however, 
it  was  deemed  advisable  to  plug  the  posterior  nares. 
-Accordingly  Belloeq's  canula  was  passed,  and  an 
effort  made  to  throw  the  button  into  the  pharynx. 
This  it  was  found  impossible  to  do,  on  account  "of  a 
broken  vomer  that  turned  the  point  of  the  instru- 
ment to  one  side.  Several  ineffectual  efibrts  were 
made  to  accomplish  the  desired  plugging,  causing 
much  pain,  but  without  exciting  any  flow  of  blood. 
Later,  however,  the  hemorrhage  again  commenced, 
and  the  pure  IMonsel's  solution  was  thrown  up  the 
nostril,  at  once  checking  the  flow.  Ergot,  chloride 
of  iron,  and  muriatic  acid  were  ordered  to  be  given 
in  combination,  three  times  a  day,  as  an  internal 
hemostatic,  conjoined  with  perfect  rest  and  low  diet. 

Hemorrhage  commenced  the  next  day,  notwith- 
standing these  measures,  and  injections  of  tannin 
were  ordered  e\ery  two  hours. 

This  general  line  of  treatment  was  pursued  until 
the  17th,  when  I  made  the  discovery  that  the  hemor- 
rhages had  taken  place  once  daily  during  the  seven 
preceding  days,  at  or  near  3  o'clock  p.m.  This  peri- 
odicity attracted  my  attention,  and  the  idea  occurred 
to  me  that  antiperiodic  doses  of  quinine  would 
effect  a  cure. 

On  the  morning  of  the  17th,  fifteen  grains  of  qui- 
nine were  administered  in  three  doses,  and  the  pa- 
tient was  carefully  observed,  to  note  the  effect  of  the 
drug  upon  the  hemorrhage.  The  usual  hour  passed 
and  no  bleeding  occurred,  but  about  one  hour  after- 
ward, a  small  amount  of  serum  or  watery  mucus 
was  discharged,  faintly  tinged  with  a  drop  or  less  of 
blood. 

On  the  18th,  fifteen  grains  of  quinine  "were  given 
with  aromatic  sulphuric  acid,  and  all  other  treat- 
ment omitted.  Xo  bleeding,  but  a  small  discharge 
of  serum  occun-ed  at  an  hour  later  than  on  the  pre- 
vious day.  The  ((uinine  was  repeated  on  the  19th 
and  2(lth,  on  which  dates  no  discharge,  either  serous 
or  sanguineous,  took  place. 

The  administration  of  quinine  was  then  discon- 
tinued, and  a  tonic-heniostatio  mixture  was  pre- 
scribed to  remedv  the  somewhat  anaemic  condition 


bi2 


THE  MEDICAL  RECORD. 


of  the  patient  and  guard  against  a  recurrence  of 
hemorrhage. 

On  the  25th,  the  patient's  condition  having  greatly 
improved,  and  all  tendency  to  a  return  of  nose-bleed 
having  apparently  disappeared,  he  was  returned  to 
duty. 

Remarks. — The  dominant  feature  of  interest  in  the 
foregoing  ease  was  the  periodicity  of  the  hemor- 
rhagic and  serous  discharge,  and  its  permanent  ar- 
rest by  quinine  after  the  failure  of  other  means. 
Since  returning  the  man  to  duty,  I  have  noticed  by 
reference  to  Frankel's  paper  on  "Nose-Bleed,"  in 
"  Ziemssen's  Cyclopedia  "  (vol.  iv.,  p.  152),  that  "  in- 
termittent epistaxis,  without  fever,  has  been  ob- 
served and  cured  by  quinine."  Such  an  event  would 
seem  to  require  the  operation  of  "malaria"  for  its 
production.  In  the  case  i-eported,  however,  the 
patient  had  never  had  ague,  and  had  not  lived  for 
many  years  in  a  malarious  region  ;  the  attack  came 
on  in  a  month  when  even  malarious  districts  are 
usually  healthy,  and  in  a  country  where  the  paludal 
miasm  but  feebly  manifests  its  presence  even  in  sea- 
sons most  favorable  to  its  evolution.  What  agency, 
then,  determined  the  intermittency  of  the  hemor- 
rhage in  this  case  ?  Might  not  a  slight  constitutional 
disorder,  reaching  its  culmination  at  a  certain  hour 
every  day  from  the  operation  of  meteorological 
causes,  bring  about  a  localized  vaso-motor  paresis 
and  give  rise  to  a  serous  or  hemorrhagic  transuda- 
tion in  a  part  richly  supplied  with  thinly  covered 
vessels,  such  as  the  pituitary  membrane?  The  hec- 
tic of  phthisis,  the  congestive  headache  tliat  occms 
periodically,  and  certain  kinds  of  cough  that  recur 
daily  at  certain  hours,  suggest  themselves  as  condi- 
tions etiologically  related  to  the  case  just  narrated. 

Quinine,  by  its  sedative  action  upon  the  circula- 
tion, by  its  interference  with  the  migration  of  leuco- 
cytes, and  by  stimulating  the  vaso-motor  area,  may 
be  rationally  selected  as  the  means  of  cure  in  such 
cases.  To  what  extent,  if  at  all,  the  "  malarial  poi- 
son" acts  in  the  manner  suggested,  and  how  cor- 
rectly the  modus  operandi  of  quinine  in  the  cure  of 
ague  is  set  forth  above,  are  subjects  that,  I  think, 
would  bear  more  investigating.  The  failure  to 
raach  a  satisfactory  elucidation  of  the  cause  of 
marsh  fevers  after  so  many  years  of  patient  inquiry, 
seoms  to  indicate  that  the  proper  line  of  research 
his  not  been  followed — the  clew  not  yet  found. 
M*laria,  bacteria,  el  id  omne  r/cni/.s,  have  been  figura- 
tive if/iies  fdtni,  and  when  stripped  of  all  sophistry 
must  be  acknowledged  to  serve  no  useful  purpo.se 
save  the  doubtful  one  of  foils  to  our  own  ignorance. 
The  active  principle  which  causes  fevers  in  marshy 
districts  has  never  been  isolated,  although  claimed 
to  have  been  so  by  several  investigators.  A  toxic 
substance  was  not  long  since  obtained  by  Klebs  and 
Gomassi-Curdeli  from  the  Pontine  marshes,  which 
they  claimed  to  be  the  malcries  morbi  of  intermittent 
fever,  but  Stemberg  has  shown  that  the  fever  ex- 
cited by  its  injection  into  the  blood  ic  not  the  fever 
of  ague.  Tliis  failure  and  the  many  others  preced- 
ing it  do  not  prove  that  such  a  princijili'  does  not 
exist.  Still,  I  am  disposed  to  believe  that  the  gen- 
esis of  ague  is  to  be  found  in  a  coalition  of  factors, 
such  as  food,  temperament,  atmospheric  conditions, 
etc.,  and  that  its  paroxysmal  charactt-r  is  dependent 
upon  an  increased  Busce))tibility  of  the  system  to 
yield  to  those  causes  which  oven  in  health  intermit- 
tently assert  themselves  by  modifying  the  interac- 
tion of  the  physical  forces  of  the  economy.  Fur- 
ther, it  seems  more  reasonable  to  me  to  suppose 
that  quinia  cures  by  modifying  the  vital  processes, 


rather  than  by  neutralizing  a  poison,  for  the  reason, 
well  known,  that  it  is  practically  impossible  to  de- 
stroy germs  without  charging  their  habitat  with 
disinfectants  to  such  an  extent  as  would  be  fatal  to 
human  life. 

The  management  of  ejiistaxis  is  usually  an  easy 
matter,  but  occasionally  a  case  is  met  that  proves 
rebellious  and  threatens  the  destruction  of  life  un- 
less speedily  terminated.  The  remedy  of  plugging 
from  behind  is  sometimes  imjiracticable,  as  in  the 
case  above,  and  even  when  it  can  lie  applied  is  not  al- 
ways successful.  Dr.  A.  Hartman,  in  a  recent  arti- 
cle,* goes  so  far  as  to  condemn  the  practice  of  plug- 
ging the  posterior  nares,  not  only  on  account  of  the 
pain  attending  it,  but  from  the  danger  of  its  caus- 
ing disease  of  the  middle  ear,  three  cases  of  which 
he  mentions  in  illustration.  He  advises  the  sur- 
geon to  localize  the  exact  seat  of  hemorrhage,  and 
to  then  ap2:>ly  a  pledget  of  absorbent  cotton  directly 
to  it.  He  states  that  this  point  is  situated  usually 
upon  the  septum  or  floor  at  the  front  jjart  of  the 
nose. 

Dr.  Verneuil,  the  eminent  French  surgeon,  reports 
a  curious  case,  in  which  epistaxis,  occurring  in  cir- 
rhosis of  the  liver,  and  which  ergot  and  digitalis 
failed  to  arrest,  was  stopped  by  a  fly-blister  over  the 
hepatic  region  (Phila.  Med.  Times,  No.  345,  p.  320). 

Mr.  Chas.  B.  Keetley,  in  the  Practitioner  for  Feb- 
ruary, 1879,  extols  the  use  of  hot  water  in  the  treat- 
ment of  nosebleed.  He  says  when  epistaxis  comes 
on  during  the  morning  ablution  with  cold  water,  or 
during  the  jjrogi-ess  of  a  cold  in  the  head,  hot  water 
is  most  eflectual.  It  answei-s  also  in  cases  of  trau- 
matic origin.  The  water,  at  a  temperature  of  120° 
to  124°  F.,  need  not  be  injected  into  the  nostril,  but 
only  applied  freely  to  the  face.  Chlor.  potass,  in 
the  proportion  of  a  large  teaspoonful  to  a  tumbler 
of  hot  water  may  be  used  as  an  injection,  the  salt 
preventing  the  swelling  of  the  mucous  membrane 
which  often  foUows  contact  with  pure  water  hot  or 
cold.  The  hot  saline  solution  has  stopped  an  epis- 
taxis instantly. 

Mr.  Cox,  of  Winchcombe,  Eng.,  in  a  case  of  in- 
tractable epistaxis  complicated  with  cardiac  disease, 
injected  up  both  nostrils  a  solution  of  one  part  lig. 
ferri  perchlor.  fort,  and  three  parts  of  water,  with 
the  result  of  immediately  and  permanently  arresting 
the  hemorrhage.  In  two  days  a  perfect  plug  was 
removed.  Another  case  in  a  child,  of  great  severity, 
in  which  all  usual  remedies  had  failed,  was  imme- 
diately checked  by  the  same  remedy.  He  prefers 
the  injection  to  a  plug  of  lint,  as  it  is  more  easily  ap- 
plied, and  more  likely  to  be  eflectual  on  account  of 
reaching  the  seat  of  hemorrhage  with  more  cer- 
tainty. 

Dr.  Leeper,  in  a  communication  to  the  Dublin 
Journal  of  Medical  Sciences,  rej)orts  a  case  success- 
fully treated  by  the  insertion  into  the  nostrils  of 
suppositories  medicated  with  perchloride  of  iron. 
The  lieniorrhiige  occurred  during  the  pi'ogress  of  an 
attack  of  typhoid  fever,  and  was  of  great  severity. 
Another  case,  occurring  in  a  man  seventy-two  years 
old,  was  treated  similarly  with  a  successful  rosidt. 
Ergot  was  used  internally. 

Dr.  liose,  an  IhiRlish  jihysician,  some  years  as;o 
suggested  the  use  of  an  India-rubber  bag,  to  bo 
passed  into  the  nostril  as  far  as  the  ]>harynx  and  in- 
flated with  air  or  iced  water,  thus  formiuK  a  painless 
plug  that  exerts  equal  pressure  upon  all  jioints  of 
contact.     The  idea  has  subsequently  been  applied 


*  Zelk  (Ar  Ohrrnhcilk. 


THE  MEDICAL  RECORD. 


543 


in  practice,  and  has  been  found  to  answer  well  in 
stopping  nasal  hemorrhage.  Its  removal  is  easily 
effected  by  turning  the  tap  and  letting  out  the  con- 
tents. 

Dr.  Cleave:-,  late  senior  surgeon  to  the  Liverpool 
Royal  lutirmary,  lauds  the  use  of  ergotin  by  hypo- 
dermic iujection  in  all  forms  of  hemorrhage  not  ac- 
cessible to  ligature,  live  grains  with  twenty-live  min- 
ims of  water  being  the  amount  he  used  in  treating 
successfully  threfe  severe  cases  of  epistaxis  that  had 
res^L'iled  plugijing  the  posterior  nares. 

It  is  hardly  probable  that  the  surgeon  will  ever 
encounter  a  case  of  nose-bleed  that  will  not  yield,  to 
one  of  the  above  remedies.  Should,  however,  the  ef- 
fusion continue  after  a  fair  trial  of  ergotin,  hypoder- 
mically,  local  pressure  by  plugging,  and  the  injec- 
tion of  styjatics  successively  employed,  he  must  look 
for  a  constitutional  dyscrasia  as  the  cause,  and  by 
removing  that  may  expect  to  secure  a  cessation  of 
the  hemorrhage. 

FOBT   SSELLING,  MiKN.,  April,  1S89. 


TEEATJIENT  OF  FKACTUEE  OF  CLAVICLE 

WITH  WIEE  SUTUEES  (LANGENBECK). 

By  W.  W.  DAWSON,  M.D., 

PROFESSOK  OF  SURGERY,  MEDIC^VI.   COLLZOK  OF  OHIO. 

The  Medical  Neu-a  gives  the  Deutsche  Med.  Woch. 
credit  for  the  following  statement  upon  the  treat- 
ment of  and  results  in  fracture  of  the  clavicle. 

"  The  unsatisfactoi-y  results  which  ordinarily  fol- 
low the  treatment  of  fracture  of  the  clavicle  in  spite 
of  the  numerous  forms  of  apparatus  at  the  service 
of  the  surgeon,  have  led  Dr.  Langenbeck  to  adopt 
the  above  method." 

The  statement  that  the  results  in  this  fracture  are 
ordinarily  unsatisfactory  is  as  remarkable  as  the 
proposed  practice  is  novel  and  questionable.  Are 
the  results  in  fracture  of  the  clavicle  unsatisfactory? 
The  deformity  following  ordinary  plans  is  insignifi- 
cant— a  slight  overlapping,  often,  especially  in  chil- 
dren, disappearing  entu-ely.  Are  not  the  functions 
of  the  arm  left  intact?  Do  patients  usually  com- 
plain of  either  pain  or  disability  ?  Even  the  medical 
practitioner,  making  no  pretensions  whatever  to 
surgery,  after  having  been  in  the  profession  a  score 
of  years,  will  have  treated  a  number  of  these  cases, 
occurring  at  all  periods  of  life,  in  the  weak  and  in  the 
strong,  from  childhood  to  old  age,  and  yet  it  is  rare 
to  see  an  "unsatisfactory  result."  Although  no 
plan  ever  yet  devised  wiU  maintain  absolute  immo- 
bility or  make  and  sustain  extension,  fixation  be- 
ing desirable  in  all  fractures,  many  inventions 
have  been  made  to  establish  it  in  this  one.  They 
embrace  a  vnst  variety  of  forms,  from  simple  sus- 
pension to  a  yoke,  from  binding  the  arm  to  the 
body  to  merely  carrying  the  hand  in  the  breast  of 
the  coat,  from  a  sling  made  with  a  handkerchief 
to  the  complicated  contrivances  of  Fox  and  Levis 
and  Dessault.  One  binds  the  arm  to  the  side  while 
another  encases  the  shoulder  and  arm  in  plaster-ot- 
Paris.  Positive  immobility,  as  we  have  said,  has 
never  been  attained,  and  for  a  useful  arm  it  is  not 
necessary  that  it  should  be.  Union  goes  on  in  the 
presence  of  slight  motion. 

Surgery  has  also  failed  to  supply  in  this  fracture 
any  satisfactory  means  of  extension.  The  point  of 
the  shoulder  can  be  raised  and  carried  backward 
and  can  be  secured  in  this  po.sition,  but  it  cannot 
be  drawn  outward,  the  shortening  cannot  be  avoided, 
the  overlapping  cannot  be  overcome,  excejit  by 
means  of  a  solid  or  semi-soUd  fulcrum  placed  in  the 


axilla,  whUst  the  arm  is  used  as  a  lever  :  to  be  efSci- 
ent  it  must  be  forcible.  This  is  not  only  painful, 
too  torturing  to  be  borne,  but  it  is  hazardous  to  the 
integiity  of  the  member.  Attempts  to  carry  the 
shoulder  from  the  median  line,  to  overcome  an  in- 
significant abridgement  in  the  length  of  the  clavicle, 
have  been  abandoned  by  surgeons  generally,  mo.stof 
them,  it  may  be  .said  now,  after  raising  the  elbow,  fix 
the  arm  across  the  chest  by  means  of  adhesive  straps. 

When  it  is  seen  that  a  useful,  an  uudamagf  d  in 
function  arm  is  obtained  by  such  sim))le  means,  it 
may  well  be  asked  why  resort  to  a  ]iractiee  singularly 
radical,  although  so  eminent  an  authority  as  Lan- 
genbeck, assures  us  that  he  obtained  sn  "  ideal  re 
suit"  in  a  boy  ten  years  old,  "which  he  treated  by 
cutting  down  on  the  seat  of  fracture,  and  suturing 
the  ends  of  the  broken  bone  accurately  together 
with  sih-er  wire,  and  the  periosteal  sac  with  catgut 
sutures."  EemarkaVile  would  be  the  case  which 
would  justify  a  resort  to  such  treatment  !  Again,  it 
may  be  said  that  it  is  doubtful  whether  silver  wires 
would  hold  together  the  fragments  of  a  markedly 
oblique  fractui'e  of  the  clavicle,  they  would  have  to 
support  tlie  weight  of  the  shoulder  and  resist  the 
action  of  the  great  nluscles  which  form  the  aimjut, 
the  pectoral  muscles  in  front,  and  the  latissimus 
dorsi  and  its  associate  behind. 

Although  the  distinguished  surgeon  obtained  sn 
"  ideal  result,"  having  treated  his  case  antiseptic- 
ally,  "the  wires  being  so  twisted  that  the  ends 
could  not  perforate  the  skin,"  yet  it  cannot  be  de- 
nied that  the  conversion  of  a  simple  into  a  compli- 
cated fracture  is  by  no  means  an  unimportant,  or 
harmless  proceeding,  and  esjiecially  ^  hen  the  wound 
is  made  at  the  liase  of  the  neck,  in  the  neighbor- 
hood of,  we  may  almost  say,  vital  structures — struc- 
tures which,  if  they  should  share  in  the  infiam- 
matorv  action,  might  give  rise  to  consequences  the 
most  disastrous. 

Third  Street  asd  Broauway.  Ctkcisxati. 


loDOFOEM  IN  Extirpation  of  the  Tongue,  in  Goi- 
tre AND  Buboes.  —Nothing  could  present  the  happy 
results  more  forcibly  than  the  statistics  of  Billroth's 
operations  for  extii-jiation  of  carcinomatous  tongues. 
Between  1871  and  1876  the  mortality  was  thirty-two 
per  cent. ;  in  1877-1880  (fifty-three  ca.ses),  with  irri- 
gations of  pot.  permanganate  solutions,  eighteen 
percent.  ;  between  April  and  October,  1881,  he  per- 
formed the  operation  eighteen  times,  -nith  the  same 
operative  technique  as  before,  but  with  iodoform 
dressing  ;  result,  eighteen  recoreries. 

The  course  of  the  recovery  presented  in  no  ease 
unfavorable  symptoms.  Billroth  himself  ascribes 
the  extraordinary  success  largely  to  iodoform.  The 
dressing  consisted  simply  in  a  piece  of  iodoform 
gauze  fifteen  to  twenty  ctm.  long,  containing  about 
one  gramme  of  iodoform,  rolled  up  so  as  to  form  a 
tampon,  and  pressed  into  the  wound.  The  tampon 
was  generally  renewed  in  from  five  to  eight  days 
after  the  operation. 

Mosetig  is  now  using  iodoform  suspended  in  gly- 
cerine as  a  local  injection  in  the  treatment  of  goitre. 
It  is  safe  and  efficient,  he  says. 

Neumann  injects  the  buboes  from  a  hard  chancre 
with  the  same  liquid  ;  the  glands  usually  become 
smaller  and  softer,  but  the  roseola  appears  invaria- 
I  bly  in  due  course.  He  also  gives  iodoform  in  pills, 
instead  of  pot.  iod.  for  constitutional  syphilis. — Br. 
TV.  T.  nelfield's  Vienna  Letter  to  Chicago  Medical  Ex- 
aminer. 


544 


THE  MEDICAfi  RECORD. 


fta%xtes  of  Mttfxcai  Sctmcf. 


COXDIIION    OF  THE    CEREBRAL   CrRCULATION   DUBINO 

Cardiac  DiAsroLE. — At  the  session  of  the  Paris  Bi- 
ological Society,  held  March  25,  1882,  M.  Franck  re- 
ported aa  original  esperimeut,  the  result  of  which, 
if  corroborated,  will  subvert  the  theory  at  present 
accepted  in  regard  to  the  role  of  the  cephalo-rachid- 
ian  flaid  in  cerebral  anieiaia  due  to  arrest  of  car- 
diac action.  It  is  generally  assumed,  as  is  well 
known,  that  the  fluid  in  question  regularly  oscillates 
between  the  cranial  and  spinal  cavities,  filling  the 
vacuum  caused  in  the  former  by  the  cardiac  dias- 
tole and  regurgitating  into  the  subarachnoid  sjjace 
within  the  spinal  canal  during  the  systole.  M. 
Franck's  experiment  consisted  in  applying  an  elastic 
ligature  around  the  superior  part  of  the  medulla  ob- 
longata, including  its  meninges.  .^He  then  removed 
a  portion  of  the  cranium  by  means  of  the  trei^hiue, 
and,  having  caused  the  heart  to  cease  beating,  found 
the  cerebral  veins  distended  with  blood.  The  cere- 
brum, instead  of  being  retracted  and  amemic,  was 
tumefied  and  congested.  M.  Franck,  therefore,  con- 
cludes that  venous  congestion  accompanies  arterial 
anaemia,  and  that  the  vacuum  produced  in  the  cere- 
bral parenchyma  by  diminution  in  the  calibre  of  the 
arterioles  is  compensated  by  repletion  of  the  veins 
and  not  by  afflux  of  the  cei^halo-rachidian  fluid. — 
Le  Prngrk  Medical,  April  1,  1882. 

Resums  op  Nerve-Stretchino  ra  Locomotor 
Ataxia  and  Kindred  Diseases. — Dr.  Langenbuch 
has  embodied,  in  a  report  made  to  the  Medical  So- 
ciety of  Berlin,  the  results  of  the  investigations  re- 
garding nei-ve-stretching,  conducted  by  himself  at 
the  Lizarus  Hospital,  and  in  private  practice.  Dr. 
Langenbuch  believes  that  the  ojieration  is  entitled 
to  recognition  as  an  established  surgical  procedure. 
He  admits  that  the  failures  have  thus  far  outnum- 
bered the  successes  attained  by  the  method  in  ques- 
tion. This  result  he  attributes  to  the  fact  that  the 
cases  have  in  many  instances  not  been  adapted  to 
the  operation,  and  that  faulty  methods  have  been 
employed  in  its  performance.  The  object  of  fixture 
investigations  should  be  to  discover  what  cases  are 
best  adapted  for  the  successful  performance  of  nerve- 
stretching  ;  what  conditions  contra-indicate  the  ope- 
ration ;  under  what  circumstances  slight  and  power- 
ful traction  should  respectively  be  made ;  whether 
the  sciatic  alone  or  these  together  with  the  anterior 
crural  nerves  should  be  sti-etched,  and  what  the  after- 
treatment  slionld  be. —  Berliner  klinische  Wocheu- 
schrifl,  March  27,  1882. 

Soiii'HATB  OF  Quinine  in  the  Tubat.ment  of  Gly- 
cosuria.— A  brief  jiapor  on  the  above  subject  was 
read  at  the  London  International  Medical  Congress 
of  last  year,  by  Dr.  Jules  Worms,  and  is  published 
in  La  Fmnt-e  Medicnlo,  April  (i.  1882.  The  cases  of 
glycosuria  in  which  Dr.  Worms  obtained  good  re- 
sults from  the  use  of  quinine,  jiresentod  no  symp- 
toms of  any  moment,  except  a  raodorate  (juantitv  of 
sugar  in  the  urine,  with,  in  some  instauin^s,  a  sense 
of  lassitude  and  anore.via.  The  quantity  of  urine 
was  normal,  as  was  that  of  urea  and  uric  acid.  The 
patients  were  usually  busily  occupied  savants,  ar- 
tists, or  financiers.  Tliey  wore,  as  a  rule,  corpulent 
and  inclined  to  gout,  and  suffered  from  nervous  ex- 
haustion. The  sulphate  of  cpiinine  was  administercul 
for  the  purpose  of  restoring  the  equilibrium  of  the 


vasomotor  system,  which  is  theoretically  disturbed 
in  glycosui'ia.  The  drug  was  administered  continu- 
ously for  a  period  varying  from  fifteen  to  twenty 
days  in  diurnal  doses  of  O.Jo  ctgr.  (7  grains).  The 
quantity  of  sugar  was  markedly  diminished  in  each 
of  the  thirty  cases  thus  treated.  In  one  case,  which 
serves  as  an  example,  the  amount  of  glucose  was  di- 
minished, in  twenty  day.s,  from  forty  grammes  (600 
grains)  to  four  grammes  (GO  gi-ains).  This  diminu- 
tion was  eifected  without  any  interference  with  the 
customary  diet  of  the  patients. 

The   Effect  of   Section  of  the  Pneumooasthic 

UPON    THE    ExH.UiATION    OF    C.4.RBONIC    DlOXXDB. — M. 

Grehaut  recently  reported  to  the  Socicte  de  Biolo- 
gie,  of  Paris,  the  results  of  his  investigations  upon 
the  effect  of  division  of  one  pneumcgastric  nerve 
upon  the  pulmonary  excretion  of  carbonic  dioxide 
{La  Trihmu:  M/dicale,  April  2,  1882).  He  adopted 
the  plan  of  jiassing  a  given  quantity  of  pure  air 
through  the  lungs  both  before  and  after  section  of 
the  nerve,  and  determining  the  relative  amounts  of 
carbonic  dioxide  contained  in  each.  His  carefully 
conducted  experiments  led  him  to  the  conclusion 
that  division  of  one  pneumogastric  has  no  influence 
upon  the  (piantity  of  the  gas  exhaled. 

The  Effect  of  Chloroform  on  the  Nervous 
Centres. — At  a  recent  session  of  the  Bordeaux  Acad- 
emy of  Medicine,  the  proceedings  of  which  are  re- 
ported in  tlie  Journ(d  de  Mkliciuede  Bordeaux,  April 
2,  1882,  M.  Vulpian  opposed  the  prevalent  belief 
that  the  involvement  of  the  nerve-centres  takes  place 
in  a  certain  orderly  and  regular  sequence.  He  main- 
tained that  all  the  centres  are  simultaneously  over- 
whelmed by  the  auiesthetic,  with  the  exception  of 
the  respiratory  medullary  centre,  which  alone  pos- 
sesses a  somewhat  greater  power  of  resistance.  M. 
Vulpian's  proofs  of  this  theory,  as  detailed  in  the 
Journal  ile  Medicine,  seem  lacking  in  conclusive- 
ness. 


Triohinje  in  Pickled  Meats. — M.  G.  Colin  re- 
cently reported  to  the  Paris  Academy  of  Sciences 
the  results  of  his  experiments  concerning  the  length 
of  time  required  by  difterent  saline  solutions  to 
cause  the  death  of  the  trichina  spiralis.  These  in- 
vestigations were  undertaken  with  a  view  to  ascer- 
taining the  conditions  under  which  pickled  meats 
may  be  consumed  without  danger.  M.  Colin  de- 
monstrated tlie  fact  that  chloride  of  sodium  kOls  the 
trichin.x>  in  two  or  three  weeks.  He  was  unable  to 
find  any  of  the  parasites  alive  in  the  American  pork 
subjected  to  critical  examination.  Samples  selected 
at  random  from  barrels  of  American  pork  at  Lyons, 
Paris,  and  Bordeaux,  and  taken  from  the  centre  of 
the  respective  pieces  of  meat  were  administered  to 
wrens,  mice,  and  ral)bits.  Xone  of  the  trichinse, 
however,  could  be  seen  to  uncoil  themselves  or  to 
execute  appi-eciable  movements  after  their  cysts  had 
been  dissolved  away  by  the  digestive  fluids.  The 
French  Chamber  of  Deputies  has  recently  passed  a 
bill  having  as  its  object  the  abolition  of  all  restric- 
tions upon  the  importation  of  American  pork,  but 
recommending  that  all  such  meat  be  critically  ex- 
amined.—  l,e  <'<)iirrier  Medicah;  April  8,  1882. 

The  Helations  between  Nasal  I'oLvri  and  Asth- 
JL\. — In  the  Archirex  (lau'ratrjt  de  Medecine,  April, 
1882,  Dr.  Joal,  of  Mont-Dore,  publishes  a  lengthy 
paper  upon  the  relations  existing  between  asthma 
and  polypi  of  the  nasal  mucous  membrane.  Start- 
ing with  the  assumption  that  asthma  is  often  the 
result  of  chronic  Schneideritis  and  coryza,  he  pro- 


THE  MEDICAL  RECORD. 


545 


ceeds  to  demonstrate  the  causative  connection  be- 
tween the  former  disease  and  nasal  polypi.  Their 
etiological  relation  is  detinitively  established  bv  the 
fact  that  many  asthmatics  aftected  with  polypi  are 
permanently  relieved  by  the  removal  of  the  neo- 
plasms. Dr.  Joal  adduces  the  histories  of  eleven 
cases  as  evidence  that  his  conclusions  are  correct. 
This  paper  will  be  continued  in  a  subsequent  num- 
ber of  the  Archives  Get) t rales  de  Medecine. 

Koch  and  the  I^^feottve  Element  in  TrisERcrLosis. 
— Ever  aince  Villemin,  more  than  fifteen  years  ago, 
claimed,  as  the  result  of  his  experiments  on  the  lower 
animals,  that  tubercle  was  a  specific  disease,  due  to 
a  special  virus,  almost  endless  experiments  have 
been  made  in  diflerent  parts  of  the  world  to  test  the 
validity  of  his  statements.  The  outcome  of  their 
conjoined  labors  has  placed  the  matter  in  a  some- 
what new  light,  for  while  it  has  been  determined 
with  great  accuracy  that  the  miliary  g^nulum  is  a 
product  of  inflammation,  it  has  also  been  shown. 
with  about  as  much  certainty,  that  various  organic 
substances  may  produce  it.  and  therefore  to  a  cer- 
tain extent  it  may  be  classed  among  the  infective 
diseases.  These  results  have  been  derived  from  the 
studies  of  Fox,  Sanderson,  Clarke,  Cohnheim,  Salo- 
monsen,  and  Buhl.  Those,  however,  who,  like 
Cohnheim,  Klebs,  and  Koch,  maintain  that  the  tu- 
bercle granulum  is  due  solely  to  the  interposition 
of  a  specific  vims,  have  naturally  hunted  for  it  with 
their  microscopes,  but  thus  far  when  one  has  pro- 
claimed a  discovery  he  has  obtained  little  credence, 
because  these  alleged  discoveries  have  almost  in- 
variably proved  premature.  The  latest  announce- 
ment comes  from  Robert  Koch,  who  has  recently 
received  an  appointment  as  advisory  councillor  in 
the  Sanitary  Department  in  Berlin.  He  claimed  by 
using  aniline  dyes  to  have  been  able  to  color  certain 
minute  bacterial  organisms  found  in  tuberculosis, 
and  he  is  j>repared  to  affirm  that  they  are  the  essen- 
tial elements  that  cause  infection. 

The  dyes  in  question  are  methyl-blue  and  vesu- 
vin,  which  cause  peculiar  staining,  difierentiating 
them  from  the  ordinai^y  bacteria  of  decomposition 
that  take  a  purple  color  with  hamatoxylon.  His 
method  is  as  follows :  A  methyl-blue  fluid  is  made, 
which  consists  of  1  c.c.  of  a  concentrated  alcoholic 
solution  of  methyl  blue  in  200  c.c.  of  distilled  water, 
to  which  0.2  c.c.  of  a  10  per  cent,  caustic  soda  so- 
lution has  been  added.  The  preparations  remain  in 
this  mixture  from  twenty  to  twenty- four  hours,  or, 
if  they  are  kept  at  a  temperature  of  10-i°  E.  in 
the  water-bath,  the  time  may  be  reduced  to  a  half 
hour.  Then  the  same  preparations  are  flooded 
with  a  concentrated  watery  solution  of  vesuvin,  and 
two  minutes  later  are  washed  with  distilled  water. 
All  animal  tissues  and  ordinary  bacteria  are  now  said 
to  be  stained  brown  (lepra  bacilli  excepted),  but  the 
tubercular  parasite  is  colored  blue. 

He  further  announces  that  he  has  been  able  to 
isolate  these  bacteria  from  the  others  with  which 
they  are  found,  Tiy  successive  cultures  in  the  well- 
known  sterilized  fluids.  He  regards  these  bacteria 
as  different  from  those  that  have  been  described  liy 
Klebs,  Schuller,  or  Aufrecht.  His  experiments 
have  been  very  numeroiis. — Berl.  lOin.  Woch.,  No. 
15,  1882. 

CONGENITAI    FlSTl'IiES    AND      DEPRESSIONS     IN     THE 

Lumbo-Sacr.^l  Eegion. — At  a  recent  meeting  of  the 
Societe  de  Chinirgie  in  Paris,  M.  Lannelongue  read 
a  report  upon  this  subject.  He  observed  that  for  a 
long  time  a  more  or  less  considerable  depression  in 


the  middle  of  the  sacral  region  has  been  obFerved. 
Fere  described  nine  cases  occurring  in  children. 
Kuhn  thought  they  indicated  the  remains  of  tie 
hydrorachis.  Later  Monod,  Terrilon,  Polnillon,  Des- 
pr6s,  and  others  published  cases.  The  reseaiches 
of  M.  Lannelongue  were  made  upon  children  from 
the  age  of  birth  to  fifteen  years.  Sometimes  one  finds 
a  median  fossette  in  the  lower  vertebral  region, 
sometimes  just  below  the  commencement  of  the  in- 
tergluteal  cleft,  sometimes  at  the  level  of  the  sacro- 
coccygeal articulation,  or  even  at  the  apex  of  the 
coccyx,  within  one  centimetre  of  the  anus.  In  130 
subjects  M.  Lannelongue  has  found  a  depression  or 
an  infundibulum,  more  or  less  marked,  in  95  in- 
stances. In  29  of  these  the  deformity  was  located 
at  the  commencement  of  the  intergluteal  groove  :  in 
;^8  it  was  at  the  level  of  the  sacro- coccygeal  articu- 
lation, and  in  28  at  the  point  of  the  coccyx.  M. 
Lannelongue  does  not  recognize  in  these  fossettes 
relics  of  a  posterior  umbilicus. — Covrrier  31(dicaL 
No.  15,  1882. 

Infanttle  Paresis  Tbeated  by  Nerve- Stretching. 
— Dr.  E.  M.  Simon,  of  Birmingham,  has  reported 
one  case  of  infantile  paralysis  of  the  right  leg,  treated 
by  stretching  the  sciatic  nerve.  The  patient  was  five 
years  old,  and  had  been  under  treatment  for  tbree 
years.  Though  the  paralyzed  had  not  kept  pace 
with  the  healthy  limb,  there  was  no  actual  deformity, 
and  the  muscles  were  fairly  nourishf  d.  Other  mus- 
cles than  those  supplied  by  the  fciatic  nerve  were 
found  to  be  afl"ected  when  tested  by  forty  Leclanchf 
cells.  During  the  latter  twelve  months  no  improve- 
ment had  resulted  from  the  treatment.  In  walking, 
the  patient  used  to  swing  his  foot,  and  brought  it  to 
the  ground  with  a  jerk,  and  was  apt  to  fall.  Mr. 
Chavasse  cut  down  upon  the  right  sciatic  nervf, 
under  antiseptic  precautions,  and  lifted  it  three 
times  forcibly  from  its  bed.  A  good  recovery 
followed  the  operation,  two  months  after  which 
careful  measurements  showed  a  marked  improve- 
ment, although  the  patient  had  sui3ered  in  the  mean- 
time from  diarrlKea  and  bronchitis.  On  January 
2,  1882,  the  sound  thigh  and  leg  had  gained  respei  t- 
ively  three-fourths  and  one-eighth  inch,  and  the 
aflFected  thigh  and  leg  one  and  one-fourth  and  three- 
eighths  respectively.  He  no  longer  swings  his  foot 
forward,  and  rarely  falls. — Brilitih  Medico!  Journal, 
February  2.'"),  1882. 

Phlebitis,  following  Typhoid  Fkvbs,  resulting 
IN  Pulmonary  Thrombosis. — Dr.  Charles  Hood  has 
read  a  paper  on  the  above  subject,  before  the  Med- 
ical Society  of  London.  His  patient  was  twenty-one 
vears  of  age,  and  when  admitted  to  the  West  London 
Hospital  had  been  ill  three  weeks.  He  had  been  up 
and  about  the  wards  for  a  number  of  days,  when  he 
was  suddenly  seized  with  intense  pain  in  the  sph nic 
region,  and  elevated  temperature  followed  by  symp- 
toms of  general  phlebitis.  An  autopsy  revealed  oc- 
clusion of  the  pulmonary  artery.  The  point  of 
special  note  was  the  extremely  insidious  nature 
of  the  attack,  and  the  doctor  urged  the  neceF^ilv  of 
careful  study  when  any  marked  symjitom  ocf  urred 
in  such  cases,  in  order  to  in.sure  an  early  diagnosis. 
His  observations  have  taught  him  that  excessive 
pain  in  the  hip,  resembling  that  of  rheumatisn-, 
often  indicates  mi.«chief.  Bemarks  inadelya  mem- 
ber of  the  society  indicated  the  belief  that  defp-sented 
and  excessive  pain  in  the  calf  of  the  leg  during  con- 
valescence of  ty)ihoid  fever,  was  the  first  cign  of  a 
coagulation  that  afterward  implicated  the  iliac  ves- 
sel.—iaHcei,  March  11,  1882. 


5i6 


THE  MEDICAL  RECORD. 


The  Medical  Record: 


7i  lUteklg  Jouvnal  of  fllcbicinc  anb  Surgerj 


aEOROE  F.  SHRADY,  A.M.,  M.D.,  Editor. 

PUBLISHED   BY 
Vrn.  'WOOD  &  CO.,  no,  27  Oreat  Jones  St.,  N.  H. 

New  York,  May  20,  1882. 

ABUSES  OF  MEDICAL  CHARITY. 

We  have  received  lately,  from  several  medical  gen- 
tlemen in  this  city  and  vicinity,  protests  against  the 
great  abuse  of  medical  charity  that  is  carried  on  in 
many  of  our  hospitals  and  dispensaries.  The  bur- 
den of  complaint  is  that  not  only  are  many  pa- 
tients treated  in  these  institutions  who  can  afford 
to  pay  moderate  fees,  but  in  not  a  few  instanues  the 
desire  for  interesting  clinical  material  on  the  part 
of  hospital  medical  attendants  is  such  tluit  special 
inducements  are  afforded  to  patients  to  submit  to 
free  treatment.  The  consequence  is  that  the  rank 
and  file  of  the  profession  are  suffering  to  a  degree 
scarcely  credible.  A  surgeon  within  thirty  miles  of 
New  York  complains  that  several  of  his  best  cases 
for  operation,  that  is,  such  as  were  willing  to  pay  a 
fee  for  the  same,  readily  found  prominent  surgeons 
in  the  larger  hosjjitals  who  were  willing  to  render 
their  services  for  nothing.  On  the  other  hand,  a 
competent  young  medical  man  in  the  city,  willing 
to  take  any  fee,  however  small,  states  that  in  con- 
sequence of  his  proximity  to  a  medical  college  and 
widely-known  dispensary,  he  is  literally  without 
anything  to  do.  Of  course  this  is  an  old  story,  but 
e.ich  sufferer  has  a  grim  satisfaction  in  applying  it 
to  his  own  experiences  in  the  hope — almost  vain — 
of  finding  some  remedy.  We  all  know  that  it  is  al- 
together unnecessary  to  dispense  medical  services 
gratuitously,  and  yet  we  fail  to  reason  together  as  to 
how  it  may  be  stopped.  We  are  all  aware  that 
there  is  no  good  reason  why  we  should  give  our  ad- 
vice to  i)eople  even  when  tliey  are  very  jioor,  save 
that,  like  good  Samaritans,  we  are  willing  to  help 
them.  .\nd  yet  there  is  no  other  profession,  calling, 
or  trade  that  does  likewise.  Even  the  clergyman 
gets  paid  by  some  one  for  preaching,  the  lawyer 
obtains  his  fee  from  the  poorest  thief,  and  certainly 
the  butcher  and  baker  do  not  keep  open  houses  for 
even  those  who  are  "a  liungered."  The  pity  for  the 
poor  is  one-sided  in  tlie  case  of  the  doctor,  and  lie  is 


the  only  one,  apparently,  who  suffers  from  its  exer- 
cise. A  surgeon  connected  for  years  with  several  of 
our  large  hospitals,  who  was  never  known  to  refuse 
professional  attendance  upon  "the  pilgrim  and  the 
stranger,"  died  recently  and  left  his  family  virtually 
destitute.  This  is  certainly  a  poor  reward  for 
charity — a  poor  return  for  so  much  of  service  that 
ungrudgingly  given  to  the  poor.  An  active  sur- 
geon in  a  hospital  estimated  that  in  operations  and 
surgical  attendance  upon  paupers  in  the  wards,  he 
had  given  time  and  labor  in  one  year  equivalent  to 
twenty  thousand  dollars.  Of  course  a  good  deal  of 
this  work  is  offset  by  valuable  experience  gained, 
but  the  major  pai-t  is  abstract  drudgery. 

We  cannot,  however,  change  this  state  of  things 
now,  if  we  would.  The  truth  is  medical  service  to 
the  really  poor  can  always  be  obtained  in  hospitals. 
But  beyond  this  it  is  not  necessary  that  we  should 
go.  The  complaint  is  that  such  services  are  con- 
stantly extended  to  those  who  can  pay  something 
for  the  same.  This  certainly  should  not  be.  A  phy- 
sician in  this  city,  who,  as  a  general  j^ractitioner, 
deals  with  all  classes,  gets  at  one  of  the  practical  solu- 
tions of  this  question  by  insisting  upon  some  fee  from 
the  poorest  of  his  patients.  No  matter  how  small 
from  each  individual,  in  the  aggregate  it  amounts  to 
considerable.  We  cannot  blame  the  hospitals  for  the 
general  work  they  do.  These  institutions  are  cre- 
ated and  supported  for  these  purposes,  but  there  is  a 
way  to  limit  the  good  offices  to  the  suitable  cases. 
On  general  principles  the  less  that  is  done  even  in 
these  infirmaries  in  a  purely  gratuitous  way,  the  better 
for  the  really  poor,  the  better  for  the  institution,  and 
the  better  for  the  profession.  The  medical  practi- 
tioner cannot  blame  a  patient  for  applying  to  a  hos- 
pital, when  by  so  doing  he  can  get  advice  and  treat- 
ment free.  Tlie  ordinary  patient  will  obtain  this 
advantage  over  the  doctor  whenever  he  can.  There 
is  no  way  of  checking  this  abuse,  save  by  active  in- 
terference of  the  hospital  authorities,  whose  business 
it  should  be  either  to  refuse  services  to  all  j^atients 
able  to  pay  for  the  same,  or  charge  them  to  the  extent 
of  theii'  pecuniary  ability. 

It  must  be  admitted,  however,  in  extenuation  of 
these  abuses,  that  the  hos2ntals  have  gi-own  into  this 
lax  way  of  doing  business  simply  because  medi- 
cal men  have  shown  the  example.  It  seems  high 
time  that  a  proper  sentiment  should  be  created  in 
the  profession  in  regard  to  the  rendering  of  gratu- 
itous services.  We  all  do  too  much  for  nothing, 
and  are  too  apt  to  give  those  who  impose  upon  us 
the  benefit  of  a  doubt  as  to  their  ability  to  pay. 
The  butcher  and  grocer  never  do  it,  and  yet  the  poor 
man's  life  may  be  more  dejicndent  upon  food  than 
on  medicine.  It  is  so  easy  for  the  doctor  to  assume 
the  position  above  that  of  taking  a  small  fee,  that  the 
man  who  should  and  would  pay  hiln  often  escapes. 

In  no  way,  perliaps,  is  medical  charity  abused 
more  than  by   those  patients  who  come  from  the 


THE  MEDICAL  RECORD. 


547 


country  for  free  treatment  here.  Most  of  them  have 
an  idea  that  they  are  specially  entitled  to  such 
privileges,  and  do  not  hesitate  to  cheat  their  doctor 
at  home  for  the  jjurpose  of  obtaining  the  advice  of 
some  hospital  or  college  man  in  New  York. 

StUl  the  proportion  of  jjecuniarily  able  patients 
that  come  here  for  free  advice  is,  we  have  reason  to 
believe,  much  less  than  foi-merly.  In  many  of  our 
hospitals  each  patient  is  questioned  before  admis- 
sion as  to  his  ability  to  pay,  and  many  of  the  dis- 
pensaries exact  a  small  fee,  even  from  the  poor,  be- 
fore services  are  rendered ;  hospital  attendants 
charge  for  services  rendered  to  patients  who  can  af- 
ford to  pay  for  them ;  and  there  appears  to  be  a 
growing  disposition  to  elevate  even  public  medical 
services  to  some  tangible  pecuniary  level.  The  more 
this  is  done  the  moi-e  will  the  younger  practitioner  in 
this  city  and  vicinity  be  benefited.  Let  us  hope,  in 
the  interests  of  all,  that  while  the  really  poor  may 
always  claim  our  services  gratuitously,  those  who 
can  afford  to  pay,  even  ever  so  little,  should  be 
compelled  to  do  so,  whether  in  or  out  of  the  hospi- 
tal. The  out-of-town  practitioner  can  do  consider- 
able to  this  end  by  advising  his  patient  as  to  the 
consultant  to  be  employed,  and  informing  the  latter 
of  the  pecuniary  means  of  the  patient.  To  allow 
such  patients  to  drift  indiscriminately  into  dispen- 
saries, clinics,  and  hospitals,  is  to  encourage  indi- 
rectly one  of  the  greatest  abuses  of  medical  charity, 
and  yet  the  very  practitioners  who  are  apt  to  com- 
plain the  most  against  the  abuse  take  not  the  easy 
means  of  preventing  it. 

It  may  not  be  generally  known  that  an  associa- 
tion— the  Charity  Organization  Society — has  been 
formed  in  this  city,  one  of  the  aims  of  which  is  to 
prevent  not  only  the  treatment  of  unworthy  cases  in 
hospital,  but  to  render  impossible  the  system  of  re- 
peating so  common  among  designing  paujiers. 
With  little  trouble  every  public  institution  could  be 
furnished  with  a  black-list,  and  the  managers  of 
each  could  intelligently  guard  against  the  commoner 
fi-auds  which  infest  the  wards,  and  which  indirectly 
cheat  the  poor  doctor  of  his  legitimate  fees.  We 
are  glad  to  learn  that  tliis  society  is  substantially 
supported  by  our  best  citizens,  and  jiromises  to  be 
a  working  power  in  systematizing  the  distribution 
of  charities  of  every  sort,  not  the  least  of  which  will 
be  the  proper  cai-e  of  the  sick  poor,  and  the  conse- 
quent correction  of  many  of  the  grosser  abuses  con- 
nected with  gratuitous  medical  services.  Conse- 
quently the  profession  should  use  its  influence  in 
the  direction  of  furthering  the  aims  of  the  organiza- 
tion in  every  way  in  its  2J0wer. 


KOCH  S   DISCOVEEX   OP   A   TDBEBCUL.Ut   PAKASrTE. 

A  PAPER  recently  read  by  Dr.  Robert  Koch  before 
the  Berlin  Physiological  Society  has  attracted  wide 
attention.  Dr.  Koch  here  makes  some  very  positive 
announcements  regarding  the  etiology  of  tuberculo- 


sis. Whether  his  views  and  conclusions  be  right  or 
not,  the  facts  that  he  relates  are  novel  and  interesting. 

By  staining  sections  of  tuberculous  tissue  with  an 
alkaline  solution  of  methyl-bine  and  then  with  vesu- 
vin,  he  has  been  able  to  see  in  all  true  tubercles  a 
minute  bacillus.  It  is  rod-shaped,  and  from  one- 
fourth  to  one-half  the  length  of  a  red  blood-corpuscle. 
It  resembles  closely  the  bacillus  leprce,  but  is  not  so 
thin,  is  slightly  split  at  the  end,  and  colors  somewhat 
differently.  These  bacilli  seem  to  make  their  way  first 
into  the  wandering  cells.  By  infiltrating,  surround- 
ing, and  irritating  them,  the  gray  tubercles  develop. 
The  tubercles  form  about  the  bacillus  as  galls  about 
the  insects'  poisons. 

Koch  claims  a  positive  universality  for  these  or- 
ganisms in  all  tuberculous  tissues.  It  is,  he  thinks, 
the  organized  virus  of  tuberculosis  which  Cohnheim 
and  others  have  despaired  of  finding.  The  evidence 
which  he  gives  for  this  universality  is  as  follows  : 

In  eleven  cases  of  miliary  tuberculosis,  the  bacil- 
lus was  always  found  ;  in  twelve  cases  of  caseons 
pneumonia,  in  one  of  tuberculosis  of  the  brain,  in 
two  of  intestinal  tuberculosis,  in  three  of  freshly  ex- 
tirpated scrofulous  glands,  and  in  four  of  fungous 
joints,  the  organism  was  also  tiniformly  present- 
Among  lower  animals,  the  bacillus  was  discovered 
in  ten  cases  of  pearl-disease  ;  in  the  caseous  cervical 
gland  of  a  pig,  in  the  organs  of  a  hen  dead  from  gen- 
eral tuberculosis,  and  in  three  monkeys,  nine  guinea- 
pigs,  and  seven  rabbits.  The  bacillus  was  inoculated 
in  172  guinea-pigs,  32  rabbits,  and  5  cats.  In  all  cases 
the  animals  died  of  tuberculosis  and  the  organism 
was  found  in  their  tissues.  The  organism  was  not 
found  in  non-tuberculous  or  non-scrofulous  tissues. 

Koch,  having  found  the  bacillus  so  uniformly 
present,  next  addressed  himself  to  the  question 
whether  it  was  an  accident  or  cause.  To  test  this 
he  undertook  to  cultivate  the  bacilli  apart  from  the 
tissues  in  which  they  normally  lay.  He  prepared  a 
special  cultivating  substance  out  of  the  senim  of  ox 
blood.  This  serum  was  heated  several  times  up  to 
58°  O.  in  order  to  destroy  all  organisms.  It  was 
then  heated  again  up  to  75"  C.  until  it  was  reduced 
to  the  consistency  of  a  brownish-yellow  transparent 
jelly.  The  bacilli  were  cultivated  in  cells  upon  this. 
They  gave  off  two  or  three  sjjores,  which  developed 
to  rod-bacUli.  The  development  was  very  slow,  re- 
quiring many  days.  The  bacilli  were  apparently 
motionles.s.  They  would  only  grow  at  a  tempera- 
ture between  30"  and  41°  C,  in  this  respect  differing 
from  anthrax  bacilli. 

The  cidtivations  were  continued  many  days,  and 
were  repeated  several  times.  Early  and  later  genera- 
tions were  then  carefully  injected  into  the  peritoneal 
cavity,  or  anterior  chamber,  or  veins  of  healthy  ani- 
mals. In  ahnost  all  cases  they  caused  a  true  tuber- 
culosis. Over  sixty  different  animals  were  tried. 
The  culture-fluid  without  the  bacilli  was  injected, 
but  produced  no  results. 


548 


THE  MEDICAL  RECORD. 


As  further  evidence  of  the  relation  between  the 
bacillus  and  tuberculosis,  Koch  states  that  in  the 
sputa  of  the  phthisical  the  bacilli  are  always  found, 
but  not  in  that  from  ordinary  broncliitis. 

Koch's  conclusions  are  very  positive  to  the  effect 
that  the  bacillus  is  the  cause  of  tuberculosis,  by 
which  term  he  includes  both  scrofulous  or  catarrhal 
phthisis  and  tuberculous  disease  proper. 

He  explains  the  phenomena  of  the  gradual  develop- 
ment of  phthisis  by  the  slow  and  jjeculiar  develop- 
ment of  the  organisms. 

The  source  of  these  organisms,  he  thinks,  must  be 
from  animal  life,  since  they  cannot  live  long  at  other 
temperatures.  Dr.  Koch  believes  that  tuberculosis  is 
a  contagious  disease,  and  that  the  sputa  and  exhala- 
tions of  the  phthisical  are  dangerous.  He  also  be- 
lieves the  milk  and  flesh  of  tuberculous  cows  to  be  a 
source  of  danger.  The  idea  dwelt  upon  by  Profes- 
sor Tyndall,  in  his  letter  to  the  Lomkm  Times,  that 
the  bacLUi  can  be  modified  by  cultivation  till  they 
become  prophylactic,  is  hardly  broached  by  Koch, 
and  must  at  this  stage  of  our  knowledge  be  con- 
sidered as  rather  sensational. 

The  above  is  a  brief  account  of  Koch's  experiments 
and  conclusions.  They  have  excited  much  more  talk 
and  attention  than  at  present  they  seem  to  deserve. 
We  confess  to  some  scepticism  regards  the  facts,  and 
still  more  in  regard  to  their  "  far-reaching  signifi- 
cance." Some  attempts  have  already  been  made  in 
this  city  to  see  the  bacilli  by  Koch's  method,  but  as 
yet  without  success.  Others,  like  Baumgarten,  find 
bacteria  in  tubercle,  but  not  those  described  by  Koch, 
which  are  already  facetiously  known  in  pathr)logical 
circles  as  "  Koch's  bugs." 

The  practical  conclusions  that  we  must  esiiecially 
guard  against  the  disease  by  disinfecting  the  sputa 
and  breath  of  the  phthisical,  and  by  avoiding  the 
disease  or  its  products  in  lower  animals,  are  so  at 
variance  with  what  most  previous  experience  has 
taught,  that  the  profession  will  demand  much  fur- 
ther explanation  and  confirmation  before  such  views 
are  accepted. 


THE   OABFIEIiD   MEMORIAL   HOSPITAL. 

The  progress  that  is  being  made  in  the  plan  for 
erecting  a  Garfield  Memorial  Hospital  has  been  duly 
chronicled  in  this  journal.  The  project  was  con- 
ceived a  short  tinft!  after  tlie  President's  death,  and 
it  then  met  with  an  enthusiastic  reception.  The 
reasons  for  tlie  establishment  of  such  a  hospital  are 
now  as  strong  as  ever.  Good  progress  in  the  sub- 
scription of  money  has  also  been  made,  laifortu- 
nately,  however,  Garfield  has  now  been  dead  eight 
mouths.  Already  he  is  beginning  to  lie  forgotten, 
and  the  Stalwarts  -his  political  antagonists— rule 
the  country.  Clonsocpiontly  those  who  are  working 
for  the  hospital  find  some  lack  of  interest  if  not  ac- 
tual opposition,  in  some  (juartors,  against  which  to 
contend. 


The  ambitious  but  careful  politician  does  not  wish 
to  ofi"end  the  Stalwart  living  by  too  loudly  glorify- 
ing the  anti-Stalwart  dead. 

It  is  not  much  that  the  medical  profession  can  do 
in  a  measure  that  requires  Congressional  aid,  but 
we  can,  at  least,  assert  it  as  the  universal  sentiment 
of  American  physicians  that  such  a  memorial  to 
Garfield  is  a  most  worthy  one,  being  at  once  a  no- 
ble monument  to  the  dead  and  an  institution  greatly 
needed  for  the  living.  Washington  is  a  large  city, 
containing  about  one  hundred  and  fifty  thousand 
inhabitants,  yet  it  has  no  general  non-sectarian  hos- 
pital, one  which  will  receive  and  treat  patients  at 
any  time  and  of  any  class.  There  are  many  stran- 
gers constantly  drifting  to  Washington,  and  thou- 
sands of  Government  clerks  scattered  throughout 
the  city,  who  are  often  in  great  need  of  advantages 
which  a  large,  well-equipped  hospital  could  afford. 

There  is  every  reason,  therefore — patriotic  and 
humanitarian — that  the  Garfield  Memorial  Hospital 
should  be  established  on  a  permanent  footing.  So 
far,  the  medical  profession  has  everywhere  endorsed 
the  project.  We  tnist  that  it  will  use  its  influence 
in  the  future  to  press  the  matter  forward.  The  hos- 
pital cannot  be  built  and  sustained  by  Washington 
alone,  nor  should  it  be  so.  It  is  to  be  a  monument 
to  the  nation's  dead  President,  and  it  is  to  treat  and 
care  for  strangers  almost,  if  not  quite,  as  much  as 
natives.  Let  those  who  are  working  for  it,  there- 
fore, have  the  hearty  support  of  the  medical  jirofes- 


MEDICAL    SOCIETY    OF    THE    STATE  OF 
PENNSYLVANIA. 

Thirty-third  Annual  Session,  held  at  Titnsmlle,  Cz-arp- 
ford  County,  May  lOlh,  11th,   and  12th. 

(Spoeial  Report  for  Thk  Mkuical  Record.) 

First  Day. — Wednesday,  May  10,  1882. 

The  meeting  was  opened  with  the  usual  formal- 
ities, and  among  the  items  of  business  the  following 
is  of  importance  to  the  profession  at  large  : 

THE   NE^V    CODE. 

Professor  Hknry  H.  Smith,  of  Philadelphia, 
offered  a  resolution  disapproving  of  the  action  of 
the  New  York  State  INIedicnl  Society,  in  reference  to 
the  ethics  of  consultation,  also  a  resolution  request- 
ing the  delegates  from  the  Medical  Society  of  Penn- 
sylvania to  the  American  Medical  Association  to 
enter  an  early  protest  against  the  admission  of  dele- 
gates from  any  society  which  does  not  adhere  to  the 
code  of  ethics  as  at  present  existing.  A  resolution 
of  similar  import  from  the  Philadelphia  County 
Medical  Society  was  also  rend. 

Remarks  in  support  of  Dr.  Smith's  resolutions 
were  made  by  Drs.  A.  Hewson,  of  Philadelphia ; 
Stewart,  of  Erie  ;  J.  L.  Atlee.  of  Lancaster :  Traill 
Green,  of  Kastou,  and  others,  after  which  the  reso- 
lution was  uiuininiously  adopted. 


THE  MEDICAL  RECORD. 


549 


Afternoon  Session. 

the  address  dy"  obstetrics, 

prepared  by  Dr.  R.  S.  Sutton,  of  Pittsburgh,   was 

read.      It  gave  a  snocinct  account  of  the  present 

condition  of 

.VBDOMINAI,   SlTtGERT   IN    EUROPE. 

Descriptions  were  given  of  the  method  of  operat- 
ing adopted  by  some  of  the  prominent  surgeons  on 
the  Continent  of  Europe.  The  elaborate  and  accu- 
rate method  of  Billroth  was  especially  noticed.  The 
antiseptic  system  was  employed,  and  the  operation 
always  done  about  nine  o'clock  in  the  morning. 
The  assistants  are  skilfully  disciplined.  For  anies- 
thesia  a  mixtui'e  of  one  hundred  parts  of  chloroform 
and  thirty  parts  each  of  ether  and  alcohol  is  used. 
X  memorandum  is  made  of  the  number  of  spoBges 
used,  and  before  the  abdominal  incision  is  sewed  uj) 
the  sponges  are  carefully  counted  to  make  sure  that 
none  of  them  have  been  left  in  the  cavity.  Most  of 
the  operations  are  entirely  complete  within  thirty 
minutes. 

Professor  Nussbaum  uses  the  antiseptic  method 
fully,  and  in  addition  to  the  carbolic  solution,  intro- 
duces iodoform  into  the  abdomen.  Dr.  Sutton  saw 
him  perform  his  8.3ith  ovariotomy.  Professor 
Shroeder,  of  Berlin,  also  uses  the  antiseptics,  and 
also  pays  great  attention  to  general  cleanliness.  He 
uses  but  four  instruments,  and  on  one  occasion  he 
performed  three  ojjerations  in  ninety  minutes. 

THE   COMMUNE   OF   GHKF.T.. 

Dk.  S.  S.  Shultz,  of  Danville,  read  an  account  of 
the  Commune  of  Gheel,  in  Belgium,  in  which  the 
cottage  system  of  caring  for  the  insane  is  in  opera- 
tion. Gheel  is  about  seven  miles  square,  and  its  in- 
habitants are  chiefly  engaged  in  the  work  of  farming 
or  of  making  lace.  A  historical  note  was  read,  show- 
ing the  religious  origin  of  the  present  system  of 
caring  for  the  insane.  The  commune  is  divided  into 
four  divisions,  each  division  being  assigned  to  a 
special  class  of  insane.  Dr.  Schultz's  opinions  were 
the  result  of  a  visit  to  the  colony,  and  were  unfavor- 
able to  the  system.  Travellers  generally,  be  said, 
were  loud  in  their  praises  of  the  method,  but  that 
was  because  they  saw  it  only  under  favorable  condi- 
tions. Whatever  success  the  method  had  was  due 
to  the  fact  that  the  long  course  of  years  in  which 
the  system  had  been  in  use  had  developed  a  race  of 
highly  trained  nurses,  and  this  was,  of  course,  a 
most  valuable  adjunct  in  any  treatment.  The  cot- 
tage life  might  be  supposed  to  have  charrps,  so,  in- 
deed, it  had.  but  not  when  the  resident  patient  is 
under  a  continual  espionage. 

Gheel  is  under  (rovernment  control.  Some  ac- 
count is  given  of  the  niles  and  regulations  of  the 
colony. 

OLEATES    IN    SKIN    DISEASE. 

Dr.  John  V.  Shoemaker,  of  Philadelphia,  pre- 
sented a  series  of  oleates,  and  ointments  prepared 
from  them.  He  called  attention  to  the  fact  that  most 
of  the  older  forms  of  oleates  were  compounds  of  in- 
definite character,  but  the  present  preparations  were 
made  by  decomposing  the  sodium  oleate  by  a  solu- 
tion of  various  salts,  and  were  constant  in  composi- 
tion. He  detailed  the  therapeutic  uses  of  the  jire- 
parations,  laying  special  emj^hasis  upon  the  cojiper 
oleate  for  use  in  parasitic  affections.  Other  valu- 
able oleates  were  arsenic  oleate  and  iron  oleate. 

THE   UNNECE.SSART    PEAR   OF   DISEASE. 

Dr.  Traill  Green,  of  Easton,  read  a  paper  upon 
the  importance  of  physicians  exerting  themselves  to 


a]lay  the  unnecessai-y  |fear  of  disease  which  was 
common  among  the  laity.  Infantile  diseases,  he 
thought,  were  greatly  overrated  in  their  danger,  and 
he  leaned  to  the  opinion  that  they  were  rather 
beneficial  than  otherwise.  He  also  alluded  to  the 
absurdity  of  some  of  the  views  in  regard  to  methods 
of  transmission  of  disease. 

THE   treatment    OF   PROOIDENTIA. 

Dr.  E.  E.  Montgojiery,  of  Philadeli)hia,  read  a 
paper  discussing  the  causes  and  operative  treatment 
of  procidentia. 

An  interesting  paper  on 

HOTnCIDAIi   SIATISTIl^S 

was  read  by  Dr.  J.  G.  Lee,  of  Philadelphia.  It  was 
a  digest  of  the  record  of  the  cases  of  murder  during 
the  years  fi'om  1871  to  1881  in  Philadeli)hia.  In 
these  ten  years  the  ratio  of  death  by  violence  to  the 
total  number  of  inquests  was  twenty-seven  per  thou- 
sand, the  greater  proportion  being  white  males  of 
from  twenty  to  thirty  years  of  age.  The  fewest 
violent  deaths  occur  in  the  very  young  and  very  old. 
Very  few  cases  of  jjoisoning  are  recorded  among  the 
fourteen  varietes  of  killing  noted.  More  wives  are 
killed  than  husbands.  July  is  the  month  most  fre- 
quent in  homicides,  March  the  least.  Dr.  Lee 
alluded  to  the  necessity  of  better  instruction  in 
jurisprudence. 


Second  Day.— Thursday,  May  11,  1882. 
defective  hearing  in  locomotive  engineers. 
Dr.  C.  S.  Tubnbull  presented  a  report   setting 
forth  peculiar  defects  in  the  hearing  of  locomotive 
engineers,  and  urging  the  importance  of  careful  ex- 
amination of  such  persons  in  reference  to  their  deli- 
cacy of  hearing. 
The  address  in 

MENTAL   DISEASES 

was  delivered  by  Dr.  C.  K.  Mills,  of  Philadelphia. 
It  was  a  dissertation  upon  some  of  the  prominent 
topics  in  criminal  lunacy,  the  case  of  Guiteau  being 
used  to  illustrate  and  emphasize  the  points  ad- 
vanced. The  speaker  thought  that  the  weight  of 
evidence  was  in  favor  of  the  theory  of  Guiteau's  in- 
sanity. In  this  connection,  the  questions  of  the  rela- 
tions of  crime  to  insanity,  and  also  the  test  of  the 
resjjonsibility  of  criminals  and  the  appropriate  dis- 
posal of  the  criminal  insane  were  discussed.  Dr. 
MiUs  did  not  favor  capital  punishment  of  insane 
murderers,  but  believed  it  would  be  l)etter  for  some 
grade  of  punishment  to  attach  to  certain  forms  of 
such  crimes.  If  Guiteau  was  executed  liearing  the 
air  of  a  martvr  and  hero,  the  example  would  be  per- 
nicious, and  might  excite  other  criminals  to  acts  of 
violence.  A  provision  such  as  to  make  an  act  of 
homicidal  insanity  punishable  by  imprisonment  in  a 
lunatic  asylum  for  a  term  of  years^  and  leaving  it  to 
juries  to  make  this  as  long  as  they  think  fit,  was 
suggested.  The  sjjeaker  thouglit  that  the  commu- 
nity was  not  at  present  sufficiently  protected  against 
the  many  cranks  and  eccentrics  now  loose  in  society. 
He  insisted  that  a  large  community  like  Pennsyl- 
vania required  at  least  one  asylum  for  the  criminal 
insane. 

Dr.  Wm.  H.  Daly,  of  Pittsbui-gh,  in  a  paper  on 

TONSILLOTOjrY, 

urged  the  importance  of  the  operation  as  a  measure 
of  relief,  and  expressed  his  firm  opinion  that  the  ex- 
cision of  the  tonsils  has  no  effect  upon  rirility,  as  some 
have  stated.     He  preferred  the  knife  to  either  caus- 


550 


THE  MEDICAL  RECORD. 


tics  or  electro- cautery.  .  The  bleeding  is  not  usually 
serious,  but  one  should  be  prepared  for  all  emer- 
gencies. After  excision  but  little  tendency  is  shown 
toward  a  return  of  the  enlargement,  and  this  can 
generally  be  kept  in  check  by  local  treatment. 

Ba.  LiPPiNCOTT,  of  Pittsburgh,  discussed  the  sub- 
ject of 

ABSCESS  OP  THE   ORBIT, 

and  especially  the  differential  diagnosis  between 
abscess  of  the  cellular  tissue  and  periostitis.  He 
also  poiated  out  that  sudden  anastomotic  aneurism 
had  been  mistaken  for  abscess.  He  recommended 
cautious  exploration  with  an  asjjirating  needle.  Tlie 
direction  of  the  exophtlialmus  was  also  an  important 
point. 

Dr.  Charles  S.  Tiknuull,  of  Philadelphia,  read 
a  paper  on  the  employment  of  powdered  boracic 
acid  in  otorrhcea.  He  said  he  had  discontinued  sy- 
ringing in  these  cases  and  also  the  use  of  iodoform. 
He  now  used  boracic  acid  in  the  form  of  impalpaVile 
powder,  packed  into  the  meatus  and  allowed  to  re- 
main as  long  as  it  would.  He  found  its  action  to  be 
very  satisfactory  and  it  never  gave  any  trouble. 
The  crystals  would  not  suffice,  only  the  fine  jjowder 
should  be  used. 

Dr.  Edward  J.  Jack.s()n,  of  Westchester,  presented 
a  paper  on  the 

COMPAEATrVE  ACTION   OF  CERTAIN  SITDRIATIC  ALKAL- 
OIDS, 

being  an  experimental  study  of  those  in  common 
use.  Details  were  given  and  charts  exhibited  show- 
ing the  special  physiological  action  of  the  different 
8ul)stances. 

Dr.  Joseph  Hearx,  of  Philadelphia,  presented  a 
paper  on 

RODENT   ULCHR. 

He  pointed  out  that  these  ulcers  are  frequently 
of  a  malignant  nature,  and  require  treatment  by 
strong  cauterization.  He  referred  to  the  sodium 
ethylate  as  having  shown,  in  his  exiierience,  the 
special  property  of  destroying  abnormal  tissue 
with  more  vigor  than  normal,  and  hence  of  great 
use  in  cases  where  a  moderate  amount  of  destruc- 
tion was  required.  Dr.  Hearn,  however,  in  ca.ses  of 
rodent  ulcer  of  marked  character  preferred  to  secure 
an  extf  nded  cauterant  action,  and  therefore  used  the 
caustic  potash. 

Afternoon  Se-ssion. 
the  address  on  hygiene 
by  Dr.  Williaji  F.  Mdhlexbero,  of  Keading,  was  a 
succinct  and  interesting  account  of  the  more  recent 
researches  on  germs  and  of  t)ie  methods  of  propa- 
gating tliera  in  culture  fluids.  An  assortment  of 
photographs  of  microscopic  views  of  various  bacteria 
and  other  growths  were  shown.  The  sjienkor  also 
discussed  the  qjiestion  of  the  pre.sence  of  phenol 
and  similar  bodies  among  the  products  of  decay. 
He  also  described  the  four  forms  of  bacteria,  and 
gave  various  methods  of  preparing,  examining, 
mounting,  and  preserving  the  specimens.  The  dis- 
tinction between  germs  and  various  bodies  .such  as 
epithelia,  pus-cells,  etc.,  was  given  at  some  length. 
Db.  William  S.  Lrm-E,  of  Philadelpliia,  read  a 
paper  on 

SUHJECTIVE   TRAUMATISM    OF   THE    EVK, 

being  a  consideration  of  the  injury  which  may 
result  to  the  eye  from  the  irritative  action  of  its 
own  optical  defects.  A  perfect  eye,  he  said,  would 
be  much  less  exposed  to  the  danger  of  sympathetic 


ophthalmia  than  a  defective  eye,  for  the  latter  would 
have  a  continuing  irritation.  In  cases,  therefore, 
where  sympathetic  ophthalmia  was  feared,  attention 
should  be  given  to  the  early  correction  of  the  opti- 
cal defects  by  means  of  glasses,  etc.  The  emmetropic 
eye  is  found  to  be  more  amenable  to  treatment  than 
the  defective  eye,  obviously  because  of  the  absence 
of  the  subjective  traumatism. 

Dr.  Henry  Lepfmann,  of  Philadelphia,  read  a 
paper  on  the 

MEDICAL   RELATIONS  OF   COMMON    FOOD   ADFLTERATIONS. 

It  was  pointed  out  that  the  general  nature  of 
adulterations  was  such  as  gave  little  fear  of  active  in- 
jury. Most  adulterations  were  clieats  rather  than 
poisons.  Glucose  and  oleomai-garine  were  espe- 
cially spoken  of  as  being  so  near  in  composition  and 
properties  to  the  bodies  for  which  they  are  used  as 
substitutes  as  to  set  aside  all  doubts  of  their  gen- 
eral usefulness.  The  adulteration  of  candies  was 
touched  upon  and  the  speaker  stated  that  he  had 
not  been  able  to  find  objectionable  colors  to  any  ex- 
tent in  them,  except  in  the  yellow  candies,  in  which 
lead  chromate  was  often  used.  Starch  and  plaster-of- 
Paris  were  largely  employed  as  make-weights.  The 
use  of  glucose  as  a  substitute  for  malt  was  enterely 
unobjectionable,  and  the  author  closed  his  paper 
by  stating  his  conviction  that  at  present  no  necessity 
existed  for  the  passage  of  laws  relating  to  food 
adulteration,  nor  for  the  establishing  of  any  official 
investigation. 

Dr.  B.  C.  Mossmann,  of  Greenville,  read  a  paper  on 

PUERPERAL   MALARIAL   FEVEK, 

being  an  acitount  of  the  symptoms,  treatment,  etc., 
of  malarial  fever  occurring  in  lying-in  women. 
Dr.  Mossmann  pointed  out  the  importance  of  recog- 
nizing this  form  of  disease,  as  the  therapeutics  and 
prognosis  are  so  much  more  satisfactory  than  in 
other  puerperal  affections  of  similar  nature.  An 
early  diagnosis  will,  therefore,  prevent  much  alarm 
and  anxiety.  Cases  were  given  illustrative  of  the 
clinical  history  of  the  disease.  The  differential  di- 
agnosis between  it  and  puerperal  fever  is  sometimes 
difficult.  The  latter,  however,  usually  begins  on  the 
second  or  third  day,  while  the  malarial  disease  is 
later. 

Dr.  ('akl  Seiler,  of  Pliiladelphia,  gave  descrip- 
tions of  the  method  of 

intra-nasal  suroSry 
by  means  of  the  galvano-cautery.  Dr.  Seiler  illustra- 
ted his  remarks  by  the  exhibition  of  various  forms  of 
batteries  and  electro-motors.  He  exjilained  that,  in 
using  the  galvano-cautery,  the  wire  should  not  be 
too  highly  heated.  A  cherry-red  heat  was  the  best, 
and  in  this  condition  would  cause  no  pain  or  hem- 
orrhage. By  means  of  the  api)aratus  shown,  opera- 
tions for  the  removiil  of  hypertrophied  nasal  mu- 
cous-membrane could  be  rapidly  and  conveniently 
performed. 


Thuid  Day.— Friday,  May  12,  1882. 
Dr.  E.  Griswold,  of  Sharon,  detailed  some  cases 
of 

Hr.RNIOTOMY, 

and  urged  the  importance  of  tlie  operation.  He 
stated  his  belief  that  many  patients  are  allowed  to 
die  from  strangulated  hernia  with  whom  a  prompt 
recognition  of  the  disease  and  operation  would  save 
life.  He  alluded  to  the  general  subject  of  liernia 
and  said  that  trusses  were  never  jierfect  cures,  and 
even  if  they  wore,  certain  classes  of  cases  were  not 


THE  MEDICAL  RECORD. 


551 


suited  for  them.  The  diagnosis  of  strangulated  her- 
nia was,  in  his  opinion,  stire  if  proper  examination 
was  made. 

Dr.  Johx  B.  Egberts,  of  Philadelphia,  presented 
a  note  on 

THE    EXCISIOX    OF     CABTILAGE    IN    NASAL    OBSTBrCTION 
FROM   DEVIATED   SEPTUM. 

He  stated  his  belief  that  the  usual  statement  tliat 
the  septum  should  not  be  completely  cut  through 
was  based  upon  mistake,  and  he  recommended  for 
the  relief  of  obstructive  deviations  the  excision  by 
means  of  a  specially  constructed  nasal  punch,  which 
was  exhibited,  of  an  elliptical  jjiece  of  cartilage, 
about  one-half  inch  long  by  one  fourth  inch  broad. 
This  was  too  large  to  produce  whistling  sounds  and 
not  large  enough  to  be  ordinarily  visible. 

Dk.  Willjam  Varian,  of  Titusville,  read  a  note  on 

A    CASE   OF   OVARIOTOMY, 

the  principal  interest  in  which  was  the  fact  that  he 
at  first  diagnosed  fibroid  tumor  of  the  uterus.  The 
tnmor  subsequently  increased  markedly  in  size,  and 
was  removed,  wheU  it  was  found  to  be  a  polycy.st  of 
great  size  with  a  genuine  fibroid  mass  on  one  side. 
Dr.  Yarian  detailed  the  method  ot  operating  and 
the  character  of  the  tumor  at  length,  and  advanced 
the  idea  that  the  growth  had  started  as  a  fibroid  and 
degenerated.  He  suggested  that  such  might  be  the 
common  history  of  ovarian  fibroids,  that  their  rarity 
might  be  explained  by  the  fact  that  operation  wa.s 
rarely  resorted  to  until  they  became  cystic. 

After  reading  a  few  papers  by  titles,  the  society 
adjourned,  to  meet  at  NoiTistown,  in  May,  1883. 


KEW  YORK  PATHOLOGICAL  SOCIETY. 

Slated  Meeting,  Mareli  22,  1882. 
Dr.  E.  C.  Seguin,  President,  in  the  CH.\rR. 

ANEURISM  OF  THE  COMMON  CAROTID  ARTERY — PUNC- 
TURE OF  THE  ARTERY  'mTH  AN  ANEURISM  NEEDLE. 

Dr.  a.  G.  Gerster  presented  a  patient  with  the  fol- 
lowing history  :  A  man,  foi-ty-six  years  of  age,  and  a 
carpenter,  noticed  seven  months  ago,  for  the  first 
time,  a  swelling  on  the  left  side  of  the  neck.  He 
also  observed  that  the  swelling  pulsated  qiiite  dis- 
tinctly, otherwise  it  caused  no  discomfort.  He  con- 
tined  to  work  at  his  ti-ade  until  about  two  months 
ago  when  he  discovered  that  he  was  losing  fiesh  and 
strength  rapidly,  and  jiresented  himself  at  the  Ger- 
man Dispensary  tor  treatment.  Dr.  Gerster  then 
diagnosticated  aneurism  of  the  common  carotid 
artei7,  and  ad%-ised  an  operation.  There  was  no 
history  of  syphilis.  The  tumor  was  about  the  size 
of  a  pigeon's  egg.  and  pulsating.  For  unavoidable 
reasons  the  patient  did  not  present  himself  for 
further  treatment  until  four  weeks  subsequently,  and 
it  was  then  found  that  the  aneurism  had  increased  to 
ths  size  of  an  ordinary  goose-egg.  The  patient  was 
then  sent  to  the  German  H6spital,  where  Dr.  Gerster 
ligated  the  common  carotid  artei-y  on  March  2,  1882. 
After  the  artery  was  tied,  pulsation  in  the  tumor  ceased 
as  usual,  and  the  wound  healed  by  first  intention. 

He  reported  the  case  with  special  reference  to  an 
accident  which  occurred  during  the  operation.  The 
artery  was  exposed  easily,  and  was  found  to  be 
healthy.  It  was  necessary,  on  account  of  the  exten- 
sion of  the  disease,  to  apply  the  ligature  between  the 
two  heads  of  the  sterno-cleido-mastoid  muscle.  For 
the  ligatore  he  used  an  B  violin  string  that  had  been 
seasoned  two  years  in  a  ten  per  cent,  solution  of 
carbolized  oil.  ^  After  making   an   incision   in  the 


sheath  of  the  artery,  he  introduced  an  aneurism 
needle — such  as  usually  was  sold  in  the  shops — with 
which  to  make  a  gioove  for  the  ligature  behind  the 
vessel.  For  this  pui-jiose  he  ordinarily  uses  a  strong 
silver  probe,  but  a  suitable  probe  not  being  at  liand, 
he  employed  an  aneurism  needle,  and  suddenly 
arterial  blood  spurted  out  of  the  wound.  At  first  he 
thought  he  had  wounded  the  jugular  vein,  and  he 
seized  the  artery  and  i)uUed  it  to  one  side  for  pur- 
poses of  inspection,  and  found  the  vein  was  unin- 
jured, but  that  the  point  of  the  needle  had  penetrated 
the  wall  of  the  arteiy,  iljaking  a  longitudinal  o])en- 
ing,  so  that  as  soon  as  the  vessel  was  stretched  the 
hemorrhage  ceased.  He  then  used  a  silver  probe, 
loosened  the  artery  from  the  vessel  behind  it,  and 
applied  a  ligature  above  and  below  the  opening  in 
the  artery.  The  subsequent  progress  of  the  case 
was  without  accident  or  serioiis  complication.  Ex- 
ceedingly profuse  general  perspiration  oceuiTed. 
apparently  due  to  the  operation,  as  it  appeared  im- 
mediately afterward,  and  continued  forty-eight  hours. 
A  few  doses  of  belladonna  were  given  and  it  ceased. 
There  were  no  other  neiwous  symptoms  whatever 
following  the  operation. 

The  President  referred  to  the  fact  that  surgeons 
had  refused  to  ligate  the  common  carotid  artery  in 
persons  over  forty-five  years  of  age,  because  of  the 
danger  of  softening  of  the  brain  caused  by  lack  of 
collateral  circulation  if  the  communicating  arteries 
are  atheromatous ;  a  frequent  condition  after  that 
period  of  life. 

Dr.  Gerster  said  that  he  was  aware  of  that  fact, 
but  the  necessity  for  incurring  the  risk  was  made 
prominent  in  this  case  because  the  aneurism  was 
threatening  to  burst  at  any  moment.  The  dangers 
and  the  liabilities  were  fully  stated  to  the  patient, 
and  he  was  willing  to  take  the  ri.sk  attending  an 
operation. 

carcinoma   of   the  phartn'x   ant)  larynx   tstth 
diphtheria. 

Dr.  Georoe  L.  Peabody  presented  a  specimen 
with  the  following  history  : 

C.  H.  O ,  a  native  of  the  United  States,  un- 
married, of  no  occupation,  entered  the  New  York 
Hospital  on  January  12,  1881.  Duiing  the  past  year 
he  has  had  an  ulceration  involving  the  left  side  of 
the  pharynx  and  extending  into  the  larynx.  His 
chief  symptoms  have  been  gi'adually  increasing  diffi- 
culty in  swallowing  and  speaking.  This  moirjing 
he  had  a  severe  attack  of  dyspnu-a,  which  led  him 
to  undergo  laryngoscoijic  examination.  At  this  ex- 
amination the  fact  was  revealed  that  the  rima  glot- 
tidis  was  reduced  to  one-eighth  of  its  normal  size, 
and  that  there  was  onlema  of  the  false  vocal  coids, 
and  that  the  tiiie  cord  of  the  left  side  was  rigid  and 
was  infiltrated  with  the  neoplasm. 

On  odmisximi  the  jjatient  was  found  to  be  well 
nourished.  There  was  considerable  congestion  about 
the  face  and  neck.  He  was  able  to  speak  only  in  a 
hoarse  whisper.  He  swallowed  with  difficulty,  and 
had  occasional  severe  attacks  of  dyspncea.  At  10.30 
P.M.  on  the  night  of  his  admission  tracheotomy  was 
performed  below  the  isthmus  of  the  thyroid.  An 
hour  later  his  pulse  was  92,  respiration  was  24,  and 
his  temperature  102°  F.  On  the  following  morning 
his  pulse,  respiration,  and  temperature  were  about 
the  same.  During  the  afternoon  his  temperature 
rose  to  104',  he  became  restless,  coughed  a  great 
deal,  and  in  the  evening  he  had  cedema  of  the  lungs. 
Notwithstanding  the  vigorous  application  of  all  the 
usual  remedies,  his  pulse  and  respii-ation  incijeased 


552 


THE  MEDICAL  RECORD. 


rapidly  in  frequency  and  he  died  at  8.50  a.m.,  Janu- 
ary lith,  thirty-four  hours  after  the  operation. 

Au/iipsi/,  fourteen  hours  after  death.  Thei'e  is  an 
irregular  ulceration  situated  on  the  left  side  of  the 
throat  involving  both  the  larynx  and  jjliarynx.  It 
begins  at  the  tip  of  the  arytenoid  cartilage  below, 
and  follows  the  course  of  the  aryteno-epiglottic  liga- 
ment, which  it  involves,  as  it  does  also  the  left  side 
and  posterior  surface  of  the  epiglottis.  It  termi- 
nates superiorly  on  a  level  with  the  hyoepiglottic 
ligament.  The  vertical  diameter  is  about  one  inch. 
In  this  situation  it  fills  the  laryngeal  pouch  anteri- 
orly ;  posteriorly  it  involves  the  wall  of  tlie  pharynx 
to  within  half  an  inch  of  the  median  line.  Although 
the  antero-posterior  diameter  of  this  ueojUasm  is 
found  to  ba  but  live  eighths  of  an  inch,  it  produces 
very  considerable  narrowing  of  the  pharynx ;  and 
involving,  as  it  does,  both  the  laryngeal  and  pharyn- 
geal walls,  it  prevents  the  epiglottis  from  closing 
and  protecting  the  entrance  to  the  larynx. 

There  is  also  a  thick  coating  of  false  membranes 
over  the  posterior  surface  of  the  epiglottis,  extend- 
ing thence  into  the  larynx,  covering  both  the  false 
and  true  cords.  It  passes  on,  lining  the  trachea  and 
bronchi  of  the  left  lung  as  far  as  they  can  be  traced. 
In  the  right  lung  the  bronchi  ai-e  not  merely  lined, 
but  are  actually  tilled  by  this  false  membrane  as  far 
as  they  can  be  traced.  In  the  bronchi  it  is  easily 
separated  from  the  mucous  membrane,  this  latter 
then  appearing  in  a  condition  of  intense  congestion. 

The  lungs  were  intensely  congested  and  oedema- 
tous. 

The  other  organs  were  substantially  normal. 

On  microscopic  examination  the  new-growth  proved 
to  be  an  ordinary  carcinoma,  in  which  the  stroma 
was  not  very  abundant. 

Dr.  Peabody  also  presented  a  specimen  of 

ANEURISM   OF   THE    HEART, 

accompanied  by  the  following  history  : 

D.  D ,  aged  tifty-three  ;  United  States;  mar- 
ried; customs  inspector;  was  admitted  to  New  York 
Hospital,  March  10,  1882.  His  family  history  is 
negative,  except  that  he  has  a  daughter  who  is  rheu- 
mitic.  Formerly  he  was  a  free  drinker,  but  has 
been  reasonably  abstemious  of  late  years.  Has  al- 
ways been  healthy  until  three  years  ago,  when  he 
had  rheumatism  for  the  tirst  time.  Three  weeks  ago 
he  began  to  suffer  from  dyspnma,  which  would  oc- 
casionally awaken  him  at  night,  and  finally  caused 
complete  orthopnisa.  Ten  days  later  his  feet  began 
to  swell,  and  he  noticed  that  he  was  increasing  in 
girth.  For  the  past  few  davs  dyspncca  has  been  so 
severe  that  he  has  been  obliged  to  sit  up  all  night, 
leaning  forward  over  the  back  of  a  chair.  His  bowels 
have  been  regular.  There  has  been  no  disturbance 
of  micturition.  There  has  been  occasional  vertigo, 
but  no  vomiting,  headaclie,  muscic  volitantes,  or 
tinnitus  aurium. 

On  ailmisxioii  he  is  seen  to  be  of  large  build  and 
very  stout.  There  is  considerable  ludema  of  the 
lower  extremities,  and  some  ascites.  He  is  very 
aniemic :  Iiis  face  is  (iyanotic  ;  respirations  rapid  and 
labored :  skin  dry.  The  area  of  cardiac  dulness  is 
oljscured  by  the  thickness  of  the  chest-walls.  Fluid 
was  made  out  in  the  right  chest,  and  twenty  ounces 
of  BBrum  were  withdrawn  by  an  aspirator.  After  this 
his  chest  was  vigorously  cujiped,  and  lie  was  given 
quebracho  dialysate.  This  jirocedure  seemed  to  bring 
him  some  relief,  but  he  still  preferred  to  sit  in  a 
chair. 

He  passed  a  fair  night.     During  the  night  he  had 


four  motions  and  passed  eight  ounces  uf  urine.  Ex- 
aminatioQ  of  this  revealed  the  following :  Specific 
gravity,  1019 ;  a  large  amount  of  albumen  ;  many 
large  and  small  hyaline  casts.  He  contimied  to 
suffer  intensely  from  dyspnoea.  There  was  no  ele- 
vation of  temperature.  He  was  given  oxygen  gas, 
brandy,  and  digitalis ;  and  his  chest  was  thoroughly 
cupped.  On  the  next  day  his  condition  was  practi- 
cally unchanged. 

On  the  13th  his  mind  seemed  to  wander.  He  grew 
steadily  weaker,  with  no  marked  change  in  his  symp- 
toms, and  died  suddenly  at  8.20  a.m.  with  a  tempera- 
ture of  100.8°  F. 

The  heart's  action  was  always  very  feeble  and  u'- 
regular,  but  at  no  time  was  a  murmur  detected. 

Antopiiii. — Seven  hours  after  death,  body  very 
large  and  fat,  ledema  of  lower  extremities.  No  fluid 
in  peritoneum.  Diaphragm  stands  on  a  level  with 
the  fourth  intercostal  space  on  the  right  side  ;  one 
space  lower  on  the  left. 

Thorr>.v. — There  is  no  fluid  on  either  side.  The 
heart,  of  enormous  size,  is  entirely  uncovered  by  lung. 
On  opening  the  pericardial  sac  "the  visceral  and 
parietal  layers  are  found  everywhere  united  by  re- 
cent adhesions,  except  over  the  posterior  surface  of 
the  left  ventricle.  Tliese  adhesions  everywhere  con- 
tain blood  ;  and  just  behind  the  left  ventricle  tliere 
is  a  mass  of  recently  coagulated  blood,  about  as  large 
as  a  hen's  egg.  The  adhesions  ai-e  somewhat  firmer 
over  the  anterior  wall  of  the  left  ventricle  than  else- 
wliere,  particularly  over  the  apex.  On  separating 
these  adhesions  there  are  found  to  be  two  situations 
in  the  left  ventricle  where  the  muscular  tissue  is  en- 
tirely absent.  One  of  these  is  situated  at  about  the 
middle  of  the  anterior  wall  of  the  ventricle,  oval  in 
shape,  with  a  long  vertical  diameter  of  six  centi- 
metres, and  a  short  lateral  diameter  of  three  centi- 
metres. Over  this  oval  area  the  pericardium  is  ad- 
herent to  a  large  clot  of  laminated  fibrin,  which  is 
contained  within  the  cavity  of  the  ventricle.  The 
other  opening  in  the  ventricular  walls  is  linear  in 
shape,  with  ragged  edges,  and  is  situated  in  the  left 
border  of  the  ventricle  about  midway  between  the 
apex  and  the  site  of  the  miti-al  valve.  Its  length  is 
three  centimetres.  The  anterior  wall  of  the  left 
ventricle  is  everywhere  extremely  thin,  and  shades 
oflf  gradually  as  the  openings  are  approached.  The 
laminated  clot  is  spheroidal  in  shape  with  a  diameter 
of  seven  centimetres.  It  fills  the  left  ventricle  from 
the  ape.x  to  a  point  within  two  centimetres  of  the 
attaohe<l  border  of  the  aortic  valve.  Over  a  large 
part  of  its  area  this  clot  is  adherent  to  the  muscular 
wall  of  the  ventricle ;  and  also  to  the  ]>ericardinm 
over  the  oval  area  where  the  wall  of  the  ventricle  is 
absent.  The  valves  are  everywhere  competent. 
The  aorta  is  atheromatous.  The  right  ventricle  Jfl 
dilated  and  its  muscular  wall  is  very  thin.  There 
is  a  layer  of  fat  nearly  a  centimetre  thick  over  its 
posterior  wall.  The  coronary  arteries  as  far  as  they 
can  be  traced  are  normal.  The  weight  of  the  heart 
is  070  grammes. 

Kidni'i/fi. — Left  capsule  is  adherent  in  places,  sur- 
face granular,  cortex  extremely  thin,  and  its  mark- 
ings ob.scure.  (derate  of  soda  is  seen  in  tubes  of  pyr- 
amids. In  the  right  kidney  the  same  conditions 
prevail,  excejit  that  the  cortex  is  more  extensively 
atrophied. 

Stomach  is  intensely  congested. 

Tntfistines  are  in  the  same  condition. 

T.irer. — The  centres  of  the  acini  are  pigmented  ; 
there  is  anaemia  with  increased  connective  tissue  at 
their  periphery. 


THE  MEDICAL  RECORD. 


553 


Brain. — There  is  a  small  patch  of  atheroma  in 
the  wall  of  the  basilar  artery.  The  brain  is  anaemic, 
Intt  otherwise  normal. 

Microscopic  examination  of  the  liver  served  merely 
to  confirm  the  naked  eye  diagnosis.  The  kii/n  ■'!/.< 
showed  marked  atrophy  of  many  Malpighian  bodies  : 
many  hyaline  casts,  and  much  fatty  epithelium  in 
the  straight  tubes.  The  Jirart  showed  much  fat  in 
the  fibres  of  the  papillary  muscles  of  the  left  ven- 
tricle. The  fibres  of  the  left  ventricle  are  in  many 
places  broken  down,  and  there  ai-e  diffluent  masses 
of  mimite  oil  globules  apparently  lying  in  the  meshes 
of  fibrous  tissiie.  The  muscular  fibres  of  the  wall  of 
the  right  ventricle  contain  an  excess  of  fat,  but  the 
transverse  striaj  are  to  be  seen  in  some  places. 

Db.  Gerster  presented  specimens  as  follows  : 

EXSEOTION   OF   THE   HEAD    OP   THE   HTXMEKUS.] 

The  first  consisted  of  the  head  of  the  humerus, 
with  a  portion  of  the  diaphysis  removed  by  exsec- 
tion  eight  weeks  ago  at  the  German  Dispensary, 
from  a  child  eighteen  months  old.  The  child's 
grandmother  is  under  treatment  for  syphilis.  The 
father  of  the  child  died  of  consumption  two  years 
ago.  Without  known  cause,  inflammation  of  the 
left  shoulder-joint  developed,  ami,  in  the  coiirse  of 
time,  five  fistuhe  were  formed,  and  local  treatment 
was  of  no  avail.  Before  Dr.  Gerster  saw  the  child, 
a  surgeon  had  scraped  out  the  diseased  bone  and 
said  that  the  joint  was  not  afiected.  Dr.  Gerster 
■Bisected  one  and  one-fourth  inch  below  the  upper 
■epiphysis  of  the  humerus,  where  spontaneous  lysis 
had  occurred.  The  remnant  of  the  head  of  the  hu- 
merus was  attached  to  the  glenoid  cavity.  The 
diaphysis  was  freely  movable  in  the  space  at  the 
line  of  lysis.  The  diseased  portion  of  bone  was 
exposed,  and  it  was  found  that  about  one  inch  in 
extent  was  involved,  which  was  removed.  The  gen- 
■eral  condition  of  the  patient  began  to  improve  im- 
mediately, and  the  fistulaj  healed  si^ontaneously. 
The  incision  healed  by  first  intention.  The  chOd 
is  now  using  its  arm  freely,  and  abduction  is  possi- 
We  to  28  or  30  degrees. 

ESSECTION    OF   THE   ELBOW-JOINT. 

Dr.  Gerster  presented  three  specimens  with  ref- 
erence to  the  above  operation. 

Case  I. — A  girl,  twelve  years  of  age,  fell  and 
struck  upon  the  elbow,  but  did  not  think  that  she 
■was  much  injured.  Three  days  afterward,  she  began 
io  feel  sick,  had  considerable  fever,  and  pain  in  the 
elbow-joint,  and  was  unable  to  use  the  limb.  The 
family  physician  ordered  cold  applications,  and  the 
joint  was  fixed  by  means  of  a  splint.  But  the  case 
went  from  bad  to  worse,  there  was  continued  fever, 
and  the  joint  assumed  a  spindle-shaped  aj^pearance, 
and  when  Dr.  Gerster  saw  the  case  he  diagnosticated 
serious  organic  disease  of  the  articulation,  basing 
lis  opinion  upon  functional  disability,  the  general 
spindle-shaped  contour  of  the  limb,  elevation  of 
body  temperature,  with  marked  exacerbation  at 
night.  He  advised  immediate  incision,  for  the  pur- 
pose of  determining,  if  possible,  what  was  the  cause 
of  the  constitutional  disturbance.  He  believes  that 
early  is  no  more  dangerous  than  late  interference, 
and  it  promises  better  results,  because  the  necessity 
for  removing  large  portions  of  the  bony  structure  of 
the  joint  is  obviated.  Accordingly  he  jierformed 
essection  _/ir<?  71'eek.t  after  the  injiu-y.  The  changes 
which  had  occurred  in  the  soft  parts  were  very 
marked.  The  entire  capsule,  all  the  ligaments, 
even  the  annrdar  ligament  of  the  radius  not  usuallv 


involved,  were  transformed  into  a  gelatinous  mass, 
characteristic  of  fully  developed  cases  of  this  class. 
Within  the  joint  a  small  sequestrum  was  found  which 
belonged  to  the  end  of  the  olecranon,  and  doulitless 
was  chipped  ofl'atthe  time  of  the  fall,  and  gave  rise 
to  the  trouble  which  followed.  This  was  removed, 
together  with  the  tip  of  the  olecranon,  which  had 
begun  to  undergo  dry  carious  change.  The  gelatin- 
ous tissue  was  dissected  away  as  much  as  could 
be  done  safely,  the  wound  was  sewed  up  with  catgut, 
and  two  button-hole  incisions  made,  one  upon  the 
radial,  the  other  upon  the  ulnar  side,  for  the  inser- 
tion of  drainage-tubes,  simply  to  reach  just  within 
the  capsiile.  Four  days  after  the  ojieration  the 
drainage-tubes'were  shortened  still  more,  and  three 
days  later  they  were  withdrawn  altogether.  The 
wound  healed  by  first  intention.  The  case  pro- 
gi-essed  favorably  from  the  beginning,  and  at  the 
end  of  thirteen  days  passive  motion  was  commenced. 
The  operation  was  performed  according  to  Langen- 
beck's  method. 

Case  II. — A  laboring  man,  twenty-two  years  of 
age,  fell  and  struck  upon  the  elbow.  The  joint 
swelled,  was  painful,  synovitis  occun'ed,  which  con- 
tinued imtil  chronic  synovitis  of  a  fungous  character 
developed,  and,  nine  weeks  after  the  injury,  a  fistula 
existed  upon  the  inner  aspect  of  the  elbow-joint.  The 
specimen  showed  that  the  articular  cartilage  had 
been  entirely  destroyed.  Exsection  was  performed 
according  to  Langenbeck's  method,  but  the  subse- 
quent progi'ess  was  not  so  favorable  as  in  the  first 
case.  A  considerable  portion  of  the  periosteum 
necrosed,  which  required  frequent  irrigation  of  the 
wound  and  a  partial  opening  up  of  the  first  long  in- 
cision upon  the  jiosterior  aspect  of  the  limb.  There 
were  five  drainage-tubes  leading  into  the  cavity,  and 
Dr.  Gerster  anticipated  that  finally  the  man  would 
have  a  useful  joint. 

Case  III. — A  man,  twenty-six  years  of  age,  bruised 
his  left  arm,  in  consequence  of  which  he  was  com- 
pelled to  leave  his  work,  but  two  days  subsequently 
he  felt  as  well  as  usual,  and  returned  to  his  labor. 
Soon  afterward  he  was  taken  suddenly  with  a  chUl, 
lasting  five  hours,  and  severe  pain  in  the  humerus. 
His  home  being  in  New  Haven,  he  went  there  and 
called  his  family  physician,  who  regarded  the  case  as 
one  of  acute  articular  rheumatism  and  treated  it  ac- 
cordingly. After  ten  days  the  physician  said  that 
the  case  was  complicated  by  typhoid  fever.  The 
elbow-  and  shoulder-joints  were  swollen,  the  tongue 
dry,  and  prostration  marked.  The  patient  continued 
in  this  condition  for  six  weeks,  and  became  very 
much  emaciated.  Finally  he  came  to  New  York  and 
presented  himself  at  the  German  Dispensaiy,  where 
Dr.  Gerster  diagnosticated  osteo-myelitis  due  to 
traumatism.  The  humerus  was  thickened  to  six 
times  its  normal  size  and  was  rough,  the  integument 
was  fedematous,  and  the  muscular  substance  had 
almost  entirely  wasted  away.  The  patient  was  sent 
to  the  German  Hospital,  where  nine  weeks  ago,  as- 
sisted by  Dr.  George  P.  Shrady  and  the  house-stafl", 
he  operated  as  follows  :  He  made  an  incision,  begin- 
ning about  three  inches  above  the  point  where  the 
musciilo-spiral  nerve  passes  around  the  humerus, 
exposed  that  nerve,  and  then  continued  the  incision 
downward  nearly  to  the  capsule  of  the  elbow-joint. 
The  soft  parts  being  divided  completely,  he  opened 
the  cavity  of  the  bone  with  a  chisel.  In  the  middle 
portion  of  the  humerus  he  foimd  sangninolent  cel- 
lular tissue,  such  as  is  found  in  the  epiphysis  of  any 
of  the  long  liones.  Further  down  he  exposed  a 
cavity  containing  pus,  and  also  a  large  sequestrum 


554 


THE  MEDICAL  RECORD. 


which  reached  down  into  the  middle  of  the  lower 
epiphysis,  and  was  siuTounded  by  gelatinous  tissue 
which  had  penetrated  the  joint.  Dr.  Gerster  con- 
tinued the  incision  and  exsected  the  elbow-joint.  H6 
also  found  that  the  upper  part  of  the  humerus  had 
a  cavity  with  pus,  but  he  did  not  detect  any  seques- 
trum. He  scooped  out,  however,  as  much  of  the 
pus  and  softened  tissue  as  possible,  and  felt  cer- 
tain that  the  scoop  had  entered  the  shoulder-joint, 
which  also  was  involved.  A  long  drainage-tube  was 
placed  accordingly  into  the  upper  part  of  the  shaft, 
and,  the  limb  being  put  upon  a  suitable  splint,  the 
ordinaiy  after-treatment  was  adopted.  Dm-ing  the 
first  two  weeks  after  the  operation  there  was  con- 
siderable fever,  the  evening  temperature  being 
103°  r.,  and  the  morning  101"  F.  The  incision  in 
the  soft  parts,  however,  closed  by  first  intention,  and 
only  the  shoulder-joint  remained  tender  and  painful. 
From  this  Dr.  Gerster  was  led  to  believe  that  the 
fever  was  due  principally  to  retention  in  the  shoiil- 
der  joint,  and  the  subsequent  jjrogress  of  the  case 
showed  that  undoubtedly  disorganization  existed 
and  amputation  would  be  necessary. 

An  accident  occurred  during  the  operation,  which 
Dr.  Gerster  thought  should  be  mentioned.  He  used 
for 

THE    ESSIAKCH    CONSTRICTOR 

a  solid  rubber  band,  one  inch  wide  and  one-sixth  of 
an  inch  thick,  and  applied  it  around  the  arm  in  the 
upper  third.  The  usual  amount  of  jjressure  was 
applied,  but  it  proved  to  be  too  much  for  this  limb, 
and  after  the  operation  there  was  decided  anjes- 
thesia  of  the  integument  of  the  hand,  and  the  pa- 
tient could  not  move  the  fingers.  Nine  weeks  after 
the  operation  the  paralysis  remained,  and  doubtless 
was  the  result  of  too  great  pressure  by  the  constric- 
tor. Fortunately  it  woTild  do  this  patient  no  special 
harm,  as  he  miist  lose  the  limb  entirely,  on  account 
of  the  irremediable  state  of  the  elbow  and  shoulder- 
joints,  and  the  entire  shaft  of  the  humerus. 

Dr.  Gerster  thought  that  diagnosis  and  interfer- 
ence, in  many  cases,  was  deferred  too  long.  He 
maintained  that  if  there  were  characteristic  fever, 
and  anatomical  changes  of  the  contour  of  a  joint, 
accom23anied  by  evidence  of  functional  disability  of 
the  same,  such  as  muscular  rigidity  on  attempting 
to  make  passive  motion  without  anicsthetics,  it  could 
be  accepted  as  absolute  evidence  of  inflammatory 
disease  of  the  joint.  If  a  fistula  leads  down  to  the 
joint,  it  is  confirmatory  evidence  of  joint  disease.  If 
the  skin  and  subcutaneous  tissue  are  pulpy  and  tede- 
matous  in  addition  to  functional  disability  and  mus- 
cular rigidity,  we  might  be  certain  that  there  was 
grave  di-sease  of  the  joint  itself.  Under  such  cir- 
cumstances, he  thought  the  sooner  exsection  was 
performed  the  better  would  be  the  results,  because 
the  amount  of  joint  structure  to  be  removed  was 
less  than  in  cases  of  long  standing,  and  mobility 
was  more  easily  established. 

Dr.  V.  P.  GiBNEY  referred  to  the  well-known  fact 
tliat  muscular  spasm  about  joints  might  be  duo  to 
nerve,  cord,  or  meningeal  lesions,  producing  what 
are  known  as  arthropathies,  in  which  the  joints  were 
as  securely  fixed  as  when  true  disease  of  the  joint- 
structures  existed.  Ho  had  frequently  had  cases  in 
which  mechanical  apparatus  for  the  relief  of  joint- 
disease  had  been  applied  and  worn,  and  in  which 
relief  was  promptly  afibrded  by  simple  treatment 
directed  to  the  spinal  column,  and  the  same  cases 
he  had  been  able  to  follow  for  six  or  eight  years 
and  no  joint-disease  ever  developed  itself. 


He  regarded  it  as  very  important  to  take  into  ac- 
count the  peripheral  nerve-supply  in  deciding  in 
any  case  the  question  whether  or  not  disease  of  the 
joint  existed.  It  was  not  a  very  uncommon  observa- 
tion to  see  "  joint  disease  "  go  through  all  its  stages 
without  the  joint  being  affected  at  all. 

With  regard  to  the  question  of  early  operative  in- 
terference, the  natural  history  of  joint  disease  in 
children  should  be  considered.  In  many  instances, 
occurring  in  children,  the  patients  would  recover 
with  much  better  joints  if  the  disease  was  left  to 
run  its  natural  course  than  if  exsection  was  per- 
formed, as  had  been  demonstrated  by  well-observed 
cases. 

When  the  disease  occurred  in  patients  over  twelve 
years  of  age,  it  might  be  advisable  to  exsect  or  re- 
move portions  of  diseased  bone  early.  But  he  re- 
garded it  as  bad  practice  to  exsect  or  resort  to  any 
operative  interference  in  cases  of  joint  disease  oc- 
curring in  young  children.  He  believed  that  a  better 
plan  was  to  keep  the  limb  in  as  good  position  as 
possible,  employ  passive  motion  at  the  proper  time, 
or  let  it  take  care  of  itself,  and  allow  the  disease  to 
run  its  natural  course.  He  thought  it  well  to  make 
a  distinction  between  the  cases  of  joint  disease  oc- 
cuiTing  in  childrea  and  those  occurring  in  adults, 
in  forming  a  prognosis  or  estimating  the  value  of' 
operative  interference. 

Db.  Geb.ster  did  not  wish  to  be  understood  as 
saying  that  functional  disturbances  about  a  joint 
alone  were  sufficient  to  justify  the  diagnosis  of 
joint  disease ;  for,  it  was  well  known  that  veiy  se- 
rious functional  disorder  could  occur  without  any 
local  anatomical  changes  whatever.  But  these  dis- 
turbances, associated  with  the  other  symptoms  men- 
tioned, he  believed  to  be  sufficient  to  enable  the- 
surgeon  to  make  a  positive  diagnosis  without  wait- 
ing for  the  time  when  a  probe  could  be  introduced 
into  the  joint  itself.  There  were  practitioners  who- 
postponed  making  a  positive  diagnosis  until  thi* 
condition  of  things  was  reached. 

Whenever  there  was  fever,  accompanied  by  change 
in  the  contour  of  a  joint,  evidence  of  inflammatory 
processes,  and  functional  disturbances  of  the  joint 
itself,  the  surgeon  was  justified  in  making  a  com- 
plete diagnosis. 

With  regard  to  early  operative  interference, 
whether  it  be  scooping  out  dfbris,  removing  se- 
questra, partial  or  total  exsection,  he  made  no  dis- 
tinction with  reference  to  the  time  when  the  opera- 
tion should  be  performed.  But  he  shared  with  Dr. 
Gibney  in  the  opinion  that  total  exsection  should 
not  be  done,  as  a  rule,  in  the  very  young  sTibject. 
He  would  perform  the  operation,  however,  under 
certain  circumstances,  for  example,  such  as  obtained 
in  the  case  rejjortcd,  where  it  was  necessai-y  as  6 
measure  for  saving  the  life  of  the  child,  and  scoop- 
ing with  fixation  of  the  joint  woiild  not  answer.  In  n 
all  cases,  he  was  willing  to  make  an  exploratory  in- 
cision as  soon  as  possible.  At  the  present  time  it 
was  almost  impossible  to  make  a  positive  and  de- 
tailed diagnosis  without  opening  the  joint  in  most 
cases  ;  and  in  oi-der  to  act  intelligently,  he  believed 
that  it  was  of  the  greatest  necessity  to  expose  the 
seat  of  the  disease,  determine  the  cause  of  the  pecu- 
liar pathological  changes  about  the  joint,  and  then 
remove  them  if  i^ossible.  Very  often  a  slight  inter- 
ference sufficed  to  save  the  joint,  as  the  exact  condi- 
tion which  gave  rise  to  the  joint  disease  varied  in 
different  cases. 

The  President  remarked  that  Dr.  Gerster "s  last 
case  was  interesting,  especially  witli  reference  to  the 


THE   MEDICAL  RECORD. 


555 


paralysis  following  the  use  of  the  rubber  constrictor. 
He  had  seen  a  similar  case,  some  sis  years  ago,  in 
Dr.  Weir's  service  at  the  Roosevelt  Hospital.  In 
that  instance  there  were  no  local  peculiarities  to  ac- 
count for  the  result.  The  patient,  however,  entirelv 
recovered,  and  he  could  not  regard  Dr.  Gerster's 
case  as  hopeless  with  reference  to  the  paralysis,  as 
the  nerves  might  be  restored,  and  that  could  not  be 
decided  until  at  the  end  of  two  years.  Recovery  in 
such  cases  was  more  apt  to  take  place  in  the  second 
than  in  the  first  year  after  the  injury. 

The  society  then  went  into  executive  session. 


Cotrcs|j0ni)aice. 


LACERATION  OF   THE   CERVIX  UTERI. 

A  Reply  by  Dr.  Montrose  A.  Fallen  to  Dr.  J. 
Henry  Bennet. 

To  THE  Editor  of  The  Medical  Record. 
Sir  :  In  your  issue  of  April  29th,  Dr.  Bennet  has 
seen  fit  to  reply  to  my  communication  to  you  of 
rebruary  25th,  wherein  he  states  that  "not  one  of 
Dr.  Pallen's  statements  respecting  my  utterances  in  the 
debate  is  true,  and  I  appeal  to  the  very  physicians  pres- 
ent ithom  he  names  as  corroborative  witnesses  of  what 
I  assert."  * 

In  order  that  the  readers  of  The  Recced  may  un- 
derstand the  question  of  veracity  raised  by  Dr. 
Bennet,  I  will  quote  what  I  said,  viz.,  "It  is  unfor- 
tunate that  Dr.  Bennet  should  permit  such  a  publi- 
cation to  go  forth  after  his  most  decided  recantation 
of  the  views  in  his  paper.  He  distinctly  avowed  (in 
the  presence  of  Drs.  Playfair,  of  London,  Hodgen, 
of  St.  Louis,  Marcy,  of  Boston,  and  many  others 
whom  I  do  not  remember),  in  his  speech  closing  the 
debate  on  his  paper,  that  for  the  past  twenty  years 
he  had  paid  comparatively  little  attention  to  gyne- 
cological subjects ;  and  that  he  felt  satisfied  that 
during  this  period  he  had  not  kept  pace  with  the 
advances  made.  ...  In  the  remarks  I  made 
on  the  afternoon  of  the  discussion,  I  took  issue  with 
every  objection  raised  by  Dr.  Bennet,  and  he  openly 
and  frankly  accorded  me  the  position  of  having  con- 
verted him.     His  statement  was  about  as  follows  : 

"Dr.  Fallen,  vjho  read  hU  extraordinary  paper  at 
the  meeting  of  the  Ilritish  Medical  Association,  held  at 
Cambridge,  in  1880,  rather  startled  me  by  the  advocacy 
of  the  treatment  of  laceration  of  the  cervix  in  contra- 
distinction to  the  views  of  his  compatriot,  Dr.  Marion 
Sims,  who  has  equally  surprised  us  by  advocating  the 
division  of  the  cervix  for  certain  troubles.  But  now  I 
Jind  I  misapprehended  the  conditions  as  then  detailed 
by  Dr.  Fallen,  and  if  I  was  wrong  in  the  views  I  enun- 
ciated in  this  paper,  I  think  Dr.  Fallen  should  be 
ihankftd  that  I  gave  him  such  an  oppm-tunity  to  air 
his  opinions.  Admitting  that  I  have  failed  to  keep 
pace  ivith  advances  made  by  the  gynecologists  of  the 
last  twenty  years,  Ida  not  like  to  have  my  ei-rors  so 
emphatically  denounced  ag  they  have  been  by  Dr.  Fallen 
and  others,"  etc. 

I  appeal  to  Drs.  Hodgen,  Marcy,  and  the  other 
Americans,  as  well  as  Drs.  Playfair,  Williams,  and 
the  other  English  gentlemen  who  were  jiresent,  if  I 
do  not  substantially  quote  the  remarks  of  Dr. 
Bennet  as  he  made  them. 


'  All  iUiHls  and  capitals  in  this  paper  o 


I  reiterate  the  statement  that  I  correctly  quoted 
Dr.  Bennet,  and  I  am  prepared  to  prove  the  truth 
of  my  remarks. 

After  reading  Dr.  Bennet's  communication,  I  ad- 
dressed the  following  letter  to  Prof.  John  T.  Hod- 
gen, of  St.  Louis ;  to  Prof.  Henry  O.  Marcy,  of 
Boston ;  and  to  Prof.  Paul  P.  Mundc,  of  New  York  : 

llti  il.^DlsoN  AvKNUE,  N.  Y.,  April  ^.S,  1.S82. 

My  Dear  Doctor  :  On  the  25th  of  February  last,  I 
pubhshed  in  The  Medical  Record  a  communication 
concerning  the  last  speech  of  Dr.  J.  Henry  Bennet, 
about  his  paper  on  laceration  of  the  cervix,  read  in 
the  Obstetrical  Section  of  International  Congress, 
held  in  London,  last  August.  I  enclose  a  copy  of 
this  publication,  and  I  beg  of  you  to  tell  me  if  I  did 
not  correctly  quote  the  remarks  of  Dr.  Bennet.  I 
ask  this  favor  of  you,  because  Dr.  Bennet,  in  a  letter 
from  Mentone,  Italy,  published  in  The  Record  of 
this  date,  charges  that  "  not  one  word  of  Dr.  Fallen's 
respecting  my  utterances  in  the  debate  is  true,  and  I 
appeal  to  the  very  physicians  present  whom  he 
names  as  corroborative  witnesses  of  what  I  assert." 

Now,  my  dear  doctor,  I  am  the  last  man  in  the 
world  to  intentionally  injure  any  person,  much  less 
Dr.  Bennet ;  but  the  truth,  however  unpalatable  it 
has  been  to  him,  must  be  given  in  a  question  of 
science. 

Very  sincerely  yours, 

Montrose  A.  Fallen. 

Unfortunately,  before  my  letter  could  reach  Pro- 
fessor Hodgen,  of  St.  Louis,  he  had  i^assed  away  in 
consequence  of  a  sudden  perforation  of  the  gall- 
bladder, and  his  death  removes  him  from  the  wit- 
ness-stand ;  yet  I  have  the  satisfaction  of  knowing 
that,  in  the  very  last  conversation  I  had  with  him  in 
London,  in  August,  1881,  he  warmly  congi-atulated 
me  on  what  he  called  "  Bennet's  admission  and  ac- 
knoicledgntent,  that  he  had  been  worsted  by  Ameri- 
cans, in  tlie  defence  of  a  purely  American  opera- 
tion." That  this  was  the  general  opinion,  is  to  be 
inferred  from  the  following  replies  to  my  note  of 
April  28th  : 

(Letter  from  Professor  H.  O.  Marcy.) 

lit;  BoYLSTON  Street,  Boston,  May  9,  1882. 

Dr.  Montrose  A.  Fallen. 

My  Dear  Doctor  :  Thanks  for  your  note.  I  dis- 
tinctly "remember  the  discussion  in  which  I  took 
part.  Dr.  Bennet  yielded,  as  I  thought,  very  grace- 
fully to  the  accumulated,  and,  as  he  was  pleased  to 
call  it,  American  evidence  as  to  the  value  of  repair 
of  the  cervix.  You  paid  him  a  handsome  compli- 
ment upon  the  great  worth  of  his  services  rendered 
to  gynecology,  which  he  often  took  occasion  to  refer 
to  very  jjleasantly  while  I  was  his  guest  at  the 
"Ferns."  There  he  went  over  the  whole  subject 
with  Dr.  Nelson,  of  Chicago,  and  myself,  and  said 
that  he  felt  most  aggrieved  that  it  was  supposed  he  had 
not  understood  what  a  ruptured  cervix  really  was  / 
He  showed  us  a  copy  of  his  work,  the  first  edition, 
upon  "  Inflammation  of  the  Uterus,"  in  which  he 
had  clearly  stated  that  these  conditions  (infiltrated 
inflamed  cervix)  were  not  rarely  produced  by  injuiy 
in  labor,  etc.  He  stated  that  he  had  no  opportxmity  to 
judge  of  the  value  of  operative  procedures,  supposed  he 
mu.'it  admit  it,  but  thought  he  had  not  seldom,  by 
caustic,  secured  a  not  very  diflerent  result.  /  cer- 
tainly  felt  that  we  could  accredit  to  him  the  acceptatiwi 


556 


THE  MEDICAL  RECORD. 


of  the   utility  of  Dr.  Emmet's  operation,  and,  to  the 

BEST    OF    MT   KECOLLECTION,    SHOULD   THINK    YOU    HAD 
QUOTED  HIM  FAIRLT  IN  YOUK  ABTICLE.       .       .       . 

Respectfully, 

Henry  O.  Mahcy. 

(Letter  from  Professor  Paul  F.  Miinde.) 

20  West  Forty-sixth  Street,  New  Yobe,  May  6,  ls^2. 

Dr.  M.  a.  Pailen. 

My  Dear  Doctor  :  In  reply  to  your  favor  of  Aj^ril 
28tli,  asking  me  to  give  you  my  recollections  of  the  re- 
marks made  by  Dr.  J.  Henry  Bennet ,  in  the  discussion 
of  his  paper  on  "  Laceration  of  the  Cervix  Uteri,"  I 
beg  to  say  that  I  remember  hearing  Dr.  Bennet  say, 
in  closing  the  discussion,  that  you  ought  to  be  thank- 
ful to  him  for  giving  you  "  the  opportunity  to  air  your 
opinions,"  and  "  that  he  admitted  that  he  had  not  kept 
pace  with  the  recent  advances  in  gynecology." 

I  was  unfortunately  detained,  and  arrived  too  late 
to  take  part  in  the  di.scnssion,  as  I  had  hoped  to  do. 
I  entered  the  hall  as  you  were  speaking,  and  heard 
Dr.  Bemiel'sjinal  remarks  in  reply.     They  ■«t3RE,  and 

MY    RECOLLECTION    IS  QUITE    DISTINCT,    SUBSTANTIALLY 
THE   SAME   AS   YOU    HAVE   QUOTED    HIU.       /  left  the  room 

with  the  ijnpression  that  Dr.  Bennet  had,  at  least  theo- 
retically, become  a  convert  to  the  operation. 
Yours  truly, 

Paul  F.  Mundk. 

From  the  evidence  of  these  unimpeachable  gentle- 
men, physicians  of  the  highest  integrity  and  intelli- 
gence, it  will  be  seen  that  Dr.  Bennet  has  denied 
what  he  uttered  in  his  last  speech  of  the  debate  on 
his  paper,  and  that  the  British  Medical  Journal  (No- 
vember 26,  1881)  and  the  "  Transactions  of  the  Inter- 
national Medical  Congress  "  (pp.  341,  342,  vol.  iv.) 
contain  his  remarks  as  he  never  delivered  them. 

From  the  above  testimony  I  fancy  that  my  brother 
physicians  will  accord  me  the  justice  of  having  quoted 
Dr.  Bennet  as  he  spoke,  and  as  Drs.  Marcy  and  Munde 
heard  him. 

Dr.  Bennet  says  :  "  To  utter  the  drivelling  idioms 
which  Dr.  Fallen  imputes  to  me  in  the  discussion 
that  followed  the  reading  of  my  paper,  I  must  have 
been  laboring  under  senile  snfteiting  of  the  brain." 
Very  resi^ectfiiUy, 

Montrose  A.  P.^^llen. 

118  Madison  Avenue,  New  Yobk,  May  9,  18S2. 


ARMY  NEWS. 


Official  List  of  Changes  of  Stations  and  Duties  of  Offi- 
cers of  the  Medical  Department,  United  States  Army, 
from  May  7,  1882,  to  May  13,  1882. 

Kino,  Wm.  S.,  Colonel  and  Surgeon.  The  ox- 
tension  of  his  leave  of  absence  on  account  of  sick- 
ness, granted  him  in  H.  O.  251,  November  7,  1S81, 
from  A.  G.  O.,  still  further  extended  six  months  on 
account  of  sickness.  S.  O.,  104,  A.  G.  O.,  Mar  5, 
1882. 

Cleaky,  p.  -T.  a.,  Capt.  and  Ass't  Surgeon.  The 
leave  of  aljsence  on  Surgeon's  certificate  of  dis- 
ability granted  him  in  S.  O.  224,  October  4,  1881, 
from  A.  G.  O.,  is  extended  six  montlis  on  account  of 
sickness.     S.  O.  107,  A.  G.  O.,  May  9,  1882. 

Hall,  W.  R.,  Capt.  and  Ass't.  Surgeon,  .\ssigned 
to  dutv  at  Fort  Bliss,  Texas.  S.  O.  95,  Dept.  of 
the  Missouri,  May  8,  1882. 


iHcliifol  3tcms   nnli  XXtvos. 


Contagious  Disrases  —  Weekly  Statement.  — 
Oomparative  statement  of  cases  of  contagious  diseases 
reported  to  the  Sanitary  Bureau,  Health  Department, 
for  the  two  weeks  ending  May  13,  1882. 


Week  Ending 

1 

Is 

i 

6 

if 

o 

1 
s 

1 
1 

Q 

i 

tS 

May     6,    1882. 

19 

8 

181 

6 

145 

78 

19 

0 

May    13,    1882. 

10 

7 

180 

8 

157 

73 

21 

0 

State  Commissioner  of  Lunacy. — The  Governor 
has  sent  in  the  name  of  Dr.  Stephen  Smith  as  Com- 
missioner of  Lunacy  in  place  of  Dr.  Ordronanx. 
There  is  nothing  personally  objectionable  to  either 
of  these  gentlemen.  Those  who  are  anxious  for 
asylum  reform,  however,  will  not  be  contented  until 
a  commission  of  more  than  one  person  is  appointed 
to  supervise  our  asylums. 

The  Crdhn.al  Insane. — An  effort  is  being  made 
to  induce  the  Massachusetts  Legislature  to  provide 
a  separate  asylum  for  the  criminal  insane.  Petitions 
have  been  received  signed  by  all  the  State  Asylum 
Superintendents.  It  is  shown  by  English  statistics 
that  fifteen  times  as  many  insane  convicts  per  thou- 
sand escape  from  ordinary  lunatic  asylums  as  from 
asylums  for  the  special  care  of  this  class. 

A  College  fob  Medical  Pbactitioners  has  been 
formed  in  St.  Louis.  The  faculty  includes  Drs.  Rum- 
bold,  Hughes,  and  other  excellent  men. 

Dr.  J.  J.  Woodw.ird  is  reported  to  be  seriously 
ill  in  Eurojie.  The  continued  strain  to  which  he 
was  subjected  during  the  President's  illness  broke 
down  his  nervous  system,  and  soon  after  the  Pres- 
ident's death  he  went  abroad.  He  is  now  at  Nice, 
and  the  reports  received  from  him  do  not  encourage 
his  friends. 

Persons  who  use  Fruits  and  Food  preserved  in 
tin  cans  have  been  found  to  sutler  eventually  from 
gastric  trouble.  This,  it  is  asserted,  is  due  to  stan- 
nous compounds  which  are  extremely  irritant.  Mr. 
Edison  is  reported  {Science)  to  have  invented  a 
method  of  preserving  articles  of  food  in  glass  ves- 
sels from  which  the  air  has  been  exhausted  and  a 
high  vacuum  produced.  The  glass  vessel  is  then 
hermetically  closed  by  sealing  off  the  channel  to  the 
air-pump,  the  envelope  produced  being  essentially 
a  homogeneous  piece  of  glass.  This  invention  ap- 
pears to  meet  the  difficulty'experienced  in  the  use 
of  tin  cans. 

The  New  York  State  Dental  Society  met  at 
Albany,  May  10th  and  11th.  The  following  officers 
were  elected  for  the  ensuing  year :  Pre.'>ident,  L.  S. 
Straw,  Nowburg ;  Vice-President,  F.  Frencli,  Ro- 
chester;  Secretiny,  J.  E.  Line,  Rochester;  Treas- 
urer, A.  H.  Broekway,  Brooklyn ;  Correspondent,  W. 
H.  Atkinson,  New  York. 

Death  of  Dr.  John  Brown  of  Edinburoh. — Both 
literature  and  medicine  will  mourn  the  loss  of  Dr. 
Brown  of  Edinbiirgli,  best  known  perhaps  as  author 


THE  MEDICAL  RECORD. 


557 


of  the  little  story  entitled  "  Eab  and  His  Friends." 
I'r.  Brown  was  the  son  of  a  clergyman,  and  was 
Inirn  at  Biggar,  Lanarkshire,  in  September,  1810. 
Ill-  received  his  education  at  the  University  of 
lliliubiirgh.  He  was  the  author  of  two  vohimes  of 
. -^says  on  medical  subjects,  and  was  a  contributor 
to  the  yort//  British  Rerieic,  Good  Words,  and  the 
s  nisni'in.     He  died  on  the  11th  inst. 

^  ;GnTE.\r"s  BoDT. — Arrangements  are  now  being 
perfected  by  one  of  our  local  societies  for  obtaining 
the  body  of  Charles  J.  Guiteau,  after  his  execution, 
for  the  purpose  of  a  post-mortem  examination. 

The  Proposed  Cokxell  Medical  School. — Nego- 
riiitions  are  still  going  on  with  the  Cornell  authori- 
fios  in  regard  to  establishing  a  medical  department, 
t  I  he  located  hei'e.  The  prosjiects  are  rejjorted  to 
lie  favorable. 

The  Missoubi  State  Medical  Association  met  at 
Hannibal  on  the  16th  of  May. 

The  Thiktysixth  Annual  Meeting  of  the  Asso- 
ciation of  Medical  Sui^erintendents  of  American  In- 
stitutions for  the  Insane  will  be  held  at  the  Grand 
Hotel,  in  the  city  of  Cincinnati,  O.,  on  Tuesday, 
May  30,  1882,  commencing  at  10  a.m. 

A  Discussion  on  Chloroform  lias  been  going  on 
for  several  weeks  at  the  Academy  of  Medicine,  Paris. 
Nothing  new  seems  to  be  brought  out,  but  it  may  he 
seen  that  the  French  surgeons  are  much  more  in  fa- 
vor of  this  anaesthetic  than  we  are  in  America.  M. 
Gosselin  even  laid  it  down  as  a  positive  fact  that 
chloroform,  when  properly  administered  according 
to  his  method,  cannot  be  dangerous.  This  view  was 
very  generally  opposed. 

The  Illinois  State  Medical  Society  will  not  hold 
its  annual  meeting  on  the  third  Tuesday  in  May. 

Dr.  Bosse,  of  Dosinau,  thinks  he  has  discovered 
that  the  oil  of  turpentine  possesses  most  extraordi- 
nai\v  curative  properties  in  the  treatment  of  diph- 
theria. He  has  emijloyed  this,  which  he  orders  to 
be  administered  in  tablespoonful  doses,  for  some 
time  with  great  success. 

Berlin  jMedical  Society. — At  a  recent  session  of 
the  Berlin  Medical  Society,  which  was  held  on  the 
30th  of  last  month,  the  names  of  Drs.  Austin  Flint, 
Seguin,  and  Putnam,  were  submitted  for  correspond- 
ing membership.  These  gentlemen  were  elected. 
On  the  same  occasion,  among  other  distinguished 
foreign  physicians,  Drs.  W.  Gull,  Pavy,  and  Grainger, 
of  England,  were  also  made  corresponding  members. 

Fatty  Heart  in  Diphtheria. — Prof.  Leyden, 
President  of  the  Berlin  Medical  Society,  thinks  that 
there  is  a  fatty  degeneration  of  the  muscular  fibres 
of  the  heart,  with  abundant  ceU-jDroliferation,  in 
diphtheria. 

The  Loulsiana  State  Medical  Society  will  not 
hold  its  regular  annual  meeting  this  year. 

M.  Pauij  Bert  has  been  elected  member  of  the 
Academy  of  Sciences  in  place  of  the  late  M.  Bouil- 
laud. 

The  Society  of  the  White  Cross. — A  society  has 
been  formed  in  Austria  under  the  above  name.  It 
will  supplement  the  work  of  the  Red  Cross  Society 
by  providing  homes  for  convalescent  and  invalid 
soldiers. 

M.  CoRNiL  has  been  elected  to  the  Chair  of  Patho- 
logical Anatomy,  in  Paris,  in  place  of  M.  Charcot. 


Germany  seems  to  be  passii^  through  a  series  of 
epidemics.  Small-pox  is  reported  to  prevail  to  an 
alarming  extent  in  the  Ehine  provinces. 

The  Alabama  Medical  Association  was  held  at 
Mobile,  Ala.,  April  12th,  13th,  and  Uth.  Dr.  J.  B. 
(iaston,  the  President,  delivered  an  address  upon 
State  sanitary  matters.  A  number  of  interesting 
papers  were  read.  The  following  officers  were 
elected  for  the  ensuing  year  :  President.  Clifford  D. 
Parke,  of  Selma ;  Vice-Presidenls.  John  ]\I.  Godfrey,  of 
SumterviUe,  and  Daniel  O.  Hopping,  of  Letohatchee  ; 
Secretary,  Thomas  A.  Means,  Montgomeiy ;  Treas- 
urer, Walter  C.  Jackson. 

The  American  Surgical  Association  wiU  hold  its 
third  annual  meeting  in  Philadelphia.  May  31st, 
June  1st  and  2d.  Papers  are  expected  from  Drs. 
Cabell,  of  Virginia,  Briggs,  of  Nashville,  Weist,  of 
Indiana,  Gunn,  of  Chicago,  and  others. 

•  Dr.  John  P.  Gray,  of  Utica,  is  recovering  from 
the  injuries  inflicted  in  the  recent  attempt  by  a  luna- 
tic to  liill  him. 

A  Large  Brain.— Dr.  Chr.  Tompkins,  of  Kich- 
mond,  reports  the  case  of  a  negro  who  recently  died 
of  phthisis,  and  whose  brain  weighed  seventy  ounces. 
The  man  was  thirty-two  years  old.  He  was  of  large 
build,  and  six  feet  two  inches  high.  He  had  been 
twice  a  murderer,  and  twice  in  a  lunatic  asyh:m. 
When  sane  he  was  considered  stupid. 

Illinois  State  Board  of  Health. — The  Illinois 
State  Board  of  Health  held  its  regular  quarterly  ex- 
aminations on  AprU  13th.  This  examination,  says 
the  Chicago  Medical  Eeriew,  exceeded  in  severitv 
that  of  many  of  the  most  rigid  medical  colleges. 

Dr.  Giovanni  Lanza,  the  Italian  Prime  Minister, 
died  March  9,  1882.  He  had  been  a  physician  for 
nearly  fifty  years. 

A  New  Wat  of  Smoking  Opiu:m. — Dr.  M.  J.  Madi- 
gan  (Chicar/o  Medical  Herien-)  describes  a  new  way  of 
smoking  opium  among  some  of  the  Americans  and 
Chinese.  They  soak  chewing-tobacco  in  laudanum, 
dry  it,  and  then  smoke  it  in  a  pipe. 

The  Missi.sseppi  State  Medical  Association  held 
its  annual  meeting  at  Oxford,  Miss  ,  April  5th,  (5th, 
and  7th,  the  President,  Dr.  B.  F.  Ward,  in  the  chair. 
About  eighty  members  were  present.  Papers  were 
read  upon  Scarlet  Fever,  Tetanus,  Veratrum  in  Puer- 
jjeral  Convulsions,  Infantile  Convulsions. 

A  resolution  was  jjassed  condemning  the  action  of 
the  New  York  State  Medical  Society  in  its  recent 
adoption  of  a  new  Code.  Eeports  of  some  obstet- 
rical and  surgical  cases  were  read,  also  a  report  of  a 
case  of  lumbricoides  perforating  the  bowel. 

The  following  officers  were  elected  for  the  ensuing 
year :  President,  Dr.  Wirt  Johnson,  of  Jackson  ; 
First  Vice-President.  Dr.  J.  M.  Greene  :  Second  Vice- 
President,  Dr.  J.  E.  Halbert ;  Third  Vice-President, 
Dr.  J.  T.  Chandler,  Oxford  ;  Fourth  Vice-Presideitl, 
Dr.  E.  I-i.  ]\rcGeliee,  Woodville  ;  Recording  Sen-elart/, 
Dr.  T.  W.  Fullilove,  of  Vaiden  ;  (hrrespanding  Secre- 
tary, Dr.  M.  S.  Craft,  of  Jackson  ;  Treasurer,  Dr. 
Robert  Kells;  Orator. Ttv.  G.  W.  Trimble,  Grenada; 
Ahernate  Orator,  Dr.  J.  B.  Sandford,  Corinth. 

The  society  adjourned  to  meet  next  year  at  Me- 
ridian. 

The  Michigan  State  Medical  Society  held  its 
seventeenth  annual  meeting  at  Ypsilanti,  May  10th 
and  11th. 


558 


THE  MEDICAL  EECORD. 


At  the  Second  Annual  Commencemknt  of  the 
Memphis  Hospital  Medical  College  there  were  thirty 
graduates  in  medicine  and  four  in  pharmacy. 

A  School  op  Dental  Surgery  is  to  be  organized 
in  connection  with  the  Medical  Faculty  of  the  Uni- 
versity of  Maryland. 

Dr.  Hugh  W.  Brock,  Professor  of  Anatomy,  Phy- 
siology, and  Hygiene  in  the  State  University  of 
West  Virginia,  died  April  28th  at  his  home  in  Mor- 
ganstown. 

Bacteria  and  Eespiration. — From  a  number  of 
careful  experiments.  Professor  Gunning  concludes 
that  inspired  air  is  freed  from  bacteria  which  may 
have  been  contained  therein  ;  and  that  the  expired 
air  does  not  carry  bacteria  along  with  it  out  of  the 
body. 

A  Night  Medical  Service,  according  to  report, 
is  to  be  established  in  Washington. 

The  late  Dante  Bossetti  was  a  victim  to  the 
chloral  habit.  "  About  1868,"  says  his  biographer, 
"  the  curse  of  the  artistic  and  poetic  temperament 
— insomnia — attacked  him."  He  then  began  the 
use  of  chloral,  and  suffered  from  it  more  or  less  for 
the  rest  of  his  life. 

A  Plot  to  Murder  and  Rob  Medical  Men  was 
recently  discovered  in  Berlin,  and  was  of  a  most  ex- 
traordinary and  diabolical  character.  Medical  men 
were  selected  because  they  could  be  most  easily  made 
victims.  It  was  arranged  that  one  of  the  party  of 
conspirators  should  play  sick  and  send  for  a  physi- 
cian. When  the  doctor  came  and  began  to  examine 
the  malingerer  as  he  lay  in  bed,  a  specially  devised 
garroting  instrument  was  to  be  thrown  around  his 
neck.  An  accomplice  was  to  pinion  the  arms.  Hav- 
ing strangled  their  victim  he  was  to  be  thrown  into 
the  water.  The  police  were  informed  of  the  plan  by 
one  of  the  accomplices.  A  policeman  was  sent  in 
place  of  the  doctor,  and  found  that  the  plot  was  as 
had  been  described.     The  men  were  arrested. 

The  story  is  well  attested,  but  has  a  somewhat 
fishy  odor. 

Profe.ssor  Henle,  of  Ocittingen,  recently  held  the 
semi-centennial  jubilee  of  his  doctorate.  Among 
Professor  Henle's  pupils  who  sent  their  congratula- 
tions were  KoUiker,  Ehlers,  and  Waldeyer.  He 
was  presented  with  a  gold  medal.  A  bust  of  the 
venerable  professor,  presented  by  the  Medical 
Faculty,  was  unveiled. 

A  Resection  of  the  Stomach  was  again  success- 
fully performed,  April  1st,  by  Dr.  Nebinger,  of 
Bamberg.  The  patient,  four  days  later,  took  nourish- 
ment, and  was  doing  well. 

PR0FES.S0R  Wagner,  of  Leipsic,  has  been  lined 
812  for  calling  homcropathy  a  swindle,  etc.  He 
was  sued  by  seventy-five  homosopaths,  among  whom 
the  spoils  are  presumably  to  be  divided. 

DiAcjNo.sis  OP  Tumors  of  the  Bladder. — Sir  Henry 
Thom))son  has  shown  that  by  a  direct  median  in- 
cision into  the  bladder,  that  organ  can  bo  ex))lored 
for  tumors.  The  incision  is  without  danger,  and 
examining  through  it  the  nature  of  the  tumor  can 
be  discovered. 

Yellow  Fever  Theorists  are  viewing  this  as  a  test 
year  in  the  South.  Below  tlie  thirty-fourth  parallel 
there  luvs  been  iVactically  no  winter,  and  the  spring 
has  been  early,  warm,  and   humid.     Besides,  a  vast 


territory  has  been  inundated,  which,  when  the  wa- 
ters retire,  will  expose  an  unusual  amount  of  dead 
vegetable  matter  to  the  ferment  of  summer.  Three 
of  the  conditions  supposed  to  favor  the  development 
of  the  disease  are  thus  found  to  be  present.  Rigid 
quarantine  has  already  been  established  against  the 
Antilles,  and  infection  from  that  known  quarter  is 
forestalled.  The  past  three  years  have  been  un- 
marked by  yellow  fever  in  the  United  States,  and 
therefore  the  germs  of  previous  epidemics  must  be 
viewed  as  now  dead.  If,  then,  yellow  fever  is  strictly 
an  exotic,  it  only  depends  upon  a  vigilant  quarantine 
maintained  throughout  the  season  to  insure  that 
the  summer  will  pass  without  a  case  of  local  origin. 

Hospital  for  the  Ruptured  and  Crippled,  New 
York. — Dr.  Allan  McLane  Hamilton  has  been  ap- 
pointed Consulting  Neurologist,  and  Dr.  Geo.  F. 
Shrady  Consulting  Surgeon  to  this  institution. 

D'aniel  W.  Perham,  M.D.,  of  this  city,  died  April 
27,  1882.  He  was  born  in  Mount  Pleasant,  Wayne 
County,  Pa.,  August  23, 1852  ;  was  the  son  of  Sylvius 
G.  and  Luoinda  H.  Perham,  immediate  descendants 
of  the  first  settlers  of  that  part  of  the  State.  He 
obtained  his  academic  education  at  the  Pleasant 
Mount  Academy,  a  private  institution  of  his  native 
place.  During  the  spring  of  1874,  he  commenced 
the  study  of  medicine  in  the  office  of  his  uncle,  Dr. 
Warren  Schoonover,  of  New  Y'ork  City,  and  entered 
BeUe^aie  Medical  College  in  the  autumn  of  the  same 
year,  and  graduated  in  the  spring  of  1877,  ranking 
high  in  his  class.  On  receiving  his  degree  he  re- 
turned to  his  native  place  and  commenced  the  prac- 
tice of  medicine  for  a  few  months,  but  by  the  advice 
of  his  uncle.  Dr.  Schoonover,  he  returned  to  New 
York  City.  June,  1877,  he  was  appointed  District 
Physician  in  the  Northeastern  Dispensary,  New 
Y'ork  City.  August,  1878,  he  became  associated  with 
Dr.  Alexander  Hadden,  of  New  Y'oi-k  City,  as  assist- 
ant in  general  practice,  which  positions  he  held  at 
the  time  of  his  death.  On  November  29,  1881,  he 
married  Miss  Cassie  Hadden,  of  Orange  County, 
whom  he  leaves,  with  his  family  and  numerous  friends, 
to  mourn  his  loss.  On  April  lOth,  in  apparent  robust 
health,  he  was  taken  suddenly  and  seriously  ill, 
which  illness  developed  into  cereViro-spinal  menin- 
gitis ;  he  grew  gi-adually  worse  in  spite  of  all  med- 
ical aid,  and  died  April  27th,  about  nine  days  from 
the  onset  of  the  disease.  He  was  a  member  of  the 
Physicians'  Mutual  Aid  Association  and  New  York 
County  Medical  Society,  and  also  a  member  of  the 
Central  Congregational  Church,  New  Y'ork. 

Ethics  in  Consultations. — Our  attention  has  been 
called  to  an  error  concerning  some  remarks  made 
upon  this  point,  in  a  recent  issue  (p.  502).  The 
question  was,  whether  a  medical  man  who  was 
called  in  an  emergency  should  not  give  u]i  the  case 
to  the  family  attendant  on  the  arrival  of  the  latter. 
In  the  case  referre<l  to,  by  an  accidental  transposi- 
tion of  letters,  we  were  made  to  say  the  opposite  of 
■what  we  intended.  The  physician  who  had  moved 
to  the  neighborhood  of  the  patient,  and  who  had 
been  in  attendance  upon  him  for  three  years,  was 
the  family  jihysician,  and  not  the  one  who  had  at- 
tended the  patient  previously.  The  latter  was  called 
in  an  emergency  in  the  absence  of  the  former,  and 
should  not  hold  the  case  unless  specially  asked  to 
do  so  by  the  patient. 

Commencement  of  the  Coli,e(;e  of  Phtsicianr  and 
Surgeons. — The  seventy-fifth  annual  commencement 
of  the  College  of  Phvsicians  and  Surareons,  the  med- 


THE  MEDICAL  EECOED. 


559 


•jcal  department  of  Columbia  College,  was  held  at 
^teinway  Hall  on  Tuesday  afternoon.  The  exercises 
were  begun  with  prayer  by  the  Kev.  Sullivan  H. 
Weston.  Acting  President  Drisler,  of  Columbia 
-College,  conferred  the  decrees,  and  Prof.  Aloii/.o 
Clark,  the  President  of  the  College,  delivered  the 
■opening  address.  The  announcements  of  the  awards 
of  prizes  were  made  by  Prof.  William  H.  Draper, 
President  of  the  Alumoi  Association,  and  by  Prof. 
■John  G.  Curtis,  the  Secretary  of  the  Faculty.  The 
first  prize  of  -SSOO,  for  proficiency  at  examination, 
was  awarded  to  C.  W.  Hunter ;  the  second  prize  of 
•S300  was  awarded  to  James  B.  Taylor ;  and  the 
third  prize  of  .S"200  was  awarded  to  J.  H.  Woodward. 
Mr.  Luther  K.  Jlarsh  delivered  the  address  to  the 
graduates.  The  degree  of  Doctor  of  Medicine  was 
■conferred  upon  one  hundred  and  fourteen  graduates. 

The  Xew  Bellevue  Hospitai/  Medic.il  Bo.\kd. — 
At  a  meeting  of  the  Commissioners  of  Public  Char- 
ities and  Correction,  May  12th,  some  changes  were 
made  in  the  Medical  Board.  ,  These  changes  were 
•chiefly  personal,  no  new  or  radical  alterations  being 
■introduced.  The  service  is  divided  as  before  into 
four  medical  and  four  surgical  divisions.  These  are 
-assigned  to  the  three  large  colleges  of  the  city,  with 
two  divisions  for  the  non-collegiates.  The  position 
of  gynecologist  is  made  more  distinctive,  and  one  of 
these  specialists  is  assigned  to  each  medical  divi- 
sion. The  Medical  Board  is  thus  increased  from 
twenty-four  to  twenty-eight. 

The  rule  is  now  established  that  the  house-stafl' 
■shall  be  apjiointed,  after  competitive  examination, 
in  proportionate  number  from  each  college,  and  from 
"the  non-coUegiate  class.  The  staff  will  be  assigned 
to  the  divisions  ■visited  by  the  physicians  or  sur- 
geons of  their  respective  colleges. 

The  newly  appointed  members  of  the  Medical 
Board  or  vi.siting  staff  are  Drs.  A.  A.  Smith,  F.  L. 
Dennis,  F.  E.  S.  Drake,  J.  W.  Wright,  G.  L.  Pea- 
bodv,  J.  J.  Williams,  W.  G.  Wvlie,  W.  C.  Hunter, 
F.  Lange,  and  W.  K.  Gilette. 

Of  the  old  Board,  Drs.  Jas.  E.  Wood  and  Erskine 
Mason  have  recently  died  ;  Drs.  L.  A.  Sayre  and  A. 
~B.  Mott  retire,  but  become  members  of  the  Consult- 
ing Board. 

The  Amount  of  Aksentc  in  Jennte  Ckasier's 
Body. — Prof.  Chittenden  gives  the  following  as  the 
■result  of  his  examination  of  the  body  of  Jennie  Cra- 
mer, for  arsenic  :  The  57  pounds  of  body  last  exam- 
•ined  contained  1.9J:98  grains.  The  internal  organs 
previously  examined  contained  1.16'Jl.  The  total 
amount  of  arsenic  in  Jennie  E.  Cramer's  body  was, 
therefore,  3.1192  gi-ains.  Prof.  Chittenden  gave  the 
relative  distribution  of  arsenic  in  the  muscle  and 
body  tissue  as  follows  : 

W7i.:te  Arsenic. 
Grain. 

1  pound  sampled  thigh-bona  contained 000 

1  pound  sampled  leg  contained Oil 

1  pounil  samj^led  transverse  section  contained.    .021 

1  pound  sampled  arm  contained 034 

1  pound  sampled  muscle  from  breast  contained  .087 
1  pound  samjjled  muscle  from  back  contained.  .260 
He  stated  that  the  distribution  of  arsenic  in  the 
muscle  and  bony  tissue  was  somewhat  peculiar,  as 
was  the  distribution  in  the  throat  and  tongue  and 
also  in  the  kidneys.  From  these  points  a  tosicolo- 
gist  is  sometimes  enabled  to  draw  conclusions  as  to 
the  length  of  time  arsenic  has  been  in  the  body 
before  death.  A  marked  feature  was  the  absence  of 
I    arsenic  in  the  thigh-bone,  and  the  large  quantity  in 


the  tissue  of  the  back.  The  striking  feature  of  the 
matter  was  the  \ineven  distribution  of  the  poison 
through  the  tissue  of  the  same  kind.  The  trachea, 
laiTux,  and  tongue  contained  nearly  four  times  as 
much  as  both  kidneys.  Again,  the  amount  in  the 
trachea,  larynx,  and  tongue  was  nearly  equ.il  to  the 
amount  in  the  entire  left  arm,  which  weighed  nearly 
two  pounds  and  a  half.  The  amount  in  the  .stomach 
and  intestines  was  more  than  half  the  amount  in  the 
entire  internal  organs.  From  all  this  he  was  led  to 
the  opinion  that  the  arsenic  found  could  not  have 
Been  in  the  body  a  long  time  before  death — not 
longer  than  24  hours. 

Prof.  Chittenden  said  :  "  There  are  certain  data 
as  to  the  probable  form  in  which  arsenic  may  have 
been  taken  by  decedent.  My  opinion  is  that  it  was 
given  in  a  soluble  and  diffusible  form.  My  opinion 
is  based  first  on  the  amount  of  arsenic  in  the  brain. 
In  one-third  of  the  brain  I  found  .0255  of  a  gi'oin  of 
white  oxide  of  arsenic.  Taking  even  that  quantity 
and  neglecting  the  remaining  two-thirds,  the  amount 
is  exceptionally  large  in  my  experience.  The  rule, 
as  based  on  my  own  experience  and  on  the  published 
results  of  other  investigations,  is  that  arsenic  taken 
as  white  oxide  or  in  other  insoluble  forms  is  never 
found  in  the  brain,  either  in  acute  or  chronic  cases 
of  arsenic  poisoning,  in  other  than  very  small  traces, 
whereas  when  arsenic  is  taken  in  the  form  of  a  sol- 
uble and  diffusible  compound,  which  can  readily 
pass  into  the  blood,  the  quantity  found  in  the  brain 
is  generally  very  much  larger,  the  reason  being  that 
when  the  arsenic  is  in  a  form  soluble  with  difficulty, 
enough  cannot  pass  into  the  blood  at  any  one  time 
to  allow  of  any  great  accumulation  in  the  brain, 
since  it  is  very  readily  eliminated — thrown  out  of 
the  body  by  the  kidneys.  This  opinion  is  partly 
based  on  results  obtained  by  French  and  German 
chemists,  corroborated  by  rejieated  experiments  of 
my  own.  The  second  point  which  influences  me  in 
my  opinion  as  to  the  form  in  which  the  arsenic  was 
taken  is  the  large  quantity  found  in  the  muscular 
tissue  of  the  back.  The  third  point  is  that  when 
solid  arsenic  is  taken  microscopic  examination 
usually  reveals  crystals  of  the  poison  on  the  mem- 
brane of  the  stomach  and  intestines. 

The  Late  Pkofessoe  Jajies  E.  Wood,  M.D., 
LL.D. — At  a  special  meeting  of  the  Medical  Board 
of  Bellevue  Hosjutal,  called  on  the  occasion  of  the 
death  of  the  late  Professor  James  E.  Wood,  and 
held  on  the  6th  of  May,  1882,  it  was  resolved  : 

First. — That  by  the  death  of  our  late  associate  the 
Board  has  lost  a  member  whose  services  for  a  period 
of  thirty-five  years  as  an  attending  surgeon  to  this 
Hospital,  and  whose  labors  as  a  clinical  teacher 
have  contributed  largely  to  the  usefulness  of  the 
Institution  in  the  relief  of  suflering  and  in  the  dif- 
fusion of  the  pi'actical  knowledge  of  surgery. 

Second. — The  memory  of  our  late  associate  will 
ever  be  gratefully  cherished  as  the  founder  of  the 
Pathological  Museum  connected  with  this  hospital, 
which  he  enriched  by  the  gift  of  his  large  and  valu- 
able private  collection,  and  which  deservedly  bears 
his  name. 

Thiril. — The  members  of  this  Board  feel  that  by 
the  death  of  the  late  Professor  Wood  they  have  in- 
dividually lost  a  generous,  warm-hearted,  and  stead- 
fast friend,  as  well  as  a  valued  associate ;  and  that 
his  death  leaves  a  void  which  must  rejnain  iinfilled, 
not  only  in  the  hospital,  and  in  the  relations  of 
friendship,  but  in  the  medical  profession  and  in 
social  life. 


560 


THE  MEDICAL  RECORD. 


Fourth. — The  Medical  Board  tenders  the  heart- 
felt sympathy  of  all  its  members  to  the  family  and 
relatives  of  the  late  Professor  "Wood  in  the  loss 
which  they  have  sustained,  together  with  the  hope 
that  they  may  derive  consolation  from  his  merited 
professional  eminence,  his  long  life  of  usefulness, 
his  unblemished  character,  and  his  private  virtues. 
A.  Clark,  President, 
Chables  McBubnet,  Sea-etary. 

A  New  Profession. — In  Europe  young  men  are 
studying  electrical  engineering.  This  profession 
has  not  yet  become  overcrowded. 

Gangrene  from  injury  to  the  Ulnar  Nerve. — 
Dr.  P.  S.  Boot,  of  Monroe,  Michigan,  sends  us  the 
following  history  of  a  unique  case  in  which  gan- 
grene seemed  to  result  from  traumatism  of  the 
ulnar  nerve: 

«'  w.  P ,  forty-seven  years  of  age,  robust,  and 

weighing  two  hundred  pounds,  was  injured  by  a  cir- 
cular saw  on  the  morning  of  November  29, 1881.  The 
wound  was  situated  on  the  anterior  part  of  the  fore- 
arm, extending  from  the  middle  of  the  lower  fourth 
obliquely  upward  and  backward  to  the  ulnar  side 
for  a  distance  of  eight  inches.  The  ulnar  nerve  and 
artery  were  divided,  and  the  ulnar  itself  slightly  in- 
jured. When  brought  to  my  office  I  found  the 
artery  bleeding  freely  from  its  diatal  extremity,  but 
there  was  no  hemorrhage  from  its  proximal  end.  I 
immediately  applied  compression  to  the  brachial 
and  tied  the  bleeding  end  ;  then,  removing  com- 
pression, endeavored  to  find  the  other  extremity, 
but  without  success.  The  wound  was  then  cleaned 
and  dressed,  carbolized  silk  sutures  being  used. 
The  parts  were  brought  into  good  apposition, 
and  carbolized  oil  used.  Three  days  later  the 
wound  looked  healthy,  with  but  little  swelling; 
dressings  were  daily  reapplied  ;  sutures  removed  on 
the  sixth  day.  Union  by  first  intention  was  only 
partial,  but  was  completed  by  granulation,  Decem- 
ber 2ith.  The  parts  supplied  by  the  ulnar  nerve 
below  the  seat  of  injmy  remained  paralyzed,  but  the 
circulation  and  temperature  of  entire  hand  was,  and 
had  been,  good  from  the  first.  No  hemorrhage  oc- 
curred from  the  untied  artery,  nor  was  there  any 
sloughing  of  tissues  in  or  about  the  wound.  There 
was  no  swelling  of  the  hand  or  fingers,  and  some 
power  of  flexion  had  been  regained  over  the  second, 
ring,  and  little  fingers  (the  ones  whose  tendons  were 
divided),  owing  to  union  above.  The  case  was  dis- 
charged as  cured,  the  patient  being  directed  to  use 
the  hand  moderately,  by  working  the  fingers,  rub- 
bing, etc.  On  .January  0, 1882,  the  patient  returned, 
stating  that  his  hand  pained  him.  Upon  examina- 
tion, the  ulnar  side  of  hand  and  little  finger  (inner 
side)  wore  found  gangrenous  ;  the  back  of  the  liand 
was  swollen  and  cedematous,  the  fingers  all  liaviug 
that  tallowy  appearance  so  common  in  imjiending 
gangrene.  The  constitutional  symptoms  were 
quite  marked,  pulse,  KU;  temperature,  100$ "  P.;  witli 
loss  of  appetite,  etc.  Patient  stated  that  he  had 
been  getting  on  nicely  until  two  days  before,  when 
he  noticed  a  large  blister  over  the  gangrenous  area. 
"  A  charcoal  and  flax-seed  poultice,  with  perman- 
ganate of  potash,  was  ordered,  and  pills  of  hydrarg. 
iodid.  and  quinine  given  every  six  hours.  Next  day 
there  was  improvement,  and  the  progress  of  the 
gangrene  was  stopped.  A  slough  half  an  inch  deep 
finally  came  away,  and  granulation  slowly  fol- 
lowed. By  February  7th  the  wound  had  healed. 
"  We  have  liore,"  writes  Dr.  Boot  in  conclusion. 


"  a  case  of  gangrene  without  other  assignable  cause 
than  traumatic  paralysis — gangrene  without  the 
least  implication  of  the  oi'iginal  wound,  and  in  a 
member  in  which  circulation  and  temperature  were 
apparently  normal.  This  point  seems  proven,  in 
that  at  time  of  original  injury,  the  anastomotic  com- 
munication, well  known  to  exist  between  the  ulnar 
and  radial  arteries,  was  amply  demonstrated.  Again 
the  disease  was  very  late  in  appearing,  and  did  not 
extend  to  the  extremity  of  the  little  finger.  Every 
care  was  taken  to  prevent  any  compression  of  hand 
by  bandaging,  and  no  exposure  to  cold  was  allowed. 
No  disease  of  the  arteries  was  evident,  and  the  pa- 
tient, in  every  way,  was  seemingly  healthy. 

"rinally,  the  treatment,  though  old,  deserves  at- 
tention. In  this  case  there  was  not  the  slightest 
hope  that  the  arm  could  have  been  saved,  but  for 
the  use  of  the  poultice.  The  internal  treatment  after 
first  prescription  was:  Quin.  sulph.,  I  ss.;  rliei.  pulv., 
3j.;  est.  nucis  vom.,  gi\  ii.;  M.,  Ft.  in  Caps.  No.  10; 
S.,  one  ter.  in  die.  This  was  continued  until  the  slough 
separated.  Had  this  case  been  one  of  hospital 
practice,  I  do  not  hesitate  to  say  amputation  would 
have  been  recommended  and  performed  ;  therefore, 
so  much  for  consei-vative  surgery." 

On  Selectino  Spectacles. — Dr.  Eeynolds  makes 
some  sensible  remards  on  this  point  in  the  Medical 
Hernhl.  He  says  :  "  Few  persons,  not  directly  con- 
cerned, know  how  difficult  it  is  to  get  spectacle 
lenses  properly  ground.  It  is  the  common  belief 
that  all  jewellers  are  opticians,  and  spectacle-ped- 
dlers are  experts  in  optics.  An  instrument  devised 
by  Professor  Snellen,  of  Utrecht,  enables  one  to  de- 
termine with  almost  perfect  exactness,  the  powers 
and  quality  of  refracting  lenses.  This  instrument, 
the  phakometer,  shows  that  nearly  all  the  glasses 
sold  in  frames  ready-made,  are  but  poor  imitations 
of  the  real  thing  for  which  they  are  sold. 

"  Crown  glass,  and  not  pebble,  is  the  only  proper 
material  for  spectacle  lenses.  The  only  lenses  fit 
for  use  are  those  made  to  order  by  some  fixed  sys- 
tem of  grading  the  refracting  power. 

"It  is  often  observed  that  the  common  lenses 
hawked  about  the  country  as  diamond,  cri/stal,  etc., 
are  the  poorest  (piality  of  glass,  so  imperfectly  ground 
as  to  represent  .sectors  having  different  degrees  of 
refraction  in  the  diflerent  parts  of  the  lens.  It  is 
quite  rare  to  find  in  tliese  an  equal  refracting  power 
in  the  two  glasses  in  the  same  frame.  Persons  who 
need  glasses  to  correct  presbyopia,  are  not  likely  to 
require  anything  like  accuracy,  unless  they  are  given 
to  literary  habits.  Persons  who  read  much  soon 
find  that  the  ordinary  glasses  of  commerce,  and 
those  peddled  by  the  'professors  of  optics,'  are  not 
adequate,  and  seek  the  aid  of  a  practitioner  of  oph- 
thalmic medicine  who  is  able  to  distinguish  between 
muscular  asthenopia  and  neuralgia." 

Physicians  who  do  not  Bead.— Whether  they  are 
too  busy,  or  too  illiterate,  or  that  they  are  not  yet 
beyond  the  influence  of  their  earlier  haliits  and  asso- 
ciations, it  seems  to  be  a  fact,  if  implicit  reliance 
can  be  placed  on  a  recent  statement  in  the  columns 
of  our  contemporary,  the  Si.  Louis  Vfdicn}  and 
Surfjicnl  Journal,  that  scarcely  one-half  of  the  twenty- 
six  thousand  physicians  practising  in  the  Western 
and  Southwestern  States  take  a  medical  journal  of 
any  kind.  Of  these,  one-half,  it  states,  take  the 
cheapest  medical  journal  they  can  obtain,  so  cheap, 
indeed,  that  it  will  be  sent  to  them  whether  it  is 
paid  for  or  not. —  College  and  Clinical  Record. 


Vol.  XXI.-No.  21. 
May  87,  1883. 


THE  MEDICAL  RECORD. 


561 


Original  Comtitunicfttions. 


THE  SURGICAL  TREATMENT  OF  CHRONIC 
NASAL  CAT.^EH.* 

By  WILLIAM  C.  JARVIS,  M.D., 


Ujttid  recently  few  diseases  have  given  rise  to  more 
dissatisfaction  in  their  treatment  than  chronic  nasal 
catarrh.  Nor  does  this  .seem  strange  when  we  learn 
that  the  practice  of  posterior  rhinoscopy,  the  most 
important  of  all  nasal  examinations  in  diagnosing 
the  extent  and  chronicity  of  this  disease,  and  per- 
forming the  necessary  operations  for  its  radical  cure, 
is  seldom  practised  even  by  the  specialist  abroad, 
and  is  largely  confined  to  the  laryngologist  in  this 
country. t 

I  would  also  a;ttribute  much  of  the  failure  which 
has  followed  the  treatment  of  chronic  nasal  catarrh 
to  the  slight  importance  that  is  attached  to  an  in- 
telligent ditferentiation  of  the  various  conditions 
found  in  this  disease,  the  recognition  of  which  is  of 
pre-eminent  importance  in  the  determination  of  the 
best  means  for  relief  or  cure.  Dr.  Frederic  I.  Knight, 
instructor  of  laryngoscopy  in  Harvard  University, 
in  an  article  devoted  to  the  consideration  of  one  of 
the  operations  J  I  projjose  to  present  to  you  this 
evening,  mentions  nasal  catarrh  as  one  of  theoppro- 
bia  medicin;e.  "The  physician,"  he  writes,  "felt 
annoyed  on  being  asked  to  prescribe  for  it,  and  per- 
haps almost  vexed  with  his  patient  for  having  such 
a  thing.  The  patient,  deriving  no  relief  from  snif- 
fing up  salt  water  or  chlorate  of  potash,  soon  took 
to  empirical  remedies,  and  the  worst  sufferers  have 
usually  tried  faithfully  all  the  vaunted  specifics  in 
turn."  He  adds  that  "  the  removal  of  these  (turbi- 
nated) hyi^ertrophies  constitutes  one  of  the  greatest 
advances  yet  made  in  the  treatment  of  the  affections 
of  this  region  (nares)." 

I  I'ecognize  and  will  speak  of  five  tissue  forma- 
tions which  occur  with  unequal  fi-equency  in  chronic 
nasal  catarrh,  but  whenever  found  are  invariably  as- 
sociated with  the  disease.  They  are  hypertroi^hy 
of  the  tissues  over  the  tui-binated  bones,  thickening 
of  the  tissues  over  the  nasal  septum,  deviation  of 
the  cartilaginous  septum,  gelatinous  polypi  and 
adenoma  of  the  vault  of  the  pharynx. 

Chronic  nasal  catarrh  is  always  accompanied  by 
hypei-trophic  changes  of  the  intra-nasal  tissues ; 
hence  the  disease  is  frequently  termed  Hypertrophic 
Nasal  Catarrh.  The  princijial  tissues  involved  in 
these  inflammatory  changes  are  those  overlying  the 
turbinated  bones.  There  is  never  any  difficulty  in 
diagnosing  pure  turbinated  hypertrophies.  They 
may  of  course  involve  any  or  all  of  the  three  turbi- 
nated bones.  They  generally  show  themselves  as 
smooth  white  or  light  pink  masses  of  tissue  en- 
croaching more  or  less  upon  the  normal  calibre  of 
the  nostril,  and  can  always  be  recognized  by  their 
gross  appearance.  Should,  however,  engorgement 
of  the  turbinated  tissues  have  occun-ed  previous  to 
the  examination,  the  determination  of  the  amount 
of  simple  hypertrophy  may  sometimes  prove  diffi- 
cult, for  it  will  be  largely  masked  by  the  congestion. 

When  there  is  any  uncertainty  in  these  cases,  it 

•  Renil  before  the  .Medical  Society  o{  the  County  of  New  York,  May 
22.1682. 
t  Wm.  N.  Daly,  M.D.,  Archives  of  LarynRology,  April  1,  ISS2. 
t  Philadelphia  Medical  News,  January  21,  1882. 


is  often  advisable  to  wait  rather  than  take  the  risk 
of  removing  undiseased  tissue. 

Congestive  hypertrophies,  however,  are,  as  a  rule, 
readily  recognized. 

I  do  not  consider  every  permanent  enlargement 
of  the  turbinated  tissues  an  hypertrophy.  The  phys- 
iological alterations  in  shape  and  size  of  normal  tur- 
binated tissue  is  transient  in  its  nature,  and  depend- 
ent, more  or  less,  upon  the  degree  of  irritation  to 
which  it  is  subjected.  Hence  thei-e  must  be  a  con- 
tinuous progression  and  retrogression  in  these  tis- 
sues as  a  part  of  their  physiological  function.  It  is 
ofily  necessary  to  watch  the  movements  of  turbi- 
nated tissues,  irritated  by  means  of  a  probe,  to  be 
convinced  of  this.  Careful  observation  has  induced 
me  to  believe  that,  in  many  cases  of  so-called  hyper- 
trophy of  the  turbinated  tissues,  the  increase  in 
size  is  due  more  to  a  loss  of  retractile  power — a  sort 
of  paresis — than  to  distinct  pathological  changes  in 
the  substance  of  these  erectile  structures.  This  will 
serve  to  explain  the  existence  of  large,  soft,  sessile 
anterior  and  posterior  hypertrophies,  which,  under 
the  microscoxie,  show  a  remarkable  di.stintion  of 
the  turbinated  corpora  cavernosa.  These  cavernous 
sinuses,  after  section  with  the  wire,  pour  out  the 
contained  blood,  and  collapse  without  further  hem- 
orrhage ;  in  this  respect  widely  differing  from  the 
true  turbinated  hypertrophy,  so  liable  to  bleed,  as 
does  also  the  normal  turbinated  tissue. 

Hypertrophy  of  the  turbinated  tissue,  though 
slight  in  the  recent  stage  of  the  catarrhal  affection, 
steadily  increases  with  a  rapidity  depending  upon 
the  degree  of  irritation  and  congestion  to  which 
the  nasal  mucous  membrane  is  subjected,  until,  as 
sometimes  happens,  the  nasal  tissues  will  be  found 
to  have  enlarged  to  such  an  extent  as  to  completely 
block  up  the  posterior  nares.  Owing  to  their  in- 
ferior position,  the  tissues  ovm-  t?ie  lower  turbinate  be- 
come more  hypei-trophied  than  those  over  the^  other 
bones. 

Indeed,  so  great  is  this  tendency  of  the  inferior 
turbinate  to  become  hypertrophied,  that  I  have 
been  induced  to  adopt  the  rule  of  looking  for  an  in- 
crease in  its  dimensions  as  an  indication  of  the  ex- 
tent and  chronicity  of  the  disease.  This  peculiarity, 
I  think,  may  be  largely  attributed  to  the  action  of 
acrid  nasal  secretions  collected  about  and  retained 
in  contact  with  their  surfaces  ;  on  account  of  the 
obstruction  in  the  nares,  the  removal  of  this  secre- 
tion is  rendered  extremely  difficult  or  even  impos- 
sible, as  the  means  usually  made  use  of  for  that 
purpose,  that  of  forced  inspiration  and  expiration, 
cannot  here  be  brought  into  play.  Hence  a  slight 
amount  of  hypertrophy  of  the  tissues  over  this  bone 
is  often  met  with  when  there  is  no  perceptible  in- 
crease in  the  size  of  the  others. 

Hypertrophy  of  the  tissties  over  the  posterior 
portions  of  the  turbinated  bones  is  more  frequently 
met  with  than  any  of  the  other  forms  of  hypertrophy. 

Posterior  turbinated  hypertrophy  is  of  such  com- 
mon occuiTence  that  I  have  been  forced  to  recog- 
nize it  as  a  distinct  peculiarity  of  the  disease, 
especially  when  it  is  connected  with  enlargement  of 
the  inferior  turbinate.  It  is  more  frequently  found 
standing  alone  in  the  summer  than  in  the  winter 
months.  Occasionally,  however,  the  tissues  over 
the  anterior  parts  of  the  turbinated  bones  will  be 
found  to  be  hypertrophied  to  a  considerable  extent, 
while  the  deeper  portions  are  but  slightly  affected. 
I  have  therefore  divided  hypertrophy  of  the  tissues 
over  the  turbinated  bones  into  two  varieties — an- 
terior and  posterior  hypertrophy. 


562 


THE  MEDICAL  RECORD. 


As  the  surgical  treatment  of  each  variety  is  diifer- 
ent,  the  division  will  be  found  a  convenient  one. 

Next  in  the  order  of  my  divisions  comes  thicken- 
ing of  the  tissues  over  the  septum. 

I  know  my  making  special  mention  of  this  pecu- 
liarity as  an  important  feature  of  the  disease  may 
cause  some  surprise,  but  my  convictions  do  not 
come  from  sudden  inspiration,  they  are  the  result  of 
careful  study,  comparison,  and  experiment.  By  the 
phrase  hypertrophy  of  the  tissue  over  the  septum,  I 
at  once  do  away  with  a  large  proportion  of  the  so- 
called  cases  of  deflection  of  the  septum.  In  adidt 
patients  these  thickened  tissues  can  sometimes  be 
traced  as  resulting  from  an  in.significant  nodule  of 
projecting  c  vrtilage  in  early  life,  perhaps  the  result 
of  an  injury.  This  cartilaginous  spur,  however,  would 
be  of  much  consequence  in  the  nose  of  a  child,  since 
the  small  size  of  its  nostril  would  tend  to  bring 
about  contact  with  the  turbinated  structures  op- 
posite, producing  an  irritative  hypertrophy,  its  size 
depending  upon  the  extent  and  chronicity  of  the 
local  subinliammatory  process. 

"We  may  also  have  localized  thickenings  of  the  mu- 
cous membrane,  over  the  cartilaginous  septum  and 
vomer,  resulting  from  the  direct  pressure  of  hyper- 
trophies or  frequently  tumefied  turbinated  tissue. 

A  certain  amount  of  turbinated  hypertrophy  is  al- 
ways discoverable  in  these  cases,  and  the  thickened 
tissues  lying  opposite  are  usually  localized  and  cor- 
respond in  their  extent  with  the  amount  of  turbi- 
nated hypertrophy. 

This  drawing  is  enlarged  from  the  careful  sketch 
of  a  patient.  You  observe  the  left  post-nasal  orifice 
is  occupied  by  a  posterior  hypertrophy,  above  the 
upper  edge  of  which  is  faintly  outlined  an  incijjient 
thickening  of  the  tissue  over  the  vomer.  The  in- 
ferior turbinated  tissue  in  the  right  naris  has  par- 
tially retracted,  leaving  on  the  vomer  opposite  its 
impress,  a  cuj^-shaped  mass  of  thickened  tissue. 
(This  same  condition  can,  of  course,  occur  in  an- 
terior hypertrophy.) 

Deviation  of  the  nasal  septum  may,  of  course,  be 
osseous  or  cartilaginous.  Deviation  of  the  bones 
which  form  part  of  the  septum,  is  seldom  sufficient 
to  give  rise  to  any  immediate  discomfort.  It  may, 
however,  be  the  cause  of  hypei-trophy  of  the  super- 
imposed tissues,  which  in  turn  may  lead  to  a  chronic 
nasal  catarrh.  Hence  I  can,  without  inconvenience, 
exclude  from  my  system  of  operations,  the  removal 
of  deviations  of  the  plate  of  the  ethmoid,  vomer,  and 
osseous  spurs  of  the  superior  maxilla,  since  exci- 
sion of  the  overlying  tissue  renders  their  removal 
unnecessary. 

Deflection  of  the  triangular  cartilage  and  colurana 
of  the  septum  are,  on  account  of  their  activity  as 
agents  in  the  production  of  catarrh,  of  extreme  im- 
portance. 

As  the  undisturbed  foreign  body  in  tlie  nose  of  a 
child  is  invariably  the  cause  of  a  chi-onic  nasal 
catarrh,  so  the  neglected  cartilaginous  splinter — a 
deviated  septum — must  load  with  absolute  certainty 
to  the  same  result.  The  nares  may  be  in  all  other  re- 
spects symmetrical,  and  the  person  in  perfect  health ; 
but  I  believe  it  impossible  for  tlie  delicate  nasal 
tissue  to  withstand  so  powerful  and  permanent  an 
irritant.  The  trouble  frequently  dates  from  a  l)low 
received  u|)on  the  nostril.  These  cases,  as  a  rule, 
give  the  most  favorable  results  when  intelligontly 
treated  by  my  method  of  operating,  as  they  so  often 
occur  in  persons  otherwise  healthy.  The  mere  re- 
moval of  the  cause  of  the  difsease  must  lead  to  a 
epontaneous  cure. 


I  have  found  it  convenient  to  divide  deviation  of 
the  cartilaginous  septum  into  two  varieties,  local- 
ized and  general. 

Localized  deflection  of  the  septum  usually  occurs 
in  the  form  of  the  peculiar  deformity  produced  by 
displacement  of  the  columna  nasi.  It  does  not 
always  set  up  catarrh  by  irritating  the  nasal  mu- 
cous membrane,  for  it  may  be  entirely  outside  of 
the  nasal  cavity.  Even  in  these  cases  its  excision  is 
often  called  for  to  remove  the  distressing  defonnity. 

General  deviation  of  the  septum  may  occur  in  the 
form  of  a  sigmoid  deflection;  in  which  case  both  the 
up23er  and  lower  margins  of  the  septum  show  a 
marked  convexity,  or  a  large  ma.ss  of  the  triangular 
cartilage  may  be  projected  toward  or  against  the 
nasal  wall. 

There  always  exists  a  corresponding  concavity 
in  marked  general  deviations.  On  the  contrary, 
in  the  tissue  formations  occurring  over  the  septum, 
no  such  depression  can  be  found. 

The  wavy  outline  given  to  the  septum  by  alternate 
masses  of  thickened  tissue,  in  the  cork-screw  nos- 
tril, may  simulate  these  depressions,  but  a  careful 
examination  will  result  in  their  easy  difl'erentiation. 

In  including  gelatinous  polypi  under  the  head  of 
nasal  catarrh,  I  am  aware  of  the  fact  that  they  are 
generally  considered  and  treated  as  an  indepen- 
dent variety  of  growths.  I  would  be  justified  in 
speaking  of  them  in  this  connection,  were  I  to 
give  as  my  only  reason  the  production  of  nasal  ca- 
tarrh by  their  action  as  foreign  bodies  within  the 
nostril.  I  am  convinced  that  gelatinous  nasal  polypi 
often  occur  as  a  secondary  manifestation  in  nastJ 
catarrh.  A  few  months  ago  I  devoted  much  time 
and  labor  in  removing  a  large  mass  of  thickened 
tissue  overlying  the  septum.  The  patient  was  suf- 
fering with  chronic  nasal  catarrh.  The  left  nostril 
was  principally  involved,  and  an  operation  was  un- 
dertaken to  relieve  an  intense  hemicrania  which 
invariably  afflicted  the  patient  in  damp  weather.  I 
eventually  opened  a  way  to  the  superior  meatus, 
and  found  a  cluster  of  glistening  bead-like  gelati- 
nous polypi  occupying  the  roof  of  the  nostril,  which 
were  removed  and  cauterized  with  chromic  acid. 
I  discovered  that  these  were  the  cause  of  severe 
headache,  for  the  patient  was  at  once  relieved. 
"While  recognizing  the  hygrometric  nature  of  the 
growths  as  explaining  the  peculiar  !-yni])toms,  I  be- 
lieve the  thickened  septtim-tissues  and  the  attendant 
nasal  catarrh  induced  the  formation  of  the  polypi. 

I  have  been  impressed  by  the  peculiar  resem- 
blance the  surface  of  tlicse  growths  sometimes  V)ear8 
to  the  mucous  membrane  over  hyportro]>hies  and  in 
other  parts  of  the  nasal  cavity.  Although  the  major- 
ity of  nasal  polyjji  show  little  more  thiin  the  familiar 
gelatinous  translucency,  I  have  met  with  a  few  of 
large  size  having  a  membranous  envelope,  containing 
numerous  meshes  of  distinctly  outlined  bloodvea- 
sels.  The  bloodvessels  diverged  from  the  jjedicles 
of  the  polypi,  and  were  apparently  a  part  of  the  nasal  m 
mucous  membrane  extended  over  their  surface,  in  "' 
this  respect  presenting  an  analogy  to  the  genernl 
structural  changes  which  occur  in  hypertrophic  nasal 
catarrh. 

Adenoma  of  the  vault  of  the  pharynx  resembles 
closely  the  ordinary  glandular  hypertrophical  faucial 
tonsil.  It  is  closely  associated  with  the  hyper- 
trophic changes  occurring  in  the  posterior  nares, 
and  should  therefore  be  included  among  nasal  hy- 
pertrophies. In  the  practice  of  posterior  rhinoscopy, 
it  is  only  necessary  to  follow  the  U))ward  sweep  of 
the  post-nasal  arches  to  bring  these  glandular  masses 


I 


THE  MEDICAL  RECORD. 


563 


in  view.  Although  holding  an  important  place  in 
modern  medical  literature,  they  are,  so  far  as  mv  ob- 
servation goes,  of  infrequent  occurrence  when  com- 
pared with  other  structural  changes  in  hypertrophic 
nasal  catarrh.  Hence,  though  recognizing  them  as 
a  feature  of  the  disease,  I  would  assign  them  ajtlace 
of  secondary  importance. 

Instruments  for  the  operations.— The  fcraseur  con- 
sists of  a  long  and  short  canida,  the  latter  of  which 
glides  over  a  screw  thread  cut  on  the  former.  A 
milled  nut,  fitting  this  thread,  is  intended  to  push 
the  outer  canula  before  it.  Well-tempered  steel 
wire  (No.  5  piano  gauge)  is  drawn  through  the  large 
canula,  and  its  ends  are  attached  to  the  retention 
pins  on  the  small  one.  As  the  outer  canula  cannot 
turn,  there  is  no  twisting  of  the  ^\'ire  loop  formed. 

The  combined  mirror  and  tonf/tte  depressor .  — A 
stout  wire,  after  being  made  to  divide  and  assume 
the  form  of  a  tongue  depressor,  is  crossed  upon  it- 
self and  then  shaped  into  a  pincette.  MiiTors  of 
different  sizes  are  received  between  the  pincette's 
blades.  These  mirrors  can  be  placed  at  any  desir- 
able angle  with  the  shaft.  The  hinge-joint  will 
permit  the  mirror  to  be  fixed  at  the  most  favorable 
angle  for  viewing  the  posterior  nares,  and  at  the 
same  time  facilitate  even  depression  of  the  tongue. 

This  instrument  will  be  sometimes  found  a  con- 
venient one.  as  it  enables  the  operator  to  bring  the 
posterior  nares  in  view  with  one  hand,  leaving  the 
other  free  for  the  maniijulation  of  the  I'craseur. 

The  tape-holders  are  intended  to  take  the  place  of 
the  unsatisfactory  and  disagreeable  procedure  of 
tying  the  ends  of  the  tape  which  pass  around  the 
soft  palate  in  cases  requiring  this  procedure. 

They  are  two  small  V-shaped  spring  clips  so  ar- 
ranged that  the  tape  passing  through  apertures  in 
its  blades  is  caught  by  a  tooth-like  projection  and 
firmly  held.  Pressure  on  the  spring  releases  the 
catch  and  sets  the  tape  free.  The  transfixion  needle-s 
need  no  special  description.  They  are  pointed  like 
the  ordinary  glover's  needle. 

Four  different  sizes  are  made,  running  from  one  to 
four  inches  in  length.  Each  number  has  a  straight 
needle,  and  three  others  of  varying  curves.  They 
are  all  furnished  with  a  light  convenient  handle. 

The  septum  scissors  are  light  insti-uments  with  the 
blades  curved  almost  at  a  right  angle,  in  order  to 
enable  the  operator  to  obtain  an  easy  view  of  the 
cartilage  to  be  removed. 

One  instrument  is  made  somewhat  after  the  pat- 
tern of  Eighardson's  mouse- toothed  scissors,  the 
other  has  a  sharp  beak  upon  the  upper  blade, which 
sinks  into  the  tissue  of  the  septum,  and  thus  enables 
the  scissors'  blades  to  retain  their  gi"asp,  while  cut- 
ting through  the  cartilage. 

A  ring  in  the  fixation  blade  is  intended  to  slip 
over  the  middle  finger  while  the  knob  on  the  movable 
blade  is  managed  with  the  thumb. 

This  simple  arrangement  enables  one  to  hook  and 
divide  the  cartilage  of  the  septum  with  great  fa- 
cility. 

I  shall  now  speak  of  the  method  of  dealing  with 
the  fir.st  condition  mentioned  in  my  paper,  and  will 
ask  your  attention  to  the  operation  devised  by  me  for 
the  removal  of  posterior  hypertrophies. 

The  operation  depends  upon  the  shape  of  the 
hypertrophied  turbinated  bones. 

The  posterior  surfaces  of  these  bones,  especially 
the  inferior,  show  a  peculiar  constriction  foimed  by 
the  hypertrophied  tissue  extending  backward  into 
the  upper  pharynx.  The  extreme  point  of  the 
growth  is  thus  thrown  beyond  its  base. 


This  constriction  forms  a  [nidus  for  the  retention 
of  the  ecraseur  wire. 

THE   OPEKATION. 

In  iising  the  fcraseur,  pass  the  two  ends  of  the 
wire  through  the  main  canula,  entering  them  at  its 
distal  extremity,  and  twist  them  around  the  reten- 
tion pins.  A  loojj  is  formed,  whose  size,  of  course, 
depends  upon  that  of  the  growth.  Giving  the  wire 
loop  a  twist  toward  the  side  of  the  nose  occujiied  by 
the  growth,  it  is  fixed  by  a  turn  of  the  nut  and 
jiassed  into  the  nostril. 

Holding  the  rhinoseopic  mirror  in  one  hand,  the 
position  of  the  wire  loop  in  the  posterior  nares  is 
carefully  watched,  while  it  is  steadily  advanced  with 
the  other  hand  until  seen  to  encircle  the  growth. 
On  drawing  the  wire  home  the  tissue  is  cleanly  divid- 
ed, and  if  not  too  large  to  pass  through  the  nares, 
it  will  generally  be  drawn  out  clinging  to  the  snare. 
Alake  traction  very  slowly,  stopping  at  short  inter- 
vals, in  order  to  prevent  hemoiThage.  If  the  nostril 
is  obstructed  by  a  deviated  septum,  or  narrowed  by 
any  other  caiise,  it  may  be  necessaiw  to  introduce 
the  wire  sheathed  in  the  main  canula,  when,  by  pro- 
jecting the  loop  within  the  naso-pharyngeal  space, 
the  gi-owth  can  be  readily  snared. 

The  hemorrhage  is  trilling,  provided  slow  traction 
is  made. 

So  much  for  the  removal  of  posterior  hypertro- 
phies. Soft  .sessile  hypertrophies  occurring  in  any 
part  of  the  nostril  can  be  easily  removed,  as  the 
wire  readily  sinks  into  the  tissue  and  takes  firm 
hold  on  the  growth.  Firm  non-pedunculated  jjos- 
terior  hypertropliies  require  both  f  craseur  and  trans- 
fixion needle.  In  using  the  transfixion  needle,  the 
amount  of  tissue  requiring  removal  is  carefully  de- 
termined, and  the  point  of  the  needle  directed 
accordingly.  The  loop  will  be  caught  by  the  point 
of  the  needle  projecting  into  the  nostril,  and  a  few 
turns  of  the  milled  nut  causes  the  wire  to  sever  the 
transfixed  tissue.  In  transfixing  posterior  hyper- 
trophies, the  position  of  the  needle's  point  can  be 
determined  by  the  rhinoseopic  mirror.  Cuiwed 
needles  should  be  used  in  transfixing  anterior  hy- 
pertrophies, in  order  to  bring  the  needle's  point 
into  view.  A  little  practice  will  enable  one  to  deter- 
mine when  complete  transfixion  has  taken  place,  by 
the  touch  in  cases  where  the  needle's  point  cannot 
be  seen.  Xasal  hypertrojihies  of  eveiy  size  and 
description  can  be  permanently  got  rid  of  by  this 
simple  method.  The  discomfort  caused  in  removing 
these  growths  will  vary  with  the  susceptibility  of  the 
patient  to  pain  and  the  amount  of  care  used  in  ma- 
nipulating the  ecraseur.  Patients,  as  a  rule,  declare 
they  do  not  sufler. 

A  pledget  of  cotton  thrust  into  the  nostrU  will 
generally  suffice  to  control  any  slight  hemorrhage 
that  may  occur.  It  is  not  necessary  to  exercise 
much  care  to  prevent  bleeding  from  anterior  hyper- 
trophies, as  the  hemorrhage  is  but  transient.  On 
the  contrary,  much  time  and  caution  is  requu'ed  in 
removing  jiosterior  hypertrophies,  as  a  protracted 
and  profuse  flow  of  blood  may  follow  the  excision 
of  these  tissues. 

RESULTS   OF   THE   OPERATIONS. 

The  immediate  result  of  the  operations  is  a  resto- 
ration of  free  nasal  respiration.  As  the  nature  of  tur- 
binated hypertrophies  renders  their  return  almost 
impossible,  the  establishment  of  free  nasal  breathing 
is  permanent.  Since  the  most  intense  inflammatory 
processes  are  centred  in  the  tumefied  tissues,  their 


564 


THE  MEDICAL  RECORD. 


removal  does  away  with  the  active  source  of  the 
disease.  The  remarkable  cessation  of  the  catarrhal 
secretion  which  often  follows  the  removal  of  these 
growths,  points  to  the  cause  and  seat  of  the  disease. 
Relief  from  the  pressure  removes  the  discharge. 
The  multiplicity  of  glands  in  the  turbinated  tissue, 
makes  it  unnecessary  to  look  for  any  other  source 
for  the  secretion. 

I  pursue  the  same  method  mentioned  in  anterior 
hypertrophies  in  excising  the  localized  and  general 
thickenings  over  the  septum.  These  projections, 
when  situated  anteriorly  upon  the  triangular  carti- 
lage, can  be  readily  removed.  The  localized  hy- 
pertrophies found  over  the  vomer  are  sometimes 
difficult  to  remove,  as  the  tissue  is  transfixed  and 
snared  when  pictured  in  the  rhinoscopic  mirror. 
Recognizing  the  floor  of  the  nose  as  a  gutter  for  the 
effla.i:  of  the  nasal  secretions,  the  thickened  tissue 
over  the  septum  often  constitutes  one  of  the  most 
serious  obstniotions  to  drainage.  There  is  i^robably 
no  oonditioa  more  favorable  for  the  development  of 
nasal  catarrh  than  a  distorted  nasal  gutter.  Reten- 
tion of  the  nasal  secretions  must  lead  to  the  forma- 
tion of  inspissated  masses  of  mucus,  which  act  as 
most  powerful  intra-nasal  irritants.  It  is  obvious 
that  only  temporary  relief  can  be  obtained  in  these 
conditions  by  the  use  of  cleansing  or  medicated 
sprays. 

Wlien  the  thickened  tissue  is  in  contact  with 
the  outer  wall  of  the  nose,  I  make  use  of  the 
No.  3  curved  transfixion  needle,  which  has  its  jjoint 
at  a  I'ight  angle  with  the  shaft.  By  successively 
hooking  and  snaring  oft'  pieces  of  tlie  septum,  it  is 
possible  to  make  an  opening  into  the  posterior  nares. 
The  patient  practice  of  this  method  has  enabled  me 
to  perforate  even  an  imperforate  nostril.  Deviations 
of  the  cartilaginous  septum  can  be  easily  removed 
in  the  same  manner. 

Especially  brilliant  results  can  be  obtained  in  re- 
lieving the  common  deformity  caused  by  displace- 
ment of  the  cartilage  of  the  columna.  Nasal  stenosis 
caused  by  a  deviated  cartilage  is  always  overcome 
by  the  careful  practice  of  this  method  without  per- 
forating the  septum.  I  would  strongly  urge  this 
pi-oeedure  to  supply  the  place  of  the  now  genei'al 
practice  of  perforating  the  septum  with  a  punch. 
When  the  enthusiastic  advocates  of  this  operation 
explain  away  the  years  of  discomfort  caused  by  the 
collection  and  inspissation  of  nasal  mucus  around 
the  edges  of  these  false  opening.s,  I  may  consider 
their  claims  for  its  suiieriority. 

The  ciiraseur  is  particularly  adapted  for  the  re- 
moval of  gelatinous  polypi.  The  elastic  loop  can 
be  easily  made  to  enter  a  nostril  tilled  witli  impacted 
polypi,  and  the  fine  steel  ring  will,  with  absolute 
certainty,  engage  each  polyp  in  turn  until  the 
meatuses  are  completely  cleared.  It  is  not  necessary 
to  follow  the  loop  with  the  eye,  for  when  oven  a 
small  part  of  the  polyp  has  been  encircled  by  the 
snare,  each  turn  of  the  nut  will  draw  the  wire 
nearer  to  the  pedicle.  I  believe  a  small  jiortion  of 
the  mucous  membrane  at  the  base  of  the  polypus 
is  often  removed  with  the  growth,  thus  effectually 
preventing  its  return.  The  recurrence  of  gelatinous 
polypi  may  be  referred  to  a  development  of  tlie 
emi)ryonic  clusters  I  have  already  spoken  of. 

I  attach  much  importance  to  the  removal  of  every 
vestige  of  a  nasal  polypus,  since  an  apparently  in- 
significant growth  of  the  kind  may,  by  irritation, 
keep  up  a  chronic  nasal  catarrh. 

Professor  Bosworth  has  successfully  removed 
adenomata  of  the  vault  of  tho  pharynx,  by  carrying 


the  doraseur  armed  with  a  large  wire  loop  through 
the  naso-pharyngeal  space  against  the  base  of  these 
glandular  hypertrophies. 

CONCLUSIONS. 

In  concluding,  I  would  urge  the  adoption  of  these 
simple  but  eS'ective  methods  for  the  removal  of 
intra-nasal  gi'owths,  as  they  possess  manifold  ad- 
vantages over  tlie  other  modes  hitherto  recom- 
mended. The  painlessness  of  the  operations  in 
most  cases,  the  small  amoimt  of  blood  lost,  the  ease 
with  which  they  are  performed  and  the  decided  and 
beneficial  results  obtained,  all  combine  to  make 
them  valuable.  The  barbarous  method  of  evulsion, 
with  all  its  train  of  terrible  suffering  and  torn  and 
bleeding  tissues,  needs  no  comment.  The  use  of 
the  ligature  and  injection  of  acids,  followed  by  the 
intended  result,  a  mass  of  putrefying  tissue  in  the 
delicate  organ  of  smell,  cannot  be  too  strongly  con- 
demned. Those  who  have  witnessed  the  manip- 
ulations of  a  galvano-cautery  battery,  with  all  its 
world  of  complicated  attachments  and  ingenious 
movements,  may  with  reason  demand  a  simpler  and 
more  reliable  mode  of  operating.  I  have  intention- 
ally omitted  .some  of  the  minutiw  of  the  operations, 
but  trust  and  believe  that,  by  giving  them  a  fair  trial, 
you  will  be  satisfied  with  the  residts  and  convinced 
that  my  claims  for  their  superiority  are  not  over- 
estimated. 

123  East  Twen-tt-fifth  Stkef.t. 


POISONING  BY  SULPHATE  OF  COPPER— 

ILEMOGLOBINUEIA—DEATH— AUTOPSY. 

By  M.  ALLEN  STARR,  A.M.,  M.D., 

LATE   nOCSE    PHYSICIAN,    BELLEVCE   nOSPITAl,. 

The  patient,  a  well-nourished  woman,  aged  forty- 
six,  took  about  one  ounce  of  sulphate  of  copper  dis- 
solved in  tea,  at  9  p.m.,  December  13th,  with  suici- 
dal intent.  As  soon  as  she  had  swallowed  it,  she 
felt  a  burning  sensation  in  her  stomach  and  all  over 
her  body,  and  becoming  alarmed  she  told  a  neigh- 
bor, who  summoned  a  policeman.  He  took  her  at 
once  to  a  station-house.  On  the  way  she  vomited 
three  or  four  times,  and  before  reaching  it  began  to 
feel  very  weak  and  to  suffer  from  severe  pain  and 
cramps  in  her  stomach.  At  the  station-house  she 
was  given  stimulants,  and,  on  the  arrival  of  the  am- 
bulance-surgeon, large  draughts  of  warm  water  and 
flour.  This  produced  free  eniesis.  At  11  p.m.,  two 
hours  after  taking  the  poison,  she  was  brought  into 
Bellevue  Hospital. 

On  admission,  patient  was  very  weak  and  unable 
to  stand  or  to  walk.  Her  surface  was  cool  and  dry ; 
pulso,  full,  strong,  112  per  minute ;  respiration 
natural,  21:  per  minute.  She  complained  of  faint- 
ness,  and  of  cramps  in  her  stomach  and  legs.  She 
was  put  to  bed  at  once,  and  the  tube  of  the  stomach- 
pump  having  been  introduced,  the  stomach  was 
washed  out  with  warm  water.  It  was  noticed  that 
the  material  first  obtained  from  the  stomach  was 
grayish-green  in  color.  This  was  afterwar<l  found 
to  contain  copper.  After  a  few  minutes  yellow  ferro- 
cyanide  of  potassium  was  obtained,  and  twenty  grains 
added  to  one  pint  of  warm  water.  This  was  thi'own 
into  the  stomach,  and  on  being  drawn  out  the  water 
was  seen  to  have  assumed  a  brown  color,  indicating 
that  tho  chemical  change  to  ferrocyanido  of  copper 
had  taken  place.  This  injection  was  therefore  con- 
tinued, the  amount  of  the  potash  salt  being  de- 
creased as   the  bro\vn  color  became  less   marked. 


THE   MEDICAL  RECORD. 


565 


When  the  watei-  returned  perfectly  clear  and  color- 
less, the  process  was  stopped.  During  this  time 
(about  forty  minutes)  the  patient  had  complained 
constantly  of  pain  in  her  stomach  and  of  cramps  in 
her  legs ;  and  had  had  several  fluid  evacuations. 
Before  the  tube  was  withdrawn,  three  ounces  of  a 
mixture  of  castor-oil  and  olive-oil  were  thrown  into 
the  stomach.  A  portion  of  this  was  rejected.  Pa- 
tient was  then  given  half  an  ounce  of  whiskey  hypo- 
dermieally,  as  the  pulse  had  become  more  weak, 
small,  and  rapid — 128  per  minute.  She  was  ordered 
twenty  grains  bismuth,  in  milk,  four  ounces  every 
two  hours. 

December  1-tth. — Patient  vomited  several  times 
during  the  night,  and  had  three  loose  brown  move- 
ments not  containing  blood.  She  complained  much 
of  abdominal  pain  and  of  cramps  in  her  legs.  This 
morning  she  has  less  pain,  but  is  very  tender  over 
the  epigastrium.  The  cramps  occur  at  longer  inter- 
vals. She  complains  of  frontal  headache  and  feels 
very  weak.  There  is  no  febrile  movement,  and  her 
pulse  is  regular,  strong,  100  per  minute  ;  respira- 
tion normal ;  skin  cool  and  dry.  Her  mental  con- 
dition is  good ;  no  aftection  of  the  senses ;  the 
pupils  are  normal  and  react  to  light.  Ordered  poul- 
tices to  abdomen  :  a  mixture  of  bismuth  in  mucil- 
age ;  and  small  amounts  of  milk  frequently  repeated. 
During  the  day  the  patient  was  quite  comfortable, 
did  not  vomit,  had'  less  pain,  but  had  several  diar- 
rhoeal  movements  attended  with  tenesmus.  Her 
urine  was  diminished  in  quantity  but,  as  it  was 
passed  with  the  movements,  could  not  be  measured. 
Its  color  was  normal. 

December  15th. — Patient  had  a  quiet  night  and 
slept.  This  morning  she  has  some  pain  and  tender- 
ness in  the  epigastrium,  but  has  not  suffered  from 
cramps  since  yesterday  afternoon.  She  has  not 
vomited  and  to-day  takes  her  milk  readily.  She  had 
during  the  night  and  continues  to  have  to-day  oc- 
casional painful  fluid  movements,  small  in  amount, 
brown  in  color,  containing  gray  masses  of  fncces,  but 
no  blood.  Her  headache  contiuiies.  At  noon  today 
she  complained  of  pain  in  the  hypoga.strium,  and 
began  to  pass  small  amounts  of  urine  frequently. 
Micturition  was  attended  with  biirning  pains  in  the 
urethra.  The  urine  was  found  to  be  very  dark,  red- 
dish black  in  color,  almost  like  ink.  It  is  turbid, 
does  not  transmit  light,  has  a  specific  gravity  1.011, 
is  acid,  and  contains  a  large  amount  of  albumen. 
On  boiling,  the  coagulum  was  lighter  than  ordinary 
albumen,  and  floated  to  the  top  of  the  specimen. 
The  substratum  of  urine  was  changed  to  a  lighter 
color.  On  the  addition  of  acetic  acid  the  albumen 
was  partly  dissolved,  and  the  substratum  of  liquid 
regained  its  original  color.  HeUer's  test  also  de- 
monstrated the  presence  of  albumen.  Microscopic 
examination  of  the  thick  sediment  which  collected 
on  standing  showed  the  presence  of  a  large  amount 
of  fine  granular  matter  stained  brown.  This  was  in 
irregular  masses,  and  also  in  the  shape  of  casts. 
There  were  a  few  epithelial  casts,  and  some  epithe- 
lial cells  from  the  kidney.  Careful  examination 
failed  to  detect  the  presence  of  any  blood-corpus- 
cles. A  portion  of  the  granular  matter  was  dried 
upon  an  object  glass,  common  salt  was  rubbed  into 
it,  a  hair  laid  across,  a  cover-glass  applied,  and  a 
drop  of  glacial  acetic  acid  allowed  to  enter  beneath 
the  cover.  The  .slide  was  then  warmed  and  sub- 
jected to  examination  under  the  microscope  with 
power  of  600  diameters.  Crystals  of  hsematin  were 
to  be  seen,  though  not  in  great  numbers.  A  speci- 
men was  then  examined  with  the  spectroscope,  when 


the  two  absorption  bands  betweea  D  and  E,  charac- 
teristic of  oxyha;moglobine,  were  distinctly  brought 
out.  These  tests  were  sufficient  to  estal>]ish  the  fact 
that  the  patient  had  developed  haemoglobin uria. 
Microscopic  examination  of  the  blood  showed  a 
slight  relative  increase  of  white  corpuscles.  The  red 
corpuscles  were  not  decolorized,  and  no  microcytes 
were  visible.  The  same  treatment  was  continued  with 
the  addition  of  small  doses  of  opium  to  allay  the  ab- 
dominal pain  and  control  the  action  of  the  bowels. 

December  16th. — This  morning  the  patient  is  found 
to  be  moderately  jaundiced.  She  passed  a  quiet 
night ;  had  no  movements,  and  did  not  vomit.  She 
made  about  forty-five  ounces  of  urine  during  the 
past  twenty-four  hours;  appearance  and  contents 
the  same  as  yesterday.  To-day  the  abdominal  ten- 
derness continues,  but  is  less  marked  over  .  the 
hepatic  region  than  elsewhere.  There  is  no 
fever,  but  the  pulse  is  more  rapid,  120  per 
minute,  and  is  now  quite  small.  Eespiration  is 
also  increased  to  30  per  minute.  Her  general 
condition  is  better  than  yesterday,  on  account  of 
the  cessation  of  all  gastric  symptoms  and  of  the 
diari'hoea.  She  takes  her  milk  with  relish.  She  is 
perfectly  conscious  and  rational,  but  is  moie  quiet, 
and  seems  inclined  to  sleep.  The  only  complaint 
is  that  of  painful  micturition.  When  questioned  she 
says  that  she  has  slight  headache.  Opium  stopped. 
December  17th. — Patient  had  a  restless  night  and 
refused  nourishment.  This  morning  she  seems  to 
be  weaker,  and  is  rather  somnolent.  She  complains 
of  frontal  headache,  and  of  pain  in  the  lumbar  re- 
gions, liut  says  that  the  abdominal  pain  has  ceased. 
The  abdomen  is  relaxed,  not  tympanitic,  but  pres- 
sure develops  tenderness  all  over  it.  She  has  not 
vomited,  and  has  had  no  movement  during  the  past 
twenty- four  hours.  She  retains  her  milk,  but  has 
no  desire  for  food,  her  tongiie  being  still  thickly 
coated  and  gray.  Her  throat  is  not  sore.  Eyesight 
and  hearing  are  perfect,  and  sensation  good.  Her 
pulse  is  feeble,  small,  and  rapid,  120  per  minute, 
respiration  30,  and  for  the  first  time  since  admis- 
sion there  is  some  fever,  temperature  being  100.J°. 
There  is  a  slight  increase  in  the  jaundice,  the  color 
of  the  skin  being  a  peculiar  grayish  yellow.  She 
passed  fifty  ounces  of  urine  during  the  past  twenty- 
four  hours'  It  presents  the  same  chemical  charac- 
teristics, and  is  almost  like  black  ink  in  color. 
Her  motions  indicate    weakness,  but    there  is  no 


Toward  evening  it  was  e\'ident  that  the  patient 
was  failing  rapidly.  Her  mental  condition  was  stu- 
pid,so  that  she  could  not  be  induced  to  make  various 
motions  that  were  desired  to  test  coordination. 
There  was  evidently  general  paresis,  as  she  could 
no  longer  turn  herself  in  bed  or  hold  a  cup.  Sen- 
sation was  not  impaired.  At  four  p.m.,  tempera- 
ture lOlJ",  pulse  very  small  but  regular,  128 ; 
respiration,  34.  Stimulation  was  given  by  the 
rectum,  but  was  rejected,  and  the  discharge  was 
followed  by  a  movement  containing  semi-solid 
black  fseces.  She  is  now  unable  to  swallow. 
At  9  P.M.  the  patient  had  sunk  into  a  semi- 
comatose condition,  and,  when  aroused,  seemed 
unable  to  make  any  voluntaiy  motions.  Sensation 
was  decidedly  impaired,  or  else  she  was  too  stupid 
to  notice  irritation.  Pupils  were  contracted  and  no 
longer  reacted  to  light.  Nutritive  enemata  were  not 
retained,  and  the  urine  was  passed  unconsciously. 
Temperature  98f°,  pulse  140,  respiration  40. 
From  this  time  she  lay  in  a  state  of  coma,  and  ^t 
two  A.M.,  December  18th,  died, 


566 


THE  MEDICAL  RECORD. 


Autopsy  twelve  hours  after  death.  Dr.  Welch 
present. 

/?oc(v-— Rigor  mortis  extreme.  Whole  surface 
uniformly  jaundiced.     Xo  ecchymoses. 

Brain. — The  membranes  were  tinted  a  grayish 
yellow  color.  A  considerable  amount  of  clear  serum 
was  present  beneath  the  pia  mater.  No  meningitis. 
No  marked  congestion.  Surface  of  the  brain  was  a 
pale  gray  color,  evidently  tinted  like  the  membranes. 
Brain  was  wet,  but  there  was  no  excess  of  fluid  in  the 
ventricles.    Substance  normal.    Cord  not  examined. 

Thorax. — On  opening  the  body  it  was  noticed 
that  the  muscles,  connective  tissue,  fat,  and  all  the 
organs  presented  a  grayish  yellow  appearance.  All 
the  blood  in  the  body  was  firmly  clotted  in  the 
veins.  The  clots  were  a  light  brownish  red  color, 
i-esembliug  chocolate,  and  very  consistent,  so  that 
they  retained  their  form  on  being  taken  out  of  the 
veins.     There  was  no  fluid  blood  in  the  body. 

Pericardium. — No  adhesions,  no  excess  of  fluid. 
Heart,  normal  size.  Both  ventricles  were  filled  with 
dark  clots.  Heart-muscle  flabby,  and  on  section 
fatty.  A  mottling  was  noticed  beneath  the  endo- 
cardium, most  marked  on  the  papillary  muscles. 
Microscopic  examination  showed  well-marked  fatty 
degeneration  of  the  muscular  tissue.  Aorta  athero- 
matous. 

Plane. — Old  adhesions  on  both  sides.  No  fluid 
in  the  cavities. 

Lungs. — Slight  yellowish  brown  coloration  of  the 
surface  of  the  lungs.  No  subserous  ecchymoses. 
Both  lungs  extremely  [edematous.  The  fluid 
squeezed  from  them  was  yellow  in  color.  Substance 
of  lungs  normal. 

Abdomen  contained  no  fluid.  Spleen  normal  in 
size  and  consistence. 

Stomafk  contained  a  lai-ge  quantity  of  semi-solid 
material,  greenish  white  in  color,  apparently  half- 
digested  milk.  This  was  tested  and  contained  no 
copper.  There  was  but  slight  evidence  of  gastritis, 
consisting  only  in  mild  congestion.  No  ecchymo- 
ses and  no  ulceration. 

(Esophagus. — Pseudo-membranous  patches  of  gray 
color  and  ulcerations  near  the  stomach. 

Jntestines. — Duodenum  empty.  It  was  deeply 
stained  with  bile.  The  ductus  communis  choledo- 
chus  was  pervious.  Jejunum  in  its  upper  three 
quarters  was  free  from  inflammation.  It  contained 
green  semi-solid  masses.  Ileum  contained  tliick 
hax'd  masses,  green  in  color.  These  masses  did  not 
give  any  reaction  on  the  addition  of  aqua  ammonia. 
For  sixteen  inches  along  the  lower  part  of  the  ileum 
there  was  extensive  ulceration, with  the  formation  of 
.sloughs  and  loss  of  substance  on  the  mucous  coat. 
The  ulceration  was  unevenly  distributed  through 
the  ileum,  and  not  confined  to  the  region  of  Peyer's 
patches.  It  extended  upward  into  the  jejuiuim, 
but  was  loss  marked  than  below.  The  large  intes- 
tine contained  large  masses  of  pasty  dark-green 
fieces,  which  distended  it  greatly.  When  these  were 
washed  out,  numerous  losses  of  substance  were  seen 
on  the  surface  of  the  mucous  membrane.  There 
were  no  distinct  ulcers. 

/^,-„(.,-.— Uniform  brownish  yellow  color,  soft  in 
consistence,  normal  size,  somewhat  fatty.  Micro- 
scopic examination  showed  ex-tensive  fatty  degenera- 
tion of  tlio  hepatic  cells.  The  fat  existed  in  large 
globules  and  not  in  small  molecules. 

()all-hliid)ler  was  mnderatoly  distended  with  very 
thick  black  bile  ;  this  bile  was  found  to  contain 
copper.  The  bladder  contained  a  small  gallstone; 
gall-duct  and  bile-ducts  not  obstructed, 


Pancreas  normal. 

Kidneys,  slightly  enlarged ;  capsule  adherent ; 
surface  mottled  with  vei-y  dark  brownish  red  and 
gray  colors,  giving  a  marbled  appearance  ;  substance 
soft.  Cut  surface  nearly  uniform  dark  brownish 
red,  and  little  distinction  to  be  noticed  between  the 
cortex  and  medulla.  Cortex  was  swollen,  and  stri- 
ated appearance  not  present.  The  mucous  mem- 
brane of  the  pelvis  was  gray  in  color,  was  coated 
with  a  thin  layer  of  mucus  and  studded  with  minute 
ulcers,  round  in  shape.  Microscopic  examination 
showed  the  tubules  of  the  kidney  to  be  filled  with 
granular  matter  stained  red,  and  similar  to  that 
found  in  the  urine.  The  cells  lining  the  tubules 
were  swollen  ;  the  Malpighian  tufts  were  com- 
pressed and  a  free  space  existed  between  the  tuft 
and  its  capsule,  such  as  is  said  to  appeal-  when  a 
large  amount  of  albumen  has  been  excreted.  The 
capsule  of  tlie  tuft  was  moderately  thickened ;  the 
capillary  walls  were  thickened  ;  no  granular  matter 
in  the  vessels. 

Ureters  normal.  Bladder  contained  some  dark 
red  urine ;  the  mucous  membrane  was  uniformly 
stained  a  pink  color  ;  no  cystitis. 

Uterus. — At  each  cornu,  small  intramuial  fibro- 
mata. The  Fallopian  tul)e  on  the  right  side  was 
distended  with  dark-red  fluid  ;  ils  fimbriated  extrem- 
ity obliterated  ;  on  left  side  there  was  a  small  cyst  in 
the  broad  ligament. 

The  medico-legal  importance  of  the  case  warrants 
its  publication.  The  number  of  cases  of  sulphate 
of  copper  poisoning  reported  is  small,  and  in  but  a 
few  is  there  a  record  of  an  autopsy.  In  no  reported 
case  is  there  any  mention  of  the  ocouiTence  of  hse- 
moglobinuria. 

First. — The  dose  of  the  poison  taken  was  sufficient 
to  cause  death  from  gastro-intestinal  inflammation, 
and  the  autopsy  revealed  some  enteritis.  This  le- 
sion has  been  found  in  every  case  of  poisoning  re- 
ported, but  in  most  cases  its  extent  has  been  greater, 
and  the  symptoms  more  marked.  Whether  the  emetic 
action  of  the  salt  had  prevented  any  great  amount  from 
remaining  in  the  stomach,  or  whether  the  injection 
into  the  stomach  of  a  solution  of  the  chemical  anti- 
dote was  so  far  successful,  may  be  uncertain.  The 
limitation  of  the  inflammation  to  the  ileum  may  be 
explained  by  supposing  that  tlie  copper  which  had 
entered  the  intestine  before  the  patient  reached  the 
hospital  was  washed  through  the  upper  part  of  the 
gut  by  the  fluids  thrown  into  the  stomach  and  by 
the  castor-oil,  so  that  it  did  not  remain  in  contact 
with  the  mucous  membrane  long  enough  to  produce 
a  local  action  until  it  reached  the  ileum,  where  it  re- 
mained. The  ab.sence  of  any  serious  gastritis  waa 
indicated  during  life  by  the  cessation  of  vomiting- 
and  the  retention  of  milk.  The  case  thus  supports 
the  statements  advanced  by  Christison,  Taylor, 
Maschka,  and  Ziemssen,  that  the  gastric  symptoms 
are  less  marked  than  tho.se  due  to  the  disturbance 
of  the  nervous  system,  and  that  death  results  from 
secondary  effects  due  to  the  absorption,  of  the 
poison  rather  than  from  gastro-intestinal  irritation, 
and  hence  is  seldom  immediate. 

Second. — Much  difference  of  opinion  exists  among- 
writers  on  toxicology  as  to  the  symptoms  of  jaun- 
dice after  copper  poisoning.  Christison  quote* 
three  cases — those  of  Orfila,  Pyl,  and  Wildberg,  in 
which  jaundice  occurred.  Taylor,  Ziemssen,  anct 
Murchison  allude  to  these  cases  and  cite  Christison 
as  authority  for  the  occurrence  of  this  symptom.  But 
they  throw  some  doubt  upon  its  frequency,  and  ileny- 
having  seen  any  cases.     Murcliison,  though  admit- 


THE  MEDICAL  RECORD. 


567 


till?;;  that  in  pbosphorns  poisoning  the  jaundice  has  a 
1!  u>il  origin,  and  claiming  that  it  mnst  lie  ascribed 
t  '  an  abnormal  process  of  metamorphosis  due  to 
t  I"  fattr  degeneration  of  the  liver,  prefers  to  con- 
si. I'M-  the  jaundice  spoken  of  in  copper  poisoning  as 
olistructive,  and  caused  by  duodenitis.  Huseman 
and  Maschka  support  the  position  of  Christisou  in 
oi>i)osition  to  the  other  writers,  and  each  relates  a 
case  in  which  there  was  jaundice.*  In  the  report  of 
till'  discussion  of  the  SociCtc  de  Biologie,  in  Paris, 
1^77,  on  the  subject  of  copper  poisoning  (to  be  found 
in  Comptes;  Rendus,  1877,  by  M.  Galippe),  jaun- 
dice is  mentioned  as  a  rare  symptom,  and  its  origin 
is  not  discussed.  In  the  case  herewith  reported, 
jaundice  appeared  about  fifty  hours  after  the  poison 
was  taken,  and  about  twenty  hours  after  the  h;e- 
moglobinuria  began.  The  autopsy  showed  that  the 
bile-duct  was  pervious,  and  that  there  was  no  duo- 
denitis. It  seems  certain  therefore  that  the  jaun- 
dice was  not  obstructive.  As  the  liver  was  in  a 
state  of  acute  fatty  degeneration,  such  as  occurs  in 
poisoning  by  phosphorus,  the  explanation  of  Mur- 
chison  may  apply. 

It  seems  more  likely,  however,  that  the  jaundice 
was  dependent  upon  the  dissolution  of  red  blood- 
.globules  and  the  setting  free  of  the  hjcmoglobine,  a 
condition  of  which  the  hremoglobinuria  gave  &\i- 
dence.  In  support  of  this  position,  Dr.  Flint's  re- 
cent work  may  be  cited.  He  says  :  "It  is  generally 
considered  as  established  that  under  certain  patho- 
logical conditions  a  pigment  analogous  to,  if  not 
identical  with,  that  of  bilirubin  may  be  a  result  of 
the  destruction  of  red  corpuscles  irrespective  of  any 
action  of  the  liver,  giving  rise  to  the  same  appear- 
ances as  when  bile  is  reabsorbed"  (p.  636).  This 
case,  therefore,  establishes  the  fact  that  jaundice 
may  occur,  and  that  it  may  be  hematogenous  in 
origin. 

Third. — Hfemoglobinuria,  as  before  stated,  is  a 
symptom  whose  occurrence  has  never  before  been 
noted  after  poisoning  by  sulphate  of  copper.  All 
writers  speak  of  a  diminution  or  suppression  of 
urine,  but  none  makes  any  note  of  abnormal  appear- 
ances. The  only  case  at  all  similar  is  reported  by 
Maschka  (op.  cit.),  in  which  the  urine  contained 
"  blood,  albumen,  and  bile,"  but  he  omits  to  state 
whether  a  microscopic  examination  showed  blood- 
corpuscles.  The  medical  literature  for  the  past  ten 
years  contains  a  number  of  cases  of  copper-poison- 
ing, but  in  none  did  this  symptom  occur,  nor  was 
it  noticed  in  the  exhaustive  discussion  of  the  sub- 
ject by  the  Societfe  de  Biologie  before  alluded  to.f 
It  seems  probable,  therefore,  that  the  case  is  unique. 
Hsemoglobinuria  is  a  condition  which  has  been  no- 
ticed after  poisoning  by  phosphorus,  and  after  the 
inhalation  of  carbonic  acid,  hydrocyanic  acid,  and 
arseniuretted  hydrogen  gases.  It  occurs  in  the 
course  of  scurvy,  and  juirpura  hemorrhagica,  after 
typhus  and  scarlet  fever,  after  tne  transfusion  of 
blood,  and  occasionally  in  hemophilia.  It  has  been 
produced  by  the  injection  of  glycerine  into  the 
blood. I  It  has  occurred  as  a  paroxysmal  disease 
after  exposure  to  cold,  or  under  certain  pialarial 
conditions.  It  has  been  noticed  as  an  epidemic  dis- 
ease among  the  new-born,  seventy- eight  per  cent,  of 


*  iIa'^:hka  :  Handbuch  der  Gerichtlichen  Medicin.  Art.  Kupfer- 
vergiftung.  1881.  Huseman  :  Jahre?bericht  der  Medicin,  1878,  I.,  s, 
391. 

1 1  may  state  that  I  have  examined  the  American.  Enplish.  French. 
and  German  Retrospects  and  Year  Bfxjks,  and  the  chief  periodicals  for 
the  past  ten  years  very  carefully  on  this  point. 

tCase  repoiteii  bySchwann  in  Eckhardt's  Beitrajie  lur  Anat.  u. 
Phys.,  18«0,  p.  B34. 


the  babes  born  in  Dresden  during  March  and  April, 
1879,  having  died  of  it.*  All  authorities  agree  that 
it  has  its  origin  in  the  blood  and  not  in  the  kidneys. 
Any  substance  which,  when  absorbed  into  the  blood, 
has  the  power  to  dissolve  or  destroy  the  blood  glob- 
ules, will  thereby  set  free  the  coloring  matter  con- 
tained in  them.  This,  under  normal  conditions, 
changes  partly  into  biliary  or  urinary  pigment  and 
partly  goes  to  nourish  the  muscular  tissue. f  When, 
however,  large  quantities  of  the  blood-corpuscles 
are  suddenly  decomposed,  the  amount  of  hiemoglo- 
bine  set  free  is  too  great  to  undergo  these  changes. 
It  then  circulates  as  oxyhajmoglobiue  and  methitmo- 
globine  in  the  blood,  and  in  the  form  of  metha;mo- 
globine  is  excreted  by  the  kidneys,  being  a  crystal- 
lizable  substance,  and  therefore  passing  readily 
through  animal  membranes.|  True  htemoglobinuria 
in  which  no  blood  globules  are  found  in  the  urine, 
is  very  rare,  but  associated  with  hicmaturia  it  is  not 
uncommon.  The  diagnosis  rests  on  the  presence  of 
hiematin  determined  by  the  spectroscopic  examina- 
tion, and  by  obtaining  the  crystals  in  urine  which 
contains  no  blood  globules.  In  such  urine  there  is 
always  albumen,  and  also  a  sediment  consisting  of 
colored  epithelia,  granular  matter,  and  casts.  These 
were  all  found  in  the  present  case,  and  an  examina- 
tion of  the  kidneys  showed  similar  collections  of 
granular  matter  in  the  tubules.  It  has  been  stated 
by  Neubauer  and  Vogel  that  the  pigment  collects  in 
the  vessels,  and  by  obstructing  the  capillaries  may 
cause  serious  symptoms.  But  examination  in  this 
case  failed  to  show  any  such  collection  in  the  vessels. 
Indeed,  the  contrast  between  the  vessels  which  were 
either  empty  or  full  of  corpuscles,  and  the  tubules 
plugged  by  the  granular  matter,  was  very  striking. 
A  similar  condition  of  the  kidney  was  noticed  in  a 
case  of  ha^moglobinuria  following  scarlet  fever.J 
That  the  presence  of  copper  in  some  form  in  the 
lilood  may  set  free  hfemoglobine,  either  by  directly 
destroying  the  corpuscles,  or  by  combining  with 
those  salts  in  the  plasma  which  are  necessary  to  pre- 
vent the  solution  of  the  globules,  is  proven  by  this 
case. 

Fourth. — The  question  naturally  arises  whether 
death  was  caused  by  the  action  of  the  poison  on  the 
nervous  system,  or  was  due  to  a  general  disintegra- 
tion of  the  blood-globules  and  consequent  lack  of 
oxygen  in  all  the  tissues.  The  latter  seems  possi- 
ble for  the  following  reasons  :  The  blood  presented 
a  peculiar  appearance  after  death,  was  firmly  coagu- 
lated, and  of  the  color  of  chocolate.  All  the  tissues 
of  the  body  were  stained,  showing  that  the  amount 
of  htemoglobine  set  free  was  great.  The  urine  was 
passed  in  large  amount  (fifty  ounces  per  diem),  and 
contained  a  great  deal  of  haemoglobine.  The  hur- 
ried respiration,  which  rose  to  30  per  minute  during 
the  last  thirty-six  hours,  may  have  indicated  a  desire 
for  oxygen  incident  upon  the  diminished  oxygen- 
cariwing  power  of  the  blood.  On  the  other  hand, 
many  nervous  symptoms  mentioned  in  the  books — 
such  as  paralysis,  an?esthesia,  twitchings  and  con- 
vulsions, affection  of  the  pupils  and  sight — did  not 
appear  in  this  case,  stupor  being  the  chief  nervous 
phenomenon  until  within  a  few  hours  of  death. 
That  a  diminution  of  the  normal  amount  of  hiemo- 
globine  in  the  blood  may  be  a  cause  of  death  is  well 
known,    the    researches    of    Quinquand    ("Etudes 


•  Bursch  Herschen  :  feld  Handbuch  der  Kinder  Krankheiten,  vol.  W 
tNeubaueru.  Vogel  TJrin.,  p.  311. 

t  Hoppe-Seyler :  Phys.  Chemie,  art.  Hwmoglobin.  Seidel  Real  Cyclo 
der  Hcilkunde,  1881.  art.  Hsemoglobin. 

S  Wissensch  :   Central-BIatt  fur  Medicin,  1879,  p.  fHH. 


568 


THE  MEDICAL  RECORD. 


Hffimatologiques  :  "  Archiees  de  Med.,  1879),  and  of 
Hoppe-Seyler  {Physiol.  Chemie),  having  demon- 
strated that,  when  the  amount  of  ha^moglobine  in 
one  thousand  grammes  of  blood  is  reduced  from 
one  hundred  and  twenty-five  grammes,  its  normal 
figure,  to  forty  grammes,  death  follows  from  lack  of 
oxygen.  The  symptoms  of  such  a  fatal  termination 
do" not  differ  materially  from  those  observed  in  the 
case  reported  here.  In  any  future  case  it  would  be 
well  to  observe  the  symptoms  with  this  theory  in 
view,  and  also  to  make  quantitative  analyses  of  the 
blood  to  determine  the  per  cent,  of  hiemoglobine 
present. 

In  conclusion,  I  desire  to  acknowledge  to  Drs. 
Welch  and  Doremus  my  thanks  for  their  assistance 
in  conducting  the  microscopic  and  chemical  exam- 
inations. 


DETECTION    OP    GALL-STONES  BY    THE 

EXPLORING  NEEDLE. 

By  JAMES  T.  WHITTAKER,  M.D., 


CINCINNATI, 


PBOFSSSOH 


OF   MEDICINE,    MEUIC.\L 


COLLEGE  OF  OHIO. 


The  diagnosis  of  cholelithiasis  is  sometimes  very 
simple  and  very  easy.  The  charactei-istic  colic,  the 
occasional  jaundice,  the  constipation,  the  duodenal 
catarrh,  occurring  in  a  female  after  the  meridian  of  life, 
leave  scarcely  a  doubt  as  to  the  nature  of  the  disease. 
The  discovery  of  gall-stoues  in  the  discharges  makes 
the  diagnosis  sure.  And  in  the  majority  of  cases 
gall-.stones  may  be  detected  in  the  discharges  if  the 
precaution  be  taken,  per.severingly,  to  pass  the  faeces 
through  a  sieve.  Murchison  says  that  Wolf,  "  who 
took  the  pains  to  examine  the  fajces  sometimes  for 
months  after  an  attack  of  biliary  colic,  never  failed 
to  find  gall-stones  in  one  of  forty-five  cases  of  bil- 
iary colic  occurring  in  his  practice  dui-ing  a  period 
of  forty-tliree  years." 

Nevertheless,  many  cases  of  cholelithiasis  are  ex- 
ceedingly obscure.  No  one  sign  of  the  condition  is 
pathognomonic ;  no  one  sign  is  even  constantly 
present.  Hepatic  colic  is  sometimes  absent,  and  is 
often  simnlated  by  hepatic  neuralgia  ;  icteriis,  per  se, 
possesses  no  diagnostic  importance,  von  Schneppel 
remarks,  as  it  may  be  present  in  many  other  condi- 
tions and  be  absent  in  hepatic  colic ;  duodenal  ca- 
tarrh occurs  oftenor  without  than  with  gall-stones  ; 
the  male  sex  is  aifected  in  one-third  of  all  the  cases, 
and  no  age  is  entirely  exempt.  Moreover,  the  pas- 
sage of  the  stones  affords  no  absolute  indication  of 
the  condition  loft.  Ewald  expresses  the  conviction 
of  every  practitioner  of  wide  experience,  when  ho 
says  :  "  In  vielen  Fallen  isl  es  unmoglich  eine  Diffe- 
rential diagnose  zu  stcllen  "  (In  many  cases  it  is  impos- 
sible to  make  a  differential  diagnosis).  We  might 
add  that  an  absolute  diagnosis  can  be  made  in  no 
case.  In  every  case  there  is  some  room  for  doubt. 
For  all  the  indications  may  be  present,  and  cancer, 
echinococcus,  abscess  of  the  liver,  or  any  pressure 
from  without  1)0  entirely  excluded,  and  yet  the  gall- 
ducts  may  be  blocked  only  by  inflammatory  thicken- 
ing of  their  walls,  or  by  inspissated  bile. 

Any  means,  therefore,  which  will  safely  and  surely 
detect  the  presence  of  a  gall-stone  will  bo  received 
with  satisfaction,  and  that  such  a  means  exists  is 
proven  by  the  iiistory  of  the  following  case. 

H.  B ,  aged  seventy-six,  has  been  deeply  jaun- 
diced for  six  months.  During  this  time  he  has  lost 
fifty  pounds  in  weight.    His  stools  are  like  putty  ;  his 


urine  has  the  color  of  tar.  His  general  strength  is 
80  much  reduced  that  he  is  not  able  to  sit  up  longer 
than  half  an  hour.  He  is  tortured  with  tinnitus 
aurium.  He  has  no  appetite,  and  is  profoundly  de- 
jected. 

The  liver  is  enlarged  ;  its  free  border  projects  two 
and  one-half  inches  below  the  margin  of  the  ribs. 
The  gall-bladder  constitute.s  a  large  tumor,  of  the 
size  of  the  fist,  smooth,  globular,  and  movable.  There 
is  some  apparently  slight  ascites.  It  was  apparent 
that  the  condition  depended  upon  total  occlusion  of 
■  the  common  duct. 

The  diagnosis  rested  between  gall-stone  and  can- 
cer. In  favor  of  cancer  was  the  enlargement  of  the 
liver  and  the  ascites.  In  favor  of  gall-stone  was  the 
condition  of  the  gall-bladder.  Against  both  condi- 
tions was  the  total  ab.sence  of  pain.  He  was  a  very 
intelligent  man,  and  he  stoutly  maintained  that  he 
had  never  had  an  attack  of  jiain.  His  daughter 
stated  that  he  had  suffered  from  pain  five  years  ago, 
a  fact  which  he  could  not  recollect,  but  had  never 
had  pain  since.  Against  cancer  was  the  absence  of 
any  primary  deposit. 

In  order  to  definitely  determine  the  diagnosis,  I 
concluded  to  explore  the  gall-bladder.  Having  fixed 
it  by  compression  from  below  upward  against  the 
livei',  I  introduced  the  needle  of  the  hypodermic 
syringe  and  withdrew  it  full  of  thin  clear  bile.  On 
the  next  day,  April  20th,  I  fixed  the  gall-bladder,  as 
before,  and  gradually  and  slowly  pushed  through  the 
abdominal  parietes,  just  below  the  gall-bladder,  a 
long  fine  needle,  in  fact,  the  longest  and  finest 
needle  of  the  Dieulafoy  asjiirator  set.  After  pene- 
tration of  the  peritoneum,  there  was  no  resistance 
whatever — it  was  as  if  in  empty  space — to  the  further 
progress  of  the  needle,  which  I  advanced  slowly  and 
in  a  straight  line  in  the  direction,  as  nearly  as  could 
be  determined,  of  the  common  choledochus  duct. 
At  the  depth  of  four  and  three-fourths  inches  I 
struck  a  stone.  The  sensation  was  perfectly  clear 
and  distinct.  It  was  a  fine  delicate  crepitus,  un- 
mistakable in  its  character.  After  penetration  of  the 
skin,  there  was  no  sensation  whatever  on  the  part  of 
the  patient.  The  needle  was  then  withdrawn,  and 
the  patient  experienced  no  more  discomfort  than 
after  a  hypodermic  injection.  Having  had  all  the 
dangers  of  cholelithectomy  freely  set  before  him,  in 
the  presence  of  his  family,  and  fully  recognizing  that 
he  was  slowly  dying  by  inanition,  feeling  "  life  not 
worth  living,"  as  he  said,  he  elected  to  take  the 
risks  of  the  operation,  which  I  asked  one  of  my  sur- 
gical colleagues,  T>r.  Joseph  Rausohoft',  to  perform. 
Dr.  Rausohoff  expressed  the  very  natural  desire  to 
feel  the  stone  himself  before  undertaking  such  a 
dangerous  operation.  Accordingly,  on  April  '29th.  we 
proceeded  to  repeat  the  exploration  of  the  week  be- 
fore. I  had  the  good  fortune  to  strike  the  stone  at 
once,  as  upon  the  previous  occasion.  Thereupon  I 
put  the  end  of  the  needle  in  his  hands,  but  he  failed 
to  feel  the  crepitus,  nor  could  I  feel  it  when  I  took 
it  from  him.  It  had  evidently  glided  off.  Thereupon 
I  explored  in  various  directions,  very  gently,  of 
course,  partially  withdrawing  it  and  re-inserting  it 
twice,  when  I  again  came  upon  the  stone.  This  time  '  r 
Dr.  Rausohoff  felt  it,  too,  perfeotly  distinctly,  and  ll 
withdrew  the  needle,  convinci'd  of  the  presence  of  ff 
the  stono. 

May  3d,  Dr.  RausoliotT,  in  the  presence,  and  with 
the  a.ssistanoo  of  Dr.  Dunham,  a  former  physician  of 
the  patient  ;  Dr.  Cilley,  Demonstrator  of  .\natoniy  ; 
Dr.  Kebler,  Lecturer  on  Histology ;  Dr.  French,  my 
assistant ;  Mr.  R.  Davis,  my  student,  a  son-in-law  of 


THE  MEDICAL  EECORD. 


569 


the  patient,  and  myself,  removed  two  large  stones, 
weighing  respectively  138  and  1G2  grains,  one  of 
which  was  tirmly  wedged  into  the  cystic  duct,  and 
three  small  stones,  weighing  i),  5,  and  i  grains. 

Of  the  method  of  operating  and  the  cause  of  the 
fatal  result,  which  occurred  on  the  day  following  the 
operation,  I  have  nothing  to  say.  These  details  will 
probably  be  reported  in  full  by  the  operating  sur- 
geon. I  desire  merely  to  call  attention  to  the  ease, 
impunity,  and  I  might  almost  say,  unconsciousness 
on  the  part  of  the  patient,  with  which  these  gall- 
stones were  detected  in  situ  by  means  of  a  long  ex- 
ploring needle. 

Petit,  1733,  first  proposed  the  operation  of  chole- 
cystotomy,  and  (according  to  Hartshornel  Le  Dran, 
Morgagni,  Good,  Handfield  Jones,  Maunder,  Hugh- 
lings  Jackson,  and  Thudicum  "have  referred  to  the 
operation  as  justifiable  and  practicable."  Di-.  Bar- 
tholow,  my  predecessor  in  the  chair  of  practice,  first 
actually  performed  the  operation  of  aspirating  the 
gall-bladder,  and  sounding  the  cystic  duct,  in  a  case 
of  echinococcus  of  the  liver  in  1876,  and  a  number  of 
cases  have  lieen  since  rejaorted  by  Brown,  Sims, 
Keen,  Bryant,  and  Lawson  Tait  (Hartstiome's  com- 
ment on  Goodeve's  article,  " Reynolds'  Sy.stem");  but, 
80  far  as  I  have  been  able  to  discover,  it  has  hitherto 
occurred  to  no  one  to  detect  a  stone  in  the  gall-ducts 
by  this  simplest,  safest,  and  surest  of  all  the  proce- 
dures tried,  viz.,  exploration  with  a  needle. 


ANTE-PAETUM     HOUE-GLASS     CONTEAC- 
TION  or   THE   UTERUiS. 

Bx  WILLIAM  L.  BKADLEY,  M.D., 

NEW    HAVEN.    COSX. 

The  so-called  strictures  of  the  uterus,  which  are 
rather  frequent  during  the  third  stage  of  delivery, 
are  very  rare,  indeed,  before  the  expiilsion  of  the 
child.  In  the  following  case  the  existence  of  a  tonic 
contraction  of  the  circular  muscular  fibres  of  the 
upper  portion  of  the  uterus  was  demonstrated  by 
repeated  introductions  of  the  hand  into  the  uterus ; 
and  therefore  it  may  be  classed  with  the  thirty 
similar  cases  which  have  recently  been  collated  and 
published  bv  Dr.  Thomas  C.  Smith  (Americrm  Jour- 
nal of  Obstetrics,  1882,  vol.  xv.,  p.  294). 

November  15,  1876,  I  was  requested  by  Dr. 
Henry  Pierpont  to  assist  him  in  a  case  of  obstet- 
rics which,  previous  to  his  being  called,  had  been 
under  the  care  of  a  professional  midwife.  I  found  a 
woman  about  thirty-five  years  of  age,  apparently  of 
delicate  constitution,  who  had  been  thirty-six  hours 
in  her  fourth  labor.  Her  pulse  was  feeble,  and  indi- 
cated threatening  exhaustion.  The  cervix  was  i'tilly 
dilated,  the  liquor  amnii  had  been  discharged,  and 
the  uterus  was  firmly  contracted.  In  her  first  labor 
she  had  been  delivered  by  forceps  of  a  still-born 
child,  and  in  the  second  and  third  labor,  the  head 
being  smaller,  the  delivery  was  without  difficulty. 
In  the  present  instance  an  examination  showed  that 
a  very  large  head  was  presenting,  and  that  the 
antero-posterior  diameter  of  the  pelvis  was'  some- 
what contracted.  The  occiput  lay  toward  the  right 
acetabulum,  and,  although  the  forceps  was  readily 
applied,  all  my  efforts,  seconded  by  those  of  Dr. 
Pierpont,  failed  to  accomplish  the  descent  of  the 
head.  To  facilitate  version,  complete  muscular  re- 
laxation was  obtained  by  the  full  administration  of 
chloroform.  My  hand  easily  passed  the  head  and 
thorax  of  the  child,  but  was  arrested  in  its  progi'ess 
and  rendered  useless  by  a  powerful  tonic  contrac- 


tion of  the  Tipper  half  of  the  uterus,  in  which  the 
pelvis  and  lower  extremities  were  firmly  enclosed. 
The  border  of  the  placenta  was  slightly  detached  in 
the  attempt  to  pass  the  constriction,  in  which  it  was 
partially  included.  Becoming  fatigiaed,  I  was  re- 
lieved by  Dr.  Pierpont,  who  met  with  the  same  ob- 
struction, but  succeeded  in  squeezing  two  fingers  far 
enough  through  the  contraction  to  seize  the  feet 
and  bring  them  down  to  the  brim  of  the  pelvis. 
Having  retained  the  feet  by  a  strong  loop,  I  per- 
formed craniotomy,  and  then  version  was  conjpleted 
by  the  bi-manual  method.  The  arms  were  now 
brought  down,  and  forceps  was  applied,  but  before 
delivery  could  be  accomplished,  the  woman  died 
from  exhaustion. 

The  foregoing  case  was  reported  February  26, 
1877,  at  a  meeting  of  the  New  Haven  Medical  Asso- 
ciation, and,  so  far  as  my  knowledge  extends,  no 
other  similar  case  has  been  reported  in  the  State. 


He^jorts  of  i^05]jital3. 


HOSPITAL  OF  THE  UOTVEESITY  OF  PENN- 
SYLVANIA, PHILADELPHIA,  PA. 

Service  of  WM.  GOODELL,  M.D., 

PROFESSOR   OF   CLINICAL   GYNECOLOGY. 

(Reported  by  QcT  Hinsdale,  M.D.) 
TWO     CASES     OF     ABDOMINAL     TUMOE. 

Here  is  a  girl  who  has  had  for  several  years  a  tu- 
mor in  the  abdomen.  It  has  been  supposed  to  be 
an  ovarian  tumor,  and  was  sent  here  as  such.  It  is 
unusually  high  up  for  an  ovarian  tumor,  but  it  may 
have  a  very  long  pedicle.  I  have  to  push  it  down 
to  get  it  in  the  neighborhood  of  the  uterus.  I 
thought  at  first  that  it  was  a  phantom  tumor,  then 
I  thought  it  might  have  something  to  do  with  the 
liver,  since  it  is  high  up  and  upon  the  right  side, 
possibly  a  distended  gall-bladder.  The  first  thing 
to  do  in  forming  our  diagnosis  is  to  draw  off  the 
urine. 

If  this  be  an  ovarian  tumor,  we  should  have  some 
movement  communicated  to  it  when  I  move  the 
womb,  unless  its  pedicle  be  very  long.  As  I  move 
the  uterus  aliout  with  the  sound,  you  see  a  very 
slight  movement  of  the  tumor  ;  it  is  hardly  perceji- 
tible.  Then,  again,  it  may  be  a  cyst  of  the  broad 
ligament.  The  uterine  sound  passes  three  and  one- 
half  inches.  Movement  of  the  tumor  communicates 
a  very  slight  motion  to  the  uterus,  as  you  can  see  by 
watching  the  sound.  It  seems  to  me  that  there  is 
some  attachment  of  the  tumor  to  the  uterus.  The 
proper  thing  to  do  is  to  aspirate  this  tumor. 

Don't  forget  that  in  doubtful  abdominal  tumors 
you  must  always  pass  the  catheter  ;  it  will  save  you, 
some  time,  from  getting  into  a  scrape.  How  do  yon 
pass  the  catheter?  If  you  fumble  about  and  cannot, 
for  any  reason,  jjass  it  readily,  do  not  hesitate  to  use 
your  eyesight ;  ask  for  a  candle,  and  see  what  you 
are  doing.  It  is  very  often  necessary  to  catheterize 
a  woman  after  labor.  The  best  way  to  do  is  to  pass 
your  index  finger  into  the  vagina,  and  directly  above 
it  feel  the  opening  of  the  urethra  with  your  thumb. 
Then,  with  your  thumb  as  a  guide,  pass  the  instra- 
ment.  Another  way  is  to  place  the  index  finger 
directly  over  the  meatus;  this,  however,  is  uncertain, 
and  you  may  in  doing  so  touch  the  clitoris,  which' 
you  should  always  be  careful  to  avoid.     If  you  have- 


070 


THE  MEDICAL  RECORD. 


to  fumble  about,  don't  hesitate,  as  I  say,  to  call  for 
a  light. 

A  man  on  his  native  heath  knows  all  the  nooks 
and  crannie3  about  him ;  he  is  perfectly  at  home. 
So  I  push  the  tumor  down  as  far  as  I  can  toward 
the  pelvis,  for  here  I  feel  that  I  am  ou  familiar 
ground.  There  are  no  arteries  to  be  afraid  of,  and 
taking  the  needle  of  the  aspirator,  I  make  a  bold 
plunge  in  tho  linea  aspera.  A  clear  liquid  flows  out. 
What  in  the  world  a  cyst  of  the  broad  ligament  is 
doing  so  high  up  as  this  one,  I  don't  know.  It  has 
no  business  there.  It  is  possible  that  it  has  con- 
tracted adhesions  to  the  omentum,  and  is  dragged 
upward  by  it. 

I  have  now  under  my  care  a  lady  who  has  a  burst- 
ing cyst  of  the  abdomen.  These  cysts  of  the  broad 
ligament  are  very  liable  to  burst.  One  of  the  paro- 
varian tubules  becomes  plugged  up  and  forms  a  re- 
tention cyst,  if  you  choose  to  call  it  so.  The  walls  are 
very  thin,  and  in  the  case  I  allude  to,  the  tumor  bursts 
about  every  three  weeks,  after  attaining  the  size  of 
a  lemon.  In  one  case  which  I  had,  the  cyst  bur.st 
four  times,  and  was  tapped  some  ten  times.  Finally, 
I  removed  it  successfully,  and  found  but  one  adhe- 
sion, and  that  was  to  the  omentum.  This  explained 
a  severe  pain  the  lady  always  suffered  when  the  cyst 
burst,  or  when  it  was  emptied  by  tapping  ;  for  the 
collapsed  cyst  then  dragged  down  the  omentum. 
The  lady  has  been  perfectly  well  ever  since. 

The  fluid  which  I  am  now  pumping  out  is  not 
quite  clear  enough  for  a  cyst  of  the  broad  ligament. 
Still,  there  is  a  little  blood  in  it  which  discolors  it. 
On  the  other  hand,  it  is  not  quite  thick  enough  for 
an  ovarian  fluid.  I  shall  give  it  to  Dr.  Formad,  who 
will  examine  it  for  ovarian  cells. 

Here  are  different  fluids  which  I  have  removed  in 
this  amphitheatre  at  different  times.  These  are  two 
perfectly  clear  fluids  from  cysts  of  the  broad  liga- 
ment; one  was  removed  in  1874,  and  the  other  early 
in  18S9,  yet  they  retain  their  perfect  limpidity. 
Here  is  a  fluid  removed  from  an  ovarian  cyst ;  it  is 
dark  and  coffee-colored ;  and  here  is  anotlier  not 
quite  so  dark. 

Our  next  patient  is  thirty-two  years  of  age,  and 
has  been  married  nine  years.  She  has  had  three  chil- 
dren and  two  miscarriages,  the  last  miscarriage  in 
February,  1879,  nearly  three  years  ago.  Shortly 
after  this  the  tumor  began  to  form  and  has  been 
growing  ever  since.  She  has  been  losing  blood 
everv  day,  she  tells  me,  a  few  drops  at  a  time,  com- 
ing from  the  vagina  and  often  in  black  clots.  She 
knows,  however,  when  her  monthlies  come. 

If  a  lady  were  to  come  to  me  without  any  tumor, 
and  tell  ine  that  she  was  constantly  losing  small 
quantities  of  blood  from  the  womb  between  the 
monthly  periods,  I  should  say  to  myself  that  one  of 
two  lesions  existed,  either  a  polypus  or  a  cancer  of 
the  cervix.  Fibroid  tumors  of  the  womb  do  not 
usually  cavise  a  prolonged  blood-dribbling ;  they 
will  induce,  as  you  well  know,  excessive  menstrua- 
tion, and  so  will  a  polypus,  but  they  do  not  often 
cause  the  bleeding  between  the  periods. 

Is  this  a  uterine  tumor?  She  tells  us  that,  at  her 
monthlies,  she  doesn't  lose  too  much.  If  we  are 
dealing  with  a  fibroid,  wo  should  expect  it  to  pro- 
duce a  free  flow  at  her  monthlies.  T  ask  her  to  let 
me  uncover  her  face  and  see  her  tongue.  She  has  the 
faciei  ulnrhiit.  She  has  been  losing  flesh  and  has 
an  anxious  exiirossion.  Wiien  you  see  a  face  like 
that  it  means  pelvic,  trouble.  This  is  especially 
seen  in  the  advanced  stages  of  ovarian  disease  and 


is  so  characteristic  of  that  condition  that  it  has  been 

termed  the  fades  ovariana. 

The  diagnosis  of  these  abdominal  tumors  is  some- 
times as  easy  as  can  be,  but  it  may  also  be  as  diffi-  . 
cult  as  can  be.  As  I  tap  lightly  upon  one  portion 
of  this  tumor,  thei'e  is  no  fluctuation  that  I  can  per- 
ceive, but,  as  I  reach  the  other  side,  I  get  a  wave 
that  can  be  transmitted,  and  I  can  outline  the  area 
over  which  fluctuation  is  felt.  This  variation  in  the 
sense  of  fluctuation  means  that  we  have  dift'erent 
cysts.  The  wave,  however,  isn't  plain ;  it  is  not  of 
a  marked  kind.  Here,  over  the  right  portion  of  the 
tumor,  I  don't  get  any  fluctuation  at  all.  I  have  no 
doubt  that  we  have,  in  tliis  case,  a  mother-cyst  with 
a  number  of  child-cysts,  each  one  containing  fluid 
of  varying  density. 

But  how  do  I  know  that  it  is  not  dropsy  of  the 
abdomen?  If  the  fluid  were  free,  as  in  ascites,  the 
intestines  would  float  up  to  the  surface,  and  we 
should  have  resonance  above ;  whereas  the  fluid, 
gravitating  to  the  sides  and  most  dependent  por- 
tions, would  produce  a  bulging  and  the  percussion- 
note  would  be  dull.  As  I  percuss,  you  notice  that 
there  is  a  semi-resonance  over  the  ascending,  trans- 
ver.se,  and  descending  colon.  There  is,  in  fact,  a 
coronal  resonance,  but,  at  the  .same  time,  a  dulness 
over  the  front  of  the  tumor.  Furthermore,  as  the 
patient  lies  on  her  back,  the  abdomen  presents  a 
convex  front,  and  her  form  is  unchanged.  If,  now, 
there  were  ascites  here  this  surface  would  flatten, 
through  gravity  of  the  fluid  toward  the  back  and 
flanks.  You  would  also  find  ascitic  fluid  displaceable 
by  pressing  on  the  abdomen ;  but  there  is  nothing 
of  the  kind  in  this  case. 

The  patient's  history  and  our  examination  make 
it  easy  for  us  to  exclude  pregnancy  as  a  possible 
cause  of  this  tumor.  I  introduce  the  uterine  sound 
and  get  a  measurement  of  two  and  a  half  inches ; 
but  I  am  not  satisfied  with  that  measurement  in  a 
woman  who  has  borne  children.  I  try  it  again. 
You  see  I  can  move  the  womb  easily  with  the  sound. 
I  have  now  hit  the  fundus  and  the  pre.ssure  hurts 
her.  This  time  we  have  a  measurement  of  plus  two 
and  a  half  inches,  almost  three.  I  do  not  find  any 
polypus  whatever.  There  is  an  intense  congestion 
of  the  womb  ;  it  contains  more  blood  than  it  ought ; 
a  digital  examination  shows  me  that  the  womb  is 
anteflexed. 

I  am  disposed  to  say  that  this  is  a  cyst  of  the  left 
ovary.  I  asked  her  if  she  has  been  obliged  to  pull 
out  hairs  from  her  lip  and  chin?  She  says  not. 
Often,  in  cases  of  ovarian  disease,  and  especially 
when  double,  a  hirsute  development  is  found  upon 
the  chin  and  a  small  beard  will  grow,  which  will 
need  a  razor. 

You  might  be  asked,  "  Can  it  not  be  a  malignant 
tumor?"  and,  from  the  fact  that  the  patient  has  not 
suffered  pain  during  its  growth,  one  might  bo  led 
astray.  But,  as  I  said  the  other  day,  these  tumors 
may  develop  without  any  pain  whatever,  and  yet 
be  very  malignant.  In  all  these  cases  we  must  re- 
member that  there  is  no  such  thing  as  infallibility, 
and  that  the  best  physician  is  not  the  man  wlio 
makes  no  blunders,  but  who  makes  the  fewest  blun- 
ders. 

The  real  point  at  issue  is.  Is  this  a  uterine  tumor 
or  is  it  ovarian?  T  am  satisfied  to  think  that  it  is  a 
cyst  of  tho  loft  ovary,  a  multilocular  cyst,  one  or 
more  of  the  subdivisions  of  which  yields  a  flviotu- 
ation  which  is  not  marked,  because  filled  with  a  col- 
loid material. 

T  sh*ll  now  aspirate  the  tumor  ;  and  here  let  me 


THE  MEDICAL  RECORD. 


671 


show  you  a  wrinkle  worth  knowing.     I  shall  freeze 

t  'i  >  skin  at  the  point  of  puncture  bv  a  freezing  mist- 
u'.\>  of  a  lump  of  ice  dipped  into"  some  table  salt. 
N  ■«!  plunge  in  the  needle,  without,  as  you  see,  a 
\\  nice  of  pain  on  the  part  of  our  patient.  A  straw- 
'  ili'red,  syi-upy  tiuid  is  pumped  out,  but  the  right 
M'le  of  tlie  abdomen  does  not  collapse.  This  shows 
t:io  presence  of  another  cyst.  Without  withdraw- 
iii!,'  the  needle,  I  direct  its  point  into  this  cyst,  but  I 
S.t  nothing  but  a  few  drops  of  colloid  material.  The 
(■  inrents  are  too  thick  to  iJow.  While  we  are  wait- 
ii.,'  for  this  Huid  to  be  removed,  if  possible,  let  me 
-  ■■>■  you  some  golden  rules  about  tapping. 

"'■>■'. — Instead  of  the  old-fashioned  trocar  always 
tiie  hollow  needle  of  the  aspirator. 

s  -(11111. — Always  empty  the  cyst  if  you  can  possi- 
I'lvdoso.  This  prevents  the  escape  of  fluid  into 
tiip  abdominal  cavity,  and  consequently  lessens  the 
Ir:'.ality  of  peritonitis. 

/■'/;•,/. — Plunge  the  needle  preferably  in  the  linea 
■Al'.y.i.  where  there  are  very  few  blood-vessels;  and 
vi  IV  rarely  asi^irate ^ec  naginaniyWheve  many  blood- 
vessels exist. 

]■' "i.tih. — If,  after  tapping,  the  cyst  inflames  and 
seiitio  symptoms  set  in,  at  once  perform  the  opei'a- 
tim  of  ovariotomy:  this  alone  will  save  your  patient. 
X'lTE. — The  first  patient  recovered  from  the  ojsera- 
atioii,  and  for  two  months  there  has  been  no  retui-n. 
(Jii  December  8,  ISSl,  two  weeks  after  tapping,  the 
s  •  ■■nd  patient  was  operated  upon  by  Dr.  GoodeU 
re  a  ward-class  of  students.  The  left  ovary  had 
"aerated  into  a  multilocular  cyst,  containing  both 
ciCiir  fluid  and  colloid  matter  in  separate  cysts. 
This  ovary,  together  with  the  right  one,  which  was 
beginning  to  undergo  cystic  degeneration,  was  re- 
moved. The  patient  recovered  promptly,  and  two 
weeks  later  was  exhibited  before  the  class. 


BlCHROM.tXE   OP   POT.A.SSA    AS   K   CaDSE  OP   DiSEASE. 

— Dr.  B.  W.  Richardson,  who,  in  the  Brit,  and  For. 
Medico- Chirurg.  Rev.,  in  18(i3,  first  called  attention 
to  the  poisonous  influence  of  the  pure  bichromate 
of  potassa  upon  abraded  surfaces,  has  read  a  second 
paper  upon  the  same  subject  before  the  Medical 
Society  of  London,  in  which  he  described  how,  in 
the  manufacture  of  the  bichromate  from  the  neutral 
salt,  the  atmosphere  becomes  filled  with  minute  par- 
ticles of  the  bichromate.  Consequently  workmen 
who  do  not  pay  strict  attention  to  personal  cleanli- 
ness, are  very  soon  attacked  by  a  violent  prickling 
and  burning  sensation  in  the  nose,  and  to  a  less  ex- 
tent in  the  mouth.  Gradually  the  mucous  mem- 
brane becomes  eroded  until  the  septum  nasi  may  be 
entirely  destroyed.  A  curious  fact  is  mentioned  in 
this  connection,  viz.:  those  addicted  to  the  habit  of 
"  snuff-taking  "  are  free  from  such  poisonous  influ- 
ence, owing,  no  doubt,  to  the  fact  that  snuff  covers 
the  mucous  membrane,  and  to  the  freqiient  use  of  a 
handkerchief.  Other  parts  of  the  body,  such  an  the 
penis,  are  often  the  seat  of  tliis  ulceration,  because 
lightly  covered  or  frequently  handled.  Horses  em- 
ployed at  the  works  also  suffer,  and  he  mentions 
one  instance  where  the  hoofs  came  off  and  the  ani- 
mal died  a  month  after  the  commencement  of  the 
disease.  Both  sexes  alike  are  prone  to  infection. 
M.  Clouet  has  found  that  those  who  have  lost  the 
septum  of  the  nose  in  this  manner  never  suffer  from 
nasal  catarrh.  Treatment  resolves  itself  into  that  of 
prevention  by  cleanliness,  use  of  rubber  gloves,  etc. 
Thq  subacetate  of  lead  has  been  resorted  to  with 
favorable  results. — Lancet,  March  11,  1882.? 


|)ro0rc0)5  of  iHctJical  Science. 


Minute  Okganisjis  akd  Pa-stei-r's  Gekm  Theobies. 
— Apropos  of  a  paper  read  by  M.  Pasteur's  prqnira- 
teur,  M.  Chamberland,  at  the  £cole  Normale,  Dr. 
De  BeUesme  takes  occasion  (Prog.  Medictd,  April 
8th)  to  state  such  views  as  have  at  one  time  or 
another  been  brought  forward  against  the  vegetable 
germ  theories  by  those  who  either  maintain  the 
possibility  of  equivocal  generation  or  the  admissi- 
bility of  a  i^hysico-chemical  theory.  He  urges  that 
it  is  important,  from  a  medical  point  of  view,  to  con- 
sider the  full  weight  of  these  theories  upon  minds 
that  have  not  the  requisite  logical  training  to  appre- 
ciate them.  The  microbe  dogma  is,  of  course,  he 
says,  nothing  that  is  new,  but  merely  a  revival  of 
tenets  that  were  current  in  the  middle  ages,  and 
have  been  at  various  times  reproduced,  only  to  be 
overturned  by  suitable  inquiries.  What,  hea.sks.  are 
these  microbes  that  Pasteur  talks  about  so  glibly  ? 
He  at  first  thought  they  were  infusoria,  while  his 
assistant  calls  them  eels  (aiguilles),  and  yet  they  are 
claimed  by  Pasteur  to  constitute  the  infectious"  ele- 
ment of  all  contagious  maladies,  and  to  be  synony- 
mous with  what  pathologists  call  vinis.  Unfortu- 
nately, however,  he  does  not  see  them  so  easily  with 
the  microscope  ;  for,  if  we  adhei-e  simply  and  purely 
to  facts,  there  is  not  now,  he  says,  a  single  virulent 
disease  of  the  human  kind,  in  which  we  have  proved 
the  presence  of  organisms  that  determine  the  dis- 
ease, and  yet  oia-  appliances  for  micrographie 
study  are  so  perfect  that  it  appears  doubtful  if  they 
can  be  much  improved  upon.  It  is  not  sufficient 
for  the  adherents  of  this  theory  to  state  that,  if  no 
destmctive  germs  are  found  in  cholera,  variola,  or 
syphilis,  it  is  no  proof  that  they  do  not  exist,  for  if 
they  make  the  statements  above  refeiTed  to  thev  are 
bound  to  ofler  satisfactory  proof  that  such  do  exist. 
Unfortunately  for  medical  science,  he  adds,  Pasteur 
and  Chamberland  are  not  physicians,  and  one  side 
of  the  case,  that  of  the  patient,  they  cannot  appre- 
ciate. Upon  an  individual  who  exists  under  such  an 
ever-changing  variety  of  conditions,  studies  can 
only  be  successfully  prosecuted  by  one  who  is  both 
physician  and  pathologist.  But," after  all,  he  says, 
what  scientific  accuracy  can  there  be  in  dividing 
microbes  into  mobile  and  immobile?  With  as  much 
sense  might  the  human  species  be  divided  into  those 
who  sit  dovra  and  those  who  stand  up,  for  there  is 
nothing  more  gained  by  it.  Indeed,  statements  such 
as  this,  that  microscopic  organisms  do  not  occur  in 
springwater  or  in  normal  animal  or  vegetable  tissues, 
fPasteur)  are  simply  erroneous,  as  it  is  a  well-known 
fact  that  they  are  found  everywhere.  Indeed,  the 
epithelium  of  certain  cavities,  such  as  that  of  the 
mouth,  contain  almost  the  entire  collection  of  these 
microbes.  Would  any  one  have  the  courage  to  deny 
that  the  mucous  membrane  is  at  times  ruptured,  so 
that  the  avenue  is  open  for  these  organisms  to  enter 
the  blood-vessels.  Why,  therefore,  are  we  not  at 
times  infected  with  our  own  organisms  ? 

Trephining  pob  Epilepsy. — 77;^  Boston  Medical 
and  Surgical  Jonrnrd,  April  20,  1882,  contains  the 
report  of  two  cases  of  trephining  for  epilepsv,  in  the 
service  of  Dr.  G.  W.  Gay,  Boston  City  Hospital.  In 
both,  the  epileptic  seizures  followed  and  appeared  to 
be  dependent  on  injuries  to  the  head.  In  one  the 
operation  was  unsuccessful,  the  patient  leaving  the 
hospital  in  much  the  same  condition  as  on  entering. 


572 


THE  MEDICAL  RECORD. 


The  other  appears  to  have  been  successful,  reports 
covering  a  period  of  over  six  months  subsequent  to 
the  operation  indicatiug  that  the  patient  was  per- 
fectly well.  In  this  instance  a  careful  examination 
of  the  skull  revealed  only  a  slight  flattening  of  the 
vertex  but  no  depression.  The  patient  localized  his 
disagreeable  sensations  and  tenderness  at  a  point  ex- 
actly in  the  middle  of  the  vertex  and  this  was  the 
point  operated  upon,  full  Listerian  precautions  being 
followed  out  during  the  operation  and  subsequent 
dressings.  The  next  day  he  appeared  and  said  he  felt 
better  than  before  the  operation.  Subsequent  to  the 
surgical  procedure  he  remained  free  from  pain,  slept 
well  and  seemed  bright  and  happy ;  previously  he 
had  complaioed  of  severe  pain,  was  extremely  deli- 
rious, and  at  times  almost  in.sane.  These  cases  are 
interesting  as  corroborative  of  those  published  by 
Dr.  W.  A.  Hammond  ("Treatise  on  the  Diseases  of 
the  Nervous  System,"  1876),  who  states  that  in  cases 
of  epilepsy  following  injuries  to  the  skull,  tre]>hining 
is  of  great  service.  Of  twenty-three  operations  by 
him,  in  seven  there  was  a  ces.sation  of  the  attacks; 
in  two  of  the  seven  there  was  neither  fracture  nor 
depression.  Of  the  remaining  sixteen  cases,  cranial 
injury  was  absent  in  three ;  and  in  the  thirteen  with 
such  injury  the  operation,  while  unsuccessful,  was 
usually  beneficial  in  lessening  the  frequency  of 
the  seizures.  Dr.  H.  inclines  to  the  view  of  Dr. 
Lente,  that  epilepsy  may  result  from  a  cicatrix  of 
the  scalp.  As  a  summai-y  of  his  experience,  he  ex- 
presses himself  strongly  in  favor  of  trephining,  or 
excision  of  the  cicatrix  in  all  cases  of  epilejjsy  where 
the  skull  or  scalp  are  injured. 

"Ba('k-swno"  for  Fractured  Clavicle.  —  Dr. 
Lorenzo  Hale,  of  Albany,  N.  Y.,  has  proposed  a  new 
method  of  treating  a  fractured  clavicle.  Though 
recognizing  Dr.  Moore's  (Roche.ster,  N.  Y.)  principle 
in  its  treatment,  he  claims  an  improvement  upon 
the  method  in  that  he  substitutes  a  back-sling  for 
Dr.  Moore's  shawl-bandage,  which  he  considers 
"cumbersome  and  warm,"  concealing  the  fracture 
from  inspection,  and  at  times,  exerting  an  undue 
pressure  on  the  depressed  fragment.  The  "  back- 
sling,"  for  such  he  calls  his  apparatus,  is  applied  by 
passing  a  common  roller-bandage  (better  webbing), 
commencing  at  the  scapula,  of  the  sound  side  below 
the  forearm  of  the  affected  side  (with  the  elbow 
drawn  backward),  then  upward  over  the  forearm, 
across  the  back,  axilla,  and  shoulder  of  the  sound 
side,  to  the  end  held  against  the  scapula.  A  second 
bandage  in  front,  from  the  wrist  to  the  sling-band- 
age on  the  sound  shoulder,  completes  the  application 
and  tends  to  steady  the  arm.  A  compi-ess,  held  in 
place  by  means  of  adhesive  plaster,  may  be  utilized 
at  the  seat  of  fracture  if  needed.  By  thi.s  method 
ho  maintains  that  the  principle  in  treatment  of  such 
fractures,  viz.,  an  upward,  backward,  and  outward 
support  for  the  shoulder,  is  accomplislied  by  the 
coolest,  most  effectual,  and  most  comfortable  moans 
yet  offered.  His  article  ends  witli  a  brief  history 
of  a  few  cases  thus  treated,  when,  after  removal  of 
the  bandage,  the  seat  of  tlio  fracture  could  not  with 
certainty  bo  detected. — Meilical  A»»ah,  March,  1882. 

Stammertoo. — Prof.  Geo.  Delon,  of  Paris,  France, 
has  read  an  interesting  paper  on  this  .subject  before 
the  Academy  of  Medicine  in  Cincinnati,  Ohio.  He 
ascribes  the  defect  to  causes  that  may  be  organic  or 
hereditary,  though  sometimes  it  may  I)e  duo  to  con- 
tagion, for  which  reason  nervous  children  slionld  be 
kept  as  far  as  possiliUi  from  associating  witli  those 
tliat  stammer.     In  those  affected  with  this  defect  the 


formation  of  the  vocal  organs  often  presents  some 

abnormality  ;  they  lack  stiength  and  suppleness. 
The  difficulty  sometimes  re.sides  in  the  tongue, 
which  may  be  too  long  or  too  short,  too  thick  or  too 
thin,  and  so  other  portions  of  the  vocal  apparatus 
may  deviate  from  the  normal.  The  respiratory 
organs  are  also  often  found  in  poor  condition,  and 
not  working  regularly.  Prof.  Delon  lays  gi-eat  stress 
on  the  nervous  element  in  this  affection.  The  timid- 
ity of  all  stammerers  is  a  feature  of  their  difficulty 
which  is  very  hard  to  combat,  and  at  the  same  time 
it  is  essential  in  the  cure  of  any  case  to  overcome  it. 
He  affirms  his  belief  that  all  cases,  where  the  organs 
have  not  been  mutilated  or  i^aralyzed,  are  capable  of 
cure.  He  does  not  believe  in  the  pos.sibility  of  self- 
treatment,  but  considers  the  intelligent  and  enlight- 
ened guidance  of  an  instructor  indispensable.  In 
his  method  Prof.  Delon  aims  to  remove  the  organic 
trouble,  by  regulating  the  resjjiration,  and  strength- 
ening and  rendering  .supple  the  organs  of  speech — 
repeated  and  rational  exercise.  The  next  step  in 
this  procedure  is  to  teach  the  jjuijil,  by  careful 
training,  how  to  so  use  the  vocal  organs  as  to  keep 
them  under  his  control.  The  patient  must  be  taught 
to  be  calm  and  deliberate.  This  requires  .special 
study  of  each  case,  and  patient,  steady  perseverance 
on  the  part  of  both  patient  and  physician.  —  Cm- 
cinnati  Lancet  and  Clinic,  April  15,  1882. 

Variot'-s  Nervous  States  Determined  bt  Hyp- 
NOTizATioN  IN  Htsteric^l  Patients. — Hypnotism, 
says  M.  Charcot,  considered  in  the  light  of  perfect 
development,  such  as  is  often  manifested  in  women 
with  hystero-epilepsy  (!  o-ise.s  mixtes,  compreliends 
several  nervous  states,  each  of  which  is  distinguished 
by  special  symptoms.  There  are  three  such  condi- 
tions :  (1),  the  cataleptic  ;  (2),  the  lethargic  ;  (.3),  the 
somnambulic.  Each  one  of  them  may  occur  simple 
and  alone  ;  but  even  in  the  same  subject  and  during 
the  same  examination  they  may  succeed  each  other, 
according  to  the  will  of  the  observer  or  operator. 

The  catalei^tic  state  may  manifest  itself  under  the 
influence  of  an  intense  noise,  a  light  placed  in  full 
view,  or  in  consequence  of  gazing  intently  for  a  long 
time  on  any  object  whatever.  The  lethargic  state 
may  then  immediately  ensue  if  the  eyes,  having  been 
closed,  are  exposed  by  raising  of  the  lids.  The 
cataleptic  subject  holds  the  eyes  open  and  has  a  rigid 
look  ;  he  is  motionless  and  as  if  petrified.  The 
limbs  remain  for  a  long  time  in  the  position  in  which  | 
they  have  been  placed.  In  moving  them  they  seem 
to  be  very  light,  and  the  articulations  appear  to 
offer  no  resistance.  Tendon  reflexes  are  either  abol- 
ished or  much  enfeebled  ;  the  phenomenon  of  neuro- 
muscular hyper-excitabilitv  is  completely  annulled. 
Pneumograiihic  tracings  show  that  there  are  long 
intermissions  between  the  respirations.  But  the 
frequent  persistence  of  .sensorial  activity  often 
admits  of  the  cataleptic  being  acted  upon  and  in- 
duced to  produce  various  automatic  acts.  The  le- 
thargic state  is  developed  in  the  cataleptic  when  the 
eyes  are  closed  or  the  subject  is  put  in  a  dark  place. 
It  can  be  produced  under  the  influence  of  the  eye. 
While  the  eyelids  are  closed  the  balls  are  in  convul- 
sive motion,  tlie  muscles  are  relaxed,  tlie  limbs 
flaccid.  The  respiratory  movements,  studied  by  aid 
of  the  pneumograph,  are  deep  but  regular.  Tendon 
reflexes  are  remarkably  exalted.  In  all  these  cases 
there  is  what  M.  Charcot  proposes  to  call  neuro- 
muscular hyper-excitability,  and  which  consists  in 
the  aptitude  certain  muscles  exhibit  in  entering  into 
contraction  under  the  influence  of  a  mechanical  ex- 


THE  MEDICAL  RECORD. 


573 


citant  applied  to  the  tendon,  the  muscle,  or  nerve 
supplying  it.  In  the  lethargic  state  all  efforts  to 
arouse  the  subject  by  actions  tending  to  produce 
fear  have  usually  no  eft'ect. 

The  somnambulic  state  can  be  determined  by  the 
fixed  eye  of  the  observer  or  by  slight  sensorial  exci- 
tations. It  can  be  produced  either  in  the  catalepties 
or  in  the  lethargies  by  gently  rubbing  the  top  of 
the  head.  In  this  state  the  individual  has  his 
eyes  wholly  or  partly  closed.  Tendon  reflexes  are 
normal.  No  neuro  -  muscular  hyper  -  excitability. 
Slight  pressure  on  the  eyeballs  will  now  cause  the 
lethargic  state  to  supervene.  —  Journal  de  Med., 
April,  1882. 

Gun-shot  Wound  with  Extensive  Injury  to  the 
First  Lumbar  Vertebra — Recovery. — The  follow- 
ing case,  reported  by  a  surgeon  whose  name  has  not 
yet  been  made  public,  is  interesting  in  so  far  as  it 
bears  upon  the  matter  of  surgical  injuries  to  verte- 
brae and  the  possibility  of  cure  resulting  after  an 
operation.  M.  H.  Francis,  Captain  Company  F, 
Eleventh  Regiment  Virginia  Infantry,  was  wounded 
May  31,  1865,  in  the  right  hip.  Almost  at  the 
same  instant  he  received  a  secondbullet  in  his  right 
leg,  which  broiight  him  to  the  ground.  While  lying 
in  the  mud  he  was  struck  by  three  other  balls,  one 
in  the  back,  another  in  the  wi-ist,  and  a  third  in  the 
thigh.  For  twelve  hours  he  lay  upon  the  battle- 
field before  removal  to  the  hospital.  After  a  mouth's 
treatment  he  left  for  home,  over  a  long,  rough  road, 
on  a  leave  of  absence.  Six  months  afterward  he  re- 
turned to  the  army,  and  entered  upon  unusually 
active  duty,  though  suft'ering  great  pain  from  time 
to  time  in  his  back.  When  the  war  closed  he  en- 
gaged in  active  fai-m-life,  and  up  to  the  summer  of 
1871  he  enjoyed  fairly  good  health,  when,  in  build- 
ing a  mill-dam,  where  he  was  much  of  the  time 
standing  in  water,  lifting  heavy  logs,  he  became  ill. 
Our  interest  is  centred  upon  the  course  taken  and 
the  effects  resulting  from  the  wound  in  the  back. 
An  examination  on  Februaiy  12,  1875,  revealed  a 
man  of  large  frame  weighing  less  than  one  hundred 
pounds,  with  his  body  drawn  to  right  side,  his  thigh 
flexed  upon  his  abdomen,  and  his  leg  upon  his 
thigh  ;  little  fever,  no  appetite,  and  strength  rapidly 
failing.  A  small  pouting  wound,  four  inches  to  the 
right  of  the  spine  and  just  below  the  twelfth  rib, 
was  discharging  yellowisli  pus.  A  silver  probe  was 
passed  inward  and  slightly  upward  until  it  encoTin- 
tered  a  hard  substance  at  a  depth  of  four  and  a  half 
inches  ;  neither  dead  bone  nor  lead,  as  proved  by 
the  "  feel"  and  Nelaton's  porcelain  probe.  As  there 
was  no  evidence  of  injtiry  to  any  vital  organ,  an 
operation  was  deemed  ad\'isable.  The  patient  was 
chloroformed,  and  an  incision  four  inches  long  was 
made  in  the  long  axis  of  the  body,  and  a  careful  dis- 
section, guided  by  the  track  of  the  bullet,  down  to 
the  first  lumbar  vertebra  in  the  body  of  whieh  the 
ball  could  be  distinctly  felt  with  the  index  finger. 
Two  unsuccessful  attempts  to  remove  it  were  made, 
but  each  time  the  instiiiment  slipped.  The  third 
trial  was  successful.  Examination  of  the  wound  by 
the  finger  disclosed  a  smooth  surface  of  dead  bone, 
which  was  left  to  the  efforts  of  nature,  as  further 
operation  was  considered  dangerous.  Improvement 
followed,  but  three  months  later  the  patient  became 
feverish  and  suffered  great  pain  from  the  formation 
of  an  abscess  in  the  side  at  a  j^oint  corresponding 
to  the  site  of  the  incision  in  the  right  side.  Upon 
being  opened,  it  discharged  a  large  quantity  of  dark- 
colored  pus  and  a  few  fragments  of  bone.     Later,  n 


piece  of  cloth,  two  inches  long  and  one-eighth  of  an 
inch  wide,  together  with  a  cup-shaped  piece  of  dead 
bone,  exactly  fitting  to  the  apex  of  the  buEet,  came 
away  from  the  opening  in  the  right  side.  In  August, 
1881,  both  wounds  had  closed  entirely ;  the  jiatient 
was  up  and  about  his  work,  strong  and  robust. 
Such  a  result,  after  so  great  an  injury  to  the  body 
of  a  vertebra,  would  not  uphold  Dr.  Sims' assertion, 
made  in  reference  to  the  case  of  President  Garfield, 
"  that  with  it  (the  injury  to  the  vertebra)  it  was  im- 
possible for  him  to  live." — tIaiUard's  Medical  Jour- 
nal, March,  1882. 

The  Hypodermic  Use  of  Woorara  in  Tetanus. — 
Impelled  by  the  incomi^leteness  of  our  knowledge 
regarding  the  effects  of  woorara  upon  man,  and  con- 
cerning the  limits  within  which  it  may  be  safely 
utilized,  therapeutically.  Dr.  Leslie  Maturin  pub- 
lishes (in  the  Dublin  Journal  of  Medical  Scie7>ce, 
April,  1882),  a  case  of  tetanus  treated  with  subcuta- 
neous injections  of  that  drug.  A  short  rt'.s!(??!f  of  its 
natural  histoiw  precedes  the  record  of  the  case. 
Woorara,  also  known  as  urari,  curare,  wurali,  and 
wourari,  is  presumed  to  be  a  combination  of  vegeta- 
ble ijrinciples,  the  poisonous  ingredient  of  which 
is,  chiefly,  the  juice  of  the  strychnos  vine.  It  is 
jirepared  for  use  by  mixing  it  with  pep]3er,  coque- 
du-levant  (cocculus  toxiferus)  and  other  acrid 
plants.  Taken  internally,  urari  has  no  toxical  ef- 
fects. It  was  first  therapeutically  employed  by  M. 
Vella,  in  1856.  It  paralyzes  only  the  motor-nerves, 
leaving  sensation  unimpaired.  Dr.  Maturin  admin- 
istered the  woorara  hypodermically,  in  doses  of 
from  three-twentieths  to  one  gi-ain.  The  spasms 
continued  for  thirteen  days,  but  the  patient  recov- 
ered. The  conchisions  reached  by  Dr.  Maturin, 
after  careful  study  of  the  case,  are  as  follows  :  Woo- 
rara seems  to  exercise  a  specific  action  in  dimin- 
ishing the  frequency  and  violence  of  the  tetanic 
spasms.  Its  acinetic  jiroperties  are  not  always  ini- 
mediafeh/  developed  uj^on  its  absorption,  being  more 
marked  'oy  a  comparison  of  its  daily  effects  than  by 
that  of  shorter  intervals  ;  it  has  not  a  cumulative 
effect ;  four  gi-ains  may,  in  the  adult,  be  exhibited 
at  intervals  during  the  twenty-four  hours  without 
danger  to  life. 

The  Bacillus  Leprje  :  Is  it  a  Realfty  oe  a  Fic- 
tion?— Under  this  interrogative  title,  Dr.  H.  D. 
Schmidt,  Pathologist  of  the  Charity  Hospital  of 
New  Orleans,  La.,  discusses  the  relations  of  para- 
sitic organisms  to  leprosy  in  the  Chicar/o  M'dical 
Journal  and  F..raminer,  for  April,  1882.  His  deduc- 
tions are  based  upon  a  critical  examination  of  nu- 
merous specimens  taken  from  the  tissues  of  three 
fatal  cases  of  leprosy  observed  by  himself,  in  1880, 
and  stained  with  methyl  violet.  Dr.  Schmidt  failed 
to  find  the  so-called  hacilbn:  leprir,  the  etiological 
relations  of  which  to  the  disease  in  question  have 
been  generally  admitted  since  the  publication  of 
Hansen's  observations  in  1870,  and  entertains  seri- 
ous doubts  as  to  its  presence  in  leprous  tissues. 
Having  retained  numerous  sections  of  these  tissues, 
taken  from  his  cases  and  presei-ved  in  alcohol  and 
water,  Dr.  Schmidt  offers  to  furnish  competent 
pathologists  with  specimens  in  order  that  they  may 
examine  and  report  upon  them.  Dr.  Schmidt's  pa- 
per closes  with  a  certificate,  signed  by  Drs.  Curtis, 
Hyde,  and  Fenger,  of  Cliioago,  to  the  effect  that 
the  subscribers  failed  to  find  any  bacilli  in  the  spe- 
cimens prepared  and  exhibited  to  them  bv  Dr. 
Schmidt. 


574 


THE  MEDICAL  RECORD 


The  Medical  Record: 


^  lUMklt)  Jottvnal  of  illcbicinc  aiib  Surgtvn. 


GEORGE  F.  SHRADY,  A.M.,  M.D.,  Editor. 


PUBLISHED   BT 

WM.  WrtOI)  &  CO.,  Nos.  56  and  58  Lafayette  Place,  IV.  Y. 


New  York,  May  27,  1882. 

THE  AIVIERICAN  MEDICAL   ASSOCIATION 
AND  THE  NEW  YORK  CODE. 

At  the  next  meeting  of  the  American  Medical  A.sso- 
ciation  the  question  of  freedom  in  consultations,  as 
advocated  bj  the  New  York  Code,  mil  doubtless 
provoke  considerable  discussion.  It  must,  neces- 
sarily, be  brought  up  in  connection  with  the  right  of 
representation  in  the  Convention  of  the  New  York 
delegates.  Whatever  decision  is  arrived  at,  it  is  to 
be  hoped  that  it  will  be  the  result  of  a  calm  consid- 
eration of  all  the  pros  and  cons  in  the  matter.  The 
association  can  hardly  afford  to  take  any  hasty  ac- 
tion in  the  premises  or  render  a  snap  judgment  on 
the  main  points  at  issue.  The  .subject  is  one  which 
will  bear  the  most  thorough  examination,  and  in 
justice  to  the  Medical  Society  of  the  State  of  New 
York,  it  should  receive  sucli  at  the  hands  of  the 
judicial  council.  The  position  of  the  New  York 
men  has  not  been  generally  understood. 

The  opponents  of  the  new  Code  make  a  mistake 
in  supposing  that  instmment  to  be  in  any  manner 
an  apology  for  homuiopathy,  eclecticism,  or  any 
other  form  of  error.  Its  advocates  are  firm  in  the 
faith  of  the  ao-called  "  old  school."  They  are  as 
jealous  of  the  fair  fiime  of  the  profession  as  their 
critics,  and  have  done,  to  say  the  least,  as  much  as 
they  to  advance  ibs  true  glory.  The  ignoble  charge 
that  they  are  actuated  by  mex'cenary  motives  and 
hanker  after  the  pecuniaiy  benefit  which  consulta- 
tions with  "  irregulars  "  would  bring,  is  too  childish 
and  flimsy  to  need  refutation.  So  far  as  we  know 
them,  and  we  tliiuk  our  opportunities  for  knowledge 
are  certainly  as  ample  as  those  of  outsiders,  they 
are  men  of  the  highest  probity  and  all  in  a  position 
to  be  free  from  such  mean  and  grovelling  propen- 
sities. To  allege  tliat  the  Code  is  in  the  interest  of 
the  specialists,  and  that  thoy  desire  to  have  license 
in  the  matter  of  consultations  and  to  bo   afforded 


scope  to  violate  even  the  restraints  of  common  pro- 
fessional decency,  is  absolutely  groundless.  The 
specialists  among  us  have  been  made  such  by  the 
action  of  their  professional  brethren.  They  have 
not  arbitrarily  assumed  the  jjosition.  They  are, 
with  scarcely  an  exception,  men  of  broad  medical 
culture,  possessing  the  attributes  of  honorable  pro- 
fessional workers,  and  their  special  knowledge  or 
skill  in  addition.  They  have  always  been  loyal 
to  the  American  Code,  and,  if  properly  understood, 
are  still  so.  They  have  been  foremost  in  everything 
relating  to  the  honor  and  advancement  of  the  pro- 
fession, and  show  a  proper  public  spirit  in  evei-y- 
thing  that  has  affected  the  progi-ess  and  dignity  of 
their  calling. 

Their  influence  in  developing  hospitals  and  in 
adding  to  the  solid  attractions  of  our  medical  schools 
has  conferred  a  great  benefit  upon  the  cause  of  hu- 
manity. To  subject  them  to  unjust  criticism  is  igno- 
minious. Three  out  of  five  of  the  committee  which 
reported  the  new  code  were  family  practitioners, 
and  the  relations  of  specialism  were  not  for  a  moment 
considered  by  the  remainder,  or  by  the  large  ma- 
jority of  the  State  Society  which  voted  for  the 
measure.  The  New  York  Code  has  done  nothing 
more  than  confer  upon  each  man  the  privilege  of 
thinking  for  himself,  and  acting  according  to  his 
own  conviction  of  right.  He  is  constituted  his 
own  judge  as  to  the  propriety  of  holding  consulta- 
tions with  any  other  legally  qualified  practitioner 
whatsoever,  or  of  refusing  to  do  the  same. 

On  the  principle  that  there  is  only  one  broad  plat- 
form upon  which  all  progi-essive  men  can  meet,  one 
platform  in  which  they  can  be  placed  upon  the  sim- 
ple level  of  seekers  after  truth — simj)le  doctors, 
nothing  more  and  nothing  less — the  New  York  Code 
has  given  the  freest  liberty  of  thought  to  the  indi- 
vidual. There  is  no  more  danger  of  consulting  with 
homoeopaths,  or  with  irregulars  generallj",  than 
heretofore ;  nor  will  there  be,  no  matter  what  lib- 
eral constiiiction  may  be  placed  upon  the  spirit  or 
intent  of  the  new  clause.  Each  man  has  his  honor 
and  conscience  in  his  own  keeping,  and  he  will 
doubtless  act  accordingly.  The  responsibility  of 
doing  properly  in  any  given  case  is  thrown  upon 
the  individual  rather  than  upon  convetitional 
rules. 

There  does  not  seem  to  be  any  harm  in  allowing 
every  man  to  govern  his  action  according  to  his 
conscience.  This  question  has  nothing  directly  or 
indirectly  to  do  with  the  recognition  of  homoeopathy 
or  any  other  irregular  practice.  No  member  of  the 
Medical  Society  of  the  State  of  New  York  can  con- 
sistently meet  a  professed  homojopathist  or  an 
avowed  eclectic.  As  a  disciple  of  a  liberal  science 
he  cannot  countenance  dogmatism  in  any  shape. 
Nor  will  he,  if  he  is  true  to  himself  or  his  principles. 
The  very  fact  of  consvdtation  imi)lies  the  existence 


THE  MEDICAL  EECORD. 


575 


of  confidence  in  each  otliei's  judgment  and  the  free- 
dom from  sectarian  influences.  Liberality  and  dog- 
matism are  always  opposed  to  each  other,  and  are 
no  more  apt  to  agree  at  the  bedside  of  the  dying 
patient  than  they  are  at  the  stake  of  the  martyr.  A 
careful  study  of  the  New  York  code  will  lead  to  the 
conclusion  that  its  provisions  concerning  consulta- 
tions do  not  really  present  any  inconsistencies  with 
similar  provisions  in  the  American  code.  We  ai'e  for- 
bidden by  it  to  consult  with  irregulars  and  such  as  are 
wedded  to  any  exclusive  dogma  "  to  the  rejection  of 
the  aids  actually  furnished  by  anatomy,  physiology, 
pathology,  and  organic  chemistry."  Practically,  this 
has  no  meaning,  and  in  the  absence  of  any  direct 
explanation  leaves  each  man  to  judge  of  its  appli- 
cation. 

It  is  beyond  the  memory  of  man  when  any  regu- 
larly educated  and  competent  medical  man,  a  mem- 
ber of  the  American  Medical  Association  or  any 
other  medical  body  in  affiliation  therewith,  has  been 
disciplined  imder  this  rule.  And  this  is  simply  for 
the  reason  that  it  has  been  impossible  to  do  so.  So 
far  as  consultation  with  the  dogmatists,  as  described 
by  the  American  code,  is  concerned,  the  New  York 
medical  man  has  been  and  always  will  be  as  free 
from  temptation  and  as  safe  from  the  commission 
of  sin  as  any  of  the  gentlemen  who  may  present 
condemnatory  resolutions  at  the  St.  Paul  meeting. 

We  speak  advisedly  when  we  say  that  the  Medical 
Society  of  the  State  of  New  Y^ork  in  its  recent  ac- 
tion had  no  dii'ect  intention  of  placing  itself  in 
avowed  antagonism  to  any  code  calculated  to  elevate 
and  advance  the  regular  profession,  but  believed 
that  it  was  taking  a  step  forward  by  granting  liberty 
of  opinion  to  its  members,  in  terms  not  to  be  mis- 
understood. If  the  American  Medical  Association 
denies  this  right  to  any  body  of  honorable,  thinking, 
competent  men,  it  is  simply  wrong,  and  the  mem- 
bers of  the  State  Society  can  afford  to  be  on  the 
other  side.  In  any  event  we  are  quite  satis- 
fied that  the  adoption  of  the  new  code  will  be 
fatal  to  irregular  practice  in  this  State.  It  will 
stimulate  every  friend  of  medical  education  and 
every  legally  qualified  practitioner  to  new  endeavor 
to  advance  the  standards  or  tests  of  professional 
scholarship.  It  will  awaken  them  to  the  defence  of 
scientific  medicine  against  all  attempts  by  quacks  to 
secure  the  sanctions  of  law.  It  will  lead  to  amend- 
ments in  our  present  laws  for  the  better  protection 
of  the  public  against  badly  equipped  medical 
schools,  and  against  general  charlatanry.  It  will 
make  our  State  too  hot  for  medical  outlaws,  and 
the  good  influence  thus  adduced  will  go  out  into 
all  parts  of  the  country  with  which  we  have  scien- 
tific, commercial,  and  social  relations.  It  is  in  the 
interests  of  liberty  and  not  license,  and  instead  of 
being  a  concession  to  homoeopathy  it  will  be  its 
death-blow. 


THE   ANTlPHliOGISTIC  ACTION  OP  LOCAL   BLOOD-LErTING. 

The  usefulness  of  local  blood-letting  in  relieving  acute 
inflammation  is  a  well-established  fact,  and  one  of 
which  advantage  is  hardly  taken  so  often  as  it  should 
be.  A  very  ingenious  demonstration  of  the  way  in 
which  such  blood-letting  acts  upon  local  inflamma- 
tion has  recently  been  made  by  Genzmer  (Centralhlatt 
far  die  Hied.  WissenscJi.).  A  description  of  it  may  be 
of  interest,  and  furnish  also  some  stimulus  to  a  more 
extended  and  rational  application  of  this  measure. 

The  old  view  that  local  blood-letting  acted  by  pro- 
ducing a  local  aniemia  has  been  for  some  time  set 
aside  as  inadequate.  The  present  view  that  this 
procedure  starts  up  the  blood-current  again  and  re- 
lieves the  inflammatory  stasis  is  the  one  illustrated 
by  Genzmer's  experiments. 

He  took  a  number  of  frogs,  curarized  them,  and 
made  local  pcinta  of  injiuy  in  the  web  of  the  foot 
with  a  red  hot  needle.  These  injured  points  were 
then  watched  under  the  microscope.  So  soon  as  the 
classical  symptoms  of  inflammation — dilatation  of 
vessels,  wandering  of  white  blood-cells,  slowing  of 
circulation,  and  finally  stasis — set  in,  a  vein  near 
the  joint  of  the  leg  was  opened.  A  fine  glass  tube 
was  inserted  and  blood  slowly  sucked  out.  As  soon 
as  the  blood  began  to  flow,  the  condition  of  things 
at  the  inflammatory  focus  changed.  The  corpiiscles 
moved  again,  very  soon  the  stasis  disappeared,  and 
the  blood  flowed  continuously  through  the  part. 
The  inflammation  was  stopped,  temporarOy  at 
least. 

In  other  experiments,  scarification  or  general 
blood-letting,  was  employed  instead  of  local  blood- 
letting but  not  with  so  good  results. 

The  inference  from  the  above  description  is  that 
blood-letting  acts  antiphlogistically,  in  a  purely  me- 
chanical manner.  This  is  very  satisfactory,  except 
that  it  appears  to  be  almcst  too  clear  and  simple  to 
be  in  accord  with  Nature's  usually  mystic  methods. 


OUK   CHBONIC   PAUPER   INSANE. 

This  hapless  and  uninteresting  class  has  recently 
received  official  attention. 

According  to  a  State  law,  sixteen  of  our  New  York 
counties  are  allowed  to  keeji  their  pauper  insane  in- 
stead of  sending  them  to  the  Willard  Asylum.  The 
insane  in  these  counties  number  1,286.  With  one 
exception  the  above  counties  kee25themin  buildings 
connected  with  the  jjoor-houses,  and  under  the  same 
executive  management. 

The  condition  of  these  insane  some  years  ago  was 
horrible  in  the  extreme.  There  is  still  a  great  need 
of  improvement,  as  has  been  shown  by  Messrs. 
Letchworth  and  Carpenter,  of  the  State  Board  of 
Charities. 

These  gentlemen,  as  a  special  committee,  visited 
and  carefully  examined  all  the  county  institutions. 
The  defects  which  they  found  were  very  niimerous. 


576 


THE  MEDICAL  RECORD. 


For  example,  in  the  sixteen  institutions  visited  was 
kept  the  following  array  of  restraining  apparatus  : 
39  cribs,  30  restraining  chairs,  48  muffs,  43  camisoles, 
30  hand-cuffs  and  shackles,  46  wristlet-bands  arid 
waist-belts.  The  number  of  restrained  at  the  time 
of  visiting  was  not  large,  however,  being  only  thirty- 
four,  besides  a  number  who  were  locked  in  rooms. 
The  committee  refer,  however,  and  justly,  to  the 
temptation  to  misuse  to  which  so  liberal  a  supply  of 
apparatus  must  lead. 

A  long  list  of  suggestions  for  improvements  in  the 
matter  of  general  care,  occupation,  diet,  amusement, 
etc.,  is  given.  The  report,  in  brief,  shows  that  our 
county  insane  are  scattered  about  in  too  small 
groups  for  humane  or  economic  treatment.  The 
county  almshouses  are  i^olitical  centres,  and  the  in- 
sane are  hindered  in  a  hundred  ways  from  getting 
proper  supervision  and  treatment. 

All  this  has  been  known  before,  but  the  report 
just  made  tabulates  the  facts  again,  and  in  an  im- 
pressive manner. 

The  remedy  suggested  is  that  of  massing  the 
chronic  pauper  insane  of  the  counties  together  into 
district  asylums.  Xo  county  should  be  allowed  to 
care  for  its  insane  alone,  unless  it  has  over  250.  If 
the  number  is  less,  two  or  more  counties  should 
unite.  These  district  asylums  should  be  regularly 
organized,  with  a  medical  superintendent,  and,  if 
possible,  a  non-political  board  of  trustees. 

This  suggestion,  made  by  the  committee,  is  essen- 
tially the  same  as  that  proposed  in  the  Record 
three  years  ago.  If  not  the  best  possible  way  of 
solving  the  question,  it  is  vastly  in  advance  of  the 
present  method. 

The  report  which  we  have  thus  commented  upon 
is  an  unusually  careful  and  judicious  one.  We  may 
perhaps  be  allowed  to  wonder  why  our  esteemed 
State  Commissioner  in  Lunacy,  Dr.  Ordronaux,  has 
never,  in  his  yearly  peregrinations,  brought  out  these 
same  facts. 

It  is  not  likely  that  any  action  will  be  taken  upon 
the  matter  this  year,  although  a  bill  has  been  intro- 
duced ;  but  the  matter  should  not  be  allowed  to  rest. 
The  profession  owes  it  to  itself  not  to  let  the  sick 
either  in  mind  or  body  be  made  the  victims  of  our 
political  machinery,  which  means  inhumanity  and 
neglect. 


AN    AGRICTTLTURAIi   DEPARTMENT. 

The  House  of  liepresentatives  has  passed  by  a  very 
large  vote  the  bill  to  create  an  agricultural  depart- 
ment. The  prospect  now  is  that  the  bill  will  become 
a  law.  Tlie  establishment  of  such  a  department 
means  an  enlargement  of  the  work  of  the  present 
Bureau,  and  to  some  branches  of  this  the  medical 
profession  can  look  with  considerable  interest.  It 
is  proposed  to  divide  the  new  establishment  into 
three  bureaus.     The   first  is   to   be  the   Bureau  of 


Agricultural  Products,  and  will  include  botany, 
chemistry,  and  entomology.  This  allows  of  a  large 
amoimt  of  scientific  work.  The  second  is  the  Bu- 
reau of  Animal  Industry,  and  is  the  one  which  wiU 
especially  claim  medical  attention.  It  is  to  be  under 
the  charge  of  a  veterinai'y  surgeon,  and  its  duties 
include  a  supervision  of  the  domestic  animals,  with 
investigations  regarding  their  number,  condition,  and 
the  diseases  to  which  they  are  subject.  Means  are 
to  be  provided  for  protecting  them  against  conta- 
gious diseases,  and  investigations  are  to  be  carried 
on  as  to  the  best  methods  of  feeding,  breeding,  and 
improving  stock. 

The  thiid  bureau  is  that  of  Lands  and  Statistics. 

It  will  be  seen  that  our  Government  is  now  likely 
to  create  a  department  which  wiU  be  very  largely 
scientific  in  its  work,  and  that  some  of  this  work 
will  doubtless  help  forward  the  science  of  compara- 
tive pathology,  in  which  there  is  now  a  growing  in- 
terest. It  will  also  be  a  satisfaction  to  know  that 
the  status  of  scientific  work  can  be  elevated  and  its 
opportunities  enlarged  by  the  creation  of  this  new 
department. 


A   TRIBUTE   TO   AMERIOAU    STRGERT. 

The  American  surgeon,  though  apt  to  be  deficient 
in  scientific  training,  is  generally  acknowledged  to 
be  quite  equal  to  his  European  confreres  in  practical 
knowledge,  ingenuity,  and  operative  skill.  For  all 
that,  surgery  in  this  country  has  not  yet  reached 
the  stage  where  an  acknowledgment  from  abroad  of 
our  achievements  is  not  gratifying. 

Such  acknowledgments,  as  in  the  case  of  Bigelow'a 
operation,  are  often  slowly,  if  not  grudgingly  given. 
We  have  recently  noted,  however,  a  very  generous 
and  candid  review,  in  the  Medical  Times  and  Gazette, 
of  what  our  distinguished  townsman  Dr.  Sayre  has 
done  in  calling  the  attention  of  European  surgeons 
to  the  plaster- jacket  treatment  of  spinal  caries.  It  is 
stated  that  before  Sayre  went  to  Europe,  and  in  ac- 
cents not  entirely  silver-tongued,  explained  the 
American  method,  very  little  was  being  done  for 
cases  of  Pott's  disease.  Such  attempts  as  had 
already  been  made  to  use  plaster-splints  had  been 
largely  abortive,  through  misapprehension  or  lack 
of  skill.  At  present,  however,  the  fixing  of  the 
trunk  in  some  kind  of  a  jacket  is  universally  admit- 
ted by  European  surgeons  to  be  helpful,  and  very 
often  curative.  There  has  thus  been  a  new  era 
created  in  this  branch  of  surgery,  and  an  inestimable 
boon  conferred  upon  a  large  class  of  suflerers. 

There  would  naturally  be  some  question  of  prior- 
ity with  regard  to  so  important  a  contribution  to  t 
surgical  therapeutics  as  tlie  plaster-jacket.  There 
can  be  no  doubt,  however,  that  the  English  reviewer 
justly  gave  Dr.  Sayre  the  credit  for  championing 
this  method,  exi)laining  its  principles,  and  success- 
fully pl^icing  it  before  tlie  i)rofession. 


THE   MEDICAL  RECORD. 


577 


Heports  of  Societies. 


NEW  YORK  ACADEMY  OF  ]\IEDICINE. 

Stated  Meetinri,  Ma;/  18,  1882. 

Dr.  Fordtoe  Bakkbb,  M.D.,  LL.D.,  President,  ra 
THE  Chatb. 

The  Statistical  Secretary,  Dr.  F.  V.  White,  for- 
mally announced  the 

DEATH   OP   JAMES   R.    WOOD,  M.D.,  LL.D. 

Dr.  Lewis  A.  Satre  offered  resolutions  prepared 
by  Dr.  Wni.  H.  Van  Buren,  which  were  followed  by 
expressions  of  profound  sorrow  and  tributes  of  high- 
est respect  from  Drs.  Sayre,  Willard  Parker,  AVni. 
Detmold,  and  the  President.  The  resolutions  were 
unanimously  adopted,  ordered  engrossed,  to  be  sent 
to  the  family  of  the  deceased,  and  a  copy  to  he  trans- 
mitted to  the  medical  journals  of  this  city. 

The  President  ajjpointed  Dr.  Frederick  S.  Den- 
nis memorialist. 

Dr.  Henry  J.  Bigelow,  of  Boston,  was  then  in- 
troduced to  the  Academy  and  spoke  on  the  subject 
of 

LITHOTEITY  WITH  EVACUATION. 

His  remarks  were  illustrated  with  instruments  and 
consisted  of  a  historical  sketch  of  the  successive 
steps  taken  in  bringing  the  operation  to  its  present 
degree  of  perfection,  together  with  occasional  prac- 
tical hints  concerning  its  application.  The  subject, 
he  said,  was  a  purely  surgical  one,  and  something 
even  more  limited  than  that ;  it  was  almost  purely 
mechanical.  The  pure  mechanics  of  the  subject 
were  the  branch  which  had  modified  lithotrity  and 
made  the  operation  what  it  is,  and  to  that  especially 
he  directed  the  attention  of  the  Academy.  The 
subject  deals  with  physics  more  generally  than 
almost  any  other  subject  in  surgery.  The  instru- 
ment which  has  changed  the  views  of  surgeons  with 
regard  to  the  bladder  is  expected  to  deal  with  air, 
water,  and  solid  material. 

Any  of  the  old  instraments  will  break  a  stone, 
but  it  becomes  a  matter  of  interest  as  to  what  one 
■  will  do  it  best.  In  1878,  in  a  discussion  in  Lon- 
don, Sir  .James  Paget  said  he  thought  the  subject 
had  been  so  thoroughly  studied  that  it  was  very 
doubtful  if  further  imi^rovement  in  the  operation 
would  be  made.  But,  curiously  enough,  the  instru- 
ments for  lithotrity  have  undergone  considerable 
modification  since  that  date  and,  although  the  old 
ones  will  do  the  work,  those  which  we  now  have  will 
do  it  much  better,  and  it  is  still  desiralile  to  im- 
prove upon  the  instruments  in  ordinary  use. 

About  six  years  ago  it  was  the  general  practice  to 
perform  the  operation  of  breaking,  in  from  two  to 
seven  minutes.  Some  operators  in  Europe  incul- 
cated the  view  that  from  two  to  three  minutes  was 
the  best  average  time,  although  the  operation  was 
occasionally  protracted  to  five  or  six  minutes.  When 
Civiale  began  to  practise  it,  he  occupied  sometimes 
half  an  hour,  but  it  was  said  that  he  soon  reduced 
the  length  of  the  sitting  and  gradually  brought  it 
down  to  three  or  four  minutes.  Passing  to  the  con- 
sideration of  instraments.  Dr.  Bigelow  exhibited 
Clover's,  and  directed  attention  to  the  fact  that  the 
small  catheter  used  (21,  French)  was  really  the  part 
that  retarded  the  progress  of  the  operation.  If 
stones  could  be  reduced  to  powder  they  could  be 


removed  readily  through  a  small  tube.  The  only 
distinctly  important  tiling  in  the  instrument  with 
which  the  best  results  had  been  obtained,  differing 
from  Clover's,  was  the  htrf/e  catheter,  and  the  range 
now  employed  was  from  25  to  31,  the  last  being 
used  in  only  very  exceptional  cases.  With  reference 
to  straight  or  curved,  he  preferred  the  straight  cath- 
eter. As  a  rule,  he  thought  he  coiild  introduce  it 
better  than  the  curved  catheter.  However,  it  was  a 
matter  of  individual  preference,  and  really  was  a 
question  of  considerable  importance. 

Dr.  Bigelow  then  illustrated  uj^ion  the  blackboard 
the  modifications  which  had  been  made  in  the  vesi- 
cal extremity  of-  the  catheter,  and  said  that  a  large 
incline  was  likely  to  wedge  the  fragments,  and  the 
orifice  should  not  be  longer  than  the  diameter  of 
the  tube. 

With  reference  to  the  bulb,  a  variety  of  modifica- 
tions had  been  made,  and  the  questions  in  physics 
involved  in  their  construction,  and  the  obstacles  to 
be  overcome,  were  stated  and  demonstrated  uj^on 
the  board. 

With  reference  to  the  fragments,  it  was  a  matter 
of  fact  that  they  are  returned  from  the  bulb  to  tie 
bladder,  and  to  prevent  this  he  had  devised  a  trap 
at  the  head  of  the  catheter.  At  first  he  used  a  rub- 
ber ball,  afterward  attached  a  bit  of  cloth  to  the 
end  of  the  tube,  both  of  which  worked  well,  yet 
sometimes  were  inefficient.  A  general  principle  ap- 
plicable to  this  portion  of  the  apparatus  was  that 
"in  an  evacuator  ichererer  iDatei'  goes  fragments  iriil 
go,  unless  prevented  by  a  strainer,  and  that  is  the 
difficulty." 

In  his  latest  instrument  there  are  two  stopcocks, 
the  tube  enters  the  bulb  in  the  axis  of  the  catheter, 
delivers  in  the  bulb  in  the  centre,  and  tlie  prolonga- 
tion into  the  bulb — only  to  a  distance  which  does 
not  at  all  interfere  with  compression  of  the  bulb — 
is  a  cylindrical  strainer,  the  aggregate  space  afforded 
hy  the  holes  being  considerably  in  excess  of  that  afforded 
hy  the  central  opening  in  the  tube,  hence  the  water 
seeks  the  largest  outlet  and  escapes  while  the  frag- 
ments are  arrested. 

Dr.  Bigelow  exhibited  Weiss's  latest  instrument, 
used  by  Thompson,  but  the  objection  was  that  the 
bulb  was  too  limber  and  the  fragments  remained 
within  it. 

To  get  rid  of  air  and  graduate  the  quantity  of 
water  in  bladders  of  difl'erent  size.  Dr.  Bigelow  at- 
taches a  hose  to  the  top  of  the  bulb,  the  other  ex- 
tremity of  which  is  placed  in  a  receptacle  containing 
water,  and  he  regarded  it  as  a  very  important  ad- 
dition. 

With  his  latest  instrument  every  bubble  of  air 
could  be  expelled  ;  with  it  the  quantity  of  water  in 
the  bladder  graduated  easily  and  exactly  at  the  will 
of  the  operator,  and  every  particle  of  detritus  could 
be  quickly  removed  from  the  bladder. 

With  regard  to  litholrites,  the  most  convenient 
instrument  was  that  which  was  best  adapted  to  the 
most  common  motions  of  the  hand.  The  rotary 
movements,  he  thought,  were  most  easily  and  fre- 
quently made  (pronation  and  supination),  and  there- 
fore he  had  had  the  handle  of  his  instrument  made 
ovoidal  in  shape,  with  an  arrangement  by  which  the 
button  of  the  older  instruments  was  more  readily 
managed.  The  blade  of  a  lithotrite  should  be  a  near 
approach  to  a  right  angle  :  the  nearer,  the  better  it 
acts. 

That  instrument  impacts  least  which  has  the  male 
blade  thickened  so  as  to  carry  high  teeth  or  notches 
which  will  crush  the  material  off  obliquely. 


578 


THE  MEDICAL  RECORD. 


With  reference  to  the  introduction  of  the  cathe- 
ter, facility  could  be  easily  acquired  by  special  at- 
tention to  relations  of  the  ojiening  in  the  triangular 
ligament. 

Concerning  the  size  of  the  instrument,  the  object 
sought  was  to  simply  hold  the  urethra  open  to  its 
normal  calibre. 

With  regard  to  results,  if  the  man  is  healthy,  no 
accidents  occur,  and  disease  of  the  kidneys  is  not 
present,  it  is  almost  a  qtiestion  of  the  surgeon's  skill 
whether  or  not  he  comes  out  of  the  operation  safely. 

The  deaths  which  had  come  to  his  notice  were 
these :  1,  from  septiciemia  following  laceration  of 
the  urethra  by  a  fragment  held  in-  the  eye  of  the 
tube ;  2,  from  injury  done  by  removing  a  loaded 
instrument  that  could  not  be  emptied  ;  3,  from  re- 
moving a  lithotrite  without  observing  that  it  was 
half  an  inch  open ;  and  4,  from  tilting  the  instru- 
ment after  it  had  been  introduced,  and  producing  a 
false  passage. 

Dr.  E.  L.  Keyes  thought  that  Dr.  Bigelow  laid 
too  much  stress  upon  instruments,  and  too  little 
upon  the  design  of  the  operation.  He  had  used  the 
fenestrated  instrument  for  the  purpose  of  absolutely 
avoiding  clogging.  Whether  the  straight  or  curved 
tube  was  used  was  not  a  matter  of  much  impor- 
tance, although  in  old  men  the  curved  had  seemed 
to  him  to  work  better  than  the  straight. 

There  was  no  amount  of  sounding  for  stone  like 
the  use  of  a  small  tube,  no  air,  and  a  good  washer, 
and  if  the  operation  did  nothing  more,  it  was  worthy 
of  special  consideration,  and  its  usefulness  as  a 
searcher  was  sufficient  to  commend  it  for  general 
adoption._2 

Dr.  Gouley  said  that  Dr.  Bigelow  had  given  the 
profession  the  best  of  all  aspirators  for  the  purpose 
of  removing  detritus  from  the  bladder.  As  an  in- 
teresting item  in  the  history  of  removal  of  calculous 
detritus,  he  exhibited  Mercier's  original  instrument, 
made  twenty-five  years  ago.  But  with  reference  to 
aspiration  he  wished  to  say  Uiat  while  it  was  indi- 
cated in  the  cases  of  old  men  who  cannot  pass  cal- 
culous detritus,  and  can  be  applied  in  these  cases 
because  the  bladders  of  old  men  are  much  more 
tolerant  of  instruments  and  stones  than  those  of 
middle-aged  or  younger  men,  it  could  not  entirely 
supercede  lithotomy  in  one  or  other  of  its  varieties. 
Aspiration  by  thick-walled  tubes  caused  violence 
which  was  greater  than  that  produced  by  frequent 
introductions  of  the  lithotrite,  or  even  by  fi-agments 
which  are  allowed  to  remain.  The  retention  of 
angular  fragments  in  the  bladder  did  not  do  so  much 
mischief  as  was  generally  .supposed,  for  within  six 
or  eight  hours  they  became  coati'd  with  tenacious 
mucus,  and  thus  their  expulsion  was  i-endered  easier 
than  if  expelled  quickly. 

He  was  firmly  convinced  that  aspiration  should 
be  restricted  to  those  cases  in  which  the  bladder  is 
not  cajiable  of  expelling  the  detritus.  Whenever 
the  bladder  can  remove  the  detritus,  it  should  be 
permitted  to  do  so. 

A  good  lithotrijitist  should  be  able  to  crush  a 
stone  with  any  of  the  old  instruments,  and  should 
not  hesitate  to  introduce  it  as  many  times  as  neces- 
sary. (!iviale  demonstrated  in  his  first  case  the 
tolerance  of  the  bladder,  ami  it  had  been  demon- 
strated many  times  since.  Tliore  were  cases  in  wliich 
it  was  preferable  to  have  several  short  sittings  of  half 
a  minute  or  a  minute,  rather  than  long  ones  of  five, 
ten,  or  thirty  minutes.  Some  cases  complicated 
with  renal  disease  could  be  successfully  treated  by 
short  sittings. 


If  all  stones  were  of  the  same  character,  surgeons 
could  resort  to  one  instrument  and  to  one  method, 
but  their  differences  in  ijosition,  size,  density,  etc., 
render  different  methods  of  operation  a  necessity. 
He  did  not  think  that  the  method  by  aspiration 
would  be  generalized  any  more  than  any  of  the 
other  operations.  There  will  always  be  cases  which 
will  indicate  rapid  lithotrity,  and  others  that  will 
equally  indicate  some  one  of  the  cutting  operations. 

Dr.  Otis  was  decidedly  in  favor  of  this  operation 
in  the  great  majority  of  cases.  Much  had  been 
said  concerning  the  tolerance  of  the  bladder,  and  it 
had  been  demonstrated  so  thoroughly  that  nothing 
need  be  added.  But  the  urethra  seemed  to  have 
been  forgotten.  Dr.  Otis  thought  that  the  injury 
to  the  urethra  was  the  dangerous  part  of  the  opera- 
tion. All  the  deaths  in  the  operation  mentioned  by 
Dr.  Bigelow  had  come  from  damage  done  to  the 
urethra.  He  believed  it  would  be  found  necessary, 
in  order  to  make  the  operation  as  safe  as  possible,to 
prepare  the  urethra  for  it  by  making  the  meatus 
correspond  in  size  with  the  calibre  of  the  canal  be- 
hind, and  remove  any  obstruction  which  might  exist 
along  the  course  of  the  canal. 

Dr.  WiijL.\rd  PARiij:R  believed  there  were  certain 
cases  in  which  the  cutting  operation  would  still  be 
necessary  and  best,  but  the  advances  made  by  Dr. 
Bigelow  in  the  method  demonstrated  were  worthy 
of  the  highest  commendation.  Again,  any  man  who 
made  one  seance  answer  the  whole  purpose  was  a 
benefactor  to  his  race.  Complimentary  remarks 
were  made  by  Drs.  Sands,  Sayre,  and  Detmold. 

Dr.  Bigelow  exhibited  the  detritus  of  the  largest 
stone  he  had  removed.  The  man  was  sixty  years  of 
age,  and  the  material  removed  weighed  1,380  grains. 
The  operation  occupied  about  one  hour,  and  the 
patient  did  not  have  a  bad  symptom  afterward. 

On  motion  by  Dr.  F.  H.  Hamii,ton,  the  thanks  of 
the  Academy  were  given  to  Dr.  Bigelow  for  his  valu- 
able and  instructive  demonstration. 

The  Academy  then  adjourned. 


NEW  YORK  SURGICAL  SOCIETY. 

Staled  Meeting,  March  14,  1882. 

Dr.  T.  M.  Markob,  President,  in  the  Chair. 

Dr.  a.  C.  Post  presented  a  patient,  illustrating  the 
benefit  arising  from  the  use  of 

THE  ACTUAL  CAUTERY  IN  CERTAIN  INFLAMJIATORT  AF- 
FECTIONS, ATTENDED  WITH  GREAT  SWELLING  AND 
INDURATION  OF   THE   CELLULAR   TISSUE. 

The  patient  was  a  woman,  who  presented  her.self 
about  two  weeks  ago,  having  suffered  a  number  of 
montlis  before  from  extensive  burns.  The  right  fore- 
arm and  hand,  parts  involved  in  the  burns,  recently 
became  inflamed,  the  parts  were  swollen  and  red,  and 
both  the  skin  and  the  cellular  tissue  became  indu- 
rated. The  condition  had  existed  about  a  week,  when 
Dr.  Post  anipsthetized  the  patient,  and  inserted  a 
small  Paquelin  cautery  through  the  skin  into  the 
cellular  tissue  at  thirty-nine  points,  with  a  distance 
of  two  or  three  centimetres  apart.  The  parts  were 
dres.sed  with  a  saturated  solution  of  lucarbonate  of 
soda,  and  the  patient  had  not  suffered  any  pain 
whatever.  Tlie  cautery  was  apj>lied  twelve  days  ago, 
and  there  had  been  a  rapid  subsidence  of  the  swel- 
ling. There  had  been  a  slight  discharge  from  the 
punctures.  r~ 


THE  MEDICAL  RECORD. 


579 


TSIGEIUNAL  NEUBAI/GIA. 

Dr.  F.  Lange  presented  a  patient  who  had  sub- 
mitted to  many  operations  and  a  great  variety  of  in- 
ternal treatment  for  the  relief  of  neuralgia  of  the 
second  branch  of  the  trigeminus.  He  was  a  man  fifty- 
eight  years  of  age,  and  had  suffered  severely  from  the 
disease  since  May,  1875,  the  first  symptoms  appear- 
ing some  years  before.  No  cause  could  be  assigned. 
There  was  no  history  of  malaria,  syjihilis,  or  rheu- 
matism, and  he  had  always  been  healthy.  For  four 
years  he  received  internal  and  other  treatment, 
but  without  obtaining  permanent  relief.  In  1879, 
Dr.  Guleke  divided  the  infra-orbital  nerve,  and  re- 
lief was  secured  for  a  few  weeks ;  but  the  pain  re- 
turned, and  the  patient  went  to  Vienna,  where  Bill- 
roth, according  to  the  patient's  statement,  resected 
the  infra-orbital  nerve,  in  May,  187'J,  to  the  extent 
of  three-fourths  of  an  inch.  Transient  relief  was 
afforded,  but  in  June  the  pain  returned,  and  then 
an  ojjeration  was  performed,  consisting  of  a  i-emoval 
of  a  portion  of  the  upper  jaw,  and  the  result  was  re- 
lief from  pain  for  about  one  month.  The  pain  then 
recurred,  and  the  common  carotid  artery  was  ligated, 
but  without  benefit.  In  September,  Dr.  Mikulicz, 
Billroth's  assistant,  removed  still  more  of  the  upper 
jaw,  and  resected  the  nerve  to  its  exit  from  the 
cranium.  After  two  months  the  pain  again  re- 
turned, and  ceased  with  the  aijplication  of  electii- 
city.  From  that  time  to  May,  1881,  he  had  no  pain, 
and  then  it  returned  chiefly  in  the  area  of  distribu- 
tion of  the  second  branch,  but  also  aflecting  the  in- 
ferior maxillary,  and  somewhat  the  lingual  branches. 
In  August,  1881,  Dr.  Lange  removed  a  sequestrum 
from  the  zygomatic  bone,  but  without  benefit,  and 
on  the  12th  of  .January,  1882,  he  performed  an  ope- 
ration, which  consisted  in  stretching  and  dividing 
the  inferior  maxillary  nerve,  stretching  the  lingual, 
and  also  the  facial.  The  hemorrhage  was  .slight. 
Recovery  took  place  without  complication.  There 
was  some  suppuration  at  the  angle  of  the  lower  jaw. 
For  about  three  days,  several  paroxysms  of  pain  oc- 
curred, but  none  since  that  time.  Whether  the 
benefit  was  to  be  permanent  or  not,  of  course  could 
not  yet  be  determined. 

The  operation,  as  recommended  by  Zonnenbui'g, 
consists  in  making  an  incision  around  the  angle  of 
the  jaw  down  to  the  bone,  and  then  at  the  inner  side 
of  the  jaw  the  internal  pterygoid  muscle  is  separated 
from  the  bone,  the  entrance  to  the  infra-maxillary 
canal  exposed,  and  the  nerve  easily  found  when  the 
head  is  hung  from  the  table  after  Rose's  method. 
Dr.  Lange,  however,  found  the  operation  in  his 
case  to  be  a  tedious  and  difiieult  one — (1\  because 
the  stift'aess  of  the  spine  would  not  permit  the  head 
to  hang  over  the  table  easily,  so  that,  altogether, 
Rose's  position  could  not  be  made  use  of;  and  (2), 
the  lower  jaw  was  so  well  developed  that  the  dis- 
tance from  the  external  incision  to  the  nerve  was 
very  great.  He  attempted  to  illuminate  the  bottom 
of  the  wound  by  means  of  a  forehead-reflector,  but 
was  unable  to  see  the  nerve.  He  was  able  to  feel 
it  with  the  finger,  and  having  ascertained  its  situa- 
tion, he  passed  in  a  hook  and  caught  and  pulled  it 
forward  (then  by  means  of  the  reflector  it  could  be 
recognized),  stretched  and  divided  it. 

The  facial  nerve  was  found  just  at  its  exit  from 
the  stylo-mastoid  foramen,  at  the  upper  edge  of  the 
digastric  muscle.  The  edge  of  tlie  parotid  glaml 
had  to  be  lifted  and  pulled  aside,  and  the  sterno- 
mastoid  muscle  had  to  be  cut  across  partially  to 
allow  easy  access  to  the  nerve. 


Complete  paralysis  ofthe  nerve  existed  for  several 
weeks.  The  eye  could  only  be  closed  by  means  ofthe 
finger.  Some  of  the  lower  branches,  to  be  sure,  had 
been  cut  already  at  pi-evious  operations.  At  present 
there  is  a  slight  action  of  the  orbicularis  muscle. 

The  lingual  nerve  was  found  and  stretched,  and 
also  the  infra-maxillary  nerve.  The  tongue  presents 
now  its  normal  sensibility.  In  the  beginning  the 
latter  was  impaired. 

Dr.  J.  W.  Howe  referred  to  a  patient  seen  at  St. 
Francis  Hospital,  who  had  suffered  from  infra- 
orbital neuralgia  for  fifteen  years.  A  variety  of 
means  were  employed  for  his  relief,  but  no  benefit 
was  affoi'ded  until  he  received  hypodermic  injectioyis 
of  strycknin.  Four  injections,  one-sixtieth  of  a  grain 
each,  were  given  in  the  region  of  the  nerve,  and 
after  the  second  one  the  neuralgia  began  to  dimin- 
ish very  much  in  severity.  On  account  of  the  local 
inflammation,  caused  by  the  hypodermic  injections, 
they  were  given  in  the  back  and  continued  for  about 
three  weeks,  when  the  pain  had  entirely  ceased. 
The  patient  remained  well  two  or  three  weeks 
longer,  and  was  then  discharged  from  the  hospital 
free  from  pain. 

Dr.  T.  T.  Sabine  then  read  a  paper  on 

PLASTIC   OPERATIONS   FOE   LOSS   OF  THE   NOSE. 

Dr.  C.  T.  Poore  reported  a  case  of 

BUPTITRE  OP  THE  QrADKICEPS  EXTENSOR  TENDON, 

as  follows  :  A  gentleman,  between  sixty  and  seventy 
years  of  age,  in  the  early  part  of  November,  1881, 
made  a  false  step  while  descending  some  stairs,  and 
iiiptured  the  quadriceps  extensor  tendon  from  its  at- 
tachment to  the  upper  border  of  the  patella.  Dr. 
Poore  saw  the  patient  two  and  one-half  hours  after 
the  accident,  and  on  examination  found  the  lower  end 
of  the  tendon  three  and  one-half  inches  above  the 
upper  border  of  the  patella.  The  case  was  treated 
very  much  like  a  fracture  of  the  patella,  and  the  j^a- 
tient  made  a  good  recovery.  The  ultimate  amount 
of  new  tendon  formed  was  two  and  one-half  inches. 
The  patient  can  now  walk  without  any  limp,  can  go 
up  and  down  stairs,  and  has  about  three-fourths  the 
normal  flexion  of  that  limb. 

Dr.  Keyes  had  had  a  similar  case  occun'ing  in  a 
gentleman,  seventy-eight  years  of  age,  whose  foot 
caught,  causing  him  to  fall.  Tlie  patient  had  pain 
in  the  knee,  with  some  swelling.  The  injury  was 
supposed  to  be  a  sprain,  and  was  treated  for  about  a 
month  with  liniments  without  apparatus.  There 
was,  according  to  all  accounts,  some  effusion  into 
the  joint.  He  did  not  get  well,  and  was  unable  to 
extend  or  depend  upon  the  leg.  When  Dr.  Keyes 
first  examined  the  knee  a  month  after  the  injury  had 
occurred,  he  found  that  the  tendon  of  the  quadri- 
ceps extensor  had  ruptui-ed  at  the  upper  part  of  the 
patella,  there  was  one  and  one-half  inch  separa- 
tion, the  lateral  bands  could  be  felt  distinctly,  and 
the  lower  end  of  the  tendon  was  thickened.  The 
patient  could  walk  reasonably  well  by  the  aid  of  a 
crutch,  but  was  unable  to  lift  the  leg ;  there  was 
tenderness  upon  pressure  over  the  knee,  most  marked 
at  the  thickened  end  of  the  ruptured  tendon.  The 
treatment  consisted  chiefly  in  giving  local  support, 
the  patient  wearing  an  elastic  knee-cap,  and  the 
final  result  was  that  he  walked  perfectly  well,  without 
either  crutch  or  cane,  but  was  unable  to  raise  himself 
with  the  injured  limb  on  g^ing  up  stairs.  The  sep- 
aration and  the  lateral  bands  are  still  to  be  felt  dis- 
tinctly, but  there  is  no  longer  any  pain.  Locomo- 
tion is  perfect  except  for  mounting  stairs. 


580 


THE  MEDICAL  RECORD. 


HABBLIP. 

Dr.  Post  presented  photographs  illustrating  the 
result  of  an  operation  for  harelip  upon  a  child  a  few 
months  old.  The  case  was  one  in  which  the  Assure 
was  single,  but  complicated  by  an  intermaxillar  pro- 
jection. He  operated  by  making  a  semilunar  incision 
upon  each  side  without  flaps.  The  operation  was 
performed  in  December,  1881. 

Dr.  H.  B.  Sands  presented  specimens  which  illus- 
trated the 

DIFFICULTIES  SOMETIMES  ENCOUNTERED  IN  THE  DIAG- 
NOSIS OF  CASES  OP  SUPPOSED  INTESTINAL  OBSTRUC- 
TION. 

The  body  from  which  they  were  removed  was  that 
of  a  man,  sixty-nine  years  of  age,  of  good  constitu- 
tion, whose  health  began  to  be  imi^aired  in  July, 
1881.  At  that  time  he  noticed  that  the  evacuations 
from  his  bowels  were  scanty  and  irregular  and  ac- 
companied by  some  pain  diffused  over  the  abdomen. 
As  time  went  on  the  patient,  who  was  accustomed  to 
dining  out,  noticed  that  he  did  not  enjoy  his  meals 
as  well  as  usual,  and  gradually  he  became  an  invalid, 
his  chief  symptoms  being  constipation,  and  the  pas- 
sage of  fragmentary  stools,  the  masses  never  being  of 
normal  size.  Dr.  Sands  saw  him  for  the  first  time, 
four  days  before  his  death,  in  consultation  with  Drs. 
Linsley  and  Flint.  The  jjatient  had  then  been  ill 
in  bed  about  six  days,  with  symptoms  which  denoted 
obstruction  of  the  intestine.  The  abdomen  during 
this  period  had  become  more  swollen,  not  to  a 
marked  degree,  but  sufiSoiently  so  to  prevent  a  sat- 
isfactory examination  of  the  viscera ;  there  was 
slight  nausea,  without  vomiting  or  fever,  and  it  was 
believed  that  a  mechanical  obstruction  existed  some- 
where in  the  colon.  Cathartics  had  been  used  with- 
out effect.  Injections  had  also  been  given,  but  only 
about  one  quart  of  water  could  be  thrown  into  the 
rectum.  Dr.  Sands  was  invited  to  see  the  j^atient 
with  reference  to  the  propriety  of  operative  inter- 
ference, and  found  the  man  without  fever,  pulse  90, 
with  but  little  pain  and  occasional  nausea,  and  upon 
inquiry  ascertained  that  the  obstruction  was  not 
complete,  because  flatus  had  occasionally  passed 
and  the  injections  had  occasionally  been  found  to 
contain  small  portions  of  ffeces.  The  abdomen  was 
so  much  distended  that  he  was  unable  to  make  a 
satisfactory  examination  and,  besides,  the  parietes 
contained  a  fair  amount  of  fat.  He  felt  inclined  to 
agree  with  the  opinion  that  the  obstruction  was  due 
probably  to  cancer,  and  that  the  stricture  was  grad- 
ually narrowing  the  calibre  of  the  intestine.  He 
made  a  digital  examination  of  the  rectum,  but 
without  result.  It  was  thought  proper  before  re- 
sorting to  a  surgical  operation  to  again  use  rectal 
injections,  and  Dr.  Linsley  administered  them  by 
means  of  a  long  tube  which  passed  into  the  bowel  to 
a  distance  of  12  inches  without  resistance,  but  only 
about  a  quart  of  water  could  be  inti-oduced. 

Rather  suddenly,  in  the  night  of  the  day  preced- 
ing the  patient's  deatli,  he  began  to  sink ;  his  pulse 
became  ra])id,  his  mind  confused,  and  he  died  with 
symptoms  of  collap.se. 

At  the  autopsy,  made  twenty-four  hours  after 
death,  the  only  stricture  found  was  situated  in  the 
rectum  six  inches  horn  the  anus,  and  caused  by  a 
very  moderate  amount  of  interstitial  deiiosit,  reduc- 
ing the  calibre  so  as  to  allow  only  the  little  finger 
to  pass  through.  Abovethat  point  there  was  no  ob- 
struction, and  very  little  solid  fecal  matter. 

On  opening  the  abdominal  cavity,  it  was  first 
noticed   that    tlie    peritoneum    contained    a   large 


amount  of  fetid  gas,,  which  led  to  the  suspicion  that 
perforation  of  the  intestine  had  occurred.  The  coils 
of  the  small  intestine  were  bathed  with  pus  and 
lymph,  which  not  only  invested  the  gut  but  formed 
a  considerable  collection  in  the  pelvic  cavity.  The 
peritonitis  was  general.  The  coils  of  small  intes- 
tine nearest  the  anterior  abdominal  wall  were  nearly 
black,  and  on  25roceding  to  remove  them  it  was  found 
that  they  were  so  soft  that  the  ligature  caused  com- 
plete rupture  of  the  coats,  and  was  followed  by  an 
escape  of  fecal  matter  into  the  peritoneal  cavity. 
The  small  intestine  was  gangrenous  to  the  extent  of 
three  or  four  feet  in  the  umbilical  region,  and  in 
one  part  there  were  found  two  perforations,  not 
more  than  one-fourth  of  an  inch  in  diameter.  It 
was  the  ojiinion  of  Dr.  Prudden,  who  had  examined 
the  specimens,  that  one  of  these  openings  was  made 
at  the  autopsy,  and  that  that  the  other  was  jsrobably 
the  result  of  a  pathological  process. 

Dr.  Sands  thought  it  highly  probable  that  the 
perforation  took  place  shortly  before  death,  and  re- 
sulted from  a  latent  entero-peritonitis,  which  had 
escaped  recognition  during  life. 

The  liver  was  studded  with  secondary  cancerous 
masses. 

The  case  was  exceedingly  instructive,  as  showing 
the  difficulties  attending  diagnosis.  The  patient 
had  a  clear  history  of  chronic  obstruction,  in  which 
constipation,  gradually  failing  health,  and  emacia- 
tion were  the  principal  features.  This  diagnosis 
was  supported  by  the  occurrence  of  scanty  fragmen- 
tary stools,  and  the  refusal  of  the  large  intestine  to 
receive  more  than  a  quart  of  injected  fluid,  and  he 
was  rather  surprised,  at  the  autopsy,  to  find  that 
the  chief  symptoms  during  life  must  have  proceeded 
from  peritonitis,  and  not  from  the  obstruction. 

It  was  fortunate  in  this  case,  that  no  operation 
was  attempted,  because  had  the  abdominal  cavity 
been  opened,  with  the  view  to  performing  enter- 
otomy,  the  intestine  would  have  been  found  so  soft 
as  not  to  allow  the  stitches  to  hold,  and  death  would 
doubtless  have  been  hastened  by  the  laceration  of 
its  coats. 

VESICAL    CALCULI. 

Dr.  Lange  presented  specimens  of  vesical  calculi 
removed,  by  the  supra-pubic  operation,  from  boys 
twelve  and  fifteen  years  of  age  respectively.  Anti- 
septic precautions  were  used,  the  bladder  was  disin- 
fected with  a  solution  of  boracic  acid,  the  opening 
in  the  bladder  was  closed  with  catgut  sutures,  and 
the  external  incision  left  open,  as  a  precautionary 
measure.  A  short  rubber  catheter  was  kept  within 
the  bladder  for  the  first  day. 

In  both  cases,  the  woimd  in  the  bladder  united  by 
first  intention,  and  the  progress  of  the  cases  after 
the  operation  was  without  accident.  In  the  patient 
twelve  years  of  age,  who  had  ln-o  stones,  Dr.  Lange 
used  for  raising  the  bladder  a  colpeuryuter,  intro- 
duced into  the  rectum,  as  suggested  by  Professor 
Braune  of  Leipzig,  so  that  the  part  of  the  anterior 
wall  of  the  bladder  not  covered  with  peritoneum  is 
made  to  touch  the  abdominal  wall  to  a  greater  ex- 
tent, and  also  render  removal  of  the  stone  easier. 

He  cut  down  upon  the  bladder  with  any  instru- 
ment within  the  organ,  then  fixed  the  walls  with 
tenaculi  before  making  the  incision  through  which 
the  stones  w'ere  removed. 

Cicatrization  in  the  external  wound  was  not  com- 
plete until  four  to  five  weeks  after  the  operation. 

The  society  tlien  proceeded  to  the  transaction  of 
miscellaneous  business. 


THE  MEDICAL  RECORD. 


581 


MEDICAL   SOCIETY  OF  THE   COUNTY  OF 
NEW  YOEK. 

Staled  Meeting,  May  22,  1882. 
Dk.  F.  K.  Sturois,  Pbesident,  in  the  Chair. 
Dr.  Wm.  C.  Jarvis  read  a  paper  (see  p.  561)  on 

THE   STJEGICAL   TREATMENT   OF   NASAL    CATARRH. 

The  discussion  was  opened  by  Dr.  L.  Elsberg, 
who  thought  the  statement  that  European  larvngol- 
ogists  use  the  rhinoscope  little  ornone should  not  go 
unchallenged.  He  did  not  know  of  any  who  would 
treat  a  case  without  using  that  in.strument.  The 
surgical  treatment  of  nasal  catarrh,  however,  he  be- 
lieved to  be  entirely  of  American  origin.  Certainlv 
twenty  years  ago  he  began  to  scarify  hypertrophied 
tissue  in  the  nose,  at  the  suggestion  of  the  late  Dr. 
Horace  Green,  who  had  practised  it  previous  to 
that  time,  but  finding  that  it  gave  rise  to  excessive 
bleeding  in  a  large  proportion  of  cases,  he  began  to 
destroy  the  tissue  by  the  apj^lication  of  strong  acids. 
But  he  soon  gave  these  up,  and  then  began  the  me- 
chanical removal  of  hypertrophied  tissue,  using  first 
cutting  forceps  and  then  blunt  scissors,  and  about  a 
dozen  yeai-s  ago,  employed  for  the  first  time  a  wire 
snare  loaned  to  him  by  Sir  Wm.  Wilde,  who  had  used 
it  for  what  he  supposed  to  be  nasal  polypus,  but 
which  was  probably  hyisertrophied  tissue  resulting 
frpm  chronic  catarrh.  He  had,  however,  finally 
come  to  the  use  of  evulsion  almost  entirely,  the 
operation  which  Dr.  Jarvis  had  disapproved  of  so 
unsparingly.  When  applied  hy  a  careful  surgeon, 
with  the  parts  well  illuminated,  the  nostrils  dilated, 
etc.,  he  thought  it  was  not  so  terrible  as  had  been 
represented. 

With  regard  to  Jarvis'  snare,  it  was  as  conve- 
nient and  good  a  wire  snare  as  any  of  which  he  knew, 
except  perhaps  Tobald's,  which  might  be,  possibly, 
a  little  easier  managed. 

With  regard  to  transfixion  needles,  he  had  come 
to  use  instead  thin-bladed  forceps,  and  had  suc- 
ceeded better  than  when  he  used  the  needles.  With 
reference  to  the  tape-holder,  it  had  not  proved  ser- 
Ticeable  in  his  hands,  and  had  been  disadvantage- 
ous rather  than  advantageous.  The  subject  is  an 
important  one,  and  he  was  glad  that  Dr.  Jarvis  had 
brought  it  before  the  jirofession. 

Dr.  GooDWiLiiiE  thought  there  were  certain  facts 
concerning  respiration  which  should  not  be  lost 
sight  of.  A  certain  amount  of  moisture  was  neces- 
sary to  keep  the  passages  through  the  nose  to 
the  lungs  in  proper  condition,  and  to  secure  that 
the  muciparous  glands  should  be  removed  to  the 
least  extent  possible.  The  snare  he  regarded  as  a 
valuable  instrument  for  removal  of  jjolypoid  growths, 
but  when  the  hyijertrophy  was  only  slight,  he 
thought  there  was  no  operation  so  good  as  scarifi- 
cation done  with  the  galvano-cautery  knife.  Hy- 
pertrophy of  the  posterior  part  of  the  nasal  septum 
could  also  be  treated  in  the  same  manner. 

With  regard  to  hypertrophy  and  deviation  of  the 
septum,  he  had  not  seen  a  case  in  which  there  was 
not  more  or  less  of  bony  deposit,  and  he  thought 
the  snare  would  not  answer  for  the  removal  of  a 
portion  of  tissue.  In  simple  deviation  with  hyper- 
trophy of  the  mucous  membrane,  the  snare  might 
answer  a  good  purpose  in  some  cases. 

Dr.  Bosworth  had  jiositive  convictions  that  the 
surgical  treatment  of  nasal  catarrh  was  eminently 
proper.  The  tissue  was  of  such  a  nature  that  it 
could  not  be  reduced  by  local  agents.     He  had  used  I 


Jarvis'  snare  or  gcraseur,  and  with  very  great  sat- 
isfaction, and  he  regarded  the  wire  as  entirely  dif- 
ferent from  that  which  is  used  in  Hilton's  in.stru- 
ment. He  regarded  it  as  the  best  instrument  now 
in  use  for  such  operations  in  the  nasal  caWty. 

With  regard  to  exostoses  referred  to  by  Dr.  Good- 
willie,  he  was  disposed  to  differ  with  him  concern- 
ing the  frequency  of  their  occurrence.  For,  in  10,099 
cases  seen  in  one  year,  he  had  found  only  two  in 
which  there  was  bony  deposit,  and  in  both  of  those 
the  snare  had  been  used  successfully,  and  he  believed 
that  the  tempered  steel  wire  was  capable  of  cutting 
through  all  such  growths. 

Dr.  Brandeis  had  used  the  ecraseur  with  some 
degree  of  success,  and  with  more  satisfaction  later 
than  when  he  first  employed  it.  He  had  been  suc- 
cessful in  the  use  and  adjustment  of  an  annealed 
copper  wire,  by  the  aid  of  two  fingers  in  the  pharynx, 
an  assistant  securing  it  with  the  screw  after  it  had 
been  slipped  over  the  growth.  He  thought  that  the 
transfixion  needles  exhibited  by  Dr.  Jarvis  were  ex- 
cellent, yet  were  open  to  the  objection  made  by  Dr. 
Elsberg,'  namely,  that  they  were  liable  to  unduly 
perforate  and  lacerate  the  adjacent  tissues.  To  ob- 
viate that  he  had  employed  an  instrument  devised 
by  Mr.  Lenox  Browne,  of  London.  Dr.  Brandeis 
believed  that  Dr.  Jarvis'  views  concerning  removal 
of  a  i^ortion  of  the  septum  by  means  of  a  punch 
were  correct.  In  those  cases  there  was  always  more 
or  less  occlusion,  and  removal  of  a  piece  by  jranch- 
ing  did  not  remove  the  obstruction,  but  simply  al- 
lowed the  current  of  air  to  pass  through  into  the  al- 
ready dilated  opposite  nostril. 

Dr.  a.  H.  Smith  had  used  Jarvis'  snare,  and  re- 
garded it  as  a  great  addition  to  the  mechanical 
means  for  the  treatment  of  difficulties  in  the  nasal 
passages.  But  he  thought  that  Dr.  Jarvis  had  not 
dwelt  sufficiently  on  the  advantage  of  the  tempered 
steel  piano-wire  over  all  others.  He  regarded 
the  rigid  piano-wire  as  essential  to  success  in  the 
use  of  the  ecraseur.  It  enabled  the  operator  to  en- 
circle the  growth  more  readily  than  by  means  of 
a  more  flexible  wire,  and  was  much  more  eflicient 
than  annealed  wire  in  all  these  operations. 

There  was  one  fact  which  should  not  be  lost  sight 
of,  and  it  was  that,  whenever  the  nasal  passages  are 
obstructed  to  any  considerable  extent  and  the  pa- 
tient breathes  through  the  nose,  there  must  be  with 
every  inspiration  a  lessening  in  pressure  in  the  naso- 
pharyngeal space,  and  hypersx-mia  is  a  necessary 
mechanical  result,  and  hypertrophy  a  consequence. 
With  regard  to  anterior  hypertrophy,  he  thought  he 
could  accomplish  all  that  was  desirable  without  re- 
sorting to  either  cutting,  evulsion,  or  the  use  of  the 
snare.  For  that  purpose  he  uses  mono-chloro-acetic 
acid,  and  the  positive  advantage  which  this  agent  pos- 
sesses is  that  the  eschar  does  not  fall  until  cicatriza- 
tion takes  place  beneath  it. 

Dr.  Bosworth  said  that  he  had  used  the  chloro- 
acetic  acid  for  several  years,  and  since  he  first  di- 
rected attention  to  its  beneficial  effects,  he  had 
met  with  very  satisfactory  results. 

Dr.  M.  J.  Roberts,  speaking  from  the  standpoint 
of  the  general  practitioner,  said  tliat  he  had  used 
.Jarvis'  snare  in  the  treatment  of  anterior  hyper- 
trophy and  with  excellent  results,  and  he  thought  it 
was  an  operation  which  general  practitioners  could 
perform  readily.  He  had  not  attempted  to  use  the 
snare  in  J;be  treatment  of  posterior  hypertrophy. 

Dr.  K.  p.  Lincoln  thought  the  instrument  exhib- 
ited illustrated  very  well  the  progress  which  had 
been  made  until  we  had  arrived  at  the  perfect  one 


582 


THE  MEDICAL  RECORD. 


we  now  have.  He  had  seen  used  and  used  nearly 
all  methods  of  treating  these  cases,  and  certainly 
this  one  was  infinitely  superior  to  many  others. 
However,  it  was  not  the  chief  method,  and  others 
had  been  employed  with  equally  satisfactory  results, 
and  probably  in  manv  cases  the  galvano-cautery, 
or  the  chloro-acetic  acid,  or,  as  he  had  commonly 
used,  the  chromic  acid  and  Vienna  paste,  all  of  which 
are  thoroughly  manageable  in  most  of  these  cases, 
were  even  better  adapted  to  the  removal  of  the 
growth.  ,   , 

Dr.  B.  Robinson  had  used  the  snare,  and  he 
thought  it  was  more  painful  than  one  would  be  led 
to  believe  from  the  description  given,  and  it  was 
liable  to  be  followed  by  hemoi-rhage,  even  if  halt 
an  hour  or  an  hour  was  consumed  in  removal  of  the 
growth.  He  was  not  thoroughly  convinced  of  its 
superiority  over  the  galvano-cautery,  and,  indeed, 
as  a  practical  instrument,  he  was  disposed  to  regard 
the  galvano-cautery  as  quite  as  useful  as  the  snare. 

Dr.  Jarvis,  in  his  concluding  remarks,  desired  to 
correct  a  false  impression  received  by  Dr.  Elsberg. 
He  had  not  made  the  statement  that  the  practice  of 
posterior  rhinoscopy  had  been  neglected  abriM^d, 
but  that  he  had  "  learned  "  such  was  the  case.  The 
eminent  American  laryngoscopist,  Dr.  Daly,  stated 
in  the  last  number  of  the  Archives  of  Laryngology 
that,  when  abroad,  he  had  observed  only  two  ex- 
aminations of  the  posterior  nares  in  London's  largest 
throat  hospitals.  Dr.  Jarvis  has  also  been  apjn-ised 
of  this  fact  in  conversation  with  American  throat 
specialists  who  had  been  in  Europe. 

In  regard  to  the  use  of  wire  in  snares,  referred  to 
in  the  discussion,  he  did  not  use  the  annealed  wire 
with  his  ecraseur.  He  considered  the  instrument 
useless  in  most  cases  unless  the  tempered  steel 
piano-wire  introduced  by  him  into  the  profession 
was  employed,  while  single  or  double  strands  of  an- 
nealed steel  or  brittle  brass  wire  might  suffice  for 
removing  small  gelatinous  polypi  and  soft  turbinated 
hypertrophies.  It  would  invariably  fracture  when 
used  to  excise  fibro-cellular  hypertrophies. 

Dr.  Elsberg  said  he  thought  that  Michel  had  de- 
scribed and  used  the  same  kind  of  wire  some  six 
years  ago.  ,111^ 

Dr.  Jarvis  said  he  had  carefully  searched  the  for- 
eign and  domestic  literature  on  the  subject,  but 
found  no  mention  made  of  the  efficiency  of  well- 
tempered  steel  piano-wire.  In  regard  to  the  use  of 
the  galvano-cautery,  he  had  witnessed,  through  the 
courtesy  of  some  of  its  enthusiastic  advocates  pres- 
ent, a  fruitless  attempt  to  remove  with  the  incandes- 
cent platinum  loop  a  tumor  occupying  the  naso- 
pharynx. The  cause  of  failure,  in  this  instance, 
was  displacement  of  the  wire  loop  and  the  impossi- 
bility of  seeing  the  wire  and  noting  the  moment  of 
incandescence.  This  same  objection  would  apply 
to  the  removal  of  all  growths  situated  in  remote 
parts  of  the  nasal  cavity.  Another  objection,  recog- 
nized by  a  well-known  galvano-cautery  expert.  Dr. 
Carl  Seller,  of  Philadelphia,  is  the  acute  coryza 
which  so  often  follows  scarification  of  hypetrophied 
turbinated  tissues  with  the  platinum  knife.  The 
cold  steel  wire  excludes  this  complication.  He 
would  attribute  the  severe  hemorrhage  mentioned 
by  Dr.  Beverly  Robinson  as  occurring  in  one  of  his 
patients,  either  to  the  hemorrhagic  nature  of  the 
trrowth  and  the  employment  of  insufficient  time  in 
its  excision,  or  to  the  tearing  off  of  a  shred  of  the 
turbinated  tissue  with  the  removal  of  the  severed 
hypertrophy.  He  did  not  consider  half  an  hour  or 
an  hour  sufficient  time  allowed  in  removing  large 


posterior  hypetrophies.  Two,  three,  and  sometimes 
four  hours' were  required  in  some  cases,  the  time 
depending  upon  the  vascularity  of  the  growth,  which 
could  be  determined  by  its  gross  appearance. 

Although  he  had  operated  in  public  and  many 
times  in  private  practice,  he  had  never  met  with  a 
single  case  in  which  severe  bleeding  followed  ex- 
cision of  posterior  hypertrophies.  The  suggestion 
made  by  Professor  Bosworth,  in  a  lately  published  . 
article,  of  leaving  the  excised  tissue  undisturbed  for 
several  hours,  he  considered  a  valuable  one. 

The  pain  and  hemorrhage  depended  entirely  upon 
the  manner  in  which  the  operation  was  performed, 
and  the  adjustment  of  the  details  to  meet  the  varying 
conditions  should  be  most  carefully  observed,  and 
could  be  easily  acquired  by  a  careful  and  intelli- 
gent study  of  the  minutire  of  the  operations. 

Dr.  L.  "L.  Seaman  then  exhibited 

A  NEW  ATPABATUS  FOB  TREATING  FRACTITRE  OF  THE 
PATELLA. 

There  were  two  bands  of  perforated  raw-hide,  one 
for  the  leg  the  other  for  the  thigh,  united  by  pointed 
steel  bars,  adjustable  at  any  angle  by  means  of  a  key. 
In  addition  there  were  two  crescent-shaped  bodies 
attached  to  the  integument,  one  above  and  the  other 
below  the  fractured  bone,  by  means  of  adhesive 
plaster,  and  retained  in  position  by  means  of  catgut 
joined  to  the  splint.  The  advantages  claimed  for 
the  apparatus  were  :  (1)  it  gives  complete  apposition 
and  control  of  the  fragments  without  punishing  the 
patient ;  (2)  the  injured  parts  are  fully  exposed  to 
the  surgeon's  view  ;  (3)  it  does  not  constrict  the 
parts  and  interfere  with  the  circulation  ;  (4)  if  there 
is  a  wound  it  can  be  easily  dressed  without  disturb- 
ance to  the  fragments  ;  (5)  the  angle  of  the  limb  can 
be  changed  without  removing  the  apparatus.  '«  hile 
wearing  it  the  patient  could  go  about  without  harm 
to  the  injured  parts. 

Dr.  Seaman  also  presented  an  apparatus  for  sup- 
plying an  artificial  fibula,  and  also  what  he  called 
the  surgical  stethoscope. 

Db.  F.  V.  White  said  that  the  apparatus  for  frac- 
ture of  the  patella  was  no  simpler  than  Turner's,  de- 
scribed in  The  Medical  Record  for  July,  18(i7. 

Db.  Malcolm  McLean  thought  that  the  inability 
to  obtain  such  apparatus  readily  was  a  practical  ob- 
jection of  considerable  importance.  The  principle 
involved  in  its  construction  was  undoubtedly  cor- 
rect ;  but  he  thought  that  the  same  principle  could 
be  applied  in  a  simpler  way,  and  that  which  he  had 
used  with  very  favorable  results  was  what  is  com- 
monly known  "as  Buck's  extension. 

Dr".  Seaman  thought  that  one  special  advantage 
which  his  apparatus  possessed  over  Buck's  extension 
was  that  it  permitted  the  patient  to  be  up  and  out.      ^ 

The  President  announced  the  death  of  Dr.  .Tames 
R.  Wood,  Dr.  Wm.  Rogers,  and  Dr.  L.  de  Bremon. 
The   President   further  directed  attention  to  the 
fact  that  the  families  of  Drs.  Rogers  and  de  Bremon 
had  been  left  in  needy  circumstances,  and  that  sul)- 
scriptions  for  their  relief  could  be  forwarded  to  Dr. 
L  H  Savre,  285  Fifth  Avenue,  for  the  family  of  Dr.   1 
Rogers,  and  to  Dr.  Plasse,  78  West  Twelfth  Street,  | 
for  the  family  of  Dr.  de  Bremon. 
The  society  then  adjourned. 

Nftbite   of   Amyl    in   Infantile  Convi-lsions.—  : 
Dr.  A.  E.  Bridger,  of  Paris,  reports  five  cases  (Lan-  \ 
cet')  in  which  he  successfully  used  nitrite  of  amyl  for 
infantile  convulsions.     The  drug  was  given  inter- 
nally and  by  inhalation. 


THE  MEDICAL  RECORD. 


583 


NEW  YORK  SOCIETY    OF  GER]iL\N   PHY- 

SICL^S. 

Stated  Meeting,  November  25,  1881. 

Dk.  Scharlau,  President,  in  the  Chair. 

foreign    body  carried  in  the  eye  without  dis- 
COMFORT. 

Dr.  Oppenheimer  exhibited  an  elderly  man,  who 
had  carried  a  .steel  splinter  in  his  eje  for  nineteen 
years  without  the  slightest  discomfort.  The  foreign 
body  was  readily  visible  in  the  anterior  capsule,  the 
iris  being  adherent  at  this  point.  The  man's  vision 
was  good,  though  not  perfect,  amoimting  to  j. 
Cases  like  the  present  one  were  quite  rare.  The  rule 
which  should  apply  to  all  cases  of  this  kind  was, 
the  earliest  possible  removal  of  the  foreign  body. 

ALBISISJirS    FACIALIS    ACQnsiTrS. 

Dr.  Jacobi  showed  a  young  girl  who  had  acquired 
a  partial  albinism  in  the  course  of  a  disease,  the 
principal  symptom  of  which  was  a  regularly  recur- 
ring headache,  lasting  from  morning  till  afternoon, 
and  extending  over  a  period  of  about  two  weeks. 
Photophobia  was  also  a  prominent  .symptom  dur- 
ing the  course  of  the  illness.  A  whitish  discolora- 
tion was  first  noticed  over  the  chin,  and  similar 
patches  soon  appeared  elsewhere.  The  eyebrows 
and  eyelashes  also  lost  their  color.  At  length  the 
pain  became  localized  in  the  supra-  and  infra-orbital 
regions.  Galvanic  reaction  was  normal  throughout, 
and  the  arterial  tonus  not  impaired.  He  considered 
the  disease  as  a  trophoneurosis  involving  branches 
of  the  trigeminus.  Under  a  course  of  treatment, 
consisting  in  the  exhibition  of  quinine  and  arsenic, 
with  the  persistent  use  of  the  galvanic  cun'ent,  an 
improvement  was  taking  place.  Even  now,  the 
color  was  unmistakably  returning  to  some  of  the 
blanched  hairs. 

Dr.  Heinemann  presented  three  specimens  of  in- 
testinal rupture,  and  gave  an  account  of  their  his- 
tories. He  also  showed  specimens  from  a  case  of 
epidemic  ceiebro-spinal  meningitis  (see  Medical 
Record,  Nov.  5,  1881). 

sarcoma  of  testicle. 

Dr.  Seibert  presented  a  specimen  of  large  tumor 
of  the  testicle,  which  he  had  removed  by  castration, 
seceral  weeks  ago.  The  patient  was  fifty-four  years 
old,  and  had  first  become  aware  of  an  increase  in  the 
size  of  his  left  testicle  about  a  year  since:  His  general 
health  had  remained  good.  The  neoplasm  extended 
upward  into  the  inguinal  canal.  Although  there 
was  apparent  fluctuation  at  this  point,  no  fluid  ap- 
peared on  aspiration.  The  adjoining  glands  were 
not  implicated.  There  were  but  few  adhesions  of 
the  growth  to  adjoining  tissues,  and  the  operation 
was  easily  performed.  Union  by  primary  intention 
occurred.  The  operation  being  wholly  within 
healthy  tissue,  rendered  the  prognosis  favorable.  On 
microscopical  examination,  the  tumor  was  found  to 
i  be  a  round-celled  sarcoma.  No  trace  of  testicular 
I  tissue  remained. 

I  Da.  Ctarrigues  exhibited  a  newly  devised  instru- 
I  ment  to  be  used  as  a  vaginal  depressor,  in  connec- 
[  tion  with  Sims'  speculum  (see  Medical  Kecord, 
I  December  17,  1881). 

DEATH  BEFORE  OPERATION  IN  AN  ATTEMPT  AT  SECOND- 
ARY TRACHEOTOMY. 

Dr.  DEO^rER  reported  a  case  as  follows  :  Primary 
tracheotomy  was  successfully  performed  in  a  child 


suffering  from  diphtheritic  laryngostenosis.  The 
anicsthetic  employed  was  chloroform,  and  it  was  well 
borne  by  the  child.  Two  weeks  later,  the  canula  was 
removed,  and  the  wound  then  closed  quickly.  Alter 
the  lapse  of  another  fortnight,  however,  cough  and 
dyspnoea  developed,  and  soon  became  so  distressing 
that  a  second  tracheotomy  appeared  necessary. 

In  attempting  to  give  the  child  the  aniesthetic  it 
struggled  violently,  and  showed  signs  of  extreme 
fright.  The  chloroform  was  immediately  removed, 
in  order  to  allow  the  patient  to  grow  calm,  when  it 
was  noticed  that  the  child  had  ceased  to  breathe. 

The  trachea  was  at  once  opened,  and  vigorous 
efi'orts  at  resuscitation  instituted  ;  but  the  child  was 
dead.  A  small  granulation  tumor  was  subsequently 
removed  from  the  trachea.  The  presence  of  several 
giowths  of  this  kind  admitted  of  no  doubt.  An  au- 
topsy was  refused.  Dr.  Degner  was  at  a  loss  to 
account  for  the  fatal  issue  in  this  case.  The  child 
had  certainly  not  died  of  sufibcation,  and  death  from 
chloroform  was  likewise  improbable. 

Dr.  Bliden  expressed  his  opinion  to  the  effect 
that  protracted  dyspnoi'a  had  very  likely  led  to  car- 
bonic acid  poisoning  with  sudden  cardiac  paralysis. 

Dr.  Obebndorfer  remarked  that  sudden  death 
from  paralysis  of  the  heart  had  been  repeatedly 
observed  after  diphtheiia. 

Dr.  Jacobi  said  that  the  assumption  of  cardiac 
paralysis  in  consequence  of  previous  diphtheria,  ap- 
peared justifiable  only  when  symptoms  of  paralysis 
had  appeared  intra  vitam.  In  the  absence  of  an 
autopsical  record,  a  decision  could  not  be  made 
whether  the  fatal  issue  was  directly  due  to  cardiac 
or  cerebral  death.  Nor  would  any  significant  anatom- 
ical le.sion  be  discoverable,  if  death  were  due  to 
fright  alone.  Since  the  child  had  inhaled  no  chlo- 
roform, of  course,  death  from  this  source  was  out  of 
the  question.  Besides,  children  as  a  rule,  bore  this 
an:esthetic  well,  and  existing  dyspnoea  was  usually 
diminished. 

In  this  connection,  he  alluded  to  a  case  that  had 
come  under  his  observation  some  years  ago.  Or- 
thopnoea  in  this  instance  was  invariably  observed  at 
night.  Nothing  was  visible  with  the  laryngoscope, 
and  he  diagnosed  a  polyjjoid  growth  attached  to  the 
anterior  wall  of  the  trachea,  which  would  naturally 
interfere  with  respiration  in  the  dorsal  decubitus. 
This  diagnosis  was  verified  by  a  subsequent  ojiera- 
tion. 


Stated  Meeting,  December  23,  1881. 

Dr.  Gruening,  President,  in  the  Chair. 

pulmonary  atrophy  following  kecuebent  attacks 
of  pleurisy'. 

Dr.  Kudlich  presented  a  specimen  of  atrophic  lung, 
removed  from  the  body  of  a  man  who  had  suddenly 
died  after  an  attack  of  violent  dyspncea.  The  pa- 
tient was  fifty-nine  years  of  age,  weighed  three  hun- 
dred pounds,  and  had  formerly  lived  in  Texas,  where 
his  first  attack  of  pleuritis  occurred.  Subsequently 
he  suffered  three  other  attacks  of  this  disease. 

Dr.  Kudlich  was  hastily  summoned  to  attend  him 
one  evening,  but  upon  his  arrival  the  patient  was 
found  dead.  He  learned  that  soon  after  eating  his 
supper,  the  patient  was  seized  with  severe  pains  in 
the  left  side,  accompanied  by  intense  dyspncea,  and 
the  usual  sense  of  impending  dissolution.  There 
was  also  some  expectoration  of  bloody  mucus.  The 
patient  then  suddenly  expired. 

At  the  autopsy  the  left  lung  was  found  to  be  re- 


581 


THE  MEDICAL  RECORD. 


duced  to  about  the  size  of  a  goose's  egg,  and  envel- 
oped in  a  thick,  unyielding  membrane.  This  rem- 
nant of  Inng  tissue  contained  a  fibrous  plug  in  its 
centre.  The  right  lung  showed  vicarious  emphy- 
sema, but  was  in  other  respects  normal.  A  special 
examination  of  the  pulmonary  vessels  disclosed  no 
morbid  change  in  their  structure.  The  larynx  was 
not  examined. 

ENDOL-^RYNGEAi   REUOV.il,   OF    A    SPLINTER   OF    liONE. 

Db.  Grueninq  exhibited  a  pointed  piece  of  bone, 
18  millimetres  in  length,  which  lie  had  removed  from 
the  larynx  of  a  woman  a  short  time  ago.  The  for- 
eign body  had  been  swallowed  five  days  before  its 
removal,  the  patient  having  had  a  suffocative  attack 
of  short  duration  at  the  time  of  the  accident.  When 
the  dyspnoea  was  relieved,  the  only  remaining  symp- 
tom consisted  of  violent  pains  accompanying  deglu- 
tition. Dr.  Gerster  made  an  examination  of  the  phar- 
ynx and  cEsophagus,  but  was  unable  to  discover  any 
obstruction  there.  As  there  was  no  alarming  dysp- 
noea at  that  time,  and  the  patient  only  showed 
complete  aphonia,  the  operation  of  ti'acheotomy  was 
deemed  unnecessary.  Dr.  Gruening,  who  was  called 
in  consultation,  found  a  whitish-looking  body  pro- 
jecting between  the  vocal  cords,  and  apparently 
firmly  lodged  there.  Attempts  to  remove  the  for- 
eign body  were  unavailing  at  first,  because  the  in- 
strument could  not  securely  seize  the  bone  splinter. 
At  length,  however,  he  succeeded  in  grasping  and 
removing  it,  whereui^on  the  former  pain  immedi- 
ately ceased.  The  aphonia  persisted  for  five  days, 
and  then  the  patient  regained  a  natural  voice.  Dr. 
Gruening  expressed  the  opinion  that  in  cases  of  this 
kind,  or  when  any  angular  or  pointed  body  had 
found  its  way  into  the  respiratory  passages,  laryngo- 
scopic  examination,  followed  in  suitable  cases  by  en- 
dolaryngeal  operations,  should  never  be  omitted. 
On  the  other  hand,  when  we  were  dealing  with 
rounded  bodies,  immediate  tracheotomy,  as  recom- 
mended by  Schiiller  for  all  foreign  bodies,  seemed 
to  be  clearly  indicated. 

Dr.  Ger.ster  took  exception  to  the  universal  appli- 
cability of  the  rule,  especially  from  the  standpoint 
of  the  general  practitioner.  Endolaryngeal  exam- 
inations and  manipulations  could  scarcely  be  ex- 
pected of  the  physician  in  general  practice,  whereas 
tracheotomy  was  always  within  the  range  of  possible 
interference.  Certainly  wlien  respiration  was  em- 
barrassed, tracheotomy  oflered  the  most  reliable 
■safeguard  against  impending  asphyxia.  The  case 
under  consideration  was  an  exceptional  one  in  this 
respect,  as  respiration  had  not  been  much  interfered 
with,  and  because  tlie  services  of  a  specialist  were 
quickly  obtained.  Sch  Ciller's  rule  about  trache- 
otomy in  all  cases  of  foreign  bodies  in  the  air-pas- 
sages must  therefore  be  ui^held  in  tlie  great  majority 
of  cases,  especially  those  occurring  in  country  prac- 
tice. 

DENTAL   PL.\TE   BEMO\TSD   FROM    LARYNX. 

Dr.  OrpKNHEiMER  showed  a  dental  plate,  which  he 
had  removed  from  the  larynx  of  a  woman  fifty  years 
of  age.  The  operation  was  rendered  difficult  owing 
to  tlie  preoence  of  several  hooks  which  had  served  to 
attach  the  plate  to  the  natural  teeth  of  the  j>atient. 
Some  degree  of  force  was,  therefore,  necessary,  and 
this  resulted  in  laceration  of  one  of  the  vocal  cords. 

FLOATINO   aARTILAOB.S   OP   KNEE-JOINT. 

Dr.  Gerster  presented  a  s|iecimen  of  an  articular 
body  ((•'eli-ii/csmaiis)  removed  bv  incision  from  the 
knee-joint  of  a  patient.    The  origin  of  the  formation 


was  ascribed  to  traumatism.  The  body  was  one  inch 
long  and  half  an  inch  broad.  Healing  by  primary 
intention  took  place,  and  the  patient  retained  good 
use  of  the  limb.  He  also  exhibited  some  articular 
excrescences  removed  by  incision  from  the  knee- 
joint  of  a  girl  fourteen  years  of  age.  The  indications 
for  ojjerative  interference  had  consisted  of  recurrent 
efl'usions  following  strangulation  of  the  excrescences 
between  the  joint  surfaces.  The  foreign  masses 
were  found  to  be  attaclied  to  the  lower  border  of 
the  patella,  and  had  evidently  grown  from  the  ar- 
ticular ligaments.  The  result  of  the  operation  was 
in  all  respects  satisfactory. 

In  this  connection  Dr.  Gerster  raade  some  remarks 
about  what  he  considered  the 

UNPOPCLARiry   OP    ANTISEPTIC   PRACTICES   IN   THIS 
COUNTRY. 

This  remarkable  condition  of  affairs,  he  thought, 
was  mainly  owing  to  the  absence  here  of  surgical 
clinics,  in  the  European  sense  of  the  term,  i.e.,  clinics 
for  didactic  purposes  and  for  the  collection  of  statis- 
tical data,  whicli  were  regularly  published,  thus  sub- 
mitting surgical  methods  and  innovations  to  the 
intelligent  criticism  of  the  profession. 

Another  grave  drawback,  he  thought,  was  to  be 
found  in  the  too-rapid  rotation  of  service,  a  system 
which  prevented  the  surgeon  from  properly  utilizing 
his  material.  In  this  way  the  criterion  of  compari- 
son with  the  results  of  others  was  lost  to  the  visiting 
surgeon,  and  he  was  lulled  into  a  sense  of  satisfac- 
tion with  his  often  quite  indifferent  or  even  poor 
results. 

But  there  was  another  circumstance  which  should 
not  be  lost  sight  of  in  attempting  to  explain  the 
non-enforcement  of  Listerian  practices  here.  Af 
compared  with  the  older  German  clinics  and  hospi- 
tal wards,  most  of  our  institutions  w-ere  in  a  vastly 
better  hygienic  condition,  so  that  antiseptics,  on  that 
account  alone,  were  less  indispensable. 

DEEP  OPENING  OF  THE  MASTOID  PROCESS. 

Dr.  KN.4.PP  narrated  this  case  as  follows :  A 
young  lady,  aged  sixteen,  had  suffered  from  otitis 
media,  with  partial  deafness,  for  a  long  time.  The 
drumhead,  though  opaque,  showed  no  perforation, 
There  was  spontaneous  pain  in  the  region  of  the 
neck,  and  tenderness  on  pressure  over  the  mastoid 
process.  General  treatment,  continued  for  a  period 
of  two  weeks,  established  no  improvement.  The 
mastoid  process  was  therefore  laid  bare,  and  opened 
by  means  of  the  chisel.  The  periosteum  and  sur- 
face of  the  bone  looked  healthy  ;  but  to  the  distance 
of  four  millimetres  the  bone  was  found  bloodless  and 
abnormally  hard,  and  beyond  this  distance  quite 
soft  and  congested.  At  a  point  about  seven  milli- 
metres from  the  surface  the  probe  came  in  contact 
with  soft  part.s,  and  immediately  a  copious  flow  of 
venous  blood  occurred.  Dr.  Knapp  therefore  con- 
cluded that  he  must  have  o]jenod  the  lateral  sinus, 
and  at  once  terminated  the  ojieration  by  closing  thi 
wound  and  inserting  a  drainage  tube.  Union  toi 
place  by  primary  intention,  excei>t  at  the  point  ci 
responding  to  the  insertion  of  the  drainage-tubi 
The  previously  existing  intense  cephalalgia  disap- 
peared from  the  time  of  the  operation.  The  bleed- 
ing was  too  profuse  to  be  accounted  for  by  hemor- 
rhagic softening. 

Dr.  Knapp  added,  that  severe  and  distinot1<f| 
localized,  protracted  headache  always  constituted 
an  indication  for  opening  the  mastoid  process.  Ini 
such  cases,  Wilde's   incision   would   suflice,   if  the 


THE   MEDICAL  RECORD. 


585 


Boperficial  parts  of  the  bone  were  found  diseased ; 
bnt  recourse  must  be  had  to  tlie  chisel  if  these  were 
found  healthy.     Antiseptic  precautions  he  had  not 
I  employed,  and  did  not  consider  essential. 

I      NECROSIS   OP    PETROrS    PORTION    OF   TEMPORAL   BONE. 

Dr.  Knapp  pi-esented  a  specimen  consisting  of  the 
I  entire  petrous  portion  of  the  temporal  bone  of  a 
i  child  of  six  years  of  age.  It  had  been  sent  him  by 
i  Dr.  Pollack'  of  St.  Louis,  who  stated  that  it  had 
j  come  away  spontaneously,  leaving  the  child  well 
I   and  healthy. 

Dr.  Gerster,  referring  to  the  success  of  Dr. 
Knapp's  first  case,  remarked  that  strict  cleanliness, 
by  excluding  the  chance  of  infection,  should  be  con- 
sidered among  the  antiseptic  precautions  of  wound- 
treatment.  With'  smaU  wounds,  simple  measures  of 
that  kiad  might  suffice  ;  but  the  surgeon  was  often 
called  upon  to  expose  very  much  larger  surfaces, 
and  to  operate  in  cases  complicated  by  the  presence 
of  numerous  channels  and  pockets.  The  conditions 
in  such  cases  were  far  different  fi'om  those  existing 
in  trifling  operations  ujjon  the  mastoid  process  or 
eyeball.  The  danger  from  infection  increased  pari 
pmau  with  the  length  of  time  required  for  an  opera- 
tion, and  the  frequency  of  contact  of  the  wound  with 
instruments,  sponges,  the  hands  of  a.ssistants,  etc. 
At  the  present  time  there  could  be  no  question  of 
the  utility  of  antiseptic  measures,  even  if  the  non- 
advocates  of  the  Lister  system  could  show  good  re- 
sults under  a  difterent  mode  of  wound-treatment. 
The  criterion  of  successful  antisepsis  was  to  be 
found  in  an  aseptic  healing  of  the  wound. 

Dr.  Grubnisg  said  that  it  did  not  appear  alto- 
gether certain  that  in  Dr.  Knapp's  case  the  sinus 
transversus  had  been  opened,  for  profuse  bleeding 
was  apt  to  occur  in  the  cancellous  tissue  of  any  in- 
flamed bone.     He  then  related  the  following  case : 

A  few  days  ago  he  had  opened  the  mastoid  i:)rocess 
of  a  young  man.  The  soft  parts  over  the  bone  were 
tender  and  swollen.  The  patient  having  given  a 
well-marked  history  of  syphilis,  specific  treatment 
had  preceded  the  surgical  interference,  but  without 
success;  nor  did  an  incision  after  Wilde  produce 
any  noteworthy  benefit,  although  the  periosteum 
was  clearly  thickened.  lu  the  subsequent  opera- 
tion bv  chiselling,  the  bone  was  found  healthy. 
Nevertheless,  a  marked  improvement  of  the  patient's 
condition  followed  the  operation,  and  the  wound 
healed  kindly. 

In  this  case  there  had  been  no  disturbance  of 
hearing,  no  catarrh  of  the  middle  ear,  and  no  red- 
ness of  the  external  auditory  canal.  It  would  ap- 
pear, therefore,  that  the  indications  as  formulated 
by  Hotz,  were  not  always  proper  ones.  The  perios- 
teal covering  of  a  thin  plate  of  bone  might  become 
inflamed,  and  lead  to  an  effusion  into  the  correspond- 
ing mastoid  cells.  The  latter  need  not  necessarily 
be  purulent  in  nature  to  produce  symptoms  of  a 
grave  type. 

Dr.  Rodisch  could  not  agree  to  the  indications 
for  surgical  measures  as  laid  down  both  by  Dr. 
Gruening  and  Dr.  Knapp.  In  his  opinion,  the  local 
abstraction  of  blood  was  sufficient  to  account  for  the 
improvement  which  was  seen  in  these  cases. 

Dr.  Grcemino  replied  that  in  cases  of  this  kind 
specialists  resorted  to  such  operations  precisely 
with  that  end  in  view,  viz.,  local  depletion  for  pur- 
poses of  revulsion. 


Corrcsponlrcncf. 


The  Virchow  Fund  has  reached  the  sum  of  76, 
612  marks  (about  $20,000). 


A   REPLY  TO    "CONCERNING    FREEDOM 
IN   CONSULTATIONS." 

To  THE  Editob  of  The  Medical  Record. 

Dear  Sir  :  I  trust  that  you  will  permit  me  to  reply 
to  a  letter  published  in  the  Record  of  May  15th, 
wliich  is  entitled,  "  Concerning  Freedom  in  Consul- 
tations." I  must,  however,  frankly  state,  before  I 
commence,  that  I  am  strongly  opposed  to  two  rules 
in  the  new  code,  yet  I  will  endeavor  to  state  my  ar- 
gument so  temperately  that  no  one  may  be  offended. 
I  read  the  paper  mentioned  above,  I  confess,  with 
pain,  for  it  differed  so  entirely  from  that  which  I 
con.sidered  right,  that  I  was  unwilling  to  think  I 
walked  in  such  mental  blindness  that  even  now  the 
brilliant  effort  of  a  most  eminent  jurist  failed  to  give 
me  Ught. 

It  is  certainly  with  great  diffidence  that  I  presume 
to  criticise  the  article  in  question,  yet  having  the 
courage  of  my  convictions,  I  claim  your  considera- 
tion in  expressing  them.  It  is  primarily  intimated 
by  the  learned  writer  of  this  paper  that  a  rule  which 
forbids  a  regular  doctor  from  consulting  with  an  ir- 
regular is  imethical,  because  it  is  a  restriction  of  a 
great  rule  of  morality.  I  presume  the  restriction  in 
question  is  that  our  chief  aim  is  to  give  relief  to  suf- 
fering humanity.  This  is  the  keystone  of  the  arch, 
and  granting  Prof.  Dwight's  premises  that  the  old 
code  legislated  against  humanity,  his  logic  is  un- 
answerable. Now,  here  is  where  I  with  justice  can 
take  exception  to  Dr.  Agnew's  view  that  the  learned 
gentleman  in  question  is  perfectly  suited  as  an  um- 
pire in  this  discussion.  No  one,  howsoever  learned 
or  how  impartial,  who  has  not  studied  all  systems 
of  medicine,  can  be  a  judge  in  whom  both  sides  can 
have  confidence,  and  I  will,  I  trust,  show  that  Prof. 
Dwight  has  not  sufficiently  investigated  this  subject 
for  his  deductions  to  be  of  value.  It  should  have 
first  been  shown  to  the  learned  professor  that  the 
vast  majority  of  the  regular  profession  consider  ho- 
moeopathy, eclecticism,  and  other  schools  which  may 
indeed  be  "  lawful  "  in  a  legal  sense,  as  bad  schools 
which  breed  doctrines  that  are  untrue  and  train 
graduates  who  from  a  false  method  are  dangerous 
to  society. 

The  logical  deduction'  from  this  is,  in  my  mind, 
that  a  body  of  men  who,  if  they  are  honest  homceop- 
athists,  are  so  terribly  mistaken,  and  who,  if  they  are 
not  honest,  are  such  pitifiil  impostors,  should  not  be 
encouraged  by  men  who  have  drawn  wealth  and 
knowledge  from  that  great  j)ublic  who  have  had  con- 
fidence in  their  protection  in  the  past  and  reliance 
upon  their  judgment  for  the  future.  The  question 
I  would  ask  such  of  these  gentlemen  who  were  in- 
strumental in  altering  the  code  and  are  teachers,  is 
this:  Do  they  believe  in  homoeopathy?  Have  they 
ever  taught  or  written  that  like  cures  like,  or  that 
infinitesimal  doses  do  good,  or  that  it  is  wholly  un- 
allowable to  mix  two  remedies  ?  I  have  listened  to 
many  of  these  gentlemen,  and  I  have  never  heard 
these  doctrines  advocated.  Well,  it  is  then  conceded 
that  these  gentlemen  do  not  advocate  homoaopathy  ? 
Do  they  still  believe  that  homoeopathy  is  bad  in 
theory  and  disastrous  in  practice  ?  Do  they,  in 
short,  hold  that  they  only  sanction  consultation  be- 
cause of  humanity?  Surely  Prof.  Dwight  knows 
that  the  greater  humanity  is  to  save  tlie  most  of 
mankind,  even  though  the  few  suffer.      Better,  far 


586 


THE  MEDICAL  RECORD. 


better,  that  a  rich  man  lose  an  eye  in  New  York 
than  that  many  in  the  wilderness  lose  their  lives 
from  peritonitis  or  pernicious  malaria.  I  would  not 
interfere  with  any  man's  liberty,  but  I  would  iiot 
call  license  liberty.  Many  crimes  are  committed  in 
liberty's  name,  but  none  more  illogical  or  deroga- 
tory to  our  honor,  in  my  opinion,  than  this  so-called 
liberal  code. 

Prof.  Dwight  has,  I  think,  again  misinterpreted 
the  letter  and  spirit  of  the  rule  which  relates  to  con- 
sultations when  he  lays  such  stress  upon  emergen- 
cies. Emergencies  do  not  govern  this  rale.  It 
simply  apologizes  for  the  first  clause.  You  may 
meet  a  homoeopath,  it  declares,  at  any  and  all  times, 
because  emergencies  sometimes  occur.  Would  it 
not  be  dignified  and  even  more  humanitarian  to  say  : 
Meet  any  man  if  his  patient  is  dying  and  no  one  of 
his  own  belief  can  be  procured. 

Would  not  this  be  more  honorable  to  the  profes- 
sion at  large  ?  Would  it  not  be  more  satisfactory  to 
any  one  who  would  not  wish  to  consult  simplv  for  a 
fee? 

These  difficulties  have  not  apparently  been  put 
before  Prof.  Dwight,  otherwise  I  cannot  help  think- 
ing he  would  at  least  have  attempted  to  solve  them, 
for  without  this  even  the  Academy  may  say  peace, 
but  there  can  be  no  peace. 

When  the  reason  why  we  should  recognize  homoe- 
opathy is  given  in  a  logical  and  non-partisan  manner, 
it  will  be  time  to  discuss  it.  Until  then  we  cannot  be 
expected  to  acquiesce  under  a  gag-law  system,  which 
even  has  not  the  respectable  sanction  of  the  majority 
of  the  profession. 

One  thing  more  and  I  have  done.  There  was  a 
suspicion,  if  I  mistake  not — a  mere  suspicion  of  a 
legal  threat — when  the  learned  professor  intimated 
that  as  the  law  gave  the  law  could  take  away.  Does 
the  learned  gentleman  presume  to  say  that  the  law, 
in  preventing  ignorant  men — I  do  not  si^eak  of  "law- 
ful" practitioners — -from  preying  upon  the  public, 
confers  a  favor  upon  the  regular  profession  more 
than  upon  socie-ty  at  large  ?  If  the  law  which  pre- 
vents men  who  have  no  diploma  from  practising  was 
granted  solely  upon  the  condition  that  we  recognize 
homoeopaths  and  other  lawful  doctors,  it  had  better 
be  annulled.  The  regular  profession  can  pay  no 
such  price  for  loss  of  honor  and  consistency.  Were 
it  not  foreign  to  make  comparisons,  I  could,  per- 
haps, show  that  no  profession  more  jealous  of  its 
integrity  and  honor  exists  than  that  to  which  Prof. 
Dwight  belongs,  and  it  is  on  that  account  that  I 
would  request,  in  justice  to  himself,  that  he  con- 
sider well  such  a  question  as  this  before  he  assumes 
to  be  its  arbiter.  Mahtis  Burke. 

141  Lexington  Avenue. 


SPURIOUS  VACCINE  VIRUS. 

To  THE  Editor  or  The  Medical  Rkcobd. 
Sir  :  I  have  been  much  interested  in  the  various 
commanications  on  vaccination  which  have  lately 
appeared  in  your  columns.^  Misery  likes  company, 
it  is  well  known  ;  and  I  felt  pleased  to  see  that  I  was 
not  alone  in  my  want  of  success  with  the  "  pure 
bovine  virus."  The  usual  advertisement  informs  you 
that  duplicates  will  be  furnished  in  case  of  failure 
in  primary  cases  ;  but  I  have  almost  invariably  been 
informed  on  returning  unsuccessful  points  that  it 
was  strange  they  did  not  take — hundreds  of  same 
batch  liad  been  sold,  and  I  was  the  only  one  to  com- 
plain.    I  have  80  often  had  this  insulting  style  of 


language  used,  that  I  now  rather  lose  my  duplicates 
than  risk  the  loss  of  temper  involved  in  asking  for 
them. 

Dr.  Gan-igues  and  "Disgusted  Vaccinator"  re- 
cord from  75  to  87.5  per  cent,  failures.  I  have 
not  kept  a  record  sufficient  to  enable  me  to  give 
exact  figures ;  but  I  know  that  I  have  frequently 
failed  in  from  eight  to  sixteen  consecutive  vaoci-  j 
nations.  I  have  usually  bought  a  dollar's  worth 
at  a  time,  and  out  of  the  eight  or  ten  points  have 
felt  pleased  to  get  two  successful  vaccinations.  I 
have  frequently  observed  the  nfe^iis-like  fungous 
vesicles  spoken  of  by  Dr.  Garrigues,  and  feel  certain 
they  must  be  the  cause  of  much  fancied  security 
where  none  exists.  These  vesicles,  or  neoplasms, 
seem  to  be  of  sufficient  frequence  and  importance  to 
requii-e  careful  study  at  the  hands  of  experts. 

From  my  own  experience,  and  that  of  friends,  with 
bovine  virus  as  usually  supplied,  I  am  compelled  to 
look  with  suspicion  on  the  statistics  of  those  in- 
terested in  the  question  in  a  commercial  sense. 
Boards  of  Health  vaccination  statistics,  I  fear,  would 
scarcely  bear  close  investigation,  judging  from  the 
little  I  have  seen  of  their  modes  of  w'orking.  I  al-' 
ways  personally  examine  each  case,  at  the  end  of  a 
week,  as  I  can  no  longer  take  success  for  granted; 
nor  could  I  trust  the  opinion  of  the  parents,  owing 
to  the  frequence  of  the  fungous  growths  simulating 
the  true  vesicle. 

This  imcertainty  of  "  taking"  is  a  matter  of  vast 
importance  at  times.  In  three  cases  recently,  on 
small-pox  breaking  out  in  families  I  was  attending, 
I  immediately  vaccinated  the  rest  of  the  family  with 
complete  failure  in  each  case,  though  several  were 
primary.  I  managed,  by  perseverance  over  several 
weeks,  to  get  all  vaccinated,  but  meantime  what  a 
risk  they  ran  ! 

To  blame  the  great  want  of  success  on  imperfect 
methods  of-  operation  will  scarcely  hold  good,  see- 
ing that  experts  emphatically  condemn  each  other's 
method,  as  pointed  out  by  "  Disgusted  Vaccinator." 
I  have  tried  all  plans,  with  about  equal  non-success. 
Between  the  usual  want  of  success  and  the  occa- 
sional volcano-like  sore,  threatening  the  loss  of  the 
arm,  I  sometimes  feel  like  giving  bovine  vims  up  in 
disgust.  A  return  to  "ye  good  old  way"  is  not  far 
off,  I  predict. 

Speculum. 

Bbooklis,  May  15.  1SS3. 


ARMY  NEWS. 


Official  List  of  Changes  of  Stations  and  Duties  of  Offi-  M 
cers  of  the  Medical  Department,  United  States  Armr/,  '  ' 
from  May  14,  1882,  to  May  20,  1882. 

Lieutenant-Colonel  Glover  Perin,  Surgeon  ;  Ma- 
jor  William   C.   Spesceb,    Surgeon ;   and    Captaia    iJ 
Philip  F.  Harvey,  Assistant  Surgeon,  directed  to    [I 
represent  the  Medical  Department  of  the  Army  at    ' 
the  annual  meeting  of  the  American  Medical  Asso- 
ciation, to  be  held  in  St.  Paul,  Minn  ,  on  June  6, 
1882.     S.  O.  114,  A.  G.  O.,  May  17,  1882. 

Majors  C.  T.  Alexander  and  J.  H.  Janewat,  Sur- 
geons, and  Captain  K.  H.  White,  Assistant-Surgeon, 
detailed  as  members  of  a  board  of  medical  ofilcers 
to  examine  into  physical  qualifications  of  members 
of  the  graduating  class,  and  of  candidates  for  ad- 
mission to  militarv  academv.  S.  O.  110,  A.  G.  O., 
May  12,  1882. 


THE  MEDICAL  RECORD. 


687 


illelJtcal  3tem0  mis  tletns. 


Contagious  Diseases  —  Wbkklt  Statement.  — 
Oomparative  statement  of  cases  of  contagious  diseases 
Mported  to  the  Sanitary  Bureau,  Health  Department, 
for  the  two  weeks  endiiig  May  20,  1882. 


May    13,    1882. 
May    20,    1882. 


1 

i 

i 

1,- 

i 

J  » 

1 

II 

1 

X3 

1 

& 

^ 

1 

i 
s 

5 

1 

10 

7 

186 

8 

157 

7.3 

21 

16 

.5 

184 

3 

196 

74. 

18 

The  Late  Mr.  Dwyer  is  exciting  more  attention 
dead  than  living.  Objection  has  been  made  to  a 
moral  which  we  ventured  to  draw  from  his  life  and 
death,  to  the  eflfect  that  a  "  hypertrophied "  phy- 
sique, so  to  speak,  is  not  necessarily  the  most  robust 
one.  A  city  man,  of  good  health  and  moderate  de- 
velopment, has  a  better  chance  in  a  confining  seden- 
tary life  than  the  country-bred  athlete,  with  hi.s 
powerful  lungs  and  heavy  muscles.  Those  acquainted 
with  modern  physiology  and  pathology  will  readily 
acknowledge  the  antecedent  probaliility  of  such  a 
view.  It  has  been  abundantly  demonstrated,  prac- 
tically, in  that  city  of  clerks,  Washington,  D.C.,  as 
well  as  here.J 

The  American  Association  fob  the  Advancement 
OF  Science  meets  at  Montreal  on  August  23,  1882, 
under  the  Presidency  of  Principal  Dawson,  of  Mc- 
Gill  University.  \York  will  be  done  in  Sections  on 
Biology,  Histology,  Anthropology,  etc. 

Wh.^t  Lunatics  Think  Concerning  the  Eesponsi- 
BiLiTT  of  the  Insane. — kt  the  debating  society 
organized  by  the  ijatients  in  the  Lunatic  Asylum  at 
Hanwell,  England,  the  question  of  the  responsibility 
of  the  insane  was  recently  discussed.  The  conclu- 
sion was  reached  that  the  insane  ought  to  be  con- 
sidered responsible.  One  of  the  patients,  who  shot 
at  the  Queen  of  England,  confessed  that  he  never 
would  have  done  it  if  his  predecessor  in  the  same 
crime  had  Vieen  executed. 

The  SMALr.Pox  Scare  which  recently  existed  in 
Cincinnati  has  much  abated.  The  Academy  of 
Medicine  met  and  passed  resolutions  deprecating 
the  unnecessary  and  sensational  reports  that  had 
been  m.ide,  and  assuring  the  public  of  the  security 
to  be  fonnd  in  vaccination. 

SpoNGE-GaAFTiNG.  — Dr.  Morton,  of  Glasgow,  suc- 
cessfully grafted  thin  layers  of  sponge  upon  a  large 
leg-ulcer.  The  pieces  gradually  came  away,  how- 
ever, and  very  little  good  was  done.  This  is  the 
third  successful  case  reported. 

A  Newspaper  Keport  of  a  Medicai,  Case. — A 
medical  friend,  to  whose  writings  references  were 
made  in  an  article  which  appeared  in  a  recent  issue 
of  a  daily  paper  in  this  city,  desires  us  to  say  that 
the  article,  evidently  inspired  by  some  enthusiastic 
admirer,  is  to  the  doctor  a  most  painful  surprise. 
The  fact  that  his  own  name  was  omitted  from  the 
article  is  some  mitigation  of  the  pain  of  mind  which 
it  has  caused  him,  yet  nothing  could  be  more  repug- 
nant to  his  feelings  than  the  mention  of  the  names 
of  distinguished   colleagues  in  such   a  connection. 


We  are  assured  that  the  gentleman  in  question  has 
never  made  use  of  the  daily  press,  directly  or  indi- 
rectly, to  advance  his  views  of  medical  topics,  and 
that  he  not  only  does  not  seek  newspaper  notoriety 
but  that  it  is  extremely  distasteful  to  him. 

"  FiFTT-Two  Doctors  at  Albany,"  says  a  West- 
ern medical  journal,  "  reckless  of  honor  but  greedy 
for  gold,  undertook  to  sell  out  the  regular  profes- 
sion, but  only  succeeded  in  selling  themselves — and 
very  cheap  at  that."  We  quote  this  judicious  criti- 
cism without  comment. 

The  New  York  Neurologicai.  Societt. — At  the 
meeting  of  this  society,  May  2,  1882,  the  President 
elect,  Dr.  Spitzka,  delivered  his  inaugural  address. 
.\ft-er  some  discussion  a  resolution  was  passed,  by  a 
vote  of  35  to  7,  condemning  the  manner  in  which 
the  election  of  Dr.  Spitzka  had  been  secured.  A 
paper  was  read  by  Dr.  Corning. 

Kegarding  a  Coi,d  IN  the  Head. — The  French 
have  a  saying,  "All  that  physicians  have  been  able 
to  do  as  yet  for  a  cold  in  the  head  is — to  call  it 
coryza."  The  following  conversation  summarizes 
also  some  very  prevalent  modes  of  treatment: 

"  What  do  you  do  for  a  cold  in  the  head  ?  " 

"  I  treat  it — with  contempt.     And  you  ?" 

"  I  ?     When  I  have  a  cold  in  the  head — I  sneeze." 

American  Medical  Assoclvtion  —  Commttation 
Kates  to  St.  Paul,  Minnesota.  —  Dr.  Alex.  J. 
Stone,  Chairman  of  Committee  of  Arrangements,  of 
St.  Paul,  Minnesota,  writes  :  "  In  anticipating  the 
meeting  of  the  .American  Medical  Association  in  this 
city  on  the  6th,  7th,  8th,  and  9th  of  June  prox.,  the 
Committee  of  AiTangements  have  secured  the  fol- 
lowing rates  from  the  various  railroads  centring  at 
this  point : 

"  The  Chicago,  Milwaukee  &  St.  Paul  E.E.  offers 
a  rate  of  S12.50  for  a  round-trip  ticket  from  Chicago 
to  St.  Paul  and  return,  to  delegates  and  ladies  ac- 
companying them  upon  presentation  of  credentials 
at  general  or  depot  offices  in  Chicago  ;  also  return 
tickets  to  all  points  this  side  of  Chicago  for  one- 
fifth  fare,  on  certificate  from  the  chaii-man  of  the 
Committee  of  Arrangements. 

"  The  Chicago,  St.  Paul,  Minneapolis  k  Omaha 
offer  the  same  rates  from  Chicago  and  all  points  be- 
tween Chicago  and  St.  Paul ;  also  from  Sioux  City 
and  all  points  north.  From  Omaha  and  all  points 
south,  two  cents  a  mile  for  round-trip  tickets. 

"  The  Minneapolis  k  St.  Louis  E.  E.  offer  the 
same  rates  (.S12.50)  from  Chicago  to  St.  Paul  and 
return,  via  the  Chicago,  Eock  Island  &  Pacific 
E.  K.,  and  a  rate  of  818  from  St.  Louis  to  St.  Paul 
and  rettirn,  via  St.  Louis,  Chicago,  Burlington  <fc 
Quincy  E.  E.  (via  Albert  Lea).  Also  one-fifth  fare 
returning  to  all  intermediate  points. 

"  All  tickets  on  above  roads  good  till  July  10th. 

"  The  St.  Paul,  Minneapolis  i-  Manitoba  E.  E.  will 
give  passes  to  every  delegate  and  to  ladies  accom- 
panying them,  over  all  divisions  of  its  road,  good  for 
the  entire  month  of  June.  Their  road  runs  through 
the  celebrated  Eed  Eiver  Valley  and  the  great 
wheat  farms  toWinnii^eg.  It  connects  Minneapolis 
and  Lake  Minnetonka  (the  largest  watering-place  in 
the  State,  with  four  large  hotels)  with  St.  Paul. 

"The  Northern  Pacific  E.  E.  wiU  return  all  dele- 
gates for  one-fifth  fare,  and  offers  free  transportation 
for  the  month  of  June  to  delegates  and  ladies  ac- 
companying them  to  the  Yellowstone  VaUey  and 
return. 

"The  St.  Paul  &  Duluth  E.  E.  offers  free 
passes  to  delegates  and  ladies  accompanying  them 


588 


THE  MEDICAL  RECORD. 


over  their  line  to  Duluth  on  the  north  shore  of  Lake 
Superior  and  return. 

"  The  two  lines  of  river  packets,  viz.:  The  St.  Paul 
&  St.  Louis  Packet  Co  ,  and  the  Diamond  Jo  line, 
offer  one-half  transportation  rates  from  all  points  to 
or  from  St.  Paul.  (They  charge  full  rates  for  berths 
and  meals.) 

"The  Lake  Superior  Transit  Co.  offer  the  fol- 
lowing rates  :  Buffalo  to  St.  Paul,  one  way,  §27. 10; 
round  trip,  S-tT.iO.  Erie  to  St.  Paul,  one  way, 
S25.40 ;  round  trip,  S-lo.60.  Cleveland  to  St.  Paul, 
one  way,  S23.75  ;  round  trip,  $39.20.  Detroit  to  St. 
Paul,  one  way,  §21.20 ;  round  trip,  $35.20. 

"  Meals  and  state-rooms  on  steamers  are  included 
in  the  above  rates. 

"  The  above  company  have  also  offered  a  com- 
plimentary excursion  down  the  lake  and  return, 
from  Duluth,  one  day  immediately  after  the  meet- 
ing. 

"  The  hotels  of  St.  Paul  are  the  Merchants  (.S3 
to  .S3.50);  Metropolitan  (83  to  §3.50);  Wind- 
sor (.52.50);  Clarendon  (§2.50);  Sherman  (§2.50); 
International  (§2);  St.  James,  (§2);  and  Com- 
mercial (§2).  The  three  first  are  provided  with 
elevators. 

"  The  Opera  House,  in  which  the  general  session 
will  be  held,  seats  a  thousand  persons. 

"Minneapolis,  a  city  of  sixty  thousand,  lies  nine 
miles  from  St.  Paul,  on  the  line  of  the  St.  Paul,  Min- 
neapolis &  Manitoba  i-oad,  and  has  fine  hotel  ac- 
commodations. Half-hourly  trains  connect  the  two 
cities.  Trains  run  almost  hourly  to  and  from  Lake 
Minnetonka." 

No  reduced  rates  can  be  obtained  from  this  city 
to  Chicago.  Beyond  the  latter  point  the  Chicago 
&  Northwestern  Railway  Co.  will  also  give  a  ticket 
to  St.  Paul  and  return  for  §12.50  ;  from  Chicago  to 
St.  Paul  and  return,  via  Omaha,  for  §36.95,  while 
round  trips  from  St.  Paul  to  Fargo,  to  Winnipeg, 
and  to  the  Yellowstone  country  will  be  free  to  dele- 
gates and  their  families. 

All  additional  information  will  be  furnished  by 
Mr.  L.  F.  Booth,  General  Eastern  Agent  Chicago  & 
Northwestern  R.  R.,  415  Broadway,  N.  Y. 

The  Georgia  Medical  Association  held  its  annual 
meeting  at  Atlanta,  April  19. 

RE5HTTEKT   FeVEK   WITH    PeCCMAR    PuLSE-RATE. — 

Dr.  L.  W.  Baker,  of  Buchan,  Mich.,  .sends  us  the 
following  note  regarding  some  peculiar  cases  of 
malarial  fever  which  he  has  been  treating.  He 
writes  : 

'•  I  have  lately  attended  several  cases  of  remit- 
tent fever  which  to  me  are  peculiar,  and  I  should 
be  pleased  to  have  some  one  explain  them.  I  shall 
not  give  an  extended  record  of  the  cases,  but  the 
main  facts. 

"  When  first  called,  before  any  medicine  had  been 
giveij,  I  found  dry  hot  surface  with  temperature 
vai-ying  in  the  different  cases  from  103°  to  105',  and 
pulse  only  from  72  to  80  per  minute,  heart-sounds 
norm  il  and  agreeing  in  frequency  with  radial  pulse, 
which  was  full  and  strong. 

"The  fever  very  stubborn,  lasting  ordinarily  from 
seven  to  fourteen  days,  and  in  one  case  four  weeks, 
notwith-itanding  that  cinchonism  was  repeatedly 
produced. 

"  Calomel  in  each  case  was  given  at  beginning  treat- 
raent  in  cathartic  doses,  and  occasionally  during 
treatment  in  small  repeated  doses.  The  excessive 
fever  was  readily  controlled  by  cold  sponging  and 
cold  sheets. 


"  In  but  one  case  did  the  pulse  after  breaking  of 
the  fever  fall  but  a  few  degrees,  and  that  was  in  the 
last  case.  First  day,  temperature  105°,  pulse  72. 
Seventh  day.  temperature  99°,  pulse  56. 

"A  brother  physician  reports  to  me  two  similar 
cases  in  his  practice." 

The  Working  of  the  Registratiok  Act  has  on 
the  whole  been  quite  successful,  according  to  Dr. 
Sturgis,  who  gives  the  following  account  of  it  : 

"  Several  cases  are  now  under  consideration,  and 
will  receive  attention  in  due  time.  Abram  E.  Cox 
was  our  pioneer  case,  and  he  is  also  the  first  man  we 
have  had  indicted  for  a  second  oflence.  He  was  a 
paper-hanger  by  trade,  but  had  a  diploma  which  he 
had  bought  from  the  defunct  Medical  School  at 
Castleton,  Vt.  On  his  promise  to  take  down  his 
sign  and  not  practice  any  more,  we  have  deferred 
sentence  on  the  second  indictment,  which  is  a  prison 
offence.  Flower  and  Johnson,  who  were  recently 
tried,  pleaded  guilty  ;  the  former  was  fined  §200  and 
the  latter  §50,  and  each  paid  the  fine.  The  trial  of 
Seither  is  postponed  until  the  princijjal  witness  for 
tlie  prosecution  is  released  from  the  Penitentiary. 
August  Furneau,  who  was  indicted  for  malpractice, 
having  killed  a  child  and  nearly  killed  the  mother, 
forfeited  his  bail. 

A  Plea  fob  So-Called  "  German  Theories." — It 
is  a  false  idea  some  have  of  railing  at  German  theo- 
ries. I  have  some  respect  for  a  medical  theory 
founded  on  twenty  years'  experience  and  study  of 
thousands  of  cases.  Theory,  of  course,  is  not  truth, 
but  is  founded  on  truth,  and  is  a  precursor  of  other 
truths.  Really  the  Germans  are  a  most  practical 
people,  as  practical  as  theoretical.  They  do  not,  at 
least,  found  an  absurd  theory  on  ten  hours'  obser- 
vation, but  their  theories  are  the  results  of  lifetimes 
of  observation.  The  fanatical  London  professors 
tell  the  students  coming  here,  by  all  means  avoid 
the  Germans,  do  not  listen  to  them,  only  look  at 
their  cases ;  and  I  know  a  young  Englishman  who 
is  in  a  state  of  continual  trepidation  lest  he  should 
catch  a  German  idea.  Myself  I  have  no  doubt 
that  he  has  been  so  thoroughly  inoculated  with 
weak  English  theories  that  his  mental  constitution 
is  proof  against  the  German  theory  epidemic. —  Cor- 
respondence  Buffalo  Medical  and  S>ir(]ical  Journal. 

Surgical  Instrd.ment  Manxifactdbers  and  Deal- 
ers IN  Council. — A  convention  of  surgical  instru- 
ment makers  and  dealers,  comprising  all  the  principal , 
manufacturers  of  the  United  States,  was  held  at  the 
Astor  House,  New  York  City,  May  2  and  3,  1882. 
The  object  of  the  convention  was  for  mutual  con- 
sultation, to  enable  manufacturers  to  keep  their 
products  up  to  the  best  standard  and  regulate  uni- 
form prices  for  consumers. 

At  the  close  of  the  meeting  the  following  resolu- 
tion was  unanimously  adopted  : 

"  Kesolrcd,  That  in  learning,  in  character,  in  use- 
fulness, in  all  that  goes  to  the  making  of  men 
honorable  among  their  fellow  men,  we  hold  the  medi- 
cal profession  of  our  country  second  to  no  other 
class  of  men.  That  as  co-laboi-ers  with  them  in  our 
sphere,  in  our  work  of  preventing,  alleviating,  and 
removing  human  suffering,  we  pursue  a  vocation 
honorable  in  itself,  worthy  of  our  best  ambition,  and 
deserving  our  most  faithful  effort." 

A  Time  op  Pkepilection  for  Fecundation  is 
thought  by  Cohnstein  to  exist  for  every  woman.  He 
gives  some  illustrations  showing  that  certain  women 
were  most  likely  to  conceive  at  a  certain  time  of  the 
year. 


Vol.  XXI.-No.  22 
June  3,  1882. 


THE  MEDICAL  RECORD. 


589 


©rtgmal  Communlcattans. 


THE  SEQUELuE  OF   MEASLES, 

With  Special  Beperence  to  the  Development  of 

A  STRi'Mors  Diathesis.* 

Bt  y.  P.  GIBXEY,  M.D., 

A  CASE  of  spinal  irritation  in  a  maiden  lady,  thirty 
years  of  age,  has  recently  come  under  my  care  in  the 
hospital,  and  as  the  patient  had  been  for  many 
months  under  frequent  observation  of  an  eminent 
gynecologist,  who  assured  me  that  the  uterine  dis- 
order, viz.,  a  retroversion  with  pelvic  cellulitis, 
would  not  account  for  the  gravity  of  her  neuroses,  I 
determined,  in  getting  the  history,  to  seek  diligently 
for  a  cause. 

Once  or  twice  in  the  cross-examination  I  was  led 
to  believe  that  a  fall,  distinctly  remembered  by  the 
lady  as  occurring  when  she  was  eleven  years  of  age, 
would  explain  all ;  but  then  I  learned  that  two  or 
three  years  had  elapsed  before  any  positive  signs  of 
ill-health  were  observed. 

From  habit,  I  asked  her  about  the  exanthemata, 
not  expecting  her  to  remember  anything  about  such 
diseases  of  infancy,  when  she  replied  that  to  measles, 
u-liicit  came  on  in  her/our/eenlh  //ear,  she  felt  that  all 
the  sickness  of  her  life  could  be  atlrihuted.  It  is  title 
that  her  family  histoiy  is  conspicuously  bad,  com- 
bining both  the  tuberculous  and  the  neurotic  diath- 
eses ;  but  it  is  equally  true  that  prior  to  this  exan- 
them  she  considered  herself  in  fair  health,  to  say  the 
least,  and  subsequent  to  it  an  invalid. 

For  sixteen  years,  then,  she  has  been  a  sufferer, 
and  her  history  during  this  period  embraces  bron- 
chitis, "  lung  fever,"  intestinal  disorders  of  various 
I  kinds,  vesical  irritation,  "  weak  back,"  disturbances 
of  special  sense,  and  fatigue  on  the  slightest  exertion, 
etc.  Indeed,  the  case  would  furnish  profitable  study 
j  for  any  and  all  the  specialties,  and  I  take  it  as  an 
introduction  to  some  remarks  bearing  on  the  evolu- 
;  tion  of  a  diathesis,  strumous,  scrofulous,  or  call  it 
'  what  you  may,  so  frequently  found  in  the  wake  of 
a  wiiooping-cough,  a  scarlatina,  or  a  measles. 
Diphthei-ia  might  well  be  included  in  this  category, 
but  it  is  always  so  difficult  to  satisfy  yourself  whether 
a  child  has  really  had  diphtheiia  or  one  of  the  simpler 
jihurvngeal  diseases.  Hence  I  have  taken  as  my 
t:ipic  the  sequels  of  measles,  because  this  aft'ection, 
Li^jparently  so  trivial,  i.s  a  major  exanthem  and  leaves 
such  conditions  of  health  that  I  am  confident  a  dis- 
I  cussion  of  the  subject  cannot  be  untimely. 
I  In  my  search  for  the  cause  of  bone  disease  in  chil- 
I  dren,  extending  over  an  active  service  of  eleven  years, 
I  have  found  this  one  exanthem  standing  in  such  re- 
lationship more  frequently  than  any  other  disease 
!  of  childhood. 

1  Let  me  distinctly  state  at  the  outset  that  I  am 
not  discussing  rotheln,  for  my  study  of  this  mild 
affection  leads  me  to  infer  that  no  seijuels  exist,  and 
that  its  interest  lies  chiefly  in  differential  diagnosis. 
!  Nor  do  I  propose  to  devote  any  time  to  a  detailed  ac- 
'  count  of  all  the  sequels  observed  in  connection  with 
I  measles.  The  gentlemen  of  the  society  can  present 
isuch  as  they  have  encountered,  with  the  best  means 
iin  their  hands  for  preventing  or  treating  them. 
'  Indeed,  two  of  the  questions  on  which  I  wish  to 
elicit  special  discussion  are  : 

•  Ktaa  before  The  Piaetitinners'  Society  of  New  York,  May  ID.  18*2. 


First. — Does  the  disease  itself  or  do  the  compli- 
cations induce  the  sequels  often  so  disastrous  ? 

Second. — Can  the  complications  be  so  managed  as 
to  prevent  or,  at  least,  to  materially  lessen  the  grav- 
ity of  the  sequels  ? 

In  a  paper  read  before  the  County  Medical  Soci- 
ety of  New  York,  in  1877,  on  "  The  Strumous  Ele- 
ment in  the  Etiology  of  Joint  Disease,"  and  pub- 
lished in  the  Nem  Yor/c  j\[edical  Journal  for  July 
and  August  of  that  year,  I  called  attention  to  the 
frequency  with  which  joint  and  bone  disea.ses  owed 
their  inception  to  a  delayed  convalescence  from 
some  one  of  the  exanthemata.  In  two  hundred  and 
nine  cases  of  spinal  caries  analyzed,  fifteen  were 
found  to  have  developed  very  shortly  after  pertussis, 
in  fact  before  the  cure  was  comiilete,  and  of  this  fif- 
teen five  gave  a  history  of  an  hereditary  predisposi- 
tion, seven  were  not  investigated  on  this  point,  while 
three  gave  histories  ahsoluteli/ free  from,  hereditary/  dis- 
eases. Measles  was  found  to  be  the  exciting  cause 
in  eighteen  out  of  the  two  hundred  and  nine.  Eight 
of  these  were  already  strumous  from  an  hereditary 
point  of  view,  one  was  not  investigated,  while  nine 
irere  free  from  hereditary  infinences.  It  would  seem 
quite  fair  to  assume,  then,  that  measles  contributed 
to  the  evolution  of  the  strumous  diathesis  in  eight 
of  the  eighteen  cases,  and  was  the  direct  cause  of 
such  diathesis  in  nine  cases.  Scarlatina  was  re- 
corded as  inducing  the  disease  four  times,  of  which 
number  one  teas  free  of  hereditari/  predisposition,  one 
was  already  strumous,  and  two  were  not  investi- 
gated. 

Eickets,  cholera-infantum,  and  vaccinia  were 
noted,  likewise,  as  factors  in  the  evolution  of  struma, 
and  in  two  cases  out  of  six,  closely  analyzed  on  this 
point,  rickets  seemed  to  be  the  cause,  rather  than  a 
condition. 

I  analyzed  271  cases  of  hip  disease,  also,  and  found 
that  pertussis  stood  in  a  causative  relationship  8 
times,  in  3  instances  there  being  no  hereditari/  inftu- 
nices  traceable.  Scarlatina  seemed  to  cause  the  dis- 
ease 8  times,  there  being  no  evidences  of  diath- 
esis in  6  o/"  the  cases  analyzed  with  regard  to  hered- 
ity. In  5  cases  measles  were  the  exciting  cause, 
and  in  only  1  case  (4  being  analyzed)  was  there  found 
any  evidence  of  heredity. 

One  hundred  and  three  cases  of  what  is  popularly 
known  as  white  swelling  of  the  knee  gave,  on  analy- 
sis :  Pertussis,  the  cause  in  4  (2  of  which  pre- 
sented already  evidence  of  an  hereditary  diathesis — 
the  remaining  2  being  free) ;  scarlatina,  the  cause  in 
4  (heredity  influencing  only  1  out  of  the  4)  ;  and 
measles,  the  cause  in  1. 

In  thirty-two  cases  of  caries  of  the  ankle,  measles 
and  scarlatina  were,  to  all  appearances,  the  cause  in 
one  instance  respectively. 

Since  the  publication  of  that  paper,  I  have  pur- 
sued my  studies  in  this  direction,  and  am  still  fur- 
ther convinced  that  not  only  do  measles  (and 
whooping-cough  and  scarlatina)  often  serve  to  bring 
out  a  strumous  diathesis  in  a  child  by  heredity 
entitled  to  the  same,  but  also  induce  such  a  diath- 
esis even  where  the  family  records  are  clear  of  any 
transmissible  diseases.  Take  the  following  case  : 
A  boy,  aged  three  years,  the  picture  of  health,  and 
always  regarded  as  exceedingly  healthy.  The  pa- 
rents, both  of  whom  I  have  the  opportunity  of  inter- 
viewing, present  very  good  histories,  both  personal 
and  family.  The  patient  I  find,  on  entering  the 
room,  walking  about  the  floor,  can-ying  his  head  a 
little  stiffly,  the  shoulders  being  appreciably  raised. 
He  wiU  not  turn  the  liead  without  turning  the  body 


590 


THE   MEDICAL  RECORD. 


at  the  same  time.  There  is  no  deformity  of  spi- 
nous processes  except  a  very  mild  degree  of  lordosis 
in  mid-dorsal  region.  Notwithstanding  the  clear 
history  thus  far  obtained,  I  strougly  suspect  verte- 
bral ostitis,  but  on  pushing  my  investigation  still 
further  I  learn  that  these  symptoms  have  not  lasted 
a  week ;  that,  in  fact,  one  week  ago  he  was  very 
active  and  was  jumping  from  the  sofa,  when  he  fell, 
striking  his  head  directly  against  the  floor — the  fall 
producing  a  little  concussion  of  the  brain,  but  that 
he  rested  well  that  night  and  did  not  manifest  any 
symptoms  whatever  vmtil  the  third  morning,  when 
he  got  out  of  bed  holding  the  head  awkwardly, 
and  complaining  of  pain  on  moving  about.  Since 
that  morning  he  has  been  resting  poorly  nights,  and 
his  cervical  stiffness  has  rather  increased.  In  view 
of  this  severe  fall,  then,  with  the  above  facts  in  view, 
I  am  on  the  point  of  excluding  any  bone  disease  in 
making  up  my  diagnosis,  and  of  attributing  the 
whole  difficidty  to  a  muscular  or  ligamentous  strain, 
relief  from  which  will  speedily  follow  after  rest 
and  counter-irritation  ;  but  on  attempting,  by  way 
of  routine,  to  explore  the  posterior  wall  of  the 
pharynx  with  my  finger,  the  little  fellow  sets  up 
violent  resistance,  and  begins  coughing  rather  spas- 
modically. The  father  now  informs  me  that  he  is 
just  getting  over  whooping-cough,  which  has  al- 
ready lasted  two  months.  With  this  additional  fact, 
I  interpret  the  fall  as  a  concussion  of  one  or  more 
of  the  vertebral  bodies,  the  nutrition  of  which  has 
been  impaired  by  the  whooping-cough  in  such  a 
way  as  to  render  them  peculiarly  vulnerable.  This 
was  a  most  unfortunate  time  for  such  a  traumatism, 
and  I  have  little  hesitancy  in  predicting  for  the 
little  patient  a  bone  disease  with  destructive  changes. 
In  the  Revue  de  Chiria-ffie,  No.  10,  1881,  Paris, 
M.  Oilier  has  very  clearly  shown  how  such  strains 
or  concussions  produce  cerebral  and  peripheral  bone 
diseases,  in  an  article  entitled  "De  I'entorse  juxta- 
epiphysaire,  et  de  ses  consequences  immediates  ou 
filoiguGes  au  point  de  vue  de  I'inflammation  des  os." 

A  little  girl,  aged  eight,  was  admitted  to  the  hos- 
pital for  the  relief  of  spinal  caries  with  a  large  bos.se 
and  incomplete  paraplegia.  The  father  was  reported 
as  subject  to  asthma,  but  otherwise  he.i,lthy  and  pos- 
sessed of  an  excellent  family  history.  The  mother 
was  likewise  healthy  and  claimed  a  family  history 
equally  good.  The  patient  herself  was  in  fine  health 
until  three  years  of  age,  when  she  had  an  attack  of 
measles  from  which  she  made  a  very  slow  recovery. 
It  is  reported  that  she  caught  cold  and  had  a  re- 
lapse, and  during  this  relapse  began  to  complain 
from  time  to  time  of  pain  in  her  back.  That  was 
the  beginning  of  her  spinal  disease,  and  her  condi- 
tion on  admission  to  the  hospital  five  years  later 
furnished  abundant  evidence  that  the  disease  had 
made  dreadful  ravage. 

Take  this  case :  A  highly  scrofulous  looking  boy, 
aged  four,  was  brought  to  the  out-door  department 
of  the  hospital  suffering  from  caries  of  the  eleventh 
and  twelfth  dorsal  and  the  first  lumbar  vertebrae 
There  was  a  bosse  of  at  least  a  quarter  of  an  inch  in 
height,  and  an  indisposition  to  extend  tlie  left 
thigli.  Tliis  was  explained  by  the  presence)  of  a 
psoas  abscess  lying  deep  in  the  iliac-fossa.  The 
familv  history  on  both  sides  on  careful  search  was 
found  to  be  good,  and  the  boy  himself  was  a  good 
specimen  of  health  and  vigor  ten  months  before  his 
appearance  at  the  hospital.  He  had  an  attack  of 
measles,  followed  by  enlargement  of  the  cervical 
glands  and  a  phycitenular  conjunctivitis  resulting  in 
corneal   ulcers,   cicatrices   of  which   remain.       He 


lapsed  into  a  wretched  condition  of  health,  and 
while  in  this  state  a  playfellow  pushed  him  from  the 
sidewalk  one  day  so  that  he  fell,  striking  his  head 
against  a  stone,  a  deep  lacerated  wound  resulting. 
This  wound  seemed  as  though  it  would  never  heal. 
Two  weeks  after  this  severe  fall  he  began  to  com- 
plain of  pain  in  his  back  and  to  assume  that  gait 
and  those  attitudes  so  characteristic  of  vertebral  os- 
titis. 

From  our  case-books  I  have  taken  cases  that  have 
come  Tinder  observation  since  the  publication  of  my 
paper  containing  the  statistics  above  mentioned. 
I  have  taken  for  analysis  such  as  I  find  fully  inves- 
tigated and  fully  written  up.  In  my  former  tables 
I  took  the  trouble  to  personally  examine  every  case 
from  which  data  were  drawn,  and  made  special  ef- 
fort to  trace  out  cases  whose  histories  had  been  hur- 
riedly passed  over.  Those  tables  I  say  rejiresent 
labor  that  I  am  loath  to  repeat.  They  were  based 
upon  cases  wherein  I  had  obtained  all  that  there  was 
in  the  family  histories  in  addition  to  the  dates  and 
severity  of  the  exanthemata.  In  this  supplementary 
report  I  am  about  to  make  I  have  not  taken  the 
trouble  to  separate  those  cases  with  clear  family 
records  from  those  wherein  heredity  undoubtedly 
plays  a  prominent  part. 

I  shall  be  able  to  show  only  that  the  exanthemata 
occurring  in  a  child  with  a  strumous  diathesis,  either 
dominant  or  latent,  render  the  child  additionally 
vulnerable  to  the  development  of  bone  disease.  So 
far  as  my  own  imi^ressions  go,  I  am  fully  warranted 
in  saying  that  many  of  these  cases  have  had  the 
strumous  diathesis  engendered  by  these  diseases  of 
which  we  speak. 

In  i8  well-marked  cases  of  spinal  caries  the  first 
symptoms  of  disease  appeared  in  13  during  conva- 
lescence from  measles,  and  in  4  prior  to  the  occur- 
rence of  measles,  all  4  of  which  were  aggravated  l>y 
this  exanthem.  Three  of  the  48  presented  their 
first  signs  in  the  wake  of  a  whooping-cough,  1  came 
on  soon  after  a  scarlatina,  and  2  after  a  prolonged 
cholera  infantum. 

Of  lis  cases  of  hip  disease,  13  began  within  a  few 
weeks  after  measles,  and  3  were  attributable  to  this 
disease  ;  9  were  traced  to  whooping-cough  in  its  final 
stage,  .5  to  scarlatina,  and  1  to  cholera  infantum. 

In  49  cases  of  articular  ostitis  of  the  knee  {known 
as  white  swelling),  the  relationship  of  the  early  stage 
and  of  the  infantile  disease  under  consideration  was 
so  close,  as  regards  time,  that  measles  was  held  ac- 
countable for  7,  whooping-cough  for  2,  and  scarla- 
tina for  2. 

Four  out  of  23  cases  of  caries  of  the  ankles  were 
traced  to  measles  or  the  condition  of  healtli  which 
measles  left,  and  3  were  traced  to  whooping-cough. 
To  sum  up  :  I  feel  fully  wan-anted  in  ascribing  37 
cases  of  bone  disease,  out  of  238  analyzed,  to  measles, 
17  to  whooping-cough,  7  to  scarlatina,  and  4  to  chol- 
era infantum. 

These  statistics  but  confirm,  however,  the  state- 
ments made  by  nearly  all  writers  on  diseases  of  chil- 
dren. They  all  admit  that  in  some  mysterious  way 
or  other  measles  often  take  a  conspicuous  part  ia 
the  evolution  of  a  strumous  or  a  tuberculous  diathe- 
sis. This  can  bo  easily  proved,  and  the  new  statistics 
just  reconled  go  toward  establishing  this  point  J 
and  I  am  fully  improsseil  with  tlie  importance  of  es- 
tablishing this  ])oint  beyond  peradventure.  I  know 
that  the  tendency  is  to  make  light  of  measles  espe- 
cially, and  there  be  many  who  claim  that  this  is  ft 
harmless,  aye,  a  salutary  disease.  It  pains  me  much 
to  see  in  the  abbreviated  report  of  the  proceedings 


THE  MEDICAL  RECORD. 


691 


of  the  Medical  Society  of  the  State  of  Pennsylvania, 
as  published  in  the  Eecokd,  No.  20,  p.  549,  of  pres- 
ent year,  the  following  from  a  man  who  occupies  an 
exalted  position  in  his  profession  :  "  Dr.  Traill 
Green,  of  Easton,  read  a  pajier  upon  the  importance 
of  physicians  exerting  themselves  to  allay  the  un- 
necessary fear  of  disease  which  was  common  amoug 
the  laity.  Infantile  diseases,  he  thought,  were 
greatly  overrated  in  theii-  danger,  and  he  leaned  to 
the  opinion  that  they  were  rather  benelicial  than 
otherwise." 

I  sincerely  hope  that  this  may  be  an  incorrect 
report,  and  that  my  quotation  may  be  the  means  of 
bringing  out  the  more  conspicuously  a  disclaimer  of 
such  views,  though  I  am  ready  to  grant  that  Dr. 
Green  has  good  authority  for  making  such  state- 
ments, but  the  authorities  I  refer  to  are  given  in 
Thomas's  article  in  "  Ziemssen's  Cyclopicdia  "  : '■ 
"  Should  measles,  on  the  other  hand,  appear  during 
a  disease  to  which  they  do  not  usually  give  rise,  they 
may  favorably  influence  the  course  of  the  latter." 
He  quotes  Behrend  as  having  seen  eczema  of  the 
scalp  in  a  woman,  of  three  years'  standing,  disap- 
pear permanently  after  measles.  "  Barthez  and 
Killiet  saw  chorea,  epilepsy,  and  incontinence  of  urine 
of  several  months'  standing  cured  by  measles. 
Weisse  reports  measles  in  the  case  of  a  girl  sutler- 
ing  from  convulsions  entii-ely  remove  the  disease." 
"  Feith  and  Schroder  ^'an  der  Kolk  rejjort  the  case  of 
a  woman  who,  for  five  years,  had  been  in  an  insane 
asylum  with  violent  attacks  of  mania,  which  did  not 
return  after  measles,  and  the  woman  was  soon  well 
enough  to  be  discharged."  "  Rilliet  found  that  a 
chronic  coxitis  improred  noticeably  after  measles." 
Now  these  quotations  are  from  an  eminently  consol- 
ing page  in  Ziemsseu,  and  yet  I  have  not  given  the 
entire  page.  I  have  italicized  this  last  item  be- 
cause I  find  in  it  a  key  to  some,  at  least,  of  the  good 
results  reported.  Chronic  joint  disease  is  especially 
a  disease  of  exacerbations,  and  it  is  very  easy  for 
one  not  familiar  with  this  fact  in  the  natural  history 
of  such  affections  to  interpret  a  post  hoc  as  a  prop- 
ter hoc.  It  is  also  well  known  to  neurologists  that 
epilepsy  and  allied  diseases  are  arrested  spontane- 
ously anywhere  between  the  age  of  childhood  and 
the  age  of  puberty.  Furthermore,  eezematous  erup- 
tions are  classed  among  the  sequels  of  measles.  I 
can  readilj-  believe  that,  occasionally,  any  acute  dis- 
ease, occurring  in  the  course  of  a  chronic  one,  will 
prove  beneficial  to  the  other,  but  I  am  far  from 
believing  this  to  be  anything  more  than  an  exceji- 
tion  to  a  pretty  universal  rule.  The  exanthemata 
of  cities  differ,  I  am  led  to  believe,  very  much  from 
those  of  the  counti-y,  and  epidemics  differ,  too,  very 
materially  in  their  severity. 

Trousseau  says:  "In  an  epidemic  which  I  ob- 
served at  the  Necker  Hospital  in  the  years  1845  and 
1846,  out  of  twenty-four  children  who  had  measles, 
twenty-two  died  of  peri-pneumonic  catarrh ;  the 
other  two  escaped  this  terrible  comi^lication.  This 
statistical  fact  enables  you  to  estimate  the  frightful 

severity  of  this  affection and  the  physician 

who  considers  measles  a  mild  disease  till  he  encoun- 
ters one  of  these  ei^idemics,  will  afterward  modify 
that  opinion."  f 

Dr.  Chadbourne,  in  the  American  Journal  of 
Obstetrics  and  Diseases  of  Women  and  Children, 
for  October,  1880,  reports  an  epidemic  of  measles 
which  prevailed  in  the  New  York  Foundling  Asylum 
in  the  spring  of  that  year.     There  were  forty-eight 

*  William  Wooii  &  Co..  NewYork.  vol.  ii.,  p.  105. 

t  Clinical  Medicine.    Philadelphia,  1S73  ;  vol.  i.,  p.  181. 


deaths  in  three  hundred  cases,  twenty  children  dy- 
ing of  capillary  bronchitis,  broncho-pneumonia,  and 
<jL'dema  pulmonum.  Twenty  died  from  convul- 
sions. 

Dr.  Raymond,  of  Brooklyn,  presented  last  year  a 
report  based  uijon  the  returns  to  the  Brooklyn 
Board  of  Health,  and  his  article  was  thus  signifi- 
cantly headed:  ''Measles  not  a  Trivial  Disease." 
It  is  published  in  the  "Proceedings  of  the  Medical 
Society  of  the  County  of  Kings,"  and  is  a  very  in- 
structive contribution.  Even  in  the  limited  number 
of  cases  of  measles  reported  to  the  Board  of  Health 
of  that  city,  in  one  year  there  were  fifty-nine  deaths 
from  complications.  Of  lesions  pertaining  to  the 
nervous  system,  six  died  of  meningitis  and  hydro- 
cephalus, thirteen  of  convulsions,  and  two  of  con- 
gestion of  the  brain.  Eespecting  the  pulmonary 
system,  three  died  of  congestion  of  the  lungs,  one 
of  pulmonary  apoplexy,  eighteen  of  pneumonia,  and 
five  of  laryngitis.  Two  died  of  dysentery.  Very 
few  days  jjass  in  the  out-door  department  of  the 
hospital  that  some  one  of  our  continued  j^atients 
does  not  appear,  after  a  long  absence,  with  the 
excuse  that  the  delay  has  been  caused  by  the 
intercurrence  of  a  measles,  a  whooping-cough,  or  a 
scarlatina,  followed  by  a  very  slow  recovery.  In 
the  majority  of  instances  I  find  that  the  bone  dis- 
ease has  been  aggi-avated,  and  added  to  this  there 
is  frequently  a  broncho  -  pneumonia,  an  otitis,  a 
naso-pharyngeal  catarrh,  or  an  ana-mia  that  the  best 
jueparations  of  iron  fail  to  reach. 

To  conclude  these  remarks  I  have  collected  twenty- 
four  cases  of  chronic  bone  disease  in  children,  twenty- 
one  of  whom  were  under  ten  years  of  age,  and  all 
under  thirteen.  All  these  have  recently  passed 
through  an  attack  of  measles.  On  a  close  analysis 
I  find  that  twelve,  or  one-half,  came  oiit  of  the  inter- 
current disease  in  a  worse  condition  ;  that  is,  the 
chronic  ailments  from  which  they  suffered  were  mate- 
rially aggravated  ;  eleven  were  unaffected  and  one 
seemed  to  be  a  little  better,  but  just  how  long  this 
improved  condition  will  last  I  cannot  say  :  suffice  it 
to  remark,  however,  that  the  patient  under  con- 
sideration has  a  subacute  blepharitis  as  a  sequel  to 
the  measles,  and  I  am  not  sure  but  that  her  struma 
is  accentuated.  The  complications  in  the  twenty- 
four  cases  I  am  now  reviewing  were  :  catarrhal  con- 
junctivitis in  three,  bronchitis  of  an  aggravated 
type  in  two,  laryngitis  in  one,  broncho-pneumonia 
in  one,  dysentery  in  one,  and  a  severe  otalgia  in 
one.  The  sequels  were  conjunctivitis  in  three,  an 
exaggeration  of  the  strumous  diathesis  in  four,  an 
ulcerated  stomatitis  in  one,  a  naso-pharyngeal  ca- 
tarrh in  one,  and  a  persisting  anivmia  in  two. 

The  questions,  then,  in  this  communication  I 
.should  like  to  have  discussed  by  the  members' of  the 
society,  are  : 

1.  Do  nervous  diseases,  and  especially  epilepsy 
and  allied  convulsive  affections,  disappear  by  reason 
of  an  attack  of  measles  ?  That  is,  can  we  reasonably 
expect  that  an  epileptic  will  be  cured,  or  materially 
benefited  even,  by  the  intercuiTence  of  measles?  I 
propound  this  question  because  of  the  quotations  I 
have  made  from  Thomas's  article  in  Ziemssen. 

2.  Does  the  disease  itself  or  do  the  complications 
induce  the  sequels  which  are  often  so  disastrous  to 
health? 

3.  Can  the  disease  or  the  complications  be  so 
managed  as  to  prevent  or  even  to  materially  modify 
the  grave  sequels  with  which  we  are  familiar  ? 

4.  The  feasibility  and  the  adWsability  of  inocula- 
tion as  a  preventive  of  this  formidable  exanthem. 


592 


THE  MEDICAL  RECORD. 


Dr.  Raese  presented  to  the  Alabama  Medical  As- 
sociation, in  1880,  a  paper  entitled,  "  Inoculation  in 
Measles  probably  the  best  means  to  prevent  serious 
results."  I  regret  my  inability  to  consult  this 
article. 

In  the  present  communication  I  have  endeavored 
to  contribute  a  mite  at  least  toward  the  establish- 
ment of  the  following  propositions  : 

I.  Measles  is  not  by  any  means  "  a  trivial  dis- 
ease." * 

II.  Measles,  and  indeed  any  of  the  exanthemata, 
with  whooping-cough  especially  included,  are  to  be 
dreaded  in  patients  suffering  from  the  chronic  bone 
and  joint  diseases  commonly  known  as  scrofulous. 

III.  Measles  and  whooping-cough  take  precedence 
among  all  the  diseases  of  infancy  and  childhood  in 
the  evolution  of  a  hereditary  strumous  diathesis. 

IV.  A  strumoui  diathesis  may  be  caused  by  an  at- 
tack of  measles  or  of  whooping-cough  in  a  child 
whose  family  history,  both  paternal  and  maternal,  is 
absolutely  free  from  hereditary  diseases.; 


A  CASE  OF  HEJUPLEGIA, 

IliLUSTR.VTINC.  THE  CONNECTION  OF  DESCENDING  DE- 
GENERATION AND  Atrophy  op  the  Antebiok  Horn 
OF  the  Spinal  CoRD.f 

By  L.  PUTZEL,  M.D., 

NEPROLOGIST  TO   JtANDALL'S   ISLAND   H08PITAI.. 

The  following  is  the  history  of  the  case  which  I 
wish  to  present  for  your  consideration  this  evening  : 

Henry  Berg,  aged  forty-two,  single,  a  native  of 
Germany,  seven  j'ears  in  this  country,  admitted  to 
my  wards  on  October  21,  1881.  The  family  and  past 
history  cannot  be  obtained  from  the  patient,  as  he 
is  in  a  semi-stupid  condition. 

Present  condition. — The  patient  is  a  man  of  mod- 
erate size,  looks  older  than  the  age  given  above  ;  he 
is  markedly  emaciated,  and  has  a  pale,  haggard 
face.  When  spoken  to,  the  expression  of  his  face 
seldom  shows  that  he  comprehends  what  is  said. 
The  pupils  are  contracted  and  react  slowly  to  light. 

The  patient  has  right  hemiplegia,  the  paralysis 
being  marked  so  far  as  the  limbs  are  concerned. 
The  face  is  not  so  deeply  lined  on  the  right  side  as 
on  the  left,  and  is  slightly  drawn  toward  the  latter. 
When  his  face  is  contracted  by  an  expression  of 
pain,  the  right  side  moves  less  than  the  left ;  the 
tongue  does  not  deviate  on  protrusion. 

Measubements  or  the  Ldibs. 

Right,  Lffr. 

Thigh 16  inches.  17  inches. 

Leg llj    "  12*     " 

Arm II      "  9i    " 

Forearm !•      "  tU     " 

The  joints  of  the  right  side  of  the  body  are  enlarged 
and  tender  on  pressure,  especially  the  metacarpo- 
phalangeal and  phalangeal  joints.  There  is  rigid 
contraction  of  some  of  the  muscles  of  the  paralyzed 
leg,  giving  rise  to  distortion  of  the  foot;  the  great 
toe  is  drawn  upward  by  contraction  of  its  extensor, 
as  is  also  the  little  toe  to  a  less  extent.  The  tendo 
Achillis  is  also  firmly  contracted,  giving  rise  to  a 
talipes  equinus. 

The  muscles  of  the  scapular  region,  on  the  par- 
alyzed side,  are  very  much  atrophied. 

•  I  would  a^fiiin  call  attention  to  the  vftliic  o(  Dr.  Uaymoiul's  (mpor 
All  cstAblishlnK  thiii  propoftitlon. 

t  Head  before  the  Section  on  Theory  and  Practice  of  Medicine  of 
the  N.  y.  Academy  of  Medicine,  May  10, 1882. 


Sensation. — Tactile  sensation  is  diminished  on  ine 
right  side  of  the  body,  with  the  exception  of  the 
tips  of  the  fingers  and  the  soles  of  the  feet.  There 
is  marked  analgesia  over  the  whole  of  the  right  side. 

ReTie.ves. — Cutaneous  reflex  is  still  perceptible  in 
the  sole  of  the  right  foot,  though  not  so  marked  as 
in  the  left.  The  patellar  tendon  reflex  is  very  much 
exaggerated  on  the  right  side,  and  is  absent  on  the 
left.  The  reflex  from  the  tendon  of  the  triceps  is 
present  on  both  sides,  being  most  marked  on  the 
left.     The  other  tendons  failed  to  respond. 

Electrical  reactions  of  the  muscles  are  similar  on 
the  two  sides  of  the  body,  with  the  exception  of  the 
muscles  on  the  posterior  asj^ect  of  the  right  fore- 
arm and  the  anterior  aspect  of  the  right  leg,  in 
which  the  atrophy  is  extensive.  In  th.ese  groups 
of  muscles,  the  reactions  to  both  cun-ents  are  so 
slight  as  to  be  scarcely  aj^preciable. 

When  the  patient  reads,  he  mispronounces  all  the 
words,  but  appears  to  understand  spoken  language ; 
when  given  a  simple  direction  in  writing  he  doeS 
not  get  its  di'ift.  If  told  to  repeat  "  Ich  bin  krank," 
he  says  "Ich  krank."  When  asked  his  age,  he  is 
unable  to  tell  it,  but  writes  45  ;  when  asked  how 
long  he  has  been  sick,  he  also  writes  4.5,  and  says, 
"  Berg"  ;  when  asked  whether  he  was  born  in  Ger- 
many, he  writes  :  "  gebor  in,"  "  Gebor  in."  If  asked 
to  give  his  native  place,  he  says,  "  Ich  kann  es  nicht " 
and  strikes  the  toji  of  his  head.  As  far  as  could  be 
ascertained,  his  illness  had  lasted  between  one  and 
two  years. 

Pht/sical  e.rainination  of  chest:  Inspectio7i. — The 
whole  right  side  moves  less  on  inspiration  than  the 
left ;  the  intercostal  spaces  are  depi-essed. 

Pnlpalion. — Vocal  fremitus  is  increased  in  the  left 
infraclavicular  region. 

Percussion. — A  high-pitched  note  on  the  left  side 
anteriorly ;  the  examination  otherwise  unsatis- 
factory. 

Aiiscullatioii . — On  the  left  anterior  aspect  the  in- 
spiratory and  expiratory  murmurs  are  high-pitched, 
especially  the  latter ;  the  breathing  is  tubular  in 
quality ;  no  rules.  At  the  right  apex,  the  respira- 
tory murmur  is  shorter,  high-pitched,  and  tubular 
in  character ;  bronchophony.  Respiration  feeble 
and  distant  over  remaining  portion  of  right  lung. 

Heart. — Aj^ex  beat  in  flfth  interspace,  midway  be- 
tween the  median  line  and  the  left  nipple.  A  very 
loud  and  blowing  systolic  murmur  is  heard  at  the 
apex,  and  is  transmitted  over  the  entire  chest. 

The  patient  has  a  somewhat  annoying  cough,  but 
esjjectorates  little ;  appetite  ])oor.  He  has  had 
diarrhoea  constantly  since  admiseion,  and,  for  the 
greater  part  of  the  time,  has  passed  urine  and  fieces 
in  bed.  Yesterday  his  rectum  prolapsed,  and  has 
been  down  ever  since.  He  is  very  weak  to-day,  and 
death  is  impending.  Patient  died  October  28th,  one 
week  after  admission. 

The  diagnosis  lay  between  embolism  of  the  left 
middle  cerebral  artery,  followed  by  descending  de- 
generation of  the  lateral  tract,  associated  with 
atrophy  of  the  right  anterior  liorn  of  f  he  s|)inal  cord, 
and  cerebral  henion-hage.  .Vlthoiigh  the  previous 
history  could  not  be. obtained,  I  leaned  strongly 
toward  the  diagnosis  of  embolism,  on  account  of  the 
combination  of  aphasia,  right  hemiplegia,  and  the 
evidences  of  cardiac  disease. 

Anatomical  diar7nosis.  —  Pachymeningitis  cere- 
bralis.  embolism  of  left  middle  cerebral  arterv-,  with 
atrophy  of  pai'ts  sujjplied  by  it,  descending  degenera- 
tion, atrophy  of  right  anterior  horn  of  spinal  cord. 
I'iUdocarditis   of  aortic   and   mitral  valves,  cardiac 


THE  MEDICAL  RECORD. 


5S3 


hypertrophy.  Emphysema  and  brown  induration  ; 
old  infarotions.     Chronic  diffuse  nephritis. 

The  autopsy  was  made  twelve  hours  after  death. 

Head. — Calvarium  thickened ;  dura  mater  ad- 
herent to  the  bones  over  their  entire  extent.  Pachy- 
meningitis of  the  convexity  most  marked  on  the  left 
side  ;  the  new  membrane  contains  a  blackish  red 
clot,  about  one-fourth  inch  thick  on  the  left  side. 
Marked  pachymeningitis  in  the  three  foss:e  of  the 
left  side,  slight  in  right  posterior  fossa.  The  pia 
mater  is  thickened  over  the  convexity  and  oj^aque. 
There  is  atrophy  of  the  entire  left  hemisphere  (left 
hemisphere,  two  and  three-fourths  inches  ;  right 
hemisphere,  three  and  one-fourth  inches  at  widest 
jiart).  The  right  occipital  lobe  projects  backward  a 
little  farther  than  the  left ;  all  the  convolutions  are 
smaller  on  the  left  side  than  on  the  right.  The  right 
hemisphere  of  the  cerebellum  is  two  inches,  the  left 
hemisphere  two  and  three-eighths  inches  wide.  The 
right  temporo-sphenoidal  lobe  projects  about  one 
inch  beyond  the  left,  anteriorly.  The  first  temporo- 
sphenoidal  convolution  and  upper  border  of  the 
second,  the  Island  of  Eeil,  the  posterior  tij)  of  the 
third  frontal,  and  the  lowermost  parts  of  the  ascend- 
ing convolutions  on  the  left  side  are  destroyed. 

The  basal  ganglia  on  the  left  side  are  flattened  ; 
the  optic  thalamus  is  irregularly  concave,  and  its  pos- 
terior tip  is  one-half  inch  anterior  to  corresponding 
part  of  opposite  side  ;  it  is  also  miich  narrower  later- 
ally. The  corpus  striatum  does  not  extend  as  far 
forward  as  its  fellow  :  about  one-half  inch  from  the 
tip  of  tail,  the  ganglion  has  disapjieared  entirely, 
leaving  only  the  thickened  ejiendyma  between  the 
lateral  ventricle  and  Island  of  KeU.  The  lenticular 
nucleus  is  entirely  destroyed,  except  a  small  portion 
anteriorly. 

The  left  middle  cerebral  artery  contains  a  white, 
fibrous  plug,  occluding  it  immediately  at  its  bi- 
furcation. The  following  appearances  are  presented 
upon  the  inferior  aspect  of  the  brain  :  Flattening  of 
the  left  optic  nerve  and  atrophy  of  the  left  optic 
tract.  Marked  atroj^hy  of  the  left  eras,  the  degene- 
ration aSecting  chiefly  the  fibres  of  the  middle 
third;  atrophy  of  pons  varolii  on  the  left  side.  The 
left  anterior  column,  immediately  after  its  exit  fvom 
the  pons,  presents  a  gi-ayish  color,  and  is  only  about 
half  as  broad  as  the  right  column.  Atrophy  of  left 
corpora  quadrigemina,  most  marked  anteriorly. 

Spinal  coril. — The  dura  mater  is  adherent  ante- 
riorly to  the  pia  mater.  There  is  atrophy  of  the 
entire  right  lialf  of  the  cord.  On  close  inspection 
the  right  anterior  horn  was  seen  to  be  decidedly 
smaller  than  the  left ;  very  distinct  gray  degenera- 
tion of  the  right  lateral  column,  extending  along  the 
posterior  horn  and  apparently  outward  to  the  cor- 
tex. The  anterior  column  on  the  left  side  is  smaller 
than  on  the  right.  Ujjon  close  inspection  a  rim  of 
apparently  normal  cortical  substance  is  foTiud  out- 
side the  degenerated  lateral  columns.  These  changes 
diminish  in  extent  in  the  dorsal  region,  but  are  still 
visible  in  the  lumbar  enlargement. 

Heart. — Pericardium  adherent;  hypertrophy  of 
both  ventricles.  Aortic  valves  thickened,  their  edges 
retracted  and  incurvated  ;  the  leaflets  adherent  to 
one  another.  Some  of  the  chordfe  tendineie  have 
been  entirely  destroyed,  others  thickened  and  soft- 
ened. Mitral  valve  remarkably  thickened  and  re- 
tracted ;  on  its  auricular  surface  is  a  vegetation 
one-third  of  an  inch  long. 

Ltings. — Old  adhesions  anteriorly.  Left  lung  em- 
phvsematous,  esj^ecially  at  apex  ;  apparently  brown 
induration  throughout ;  recent  pneumonia  of  lower 


lobe.  Old  infarction  in  anterior  tip  of  right  upper 
lobe ;  right  lower  lobe  in  same  condition  as  left. 

Spleev. — Normal  size,  capsule  thickened,  remains 
of  two  old  infarctions. 

Lirer. — Diminished  in  size,  surface  slightly  gran- 
ular ;  increase  of  interstitial  tissue ;  small  calculi  in 
gall  bladder. 

7i7(/Hevs.— Chronic  diffuse  nephritis,  remains  of  a 
few  old  infarctions. 

Joints. — Some  were  opened,  but  nothing  abnormal 
was  found. 

The  following  report  has  been  kindly  furnished 
me  by  Dr.  William  H.  Welch,  to  whom  the  speci- 
mens were  referred  for  examination  : 

"  The  specimen  consists  of  the  jions,  medulla  ob- 
longata, and  spinal  cord,  hardened  in  Miiller's  fluid. 
The  anterior  pyramid  of  the  medulla  oblongata  upon 
the  left  side  is  markedly  atrophied.  Upon  this  side 
the  anterior  pyramid  measures  3  mm.  in  width, 
whereas  upon  the  right  side  it  measures  5  mm. 

"The  spinal  cord  is  the  seat  of  well-marked  second- 
ary descending  degeneration.  The  anterior  column 
of  the  left  side  is  distinctly  smaller  than  that  of  the 
right  side.  The  right  lateral  column  is  smaller  than 
the  corresponding  column  of  the  opposite  side.  The 
degenerated  parts  can  be  detected  in  the  hardened 
specimen  by  presenting  a  lighter  color  than  the  rest 
of  the  white  matter,  although  this  contrast  in  color 
is  less  striking  than  is  u.sual  in  cases  of  equally  ad- 
vanced degeneration.  There  is  thus  seen  to  be  a 
naiTow  band  of  gray  degeneration  occupying  the 
column  of  Tiirck  in  the  left  anterior  column,  and  a 
larger,  wedge-shaped  jjatch  of  degeneration  in  the 
situation  of  the  pyramidal  fasciculus  of  the  right 
lateral  column,  this  latter  degenerated  patch  not  ex- 
tending to  the  periphery  of  the  cord.  This  descend- 
ing degeneration  can  be  traced  throughout  the  cer- 
vical, dorsal,  and  most  of  the  lumbar  region.  It 
gradually  disappears  in  the  lumbar  region. 

"  The  right  anterior  horn  of  the  spinal  cord  is 
smaller  than  the  left  one.  This  difference  in  size 
is  not  gi'eat,  although  it  is  undoubtedly  present. 
The  difference  is  most  marked  in  the  cervical  region, 
it  can  also  be  observed  in  the  dor.'al  region,  but  in 
the  lumbar  region  it  is  not  distinct,  although,  e^(n 
there,  there  seems  to  be  a  slight  diflerence  in  size 
between  the  horns  of  the  two  sides. 

"  Mla-oscnpiical e.riiniination  shows  the  usual  patho- 
logical changes  of  descending  degeneration  of  Tiirck. 
In  the  posterior  part  of  the  right  lateral  column 
over  a  triangular  patch  close  to  the  piosterior  horn, 
but  not  reaching  the  periphery  of  the  cord,  there  is 
a  marked  increase  of  the  neuroglia  with  atrophy  and 
disappearance  of  the  nerve-fibres.  This  degenerated 
patch  stains  deeply  in  carmine,  and  in  hEcmatoxylin 
and  eosin.  The  neuroglia  here  has  acquired  a  dis- 
tinctly fibrillated  texture  and  contains  many  stellate 
cells  of  Deiters.  Only  near  the  blood-vessels  can 
the  granular  corpuscles  of  Gluge  occasionally  be 
seen.  The  nerve-fibres  have  in  great  part  disap- 
l^eared,  those  remaining  being  smaller  than  normal 
in  diameter. 

"There  is  a  similar  increase  of  neuroglia  with 
atrophy  of  nerve-fibres  in  a  narrow  tract  of  the  left 
anterior  column  bordering  on  the  median  fissure 
(degeneration  of  Tiirck's  column). 

"  Careful  comparison  of  the  ganglion  cells  of  the 
two  anterior  horns  shows  a  considerable  number  of 
round,  shrunken  ganglion  cells  filled  with  yellow 
pigment  particles,  and  with  few  or  no  processes  in 
the   right  anterior  horn.     Here  and  there  similar 


594 


THE  MEDICAL  RECORD. 


atrophied  cells  can  be  detected  in  the  left  anterior 
horn,  but  on  this  side  they  are  scanty  and  much 
fewer  than  on  the  opposite  side.  Careful  enumera- 
tion of  the  ganglion  cells  of  the  two  horns  shows  a 
diminution  in  the  number  of  the  right  horn  as  com- 
pared with  the  left.  This  atrophy  affects  ganglion 
cells  in  all  of  the  groups,  and  it  is  difficult  to  deter- 
mine that  it  is  more  marked  in  one  group  than  in 
another.  This  atrophy  is  not  to  be  compared  in 
degree  or  extent  with  that  observed  in  cases  of  acute 
or  chronic  primary  polio-myelitis.  There  are  plenty 
of  well-preserved  ganglion  cells  in  the  right  as  well 
as  in  the  left  anterior  horn,  but  that  a  moderate 
degree  of  atrophy  of  the  ganglion  cells  of  the  right 
anterior  horn  exists  cannot  be  doubted.  No  other 
change  in  the  gray  matter  can  be  seen,  notably  no 
increase  of  neuroglia  or  of  cells  in  the  right  anterior 
horn.  The  atrophy  of  ganglion  cells  is  most  evident 
in  the  cervical  region,  it  can  also  be  observed  in  the 
dorsal  region,  but  in  the  lumbar  region  it  is  very 
slight." 

Re7}inrks. — This  case  presents  several  features  of 
clinical  and  pathological  interest,  which  appear  to 
be  dependent  upon  the  atrophy  of  tlie  right  anterior 
horn  of  tlie  spinal  cord.  This  lesion  of  tlie  gray 
matter  appears  to  have  been  directly  due  to  propa- 
gation by  continuity  from  the  sclerotic  process  in 
the  lateral  tract,  and  furnishes  another  proof,  if  such 
were  necessary,  of  the  continuance  of  the  pyramidal 
track  into  the  anterior  horns.  The  presence  of  a 
few  atrophied  cells  in  the  left  anterior  horn  may 
perhaps  be  explained  by  a  similar  connection  with 
the  degenerated  column  of  Tiirck. 

In  the  first  place,  the  electrical  contractility  of 
the  extensors  of  the  forearm  and  leg  on  the  par- 
alyzed side  was  so  much  diminished  as  to  be  scarcely 
perceptible.  As  a  rule,  the  electrical  contractility 
of  the  paralyzed  muscles  in  hemiplegia  is  not  at  all 
affected,  or  very  slightly,  the  muscular  irritability 
being  sometimes  slightly  increased,  sometimes  di- 
minislied.  In  the  present  instance,  I  think  the  dimi- 
nution was  out  of  proportion  to  the  amount  of  mus- 
cular atrophy,  and  that  it  must  be  explained  in  part  by 
the  affection  of  the  ganglion  cells  of  the  anteiior  horn. 

The  occurrence  of  enlargement  and  tenderness  of 
the  joints  of  the  paralyzed  limbs  also  possesses  a 
certain  amount  of  pathological  interest  in  view  of 
the  statements  of  Charcot  with  regard  to  the  morbid 
anatomy  of  arthropathies. 

But  the  chief  interest  of  the  case  attaches  to  the 
occurrence  of  well-marked  ati'ojjhy  of  the  ])aralyzed 
limbs  in  hemiplegia  of  cerebral  origin.  In  this  pa- 
tient the  circumference  of  the  right  thigh  was  one 
inch,  that  of  tlie  right  forearm  one-half  inch  less 
than  that  of  the  corresponding  parts  on  the  ojipo- 
site  side  of  the  body.  As  you  are  well  aware,  or- 
dinary cases  of  cerebral  hemiplegia,  with  the  excep- 
tion of  those  occurring  during  childhood  (in  which 
I  have  often  seen  as  well-marked  atrophy  as  in  acute 
infantile  paraly.sis)  may  last  for  years  without  the 
supervention  of  atrophy  in  the  paralyzed  parts. 

Eulenburg  says  :  "  Diseases  of  other  parts  of  the 
brain  (he  had  previously  spoken  of  the  medulla  ob- 
longata), so  far  as  our  present  knowledge  goes,  do 
not  lead,  at  least  ilirnctly,  to  nutritive  disturbances 
of  the  muscles.  The  lai-ge  majority  of  true  cerebral 
paralyses,  even  after  their  long  continuanc^e,  are 
therefore  not  combined,  as  a  rule,  witli  any  notice- 
able diminution  in  the  size  of  the  afVocted  nnisi'lcs." 

Notlmagel  says  :  "  It  is  a  very  striking  fact  that 
the  paralyzed  limbs  of  hemiplegics,  despite  their  oc- 


casionally complete  immobility,  do  not  emaciate  after 
the  lapse  of  years,"  Further  on, he  adds:  "In  a 
few  vei-y  rare  cases  early  atrophy  of  the  paralyzed 
muscles  has  been  observed.  Whether,  as  Bastiac 
and  Charcot  consider  probable,  a  spread  of  the  sec- 
ondary spinal  degenerations  to  the  gray  anterior 
horn  should  be  regarded  as  the  cause,  still  requires 
further  investigations,  though  the  appearances  in 
the  case  reported  by  Pitres  speak  in  its  favor." 

Bouchard  remarks  that  the  gray  matter  always  re- 
mains intact  in  secondary  degeneration  of  the  spinal 
cord. 

Within  the  past  decade  attention  has  been  called 
clinically  to  the  relation  of  atrophy  of  the  anterior 
horns  of  the  spinal  cord  to  systemic  degeneration 
of  the  posterior  colwnins,  and  also  to  primary  sclero- 
sis of  the  lateral  columns.  In  a  small  number  of 
these  cases  post-mortem  demonsti'ation  of  this  con- 
nection has  been  obtained. 

With  regard  to  the  class  to  which  my  case  be- 
longs, i.e.,  atrophy  of  the  paralyzed  muscles,  due  to 
atrophy  of  the  anterior  hom,  following  secondary 
degeneration  of  the  lateral  tracts,  very  little  has 
been  determined  clinically,  and  extremely  few  cases 
have  been  examined  post-mortem.  I  have  succeeded 
in  obtaining  from  the  literature  of  the  subject  histo- 
ries of  the  following  cases,  of  Tvhich  I  append  short 

Pilre.-<  {Arch,  de  Physiol,  1876,  p.  657)  :  A  case  of 
left  hemiplegia  ;  admitted  to  hospital  in  1875.  She 
had  been  paralyzed  four  years  previously.  During 
the  period  of  late  rigidity,  marked  atrophy  occurred 
in  the  deltoid  and  some  muscles  of  the  hand  on  the 
paralyzed  side.  The  electrical  contractility  was  not 
examined.  The  autopsy  revealed  sclerosis  of  the 
left  lateral  column  and  destruction  of  cells  in  a  lim- 
ited area  of  the  con-esj^onding  anterior  horn  of  the 
cervical  enlargement  of  the  cord. 

Charcol  ("Le(;ons  surles Maladies du  SysttmeNer- 
veux,"  I.,  p.  G2)  :  A  woman,  aged  seventy  years. 
Left  hemiplegia  from  cerebral  hemon-hage.  The 
paralyzed  limbs,  which  soon  became  contractured, 
began  to  atrophy  two  months  after  the  attack.  This 
was  accompanied  by  very  marked  diminution  of  elec- 
trical contractility.  At  the  autopsy  it  was  found 
that  the  descending  sclerosis  of  the  left  lateral  col- 
umn had  extended  to  the  corresponding  anterior 
gray  hom,  and  had  produced  atrophy  of  a  certain 
number  of  motor-cells. 

Brhsaud  ("Revue  Mensuelle,"  1879,  p.  G25)  :  A 
woman,  aged  sixty-eight  years,  came  under  observa- 
tion in  1870.  In  1870  she  suddenly  had  an  attack  of 
left  hemiplegia.  The  leg  soon  recovered  almost  en- 
tirely, but  the  arm  became  contractured.  In  1872 
she  had  a  second  attack,  with  loss  of  consciousness 
and  inability  to  make  herself  understood  for  a  month. 
She  then  began  to  suffer  from  intense  paroxysmal 
pains  in  the  liack  of  the  neck  and  the  left  shoulder, 
which  have  continued  ever  since.  After  a  long  time 
the  right  lower  limb  also  gradually  became  par- 
alyzed. 

Position  of  the  body  :  In  dorsal  decubitus,  slightly 
inclined  to  the  left  side.  The  head  is  drawn  toward 
the  left  shoulder,  and  slightly  flexed  anteriorly ;  the 
mouth  is  slightly  drawn  toward  the  right.  The  left 
arm  is  drawn  toward  the  trunk :  the  forearm  forms 
a  right  angle  with  the  arm.  This  limb  is  entirely 
powerless.  Both  thighs  are  flexed  upon  the  pelvis, 
and  the  legs  upon  the  thighs. 

The  autopsy  showed  well-marke<l  descending  late- 
ral degeneration,  and  atrophy  of  the  left  anterior 
horn  with  the  exception  of  the  lumbar  region.     In 


THE  MEDICAL  RECORD. 


695 


the^affected  portions  of  the  gray  matter,  the  gan- 
glion cells  were  shrunken  and  less  in  number  than 
on  the  opposite  side.  They  were  granular,  and  did 
not  stain  readily  in  carmine. 

It  is  a  curious  fact  that  although  Brissand's  ar- 
ticle treats  of  muscular  atrophy  in  hemiplegia,  no 
mention  is  made  in  his  imperfect  clinical  history  of 
the  case  of  the  presence  of  atrophy.  But  I  infer 
from  the  context  of  his  subsequent  remarks  that  the 
muscular  atrophy  in  this  case  aflFected  chiefly  the 
shoulder  muscles. 

Brissaud  also  reports  the  results  of  the  micro- 
scopical examination  of  a  cord,  which  revealed  the 
same  changes  as  in  the  case  just  quoted.  But  im- 
fortunately  he  was  unable  to  obtain  a  clinical  histoi-y 
of  the  patient. 

This  author  also  gives  the  histories  of  thi-ee  clini- 
cal cases  (without  post-mortems),  from  which  it  ap- 
pears that  contracture  of  the  paralyzed  side  first  de- 
velops and  then  disappears,  the  atrophy  developing 
at  the  same  time.  As  in  my  own  case,  contracture 
and  muscular  atrophy  maybe  present  concomitantly. 
Since  writing  the  above  paper  I  have  met  with  a 
clinical  case  which  undoubtedly  belongs  to  the  same 
category  as  the  one  described  above.  The  following 
is  the  history  of  this  j^atient  :  J.  B.,  aged  thirty- 
eight  years,  a  driver ;  his  mother  had  "  fainting 
spells  "  when  young  ;  a  cousin  on  the  father's  side 
had  chorea ;  the  patient  and  one  of  his  sisters  had 
chorea  during  childhood ;  he  states  that  aU  his 
sisters  and  himself  have  had  "  spasms  "  when  fright- 
ened or  angi-y ;  he  was  semi-conscious  during  these 
spasms.  The  patient  had  a  severe  attack  of  acute 
articular  rheumatism  at  the  age  of  twelve  or  thirteen 
years ;  a  second  milder  attack  at  the  age  of  sixteen 
years  ;  he  has  had  shortness  of  breath  as  long  as  he 
can  remember ;  was  a  hard  drinker  formerly.  Has 
suffered  since  childhood  from  severe  headaches,  oc- 
curring every  week  and  lasting  usually  twenty-four 
hours  (mother  and  sisters  are  also  troubled  with 
severe  headaches).  Last  December  the  patient  went 
to  bed  about  twelve  o'clock  at  night,  feeling  well, 
and  at  about  two  o'clock  a.m.  found  himself  upon  the 
floor ;  he  had  Iiad  a  dream  in  which  he  imagined 
that  he  fell  from  a  hearse ;  he  wet  the  bed  at  the 
time  of  the  .seizure.  The  patient  was  unable  to  rise 
from  the  floor  because  his  entire  left  side  was  ])ar- 
alyzed  ;  he  was  deliriotis  for  a  couple  of  hours  after 
the  attack.  For  two  weeks  he  was  unable  to  hold 
his  water,  passing  a  small  quantity  every  few  min- 
utes. A  few  days  later  he  began  to  exhibit  a  ten- 
dency to  laugh  and  ci-y  without  cause,  and  this  has 
continued  ever  since,  to  a  less  extent.  Within  two 
or  three  weeks  after  the  attack  he  began  to  walk, 
and  improved  quite  rapidly  in  this  respect.  The 
arm  has  remained  entirely  powerless,  but  the  limb 
moves  involuntarily  when  the  patient  gapes  ;  about 
four  months  ago  he  began  to  have  i^ain  in  the  left 
shoulder,  and  this  has  persisted. 

Present  condition. — The  patient  is  a  well-nourished 
man  with  an  intelligent  expression  of  countenance. 
The  lines  on  the  left  side  of  the  face  are  not  quite  as 
pronoirnced  as  on  the  right  side ;  slight  paresis  of 
left  side  of  face.  No  disturbance  of  the  special 
senses  ;  the  tongue  is  freely  movable  and  protrudes 
in  a  straight  line.  The  left  arm  is  carried  in  a  sling ; 
he  presents  the  typical  hemiplegic  gait. 

The  apex  beat  of  the  heart  is  felt  about  an  inch  to 
the  left  of  the  mammary  line  :  a  systolic  murmur, 
which  is  transmitted  upward,  is  heard  at  the  base  ; 
the  pulse  is  feeble  and  iiTegular.  There  is  absolute 
loss  of  motion  in  the  left  upper  limb,  with  the  excep- 


tion of  a  slight  power  of  drawing  the  limVi  backward  ; 
there  is  rigidity  of  this  limb,  most  marked  at  the 
shoulder,  but  the  patient  thinks  that  this  feature  is 
less  marked  now  than  a  month  ago.  Tliewife  of  the 
jiatient  states  that  the  arm  has  been  wasting  away 
for  the  last  six  weeks.  lIi:)on  inspection  all  the 
muscles  around  the  left  shoulder  are  seen  to  be  con- 
siderably atrophied,  especially  the  deltoid.  The  fol- 
lowing are  the  measurements  of  the  upper  limbs  : 
Right  arm,  10  inches  ;  left  arm,  !•  inches  ;  right 
forearm,  9|  inches  ;  left  forearm,  9  inches. 

Slight  tenderness  of  the  shoulder-joint  is  expe- 
rienced upon  pressure  against  the  head  of  the  hu- 
merus (the  tenderness  is  considerably  less  now  than 
formerly)  and  upon  attempting  voluntary  motion. 

The  mechanical  irritability  of  all  the  muscles  of 
the  left  arm  is  very -decidedly  exaggerated;  upon 
tapping  them  smartly  in  any  part  of  the  limb,  they 
immediately  contract  vigorously,  starting  out  in 
bold  relief.  The  tendon  reflexes  at  the  elbow  and 
wrist  joints  are  also  considerably  increased  when 
compared  with  the  other  arm.  The  left  lingers  are 
stiff  and  slightly  flexed  in  the  palm  ;  there  is  slight 
flexion  at  the  wrist,  and,  to  a  trifling  extent,  at  the 
elbow  ;  the  arm  cannot  be  raised  passively  at  the 
shoulder  on  account  of  the  severe  pain  produced 
when  it  is  a  little  removed  from  the  trunk. 

Tactile  sensation  appears  to  be  alike  in  both  upper 
exti-emities  ;  the  farado-cutaneous  sensibility  of  the 
left  forearm  is  diminished  ;  considerable  diminution 
of  farado-muscular  excitability  of  left  arm  compared 
with  right. 

The  lower  limbs  appear  to  be  of  equal  size  ;  there 
is  slight  rigidity  of  the  left  leg  and  the  left  patellar 
tendon  reflex  is  slightly  exaggerated  ;  the  jjower  in 
this  limb  has  been  almost  completely  restored. 

Remarks. — The  early  age  at  which  the  attack  oc- 
curred, the  presence  of  organic  heart  disease,  and 
the  rapidity  in  the  restoration  of  motion  in  the  lower 
limb  point  to  embolism  (right  middle  cerebral)  as 
the  cause  of  the  disease.  In  addition,  descending 
degeneration  of  the  left  pyi-amidal  tract  and  atrophy 
of  ganglion  cells  in  the  right  anterior  horn  of  the 
cervical  portion  of  the  spinal  cord  are  also  probably 
present.  The  former  is  indicated  by  the  muscular 
rigidity  and  exaggerated  tendon  reflexes,  the  latter 
by  the  rapid  and  considerable  atrophy  of  the  muscles 
of  the  arm  (a  little  more  than  three  months  after  the 
attack)  and  the  diminution  of  farado-muscular  con- 
tractility. The  diminution  of  the  rigidity  of  the 
upper  limb  after  the  beginning  of  atrophy  is  corrob- 
orative of  the  similar  statement  made  bv  Brissaud. 


Baths  fok  the  Netviy  Bokn. — Dr.  F.  Winckel,  of 
Dresden  (Cenlralb.  f.  Gyvakol,  .January  7,  1882), 
makes  the  novel  suggestion  of  keeping  certain 
newly  born  children  permanently  in  warm  water. 
This  he  considers  more  useful  than  rolling  them  in 
cotton-wool,  applying  warm  bottles,  and  keeping 
them  in  warm  rooms.  The  following  abnormal  con- 
ditions are  mentioned  as  being  suitable  for  the  per- 
manent bath  :  1.  Children  bom  between  the  twenty- 
eighth  and  thirty-sixth  weeks.  2.  Children  born 
asphyxiated  ond  weak  from  flooding  during  labor,  or 
who  have  accidentally  lost  blood  from  the  stump  of 
the  cord.  3.  Where  there  is  disease  or  fi-etting  of  the 
skin.  4.  In  emaciation,  to  prevent  bed-sores.  The 
author  has  employed  this  treatment  successfully  in 
cases  such  as  those  above  mentioned,  and  gives  de- 
tails of  temperatures  and  results.  —  Ghittgow  Medical 
■Journal,  March,  1882. 


596 


THE  MEDICAL  RECORD. 


FRACTURE  OF  THE   PATELLA,  TREATED 

BY  WffiING  THE  FRAGHEENTS. 

An  Unsuccessful  Case. 

By  JOHN  A.  WYETH,  M.D., 


The  operation  which  is  the  subject  of  this  article, 
though  not  new,  has  under  the  influence  of  lattei-- 
day  antiseptic  surgery  been  resuiTected,  success- 
fully practised,  and  the  successful  cases  have  pretty 
generally  been  published.  I  regret  that  I  have  to  add 
to  the  list  a  signal  failure  by  myself,  and  I  wish  it 
to  obtain  the  widest  publicity. 

On  September  11,  1881,  a  young  woman,  aged 
twenty,  German  by  nativity,  and  unmarried,  was  ad- 
mitted to  Mount  Sinai  Hospital.  Ten  days  pre- 
viously, during  a  storm  at  sea,  she  had  been  thrown 
against  the  guard-rail,  striking  her  left  patella,  and 
fracturing  it  while  the  leg  was  in  strong  flexion.  A 
splint  was  applied  soon  afterward  by  the  shiji's  sur- 
geon, and  she  remained  in  the  steerage  for  ten  days, 
until  she  was  landed  in  New  York  City.  On  the  fol- 
lowing day,  September  11th,  I  first  saw  her.  The 
notes  of  her  case  were  taken  by  the  House  Surgeon, 
Dr.  E.  M.  Cramer,  to  whom  I  am  much  indel)ted. 
The  knee-joint  and  the  entire  leg  and  foot  were 
greatly  swollen.  There  were  two  large  ulcerations 
on  the  posterior  aspect  of  the  knee  and  leg,  and 
several  dark  spots  over  the  sides  and  front  of  the  leg 
capped  by  dark-colored  blisters.  The  fragments 
were  widely  separated,  although,  owing  to  the  swol- 
len condition  of  the  member,  the  exact  amount  of 
displacement  could  not  be  determined.  The  ad- 
justment of  any  apparatus  was  for  the  present  im- 
possible. She  was  put  to  bed,  the  leg  elevated,  and 
constant  warm-water  dressings  ordered. 

The  case  gave  me  great  concern.  It  was  evident 
that  the  ulcers  would  not  allow  any  of  the  ordinary 
mechanical  appliances  for  the  treatment  of  fractured 
patella.  It  would  be  several  weeks  before  they 
could  be  sufticieutly  healed,  even  if  the  reparative 
power  of  the  patient  were  good  (which  subsequent 
unfortunate  results  proved  not  to  l)e  the  case). 

I  knew  that  recovery,  if  left  to  nature,would  leave 
her  unfit  for  work  for  at  least  a  year  ;  that  with  a 
ligamentous  union  of  considerable  length,  she  would 
have  a  limp  for  many  years,  if  not  throughout  life, 
and  would  be  in  constant  danger  of  a  reseparation 
of  the  fragments.  She  was  young,  unmarried,  with- 
out help,  and  dependent  upon  her  labor  for  the 
means  of  existence. 

I  had  known  of  five  cases  which  had  been  treated 
antiseptically  by  the  heroic  measure  of  cuttiiig  down 
on  the  fragments  and  wiring  them  together.  All 
had  i-ecovered  and  aU  were  gratifying  successes. 
These  cases  will  be  given  with  others  hereafter.  I 
had  never  heard  or  read  of  an  unsuccessful  result  in 
a  patella  which  had  been  wired  under  antiseptic 
precautions. 

Her  general  condition  seemed  favorable.  Appe- 
tite good,  urine  normal,  and  no  lesion  anywhere  ex- 
cepting in  the  injured  log.  I  determined  to  do  this 
comparatively  new  operation,  explaining  fully  the 
dangers  it  involved,  and  equally  fully  the  benefits  I 
hoped  to  derive  from  it  for  her.  It  was  accepted  in 
full.  By  September  '21st,  the  swelling  in  the  foot, 
lower  leg,  and  thigh  were  reduced  to  the  same  si/e 
as  the  corresponding  extremity.  The  knee  was  still 
swollen,  though  much  loss  so  tlian  when  ad- 
mitted, but  the   ulcers  over  the   ham  auil  popliteal 


space  were  not  improved.  In  order  to  insure  the 
fullest  anti8ei:)tic  aid,  I  used  two  steam  spray  ma- 
chines, so  that  if  an  accident  .should  occur  to  one,  the 
other  would  prevent  any  possible  infection.  They 
both  ran  uninterruptedly  during  the  operation.  Tho 
sponges  were  fresh  and  carbolized,  and  every  instru- 
ment was  flooded  with  five  per  cent,  carbolic  solution. 
The  assistants  were  disinfected.  After  the  patient 
was  aniesthetized  the  ulcers  were  mopped  out  with 
chloride  of  zinc,  and  the  leg  washed  with  five  per 
cent,  carbolic  solution,  and  the  spray  started.  A  trans- 
verse incision  was  made  over  the  line  of  separation, 
and  two  short  cuts  perpendicular  to  this  at  the 
points  where  the  fragments  were  to  be  wu'ed.  A 
clot  of  blood  occupied  the  interval  between  the  frag- 
ments, and  extended  beneath  into  the  joint.  The 
separation  was  more  than  one  inch.  Both  broken 
surfaces  were  scraped  thoroughly,  and  two  holes 
were  drilled  through  the  upper  segment.  The  low- 
er was  so  narrow,  being  a  mere  rim  of  bone  hanging 
on  to  the  upjier  end  of  the  ligamentum  patelhe,  that 
I  passed  the  wires  underneath  this  through  the  fibres 
of  the  ligament.  All  hemorrhage  was  stopped,  the 
joint  cleanly  irrigated  with  a  five  per  cent,  carbolic 
solution,  two  drainage-tubes  of  one-fourth  inch  cal- 
ibre were  inserted,  one  on  each  side  of  the  jomt,  and 
the  wires  were  tightened,  bringing  the  fragments  in 
close  apposition.  The  woimds  were  closed  with 
catgut  sutures  and  a  Lister  dressing  api^lied.  The 
patient  rallied  well  from  the  ether.  This  was  Sep- 
tember 21st.  On  the  23d  she  complained  of  pain  in  the 
knee,  foot,  and  bowels,  and  during  the  night  had  a 
stool  which  contained  V)lood.  On  September  21th  the 
dressings  were  changed  under  spray.  The  wound 
had  an  angry  and  threatening  appearance. 
A  few  drops  of  pus  escaped  from  the  tubes.  The 
wound  was  washed  and  the  joint  irrigated  with  three 
per  cent,  carbolic  solution.  Temperature  to-day  av- 
eraged 101  A.  Ordered  TTt  xv.  Magendie,  in  two 
doses.  2Gth,  More  comfortable.  27th,  Constant 
tenesmus.      Quinia,  gr.  xx.^  daily. 

Wound  dressed  daily  and  discharge  increasing. 
Diarrhoaa  severe  and  annoying.  Opium  in  full 
doses.     Temperature  102". 

October  9th. — More  pus  than  at  any  other  pre- 
vious dressing  ;  carbolic  solution  (three  per  cent.) 
injected  into  the  tubes  came  out  through  the  old 
ulcers  on  the  back  of  the  leg,  showing  that  these 
had  opened  into  the  joint.  Free  incisions  were 
made  laterally  and  posteriorly  on  account  of  bur- 
rowing pus,  two  large  tubes  passed  through  the 
joint  antero-posteriorly,  and  one  transversely,  which 
went  beneath  the  patella.  One  hour  and  a  half  after 
this  operation  the  temperature  rose  to  101  ;  pulse 
130,  and  thready.  From  date  of  operation  to  Oc- 
tober 9th  temperatiue  has  ranged  from  101  to  103. 
On  October  9th  the  temperature  reached  105,  and 
the  pulse  was  ICO. 

October  10th. — The  highest  temperatiire  (always 
taken  in  the  rectum)  was  102,  and  the  lowest  08?.. 

From  October  12th  to  November  l.st  temperature 
ranged  from  99i  to  102 — once  or  twice  reaching  103, 
and  always  highest  in  the  evening.  The  diarrhoea 
continued  incessantly,  there  being  from  four  to  ten 
discharges  a  day.  tjuinia  and  iron  were  given  con- 
stantly. The  joint  continued  to  ilisehargo  a  quan- 
tity of  badly  smelling  pus,  and  later  in  November 
several  incisions  had  to  be  made. 

December  1st. — It  was  ewlent  to  me  that  the  dis- 
integration of  the  joint  was  complete,  and  I  deter- 
mined to  amputate  the  thigh  as  a  last  resort  to  save 
the  unfortunate  patient's  life.     The   operation  was 


THE  MEDICAL  RECORD. 


697 


postponed  on  account  of  erysipelas,  which  attacked 
the  leg  during  the  night.  The  temperature  rose  to 
lOoi,  and  pulse  1(30. 

December  '2d. — The  temperature  was  100  at  8 
A.M.,  and  100;  at  S  p.m.  Milk  and  whiskey  evei-y 
two  hours,  beef-tea  every  hour,  and  quinia  gr.  xv. 
daily.  Her  condition  slightly  improved  from  this 
time  to  December  16th,  when  I  amputated  the 
thigh  at  its  middle.  The  erysipelas  migrans  was 
still  present  in  a  mild  form.  An  :ibscess  had  formed 
on  the  instep  of  her  left  (lame)  foot,  and  two  others 
on  the  thigh — one  in  the  groin  and  one  over  the 
trochanter.  It  seemed  desperate  to  amputate  under 
such  conditions,  but  death  without  it  was  inevitable. 
Lateral  transfixion  flaps  were  made.  On  sewing 
through  the  femur  it  was  found  to  be  full  of  pus  at 
the  point  of  section  (the  lower  third).  The  flaps 
were  split  up  and  the  bone  again  divided  in  its 
middle,  where  it  was  sound.  Cldoroform  was  used. 
The  operation  lasted  twenty  minutes.  The  flaps 
were  kept  wide  apart  and  a  constant  iirigation  im- 
mediately commenced.  Everything  was  prepared 
for  transfusion,  but  happily  there  was  no  hemor- 
rhage, and  the  patient  rallied  slowly  but  steadily. 
Six  hours  after  the  operation  her  temperature  was 
99,  pulse  130. 

At  8  A.M.  the  next  day,  December  17th,  tempera- 
ture, 100;^.  During  the  night  3  ij.  of  brandy  and 
3  j.  beef-tea  were  given  by  mouth  and  one  hypo- 
dermic of  brandy.  At  1  v.  m.  i^atient  had  a  chill, 
and  at  half-past  two  o'clock  the  thermometer  regis- 
tered 103>  in  the  rectum  ;  pulse,  HO.  During  the 
day  and  night  3  viij.  milk,  3  iij.  of  beef-tea,  and  gi-. 
xiviij.^of  quinia  were  taken. 

December  18th,  19th,  and  20th,  and  during  the 
remainder  of  this  month  the  temperature  gradually 
declined  until  it  reached  the  normal  standard  by 
January,  1882,  since  which  time  it  has  so  remained. 
Nourishment  was  carefully  given.  The  flaps  were 
under  a  constant  irrigation  of  one  per  cent,  carbolic 
acid  solution  for  three  weeks.  There  was  no  slough- 
ing and  no  perceptible  process  of  granulation  in 
this  j5eriod.  After  this  the  irrigation  was  discon- 
tinued, and  tlie  raw  surfaces  were  sprinkled  daily 
with  powdered  iodoform.  At  this  writing.  May,  1882, 
the  stump  has  healed  beautifully  and  the  patient 
is  well. 

I  have  given  this  case  in  detail  because  it  is  prac- 
tically a  new  operation,  and  because  it  was  a  failure. 
Up  to  this  date  no  other  failure  has  been  reported, 
which  is  a  pity. 

It  may  be  said  in  extenuation  of  any  failure  that 
fracture  of  the  patella  is  not  free  from  danger  when 
treated  Viy  other  means  than  invasion  of  the  joint. 
A  patient  died  some  years  ago  in  a  London  hospital 
in  which  Malgaigne's  hooks  were  being  used,  ery- 
sipelas having  attacked  the  knee  (London  Lancet, 
November  22,  1879). 

il^VIn  the  Gazette  de^  Hopitaux,  October  27,  1881,  a 
case  is  reported  by  Kichet  which  was  treated  by  an 
elastic  bandage  and  an  immovable  dressing.  Ery- 
sipelas attacked  the  patient,  commencing  in  a  slight 
abrasion  caused  by  the  apparatus  over  the  spine  of 
the  tibia,  and  the  man  died. 

It  may  be  further  said  in  justification  of  any  oper- 
ation so  severe  as  the  invasion  of  the  knee-joint  is 
deemed  to  be,  that  recent  surgical  literature  is  full 
of  heroic  procedures  upon  this  joint,  and  no  failures 
are  recorded.  Possibly  there  were  none — probably 
there  were.  In  one  journal  (the  tiazette  des  Ilnpitaii.r 
for  1881)  Dr.  Jules  Backel,  of  Strasburg,  reports 
eight  cases  in  which  he  opened  into  the  joint  and  in 


which  drainage  was  established.  All  recovered,  and 
five  of  these  with  perfect  motion.  My  colleague.  Dr. 
Gerster,  has  operated  on  two  cases  recently  in  this 
manner,  both  with  success.  In  addition  to  these,  I 
have  learned  of  other  cases  which  cannot  be  without 
interest  in  this  connection.  Dr.  William  T.  Bull,  sur- 
geon to  the  Chambers  Street  Hospital,  New  York, 
kindly  allowed  me  to  publish  this  case  from  the 
records  of  the  hospital  : 

Adam  Schutf,  aged  fifty-one,  a  jiorter,  admitted 
January  31,  1878.  While  clearing  snow  from  a  sky- 
light, two  inches  in  thickness,  the  glass  broke  and 
the  right  leg  slipped  through  to  a  little  above 
the  knee.  A  flap  2x3  inches  was  torn  up  from 
the  front  of  the  knee  to  such  an  extent  that  the 
ligamentum  patelhe  was  completely  severed,  and 
the  lateral  attachments  so  torn  that  a  linger  could 
be  passed  into  the  joint  on  either  side  of  the  patella. 
A  second  wound  on  the  outer  side  also  com- 
municated with  the  joint.  Hemorrhage  was  severe 
but  shock  slight.  Three  articular  arteries  were  tied 
and  the  cavity  irrigated  with  strong  carbolic  solu- 
tion. Under  spray,  the  ends  of  the  ligamentum 
patella^  were  reunited  with  silver-wire  sutures. 
Four  drainage-tubes  inserted. 

February  1. — Dressing  changed  under  strict  anti- 
sepsis. 

February  3^. — Flap  was  swollen  and  threatening. 

February  5th.— Flap  was  sloughing. 

February  17th. — Last  drain  was  removed. 

February  23d. — A  plaster  splint  applied. 

March  12th. — Plaster  splint  was  removed.  Joint 
still  swollen.     Slight  passive  motion. 

March  1-lth. — Pus  cavity  above  joint  opened.  The 
bone  became  necrotic  after  this,  and  on  September 
1,  1878.  the  patella  was  removed. 

March  1,  1879,  patient  {^resented  himself.  Ha  has 
a  new  patellit  ami  can  bend  Ins  knee  at  a  right  angle. 

This  was  a  splendid  result  after  such  an  injury. 

In  the  Lancet,  November  22,  1879,  ^p.  7(57,  Mr. 
Spencer  Watson  reports  the  case  of  a  boy,  ten  years 
old,  who  received  a  penetrating  wound  of  the  knee- 
joint.  Synovia  escaped.  A  sinus  resulted.  Great 
pain  and  swelling.  Later  he  opened  the  joint  under 
Lister  and  secured  free  drainage.  A  splint  and  a 
dressing  of  carbolized  lint  were  apjjlied.  Patient  re- 
covered with  perfect  motion. 

In  the  same  journal  for  1870,  p.  815,  Mr.  Mac- 
namara  reports  two  cases  treated  by  drawing  oflf  the 
effusion  into  the  joint  with  an  aspirator,  and  divid- 
ing the  tendon  of  the  rectus  in  order  the  better  to 
approximate  the  fragments.  In  one  good  union 
(.seemingly  bony)  and  perfect  motion  ;  in  the  second, 
in  which  both  the  tendon  of  the  rectus  and  the 
ligamentum  patelhe  were  divided,  close  fibrous 
union  and  a  stifl'  knee.  Patella,  however,  was  mov- 
iible  over  the  joint. 

Schede,  of  Berlin  {Cenirtilblattfur  Chirurgie,  1877, 
p.  657),  reports  a  number  of  cases  in  which  he  had 
aspii-ated  the  joint  after  this  fracture,  drawn  oflf  the 
effusion,  washed  the  cavity  oiit  with  three  per  cent. 
carbolic  until  the  liquid  returned  was  clear  (all 
under  Lister),  and  then  an  adhesive-plasteraj^paratus 
was  put  on  to  ajjproximate  the  fragments.  If  the 
eflfusion  reoccurred,  a  second  aspiration  was  per- 
formed. 

The  dressing  is  readjusted  several  times  during 
the  first  few  weeks.  He  claims  that  the  three  last 
cases  so  treated  all  recovered  with  bony  union  and 
perfect  function.  No  accidents  have  followed  in 
any  of  his  cases  treated  this  way. 

As  to  the  operation  which  is  more  particularly 


598 


THE  MEDICAL  RECORD. 


the  subject  of  this  paper,  viz.,  wiring  the  fragments 
of  a  fractured  palella  together,  I  have  gleaned  the  fol- 
lowing oases  from  personal  sources  and  from  pub- 
lications : 

About  the  year  1838,  in  the  city  of  Philadelphia, 
Dr.  George  AlcClellan,  a  distinguished  siirgeon  of 
his  day,  treated  a  fracture  of  the  patella  by  making 
a  longitudinal  incision  over  the  knee,  exposing  the 
fragments,  drilling  a  hole  or  holes  in  each  fragment 
and  bringing  them  together  by  means  of  a  soft  iron- 
wire  suture. 

Prof.  J.  N.  McDowell,  afterward  of  St.  Louis, 
who  witnessed  this  opei-ation,  said :  "  Dr.  McClellan's 
experiment  was  a  success ;  the  i>atient  recovered 
with  the  only  bony  union  I  believe  I  have  ever  seen 
in  this  fracture ;  but,  gentlemen,  my  advice  is,  don't 
you  try  the  same  exiieriment."* 

This  was  McDowell's  judgment  on  this  operation, 
before  the  dawn  of  anti.septic  surgery. 

It  is  not  stated  whether  this  was  a  recent  or  old 
fracture,  but  I  infer  that  it  was  recent. 

Prof.  Cooper,  of  San  Francisco,  California,  writes 
to  the  London  Medical  Times  and  (jlmi'lle  for  Novem- 
ber 2,  1861  (p.  467) :  "  Our  method  of  treating  frac- 
tures of  the  patella  is  by  exposing  the  fragments  by 
a  longtitndinal  incision,  drilling  the  holes  slantingly 
through  these,  and  bringing  them  into  appo.sition  by 
means  of  silver  wires.  By  this  method"  bony  union 
always  occurs.  The  wound  is  kejit  open  by  packing 
with  lint,  and  the  leg  is  tightly  bandaged." 

Cooper  does  not  say  how  many  he  has  treated  in 
this  way,  but  the  inference  is  natural  from  his  lan- 
guage that  he  had  treated  more  than  one,  and  that 
success  had  attended  every  case.  I  am  unable  to 
find  that  he  published  any  unsuccessful  cases. 

Dr.  John  Khea  Barton  in  one  instance  connected 
the  fragments  together  with  silver  wire,  but  lo.st  his 
patient  (Gross  :  "System  of  Surgery,"  p.  1004). 

Dr.  Moses  Gunn,  of  Chicago,  wired  a  fractured 
patella,  and  the  patient  died  from  exhaustion  and 
suppuration. 

Mr.  Lombard,  of  Boston,  sends  me  the  record  of 

the  following  case  :  Rebecca  C ,  aged  twenty-seven, 

entered  hospital  March  6,  1865.  One  year  previous 
she  struck  her  left  knee  violently  against  the  edge  of 
a  trunk,  producing  a  transverse  fraetui-e  of  the  pa- 
tella. Much  swelling  and  inflammation.  Apparatus 
applied.  On  admission  knee  not  swollen.  Upper 
fragment  quite  small.  Separation  one  inch  and  a 
half.  Can  be  approximated  readily.  Patient  "  scrof- 
ulous." 

March  8th. — EUierized— operator.  Dr.  S.  Cabot. 
Transverse  incision.  The  synovial  membrane  was  cut 
and  joint  ojiened.  Edges  of  fragments  fresliened. 
Silver  wires  passed  through  the  ligamentum  patellre 
at  its  insertion  into  the  lower  fragment,  going  be- 
neath both  fragments  and  piercing  tlio  tendon  of  the 
rectus  at  its  attachment  to  the  upper  fragment. 
The  wires  were  tightened  and  twisted,  bringing  the 
fragments  into  apposition.  The  ends  of  the  wire 
were  left  projecting  from  the  wound.  Considerable 
hemorrhage.  Wound  syringed.  Adhesive-plaster 
dressings  applied,  wet  compres.ses,  and  long  straight 
splint.  Except  for  slight  erysipelas,  wliich  devel- 
oped on  the  third  day,  and  lasted  five  days,  the  knee 
itself  did  well,  there  being  very  little  pain  and  swell- 
ing. 

March  19th. — Almost  all  of  wound  has  united. 

April  16th. — Nocrepitus,  slight  discharge  of  laud- 
able pus  from  outer  side  of  knee. 


•  Dr.  W.  A.  Dyrd,  New  Yorlt  Medical  Journal,  May,  1870.  p.  JfiS. 


May  7th. — On  examination  of  chest,  tubercular  de- 
posits discovered  at  apices  of  lungs. 

May  27th. — A  short  incision  was  made  in  an  attempt 
to  remove  wires,  the  ends  of  which  broke  and  the 
remainder  left  in  the  wound. 

June  14th. — Sinuses  on  each  side  of  knee  nearly 
closed. 

June  16th. — Dextrine  bandage. 

June  18th. — Bandage  .slit  up  and  sinuses  examined. 
Probe  passes  three  and  a  half  inches  up  the  inner 
side  of  thigh  from  opposite  the  knee-joint.  Counter- 
opening.     Oil-silk  tent. 

June  30th. — Tent  removed.  Knee  normal  size. 
Sinuses  closed  in  from  below. 

July  9th. — Knee  still  continues  to  be  painful.  Pa- 
tient objects  to  having  it  moved.  Slight  local  swell- 
ing. Moderate  discharge  from  counter  -  opening. 
Some  slight  motion  in  knee  seen  in  lifting  leg  from 
the  splint.  General  health  apparently  good.  Cough 
diminishing. 

July  13th.— Discharged  well  (?). 

In  a  letter  dated  Oct.  19,  186.5,  Dr.  Foster  wi-ites 
from  the  patient's  residence  at  New  Bedford  :  "Mrs. 

C died  August  10,  186.5,  live  months  after  the 

operation,  and  less  than  one  month  after  she  was  last 
seen.  All  eft'orts  to  obtain  an  autopsy  were  futile.  The 
region  of  the  sacrum  was  covered  with  bed-sores. 
An  abscess  opened  in  right  groin.  Cough  continued. 
Strength  could  not  be  maintained.  Continued  to 
complain  of  pain  in  the  knee  ;  could  not  bear  to 
have  it  moved  ;  wore  splint  to  time  of  death. 

These  five  cases  were  oi>erated  upon  before  the 
introduction  of  antiseptic  surgery.  Three  died  and 
two  (at  least)  recovered.  (I  count  only  one  case  for 
Cooper.) 

The  cases  to  be  given  were  done  under  antiseptic 
precautions,  more  or  less  rigorously  enforced. 

Mr.  Royes  Bell,  on  October  27,  1870,  presented  to 
the  London  Medical  Society  (see  Lancet,  1879,  p. 
657)  a  man,  a  porter  by  oocupation,  who  had  re- 
ceived a  transverse  fracture  of  the  patella  on  Sep- 
tember 24,  1878.  He  had  been  treated  by  the  "  old 
method  "  at  Yeovil  Cottage  Hospital  by  Dr.  Aldridge 
for  seven  weeks,  when  he  had  been  discharged 
with  the  fragments  in  close  apposition  and  united 
by  fibrous  union. 

February  1,  1879. — While  in  the  act  of  stooping, 
under  no  extra  weight,  a  rupture  of  the  fibrous  band 
occurred,  and  when  Mr.  Bell  saw  him  in  .July  there 
was  a  separation  of  two  and  one-half  inches. 

July  12tli. — He  cut  down  uj)on  the  fragments  an- 
tiseptically,  by  a  longitudinal  incision,  drilled  the 
fragments  and  wired  them  together.  Tlie  tendon  of 
the  rectus  and  some  lateral  attachments  of  the  pa- 
tella were  divided  and  the  fractured  surfaces  fresh- 
ened. Drainage-tubes  were  inserted  on  each  side  of 
the  joint,  which  were  removed  on  August  6th,  and 
slight  passive  motion  begun. 

September  27th.  -Tlie  wires  were  removed  with 
forcible  motion  under  chloroform.  The  result  was 
an  apparent  bony  union  and  perfect  free  motion  of 
the  joint. 

On  November  17,  1879,  Mr.  Rose  presented  to  the 
same  society  two  cases  of  transverse  fracture  of  the 
patella  due  to  the  muscular  action  which  he  had 
treated  at  the  Royal  Free  Hospital  by  wiring  the 
fragments. 

Case  I. — Female,  aged  thirty-two  years  ;  stoutand 
full  habit ;  admitted  .Vugust  9th.  Fracture  occurred 
when  she  was  in  the  act  of  trying  to  save  herself 
from  a  fall.  Rapid  and  excessive  effusion  into  joint 
followed  ;    separation  two  inches.      Operation  ka- 


THE  MEDICAL  RECORD. 


599 


gust  27tli ;  strict  antisepsis ;  longitudinal  incision. 
A  large  quantity  of  dark  clotted  blood  pressed  out 
of  joint.  Thin  slice  pared  from  each  fractured  sur- 
face, and  two  holes  drilled  in  each.  Counter- open- 
ings on  each  side  and  horse-hair  drains.  Tempera- 
ture never  rose  above  99^  F.  nor  pulse  over  ilO. 
Dressings  changed  eight  times.  Last  thread  of 
horse-hair  removed  on  twentieth  day,  and  wires  in 
sixth  week.  Before  the  society  on  Novemlier  I'.Uh, 
the  union  was  said  to  be  bony,  and  the  motion  in 
the  joint  demonstrable,  but  as  yet  limited. 

A  second  ease  by  Mr.  Rose,  presented  at  the  same 
time,  and  operated  upon  the  same  day  as  the  pre- 
ceding, was  also  a  transverse  fracture  due  to  muscu- 
lar action.  The  operation  was  similar  in  its  details 
to  the  first.  Bony  union  occurred,  and  the  motion 
at  the  joint  was  perfect  and  very  free. 

In  the  Lancet,  1878,  vol.  ii.,p.  lU,  is  a  synopsis  of 
another  case  by  H.  Smith. 

A  sailor,  twenty-two  years  of  age,  one  year  previ- 
ously fractured  his  patella.  Fifteen  weeks  later  the 
fragments  were  more  widely  torn  apart  by  a  second 
accident.  He  could  only  walk  by  the  aid  of  two 
canes  and  a  knee-cap.  Silver  wires  were  used  and 
strict  Lister  modus  operandi.  Tendon  of  rectus  di- 
vided in  order  to  adjust  fragments.  Horse-hair 
drainage;  nnion per jn- imam.  No  fever.  Five  weeks 
after  operation,  passive  motion.  Ninth  week,  patient 
can  walk  about  and  bend  leg  at  angle  of  45°.  Frag- 
ments accurately  in  apposition. 

H.  C.  Cameron,  of  Glasgow,  has  one  case  reported, 
viz.,  a  transverse  fracture  of  patella  in  which  liga- 
mentous union  had  occurred,  and  had  been  again 
separated  by  a  second  accident.  Under  spray  the 
edges  of  the  fragments  were  freshened,  and  silver 
wires  used.  No  suppuration.  Union  not  bony. 
Patient  has  a  verv  useful  limb  (Centralblatt  fiir 
Chirurgie,  No.  7,  1879,  p.  108). 

^t  the  seventh  Conrp-ess  der  Deutschen  GeselMiaft 
far  Chirurgie,  Trendelenberg  reported  a  successful 
case.  A 'seventeen-year  old  lad  fell  and  broke  his 
patella,  which  after  si.K  weeks  was  united  by  a  liga- 
mentous band,  about  an  inch  of  separation  existing. 
The  edges  of  the  broken  bones  were  freshened  and 
wired  with  silver  sutures.  "  The  result  is  very  good 
and  the  extension  of  the  limb  is  perfect"  (Central- 
Matt  fiir  Chirurgie,  No.  7,  1879,  p.  600). 

In  the  Deutsche  Medicinische  Wochenschrift,  No.  17, 
1878,  p.  216,  Uhde  gives  a  brief  report  of  another 
case. 

A  heavy  man,  twenty-one  years  of  age,  on  Novem- 
ber 10,  1877,  sustained  a  transverse  fracture  of  the 
patella  by  muscular  action. 

In  January,  1878,  reseparation — 4  ctm. — by  a  sec- 
ond accident. 

Operation  February  25th.  Edges  scraped  with  a 
bone  knife  and  sharp  spoon ;  iron  wire  ;  five  per 
cent,  carbolic  for  toilet. 

February  27th. — Dressings  changed. 

March  3d.— Union  pe;-  primam. 

April  9th. — Wires  removed.  The  result  was  union 
of  the  broken  bones.  (Details  fail,  but  I  infer  that 
the  result  was  a  restoration  of  function.) 

On  page  767  of  the  Rerue  de  rhirurgie,  for  1881, 
occurs  the  following:  "  Langenbeck— Fracture  of 
the  Patella— Metallic  Sutures— Becovery  with  Mo- 
tion." 

In  Centralblattfur  Chirurgie,  1880,  p.  240,  Metzler 
adds  a  case:  "Male,  aged  twenty-six;  fell  down- 
stairs ;  upper  large,  lower  small  fragment ;  separa- 
tion 2  ctm.  Silk  inter-osseous  sutures  ;  inigation 
with  carbolic  solution.     Recovered." 


Prof.  T.  T.  Sabine,  of  New  York,  operated  upon  a 
case  of  compound  comminiited  fracture  of  the  pa- 
tella, in  which  he  wired  a  nurtiber  of  fragments  to- 
gether. The  bones  united,  and  the  patient  recov- 
ered with  good  motion  of  joint.  (This  case  I  am 
not  at  liberty  to  give  in  detail,  as  it  will  soon  be  re- 
ported to  the  New  York  Surgical  Society.) 

Mr.  Lister  operated  upon  two  cases,  which  recov- 
ered. Silver-wire  sutures  were  used. — British  Medi- 
c(d  Journal,  December,  1877,  p.  850  ;  Medical  Gazette 
(N.  Y.),  1881,  p.  330. 

I  am  indebted  to  Dr.  W.  T.  Bull,  Surgeon  to 
Chambers  Street  Hospital,  for  the  following  case  : 
Mary  Sweeny,  domestic,  aged  twenty-five  ;  admitted 
October  22,  1876.  Had  fallen  downstairs  and  frac- 
tured right  patella  by  direct  violence.  Treated  by 
adhesive-plaster  apparatus  and  posterior  splint. 
December  17th,  discharged  cured.  Fibrous  union  ; 
one-fourth  inch  separation  on  outer,  and  one-half 
inch  on  inner  side. 

Readmitted  October  17,  1878,  on  account  of  inca- 
pacity of  leg,  result  of  the  old  fracture.  December 
23d,  a  long  incision  was  made  under  spray,  the  edges 
of  the  fragments  pared  and  draw  n  together  by  iron 
wires.  Lister  dressings  ;  one  horse-hair  and  two 
drainage  -  tubes  ;  posterior  splint.  Fourth  day, 
pulse,  116  ;  respiration,  32  ;  temperature,  105°  ;  no 
odor  in  wound.  Seventh  day,  pulse,  108  ;  respira- 
tion, 32;  temperature,  98i-  ;  suppuration;  joint 
syringed  1-20  carbolic.  Twelfth  day,  the  spray 
was  discontinued  at  the  dressings  ;  carbolic  com- 
presses. Pulse,  120  to  140  ;  temperature,  99°-101°. 
Later,  complete  disorganization  of  the  joint  oc- 
curred, and  an  abscess  formed  in  the  thigh.  Pa- 
tient died  from  exhaustion  January  6,  1878.  At 
the  autopsy,  there  was  no  union  of  the  fragments. 
Ero.sion  of  the  cartilages  had  occurred,  and  adhe- 
sions between  tibia  and  femur  were  established. 

There  are  in  all  19  cases  given  in  this  article  :  5 
without  antiseptic  treatment — 3  of  these  died,  2  re- 
covered ;  14  with  Listerism,  more  or  less  modified, 
and  the  result  can  be  thus  summarized  : 

1.  Bell,  "  apparent  bony  union  and  free  motion." 

2.  Rose,  "said  to  be  bony  union  ;  motion  limited." 

3.  Rose,  "bony  union;  motion  perfect." 

4.  Smith,  "  accurately  in  apposition;  knee  bends 
at  45°." 

5.  Cameron,  "  not  bony  union  ;  useful  limb." 

6.  Trendelenberg,  "  result  very  good  ;  extension 
perfect." 

7.  Uhde,  "bony  union,  good  result." 

8.  Langenbeck,  "  recovered  with  motion." 

9.  Metzler,  "  recovered." 

10.  Sabine,  "  bony  Tinion  ;  good  motion." 

II  and  12.  Lister,  "recovered." 

13.  Bull,  "  died." 

14.  Wyeth,  "suppuration;  osteo-myelitis  ;  ampu- 
tation of  thigh." 

The  result  in  some  of  these  cases  is  left  too  much 
to  conjecture.  The  reports  in  the  journals  are  not 
explicit.  Only  one  died  out  of  the  fourteen.  One 
suffered  the  loss  of  a  leg,  and  her  life  hung  by  a 
thread  for  many  weeks. 

In  five  other  cases,  bony  union  was  supposed  to 
have  been  obtained.  I  doubt  this  very  much,  since 
the  supposition  has  not  been  confirmed  by  a  post- 
mortem examination,  and  since  in  my  ovra  case  the 
fragments  were  in  close  and  perfect  apposition,  and 
had  been  so  from  September  21st  to  December  1 6th, 
and  there  was  no  osseous  union.  The  remaining 
seven  cases  recovered.  In  one,  as  stated,  "no  bony 
union,"  and  in  the  rest  motion  more  or  less  limited. 


600 


THE  MEDICAL  RECORD. 


After  the  study  of  these  oases,  and  in  the  light  of 
my  own  sad  experience,  I  am  led  to  conclude  that 
the  benefits  to  be  derived  from  a  close  adaptation 
of  the  fragments  are  not  great  enough,  as  compared 
to  the  results  obtained  by  Hamilton  and  others  by 
safer  methods,  to  justify  the  risk  which  experience 
has  shown  (despite  the  best  known  scientific  pre- 
cautious) is  incurred  by  opening  into  the  joint  and 
wiring  the  fragments  together. 

This  conclusion  is  almost  analogous  to  that  ar- 
rived at  by  Professor  Frank  H  Hamilton,  in  the 
sixth  edition  of  his  classical  work  on  "  Fractures  and 
Dislocations  "  :  "  As  to  the  method  of  cutting  into  the 
joint  and  wiring  the  fragments  together  under  car- 
bolic acid  spray,  I  feel  bound  to  say  that  as  applied 
to  a  primary  accident  it  is  oftering  a  very  grave  and 
dangerous  substitute  for  other  perfectly  safe,  and,  so 
far  as  is  yet  proven,  equally  efficient  methods  ;  it  is 
hazarding  the  life  of  the  patient  without  ottering 
any  equivalent"  (p.  516). 


DUSTASIS  OF  THE  CONDYLOID  EPffHY- 
SIS  OF  THE  FEMUR. 

Bt  DAVIS  HALDERMAN,  M.D., 

PROFESSOR    OF  SURGERY    IS    STARLING    MEDICiL   COLI-EOE. 

The  victim  of  this  injury  was  a  mulatto  male, 
eighteen  years  of  age,  of  delicate  organization,  and 
apparently  of  so-called  scrofulous  or  tubercular  con- 
stitution. 

The  accident  happened  in  connection  with  a  run- 
away team  attached  to  a  scraper,  wherein  the  patient 
was  struck  a  powerful  blow  by  the  latter,  over  the 
front  and  lower  part  of  tlie  right  thigh,  felling  him 
to  the  ground.  Three  hours  afterward  the  patient 
was  brought  to  St.  Francis  Hospital,  Starling  Med- 
ical College,  and  was  taken  for  examination  before 
the  class  of  students.  By  this  time  there  was  great 
tumefaction  about  the  knee,  of  a  fluctuating  char- 
acter ;  the  leg  and  foot  were  cold,  and  the  (lori^ali.s 
pedis  nrteiy  inmi  pidseleas.  Numbness,  too,  was  com- 
plained of  below  the  joint,  while  in  the  latter  ex- 
cruciating pains  were  experienced.  The  patient 
also  suffered  considei-ably  from  shock. 

The  liml)  on  measurement  was  found  to  be  two 
inches  shortened.  Owing  to  the  swelling,  the  line 
of  separation  could  be  with  difficulty  made  out,  but 
it  was  finally  located  two  inches  above  the  articular 
plane  in  front ;  and  the  lower  end  of  the  shaft  could 
be  distinctly  felt,  directly  beneath  the  integument, 
in  the  popliteal  space,  on  a  level  with  the  anterior 
tibial  tuberosity. 

Efforts  now  were  made  with  the  aid  of  an.-esthetics 
at  adjustment,  but  without  success ;  for,  although 
tlie  lirab  by  means  of  extension  and  counter-exten- 
sion, could  be  brought  down  to  near  its  natural 
length,  and  the  projection  in  the  popliteal  space  be 
m  ide  aomewliat  to  recede,  the  moment  the  efforts 
were  relaxed,  the  displacement  would  recur.  In 
view  of  this,  and  the  crippled  condition  of  tlie  cir- 
culation, it  was  de(!rne(l  advisable,  for  the  time  being 
at  least,  to  i)laco  tlie  pitient  in  bod,  with  the  limb 
slightly  elevated,  and  in  as  comfortable  position  as 
possible,  and  await  results.  .\t  the  end  of  twenty- 
four  hours  the  swelling  had  increased  ;  some  slight 
discoloration  over  the  foot  and  leg  had  set  in,  but 
the  temperature  was  somewhat  improved ;  and 
while  the  aliock  had  been  for  the  most  part  re- 
covered from,  the  pains  about  the  joint  still  seemed 
out  of  proportion  for  injuries  of  this  kind,  and  the 


dorsalis  pedis  artery  remained  pulseless,  and  so  con- 
tinued to  the  end. 

It  was  now  detennined  to  place  the  limb  in  a 
flexed  position  upon  a  double  inclined  plane,  with 
moderate  extension,  and  see  if  by  this  means  suffer- 
ing might  not  be  lessened.  In  its  adjustment,  the 
limb  was  brought  down  within  one-half  inch  of  the 
length  of  its  fellow  ;  but  no  weight  sufficient  to  keep 
it  there  could  be  borne.  The  patient  from  this  on 
felt  easier,  so  far  as  the  injured  extremity  alone  was 
concerned.  By  next  day,  however,  the  second  after 
the  accident,  considerable  constitutional  disturbance 
had  supervened,  pulse  was  118,  temi^erature  102  , 
and  burning  sensations,  in  the  foot  and  under  side 
of  the  leg,  were  experienced,  while  the  toes  and 
plantar  asjjects  of  the  foot  were  dull  on  pinching 
and  pricking.  It  was  thus  evident  gangrene  of 
these  parts  was  threatening ;  but  it  was  still  thought 
the  collateral  circulation  about  the  knee  might  ar- 
rest the  morbid  action  below  tliis  point — a  hope 
that  was  warranted  by  the  natural  warmth  and  sen- 
sibility over  the  upper  part  of  the  leg,  and  that  was 
maintained  to  the  last,  which  was  three  days  later. 
Meantime,  the  discoloration  below  this  point  spread 
and  deepened  ;  flectenuhe  finally  formed  over  the 
lower,  outer,  and  under  part  of  the  leg  and  ham ; 
and  at  the  latter  place  also  quite  an  escliar,  from 
the  pressui-e  of  the  end  of  the  bone  beneath  the 
skin.  The  leg  and  foot  at  last  became  cold  and  in- 
sensible to  deep  pricking,  except  near  the  knee  and 
along  the  inner  aspect  of  the  leg,  corresponding  to 
the  course  of  the  great  saphenous  nerve,  which, 
save  at  its  termination,  remained  intact.  Accord- 
ingly, on  the  fifth  day  after  the  injury,  the 
liml)  was  removed  at  the  inferior  part  of  the  middle 
third  of  the  thigh,  the  damaged  state  of  the  tissues 
being  such  as  to  preclude  amputation  lower  down. 

Condition  op  Ampi'tated  Limb. — Dissection  of 
the  amputated  limb  revealed  the  tissues  about  the 
injury  to  have  been  badly  damaged  ;  the  soft  parts 
for  some  distance  around  being  extensively  lacerated 
and,  in  the  immediate  vicinity  of  the  jbreak,  pnl- 
pified.  Blooil  was  widely  extravasated  up  and  down 
the  limb,  and  filled  the  joint  cavity  through  a  rent 
from  the  injury  on  its  inner  side.  The  lower  end  of 
the  femur  was  completely  denuded  of  its  covering — 
periosteum,  nin.scle,  etc.,  and  lay  bare  amid  the 
debris  of  the  injury,  as  did  also  a  mass  of  broken- 
off  cancellous  bone,  about  the  size  of  the  end  of  a 
man's  thumb. 

The  detached  epiphysis,  still  connected  with  the 
popliteus  and  gastrocnemius  muscles,  was  tilted 
backward  by  their  action,  and  at  the  same  time  was 
overlapped,  at  its  posterior  and  outer  aspect,  by  the 
shaft  to  the  extent  of  several  inches.  Between  them 
and  on  tlie  anterior  and  inner  aspect  of  the  latter 
bone,  lay  the  internal  popliteal  nerve,  and  the  pop- 
liteal vein  and  artery,  impinged  upon  by  the  frag- 
ments— that  is,  these  parts,  instead  of  being  in  tlieir 
natural  jiosition  behind  the  bone,  had  been  dis- 
placed to  the  front  of  it  and  were  held  there  by  the 
hooked-shaped  jn-ojection  of  tlie  divided  internal 
condyloid  ridge  over  which  they  had  caught,  so  that 
any  effort  at  adjustment  served  only  the  more 
heavily  to  boar  down  upon  and  closely  to  embrace 
them  and  thus  to  out  off  the  circulation  and  in- 
nervation beyond.  The  artery  was  contused,  and 
showed  plainly  the  results  of  inflammatory  action. 
Its  walls  were  tliickened,  its  interior  roughened, 
and  filled  witli  clotted  blood.  The  same  held  in  re- 
gard to  the  vein,  and  the  nerve,  too,  as  oonoenied  its 
pressure.    The  outer  popliteal  nerve,  although  still 


THE  MEDICAL  RECORD. 


601 


sustaining  its  proper  relation  to  the  bone,  was 
dragged  down  and  also  pressed  upon  heavily  by  the 
latter  in  its  malposition. 

It  will  thus  be  seen  the  circulation  through  the 
main  artery  and  vein  was  greatly  crip))led,  if  not 
^abolished,  from  the  start ;  that  both  popliteal 
nerves  were  paralyzed  from  pressure  ;  that  the  joint 
cavity  was  opened,  and  the  surrounding  tissue  badly 
■damaged  ;  the  bone  comminuted  ;  and  all  this,  with- 
out a  breach  of  integument,  than  which  a  worse 
■state  of  complications  cannot  well  be  conceived,  nor 
how  it  occurred  from  the  single  blow  as  above  in- 
■dicated.  But  the  nature  of  this  injury  Vieing  es- 
sentially the  same  as  that  of  a  fracture  of  the  lione 
from  befoi-e  downward  and  backward  at  this  point, 
like  the  latter,  owing  to  the  great  strength  of  the 
bone  here,  it  can  only  occur  from  a  degree  of  violence 
■that  must  always  occasion  serious  complications. 

Said  displacement  ot  vessels  and  nerves  is  be- 
lieved to  be  imique.  How  it  occurred,  without  their 
Tupture,  would^e  difficult  to  explain. 

Judging  from  the  result  of  the  post-mortem  ex- 
amination, it  is^oi  course  plain  that  the  limb  should 
have  been  amputated  at  once  ;  and  it  furnishes  but 
•another  instance  of  the  soundness  of  the  doctrine  in 
regard  to  the  -necessity  of  early  amputation  above 
-the  seat  of  the  injury,  when  the  circulation  is  badly 
■crippled,  as  it  was  here,  despite  the  achievements  of 
conservative  surgery,  now  and  then,  in  cases  of  a 
similar  kind. 

The  failure  at  reduction  was  evidently  in  a  gi-eat 
measure  owing  to  the  drawing  downward  and  back- 
■ward  of  the  proximal  end  of  the  epiphysial  frag- 
ment through  the  action,  whenever  extension  was 
made,  of  the  aforesaid  muscles  attached  thereto. 
The  operation  would  doubtless  have  been  facilitated 
liad  it  been  exercised  with  the  leg  ^lartly  flexed,  as 
this  position  would  have  had  the  eflfect  of  relaxing 
the.se  muscles.  Still  it  is  not  believed,  with  the 
damaged  state  of  the  surrounding  soft  parts,  and 
with  the  arthritic  and  vascular  complications,  that 
limb  or  life  could  have  been  saved,  had  even  the 
adjustment  been  accomplished,  though  it  is  not 
likely,  as  concerned  the  above  mentioned  incarcera- 
-tion  of  the  popliteal  artery  and  vein,  that  any 
manoeuvre  or  manipulation  which  might  have  been 
employed  would  have  succeeded  in  freeing  them. 

After  the  amputation  the  patient  did  quite  well 
for  a  while ;  at  the  end  of  the  third  week  was  able  to 
•sit  up  in  his  chair  at  times,  and  bade  fair  to  make  a 
•good  recovery,  but  afterward,  unfortunately,  was 
1;aken  with  pysemia,  of  which  he  finally  died  on  the 
i;hirtieth  day  after  the  amputation  and  the  thirty- 
:flfth  after  the  receipt  of  the  injui-y. 


ON  THE  USE  or  IPECACUANHA  DURING 

LABOE. 

By  LEONAED  F.  PITKIX,  M.D., 

NEWARK,    N.  J. 

The  value  of  ipecacuanha  as  an  emetic  and  expec- 
torant has  been  well  known  and  appreciated  for  an 
indefinite  period.  About  two  years  ago,  my  atten- 
tion was  drawn  to  an  article  wi-itten  by  a  Southera 
physician,  in  which  it  was  affirmed  that  it  increased 
the  expulsive  power  of  the  uterus  if  administered 
in  cases  of  tedious  labor.  I  determined  to  give  it 
a  trial.     During  September  of  last  year  I  was  called 

to  attend  Mrs.  C during  her  confinement  with 

her  third  child.  She  had  had  sharp  pains  for  nearly 
four  hours.     I  found  her  in  a  very  nervous  state,, 


and  greatly  excited,  and  apjjrehending  some  calam- 
ity. On  examination,  intrf  ducing  mj-  finger  into 
tlie  vagina,  I  found  the  os  hard,  rigid,  and  undi- 
lated  ;  with  difficulty  I  jiassed  my  finger  into  the  os, 
and  just  at  its  internal  edge  I  noticed  a  constrict- 
ing ring  utterly  devoid  of  elasticity.  Her  pains 
continued,  Init  were  very  irregular;  and  after  a  peri- 
od of  two  hours,  no  visible  eflcct  on  the  rigid  os 
was  noticeable.  I  then  administered  a  five- grain 
powder  of  ipecacuanha,  repeating  it  twice  at  inter- 
vals of  about  twenty  minutes.  To  my  surprise,  the 
patient  soon  became  much  quieter,  and  ceased  her 
cries  of  pain,  which  before  were  to  be  heard  dis- 
tinctly all  over  the  house.  On  making  another  ex- 
amination, I  found  the  os  softened  and  dilating  rap- 
idly under  the  pains,  which  were  now  regular  and 
strong.  Labor  was  soon  completed  without  further 
difficulty,  I  have  used  it  in  several  cases  since, 
where  the  pains  were  irregular  and  the  os  rigid  and 
undilatable,  and  always  with  benefit.  I  do  not 
think  it  increases  the  mnsciilar  power  of  the  uterus. 
It  seems,  however,  to  have  a  specific  effect  on  the 
rigid  OS  uteri,  softening  and  relaxing  its  fibres,  as 
well  as  a  co-ordinating  influence  on  the  irregularly 
contracting  uterine  muscles,  causing  them  to  act  in 
harmony.  Opium  and  ergot  are  the  only  oxytoxics 
of  value'  which  we  have  at  our  command  :  but  many 
serious  accidents  have  followed  the  injudicious  use 
of  the  latter,  and  its  effects  are  often  far  from  what 
we  desire.  Hence,  the  discovery  of  any  remedy 
which  will  alleviate  the  suflerings  which  the  partu- 
rient female  has  to  undergo  during  protracted 
labor  and  hasten  its  favorable  termination,  will  be 
heartily  welcomed.  I  would  much  like  to  hear  the 
experience  of  other  physicians,  whose  obstetric 
practice  will  allow  of  their  giving  it  a  fair  trial. 


Tachtcabdia  Due  to  Dyspepsia, — The  Prage^- 
Medicinisclie  Wochenschrift  contains,  in  its  numbers 
for  April  12  and  19,  1882,  a  serial  article  by  Dr. 
Adolph  Ott  upon  the  above  subject.  The  histories 
of  these  cases  embrace  nothing  of  moment  except- 
ing acceleration  of  cardiac  action,  during  diges- 
tion, and  moderate  meteorism.  The  heart -beats 
numbered  from  100  to  160  per  minute,  and  their 
intensity  was  frequently  abnormally  increased. 
These  symptoms  disappeared  after  regulation  of 
the  digestion.  Tachycardia  occurring  under  these 
conditions  is  generally  refeiTcd  either  to  irritation 
of  the  entire  sympathetic  system,  of  the  splanch- 
nic nerves,  or'  of  the  excito-motor  reflex  centre 
through  increased  resistance  in  the  peripheral  vas- 
cular channels,  Dr,  Ott  denies  that  irritation  of 
the  sympathetic  or  any  part  of  it  has  any  causative 
relation  to  tachycardia,  because  such  irritation  is 
uniformly  attended  by  considerable  increase  of  ar- 
terial pressiire,  which  is  absent  in  dyspeptic  tachy- 
cardia. The  absence  of  myosis  also  militates  against 
the  acceptance  of  the  theory  under  discussion. 
Neither  can  tachycardia  be  explained  by  assuming 
an  excitement  of  the  excito-motor  cardiac  centre, 
since  this  also  would  result  in  augmented  inter- 
arterial  pressure,  which  we  have  seen  to  be  lacking 
in  the  cases  in  question.  Dr.  Ott  accordingly  con- 
cludes that  dyspeptic  tachycardia  is  produced  by 
diminution  or  destruction  of  vagus  irritability — 
either  through  repeated  slight  irritation  of  the 
peripheral  pneumogastric  filaments  in  the  stomach, 
or  by  pressure  of  the  latter  organ,  when  distended, 
upon  the  heart,  j 


602 


THE  MEDICAL  RECORD. 


The  Medical  Record: 

'Ti  iDwklg  Journal  of  itlcliuinc  anb  Surgevn. 

GEORGE  F.  SHRADY,  A.M.,  M.D.,  Editor. 


PUBLISHED   BY 

WM.  WOOD  4  CO.,  i\os.  56  and  58  Lafayette  Plate,  N.  Y. 

New  York,  June  3,  1882. 

THE  AMERICAN   HIEDICy^  ASSOCIATION. 

The  coming  week  will  witness  the  meeting  of  the 
American  Medical  Association  at  St.  Paul,  Minn. 
It  is  quite  probable  that  the  number  of  delegates 
and  permanent  members  will  be  equal  to  that  pres- 
ent on  similar  occasions.  The  West  will  doubtless 
be  best  represented,  while  the  delegates  from  the 
Kast  will  be  comijaratively  few  in  number.  It  is 
f  lir  to  say,  in  any  event,  that  the  occasion  will  be 
one  of  usual  enjoyment  to  all  concerned.  Cer- 
tainly great  pains  have  been  taken  to  make  the 
meeting  a  success  both  scientifically  and  socially. 
That  the  Committee  of  Arrangements  will  succeed 
l)etter  in  the  latter  than  the  former  goes  without  the 
saying,  There  will  be  no  lack  of  excursions  and 
other  entertainment.s,  and  the  delegates  will  have 
very  substantial  reasons  for  recollecting  the  hospi- 
tality of  the  profession  in  the  far-off  city  of  the 
Northwest.  From  present  indications  there  will  not 
be  as  much  scientific  work  done  in  the  different 
sections  as  formerly  ;  still  it  is  difficult  to  say  be- 
forehand how  many  papers  will  be  presented  at  the 
List  moment.  It  is  to  be  deplored  that,  despite  its 
widely  representative  character,  the  association 
f.ills  so  far  short  of  its  opportunities  for  advancing 
the  true  interests  of  progressive  medicine.  Con- 
trasted with  the  British  Association,  it  is  far  be- 
hind in  the  number  and  cliaracter  of  papers  pre- 
sented at  its  yearly  gatherings.  The  reasons  for 
this  are  various.  In  the  first  place,  authors  are  for- 
bidden to  publish  their  papers  save  in  the  Transac- 
tions of  the  Association.  This  volume  generally  ap- 
pears several  months  after  the  meeting,  and  is  so 
lilted  with  vohiniinous  and  uninteresting  material 
tliat  any  good  i)aper  is  apt  to  be  lest  sight  of.  Then, 
again,  the  volume  lias  such  a  restricted  circulation, 
among,  at  best,  a  few  hundred  members,  that  any 
valuable  papers  appearing  in  it  are  apt  to  be  perma- 
nently buried. 


Secondly. — The  various  State  and  local  societies 
are  absorbing  the  best  talent  over  the  country,  and 
are  constantly  gleaning  the  riper  and  more  available 
fruits  of  original  investigation  and  practical  experi- 
ence. Medical  men  who  are  striving  for  reputation 
find  it  to  their  interest  to  begin  with  their  work  near 
home,  within  at  least  an  easy  range  for  consultation. 
This  will  probably  explain  why  the  British  Medical 
Association  can  develop  so  much  talent.  Great 
Britain  at  best  has  but  a  limited  area  compared 
with  this  country,  and  consequently  the  whole 
kingdom  is  thoroughly  farmed  by  the  leading  con- 
sultants of  London,  Dublin  and  Edinburgh.  For 
this  reason  the  real  workers  in  the  profession  here 
concentrate  their  best  efforts  upon  some  one  or  more 
of  their  local  societies,  and  trust  to  the  wide  publicity 
of  the  proceedings  of  these  bodies  in  the  different 
journals  for  not  only  a  local  but  a  general  reputa- 
tion. The  American  Medical  Association,  as  at 
present  constituted,  can  hardly  be  the  representative 
scientific  body  of  this  counti-y.  With  few  excep- 
tions, the  best  men  cannot  be  induced  to  work  for 
it  as  they  should.  Its  meetings  are  too  few  and  too 
widely  scattered  ;  its  permanent  membership  is  not 
constant  or  active  enough  to  give  it  force,  and  only  a 
very  few,  who  take  commendable  pride  in  guiding  the 
new  members  and  delegates  in  the  way  they  should 
go,  attend  the  meetings  regularly.  With  the  majority 
of  the  members  this  is  obviously  impossible,  as  the 
distances  for  travel  are  generally  very  great,  requir- 
ing the  expenditure  of  much  time  and  money,  with- 
out a  fair  return  in  scientific  benefit.  But  it  is  dif- 
ficult to  see  how  this  can  be  remedied. 

Thirdly.— The  mistaken  policy  of  the  association, 
in  restricting  the  publication  of  its  papers  to  the  an- 
nual volume  of  Transactions,  has  much  to  do  with  the 
interference  of  its  usefulness.  If  it  were  not  for  the 
prompt  publication  of  its  proceedings  by  the  medi- 
cal press,  the  association  would  in  all  probability  have 
ceased  to  exist  long  ago.  With  the  advancing  re- 
quirements for  information,  and  with  the  keen  ap- 
preciation of  what  is  valuable  in  medical  science, 
there  is  a  bare  chance  of  the  association  being  left  out 
in  the  cold,  unless  it  shows  more  of  a  determination  to 
move  with  the  age,  to  command  the  best  talent  in  its 
workers,  and  thus  secure  on  the  part  of  the  profession 
generally  a  wider  interest  in  its  proceedings,  and  a 
proportionately  greater  respect  for  its  influence. 

SURGKBY    IM   POMPEII. 

A  VERY  interesting  and  remarkable  collection  of 
surgical  instruments  has  been  found  in  one  of  the 
houses  in  Pompeii.  It  evidently  belonged  to  one 
practitioner  or  establishment,  and  formed  quite  as 
large  an  equipment  as  the  modern  surgeon  is  usually 
supplied  with.  A  description  of  the  collection, 
which  is  in  the  museum  at  Naples,  has  recently  been 
given  by  a  writer  in  the  Rei'ue  Medicate.  A  number 
of  instruments  are  classed  together  as  obstetrical. 


J 


THE  MEDICAL  RECORD. 


603 


One  of  these  is  a  pair  of  forceps  constructed  some- 
what like  the  modem  forceps,  but  with  smaller 
blades,  a  little  over  eight  inches  long.  They  were 
intended  apparently  for  the  removal  of  the  placenta. 
There  is  an  ingenious  vaginal  syringe,  consisting  of 
a  tube  with  terminal  and  lateral  holes,  so  as  to  dis- 
tribute the  stream  just  as  in  modern  syringes.  There 
is  also  a  trivalve  speculum,  so  an-anged  that  the 
three  parts  can  be  opened  or  shut  simultaneously, 
and  a  bivalve,  rectal  speculum,  made  upon  the  same 
principle  as  those  of  the  present  day. 

Male  and  female  catheters  were  found.  The  for- 
mer are  eleven  inches  long,  and  have  a  curious 
double  curve,  something  like  a  very  long  letter  S. 
It  must  have  been  difficult  to  introduce  them,  but 
being  once  in,  they  are  well  calculated  to  empty  the 
bladder  thoroughly.  The  female  catheters  are 
straight,  and  made  of  silver. 

There  is  a  curious  instrument,  consisting  of  a  long 
rod  with  a  square  plate  of  iron  fixed  at  the  end  at  an 
angle  of  13.5\  The  plate  is  about  four-fifths  of  an 
inch  long  and  three-fifths  of  an  inch  wide.  It  was  at 
first  thought  to  be  a  cautery  for  deep  parts,  but  its 
surprising  resemblance  to  the  modern  laryngeal 
mirror  suggests  that  it  may  have  had  some  such  use 
in  ancient  times. 

Besides  the  above  instruments  there  were  metallic 
trocars  similar  to  modem  ones,  lancets,  bistouries, 
spatulas,  forceps,  needles,  hooks,  and  most  of  the 
things,  indeed,  which  are  found  in  the  modern 
pocket-case. 

Judging  from  the  descriptions  of  the  instruments, 
there  was  a  large  amount  of  obstetrical  and  urethral 
surgery  in  Pompeii.  Lives  of  luxuriousness  and 
sensuality  brought  their  fruit  then  as  now. 


KOCH   AT  THE   GERMAN   CONGRESS   FOR    ISTERNAIi   MED- 
ICINE. 

At  the  Congress  for  Internal  Medicine,  recently 
held  at  Wiesbaden,  Dr.  Koch  presented  microscopic 
sections  showing  his  tubercle  bacillus.  He  also 
described  his  work,  and  announced  again  his  con- 
clusions. 

The  ensuing  discussion  was  somewhat  disajipoint- 
ing,  owing,  no  doubt,  to  the  fact  that  no  one  had 
time  or  opportunity  to  repeat  Dr.  Koch's  experi- 
ments. 

Drs.  Aufrecht  and  Klebs  accepted  the  demonstra- 
tions of  Koch.  The  former  even  went  so  far  as  to 
assume  that  the  centre  of  true  miliary  tubercles  is 
filled,  not  with  degenerated  cells,  but  with  micro- 
organisms, partly  rod-bacteria,  partly  micrococci. 
Aufrecht  had  seen  organisms  in  tubercle  like  those 
found  by  Baumgarten  as  well  as  by  Koch.  Profes- 
sor Klebs  said  that  he  had  for  some  years  occupied 
himself  with  the  question  of  the  infectiousness  of 
tuberculosis,  and  he  had  tried  to  discover  a  disease- 
bearing  organism.  He  was  gratified  at  Koch's  suc- 
cess, but  warned  him  of  the  severe  attacks  his  views 


would  have  to  encounter.  Dr.  Seitz  asked  some 
pertinent  questions  with  regard  to  how  Koch  would 
explain,  on  his  theory,  the  existence  of  hereditary 
phthisis,  and  of  the  frequent  occurrence  of  phthisis 
in  certain  diseases,  e.c/.,  diabetes.  Dr.  Riihle  fol" 
lowed  with  a  similar  inquiry,  and  said  that  even  if 
Koch's  facts  regarding  inoculation  of  the  tubercular 
bacilli  were  correct,  the  etiology  of  human  phthisis 
would  yet  be  unsolved. 

Koch  replied  to  these  gentlemen,  and,  as  his  an- 
swer contains  a  very  clear  statement  of  his  view, 
we  give  it  quite  fully. 

It  is,  he  said,  a  well-known  fact  that  the  develop- 
ment of  micro-organisms  is  greatly  influenced  by  the 
character  of  their  nutritive  media.  Human  bodies 
do  not  always  oflfer  equally  good  nurture  ground 
for  pathogenic  bacteria.  Some  persons  may,  while 
most  do  not,  inherit  a  system  which  is  well  calculated 
for  the  development  of  the  tubercular  bacilli.  These 
former  are  the  hereditarily  disposed  to  phthisis. 
The  distinction  between  phthisis  and  miliary  tuber- 
culosis must,  said  the  speaker,  fall  to  the  ground. 
For  such  distinction  only  depends  upon  the  mode 
and  amount  of  bacilli  infection.  In  acute  miliary 
tuberculosis  large  numbers  of  the  pathogenic  or- 
ganisms are  poured  into  the  blood.  In  phthisis, 
however,  only  one  or  a  few  get  into  the  lungs.  Thus 
in  the  lower  animals,  when  a  very  few  tubercular 
organisms  are  inoculated  in  the  anterior  chamber  of 
the  eye,  there  is  a  slow  and  perhaps  local  tubercu- 
lous infection.  If  large  numbers,  however,  are  in- 
oculated, the  animal  soon  dies  of  a  general  tuber- 
culosis. 

The  above  account  includes  the  most  important 
part  of  the  debate,  which  afterward  drifted  off  into 
a  discussion  regarding  phthisis  in  children. 

It  will  be  seen  that  our  German  brethren  take  Dr. 
Koch's  discovery  calmly,  and  are  not  as  yet  inclined 
to  consider  it  an  epoch-making  afiair.  By  Dr. 
Koch's  own  explanation  it  is  shown  that  the  exist- 
ence and  infective  power  of  a  bacillus  does  not 
solve  entirely  the  problem  of  the  etiology  of  phthisis. 
This  bacillus  only  grows  upon  suitable  ground,  i.e., 
in  the  phthisically  predisposed.  We  have  yet  to 
find  exactly  what  constitutes  or  brings  aboiit  this 
peculiar  predisposition.  Again,  according  to  his 
experiments  the  inoculation  of  the  bacillus  always 
produces  tuberculosis  in  lower  animals.  Must  we 
infer,  therefore,  that  lower  animals  are  always  pre- 
disposed ?  We  shall  be  very  glad  to  find  that 
Koch's  conclusions  are  justified  by  further  studies 
and  experiments.  But  the  evidence  at  present  calls 
for  much  caution  in  interpreting  their  significance. 


THE   BRAIN   CORTEX    AND   CR.ANIAI/   SUBFACE. 

The  cortex  of  the  brain  and  the  correlative  parts  of 
the  cranial  surface  are  proving  to  be  objects  of  a 
great  deal  of  scientific  inquiry.  We  have  referred 
to   Charcot's  recent  experiments  upon  hypnotized 


■604 


THE  MEDICAL  RECORD. 


-patients,  in  which  electrical  currents  applied  to  the 

■cranium  were  found  to  excite  muscular  movements 

•of  the  opposite  side  of  the  body.  M.  Delaunay  has 
been  making  experiments  of  a  different  character, 
but  from  which  he  draws  conclusions  that  are  quite 
as  novel. 

It  is  unquestionable  that  there  is  some  relation 
between  the  temperature  of  the  brain   and  that  of 

^.he  cranial  surface.  Different  parts  of  this  surface 
have  different  temperatures,  which  temperatures 
vary  slightly  in  accordance  with  cerebral  changes. 
Exactly  what  the  laws  are  that  regulate  the  relation 
between  cortical  and  cranial  temjieratures  is  not 
known  ;  but  it  is  almost  certain  that  this  relation  is 
a  physiological,  not  a  physical  one.     There  seems 

4o  be  some  vaso-motor  sympathy  between  the  two 
parts,  by  which  a  change  in  the  vascular  supply  and 

i;emperature  of  the  cortex  induces  also  a  change  in 

ithe  scalp.  M.  Delaunay  announces  the  highly  in- 
genious view  that  an  increase  in  the  temperature  of 

ithe  cranial  surface  will  call  out  an  increased  activity 
in  the  brain  beneath.  In  other  words,  he  considers 
it  a  rule  that  will  work  both  ways.  This  stimulus 
of  warmth  to  the  cranial  vasomotor  nerves  will  sym- 
I^athetically  affect  the  brain  cortex.  M.  Delaunay's 
proofs  of  this  interesting  hypothesis  rest  upon  ex- 
periments made  upon  himself  during  sleep.  He 
states  that  the  application  of  warmth  to  the  cranial 
surface  changes  the  character  of  his  dreams  from 

.al»surd  and  childish  fancies  to  logical  and  coherent 
thought !  We  leave  it  to  our  readers  to  ponder 
over  and  test  this  highly  interesting  announcement. 
If  true,  there  is  a  rich  field  for  warm  flatirons  in 

.soothing  uneasy  slumbers. 


A  Self-Acting  Kepokting  Machine. — Several 
journals  give  an  account  of  an  instrument,  invented 
by  Herr  A.  Gentilli,  of  Vienna,  and  named  by  him 
the  glossograph,  consisting  of  an  ingenious  combi- 
nation of  delicate  levers  and  blades  which,  placed 
iipon  the  tongue  and  lips  and  under  the  nostrils  of 
the  speaker,  are  vibrated  by  the  movements  of  the 
former  and  the  breath  flowing  from  the  latter.  The 
vibration  is  transmitted  to  pencils,  which  transcribe 
the  several  signs  produced  by  the  action  of  the 
tongue  and  lips  and  the  breatli  from  the  nostrils, 
upon  a  strip  of  paper  moved  by  a  mechanical  ar- 
rangement. As  in  shorthand,  a  special  system  of 
writing  which  may  fitly  be  termed  glossography,  is 
produced,  based  upon  the  principle  of  syllabic  con- 
stru<rtion  and  (combination  of  consonants.  It  is  said 
to  1)0  especially  suitaljle  for  those  languages  the  or- 
tliograpliy  of  wliicli  differs  least  from  the  jihonetic 
record  of  tlie  ai)i)aratus.  The  instrument  is  self- 
acting  in  the  fullest  sense.  Moreover,  its  applica- 
tion involves  as  little  fatigue  to  the  speaker  as  se- 
vere attention  on  thejiart  of  the  person  transcril>ing. 
In  reporting  jjroceedings  in  Parliament  or  courts  of 
law,  it  is  not  necessary  that  the  speaker  should  >i.se 
the  apparatiis  himself.  Anybody  may  articulate  it 
by  repeating  in  a  low  voice  the  words  of  a  speaker, 
■which  is  sullicient  for  recording  the  signs.   _ 


tlcuieiDSi  arib  Uotice0  of  fiooka. 


A  TRF..A.T1SE  ON  THE  SciENCB  AND  PRACTICE  OF  MEDI- 
CINE ;  or  the  Pathology  and  Therapeutics  of  Inter- 
nal Diseases.  By  Alonzo  B.  Palmek,  M.D., 
LL.D.     New  York  :  G.  P.  Putnam's  Sons.     1882. 

This  volume  of  89(5  pages,  written  by  one  of  the  old- 
est professors  of  medicine  in  this  country,  was  de- 
signed for  the  use  of  students  and  physicians.  The 
author  believes  that  the  time  has  not  yet  arrived  for 
a  strictly  scientific  classification  of  diseases,  and 
therefore  in  the  arrangement  of  the  subjects  "  con- 
venience "  has  been  followed  chiefly.  What  he  de- 
nominates "  a  natural  order,"  however,  has  been  ob- 
served ;  in  other  words,  the  book  is  composed  of  a 
series  of  articles  on  medical  topics,  beginning  with 
general  jiathology  and  therapeutics,  and  closiog 
with  local  diseases.  Here  is  one  of  the  weak  points 
in  the  author's  labor.  It  is  too  much  like  the  work 
done  by  a  reaper  who  walks  into  a  field  of  grain 
and  "  strikes  in,"  and  too  little  like  that  done  by 
one  who  follows  a  well-matured  plan  which  carries 
with  it  the  conviction  that  the  fruit  of  the  field  is 
to  be  cleanly  gathered. 

Again,  at  the  outset  there  is  evidence  that  the 
editorial  work  has  been  too  poorly  performed.  The 
lack  of  system  in  the  general  arrangement  predicts 
confusion  and  incompleteness  in  the  details.  And 
so  it  is.  For  example,  the  author  says:  "Local  dis- 
eases are  then  treated  of,  closing  with  the  complex 
affections  of  the  nervous  system,  and  an  account  of 
human  parasites  is  added,  and  a  description  of  the 
internal  diseases  which  they  produce  closes  the 
work."  But  the  reader  turns  the  leaves  and  finds 
the  end  of  the  book  without  seeing  any  account  of 
the  affections  of  the  nervous  system  or  diseases  prO' 
duced  by  parasites.  In  addition,  no  account  is  found 
of  diseases  of  the  lungs,  pleura  or  heart.  Nor  is  there 
anything  upon  either  the  title-page  or  the  cover,  01 
in  the  preface,  to  indicate  that  there  is  to  be  more 
than  one  volume.  The  information  that  this  is  the 
first  volume  is  found  only  in  the  table  of  contents, 

Again,  there  is  lack  of  system  in  what  the  author 
has  to  say  on  each  disease.  In  many  instances  we 
find  a  continuous  story,  without  special  reference  to 
etiology,  morbid  anatomy,  diagnosis,  differential 
diagnosis,  prognosis  or  treatment.  In  other  words, 
the  absence  of  subdivisions  compels  the  reader  to 
go  over  the  whole  article  for  the  sake  of  finding 
what  has  been  said  on  any  particular  point.  Per' 
haps  tBere  is  skill  in  this. 

jloreover,  the  natural  order  which  the  author  fol' 
lows  has  not  been  made  apparent  in  the  text  bj 
anything  which  indicates  where  "general  pathologj 
and  therapeutics  "  ends,  and  the  study  of  "  genenu 
diseases"  begins.  The  general  value  of  the  book  is 
much  reduced  by  these  deflciences,  which  could  haVe 
been  easily  supplied. 

There  are  also  incongruities.  For  example,  under 
the  head  of  "  Bites  of  Insects,"  the  author  pre- 
sents the  theory  he  accei)ts  with  regard  to  the  for- 
mation of  pus.  The  jiathology  of  infliimniation  has 
already  been  discussed  upon  lupceding  pages,  and  it 
would  seem  that  that  miglithave  been  sufficient.  The 
theory,  however,  is  so  nicely  elaborated  that  the 
language  is  worthy  of  ((uotation  :  "  Every  cell  in  l^c 
living  tissues  has  a  cell  wall,  and  a  more  highly  Vi- 
talized bioplasm  within.  In  the  natural  condition, 
in  the  nutrition  of  the  living  cell,  the  nutrient  mat- 


THE  MEDICAL  RECORD. 


605. 


lowly  through  the  former  cell  wall  to  the 
aiiJ   changes    are  gradually    i^roduced. 
Wiieu  a  cell  wall  is  penetrated  by  the  lancet   of  a 
Ilea,  exposing  the  bioplasm  of  the  cell,  niitrient  ma- 
teii  il  is  speedily  taken  in   and  appropriated,   and  a 
r;i[Uil  but  morbid  cell  growth  takes  place.     These 
tells  then  become  embryonic,  undergo  rapid  change, 
au  1     frequently    become    pus-corpuscles,    many  of 
whith  may  thus  be  quickly  produced.     In  all  ordi 
inrv  forms  of  inflammation,  the  bioplasm    of   cells 
ases,   gives    otf  diverticula,  which  become  de- 
1,  and  in  turn  grow  and  give  otf  more  process- 
I  itil  from  a  few  particles  of  irritated  bioplasm, 
illy  supplied  with  pabulum,  numerous  embry- 
cells,    many    becoming     pus     cells,     result. 
i;2;h  leucocytes   are    exuded  from   vessels   and 
I'l   -I'ut   themselves   as    corpuscles,    I    cannot   but 
t!iink  that  in  the  ordinary  processes  of   suppuration 
til"  chief  production  of  pus  is  frorp  the  multiplica- 
ti  111  and  transformation  of  the  cells  of  the  tissues 
iu\  ilveil.     In  these  small  injuries  etfeoted  by  the 
riiM.  the  process  is  limited  and  suppuration  is  not 
e>t.ililished."     That  this  statement  is  definite  cannot 
lie  disputed,  but  it  seems  to  us  that  it  has  been  put 
so  clearly  as  even  to  surprise  the  microscope,  al- 
though it  contains  the  germ  of  the  view  which  has 
stood  in  opposition  to  the  theory  of  diapedesis  of 
wliite  blood-corpuscles. 

i'iiis  leads  us  to  the  general  criticism  that  the 
li  ilk  is  essentially  one  of  clinical  medicine,  under 
the  form  of  a  "  treatise  on  the  science  and  practice 
of  medicine."  The  author  has  expressed  a  desire  to 
avoid  the  extremes  of  "  superficial  brevity  and  elabo- 
r.it>>  profuseness,"  and  in  a  considerable  i^ortion  of 
the  liriok  he  has  accomplished  his  purpose  well  ;  but, 
viewed  even  as  a  work  on  clinical  medicine,  we  are 
impressed  with  the  idea  that  he  has  rather  overdone 
the  work  and  sheared  too  closely  while  discussing 
questions  of  diagnosis,  differential  diagnosis  and 
certain  features  of  treatment. 

Furthermore,  he  says  that,  "  not  having  himself 
'       1  devoted  to  original  work  in  morbid  anatomy, 
description    of    anatomical    and    histological 
I  ires  jjartakes  of  the  character  of  a  compilation 
1  the  more  recent  and  reliable  sources."     Nor  is 
■   any  evidence  that  the  author's  compilation 
revised  by  an  expert,  and  he  has,  therefore,  ex- 
[       -.1  it  unnecessarily  to  adverse  criticism.    No  man 
"iv     I  has  not,  to  a  considerable  extent,  devoted  his 
.to  the  study  of  gross  and  microscopical  jjatho- 
il  anatomy,  can  act  wisely  and  give  his  mauu- 
t  on  morbid  anatomy  for  publication  before  it  has 
...i  lergone  careful  revision  by  someone  who  has  "de- 
voted himself  to  original  work  "  in  that  dej^artment. 
To  have  done  so  would  have  added  largely  to  the  value 
of  Prof.  Palmer's  book.    Asit  now  stands  the  language 
is  that  of  a  writer  who  is  not  quite  sure  of  bhe  ground 
which  he  occupies,  and  to  protect  himself  he  has  in- 
corporated sentences  which  reveal  his  doubts  still 
more  clearly.     For  example,  the  unqualified  state- 
ment that  "  every  cell  in  the  living  tissues  has  a  cell 
wall,"  has  been  consiilerably  modified   since  many 
years  ago  it  was  announced  by  Schwann.     Indeed, 
the  author  himself,  several  pages  preceding,   and 
quoting  from  Beale,  says  that  "  the  outer  wall  is  not 
considered  essential  to  the  cell  as  a  life  element." 
Further,  he  says,  speaking  of  the  morbid  anatomy 
of  erysipelas,    that    "  the   circumscribed   blush,   or 
congestive  redness,  is  soon  followed  by  inflamma- 
tory eS'usions  (serum,  lymph,  and  corpuscles)  in  the 
substance  of  the  skin  and  the  subcutaneous  tissue." 
This   description  is  hardly  what  it  should  be,  even 


when  supplemented  by  the  statement  that  "some 
authors  are  of  the  opinion  that  the  primary  seat  ot 
the  inflammation  is  in  the  lymphatic  system."  Cer- 
tainly it  is  not  "elaborately  profuse." 

But,  passing  from  the  pathological  to  the  clinical 
aspect  of  the  book,  we  notice  the  author's  classifica- 
tion of  fevers.  Sandwiched  between  the  classifica- 
tion, however,  and  what  he  has  to  say  upon  fevers,, 
are  nearly  thirty  pages  devoted  to  the  consideration 
of  "  minor  ailments,"  such  as  "  conditions  of  the- 
tongiie,"  "morbid  appetite,"  "nervousness,"  "rheu- 
matic pains,"  "  taking  cold,"  etc.  The  reason  given, 
for  their  insertion  at  this  place  is  because  they  "  are- 
accompanied  with  feverishness,"  an  excuse  which 
would  bring  a  very  large  proportion  of  diseases- 
within  the  same  brackets.  The  arrangement  forms- 
an  unpleasant  medley. 

The  author  divides  fevers  into  symptomatic  and 
idiopathic.  The  idiopathic  is  subdivided  into  non- 
specific and  specific,  and  the  specific  into  periodical,, 
continued,  and  eruptive.  Among  the  continued  we 
find  whooping-cough,  mumps,  and  cholera.  No 
mention  is  made  of  typho-malarial  fever.  As  can  be- 
readily  seen,  the  classification  possesses  some  novel- 
ties. In  the  light  of  generally  accepted  views,  the- 
propriety  of  classing  pertussis,  parotoditis,  andi 
cholera  among  the  continiied  fevers  is  questionable. 
Those  views,  however,  may  be  en-oneous.  W'ithi 
more  jsropriety  could  certain  other  aflections  be  re- 
garded as  essential  fevers  than  those  mentioned.  la- 
the preparation  of  the  jiages  on  diseases  of  the  liver,, 
the  author  states  that  he  has  "  drawn  freely  from  Dr_ 
Murchison's  admirable  -wi-itings."  Exactly  why  the- 
subject  of  "  Jaundice — C'hohi-mia  "  should  be  di- 
vided, and  have  placed  between  its  pathology  and 
diagnosis  several  images  on  organic  diseases  of  the 
liver,  is  not  apparent.  Such  fragmentai-y  deliveries- 
are  hardly  excusable.  The  author  gives  as  a  reason 
for  writing  his  book,  that  the  few  works  by  Ameri- 
can authors  are  insufficient  "  to  fully  supply  the 
wants  of  the  reading  American  profession, '  as  proven- 
by  the  large  number  of  foreign  works  which  are  re- 
produced in  this  counti-y,  and  yet  he  himself  has- 
"drawn  largely"  from  those  foreign  writings.  The- 
morbid  anatomy  is  almost  entirely  from  foreign  au- 
thors, and  the  \-iews  of  Eindflei-sch  and  others  are  ap- 
I^arent.  The  symptomatology  has  no  essential  vari- 
ation from  that  based  upon  private  and  hospital 
practice  in  large  cities,  nor,  so  far  as  -n-e  have  dis- 
covered, do  the  therapeutics  of  tha  book  give  us  any- 
essential  differences,  notwithstanding  the  claim  thatr 
"  the  practical  directions  of  the  authors  of  foreign 
works  cannot  be  accepted  as  projjer  guides  to  be- 
fully  followed  in  the  treatment  of  the  ordinary  medi- 
cal diseases  of  our  general  jDopulation." 

The  book  as  a  literary  production  is  fair,  althougb 
there  are  some  evidences  of  carelessness  in  proof- 
reading, punctuation,  and  indexing.  The  "  liquor- 
sodai  chlorata; "  was  doubtless  intended  for  liq. 
sodas  chlorinatie;  "Kibel's  fever  cot,"  tor  Kibbee'a 
fever-cot.  The  substitution  of  the  word  "penetra- 
tion "  for  perforation,  in  connection  with  the  sub- 
ject of  ulceration,  does  not  seem  to  be  in  favor  of 
euphony  at  least,  and  the  expression  "  diseases 
chiefly  of  the  small  intestines  in  general "  is  some- 
what redundant.  The  book  is  printed  well,  with  type- 
of  good  size  and  upon  good  paper.  There  is  con.sider- 
able  good  material  upon  these  pages,  and  much  of 
it  is  presented  in  -well-chosen  language,  but  we  feel 
obliged  to  .say  that  the  work  as  it  now  stands  wiU 
not  supply  the  want  of  the  advancing  medical  stu- 
dent or  physician. 


606 


THE  MEDICAL  RECORD. 


Reports  of  Societies!. 


THE  PRACTITIONERS'  SOCIETY  OP    NEW 
YORK. 

Stated  Meeting,  May  19,  1882. 

Dr.  W.  M.  Polk,  PRE-srogNT  (pro  tern.),  vx  the 
Chair. 

the  sequeiiie  op  me.vsles,  with  speci.\l  reference 
to  the  devblop.vient  of  a  strumous  diathesis. 

Db.  V.  P.  GiBNEY  read  a  paper  on  the  above  sub- 
ject (vide  page  589). 

Dr.  Gibiiey,  in  response  to  a  question,  said  that,  in 
some  cases,  there  was  no  doubt  at  all  that  measles 
were  the  cause  of  the  bone  affection.  That  is  to  say, 
the  measles  were  the  cause  of  a  diathesis  which  laid 
the  foundation  for  the  subsequent  disease.  The 
children  were  not  strumous  before  they  had  the 
measles.  The  average  age  of  the  children  whom  he 
had  seen  was  five  or  six  years,  the  range  being  from 
two  to  ten. 

Dr.  George  F.  Shbady  said  that  he  had  observed 
cases  whei-e  measles  seemed  to  be  the  exciting 
cause  of  joint  disease  in  strumous  children.  He 
called  to  mind  two  patients  in  particular,  in  whom 
such  a  relation  of  cause  and  effect  existed. 

Dr.  Gibney,  in  response  to  a  question  from  Dr. 
Walker,  said  that  he  had  not  noticed  any  arrest  of 
bone  development  to  follow  measles. 

Dr.  Beverly  Robinson  said  that,  as  regards  the 

EFFECT   op   MEASLES    UPON   MUCOUS   MEMBRANES, 

there  was  no  one  of  the  acute  fevers  of  childhood 
which  affected  so  disastrously,  as  this,  the  mucous 
lining  of  the  nose.  He  could  recall  two  or  three 
most  obstinate  nasal  catarrhs  directly  attributable 
to  measles.  He  did  not  remember  that  the  ears 
were  often  affected,  however,  and  he  had  been 
rather  struck  by  this  fact.  In  these  nasal  catarrhs 
there  was  sometimes  a  very  fetid  odor  to  the  breath, 
which  could  not  be  accounted  for  by  any  especial 
anatomical  change.  There  was  no  bone  disease  and 
there  were  no  ulcerations.  The  patients  in  whom  he 
had  noticed  this  had  not  been  in  bad  hygienic  sur- 
roundings nor  were  they  of  a  strumous  diathesis. 
The  speaker  suggested,  therefore,  the  advisability 
of  paying  more  attention  to  the^se  catarrhs  when  they 
come  on  during  measles.  There  was  another  change 
which  he  had  noticed  in  cases  where  the  cough  had 
lasted  for  some  time,  or  which  had  ended  in  ca- 
tarrhal phthisis.  In  these  he  had  found,  on  au- 
topsy, considerable  enlargement  of  the  bronchial 
glands,  these  glands  being  sometimes  in  a  state  of 
cheesy  degeneration.  He  had  thought  it  probable 
that  these  glands,  by  pressing  on  the  bronchi, 
cau.sed,  in  part,  the  obstinate  cough.  On  more  than 
one  occasion  he  had  used  local  irritation  between 
the  shoulders,  in  the  hoi)e  of  affecting  these  enlarge- 
ments. In  some  cases  he  thought  ho  had  been  suc- 
cessful, though,  of  course,  it  was  impossible  to 
speak  positively. 

Dr.  Samuel  Se.xton  said  that,  in  1861,  when  his 
regiment  first  went  into  camp,  they  were  attacked 
with  an  epidemic  of  measles.  A  very  large  number 
of  the  command  were  affected.  He  was  surprised  at 
the  time  to  see  how  few  men  were  invalided  by  the 
disease. 


As  regards  the 

FREQUENCY  OP  AURAL  COMPLICATIONS, 

he  thought  that  measles  stood  next  to  scarlet  fever 
in  causing  such  complications.  I 

However,  he  had  been  surprised  at  the  Eye  and 
Ear  Infirmary  to  find  how  many  persons  attributed 
ear  trouble  to  measles  and  scarlet  fever,  yet,  on  close 
inquiry,  how  little  they  really  had  to  do  with  it  in 
many  instances.  It  was  peculiar  that  the  eruption 
of  measles  very  rarely  extended  into  the  auditory 
meatus  and  affected  the  tympanum.  He  had  made 
some  studies  in  order  to  get  at  the  exact  facts  here, 
but  they  were  not  yet  completed. 

The  acute  purulent  inflammation  of  the  middle- 
ear  in  measles  does  not  materially  differ  from  that 
induced  by  other  causes,  but  there  is  very  often  a 
sub-acute  form  of  middle-ear  inflammation  without 
pain  or  discharge,  which  is  to  be  apprehended.  It 
is  not  usually  noticed  for  some  time,  and,  indeed, 
may  only  be  discovered  when  the  hearing  power  i- 
called  into  requisition  at  school,  or  when  a  severe 
cold  in  the  head  causes  an  exacerbation  of  the  al- 
ready existing  disease.  He  thought  such  cases 
more  common  than  is  usually  supposed. 

He  recalled  a  case  where  a  long  standing  purulent 
inflammation  of  the  middle-ear  was  seemingly  cured 
by  an  attack  of  measles.  But  this  was  very  excep- 
tional. The  speaker  referred  to  the  fact  that  the 
ear  was  very  often  in  a  hyperi^mic  condition  during 
the  course  of  an  attack  of  measles  from  reflected 
sympathy  ;  thus  it  was  important  to  remember  that 
dentition  is  active  during  the  period  of  life  when 
this  exanthem  is  most  prevalent,  and  the  same  re- 
flex irritation  in  the  ear  may  be  induced  by  nasal 
catarrh. 

He  thought  that  something  might  be  done  to  I 

PREVENT   AURAL   COMPLICATIONS 

by  the  timely  use  of  remedies.  When  suppuration 
threatened,he  believed  that  much  good  could  be  done 
by  the  use  of  calcium  sulphide.  A  case  was  related 
in  which  one  ear  had  suppurated  and  the  other 
threatened  to  do  so.  The  i^atieut  was  put  upon  the 
calcium  sulphide,  and  the  threatening  symptoms 
abated.  Aconite  was  given  at  the  same  time  to  relieve 
the  nervous  irritation.  He  deprecated  over-much 
syringing  of  an  acutely  inflamed  ear,  and  believed  that 
surgical  interference  by  perforating  the  membrana 
tympani  had  been  too  frequently  practised.  He  did 
not  perforate  the  drum-membrane  once  now  to  a 
hundred  times  formerly. 

The  question  of  an  aniosthetic  was  always  to  be 
considered  when  this  operation  had  to  be  performed, 
for  it  was  by  no  means  always  free  from  pain. 

Dr.  Robert  P.  Weir  said  that  the  subject  of  pre- 
venting aural  and  nasal  complications,  ir.  children 
affected  with  scarlatina  or  measles,  had  interested 
him  some  time  ago  when  he  was  connected  with  the 
New  York  Eye  and  Ear  Infirmary.  He  was  then 
also  in  general  practice,  but  he  used  to  hearspecial- 
ists  talk  very  glibly  about  preventing  the  aural 
troubles  which  resulted  from  the  exiuithematn. 
But  practically  he  had  found  it  impossible  to  do 
anything  of  importance.  The  children  are  irritable 
and  unmanageable,  and  would  not  submit  to  nasal 
medication,  or  the  medication  was  so  distressing  in 
the  eyes  of  the  parents  or  nurses  that  it  would  not 
be  properly  carried  out.  He  felt  as  Dr.  Sexton  did 
with  regard  to  jnineturing  the  dnim  in  children. 
He  thought  that  nature  did  this  satisfactorily  if  it 
was  necessary.     In  his  experience   with   such   pa- 


THE  MEDICAL  RECORD. 


607 


its  the  drum  membrane  healed  satisfactorily  after 
„  cultural  puncture  if  simjilv  and  properly  treated, 
;iud  no  permanent  damage  to  it  i-esulted  as  a  rule. 

Dit.  James  B.  Hcister  related  the  history  of  an 
epidemic  in  the  ai-mj,  which  attacked  a  body  of 
I'll  II)  men,  nearly  half  of  whom  were  affected.  The 
ili  sense  was  of  a  virulent  type.  The  men  who  were 
attu'ked  were  all  from  the  country,  and  for  the  most 
put  had  never  had  the  disease  before.  None  died 
iv'iai  the  measles  directly,  but  there  were  many 
.1 -aths  from  pneumonia  which  developed  in  the 
I' lurse  of  the  disease.  Many  others  were  perma- 
nt'iitly  disabled. 

"  irH   KEGARD   TO   THE   EFFECT   OF   IIEASI/ES    UPON   THE 
BEPRODTJCTITE   OEGANS, 

he  had  seen  very  little.  He  had,  however,  observed 
attacks  of  vaginitis  occurring  during  the  coui-se  of 
the  measles,  followed  by  an  obstinate  form  of  leucor- 

rleea. 

Dii.  Charles  L.  Dana  referred  to  Dr.   Gibney's 

I  i.'vy  whether  an  attack  of  measles  would  ever  cure 
•  liilepsy.  This  seemed  improbable  and  dithcult  to 
pMve.     Most  epileptics  have  had  measles  either  be- 

I  re  or  after  their  disease  developed.     On  the  other 

II  ind,  children  who  have  epilepsy  sometimes  re- 
efer spontaneously  or  under  treatment  during  or 

'lie  end  of  their  childhood.  He  recalled  some 
■s  of  this  kind.  It  would  be  hard  to  say,  there- 
;  re.  that  the  measles  were  ever  a  genuine  cause  of 
cure. 

Dr.  Sexton  said  that  aural  complications  had  a 
very  short  course  as  a  rule.  He  did  not  think  that 
there  was  as  much  done  in  the  way  of  treatment  as 
there  used  to  be.  The  practice  of  syringing  out  the 
ear  often  did  more  harm  than  good. 

Dr.  Georbe  L.  Peabodt  said  there  could  be  no 
doubt  that  measles  led  sometimes  to  catarrhal  pneu- 
monia, and  this  to  tuberculosis.  Measles,  however, 
were  only  indirectly  the  cause  of  tuberculosis. 

He  had  once  made  an  autopsy  on  a  case  of  measles 
and  had  carefully  examined  the  skin.  Tn  the  parts 
where  the  eruption  existed,  he  found  large  colonies 
of  micrococci.  These  evidently  came  from  without, 
however,  since  they  existed  chiefly  in  the  sweat 
glands  and  were  evidently  making  their  entrance 
through  these  channels.  Where  the  skin  was  free 
from  ei'uption,  there  were  no  micrococci. 

Dr.  Robinsox  referred  to  a  paper  by  Dr.  Keating, 
of  Philadelphia,  in  a  recent  number  of  the  American 
Journal  of  Medical  Sciences,  in  which  it  was  main- 
tained that  measles  were  the  eruptive  disease  of 
childhood  most  frequently  followed  by  fibrinous 
coagula  in  the  heart.  Dr.  Robinson  suggested  the 
probability  that  the  pneumonia  following  measles 
was  of  the  embolic  foi-m.  He  had  had  no  practical 
experience,  but  thought  it  fair  to  assume  such  to  be 
the  case. 

Dr  GrBSET,  in  conclusion,  said  that  he  had  wished 
to  have  it  shown  that  measles  are  not  the  trivial  dis- 
ease they  are  sometimes  considered.  He  knew  that 
conditions  of  bad  health  were  brought  on  by  this 
affection. 

TCBERCULAR    SYPHTTjIDES   UPON   THE    AFRICLES. 

Dr.  Samuel  Sexton  related  the  ease  of  a  married 
woman,  aged  about  twenty-eight,  who  presented 
herself  with  a  very  peculiar-appearing  eruption, 
nearly  covering  both  auricles.  The  crusts  were 
very  thick  and  nearly  occluded  the  meatus.  Xo 
very  good  history  of  syphilis  could  be  obtained. 
Yet  the  eruption  was  characteristic,  and   was  un- 


doubtedly a  tubercular  syphilide.  She  was  placed 
upon  the  mixed  treatment  in  small  doses  (potas. 
iodid.  gr.  v.,  corros.  sublimate,  gr.  /,).  Under  this 
she  very  rapidly  improved.  The  unusual  place  of 
the  eruption  and  the  speedy  relief  under  small  doses 
of  [iotas,  and  mercury,  were  the  interesting  features 
in  the  case. 

REMOVAL  OF  NASO-PHARYNGEAL  POLYPUS  BY  NKLATON'S 
OPERATION — DEATH . 

Dr.  Robert  F.  Weir  related  the  history  of  an 
opei'ation  for  removal  of  a  nasopharyngeal  j5olypus, 
which  had  some  points  of  extreme  interest. 

The  patient  was  a  boy,  aged  eight.  A  year  ago  he 
had  had  diphtheria,  and  this  was  followed  by  the 
"  snuffles."  This  symjjtom  did  not  attract  attention 
for  some  time.  It  was  at  last  noticed  that  he  could 
not  sleep  in  the  ordinary  position.  He  then  began 
to  have  nasal  hemorrhages.  * 

He  was  taken  first  to  a  quack  who  blew  powders 
up  his  nose.  He  then  went  to  a  physician  in  New- 
ark, who  tried  to  remove  the  tumor,  which  hung 
down  just  in  view,  by  splitting  the  soft  palate  after 
Manne's  method.  The  child  developed  some  alarm- 
ing symijtoms  from  hemorrhage  and  shock,  and  was 
resuscitated  with  difficulty.  Recently  he  was  sent 
to  Dr.  Lefferts,  of  this  city,  who  turned  the  case 
over  to  Dr.  Weir. 

The  child  was  then  in  hardly  a  fair  condition  of 
health,  but  no  delay  in  order  to  improve  him  was 
allowable  on  account  of  the  recui-ring  hemorrhages 
and  disturbed  sleep. 

An  examination  showed  the  tumor  to  have  en- 
croached anteriorly  in  the  nostrils,  but  not  entirely 
to  have  occluded  them.  It  also  hung  down  nearly 
to  the  base  of  the  tongue.  The  tumor  was  thought 
by  digital  examination  to  be  attached  to  the  base  of 
the  basilar  process  of  the  occipital  bone. 

The  points  to  be  determined  before  operating 
were  :  ( 1 )  the  kind  of  operation ;  (2)  the  question 
of  preliminary  tracheotomy. 

Firfl. — The  experience  under  the  fii-st  head,  in 
this  city,  was  emVnaced  in  the  cases  of  Dr.  Sands  and 
Dr.  Peters.  They  had  adopted  the  plan  of  taking  out 
the  lower  portion  of  the  upper  jaw,  as  suggested  by 
Maisonneuve,  and  thus  eflecting  a  broad  entrance  to 
the  lateral  aspect  of  the  base  of  the  basilar  ].irocess. 
This  operation,  though  a  good  one  for  large  tumors, 
would  involve  an  unnecessary  disturbance  of  the 
parts  in  the  present  case.  Vallet's  operation  also  did 
not  seem  advisable,  though  in  it  less  destruction  of 
the  bony  parts  took  place,  with  an  efficient  lateral 
exposure.  The  speaker,  therefore,  in  this  instance,  as 
the  roof  of  the  mouth  was  a  wide  one,  determined 
upon  that  devised  by  Nelaton,  which  consisted  in 
cutting  through  the  soft  palate,  then  removing  a 
large  portion  of  the  hard  j^alate  along  with  part  of 
the  vomer.  [This  was  demonstrated  upon  a  sluall, 
as  was  also  bony  sections  of  Vallet  and  Maison- 
neuve.] 

This  method  exposed  the  basilar  process  and  nasal 
fossre  completely,  and  was,  he  thought,  best  adapted 
for  removal  of  tumors  of  moderate  size.  It  had  been 
done,  according  to  Robin-Masse,  seventeen  times 
with  only  three  deaths.  This  as  well  as  the  other 
operations  were  devised  with  the  idea  of  having  a 
permanent  opening  leading  to  the  basilar  process. 
The  osteoplastic  operations  shoTild  not  be  entertained 
by  the  surgeon,  because  of  the  well-known  tendency 
of  such  tumor  to  retui-n,  which  demanded  a  num- 
ber of  secondary  operations  often  extending  over 
vears. 


608 


THE  MEDICAL  RECORD. 


Second. — The  second  point  was  that  regarding  the 
advisability  of  doing  a  preliminary  tracheotomy. 

The  speaker  had  studied  the  question  carefully,  and 
had  tiaally  concluded  not  to  do  this.  In  Dr.  Sands' 
case,  however,  it  was  not  done,  and  the  hemorrhage 
was  easily  controlled,  and  trachea  saved  from  blood 
intrusion  by  keeping  the  head  well  forward,  with 
the  patient  only  under  partial  aniesthesia.  This 
plan  was  somewhat  troublesome,  but  eSeotive.  In 
Dr.  Peters'  ease  it  was  done  with  a  satisfactory 
result.  Notwithstanding  this.  Dr.  Weir  was  inMu- 
enced  in  his  decision  in  part  by  his  belief  that  tra- 
cheotomy was  not  the  comparatively  safe  operation 
often  supposed.  He  had  found  in  support  of  this 
view  that,  in  ninety-three  cases  of  tracheotomy 
perfomed  for  the  early  removal  of  foreign  bodies  in 
the  air  passages,  there  had  been  twenty-six  deaths. 
On  the  other  hand,  however,  the  risk  that  accrued 
frofli  blood  entering  the  trachea,  etc.,  was  not  to  be 
statistically  estimated.  He  believed  now  that  his 
decision  not  to  perform  tracheotomy  was  an  error 
of  judgment.  This  would  be  apparent  from  the  de- 
tails of  the  operation,  which  were  as  follows  : 
^The  patient  was  anresthetized  and  the'  head 
thrown  strongly  backward  over  a  hard  pillow  (Ro.se's 
position)  so  far  that  blood  would  not  i-un  into  the 
trachea,  and  sujjported  on  a  sand-bag.  The  ojiera- 
tion  was  then  begun,  with  the  mouth  held  open  by 
Dr.  Weir's  mouth  gag  ;  the  soft  parts  of  the  haid 
palate  were  cut  in  the  median  line  and  stripped  fi'om 
the  bone,  and  the  latter  divided  with  a  chisel  on  each 
side  from  the  level  of  first  biciispid  tooth  and  trans- 
versely at  this  point,  so  that  a  space  nearly  an  inch 
wide  was  made,  affording  a  complete  view  of  the 
tumor  antero-posteriorly,  with  no  difficulty  except 
quite  free  venous  oozing,  some  of  which  came  from 
a  wound  of  the  tumor  itself. 

At  this  moment  the  patient  suddenly  began  to 
gasp  and  choke.  The  speaker  could  not  say  whether 
blood  had  been  sucked  into  the  trachea  or  not. 
The  asphyxia  was  so  great  that  tracheotomy  was 
at  once  performed  with  a  single  cut,  a  tube  in- 
serted, when  the  patient  revived.  Dr.  Weir,  how- 
ever, noticed,  when  he  performed  tracheotomy, 
what  lie  considered  an  important  fact  in  connec- 
tion with  Rose's  method,  and  which  a  subsequent 
experience,  in  two  other  operations  in  which  the 
plan  was  adopted,  has  confirmed,  that  the  trachea 
was  so  stretched  that  the  anterior  and  posterior  walls 
were  very  close  together,  and  in  the  first  incision 
the  posterior  wall  was  nearly  cut  through.  It  seemed 
to  him,  therefore,  very  probable  that  this  stretching 
and  compression  of  the  trachea,  more  possil)le  in 
the  young  subject,  had  something  to  do  with  the 
bad  symptoms.  The  tumor  was  then  readily  re- 
moved without  any  difficulty  and  without  much  loss 
of  blood.  The  child  was,  however,  much  i)rostrated, 
but  rallied,  and  at  the  close  of  the  cauterization  of 
the  narrow  attachments  of  the  tumor,  was  apjiar- 
ently  doing  well.  He  was  then  removed  to  the 
ward.  In  a  few  moments  word  was  sent  up  that  the 
child  was  sinking.  Death  occurred  so  suddenly  that 
arterial  transfusion,  which  was  contemplated,  could 
not  be  resorted  to.  Tlie  tumor  was  attached  at  the 
usual  place  of  such  growths,  on  the  basilar  process. 
It  measured  1}  by  1|  by  Ijt  inches,  and  weighed  17 
grammes,  or  over  half  an  ounce.  Dr.  (1.  L.  Pea- 
body,  pathologist  of  the  New  York  Hospital,  pro- 
nounced it  a  fibro-sarcoma.  It  had  a  few  mucous 
cells,  and  probably  originated  as  a  myxo-sarcoma. 

Dr. Weir  would,  in  a  similar  case,  perform  the  same 
operation,  but  would    perform  preliminary  trache- 


otomy with  a  sponge  tampon  (Nussbaum)  in  the 
pharynx,  and  in  addition  would  then  keep  the  head 
le-ss  dependent — although  certain  .steps  of  the  opera- 
tion are  facilitated  by  this  position.  The  procedure 
adopted,  of  throwing  the  head  strongly  back,  is  an 
extremely  helpful  one  in  many  cases,  though  it  did 
not  work  well  in  the  present  one.  He  had  often  re- 
sorted to  it.  It,  however,  was  open  to  the  serious  ob- 
jection that  it  markedly  favors  venous  bleeding. 
Hence  the  usefulness  of  tracheotomy,  either  with  a 
Trendelenberg  tube  or  the  ordinary  tube,  and  plug- 
ging the  jiharynx,  in  permitting  a  variety  of  posi- 
tions suitable  to  the  exigencies  of  the  case. 

NASO-PHABTNGBAL    POLTPCS   WITH    EXTENSINE   ATTACH- 
MENTS— PROPOSED   OPERATION   FOR   REMOVAL. 

Dr.  George  F.  Shrady  said  that  Dr.  Weir's  case 
was  particularly  interesting  to  him,  as  he  had  at  the 
time  a  boy  upon  whom  he  proposed  to  operate  for 
the  same  trouble.  The  patient  was  fourteen  years 
of  age,  and  had  suffered  from  the  disease  for  three 
years.  The  growth  was  much  larger,  and  evidently 
had  more  extensive  attachments  than  in  Dr.  Weir's 
case.  It  entirely  filled  the  posterior  nares  on  the 
left  side,  and  straddling  the  post  nasal  septum,  par- 
tially occluded  the  right  posterior  nasal  opening, 
crowding  the  velum  palati  and  hard  palate  down- 
ward and  forward  almost  in  a  perpendicular  direc- 
tion. It  was  attached  to  the  basilar  process  of 
the  occipital  bone,  to  the  left  side  of  body  of  the 
sphenoid,  and  tp  the  margin  of  the  internal  ptery- 
goid plate.  Dr.  Shrady  also  believed  that  it  was 
adherent  to  the  apex  of  the  petrous  portion  of  the 
temporal  bone,  and  had  extended  through  the 
sphenopalatine  foramen  into  the  zygomatic  fossa, 
and  thence  into  the  spheno-maxillaiT  fossa.  The 
latter  was  more  than  probable,  as  exophthalmus 
existed  on  that  (the  left)  side.  Possibly,  also,  the 
antrum  was  involved,  crowding  up  the  floor  of  the 
orbit.  There  was  a  firm  movable  fibrous  tumor  in 
the  substance  of  the  left  cheek,  immediately  under- 
neath the  malar  process,  which  was  suspected  to 
have  a  connection  posteriorly  with  the  original  tu- 
mor through  the  spheno-maxillary  fossa. 

In  his  case  Dr.  Shrady  did  not  think  that  Yallet's 
or  Nelaton's  procedures  would  be  of  any  avail.  He 
proposed  to  perform  Maisonneuve's  operation  of 
partial  resection  of  the  upper  jaw,  saving  the  velum 
if  possible,  and  working  from  the  base  of  the  tumor 
either  into  the  antrum,  the  spheno-maxillary  fossa, 
or  both,  as  might  be  rendered  necessary.  He  be- 
lieved that  was  the  only  plan  that  would  give  him 
ample  room  for  rapidly  detaching  the  growth  and 
controlling  hemorrhage.  If  possible  he  would  sur- 
round the  V>a.se  of  the  tumor  when  exposed,  with 
the  galvano-cautery  wire,  and  remove  it  by  that 
means.  He  thought  Dr.  Weir's  experience  in  the 
case  related  empliasi/.ed  the  necessity  of  prelim- 
inary tracheotomy  in  all  similar  operations.  Dr. 
Shrady  would  certainly  open  the  windpipe  in  his 
case,  and  tampon  the  throat  with  a  sponge.  This  he 
thought  was  a  surer  and  simpler  procedure  for 
I)reventing  the  entrance  of  blood  into  the  trachea 
than  that  recommended  by  Trendelenberg  and 
others. 

Dr.  Shrady  stated  that  he  would  report  the  result 
of  the  operation  at  a  future  meeting  of  the  society. 

Dr.  Beverly  Koiunson  suggested  that  the  forc- 
ing back  of  the  neck  might  have  stretched  the 
pneumogastric  nerves  so  strongly  as  to  have  caused 
an  interference  with  the  heart's  movements,  or, 
indeed,  a  real  cardiac  paralysis. 


THE  MEDICAL  RECORD. 


609 


NEW  YORK  ACADEMY  OF  MEDICINE. 

SECTION  IN  PRACTICE  OF  MEDICINE. 

Stated  Meeting,  May  16,  1882. 

De.  John  C.  Peters,  Chairman,  jiro  tern. 

Vs.  L.  PoTZEii  read  a  paper  (see  p.  592)  entitled  : 

A  I'ASE  OF  HEMIPLEGIA,  ILLUSTKATINO  THE  CONNECTION 
OF  DESCENDING  DBGENEISATION  AND  ATKOPHY  OF  THE 
ANTERIOR  HORN  OP  THE  SriNAIj  CORD. 

Dr.  E.  C.  Seguin  said  there  was  nothing  to  be 
offered  in  way  of  criticism  upon  the  communication, 
and  he  regarded  it  as  an  esceedinglr  valuable  con- 
tribution to  the  Literature  of  the  subject.  He  had 
seen  several  cases  of  atrophy  occurring  in  jjaralyzed 
limbs  in  hemiplegia,  but  he  had  not  beeu  able  to 
obtain  jjost-mortem  examinations.  He  had  thought 
that,  in  these  cases,  there  was  a  degree  of  polio- 
myelitis, secondary  probably,  and  existing  upon  the 
same  side. 

Dr.  .V.  McL.  Hamilton  said  that  in  the  majority 
of  eases  he  had  found  evidence  of  secondary  degen- 
eration and  contractures,  and  more  or  less  atrophy 
of  the  upper  extremity  particularly,  and  probably 
in  one-half  of  the  cases  or  more  it  was  due  to 
secondary  degeneration.  But  he  had  not  been  able 
to  obtain  autopsies. 

Dr.  V.  P.  GiBNET  asked  whether  the  acute  atrophy 
which  occurred  was  the  same  as  that  seen  in  in- 
fantile paralysis.  His  ex2Jerience  differed  from  Dr. 
Putzel's,  in  that  he  did  not  recall  any  case  where 
any  grea*  amount  of  atrophy  took  place.  If  he 
frnmd  no  atrophy  in  the  upper  extremity,  and  it  was 
f mud  that  the  child  had  a  limiJ,  he  suspected  cere- 
bral hemorrhage.  He  supposed  that  Dr.  Putzel  re- 
ferred to  infantile  hemiplegia,  and  would  ask 
whether  any  gentleman  had  found  much  atrophy  in 
these  cases. 

Dr.  Sbghin  said  that  the  question  was  an  im- 
portant one.  He  thought  that  his  experience  ac- 
corded with  Dr.  Gibney's.  He  had  been  accustomed 
to  distinguish  between  what  he  had  called  relative 
atrophy  and  pathological  or  positive  atrojihy. 
Relative  lack  of  development  was  very  common,  and 
without  positive  atrophy ;  that  is,  without  disap- 
pearance of  muscular  tissue  and  the  presence  of 
abnormal  muscular  reaction. 

With  reference  to  atrophy  in  hemiplegia  in  adults, 
be  could  say,  as  Dr.  Hamilton  had  said,  that  it  was 
very  rare.  He  had  met  -nuth  one  case  in  which 
positive  atrophy  was  associated  with  hemiplegia, 
but  in  that  case  there  was  history  of  injury  upon 
the  side  of  the  neck  associated  with  the  peculiar  ap- 
pearance of  the  skin  and  nails  following  nerve  in- 
jury, and  he  should  not  be  willing  to  refer  to  it  as  a 
case  of  positive  atrophy  in  hemiplegia  occurring_in 
a  child. 

Dr.  Hamilton  thought  that,  in  a  great  many  cases 
iif  infantile  hemiplegia  with  atrophy,  the  history 
was  not  fully  known.  He  did  not  think  it  was  com- 
mon in  simjile,  ordinary  cases.  He  recognized  the 
distinction  between  relative  and  pathological  or 
positive  atrophy  mentioned  by  Dr.  Seguin. 

Db.  Van  Santvoord  asked  if  the  brain  lesion  was 
due  entirely  to  the  embolism  or  did  the  pachymen- 
ingitis participate. 

Dr.  PuTZEii  thought  it  was  almost  entirely  due  to 
the  embolism,  because  the  pachymeningeal  mem- 
brane was  so  thin.  With  reference  to  atrophy  in 
children,  he  did  not  mean  the  positive  pathological 
atrophy   mentioned   by   Dr.    Seguin.     He   did   not 


understand  how  that  could  occur  in  such  cases. 
What  he  meant  was  a  difference  in  the  size  of  the 
limbs,  presenting  about  the  same  relation  seen  in 
well-marked  cases  of  acute  polio-myelitis.  The  gen- 
eral appearance  of  the  limbs  compared  with  healthy 
ones  was  quite  frequently  as  well  marked  as  in  in- 
fantile paralysis. 
Dr.  a.  McLane  H-aiulton  then  read  as  follows  : 

A    case   of  WORD-BLDTDNESS  VriTH   LO.SS   OF   taste    ANT) 
SENSE  OF  LOCALIZATION. 

The  following  case  possesses,  I  think,  points  of 
interest,  because  a  rather  rare  collection  of  symp- 
toms are  presented  by  the  i^atient  who  has  recently 
been  under  my  oliservation.  The  most  remarkable 
manifestation  of  his  cerebral  disease — a  certain  im- 
pairment of  what  may  be  called  the  sense  of  rela- 
tion— is,  I  think,  unusual,  and  with  this  there  is  the 
affection  to  some  degree  of  the  faculty  of  localizing. 
The  man  also  was  apt  to  reverse  objects,  a  symptom 
which  was  a  feature  of  the  aphasia  of  the  late  Dr. 
Allin,  whose  case  has  been  so  admirably  reported  by 
Dr.  BaU. 

Wm.  H.  M ,  aged  thirty-three  years,  is  a  print- 
er. He  is  a  man  of  good  habits,  and  has  not  had 
syphilis.  His  family  history  is  good,  his  father  and 
mother  ax-e  alive,  and  there  is  no  neurotic  taint.  He 
possesses  more  than  ordinarj-  intelligence,  and  in 
following  his  trade  has  been  engaged  in  "  book- 
work."  He  was  always  considered  skilful  at  his 
trade  and  made  few  mistakes  in  composition.  He 
never  has  had  lead  disease. 

For  a  short  time  previous  to  October,  1881,  he  had 
had  domestic  troubles,  was  worried,  and  lost  ilesh 
and  strength.  He,  for  several  of  the  early  days  of 
October,  felt  "  distressed  about  the  head,"  and  had 
slight  Tertical  pain,  but  no  vertigo.  Upon  the  after- 
noon of  the  10th,  he  had  a  sense  of  impending  trou- 
ble, but  had  no  idea  of  his  real  condition  until  his 
foreman  called  his  attention  to  the  remarkable 
character  of  his  work.  His  "  stick  "  contained  mat- 
ter which  was  full  of  mistakes,  known  to  his  craft  as 
"  doublets."  .In  almost  every  line  he  had  repeated 
one  word  several  times,  and  many  of  the  words  were 
transposed.  In  other  places  the  type  were  upside 
down.  He  knew  nothing  of  all  this  until  his  atten- 
tion was  directed  to  it,  and  his  mistakes  were  re- 
peated to  him,  but  he  could  not  correct  them  but 
made  fresh  blunders.  At  half  jjast  five  he  still  felt 
badly  and  was  obliged  to  stop  work.  He  went  to 
a  neighboring  eating-house  where  he  had  frequently 
dined,  and  though  the  door  knob  was  large  he  had 
considerable  difficulty  in  finding  it.  After  entering 
he  staggered,  could  walk  only  with  difficulty,  and 
dragged  his  right  foot.  He  could  not  ask  for  what 
he  wanted  and  was  considered  drunk. 

He  managed  to  leave  the  place  and  went  home. 
His  right  leg  remained  numb  and  weak,  and  he  fell 
freqiiently.  He  remembers  that  while  walking  he 
was  inclined  to  i>roceed  in  a  semi-circular  direction, 
mainly  toward  the  right,  and  that  his  face  was 
turned  toward  the  right. 

He  next  became  unconscious  and  remembers 
nothing  until  next  morning,  when  he  was  found  by 
jiersons  who  had  broken  into  his  room.  He  heard 
all  questions  but  could  not  reply.  He  could  move 
his  right  leg  feebly  as  well  as  his  arm.  He  was  next 
taken  to  the  Chambers  Street  Hosi)ital,  where  he  re- 
mained for  two  days.  So  far  he  could  not  .speak, 
but  with  the  next  month  began  to  talk,  but  could 
not  read.  He  could  repeat  words  after  another  per- 
son. 


610 


THE  MEDICAL  RECORD. 


I  first  saw  the  patient  about  the  end  of  February 
last.  He  is  a  man  of  spare  build,  rather  poorly 
nourished,  and  has  an  annoying  cough.  He  pre- 
sents a  poorly  marked  paresis  of  the  right  side,  but 
there  is  a  very  slight  clumsiness  in  his  gait.  The 
dynamometer  shows  that  he  can  force  the  index 
about  twenty  degrees  farther  around  on  the  left 
side,  and  his  hand  grasp  is  stronger  on  this  side. 
The  right  angle  of  the  mouth  is  lower  than  the 
left,  and  there  are  transitory  fibrillary  tremors  of 
the  facial  muscles.  No  lead  line  is  to  be  foxin<l,  and 
there  is  no  marked  extensor  paralysis,  he  being  alile, 
with  his  hands  upon  the  table,  to  lift  upon  the  dor- 
sal surface  of  the  finger  a  weight  of  one  and  one-half 
pound.  Tactile  sensibility  and  the  temperature 
are  affected  on  the  right  .side.  He  has  occasionally 
frontal  headaches.  The  left  pupil  is  very  slightly 
dilated.  Has  control  over  tongue ;  no  deviation  of 
uvula  or  irregularity  of  fauces.  The  tendon  re- 
flex is  very  faint  on  both  sides.  There  are  no  dart- 
ing or  stabbing  pains.  There  is  no  cumulative 
tremor  when  a  cap  or  glass  is  carried  to  his  mouth. 
The  functions  of  the  bowels  and  bladder  are  unaf- 
fected. Specific  gravity  of  urine,  1020 — normal; 
heart  and  lungs  normal. 

Shortly  after  the  seizui-e  his  right  arm  would  often 
be  spasmodically  drawn  across  the  che.st,  and  at  the 
same  time  the  leg  would  be  flexed.  These  seizures 
were  temporary,  however. 

An  ophthalmoscopic  examination  was  made  by  Dr. 
Ely,  who  found  inflammatory  changes  in  the  vicinity 
of  the  macula  in  right  eye  ;  in  left,  large  patches  of 
retino-choroidal  atrojshy  were  found.  Both  optic 
disks  were  atrophic. 

The  patient  is  emotional,  and  sometimes  cries 
quite  easily.  He  is  able  to  converse  intelligently, 
seems  to  have  a  good  memory,  and  has  had  no  delu- 
sions or  hallucinations. 

The  interesting  feature  of  his  trouble  is  shown 
when  he  attempts  to  read.  He  does  so  with  great 
difiiculty,  going  over  the  ground  slowly  and  referring 
to  previous  words,  just  as  the  beginner  in  German 
does  who  is  troubled  by  the  construction  of  the  sen- 
tence he  is  attempting  to  unravel.  He  reads  sub- 
stituted words  which  look  something  like  those  of 
the  printed  matter  ;  for  instance :  Xew  Haven  for 
New  Hampshire;  situate  for  staled;  continue  for 
countersign;  desirous  ior  declares ;  aldermen  for  An- 
derson, etc.  ;  but  with  proper  names  he  had  great 
diflBeulty.  George  W.  Hunt,  a  name  printed  in  the 
paper  he  was  asked  to  read,  was  rendered  John  H. 
Hunt,  and  he  made  several  attempts,  and  finally 
gave  up  in  disgust.  He  prefixes  unnecessary  ar- 
ticles to  whatever  words  he  may  be  asked  to  read. 
He  knows  the  denominations  of  coins,  but  cannot 
add  them  up.  Though  his  trade  is  one  that  makes 
him  expert  in  estimating  distances,  lie  cannot,  wlien 
asked  to  make  a  line  of  certain  length,  api>roximate 
tlie  true  space.  He  always  fell  short.  A  line  three- 
eighths  of  an  inch  was  said  to  rejiresent  half  an  inch, 
and  three-fourths  of  an  inch  one  inch.  He  had  no 
idea  of  adjustment.  When  told  to  place  liis  index 
finger  on  the  figures  12  on  the  dial  of  my  watch,  he 
could  not  do  so  readily  ;  and  when  told  to  find  a 
point  midway  between  12  and  (i,  he  selected  4, 
and  repeated  the  test  several  times  without  know- 
ing Ills  mistake.  Upon  more  than  one  occasion  he 
has  made  singular  mistakes  in  the  location  of  ob- 
jects. One  of  his  duties  was  to  place  the  knives 
and  forks  at  the  jiationts'  plates.  He  once  or  twice 
placed  two  forks  or  two  knives  at  the  same  phite. 
At  other  times  he  i)laced  the  knife  and  fork  at  one 


plate  with  the-  points  reversed,  while  at  other 
plates  they  were  properly  arranged.  When  his  at- 
tention was  called  to  these  things,  he  always  ex- 
i:)ressed  great  surprise  or  annoyance,  but  invariably 
repeated  the  mistake  when  he  next  attempted  the 
act.  By  accident  a  very  curious  mental  condition 
was  discovered — a  loss  of  appreciation  of  situation. 
As  a  rule,  the  normal  individual,  when  aware  of  the 
direction  of  one  point  of  the  compass,  is  able  to 
designate  the  other.  If  he  is  placed  with  his  face 
to  the  north,  he  knows  that  the  east  is  on  his  right 
hand,  tlie  west  on  his  left,  and  the  south  behind 
him.  In  the  case  of  my  patient  the  case  was  dif- 
ferent. Dr.  O'Brien  and  myself  repeatedly  tested 
this  failure.  It  made  no  difference ;  and,  though  he 
could  tell  his  right  hand  from  his  left,  he  was  apt  to 
transpose  the  points ;  and  even  when  three  of  them 
were  properly  designated  after  prompting,  he  would 
be  apt  to  reapply  a  term  already  used  to  the  fourth. 

These  blunders  were  not  the  result  of  ignorance, 
for  he  conversed  intelligently  and  had  a  very  fair 
knowledge  of  general  geography. 

I  find  that  with  these  symptoms  there  is  some  loss 
of  taste — salt  or  sugar  not  being  recognized. 

Since  I  first  saw  him  there  has  been  decided 
diminution  in  the  aphasia,  and  under  large  doses  of 
iodide  of  potassium  lie  has  greatly  improved. 

Dr.  Potzel  said  that  of  course  the  diagnosis  was 
speculative  ;  but  in  view  of  the  well-marked  aphasic 
phenomena,  he  should  be  inclined  to  locate  the 
lesion  farther  back  than  had  Dr.  Hamilton,  and 
woiild  say  that  the  disease  existed  in  the  neighbor- 
hood of  the  first  tenijioral  and  the  third  frontal  con- 
volutions— perhaps  the  outskirts  spreading  farther 
back  toward  the  terminal  filaments  of  the  fi-ontal 
bulb. 

Dr.  Seguin  said  that  the  "  symptom  complex  " 
was  one  which  he  had  met  with  several  times,  and 
in  many  of  the  cases  there  had  been  hemiopia,  with 
shght  hemiplegia  and  persistence  of  some  kind  of 
aphasia — in  one  case  the  word  blindness,  and  in  an- 
other case  chiefly  the  word  deafness. 

If  there  was  hemiauiesthesia  in  Dr.  Hamilton's 
case,  with  recovery  of  motion  and  spoken  speech, 
more  particularly  the  reading  part  and  sense  of  lo- 
cation, it  seemed  to  him  the  suggestion  of  Dr. 
Putzel,  that  the  location  of  the  lesion  must  be  placed 
farther  back,  was  connect.  He  would  locate  it  very 
near  the  site  of  the  lesion  in  the  case  of  Dr.  Alliu 
who  had  recovered  from  motor  troubles,  had  only  a 
slight  degree  of  hemianivsthesia  and  no  hemiopia, 
but  there  remained  aphasia,  slightly  ataxic,  and  to 
a  certain  extent  ataxic  in  reading.  In  that  case 
there  was  a  patch  of  softening,  involving  the  inferior 
lobule,  not  extending  down  to  the  temporal  con- 
volution or  to  the  limits  of  the  pai'ietal  lobe. 

Dr.  Seguin  tlien  referred  to  a  case  in  which  the 
patient  was  able  to  sjiell  out  words  of  one  .syllable, 
but  was  unable  to  comprehend  a  word  of  tlin'i'  syl- 
lables ;  and  ho  could  write  in  five  or  six  languages, 
but  was  unable  to  speak  at  all.  The  peculiarity 
in  the  sense  of  location  in  Dr.  Hamilton's  case  was 
very  im]>ortant.  He  had  noticed  this  symptom, 
particularly  tlie  turning  of  things  upside  down,  the 
reversal  of  relations,  in  one  patient,  but  in  wiitint; 
he  did  not  got  the  lines  wrong.  For  example,  tlic 
patient  after  turning  the  pencil  around  two  or  three 
times  would  invariably  stop  it  with  the  pointed  end 
upward. 

Dr.  Hamilton  had  seen  one  other  case  in  whicli 
there  was  inability  to  take  hold  of  objects  by  the 
right  end.     The  symptom  with  which  he  was  espc- 


THE   MEDICAL  RECORD. 


611 


oially  struck  in  the  ease  he  had  reported  was  the 
jiatient's  inability  to  find  the  points  of  compass. 
With  regard  to  localization,  he  thought  that  the 
lesion  was  either  compound  or  one  beginning  in 
aphasia,  and  confined  to  the  third  convolution;  and 
srv.mdarily,  his  sense  of  the  relation  of  locality  was 
(lipendent  upon  an  extended  lesion  in  the  frontal 
lobes. 

TEMPORARY    HEMJAX.ESTHESIA   AND    APHASIA. 

Dr.  a.  H.  Smith  narrated  a  case  as  follows :  An 
associate  editor  of  one  of  our  weekly  papers,  a  man 
of  full  habit,  but  not  accustomed  to  taking  stimu- 
lants, on  a  Saturday  night  sat  uji  late  reading  proof- 
sheets,  and  in  the  morning  had  a  severe  pain  on  the 
left  side  of  his  head,  vomited  se%-eral  times,  his 
speech  was  confused,  and  he  had  great  difficulty  in 
remembering  words.  At  eleven  o'clock  there  was 
severe  pain,  some  nausea,  slight  fever,  a  sense  of 
numbness  of  the  right  hand  and  foot,  jjupils  sym- 
metrical, tongue  131'otruded  in  a  direct  line,  no  loss 
of  cutaneous  sensibility,  organs  of  special  sense 
normal,  speech  somewhat  thick,  slightly  ataxic,  and 
there  was  decided  ditKculty  in  recalling  certain 
words,  and  a  peculiar  disposition  to  iise  prominent 
words.  This  condition  jiassed  off  entirely  in  the 
course  of  the  day,  and  on  the  following  morning  he 
seemed  entirely  well. 

The  treatment  consisted  in  moving  the  bowels, 
and  giving  a  few  doses  of  bromide,  j.  What  was  the 
prognosis? 

Dr.  Seguin  thought  that  the  patient  was  in  danger 
of  a  recurrence  of  the  attack. 

Dr.  V.  P.  GiBNEr  narrated  a  case  as  follows : 

PARALYSIS    OP   ri.EXORS   OF  EIGHT   FOOT,    OF  CEREBRAL 
ORIGIN. 

Thos.  O'B ,  aged  twelve,  was  admitted  to  hos- 

pitid  June  13,  1879.  The  family  histoi-y  is  as  fol- 
lows :  Father  died  suddenly  of  heart  disease,  though 
we  could  learn  nothing  of  his  family.  Maternal 
family  thoughtto  be  rheumatic.  The  patient  had  ex- 
cellent health  during  infancy ;  indeed,  was  in  good 
health  and  free  from  lameness  up  to  twelve  months 
ago  when  he  is  i-eported  to  have  had  cerebro-spinal 
meningitis.  Was  ill  about  two  months.  Taken 
with  vomiting,  had  high  fever,  strabismus,  and  re- 
tention of  urine. 

Made  a  perfect  recovery  at  the  end  of  the  two 
months,  and  went  back  to  school,  and  was  to  all  ap- 
pearance well  for  two  months,  when  he  was  taken 
with  nausea  and  vomiting  in  school  one  day — went 
home,  ahd  was  sick  for  several  weeks,  having  pains 
thought  to  be  rheumatic  in  right  shoulder  and  arm. 
The  symptoms  finally  seemed  to  yield  to  a  blister  to 
the  nape,  and  he  was  well  again  for  two  or  three 
months,  when  one  day,  walking  in  the  street,  he  fell 
quite  suddenly,  without  loss  of  consciousness,  and 
on  getting  up  fell  again.  He  was  able  to  walk  home 
without  any  special  lameness,  but  three  days  later 
the  left  foot  and  ankle  became  weak,  and  he  dragged 
the  foot  in  walking.  This  member  continued  weak, 
the  arm  not  being  affected  at  all.  Within  a  few  days 
past  has  complained  of  pain  in  the  knee  of  same 
side. 

On  examination  the  only  loss  of  power  discovered 
was  in  the  anterior  tibial  and  peroneal  groups  of 
muscles  of  right  foot.  All  the  muscles  of  face  and 
upper  and  lower  extremities  examined  and  noted, 
but  details  not  transferred  in  this  report. 

He  could  not  extend  the  toes  or  flex  the  foot  or 
evert  the  foot.     No  anresthesia,  and  no  change  in 


electrical  reaction  to  either  cnmar.  The  right  foot 
colder  than  the  left. 

The  power  to  flex  and  extend  the  leg  not  quite  as 
great  as  on  left  side. 

Can  extend  foot  well. 

Kight  thigh  one  inch  smaller  than  its  fellow  ;  knee 
same  size,  and  calf  only  one-fourth  inch  smaller. 

Limbs  of  equal  length.  Decided  tenderness  on 
pressure  over  sjjinous  processes  of  first  and  second 
cervical  and  second  and  third  dorsal.  None  on 
concussion.  He  states  that  slight  blows  on  head 
cause  it  to  ache. 

The  treatment  consisted  in  daily  ajiplications  of 
faradism,  apparatus  to  retain  foot  in  normal  posi- 
tion, ergot  and  potass,  iodid. 

September  2Gth. — Discharged,  relieved  to  such 
an  extent  that  we  felt  like  pronouncing  the  case 
cured.  He  stands  squarely  on  both  feet  and  walks 
without  appreciable  lameness.  Can  flex  and  extend 
— indeed,  can  execute  all  the  movements  of  foot 
quite  as  well  on  the  right  side  as  on  left.  The  power 
in  the  flexors  is  only  about  one-half  as  gi'eat  as  it  is 
in  those  of  left  side.  The  faradic  reactions  dimin- 
ished about  one-half.  He  reported  for  observation 
on  the  7th  of  October,  and  was  found  to  have  had  no 
relapse,  and  again  on  the  loth  of  December.  On 
this  date  he  complained  of  frontal  headache  if  he 
walked  much  or  if  he  studied.  I  examined  him 
shortly  after  this  visit,  finding  a  certain  degiee  of 
hypermetropia  with  ophthalmoscope,  and  thinking 
his  headache  might  depend  on  the  error  in  refrac- 
tion, we  refeiTed  him  to  the  Manhattan  Eye  and  Ear 
Hosjiital.  Dr.  Webster  wrote  me,  December  20 : 
"  He  has  corneal  opacities,  both  eyes.  E.  E.  V=fft, 
hypermetropia  of  at  least  -.^f  by  ophthalmoscope. 
L.  E.  V  =  fH,  irregular  astigmatism  with  the  ophthal- 
moscope. But  little  can  be  done  for  this  eye  in 
the  way  of  glasses,  certainly  not  without  the  use  of 
atropia." 

Dr.  Putzel,  on  going  over  the  case  this  morning, 
regards  the  paralysis  of  cerebral  origin,  and  thought 
it  most  Ukely  a  hemorrhage  near  cortex — possibly  a 
i,umor.     I  ordered  ergot  again  in  3  ss.  doses,  t.i.d. 

March  8,  1880.  —  Reports  headache  subsided 
promptly  with  the  ergot. 

April  17th. — No  lameness.  No  headache  for  three 
months.  Taking  no  medicine.  Studies  now  with- 
out any  inconvenience. 

November  27,  1881.— Found  (living  at  224  East 
Thirty-sixth  Street)  and  in  good  health,  free  from 
lameness,  and  rarely  has  any  headache. 

Dr.  Segdej  thought  that  the  lesion  in  Dr.  Gibney's 
case  was  primarily  in  the  paracentral  lobule. 

Dr.  Pctzel  had  known  of  a  case  of  softening  of 
the  paracentral  lobule  associated  with  paralysis 
of  the  foot,  but  unfortunately  there  were  other  foci 
of  softening,  so  that  the  connection  was  not  clear. 

The  Section  then  adjourned. 


Treatment  of  Vomiting  in  Phthisis — Pappaia- 
.iDiCE  IN  Crout. — Dr.  Brookes  D.  Baker,  Govern- 
ment Physician  at  S.  Kona  Hawaii,  Sandwich 
Islands,  writes  :  "  I  have  found  by  experience  that 
the  vomiting  in  phthisis  can  be  controlled,  in  some 
thoroughly,  in  others  partially,  by  the  ether  spray 
on  the  back  of  the  neck,  doing  it  just  before  meals. 
In  very  bad  cases  I  have  used  it  on  the  stomach  as 
well. 

"  In  cases  of  croup  and  diphtheria,  the  juice  from 
the  green  fruit  of  the  pappaia  breaks  up  the  mem- 
brane, so  that  it  comes  away  quite  freely." 


612 


THE  MEDICAL  RECORD. 


THE  GERIMAN  CONGRESS  FOR  INTERNAL 
MEDICINE. 

Held  nt  Wiesbaden,  April  20,  21,  and  22,  1882.. 
Pbofessok  Prerichs,  op  BERLrN,  President. 
A  NEW  medical  organization  under  the  above  title 
met  at  Wie.sbaden,  Ajjril  20th.  Professor  Frerichs 
occupied  the  chair  as  President,  and  in  his  opening 
address  showed  the  need  and  purposes  of  the  new 
organization.  About  two  hundred  persons  were 
present,  including  such  prominent  men  as  Leyden, 
Rosenstein,  Koch,  Klebs,  Aufrecht,  Jurgensen, 
Ewald,  and  Nothnagel. 

A  number  of  important  debates  took  jjlace,  and 
many  interesting  papers  were  read. 

The  meeting  opened  with  a  discussion  on  Bright's 
disease,  introduced  by  Leyden  and  Rosenstein.  In 
the  final  resume  of  the  discvission.  Professor  Ley- 
den said,  among  other  things,  that 

Fimt. — Nephritis  is,  pathologically  sjieaking,  a 
unit,  inasmuch  as  there  is  no  essential  difference  be- 
tween the  parenchymatous  and  interstitial  forms, 
and  all  forms  of  nephritis  are  on  a  common  type. 

But  in  this  unity  there  is  so  gieat  a  variety  of 
symptoms,  such  differences  in  course  and  in  anatom- 
ical proportions  as  well  as  in  etiology,  that  for 
medical  piirposes  it  is  best  to  make  separate  sub- 


Second. — ^The  typical  nephritis  runs  its  course  in 
thi-ee  stages.  Contracted  kidney  may  undoubtedly 
follow  the  nephritis  resulting  from  scarlatina,  articu- 
lar rheumatism,  intermittent  or  typhoid  fever. 

Third. — Leyden  held  it  as  established  that  there 
is  a  form  of  contracted  kidney  not  the  result  of  a 
nephritis.  It  is  rather  developed  in  conjunction 
with  an  arterial  sclerosis,  and  is  usually  found  in 
old  age.  It  is  this  form  which  Bartels  has  described 
as  the  gray  contracted  kidney. 

Professor  Rosenstein  was  inclined  to  classify 
kidney  disease  from  an  anatomical  rather  than  a 
symptomological  standpoint.  He  did  not  believe  in 
arterial  or  capillary  fibrosis  as  a  starting-point  of  the 
disease,  but  thought  it  secondary. 

In  the  afternoon  session  of  the  Congress,  Dr. 
Koch  demonstrated  his  discovery  of  the  bacillus  of 
tubercle. 

The  discussion  upon  it  was  closed  by  Dr.  B.\g- 
iNSKT,  of  Berlin,  who  referred  to  the  fact  that  in 
children  chronic  cheesy  pneumonia  and 

jrniART   TUBERCULOSIS 

were  more  frequent  than  the  ordinary  chronic  phthi- 
sis as  seen  in  adults.  This,  he  thought,  due  to  tlie 
fact  that  in  children  the  right  heart  was  relatively 
stronger  than  the  left,  while  in  adults  the  reverse  is 
the  case.  For  this  reason  the  blood-pressnre  in  the 
lungs  is  greater,  proportionately,  in  children.  The 
lung-tissue  is  more  vascular  and  succulent,  and  af- 
fords a  better  nurture-ground  for  the  bacillus  tuber- 
culosis ! 

The  moi-ning  of  the  second  day's  session  was  do- 
voted  to  a  discussion  of  the 

ANTIPYRETia   TREATMENT. 

This  was  introduced  by  Libbermeister  and  Riess. 
The  former,  after  giving  the  history  and  object  of 
the  treatment,  laid  down  the  following  propositions 
as  expressing  his  own  and  Dr.  Riess's  views  : 

Firsl.—ln  many  cases  of  fever,  the  patients  are 
directly  in  danger  from  the  height  of  the  fever. 

Sucond. — In  such  cases  it  is  the  task  of  the  physi- 
cian to  try  and  reduce  the  temperature  by  appro- 
priate means. 


Third. — The  fundamental  principle  of  the  anti- 
pyretic treatment  consists  in  the  dii-eet  withdrawal 
of  heat  by  cooling  baths. 

Fourth. — In  many  cases  the  use  of  antipyretic 
medicines,  such  as  quinine  or  salicylic  acid,  is  in- 
dicated. 

Dr.  Kiess,  in  opening  the  discussion,  described 
his  method  of  treating  fever  patients  by  the  perma- 
nent baths  of  25"  R.  temperature.  He  showed  a  se- 
ries of  temperature  charts  of  his  cases.  He  was 
able,  he  said,  by  his  method  to  keep  the  temperature 
in  typhoid  fever,  pneumonia,  etc.,  almost  constantly 
within  normal  bounds,  and  to  cause  bad  symptoms, 
especially  cerebral,  rapidly  to  disappear.  Among 
275  cases  of  tyjihoid,  the  average  duration  of  the 
disease  was  18.2  days  ;  the  mortality  9.1  per  cent. 

A  very  lively  discussion  followed,  in  which  Drs. 
Jiirgensen,  Curschmann,  IJinz,  Gerhardt,  Riihle,  and 
Mayer  took  part.  All  recognized  the  vahie  of  the 
antipyretic  treatment,  but  there  was  great  dift'erence 
as  to  how  energetically  it  should  be  employed. 

Professor  Jurgensen  contended  strongly  for  the 
use  of  baths  as  soon  as  the  temperature  rose  to  a 
medium  height. 

Dr.  Curschji.^nn  warned  against  the  excessive  use 
of  baths  as  dangerous.  Cases  of  uncomplicated 
typhoid,  if  carefully  nursed,  will  run  a  good  course 
without  treatment.  In  his  hospital  he  had  treated  one 
hundred  to  one  hundred  and  fifty  cases  a  year  with 
a  mortality  of  six  per  cent,  to  seven  per  cent.  He 
used  quinine  and  baths,  the  baths  being  gradually 
cooled  as  directed  by  Ziemssen. 

Dr.  GERH.tRDT  maintained  similar  views  to  the 
previous  speaker.  The  patient  was  in  danger  from 
the  specific  poison  of  the  disease  as  well  as  from  the 
fever.  Besides,  some  diseases  needed  special  anti- 
pyretics ;  thus,  for  rheumatic  fever,  the  salicylates 
of  sodium  or  potassium  ;  for  intermittent  fever,  qiii- 
nine ;  for  typhoid  fever,  quinine  and  baths,  sui^ple- 
mented  by  alcohol  and  the  greatest  possible  amount 
of  nourishment.  He  did  not  believe  in  the  utility 
of  salicylate  of  sodium  in  t^i^hoid  fever. 

Dr.  Binz  argued  against  the  view  maintained  l)y 
Riess  that  our  treatment  of  fevers  must  necessarily 
be  symptomatic,  not  causal.  He  referred  to  the 
specific  action  of  quinine,  the  salicylates,  and  of  mer- 
cury in  syphilitic  fever.  In  giving  a  specific  it  is  not 
necessary  to  give  such  large  amounts  as  to  entirely 
annihilate  the  poison.  It  may  be  enough  to  simply 
hinder  its  active  develojjment  and  growth. 

Dr.  RfHLE  argued  very  strongly  for  the  abortive 
action  of  calomel  in  typhoid.    He  also  insisted  upon 
the  necessity  of  studying  the  individual  cafee  care- 
fully before  applying  any  form  of  antipyretic  treat-  ' 
ment. 

Dr.  Meter  advocated  the  use  of  warm  baths, 
2r>"  to  28°  R.,  for  children  with  fever.  He  gave  qui- 
nine also  in  1  to  1.5  gramme  doses. 

Professor  Eustein,  of  Gottiugen,  gave  a  descrip- 
tion of  the  pathological  anatomy  of 

OOUTY   arthritis, 

^■ith  microscopic  demonstrations.  He  showed  in  .a 
series  of  preparations  the  deposit  of  uric  acid  salts 
in  tlie  cartilaginous  tissues  and  the  gradual  destruc- 
tion of  these  tissues  thereby. 

Dr.  FiNKLER,  of  Bonn,  communicated  the  results 
of  his  experiments  upon  the 

TISSUE   OHANOES   IN    FEVER 

("  Pfiiger's  Archivs,"  XXVII.,  p.  2C.7).  He  found  that 
the  increased  oxidation  in  fevers  continues  even  iu 
cold  packs,  but  is  less  than  when  tlie  animal  is  in  a 


THE   MEDICAL  RECORD. 


613 


warm  medium.  The  increased  oxidation  in  fevers 
is  due  to  an  increase  of  the  same  tissue-changes 
which  occur  in  health.  There  is  an  increase  of  heat 
production  with  a  modification  of  the  heat-regu- 
lating apparatus. 

Dr.  Rossbach,  of  Wiirzburg,  spoke  concerning 
the  genesis  of  coi-yza,  and  also  upon  a  special  vaso- 
motor neurosis  of  the  pharrnx.  The  application  of 
cold,  wet  cloths  to  the  pre\"iously  warmed  abdo- 
men produces  a  powerful  reflex  constriction  of  the 
vessels  of  the  pharyngeal  mucous  membrane,  com- 
pletely emptying  them.  This  is  followed  by  a  hy- 
penemic  and  catarrhal  condition. 

Dr.  Eossbach  related  a  curious  case  of 

IN'TEKMITTENT   PH.\KT>"GITIS. 

The  patient  was  neurasthenic  and  hysterical.  He 
also  complained  of  hyperesthesia  of  the  skin.  He 
suffered  every  day  from  one  or  more  attacks  of 
swelling  and  redness  of  the  pharynx,  the  mucous 
membrane  presenting  the  perfect  image  of  a  catarrh. 
Without  any  treatment  it  would  go  away,  often  with- 
va  a  quarter  of  an  horu\ 

Dr.  Heuk  related  a  case  of  successful  extirpa- 
tion of  the  pylorus  for  cancer.  The  operation  was 
done  by  Prof.  Czemy. 

Prof.  XoTHSAaEL,  of  Jena,  communicated  the  re- 
sults of  some  investigations  regarding  the 
Acnos  OF  oprcM  and  morphixe  upon  the  intestine. 

He  found  that  the  constipating  action  of  these 
drugs  is  due  to  its  stimulation  of  the  splanchnic. 
Morphine  acts  upon  this  as  digitalis  does  upon  the 
vagus. 

Dr.  Finkelnbubg,  of  Bonn,  described  a  special 
form  of  nervous  disease  indirectly  resulting  from 
hypnotism.  A  boy,  aged  eighteen,  had  been  for 
some  time  in  the  service  of  the  celebrated  mesmer- 
ist Hansen.  As  a  result  lie  had  become  so  sus- 
ceptible that  even  the  recollection  of  Hansen's  pro- 
cedures would  throw  him  into  a  trance.  The  speaker 
considered  the  phenomena  to  be  due  to  a  psychical 
irritation,  which  acting  upon  vei-y  excitable  centres 
tetanized  them,  so  to  speak.  Other  centres  would 
be  more  or  less  modified  by  secondary  excitations 
and  inhibitions. 

Dr.  Lecbe,  of  Erlangen,  showed  that 

C.^^NE-SUGAR   TURNED   INTO    GRAPE-SrGAK 

in  healthy  human  stomachs,  but  that  the  process 
failed  ui  diseased  conditions.  Grape-sugar  has  not 
usually  been  found  in  the  stomach,  because  it  is 
80  soon  absorbed.  But,  if  such  absorption  is  pre- 
vented, it  will  be  found. 

Dr.  ZfELZER,  of  Berlin,  showed  preparations  il- 
lustrating the  action  of  chloroform  and  morphia  on 
the  one  hand,  and  of  strychnine  on  the  other, 

UPON   THE    SPINAL   CORD. 

By  the  first  the  tissue  decomposition  in  the  nervous 
system  is  hastened,  by  the  latter  it  is  diminished, 
as  is  shown  by  the  increase  and  decrease  of  the  re- 
lative amounts  of  phosphoric  acid  in  the  urine. 
There  are  corresponding  microscopic  changes  in  the 
spinal  cord.  Zuelzer  based  his  conclusions  upon 
experiments  on  eleven  animals,  dogs,  and  rabbits. 

Dr.  Schultze,  of  Heidelberg,  offered  an  explana- 
tion of  the 

PHENOMENA   OF   TETANUS 

in  some  oases.  He  thought  the  normal  excitability 
of  the  peripheral  electromotor  points  might  be  so 
excited  by  disease  as  to  cause  a  7-efte.i:  tetanus,  with- 
out having  to  assume  any  gross  lesion  of  the  system. 


Db.  Ungab,  of  Bonn,  spoke  regarding  the  value  of 

liETDEN'S  CRYSTALS  IN  THE  EXl'LANATION  OF  BBONCHIAL 
.ASTHMA. 

The  fact  that  these  crystals  are  found  not  only  in 
bronchial  asthma,  but  in  fibrinous  bronchitis,  sug- 
gested the  view  that  lironchial  astlima  was,  after  all,  a 
fibrinous  capillary  bronchitis,  and  that  the  symp- 
toms were  due  to  a  mechanical  plugging  of  the  bron- 
chioles rather  than  to  any  spasm. 

This  view  was  very  generally  disputed. 

The  Congress  then  adjourned  to  meet  again  in 
Wiesbaden  next  year.  It  was  considered  a  marked 
success. 

Professor  Frerichs  was  re-elected  President. 


Ueiu  instruments. 


A]Sr  IMPROVED  TJOTVEESAL    KNIFE    FOR 

UTERINE    SURGERY. 

By   a.   F.    C0:MINGS,    M.D., 


The  universal  knives  heretofore  used  in  uterine  sux- 
gei-y  are  so  heavy  in  the  handle  that  their  utility  in 
dissecting  and  'denuding  is  seriously  impaired. 
Their  shanks  and  joints  have  also  been  so  large  that 
they  have  obstructed  the  view,  and  it  has  been  im- 
possible to  use  them  in  delicate  operations.  Their 
cost  has  also  been  a  serious  drawback  to  their  gen- 
eral use. 

To  obviate  these  objections  I  have  devised  the 
knife  shown  in  the  accompanying  engraving,  which 


is  no  heavier  than  an  ordinaiy  scalpel,  and  which 
can  be  manufactured  for  less  than  half  the  cost  of 
any  other  universal  knife  yet  offered  to  the  profes- 
sion. 

It  is  patterned  after  the  ordinary  right-  and  left- 
hand  denuding  knives  in  regard  to  size  and  length 
of  handle  and  shank,  the  handle  being  octagonal  in 
form. 

The  shank  is  slotted  at  H,  and  the  inside  of  the 
slot  coiTugated  to  prevent  the  slipping  of  the  blade, 
the  shank  of  which  is  also  corrugated  and  clamped 
tightly  by  means  of  a  screw  passing  through  blade 
and  shank  of  handle  at  H. 

Fig.  A  is  a  double-edged  denuding  blade,  with 
shank  at  right  angles  to  its  flat  surface,  which  may 
be  readily  set  at  any  angle  in  the  handle  at  H. 
Gynecologists  will  readily  appreciate  this  adjust- 
ment when  they  remember  that  the  cervix  uteri  and 
vaginal  walls  upon  examination  rarely  present  at  the 
same  angle  in  diflerent  cases  or  conditions. 

Fig.  B  represents  an  ordinaiy  scalpel  blade,  and 
Fig.  C  a  probe-pointed  bistoury  for  anterior  or  pos- 
terior sections. 

The  engraving  shows  exact  size  of  blades,  shank  of 
handle,  and  joint,  but  for  lack  of  space  the  length 
of  handle  is  not  shown.  Including  shank  it  should 
be  about  seven  inches. 


614 


THE  MEDICAL  RECORD. 


ARMY   NEWS. 

Official  Lint  of  Changes  of  Stations  and  Duties  of  Offi- 
cers of  the  Medical  Department,  United  States  Armr/, 
from  May  21,  1882,  to  Mrv/  Ti,  1882. 

MosELBY,  E.  B.,  Captain  and  Assistant-Surgeon, 
granted  leave  of  absence  for  four  months.  S.  O. 
120,  A.  G.  O.,  May  24,  1882. 


iHctiical  Jtcms   anti  Iterus. 


CoNTAQious  Diseases  —  Weeklt  Statement.  — 
Oomparative  statement  of  eases  of  contagions  diseases 
reported  to  the  Sanitaiy  Bureau,  Health  Department, 
for  the  two  weeks  ending  May  27,  1882. 


Wxek  BndlBg 

fl 

i 

f 
£ 

D.'S 

S 

1 

i 

a 

i 

H 

^ 

s 

J 

Q 

1 

tH 

May    il,    1883. 

18 

5 

184 

•3 

196 

74 

10 

0 

May    28,    1882. 

6 

6 

131 

4 

191 

73 

14 

0 

KELATrvB  Power  op  Antiseftios. — The  Revue 
Scientijique  contains  an  abstract  of  experiments  made 
by  M.  de  la  Croix  to  ascertain  the  relative  vahie  of 
various  substances  in  preventing  the  development 
or  evolution  of  the  microbia  of  putrefaction.  He 
placed  finely  divided  boiled  or  raw  meat  in  water, 
and  ascertained  the  maximum  and  minimum  quanti- 
ties of  each  substance  that  were  efiective.  The 
figures  in  the  following  table  indicate  the  number 
of  gramme.s  of  water  in  which  one  gramme  of  the 
substance  mentioned  prevents  the  development  of 
microbia  : 


Substance  E-mploye 


Alcohol 

Chloroform 

Soda  biborate 

Eucalyptol. . .    

Phenol 

Thymol 

Potash  permanganate , . 
Borated  soda  salicylate . 

Benzoic  acid 

Sulphurous  acid 

Alum  acetate 

Salicylic  acid 

Mercury  bichloi-ide  . . . . 

Sulphuric  acid 

Iodine 

Bromine ,  . 

Chlorine 


Maximum  dose 

Minimum   dose 

in  which  de- 

in  which  de- 

velopment  is 

velopment    is 

not  arrested. 

arrested. 

30 

1.77 

134 

1 

107 

14 

308 

14 

1002 

10 

2229 

20 

3041 

35 

.3377 

30 

4020 

50 

7534 

72 

7535 

478 

7677 

343 

,S35S 

252."> 

KJ7S2 

i:;,'. 

20020 

410 

20875 

493 

34509 

431 

From  which  it  will  be  seen  that  chlorine,  the  hypo- 
chlorites, and  perchloride  of  mercury  are  verj'  elieo- 
tive,  while  alcohol  is  comparatively  impotent. 

A  Happy  SnisaBON.  — The  French  surgeon  CJos- 
aelin,  who  has  of  late  said  a  good  deal  about  his 
"  perfectly  safe  "  way  of  giving  chloroform,  has  been 


described  by  Chnrivuri  as  follows  :  "Gosselin,  a  sur- 
geon who  at  the  HOpital  La  Charite  cuts  off  limbs 
with  such  good  feeling,  and  disarticulates  with  such 
happy  ease,  that  he  seems  rather  anxious  to  cut 
something  in  order  to  amuse  himself.  His  smile  of 
bonhomie  makes  one  think  that  the  operation  is 
real  pleasure — to  himself." 

A  Dis.iPPOiNT.MENT.  —  The  Centura/,  which  an- 
nounced in  its  prospectus  that  it  would  advertise  no 
patent  medicines,  has  recently  appeared  with  a 
column  advertisement  of  the  notorious  "  Dr."  Flower, 

of  this  city. 

Medical  Inspection  of  Schools. — The  Sanitary 
Engineer  discusses  the  above  subject,  and  recom- 
mends the  appointment  of  medical  school  inspectors 
as  advocated  by  the  profession  so  long.  It  en-s, 
however,  in  saying  that  there  is  no  city  which  has 
such  inspectors.  In  Cleveland  there  is,  we  believe, 
practically  a  medical  sujjervision  of  the  schools. 

Purulent  Infantile  Ophthalsiia  is  treated  by 
Professor  Gosselin,  not  with  astringents  but  with 
alcohol  and  water  (  3  i.-  3  v.).  Four  or  live  injections 
are  used  daily.  Gosselin  .says  that  he  is  never  dis- 
appointed in  the  result.  We  fear  other  physicians 
may  be.     Prof.  Gosselin  is  a  sanguine  man. 

Dr.  Edward  W.  Jenk.s  has  been  obliged,  by  ill- 
health,  to  resign  his  position  as  Professor  of  Gyne- 
cology in  the  Chicago  Medical  College.  Dr.  Jenks 
thinks  that  he  will  have  to  return  to  Detroit.  In 
any  event  he  proposes  to  establish  soon  a  private 
hospital  for  the  diseases  of  women. 

Pij^Mic  Parotitis — a  Quert. — Dr.  A.  M.  Leonard, 
of  Camden,  N.  J.,  reports  the  following  interesting 

case,  and  asks  an  opinion  upon  it  :  "  Arthur  N , 

aged  sixteen,  some  four  weeks  ago  was  taken  with 
swelling  of  the  parotid  glands  on  both  sides,  but  be- 
lieving it  to  be  only  an  attack  of  mumps  no  jjliysician 
was  employed.  In  a  few  days  the  swelling  on  the 
left  side  abated,  but  that  on  the  right  began  to  sup- 
purate, forming  a  large  abscess  which  I  advised  him 
to  have  opened,  but  he  did  not,  and  camphor  was 
applied  to  '  scatter  it.'  as  they  afterward  told  me. 
Soon  after  he  began  the  applications  of  cam])hor  the 
entire  surface  of  the  body  broke  out  with  numerous 
small  vesicles,  which  soon  coalesced,  forming  large 
patches  resembling  somewhat  those  seen  in  poison- 
ing by  i\-y.  Vaseline  was  applied,  which  proved 
beneficial,  but  the  skin  about  the  neck,  hnnds,  and 
feet  underwent  complete  desquamation.  I  then  or- 
dered liim  to  take  30  TP .  st,t.  ferri.  iodide  three 
times  a  day.  Then  three  large  absces.ses  broke  out 
about  the  axillary  glands.  These  were  opened,  and 
they  discharged  a  thick,  dirty,  grumous  pus,  and 
he  has  now  recovered  his  usual  health. 

"  Now  is  this  condition  of  aflairs  due  to  lymphatic 
absorption,  or  to  some  peculiar  condition  of  the 
glands'?     I  suspect  there  is  some  strumous  taint." 

Self-^Iittilation. — Dr.  Thomas  Partridge  relates 
the  following.  I'l  propos  of  a  di.scussion  on  the  sub- 
ject of  self-mutilation  which  has  been  going  on  in 
the  Jiritixh  Medical  Journal:  "Several  years  ago, 
when  assistant  surgeon  in  a  foreign  naval  service, 
my  .ship  was  stationed  for  three  weeks  in  an  ex- 
treme northern  jjort  of  America.  During  our  stay, 
several  men  contracted  syphilis  from  the  half- 
breeds  (Indian  and  French).  Three  weeks  or  a 
month  afterward,  when  we  had  returned  to  our 
deiiot,  I  was  summoned  to  the  surgical  room  to  see 
a  stoker,  said  to  be  dying.     On  arrival,  I  found  him 


THE  MEDICAL  RECORD. 


615 


pallid,  with  a  weak  pulse,  and  very  exhausted.  On 
removal  to  the  sick  bay,  I  noticed  a  discoloration  of 
the  trousers  about  the  thighs  ;  and,  on  examination, 
detected  bleeding  from  the  penis.  On  retracting  the 
prepuce,  a  jet  of  red  blood  spurted  out.  Calling  in  the 
assistance  of  my  chief,  we  succeeded  in  stopping  the 
hemorrhage  by  pressure  and  styptics,  but,  as  may 
be  imagined,  not  without  some  trouble.  It  trans- 
pired that  the  poor  fellow,  an  Irishman,  of  a  low 
mental  type,  had  a  chancre.  He  thought  to  get  rid 
of  it  by  incision  ;  and,  in  doing  so,  wounded  the 
dorsalis  penis  artei-y.  The  pocket-knife  with  which 
he  cut  himself  was  in  his  pocket,  one  blade  having 
a  smear  of  blood  on  it.  Had  a  little  longer  time 
elapsed  before  he  was  noticed,  death  would  have  en- 
sued, perhaps  leading  to  various  surmises  ;  and,  as 
he  was  disliked  by  his  mates,  this  might  possibly 
have  caused  unjust  suspicions  against  one  or  other 
of  them." 

The  Uses  of  NrrRATE  of  Silver. — Dr.  Chas.  K. 
Mills,  speaking  of  nitrate  of  silver  {Philadelphia 
Medical  Times),  said  that  in  nervous  disorders  he 
had  found  it  one  of  tlie  most  useful  remedies.  In 
posterior  spinal  sclerosis,  it  ranked  next  to  iodide 
of  potassium.  In  chorea  he  had  given  it  also  with 
apparent  success  ;  and  sometimes  it  seemed  to  be 
of  use  in  sclerosis  of  the  lateral  columns.  In  epi- 
lepsy it  was  not  so  good  as  the  bromides,  or  as  the 
zinc  salts  with  belladonna. 

Goitre  in  the  Lower  Animals. — Goitre  is  not  an 
affection  peculiar  to  man  alone  { Cii)cimi(ili  Lancet 
and  Clinic).  BI.  Adam,  veterinary  surgeon  at  Augs- 
burg, has  remarked  that  after  staying  a  certain 
length  of  time  in  that  city  a  number  of  horses  were 
attacked  with  goitre.  There  are  only  a  certain  num- 
ber of  stables  where  goitre  .shows  itself,  all  situated 
at  the  east  of  the  city.  It  is  impossible  to  determine 
the  cause  of  it.  Goitre  is  not  rare  with  the  dogs  of 
Augsburg,  and  is  unusually  fre(iuent  with  the  in- 
habitant i  of  that  city.  The  disease  does  not  prevail 
in  Switzerland,  however. 

Epidemic  of  Whooping-Codgh  in  London. — To- 
ward the  close  of  1881  whooi>ing-cough  became 
epidemic  in  London,  and  it  has  since  been  very- 
prevalent  and  fatal  there.  During  the  first  thirteen 
weeks  of  this  year  there  were  2, '224  deaths  from  this 
disease,  which  is  about  three  times  the  usual  rate. 

Disinfection  by  Bromine. — Dr.  Wernick  is  said  to 
have  made  the  use  of  this  powerful  disinfectant  lu-ac- 
ticable  by  employing  a  patent  siliceous  sponge,  in- 
vented by  Dr.  Frank,  and  which  is  saturated  with 
the  bromine.  A  piece  of  this  sponge  left  for  a  few 
hours  in  a  closed  room  will  completely  disinfect  it. 

A    New   Treatment    for    Pruritus. — Dr.  H.  K. 

Steele,  of  Denver,  Col.,  sends  to  the  Cincinnati  Lan- 
cet and  Clinic  a  description  of  a  new  method  of  treat- 
ing pruritus  of  vulva  or  anus  :  "  The  remedy  is 
quinia  sulphate,  rubbed  up  with  only  sufficient  lard 
to  hold  it  together.  The  nearer  you  get  the  full 
strength  of  the  quinia  the  more  efficacious  it  will 
prove.  Api)lT  freely  and  thoroughly.  It  has  proven 
a  specific  in  my  hands." 

A  New  Wax  to  Put  Off  Old  Age.— Dr.  William 
Schmcile,  Professor  of  Pathology  in  Bonn,  has  writ- 
ten an  ingenious  work,  entitled,  "  Wissenschaftliche 
Kunste  zur  Verlangerung  und  Verschijnerung  des 
menschlichen  Lebens,"  or  "  Scientific  Method  of 
Prolonging  and  Making  Comfortable  Human  Life." 
He  bases  his  method  upon  the  hypothesis,  that  the 


condition  known  as  old  age  is  produced  by  a  mis- 
proportion  between  the  organic  framework  and  inor- 
ganic constituents  of  the  human  body.  In  order  to 
l)revent  this  condition  and  preserve  the  elasticity  of 
youth,  it  is  only  necessary  to  introduce  some  sub- 
stance which  will  dissolve  the  excess  of  mineral 
matter  and  allow  of  its  absorption  and  excretion. 
Such  substances  are  the  inorganic  acids,  and  chief 
among  these,  citric  acid,  the  next  in  value  being 
lactic  acid.  Citric  acid  is  best  taken  in  the  form  of 
lemon-juice,  and  it  is  recommended  that  a  person 
swallow  the  juice  of  from  two  to  eight  lemons  daily, 
year  in  and  year  out !  Such  a  practice  also  secures 
one  against  the  attacks  of  rheumatism,  which  afflict 
old  age.  It  also  jjrevents  the  degeneration  of  the 
arteries  and  the  calcifications  of  the  vascular  sys- 
tems. Our  speculative  author  also  avers  that  many 
of  the  fevers  and  inflammatory  diseases  of  old  age 
are  due  to  reflex  and  sympathetic  processes.  He 
states  that  a  treatment  which  benumbs  these  re- 
flexes will  tend  to  ward  ofi  such  complications.  For 
this  purpose  he  advises  small  and  frequently  re- 
jjeated  doses  of  acetate  of  moi-j)hia.  The  number  of 
cases  illustrating  the  effects  of  this  scientific  elixir 
vit:e  are  small.  One  person,  who  fed  himself  on 
lemons  as  directed,  died  at  the  age  of  110,  and  then 
his  death  was  an  unnatural  one. 

German  Medh-al  Professor.shits. — In  place  of 
the  late  Professor  Duchek,  who  held  the  Chair  of 
Internal  Medicine  in  Vienna,  either  Professor  Erb  or 
Professor  Nothnagel  will  be  called.  In  Professor 
Klebs'  place,  at  Prague,  Professor  Ejipinger,  his 
assistant,  is  to  be  nominated. 

The  Number  of  Students  at  the  Vienna  Univer- 
sity during  the  past  semester  was  4,823.  Of  these, 
1,412  were  medical  students,  being  double  the  num- 
ber present  four  years  ago. 

M0RT.\LITY     FROM    ExCISION    OP   THE   ThYTJOID. — In 

a  review  of  the  subject  of  extirpation  of  the  thyroid 
for  goitre  and  other  troubles,  Kocher  {Correnpondem- 
Dlatt)  gives  the  following  statistics  :  Among  193 
cases,  in  which  the  gland  was  not  aflected  by  any 
cancerous  growth,  the  mortality  was  23.  Among  21 
cases  of  cancerous  disease,  the  mortality  was  13.  Of 
the  first  series  Professor  Billroth  removed  50,  with  a 
mortality  of  (i ;  Kocher  38,  with  a  mortality  of  5. 

Successful  Vaccination  after  Small-pox. — E. 
C.  Carter,  M.D.,  Assistant  Surgeon  U.  S.  Army, 
writes  :  "Two  soldiers,  who  had  had  small-pox,  were 
successfully  vaccinated  at  Angel  Island,  Cal.  Only 
one,  however,  had  well-marked  variola  scars." 

The  Late  Erskine  Mason,  M.D. — Resolutions. 
— At  the  stated  meeting  of  the  New  York  Pathologi- 
cal Society,  held  May  10,  1882,  the  following  report 
was  read  and  unanimously  adopted  : 

This  society  has  heard  with  profound  regret  of  the 
death  of  Dr.  Erskine  Mason,  at  one  time  its  presid- 
ing officer.  For  many  years  an  active  member,  he 
took  a  deep  interest  in  the  work  of  the  society,  and 
was  a  regular  attendant  at  its  meetings,  pre.senting 
many  valuable  specimens,  and  taking  part  freely  in 
its  discussions.  He  will  long  be  remembered  for 
the  clear  and  intelligent  manner  in  which  he  pre- 
sented his  cases,  and  for  the  valuable  lessons  he 
deduced  from  them.  By  the  death  of  Dr.  Mason, 
this  society  has  lost  one  of  its  most  active  and  effi- 
cient workers,  and  a  member  who,  by  liis  kindliness 
of  manner  had  endeared  himself  to  his  associates. 
Strong  in  his  convictions,  he  was  nevertheless  al- 
ways courteous  in  discussion  to  those  who  held  dif- 


61(5 


THE  MEDICAL  RECORD. 


ferent  opinions,  seeking  the  elucidation  of  the  truth 
rather  than  endeavoring  to  enforce  his  own  ideas. 
Strictly  honorable  in  all  his  professional  relations, 
he  hid  won  the  respect  of  his  brethren  both  as  a 
man  and  as  a  surgeon.  In  him  we  have  lost  one 
who  set  us  a  bright  example  of  energy  anl  industry, 
of  careful  and  thoughtful  study,  and  of  professional 
honesty  and  courtesy. 

Beso'lred,  That  the  above  minute  be  entered  upon 
the  records  of  the  society. 

BoBT.  Watts, 

J.  H.  BlPliEY, 

E.  L.  Keyes, 

('onimittci'. 

Intestin.^l  Obstrootion. — Dr.  J.  C.  Dreher,  of 
Smithville,  Ohio,  writes:  "In  reading  the  article 
'  On  the  Treatment  of  Some  Forms  of  Intestinal 
Obstructions  by  Opium,'  by  Prof.  George  E.  Post, 
M.D.,  in  the  Keoord  of  April  22,  1882,  I  am  re- 
minded of  a  case  which  came  to  my  notice  a  few 

years  ago.     Mrs.   C ,  seventy  years   of  age,  had 

an  irreducible  femoral  hernia,  intolerable  pain,  and 
fecal  vomiting.  Taxis,  enemata,  tobacco  poultices, 
etc.,  proved  unavailing,  and  an  operation  was  de- 
cided upon,  but  the  patient  preferred  death  to  the 
cutting.  Tobacco  jjoultices  were  again  continued, 
and  five-grain  doses  Dovers  every  three  hours  ad- 
ministered. On  the  lifth  day  of  treatment,  she  had 
three  or  four  spontaneous  moves.  All  pain  and 
sensitiveness  of  the  parts  ceased  on  the  second  day 
of  the  opium-treatment.  Her  recovery  was  rapid, 
and  she  is  alive  and  well  this  day.  The  Dovers 
used  in  this  case  contained  potas.  bromide  instead 
of  sulphate,  but  of  course  the  opium  did  the  work." 

FODB     MiCROCEPHALI    AND   ONE    ClINOCEPHALUS   IN 

ONE  Famlly. — Dr.  Tirizzi  i-eports  the  cases  of  five 
children  of  a  Catanian  couple,  of  which  four  were 
microcephalic  and  one  clinocephalic.  Two  mi- 
crocephali  are  still  living ;  the  author  dwells  at 
length  upon  the  history  of  one  of  these,  a  male, 
gives  a  short  7-('si(me  of  the  history  of  the  other,  a 
female,  and  briefly  refers  to  the  remaining  children. 
The  male  microcephalus  has  strange  habits  and  very 
little  intelligence,  but  his  senses  are  unimpaired. 
He  delights  in  running.  In  her  tendencies  and 
character  the  female  differs  altogether  from  the 
male.  In  concluding,  the  author  avails  himself  of 
the  cases  described  to  combat  the  evolution  theory, 
according  to  which  man  is  derived  fi'om  the  ape ; 
he  considers  a  microcephalus  not  a  type  of  man  re- 
verted to  the  primitive  human  form,  but  as  a  simple 
anomaly  or  aberration  from  the  normal  type.  "  We 
admit  neither  transformation,  pantheism,  or  mate- 
rialism," lie  writes.  "  Our  ideas  may  be  regarded 
as  old  and  obsolete,  but  this  is  of  little  importance 
to  us,  inasmuch  as  distinguished  men  and  men  of 
profound  thought  hold  the  same  opinions  as  we.  Un- 
less facts,  carefully  observed  and  well  authenticated, 
and  undisputablo  proof  are  offered  to  sustain  other 
theories,  we  will  not  deviate  the  least  from  the  path 
we  have  laid  out." — Annali  Universi  di  Med.  e  Chit:, 
June,  1881. 

The  Danlsh  Veterinary  Society  has  offered  a 
prize  of  2,000  francs,  and  a  second  of  1,000  francs, 
for  the  best  essays  on  the  benefits  to  living  animals 
which  have  resulte<i  from  vivisection.  The  essays 
may  be  written  in  Danish,  Swedish,  English,  French, 
or  German. 

Professor  Arlt,  the  venemble  oculist  and  senior 
member  of  the  Vienna  Medical  Faculty,  celebrated 


on  April  18th  the  jubilee  of  his  seventieth  birthday. 
Professor  Arlt  has  kept  in  active  practice  up  to  the 
present  time.  He  now  retires  as  a  teacher  in  the 
University. 

Analysis  of  Bitteb.s. — Dr.  H.  W.  Vaughan,  State 
Assayer  of  Bhode  Island,  has  made  a  report  on  the 
analysis  of  the  various  "  bitters  "  found  in  the  mar- 
ket, classifying  them  in  three  divisions :  1,  bever- 
ages ;  2,  medicinal  beverages  ;  3,  reputed  medicines. 
The  percentage  of  alcohol  in  some  of  class  1  is  as  fol- 
lows: Hostetters,  13.20;  Baker's,  10.o7 ;  Drake's 
Plantation  Bitters,  .38.24;  Wild  Cherry,  .35.89; 
Standard  Wine  Bitters,  25.19 ;  Peruvian  Bitters, 
22.10  ;  Sherry  Wine  Bitters,  22.10 ;  California  Wine 
Bitters,  Is.  20. 

Those  of  the  second  class  vai-y  from  10. 10  per  cent, 
of  alcohol  in  Atwood's  Quinine  Bitters  to  1G.08  in 
Luther's  Temperance  Bitters.  Those  of  the  third 
class,  professedly  designed  as  medicines,  but  very 
well  suited  for  forming  a  taste  for  all  kinds  of  strong 
drink,  vary  from  veiT  strong  to  very  weak.  For  in- 
stance :  Eichardson's  has  59.11 ;  Wan-en's  Bilious 
Bitters,  29.60  ;  Atwood's  Jaundice  Bitters,  25.60 ; 
Puritan  Bitters,  25.50 ;  Hoofland's  German  Bitters, 
20.85  ;  Oxygenated  Bitters,  19.23  ;  Walker's  Vinegar 
Bitters,  7.50  ;  Pierce's  Bitters,  6.36. 

Endowment  or  Jefferson  Medical  College. — 
A  movement  is  on  foot  to  secure  a  permanent  en- 
dowment fund  for  the  college.  The  subject  was 
proposed  at  the  .\lumni  meeting  and  referred  to  the 
Executive  Committee.  At  the  Alumni  supper  one 
member  pledged  himself  to  raise  ^^1,000  before  the 
next  meeting  of  the  association. —  Coll.  a»d  Clin, 
Record. 

The  Middlemore  Prize  in  Ophth.vlmology. — 
We  are  requested  to  remind  intending  competitors 
for  this  prize  that  all  essays  must  be  forwarded  by 
May  31st  next,  under  cover,  with  a  sealed  envelope 
bearing  the  motto  of  the  essay,  and  containing  the 
name  and  address  of  the  author,  addressed  to  the 
General  Secretary  of  the  British  INIedical  .Association, 
161a,  Strand,  London.  The  amount  of  the  prize  is 
£50  ;  and  the  subject  of  the  essay  is  "  The  Scientific 
and  Practical  Value  of  Improvements  in  Ophthal- 
mological  i\[edicine  and  Surgeiy  Made  or  Published 
in  the  Past  Three  Years." 

Medical  Kegister  of  New  York,  New  Jeb.sey,  and 
Connecticut. — Vol.  XX.  of  this  annual  for  the  years 
1882  and  1883,  commencing  .June  1,  1882,  has  made 
its  appearance  promptly  on  time,  and  is  full  of  the 
usual  interesting  material.  The  city  list  is  increased 
by  one  hundred  names,  and  a  full  list  of  all  the 
apothecaries  in  this  city  and  Brooklyn  has  been 
added.  It  is  got  up  in  its  usual  style,  and  reflects 
credit  upon  the  indefatigable  editor,  Dr.  AV.  T. 
WHiite. 

The  Abortive  Treatjient  of  Buboes. — Dr.  M.  K. 
Taylor,  Assistant-Surgeon,  United  States  Army,  de- 
scribes (American  Journal  of  Medical  Sciences)  a  very 
succe.ssful  method  of  treating  buboes,  .adopted  by 
himself.  When  the  glands  have  reached  a  moder- 
ately large  size,  he  freezes  the  surface  with  ether, 
seizes  the  gland  Vietween  the  fingers  and  injects 
about  twenty  minims  of  a  carbolic  acid  solution 
(wr.  iv.  to  3  j.)  Pain  and  sorenes.->  leave  very  soon, 
and  the  patients  are  generally  able  to  resume  work 
within  three  or  four  days.  Dr.  Taylor  has  tested 
his  method  on  as  many  as  150  cases.  He  has  used 
it  successfully  also  in  non-specific  enlargement  of 
cervical  glands. 


Vol.  XXI.-No.  23. 
June  10,  1882. 


THE  MEDICAL  RECORD. 


617 


©rigiuftl  ComimiiticatujnQ. 


A  STUDY    OF    NASAL    CAT.ARRH,    BASED 
ON   PATHOLOGICAL   INVESTIGATION. 


PROFES: 


By  F.  H.  BOSWORTH,  M.D., 

IF   DISEASES    OF   THE   THROAT.    IN  THE  B^  LLETCE   HOSI 


TAL   MEDICAL    COLLEGE,    NEW   YORK. 

TWO  FORMS  OF  THE  DISEASE,  RHINITIS  HTPERTROPHICA 
AND  RHINITIS  ATROPHICA,  CONSTITUTING  IN  ITS  LAT- 
TER  STAGES   THE    SO-CALLED   OZXNA. 

That  our  knowledge  of  nasal  catarrh  is  based  far 
more  on  clinical  study  than  on  pathological  investi- 
gation is  not  surprising  when  we  remember  how 
rarely  post-mortem  examinations  are  extended  to 
the  nasal  mucous  membrane,  and  also  that  in  those 
cises  which  demand  the  removal  of  diseased  tissue 
this  ablation  has  been  usually  accomplished  by 
means  of  destructive  agents.  Since  Dr.  Jarvis  in- 
troduced his  ingenious  snare  ecraseur,  I  have  made 
very  extensive  use  of  his  instrument  in  the  nasal 
cavity,  and  in  this  manner  have  been  able  to  remove 
portions  of  the  diseased  membrane  en  masae,  and 
in  such  a  shape  that  they  have  furnished  me  with 
sections  for  microscopical  study  in  which  the  struc- 
ture of  the  membrane  has  been  absolutely  unmuti- 
lated.  I  have  thus  secured  specimens  from  all  por- 
tions of  the  nasal  cavity,  and  in  all  varieties  and 
stages  of  catarrhal  inflammation.  Nasal  catarrh  is 
an  unfortunate  and  indefinite  name,  but  it  has  been 
di'jjaifled  by  such  longtime  usage  that  it  is  very  dif- 
ficult to  abandon  it.  We  may  accept  the  term  "  ca- 
tarrli "  as  defining  the  prominent  symptom  of  the 
liisi-ase,  viz.,  an  inflammation  characterized  by  a 
rtuid-  discharge  in  distinction  from  a  croupous  or 
diphtheritic  inflammation  in  which  the  exudation  is 
j  membranous  ;  but  an  excess  of  fluid  discharge  is 
I  also  met  with  in  syphilitic  and  strumous  disease  of 
I  the  nose,  and  these  diseases  are  ulcerative  in  char- 
'  acter,  and  bear  no  relation  whatever  to  catarrhal  dis- 
j  ease  of  the  nose,  and  should  never  be  classified  in 
the  same  category.  Excess  of  discharge  is  also  a 
symptom  of  nasal  polypus,  fibroid,  and  other  tumors, 
'  tbe  presence  of  foreign  bodies,  etc.,  but  these  aflfec- 
!  tions  are  not  to  be  regarded  as  varieties  of  nasal  ca- 
tarrh. 

On  the  other  hand  we  may  use  the  term  nasal  ca- 
tarrh as  defining  the  character  of  the  morbid  pro- 
cess which  is  going  on  in  the  nasal  mucous  mem- 
brane, viz.,  an  inflammation  of  a  catarrhal  character, 
and  this,  it  seems  to  me,  is  its  proper  significance. 
There  still,  however,  remains  an  element  of  indefi- 
niteness.  By  common  consent  the  termination  Ms 
is  used  to  designate  inflammation,  as  bronchitis,  etc., 
but  as  we  proceed  upward  in  the  air  jjassiges,  we 
stop  at  pharyngitis,  and,  dropping  an  excellent  .sys- 
tem of  nomenclature,  designate  an  inflammation  of 
the  lining  membrane  of  the  nose  as  nasal  catarrh, 
and  then  loosely  use  the  name  to  cover  a  number  of 
totally  distinct  diseases.  The  Germans  have  adopted 
the  name  "rhinitis"  to  define  an  inflammation  of 
the  nasal  mucous  membrane,  and  in  the  interest  of 
exactness  it  is  to  be  desired  that  the  name  may  be 
generallv  adopted,  in  our  text-books  at  least.  All  in- 
flammations of  mucous  memljranes  are  either  ca- 
tarrhal, croupous,  or  diphtheritic.  By  common 
usage,  when  we  use  the  name  bronchitis,  pharyngi- 
tis, etc.,  we  refer  to  a  catarrhal  inflammation,  while 
the  latter   varieties  are   designated   by  the   prefix 


croupous,  or  diphtheritic.  We  may  then  under- 
stand rhinitis  to  define  a  catarrhal  process.  In 
my  study  of  the  patliology  of  the  nasal  mem- 
brane, I  find  that  the  whole  subject  of  chronic  nasal 
catarrh,  so-called,  may  be  emViraced  under  two  va- 
rieties, one  of  which  consists  in  a  true  hypertrophy, 
while  the  other  is  characterized  by  atrophy  of  the 
membrane.  Following  the  above  nomenclature, 
these  are  : 

First. — Khinitis  hypertrophica  chronica. 

Second. — Khinitis  atrophica  chronica. 

The  first  variety  corresponds  to  what  we  usually 
call  hypertrophic  nasal  catarrh.  The  second  variety 
corresponds  to  what  is  usually  called  dry  catan-h, 
and,  in  its  later  stages,  ozana. 

For  a  better  comprehension  of  the  changes  which 
take  place  in  the  membrane  as  the  result  of  these 
morbid  processes,  the  structure  of  the  normal  mu- 
cous membrane  may  be  briefiy  described.  That 
portion  of  the  nasal  cavities  which  is  above  the  up- 
per border  of  the  middle  turbinated  bones  is  called 
the  olfactory  tract,  while  the  lower  portion  is  called 
the  respiratory  tract.  The  structure  of  the  mucous 
membrane  in  these  two  regions  diflers  quite  mark- 
edly. In  the  olfactory  region  there  is  found  a  thick, 
soft  membrane,  containing  numerous  glands  pecul- 
iar to  itself,  together  with  epithelial  and  olfactory 
cells,  in  which  the  olfactory  nerve  terminates.  This 
region  I  believe  to  be  rarely  if  ever  involved  in  the 
morbid  processes  which  characterize  nasal  catarrh. 

In  the  respiratory  region  we  find  a  mucous  mem- 
brane which  resembles  more  closely  the  ordinary 
membrane. 

In  Fig.  1  is  shown  a  section  of  a  typical  mucous 


\/ 


membrane,  drawn  somewhat  diagramatically.     It  is 
composed  of  three  layers,  an  epithelial  layer  (c),  the 


618 


THE  MEDICAL  RECORD. 


mucosa  proper  or  adenoid  layer  (/),  aud  the  submu- 
cous connective-tissue  layer  (a).  In  the  respiratory 
tract  of  the  nose  the  epithelial  layer  is  composed  of 
ciliated  epithelia,  with  the' ciliary  vibratory  move- 
ments toward  the  posterior  nares.  The  mucosa 
proper  is  composed  larj;ely  of  connective  tissue, 
with  a  few  fibres  of  elastic  tissue.  In  this  layer  is 
found  a  large  number  of  blood- vessels  iind  nerves, 
together  witli  a  numerous  distribution  of  glands  of 
the  acinous  variety  {d),  but  with  more  tortuous  out- 
lets. It  is  in  the  submucous  layer,  however,  that 
the  most  striking  changes  from  the  simple  type  are 
found.  Kohlrausch,*  in  1853,  described  what  he 
supposed  to  be  merely  large  venous  sinuses,  as  ex- 
isting in  this  layer  of  the  membrane.  In  1873,  Bige- 
low,t  of  Boston,  demonstrated  that  these  so-called 
sinuses  or  loops  of  Kohlrausch  composed  a  true 
erectile  tissue.  The  observations  of  Kohlrausch 
were  made  by  injecting  the  jugular  vein,  while  Bige- 
low  indited  the  tissue  locally,  demonstrating  the 
existence  of  a  true  erectile  tissue,  in  the  same  man- 
ner as  is  done  with  the  penis.J 


Via.  2.— Section  of  the  CavcmonB  or  Erectile  Tisfliio  of  the  Middle 
and  Lower  Turbinated  Boned,  inHuted  and  dried,  x  2  diameters.  (Bige- 
low. ) 

This  tissue  is  very  beautifully  shown  in  Fig.  2, 
from  Bigelow's  original  article,  tlie  parts  having 
been  first  inflated,  tlien  dried,  and  the  section  made. 
This  cut,  it  may  be  mentioned,  also  shows  why, 
after  cutting  operations  upon  this  tissue  resulting 
in  hemorrhage,  the  use  of  hemostatics  is  iitterly 
futile,  as  lias  been  my  almost  unvarying  experience, 
and  that  the  only  resort  for  the  arrest  of  the  bleed- 
ing is  in  the  use  of  plugs. 

Returning  now  to  the  morbid  changes  as  the  re- 


•  Mttllcr'i:  Archives,  1883,  p.  Ufl. 

t  Boston  Medical  and  Surficnl  Journal,  April  29,  187B. 

X  Sattcrthwaitc  :  Mannal  of  HIstoloKy. 


suit  of  inflammatory  processes,  I  made  a  large 
number  of  cuttings  by  the  snare  from  various  por- 
ti.,ns  of  the  cavity,  and  found  that  the  changes  varied 
but  little  in  the  diflferent  regions. 


Fio.  .3. — Rhinitis  Hypertrophica  Chronica  :  A,  epithelial  layer ;  B, 
hmit-inc;  structureless  membrane;  C,  adenoid  layer;  D.  blood-vewd 
filled  with  blood  ;  E,  acinous  pland  ;  F,  venous  sinu.s,  composing  the 
so-called  erectile  tissue. 

RHINITIS   HTPERTKOPHICA. 

The  accompanying  cut.  Fig.  3,  represents  a  section 
of  a  mass  removed  from  the  posterior  portion  of  the 
lower  turbinated  bone.  The  changes  may  be  de- 
scribed as  follows  :  The  whole  mucous  membrane  is 
markedly  thickened  and  deeply  corrngnted.  The 
epithelial  layer  is  augmented  or  increased  in  width. 
The  outermost  layer  of  epithelium  in  specimens 
from  middle  turbinated  bones  exhibit  fine  cilise, 
while  in  sections  from  the  lower  turbinated  bone 
the  cilipe  are  occasionally  wanting  in  places.  There 
are  deep  valleys  running  downward  into  the  adenoid 
layer  wliich  are  tilled  vrith  stratified  epithelia.  The 
latter  consists  of  elongated  epithelia,  ten  to  twelve 
layers  in  diameter.  The  layer  nearest  the  adenoid 
tissue  is  occupied  by  distinctly  developed  large 
columnar  epithelia,  wbicli,  especially  where  they  go 
to  till  the  valleys,  are  very  large,  and  corajiosed  of 
several  strata.  The  boundary  line  between  the 
epithelia  and  the  adenoid  tissue  is  everywhere  well 
marked,  and  in  some  places  there  is  even  pre.sent  a 
layer  without  distinct  structure,  the  so-called  strufl- 
tureless  membrane. 

The  (tdenoid.  Imier  is  very  wide,  and  is  composed 
in  most  of  a  myxomatous  retioulnni,  with  numerons 
lymph-corpuscles,  while  in  some  portions  the  lymph- 
corpuscles  are  very  scanty,  and  the  whole  mucosa  is 
composed  of  very  dense  decu.ssating  bundles  of 
fibrous  connective  tissue.  The  mucosa  is  in  nil  in- 
stances richly  snpjdied  with  relatively  wide  capillar^' 
blood-vessels,  mostly  filled  with  blood.  The  acinous 
mucous  glands  are  very  numerous  and  evidently  in- 
creased in  si/.e  and  number.  Thoy  are  composed  of 
cuboidal  epithelin,  whicli,  in  many  instances,  oNliibit 
the  features  of  inflammatory  corpuscles.     The  ducts 


THE   MEDICAL  RECORD. 


619 


of  the  glands  are  traceable  into  the  valleys  on  the 
surface  of  the  membrane,  where  their  columnar  epi- 
thelia  blends  with  that  of  the  outer  epithelial  coat. 

The  siibinucous  coat,  beneath  the  adenoid  tissue, 
consists  of  a  broad  layer  of  either  myxomatous,  or 
fibrous  reticular  structure,  in  which  there  are  present 
enormously  enlarged  blood-vessels  of  a  venous  char- 
acter. These  veins  are  so  abundant  that  they  com- 
pose a  true  erectile  tissue.  The  connective  "tissue, 
however,  between  these  large  veins  is  broader  than 
is  usually  found  in  true  cavernous  tissue,  and  is  sup- 
plied with  bundles  of  smooth  muscular  fibres.  The 
muscle-coat  of  the  veins  is  also  increased  in  breadth. 
The  arteries,  though  scanty,  are  all  of  a  wavv 
course,  constituting  the  so-called  helicine  arteries. 
The  submucous  layer  also  contains  a  number  of 
racemose  mucous  glands,  increased  in  size.  The 
presence  of  these  glands  in  this  layer  of  the  mem- 
brane is,  I  believe,  anomalous.  Ai-ound  these 
glands  there  are  found,  as  a  rule,  heaps  of  lymph- 
ccrpusoles. 

The  characteristic  features  of  hypertrophy  of  the 
nasal  mucous  membrane,  then,  may  be  briefly  sum- 
marized as  follows  : 

First. — Increase  of  the  covering  epithelium,  with- 
out desquamation. 

Second. — Increase  of  the  adenoid  layer  and  its 
eapillaries,  with  stagnation  of  blood,  together  with 
a  new  formation  of  tibrous  connective  tissue  replac- 
ing the  adenoid  layer. 

Third. — Increase  of  the  racemose  glands,  both  in 
the  adenoid  and  submucous  layer. 

Foartli. — Hypertrophy  of  the  connective  tissue 
between  the  enlarged  veins  in  the  submucous  layer. 
Fifth. — In  advanced  stages  of  the  hypertrophic 
process,  an  absence  of  lymph-corpuscles,  they  hav- 
ing evidently  been  transformed  into  connective 
tissue. 

There  are  certain  deductions  which  it  seems  to 
me  may  be  clearly  drawn  from  the  study  of  these 
morbid  changes.  In  the  early  stages  of  the  disease 
we  have  to  deal  with  merely  an  excessive  secretion 
from  the  diseased  membrane.  As  the  later  morbid 
conditions  develop,  we  find  two  new  features  added, 
viz.:  the  connective-tissue  hypertrophy,  resulting  in 
a  permanent  stenosis  ;  and  the  dilatation  of  the 
venous  sinuses,  resulting  in  a  liability  to  constantly 
recurring  but  temporary  stenosis  from  turgescence 
of  the.se  vessels  under  the  influence  of  various  irri- 
tating causes.  The  rational  treatment  of  hyper- 
trophic nasal  catarrh  should  therefore  be  based  on 
the  recognition  of  these  three  conditions:  (1)  ex- 
cessive discharge  ;  (2)  stenosis  from  structural  hy- 
pertrophy ;  (3j  temporary  stenosis  from  turgescence 
of  the  venous  sinuses. 

1.  The  proper  management  of  the  excessive  dis- 
charge in  the  use  of  the  virious  cleansing  and  as- 
tringent solutions,  and  the  methods  by  which  they  are 
best  applied,  is  familiar  to  all,  and  my  own  views  and 
methods  I  have  given  in  my  work  on  "  Diseases  of 
the  Throat  "  and  elsewhere. 

2.  The  treatment  of  the  structural  stenosis  by  the 
use  of  destructive  agents,  such  as  acetic  acid,  chromic 
acid,  the  galvano-cautery,  or  by  Jarvis'  snare  gcraseur 

I  has  also  been  sufficiently  described ;  and  I  have 
nothing  new  to  ofJ'er.  My  microscopic  examinations, 
I  however,  it  seems  to  me,  show  conclusively,  that 
,  when  we  have  structural  changes  in  the  nose,  such 
I  as  have  been  described,  we  cannot  accomplish  their 
!  absorption  by  medicated  solutions,  but  that  the 
:  tissue  must  necessarily  be  destroyed  or  ablated. 
As  I  have  shown,  in  comparatively  early  stages  of  the   I 


disease  there  is  an  extensive  transformation  of 
lymjjhoid  cells  into  connective  tis.sue,  and  in  the 
later  stages  these  lymphoid  cells  have  given  place 
entirely  to  connective  tissue  ;  and  certainly  when  the 
latter  has  occurred  the  only  resource  is  in  destruc- 
tion or  removal. 

In  a  paper  read  before  the  American  Laryngo- 
logical  Association,  in  June,  1880  (Arcliires  of  Laryn- 
gology, April,  1881),  I  called  attention  to  tlie  value 
of  glacial  acetic  acid  as  a  destructive  agent  in  hyjjcr- 
trophy  of  the  nasal  mucous  membrane.  Since"  that 
time  I  have  used  this  agent  to  the  exclusion  of  all 
others,  and  am  disposed  to  speak  most  positivelv 
of  its  value  above  all  other  caustics.  So  excellent 
are  the  results  that  I  have  obtained,  that  I  regard  it 
as  even  more  efficient  than  the  galvano-cautery,  and 
certainly  far  less  painful.  In  those  cases  "which 
admit  of  the  u.se  of  the  snare,  that  should  be  used. 
In  those  cases  in  which  the  snare  cannot  be  used,  I 
prefer  the  acetic  acid. 

3  When  there  is  a  constantly  recuiTing  but  tem- 
porary stenosis,  due  to  a  sudden  turgescence  of  the 
venous  sinuses,  I  think  we  may  infer  that  the  condi- 
tion is  due  to  an  impairment  of  tone  in  the  muscular 
coat  of  the  veins,  by  which,  under  the  influence  of 
various  exciting  causes,  such  as  a  damp  atmosphere, 
etc.,  the  vessel-coats  relax  and  the  vessels  become 
distended,  in  one  or  both  nasal  cavities,  or  perhaps 
alternating  from  one  to  the  other  In  those  cases 
in  which  l^his  condition  is  prominent,  I  have  found 
excellent  results  from  the  use  of  a  very  mild  faradio 
current.  The  electrode  which  I  have  devised  for 
this  purpose  has  served  excellently  well  in  my 
hands.  It  is  equally  adajjted  for  each  nasal  cavitv, 
and  can  be  applied  to  the  middle  or  lower  turbi- 
nated bones.  The  current  should  be  applied,  as  a 
rule,  twice  each  week,  and  for  about  two  to  three 
minutes  in  each  cavity. 

EHDjrnS   ATKOPHICA. 

The  accompanying  cut.  Fig.  4,  represents  a  sec- 
tion of  membiane  removed  from  the  middle  tur- 
binated bone  in  a  case  of  atrophic,  or  dry  catarrh, 
which  had  gone  on  to  the  development  of  fetid  dis- 
charges.    The  change  may  be  described  as  follows  : 

The  epithelial  layer  is  considerably  decreased  in 
width.  The  outer  nearly  smooth  surface  is  occu- 
pied by  a  relatively  broad  layer  of  flat  epithelia, 
partly  in  a  state  of  desquamation,  and  entirely 
devoid  of  ciliai.  Below  this  there  is  found  stratified 
cuboidal  epithelium,  displayed  in  five  or  six  layers, 
while  the  portion  nearest  to  the  adenoid  tis.sue,  in 
some  portions  at  least,  is  occupied  by  a  row  of 
columnar  epithelium.  Where  the  latter  is  i:i]ainly 
visible,  the  boundary  line  between  the  epithelial 
coat  and  the  adenoid  tissiie  is  distinctly  marked. 
In  many  places,  however,  the  boundary  line  cannot 
be  traced,  and  the  adenoid  seems  to  blend  with  the 
covering  epithelium,  while  the  latter  exhibits  fea- 
tures similar  to  those  of  the  adenoid  tissue. 

The  adenoid  layer  is  thinner  in  diameter  than 
normal,  and  is  occupied  by  crowded  lymph-cor- 
puscles in  a  very  delicate  fibrous  reticulum.  The 
capillary  blood-vessels  are  small,  scantily  distrib- 
uted, and,  as  a  rule,  quite  empty.  The  acinous 
glands  are  small,  and  evidently  diminished  in  num- 
ber. They  are  lined  by  a  short  columnar  or  (■nI)oidal 
epithelium,  while  their  ducts  exhibit,  around  a  large 
calibre,  well-defined  columnar  epithelium.  Around 
the  scanty  acinous  glands  there  are  heaps  of  lymph- 
corpuscles. 

The     submucous     layer.  —  The     adenoid    layer 


620 


THE  MEDICAL  RECORD. 


merges  into  a  layer  of  a  more  fibrous  constniction, 
with  relatively  less  numerous  lymph-corpuscles. 
There  is  a  lai-ger  number  of  blood-vessels  found  in 
this  layer,  which  on  an  average  exhibit  a  wider  calibre 
than  those  of  the  adenoid  tissue. 


The  prominent  features  of  the  atrophic  process  are 
briefly  as  follows  : 

First.  — Decrease  of  the  covering  epithelium,  with 
profuse  desquamation. 

S'.coii-l. — Decrease  of  the  adenoid  layer,  with  lack 
of  blood-vessels,  together  with  destruction  of  the 
acinous  glands. 

Third. — Pi.  total  disappearance  of  the  venous 
sinuses  of  the  submucous  layer  of  the  membi-ane. 

In  brief,  we  find  here  an  atrophy  of  the  mucous 
membrane  in  which  the  mox'bid  process  is  not  due 
to  a  connective-tissue  hypertroj^hy  encroaching  on 
the  glmdular  structures  of  the  membrane,  but 
rather  to  the  transformation  of  epithelial  structures 
into  inflammatory  corpuscles,  together  with  an  active 
epithelial  desquamation  from  the  surface  of  the 
membrane  and  the  lining  of  the  acini. 

As  has  been  seen,  the  follicles  are  surrounded  by 
heaps  of  lymph-corpuscles,  but  there  is  no  evi- 
dence of  transformation  of  these  corpuscles  into  con- 
nective tissue,  showing  thus  that  tlie  inflammatory 
process  is  most  marked  in  the  neighborhood  of  the 
acini,  but  that  it  does  not  develop  into  a  hyper- 
plastic process.  The  morbid  changes  are  therefore 
atrophic  from  their  outset,  and  bear  no  relation  what- 
ever to  tlie  hypertrophic  form  of  disease. 

Atrophic  catarrh  commences  in  the  very  large 
majority  of  cases  in  early  childhood,  but  its  progre.ss 
is  80  exceedingly  slow  and  insidious  that  it  may 
exist  for  several  years  before  it  gives  rise  to  any 
prominent  symptoms.  In  the  early  stage  it  consists 
merely  in  a  moderate  ooryza,  with  no  tendency  to 
the  drvness  or  formation  of  incrustations  which 
characterize  its  later  stages.  As  it  develops,  and 
the  glands  become  destroyed,  the  mucous  membrane 
commences  to  feel  their  loss.  The  supply  of  mucus 
becomes  deficient,  and  the  natural  result  is  that  it 


dries  upon  the  surface  of  the  membrane.  There  is 
thus  formed  on  the  convexity  of  the  turbinated  bones 
a  thin,  dry  pellicle  of  inspissated  mucus,  resembling 
in  its  appearance,  and  also  in  its  action,  a  film  of 
collodion.  In  drying  it  contracts,  and  thus  clings 
closely  to  the  rounded  turbinated  bones,  extending 
into  the  sinuosities  beneath  them.  This  condition 
gives  rise  for  the  time  to  more  or  less  in-itation  in 
the  parts,  with  a  feeling  of  burning  or  jmckling, 
which  lasts  until  the  small  incrustations  may  be  dis- 
lodged. These  crusts  may  recur  again  and  again 
for  weeks,  or  longer,  and  the  parts  improve  and  the 
symptoms  disappear  for  a  time.  The  further  pro- 
gress of  the  disease  shows  a  tendency  to  more 
frequent  recurrence  of  these  incrustations  ;  they  ad- 
here more  closely  and  remain  longer  in  the  canity, 
and  finally  a  new  development  of  symptoms  sets  in. 
As  these  crusts  form  on  the  surface  of  the  turbinated 
bones,  and  remain  for  days  even  at  a  time,  the  secre- 
tion of  mucus  goes  on  beneath  them,  but  being  pro- 
tected by  an  air-tight  covering  it  remains  fluid  until 
it  has  forced  or  broken  its  way  out,  thus  lifting  up 
the  incrustation.  In  this  way  the  dry  mass  is 
builded  up  from  beneath.  Moreover,  the  imprisoned 
mucus  soon  commences  to  degenerate  into  pus,  and 
become  decomposed.  We  thus  find  a  new  symptom 
commencing  to  show  itself  in  the  stench  which  these 
decompo.sing  masses  emit. 

It  is  easy  to  understand  the  progress  of  the  dis- 
ease thus  far  :  a  loss  of  glands  giving  rise  to  in- 
spissated mucus,  this  drying  and  adhering  to  the 
convexities  of  the  bones,  and  being  retained  thus  for 
days,  decomposing  and  giving  rise  to  an  odor :  but 
there  is  another  prominent  feature  of  the  late  stage 
of  the  disease  which,  as  far  as  I  know,  has  not 
been  satisfactorily  accounted  for,  and  that  is,  the 
atrophy  of  the  turbinated  bones.  If  we  examine 
the  nasal  cavities  of  one  who  has  sufl'ered  from  this 
disease  a  number  of  years,  we  find  them  exceed- 
ingly roomy,  and  looking  through  them  see  plainly 
a  considerable  area  of  the  wall  of  the  pharynx.  This 
roominess  is  due  to  an  almost  total  disappearance,  in 
many  cases,  of  the  lower  and  middle  turbinated 
bones.  These  bones  are  seen  simply  as  small  cord- 
like projections  from  the  outer  wall  of  the  ca%'itie8. 
In  cases  in  the  earlier  stages,  of  course,  the  atrophy 
of  the  bones  may  not  have  advanced  so  far.  This 
condition  I  believe  to  be  caused  by  the  pressure  ex- 
ercised on  these  bones  by  the  drying  and  contraction 
of  the  inspissated  mucus,  and  is  an  illustration  of 
what  we  very  often  see  in  disease,  viz.,  compara- 
tively trivial  cau.ses  acting  through  a  long  number 
of  years  resulting  in  morbid  changes  apparently  dis- 
proportionate to  the  vigor  of  the  exciting  cause. 
This  atrophy  is  undoubtedly  due,  in  part,  to  this 
direct  pressiire  upon  the  bone,  Vmt  its  mode  of 
action  is,  of  course,  to  interfere  with  the  nutrition 
of  the  bono  by  the  pressure  upon  the  membrane 
and  the  submucous  tissue  which,  in  this  region, 
forms  the  periosteum,  or.  at  least,  is  merged  with  it. 

Hartmann,  (iottstoin.  and  Fninkel  speak  of  this 
condition  of  the  turliinat.ed  bones  as  a  lack  of  devel- 
opment rather  tlian  an  atroj-liy.  I  liavo  found  that, 
as  a  rule,  the  extent  of  the  atrophy  of  the  bones  is 
an  indication  of  the  duration  of  the  disease,  and 
that  the  complete  atrophy,  which  characterizes  the 
later  stages  of  the  disease,  is  onlv  met  with  in  cases 
which  have  lasted  many  years,  while,  in  cases  of  a  few 
years'  standing,  this  wasting  of  the  bone  is  not 
prominent. 

As  the  secretions  become  pent  up,  and  the  mucus 
becomes   imprisoned   beneatli  the   crusts,    we  find 


THE  MEDICAL  RECORD. 


621 


that  the  mucous  discharge  becomes  converted  into  a 
purulent  one.  As  a  rule,  when  a  mucous  discharge 
occurs  in  a  closed  cavity,  as  the  vagina  or  urethra, 
it  becomes  purulent,  the  secretion  seeming  to  in- 
fect the  membrane,  exciting  a  renewed  activity  in 
cell  proliferation,  by  which  the  discharge  is  con- 
verted into  a  inirulent  one.  This,  it  seems  to  me, 
is  what  takes  place  in  the  nasal  cavity  under  the 
conditions  above  described. 

Another  symptom  of  oza^na  may  be  here  alluded 
to,  and  that  is  the  occurrence  of  a  dry  phar^-ngitis. 
This  symptom  is  very  constant,  and  its  occurrence 
should  always  suggest  an  examination  of  the  nasal 
cavity  for  the  probable  existence  of  an  atrophic  ca- 
tarrh. The]  method  of  its  development  is  very  sim- 
ple. The  accumulation  of  dry  crusts  in  the  nose, 
with  the  atrophy  of  the  turbinated  bones,  robs  the 
nares  of  their  normal  function  liy  which  the  inspired 
air  is  rendered  warm  and  moist.  Hence  the  air 
which  reaches  the  pharynx  is  abnormally  dry,  and, 
consequently,  its  membrane  is  soon  deprived  of  its 
moisture.  The  pharyngitic  sicca,  therefore,  is  a 
symptom,  artificially  produced,  rather  than  an  ex- 
tension of  the  disease. 

The  fetor  I  Vielieve  to  be  due  entirely  to  retention 
of  secretion ;  that  this  is  true  is  shown  by  the  fact 
that  it  is  removed  entirely  by  cleansing,  nor  does 
the  odor  return  until  there  is  a  new  formation  of  in- 
crustations. We  thus  find  the  fetor  developed  from 
a  purely  catarrhal  process,  without  ulceration  or 
necrosis,  and  due  entirely  to  retention  of  secretions 
and  their  subsequent  decomposition.  A  fetid  dis- 
charge never  occurs  in  the  hypertrophic  form  of 
catarrh,  but  is  only  met  with  in  the  atrophic  form. 
As  we  have  seen,  the  stench  is  only  a  symptom  of 
the  late  stage  of  the  disease,  but  still  it  is  the 
symptom  which  has  given  the  name  to  it  of  ozjpna. 
The  name  is  objectionable,  and  should  only  be  ac- 
cepted as  applying  to  a  class  of  diseases  in  the  nose 
which  are  attended  with  stench,  including  syphilis, 
scrofula,  etc.  At  the  recent  medical  congress,  in 
London,  the  subject  received  a  very  thorough  dis- 
cussion, but  it  only  served  to  bring  out  various  di- 
vergent opinions. 

Krause,  of  Berlin,  reported  the  results  of  two 
autopsies  on  patients  suffering  from  ozsena  or  atro- 
phic catarrh,  in  which  microscopic  changes  were 
found  almost  identical  with  these  I  have  given,  with 
the  exception  that  he  finds  large  numbers  of  fat- 
globules,  the  result  of  cell  disintegi-ation.  The  se- 
cretion of  this  fat.  its  retention  beneath  the  crusts, 
and  its  further  change  into  the  fatty  acids,  he  says, 
accounts  for  the  fetor  which  attends  the  disease. 
Loewenberg  suggests  that  the  fat-granules  which 
Krause  describes  are  micrococci.  Certainly,  the  ex- 
istence of  decomposing  fat  would  not  give  rise  to  the 
peculiar  odor  of  oz»na. 

E.  Frinkel  finds  numerous  bacteria  and  micrococci 
in  the  discharges,  and  reasons  that  the  fetor  is  due 
to  their  presence.  This,  it  seems  to  me,  is  simply 
asserting  the  existence  of  decomposition,  which  is 
always  attended  with  the  development  of  micrococci. 

Zaufal  attriliutes  the  development  of  ozasna  to 
the  peculiar  formation  of  the  nose,  which  favors  the 
accumulation  of  the  secretions.  The  peculiar  for- 
mation of  the  nasal  cavity  in  ozrena  is  a  result  of 
the  disease,  and  not  a  cause,  the  atrophy  of  the  tur- 
binated bones  occurring  as  a  result  of  the  atroj^hy 
of  the  membrane,  as  I  have  already  shown. 

Fournier  believes  that  the  odor  of  oza*na  is  due  to 
the  secretion  of  the  glands,  and  that  the  fetor  is  a 
secretion  peculiar  to  the  glands  of  the  nasal  mucous 


membrane,  and  that  it  is  made  prominent  by  the 
inflammatory  process.  This  is  ingenious,  but  I  be- 
lieve that  it  is  a  universal  rule  that  a  fetid  secretion 
does  not  occur  ;  an  excretion  may  be  fetid,  but  not 
a  secretion.  The  development  of  a  fetor  occurs 
after  the  matter  is  secreted.  Fournier  also  describes 
a  dry  and  a  moist  form  of  the  disease.  These  I  be- 
lieve to  be  one  and  the  same,  the  secretion  of  puru- 
lent matter  being  often  comcident  with  the  forma- 
tion of  incrustations. 

Watson  recognizes  three  forms  of  ozsena  : 

First. — ^The  eczematous  or  scrofulous  form. 

Second. — The  phthisical  or  lupoid  form. 

Third. — The  sy])hilitic  form. 

I  cannot  but  think  there  is  an  element  of  confu- 
sion here  in  classifying  syphilitic  and  scrofulous 
disease  of  the  nose,  which  I  believe  always  to  be 
ulcerative  in  character,  with  the  atrophic  disease 
which  I  have  described,  and  which  I  believe  to  be 
purely  local  and  uncomi:)licated  with  any  constitiT- 
tional  taint  whatever. 

Causes. — I  know  of  no  cause  for  the  disease  other 
than  taking  cold  ;  but  why  in  one  case  this  should 
lead  to  desquamation  of  the  epithelial  lining  of  the 
glands  and  their  subsequent  destruction,  while  in 
another  case  it  leads  to  the  development  of  a  hy- 
pertrophic process,  I  cannot  say.  I  believe  the  dis- 
ease to  be  a  purely  local  one,  and  in  no  way  con- 
nected with  any  constitutional  condition  or  diathesis. 

As  a  rule,  patients  suffering  from  the  disease 
enjoy  thoroughly  good  health.  Indeed,  it  is  the 
rare  exception  to  meet  with  it  in  one  suffering  from 
impaired  health  from  any  cause.  This  statement  I 
believe  to  be  contrary  to  the  generally  accepted  be- 
lief, but  I  make  it  advisedly.  Certainly,  it  holds 
true  in  my  own  experience,  and  it  has  been  a  large 
one,  covering  several  hundred  cases.  I  have  sought 
also  for  evidences  of  syphilis  and  scrofula  as  a  pos- 
sible cause,  but  I  have  not  as  yet  been  able  to  trace 
a  single  case  to  either  of  these  taints.  It  may  in- 
volve one  or  both  nasal  cavities,  or  it  may  involve 
only  a  portion  of  one  cavity.  It  may  attack  the 
middle  or  lower  turbinated  bone,  one  or  both.  We 
find  occasionally  hypertrophy  in  one  cavity  and 
atrophy  in  the  other.  I  have  seen  a  few  cases  of 
hypertrophy  of  the  lower  turbinated  bone  with 
atrophy  of  the  middle,  A  constitutional  condition 
will  scarcely  explain  these  vagaries.  It  has  been  a 
favorite  idea  to  regard  the  disease  as  a  manifesta- 
tion of  scrofula.  .\s  a  rule,  patients  suffering  from 
atrojihic  catarrh  enjoy  perfect  health.  Furthermore, 
it  is  exceedingly  rare  to  find  it  in  one  suffering  from 
anv  of  the  manifestations  of  scrofula.  With  syphilis 
it  has  absolutely  no  connection.  Syphilitic  disease 
of  the  nose  consists  in  ulceration  and  necrosis.  I 
have  never  in  a  single  case  of  atrophic  catarrh  found 
ulceration.  The  mucous  membrane  is  absolutely 
unbroken.  In  this  connection  I  may  say  that  for 
many  years  I  have  been  in  search  of  the  so  called 
ulcers  in  catarrhal  diseases  of  the  nose  and  throat 
not  due  to  syphilis,  scrofula,  or  one  of  the  constitu- 
tional taints,  and  that  I  have  yet  to  find  the  first 
one.  By  the  term  ulceration  should  be  understood 
a  .solution  of  continuity  with  progressive  waste  of 
tissue.  I  have  examined  many  hundreds  of  cases, 
and  by  this  I  mean  I  have  seen  the  whole  cavity 
satisfactorily,  and  I  have  never  seen  any  ulceration 
which  was  not  due  to  a  constitutional  condition,  ex- 
cluding, of  course,  those  due  to  the  presence  of 
foreign  bodies. 

Diagno.<:is.—The  diagnosis  in  this  disease  will  be 
made,  as  a  rule,  by  an  examination  through  the  nos- 


622 


THE  MEDICAL  KECORD. 


trils.  In  the  early  stages  there  will  be  seen  adher- 
ing to  the  lower  or  middle  turbinated  bone  a  grayish 
semi-transparent  membrane  with  a  wrinkled,  pareh- 
ment-like  or  shrivelled  aspect.  The  cavity  will  be 
seen  to  be  fairly  patent.  In  the  later  stages  there 
will  be  seen  either  the  broad,  roomy  cavity,  before 
alluded  to,  with  the  shrunken,  cord-like  turbinated 
bones,  or  there  will  be  brought  into  view  a  greenish 
yellow  mass  of  dried  muco-pus  of  unsightly  ap- 
pearance and  unsavory  odor,  which  more  or  less 
completely  obstructs  the  cavity  and  prevents  a  view 
of  the  parts  beyond.  If  this  be  removed  and  the 
cavity  cleanse  1,  there  will  be  found  the  condition 
before  described  of  a  roomy  cavity  and  shrunken, 
turbinated  bones.  The  diagnosis  is  based  on  the 
elimination  of  ulcerative  disease;  hence,  after  cleans- 
ing it  will  be  comparatively  easy  to  discover  the  ab- 
sence of  any  ulcerative  process. 

Trp.ntmeiil. — The  first  indication  in  the  treatment 
of  the  disease  is  of  coui'se  the  thorough  cleansing 
of  the  cavities  by  the  removal  of  all  the  incrusta- 
tions. In  the  accomplishment  of  this  end  there  is 
no  especial  virtue  in  any  remedy  or  local  agent. 
The  literature  of  the  subject  embraces  a  formidable 
array  of  drugs,  among  which  are  prominent  carbolic 
acid,  salicylic  acid,  boracic  acid,  permanganate  of 
potash,  phosphate  of  soda,  bicarbonate  of  soda, 
thymol,  borax,  etc.  The  essential  i-equisites  of  a 
good  cleansing  solution  are  .secui-ed  by  any  solution 
which  is  alkaline  and  disinfectant.  The  fluid  should 
be  alkaline  for  its  solvent  action  upon  mucus.  It 
should  be  disinfectant  in  order  to  neutralize  the  re- 
sults of  the  process  of  decomposition  which  is  going 
on  in  the  retained  secretions.  Any  fluid,  then,  pos- 
sessing these  qualities  is  an  efficient  cleansing  solu- 
tion.   The  formula  I  generally  pi-efer  is  the  following : 

IJ .  Acidi  carbolici gr.  xij. 

SodiB  bicarb 3  ss. 

Sod.T}  biborat 3  j. 

Aqu:e Oj. 

M. 

Of  quite  as  much  importance  is  the  method  by 
which  the  cleansing  is  accomplished.  Tlie  most  effi- 
cient douche  we  possess  is  the  ordinary  post-nasal 
syringe.  Bv  means  of  this  instrument  a  stream  can 
ba  driven  with  great  force  through  the  cavities.  In 
ordinary  cases  this  is  sufficient  to  thoroughly  de- 
tach all  the  crusts,  and  cleanse  the  parts.  In  ad- 
vanced oases,  however,  it  will  be  necessary  to  use  a 
probe  with  a  pellet  of  cotton.  This  can  be  passed 
through  the  nostril  and  along  the  turbinated  bones, 
thereby  separating  the  crusts,  after  which  they  can 
bo  easily  washed  out  witli  the  syringe.  Occasion- 
ally it  will  bo  necessary  to  throw  a  stream  through 
the  nostril  by  means  of  an  ordinary  ear-syringe. 
The  essential  point  is  to  remove  all  secretions  from 
the  nose,  and  the  success  of  the  manipulation  can 
only  be  determined  by  repeated  inspections  by 
means  of  a  good  illumination,  and  with  the  an- 
terior nasal  speculum  in  place.  After  the  parts  are 
thoroughly  cleansed,  the  next  step  consists  in  tlie 
application  of  a  stimulant  agent.  If  the  disease  is 
essentially  an  atrophic  process,  and  tlie  fetor  is  due 
to  a  process  entirely  outsiilo  of  the  membrane,  then 
the  rational  treatment  and  tlie  one  directly'  curative 
of  the  disease  in  the  membrane  proper,  is  to  stimu- 
late the  parts  to  a  better  performance  of  their  normal 
function,  viz.,  the  secretion  of  mucus. 

Oottstein,  in  the  riiTliwr  Klinixrhi:  IVochomchrifl, 
No.  4,  IHSl,  advocates  the  use  of  the  cotton  tampon 
for  the  promotion  of  .soci'etiou  and  the  correction  of 


fetor  in  atrophic  rhinitis.  His  plan  consists  in  pack- 
ing pellets  of  cotton  between  the  turbinated  bones 
and  the  septum,  and  allowing  them  to  remain  twenty- 
four  hours.  His  paper  has  been  the  subject  of  much 
comment,  and  has  excited  no  little  interest  since  its 
publication.  The  plan  is  a  novel  one,  certainly,  but 
it  seems  a  somewhat  cumbersome  and  roundabout 
way  of  accomplishing  a  very  simple  purpose.  It  is, 
moreover,  attended  with  no  little  discomfort,  as  it 
involves  a  plugged-up  nose  for  the  twenty-four 
hours.  What  is  accomplished  by  Gottstein's  plugs 
is  simply  the  stimulation  of  the  membrane  by  the 
irritating  presence  of  a  foreign  body.  A  flow  of 
mucus  is  necessarily  excited,  and  of  course  the 
fetor  corrected,  for  the  cause  of  the  fetor  in  re- 
tained secretion  no  longer  exists  as  long  as  the  pro- 
fiise  discharge  of  mucus  continues.  Gottstein's 
plan,  therefore,  is  rational  in  its  action,  but  we  can 
accomplish  the  same  end  by  means  much  more 
simple,  more  thorough,  and  with  much  less  discom- 
fort to  the  patient.  It  is  alluded  to  here  mainly  on 
account  of  its  originality,  and  from  the  fact  that  it 
recognizes  the  main  indication  for  treatment  _^iii 
stimulating  the  membrane. 

After  the  thorough  cleansing  of  the  cavities,  there- 
fore, there  should  be  applied  a  stimulating  agent. 
For  this  purpose  I  know  of  nothing  better  than 
Galanga.  This  shoiild  be  applied  in  the  form  of 
powder  and  by  means  of  the  Smith  powder  insufflator. 
Another  almost  equally  valuable  agent  is  Sangui- 
naria,  applied  in  the  same  manner.  I  have  used  many 
diff"orent  remedies,  but  I  know  of  none  possessing 
the  same  valuable  qualities  as  the  above.  They 
stimulate  the  membrane  without  possessing  too  irri- 
tant qualities.  By  their  action  a  flow  of  maicns  is 
excited,  which  not  only  supplies  the  deficient  moist- 
ure to  the  membrane,  but  also  does  more  :  it  seems 
to  flush  all  the  conduits  of  the  membrane,  as  it 
were,  and  wash  out  the  worn-out  detritus,  cleanse 
the  glands  of  their  exfoliated  epithelium,  and  re- 
store a  healthier  action  to  the  diseased  secreting 
apparatus.  If  the  glands  are  destroyed  they  cannot 
be  restored  but  there  unquestionably  remains  a  large 
number  of  glands  in  the  membrane  wliose  proper 
function  is  hampered,  and  these  imdoubtedly  can  be 
restored  to  a  healthier  activity,  and  this  is  all  that 
can  be  hoped  for  at  the  commencement  of  treatment. 

This  plan  should  be  carried  out  faitlifully  every 
day.  In  this  manner  the  fetor  is  entirely  arrested — ■ 
for,  as  a  rule,  fetor  cannot  arise  from  secretion  re- 
tained no  longer  than  one  day — and  the  patient  en- 
tirely and  immediately  relieved  of  one  of  the  most 
distressing  features  of  the  disease.  In  the  course 
of  a  few  weeks  it  will  be  found  that  two  days  may 
elapse,  and  then  three,  without  treatment,  the  rule 
being  that  the  formation  of  incrustations  must  be 
arrested  from  the  outset,  and  that  the  intervals  of 
treatment  must  be  regulated  by  the  length  of  time 
which  a  patient  may  be  without  the  treatment  with- 
out the  formation  of  ciMists  in  the  nose.  In  addition 
to  the  treatment  at  the  hands  of  the  physician,  the 
patient  may  use  the  cleansing  solution  already  given 
daily  at  home,  by  means  of  the  postnasal  tube  at- 
tached to  a  fountain-syrinfro.  Tliis  is  much  better 
than  the  Weber  nasal  douche,  in  that  the  parts  are 
more  thorouchly  bathed.  In  many  cases,  however, 
it  will  be  difficult  for  patients  to  learn  to  introduce 
the  post-nasal  tube,  in  wliich  case  they  may  use  the 
ordinary  anterior  douche.  T  have  never  found  the 
use  of  this  to  be  attended  with  dnntrer  to  the  ear; 
certainly  in  this  form  of  catarrh.  If  there  is  any 
objection   to  the  douche,  the  Delano  or  Goodyear 


THE  MEDICAL  RECORD. 


623 


atomizer  mav  be  used.  The  object  to  be  accom- 
plished is  to  soften  and  moisten  the  membrane  daily. 
i  By  the  above  plan  of  treatment,  I  believe  we  ac- 
l  complish  all  that  can  be  done  for  these  cases.  The 
t  question  j^resents,  Can  we  cure  them  ?  FrSnkel,  of 
Berlin,  very  frankly  says  :  "A  cured  oz:pna  is  un 
j  known  to  me,"  referring  to  the  atrophic  catarrh. 
In  the  early  stage  of  the  disease,  before  the  fetid 
symptom  has  set  in,  I  have  seen  cases  recover.  In 
the  advanced  stages,  characterized  by  fetor,  and  in 
which  the  turbinated  bones  have  almost  entirely 
disappeared,  I  have  not  seen  a  case  cured,  if,  by  a 
cure,  is  meant  a  condition  secured  in  which  there 
remains  no  necessity  for  any  measure  of  local  treat- 
ment. All  eases  can,  I  believe,  by  thorough  and 
painstaking  treatment,  be  brought  to  that  point 
when,  by  the  use  of  very  simple  means,  the  ground 
that  has  been  gained  can  be  secured,  and  the  pa- 
tient be  kept  entirely  free  from  any  annoying 
symptoms  wliatever.  If  the  physician,  by  local 
treatment,  has  so  far  helped  a  patient  siiffering  from 
atrophic  catarrh,  with  fetor,  that,  by  the  daily  use  of 
the  post-nasal  douche  at  home,  he  is  entirely  free 
from  both  fetor  and  incrustations,  nothing  more 
can  be  accomplished.  The  patient  must  be  content 
to  place  his  nasal  cavities  in  the  same  category  as 
his  hands  and  teeth,  as  something  to  be  cleaned  with 
his  morning  toilet.  For  this  purpose,  a  solution  of 
common  salt  answers  every  purpose.  This  may  be 
used  by  simple  insufflation  from  the  palm  of  the 
hand,  by  the  Weber  douche,  by  the  post-nasal 
douche,  or  by  a  Goodyear  atomizer.  The  instrument 
used  is  of  little  importance  provided  the  whole  mem- 
brane is  bathed  and  softened  and  moistened. 

This  may  seem  a  poor  result,  but  it  is  certainly  a 
great  deal  gained,  and  is  something,  moreover,  which 
I  think  can  only  be  attained  by  the  aid  of  a  physi- 
cian. A  patient  cannot  accomplish  it  by  using  syr- 
inges and  douches  himself.  The  crusts  adhere  so 
tenaciously  in  the  sinuosities  of  the  nasal  cavity, 
that  it  is  impossible  to  detach  them  by  means  of 
syringes  or  douches.  'These  cases  should  be  treated, 
then,  with  painstaking  and  care,  but  with  definite 
ideas  as  to  what  we  can  accomplish,  and,  even  if  the 
cure  is  not  a  radical  one,  the  partial  success  at- 
tained is  well  worth  the  effort.  Moreover,  I  think 
entire  candor  with  our  patients  in  the  matter  of 
prognosis  will  be  better  than  to  lead  them  to  expect 
an  entire  and  thorough  cure  when  our  hopes  of  such 
a  result  are  based  on  such  insecure  grounds. 

Note. — I  am  much  indebted  to  Dr.  Charles  Heitz- 
man,  of  this  city,  for  valuable  aid  in  making  the 
microscopic  examinations  above  described. 

I  should  also   state  that  the  above  report  of  the 
pathological  changes  in   nasal  catarrh  formed  part 
of  a  paper  read  by  my.self  at  the  International  Con- 
gress in  London  last  summer. 
26  West  FonxT-SrxTH  Street,  New  Yore. 


Chbont[c  Kheu.matic  .\bthbitis  in  a  Dog. — At  the 
Pathological  Society,  of  London,  recently.  Dr.  Nor- 
man Moore  exhibited  a  specimen  showing  bony  out- 
growths on  the  carpal  and  metacarpal  bones,  with 
ankylosis.  The  disease  was  of  long  duration.  It 
probably  caused  great  pain,  and  was  believed  to  be 
one  of  the  commonest  causes  of  the  howling  of  dogs 
at  night.  The  President  fDr.  Wilks)  said  that  the 
dogs  of  the  Hospice  of  St.  Bernard  were  very  sub- 
ject to  chronic  rheumatism,  on  account,  the  monks 
believed,  of  their  exposure  to  cold. 


SOME  PRACTICAL  SUGGESTIONS  IN  THE 
TREATMENT  OF  SPINAL  CAEIES.* 

By  AP.  morgan  VANCE,  M.D., 

LATE  INTERNE  HOSPITAL  FOB  BUPTDBED  AND  CRIPPLED,  NEW  TOEK  ; 
ORTHOPEDIC  SDBGKON  TO  EENTUCKY  INFIRMARY  FOB  WOMEN  AND 
CHILDREN. 

EvEBY  practitioner  of  experience  knows  the  im- 
portance of  the  closest  attention  to  the  "  small 
things  "  in  surgery.  Nowhere  is  the  obseiTance  of 
detail  so  necessary  as  in  the  orthopedist's  depart- 
ment, and  it  is  especially  so  in  the  treatment  of 
spinal  caries.  One  will  hear  this  plan  of  treatment 
and  that  plan  advocated,  viz.,  the  various  forms  of 
plaster  and  steel  braces,  with  modifications  ;  but  it 
is  not  the  form  of  apparatus  used  that  insures  suc- 
cess, or  results  in  failures  ;  it  is  the  degree  of  skill 
with  which  applications  are  made.  In  my  oijinion, 
good  results  can  be  obtained  with  any  of  the  recog- 
nized forms  of  apparatus  if  properly  applied  and 
afterward  attended  to  by  the  surgeon  himself.  The 
two  old  sayings,  "What  is  worth  doing  at  all,  is 
worth  doing  well,"  and  "What  you  want  well  done, 
do  yourself,"  are  nowhere  better  exemplified  than 
here. 

It  is  my  purpose  in  this  paper  to  give  some  prac- 
tical points  in  the  treatment  of  this  ailment,  culled 
from  experience. 

The  diagnosis,  as  a  rule,  is  easily  made,  for  yon 
are  not  called  until  deformity  has  taken  place.  Be- 
fore this  stage  of  the  disease,  the  diagnosis  is  not 
difficult,  though,  of  course,  there  are  exceptional  * 
cases — especially  if  either  extremity  of  the  column 
is  involved.  Given  the  diagnosis,  what  shall  the  treat- 
ment be  ?  The  indications  are  to  secure  as  perfect 
rest  as  is  possible  to  the  diseased  structures,  and 
this  can  best  be  secured  by  mechanical  appliances. 
The  splint  or  brace  that  attains  the  object  as  well 
as  any  other,  and  at  the  same  time  requires  the 
least  attention  in  keeping  it  in  such  repair  that  the 
indications  can  be  continuously  met,  and  has  the 
fewest  objections  to  its  employment,  that  form 
of  apparatus  is  the  one  to  be  used.  So  far  as  my 
own  observation  goes,  there  has  not  been  proposed 
any  splint  that  is  fi'ee  from  objections.  A  dis- 
cussion in  this  connection  of  the  two  principal 
forms— the  steel  brace  and  plastic  dressings— will 
not  be  out  of  order.  The  chief  objection  to  the  use 
of  the  former  is  that,  as  a  rule,  the  surgeon  is  not 
mechanic  enough  to  construct  the  instrument,  or 
even  to  give  it  the  proper  attention  after  adjustment, 
and  he  consequently  requires  the  assistance  of  the 
instrument  maker.  This  individual  has  his  own 
ideas,  and  these  always  conflict  with  those  of  the 
medical  man,  thus  giving  to  the  machine  when  con- 
structed and  applied  to  the  patient  a  "hybrid" 
character  that  ma<-  or  may  not  fulfil  the  indications. 
The  mechanic  is  paid  for  his  work,  the  case  is 
turned  over  to  the  mother  with  the  usual  result,  and 
the  disease  slowly  progi'esses  with  the  additional 
torture  which  a  misapplied  brace  causes.  This  is  in 
private  practice  ;  but  in  hospital,  where  one  can  daily 
observe  the  case,  and  can  adjust  the  instrument  with 
an  eye  to  all  the  indications,  the  result  is  different, 
and  very  good  results  are  often  obtained.  There 
are,  of  course,  other  minor  objections,  but  they  can 
be  easily  overcome. 

The  objections  to  the  latter  are  manif.old  ;  but 
after  a  large  experience  with  both  forms  I  believe 

*  Read  before  the  Kentucky  State  Medical  Society,  Loaisville,  April, 


624 


THE  MEDICAL  RECORD. 


the  advantages  which  the  plastic  dressings  possess 
over  the  steel  are  undeniable,  and  sufficiently  answer 
all  criticism.  It  is  unnecessary  to  note  in  this  con- 
nection the  progress  that  has  been  made  within  the 
last  decade.  The  plaster  jacket,  as  applied  by  Dr. 
Sayre — its  greatest  advocate— has,  to  my  mind,  a 
great  many  defects.  These  have  occurred  to  me  in 
my  own  practice,  as  well  as  from  the  observation  of 
cases  in  the  hands  of  fellow  practitioners.  In  many 
instances  the  failure  depends  not  upon  the  jacket, 
but  upon  its  improper  application.  To  many  men 
the  one  thing  necessary,  be  the  disease  located 
where  it  may,  is  to  get  the  child's  body  enveloped  in 
a  plaster  casing.  The  following  case  will  illustrate 
this  point :  A  girl,  fourteen  years  of  age,  with  sacro- 
lumbar  caries,  wore  a  splint,  the  lower  border  of 
which  reached  only  to  the  upper  border  of  the  de- 
formity. I  have  seen  also  several  cases  of  disease  in 
the  upper  dorsal,  where  the  upper  border  of  the 
jacket  was  above  the  kyphosis,  and  not  even  supple- 
mented by  a  head  support.  I  refer  to  these  simply 
to  relieve  the  apparatus  of  the  odium  of  failui'e. 
Cases  have  come  to  me  in  which  the  splints — that 
had  been  applied  by  men  high  in  our  calling — were 
doing  absolute  injury  instead  of  giving  the  required 
rest  in  the  comfortable  manner  described  by  the  ad- 
vocates of  this  plan.  Of  the  plaster  jacket,  as  it  is 
usually  applied,  I  may  be  pardoned  for  the  following 
siiggestions : 

Never  suspend  a  patient  with  caries  of  the  spine. 
It  cannot  possibly  do  good,  and  may  do  much 
■  barm. 

Do  not  use  any  dinner  or  respiratory  pads.  The 
use  of  these  pads,  in  my  opinion,  is  a  great  mistake, 
and  in  many  cases  they  interfere  with  the  proper 
support. 

The  plaster  jacket  should  be  renewed  every  three 
or  four  weeks. 

Use  a  head-support  whenever  the  disease  is  above 
the  sixth  or  seventh  dorsal  vertebra. 

Apply  the  jacket  while  the  patient  is  lying  upon 
a  hammock,  after  the  plan  of  Mr.  Davy,  of  London. 
The  advantages  of  this  method  will  be  referred  to 
farther  on. 

This  splint  cannot  be  used  carelessly.  Each  case 
must  be  studied  individually,  and  this  must  be  kept 
up  after  the  brace  is  fitted.  If  this  rule  is  not  fol- 
lowed, trouble  will  come  sooner  or  later.  Excoria- 
tions, increase  of  deformity,  and  abscesses  will  ap- 
pear without  your  knowledge. 

To  meet  the  objections,  a  number  of  modifica- 
tions have  been  introduced  within  the  past  five  or 
six  years.  One  of  the  most  important  is  the  sub- 
stitution of  removable  splints  of  lighter  material. 

In  the  summer  of  '77  the  writer  devised  and  first 
used  the  removable  paper  brace.  Since  that  time 
modifications  and  improvements  have  suggested 
themselves,  so  that  to-day  I  am  able  to  exhibit  what 
I  believe  to  bo  that  appliance  which  will  meet  all 
demands  in  the  treatment  of  the  disease,  and  against 
whicli  fewer  objections  to  its  use  can  be  urged  than 
against  any  plastic  dressing  yet  proposed.  The  re- 
sults are  certainly  as  favorable  as  could  be  reason- 
ably expected.  It  is  requisite  that  a  cast  of  the 
trunk  be  first  obtained  by  plaster-of- Paris.  The 
process  is  simple,  and  the  details  are  already  given 
in  my  original  article  in  this  journal  (June  21. 1879), 
and  referred  to  again  at  the  last  meeting  of  this  so- 
ciety. They  are  substantially  as  follows :  In  order 
to  cause  the  plaster  to  set  very  quickly,  atablespoon- 
ful  of  alum  should  be  added  to  the  quart  of  water. 
The  plaster  jacket  is  then  applied  in  the  usual  way, 


and  it  can  be  almost  immediately  removed  by  a  ver- 
tical incision  in  front.  The  cut  edges  should  be 
brought  together  after  its  removal  and  fastened  in 
api^osition  with  twine.  Place  the  jacket  thus  re- 
moved on  a  table,  and  render  it  water-tight  'oy  plas- 
teiing  around  the  base  and  up  the  incision.  Partially 
fill  with  bricks,  or  other  solid  material,  in  order  that 
less  plaster  may  be  employed  in  making  the  cast, 
the  sjjaces  being  well  fiUed  with  jdaster  of  the  con- 
sistency of  thick  cream  ;  the  external  jacket  can  be 
removed  within  ten  or  fifteen  minutes.  First,  grease 
the  cast  thoroughly,  to  prevent  any  moisture  from 
the  plaster  retarding  the  drying  of  the  paper  jacket. 
Secondly,  apply  an  ordinary  roller  to  protect  the 
brace  from  grease,  and  to  give  a  smoother  surface. 
Thirdly,  let  Canton  flannel  be  fitted  tightly  and 
smoothly  over  the  cast,  and  secured  by  a  seam  in  the 
back.  This  forms  the  lining  of  the  brace  to  be  con- 
structed. Fourthly,  apply  with  a  common  painter's 
brush  the  glue,  consisting  of  two  parts  of  Irish  glue, 
two  parts  of  oxide  of  zinc  finely  powdered,  four  parts 
of  hot  water.  The  Irish  glue  is  first  dissolved  in 
water.  The  addition  of  one  part  of  potass,  bi-chromate 
to  fifty  parts  of  glue  renders  it  more  impervious  to 
water.  'The  glue  thus  prepared  will  keep  indefinitely, 
and  is  always  ready  for  use  by  simply  reheating  it. 
Fifthly,  the  next  step  is  to  apply  horizontally,  begin- 
ning at  the  bottom  of  the  back,  strips  of  brown  Ma- 
nilla paper,  one  and  one-half  inches  in  width,  pre- 
viously coatf  d  with  glue.  The  paper  is  of  moderate 
weight,  such  as  is  used  by  mechanical  draughtsmen. 
The  strips  are  long  enough  to  reach  a  httle  more  than 
half-way  around  the  cast,  and  one  overlaps  the  other 
about  half-way  in  going  from  below  upward.  Having 
finished  the  back,  cover  the  front  in  a  like  manner, 
lapping  the  ends  of  the  sides,  so  as  to  give  support 
where  it  is  most  needed. 

Narrow  steel  springs,  such  as  are  used  in  hoop- 
skirts,  two  inches  shorter  than  the  cast,  are  placed 
vertically  at  intei-vals  of  one  and  one-half  inches,  and 
held  accurately  to  the  cast  by  means  of  strong  flax- 
thread  wound  around  the  whole. 

Another  coating  of  glue  is  now  applied,  and  a  sec- 
ond layer  of  paper  slips  placed  rerttcalfy,  lapping  as 
before.  A  few  turns  of  thread  will  secure  accui-ate 
adaptation  to  the  cast ;  then  a  thickness  of  heavy 
linen  or  duck  to  add  toughness  and  strength.  A 
third  coating  of  glue  followed  by  a  roller  tightly 
drawn  and  smoothly  apjjlied  completes  the  process. 
When  dry  the  brace  is  removed  by  cutting  down  the 
front  and  springing  the  whole  of!"  the  cast.  Perfora- 
tions by  means  of  an  ordinary  penknife  to  the  de- 
sired extent  are  made,  care  being  taken  to  avoid  the 
steel  springs.  Strips  of  heavy  leather  one-half  inch 
in  width,  with  metal  eyelets  one  inch  apart,  are  sewed 
half  an  inch  from  the  edge  in  front,  and  when  ap- 
plied to  the  patient  double  laces  are  used.  The 
edges  of  the  splint  should  be  neatly  bound  with 
leather.  The  apparatus  is  applied  by  springing  it 
open  enough  to  admit  the  patient's  body,  and  should 
be  worn  over  a  tightly  fitting  knit  shirt. 

At  a  meeting  of  the  Louisville  Medico-Chirnrgi- 
cal  Society,  October  14,  1881,  I  reported  a  few  ]>rac- 
tical  modifications,  such  as  strips  of  thick  linou  in- 
stead of  the  paper,  and  thin  sheepskin  apjdied  with 
glue.  The  best  method  probably,  considering  all 
the  conditions,  is  tliat  of  saddle-skirt  or  saddle 
leather,  soaked  in  hot  water  and  moulded  to  the 
cast,  the  stift'noss  being  regulated  by  the  degree  of 
heat  in  the  water.  An  ordinary  roller  is  used  for 
compression,  but  if  there  is  much  deformity  a  Mar- 
tin's bandage  is  more  serviceable.     This  is  the  sim- 


THE  MEDICAL  RECORD. 


625 


plest  antl  the  most  durable  of  all  the  materials  I 
have  tried. 

As  above  mentioned,  I  wotdd  like  to  insist  more 
strongly  on  the  danger  of  suspending  the  patient  in 
order  to  secure  the  shell  for  the  cast.  A  year's  ex- 
perience convinces  me  that  the  advantages  of  having 
the  patient  lie  on  a  hammock  are  very  great.  The 
idea  that  there  is  any  extension  at  all  is  a  false  one, 
and  even  if  an  attempt  be  made  to  secure  this,  the 
apparatus  will  not  only  be  unbearable,  but  also  dan- 
gerous. The  anatomical  relationship  of  the  parts 
utterly  disproves  the  possibilities  of  extension  be- 
tween the  pelvis  and  axillae.  The  benefit  derived 
is  from  the  compression  of  the  splint,  just  as  rest  is 
produced  by  the  plastic  treatment  of  fractures  ;  and 
the  more  equable  and  perfect  this  compression,  the 
better  the  elfect ;  hence,  rather  than  use  the  dinner 
or  respiratory  pads,  I  lessen  the  antero-posterior 
diameter  of  the  trunk  by  the  use  of  the  hammock, 
and  get  the  cast  while  in  this  position.  So 
when  the  brace  of  whatever  material  is  applied  and 
laced,  the  body  is  compressed  on  all  sides,  the 
greatest  splint  action  being  between  the  abdomen 
and  thorax  anteriorly  and  the  sjiinal  column 
posteriorly. 

I  have  never  seen  any  difficulty  arise,  orcomplaLnt 
made,  after  the  first  day  or  two,  from  tightness  of 
the  splint.  Nor  have  I  ever  noticed  hernia  as  a  result 
of  the  compression  of  the  abdomen. 

As  suggested  by  the  late  Dr.  Hodgen,  of  St.  Louis, 
a  head-spring  and  shoulder  straps  should  be  used 
whenever  the  disease  is  above  the  sixth  or  seventh 
dorsal ;  no  extension  being  attempted,  the  weight 
of  the  head  alone  as  far  as  possible  being  lifted  from 
the  diseased  vertebrre. 

When  abscesses  appear  the  hiechanical  treatment 
should  be  continued  and  rest'  in  horizontal  position 
enjoined.  Confinement  in  this  position  is  not  as 
necessary  in  psoas  abscess  as  it  is  in  the  other  form, 
which  may  interfere  with  the  mechanical  treatment. 

Should  paraplegia  appear,  the  mechanical  support 
must  be  kept  up  unremittingly.  I  have  seen  little 
effect  from  the  special  treatment  of  this  nerve  lesion, 
and  should  advise  nothing  more  than  tonic  treat- 
ment.    Time  will  do  the  rest. 

The  introduction  of  vertical  pads  in  the  splint,  so 
arranged  that  they  will  lie  on  either  side  of  the 
spinal  column,  makes  it  much  more  accurate  and 
comfortable.  They  should  be  thick  enough  only  to 
relieve  jiressiu'e  over  the  processes.  I  have  used 
this  addition  for  a  year  in  a  number  of  cases,  and 
have  been  much  pleased  with  its  efficacy. 

The  question  of  prognosis  is  one  that  will  always 
come  up  at  the  first  examination  of  a  case  of  Pott's 
disease.  If  the  surgeon  is  honest  and  wise  he  will 
never  give  any  but  a  very  guarded  one,  explaining 
to  the  parents,  as  far  as  possible,  the  difficulties  that 
may  arise,  and  the  impossibility  of  overcoming  any 
deformity  that  may  exist,  and  in  certain  regions  of 
arresting  even  the  increase  of  deformity. 

Dr.  Oscar  Allis,  of  Philadelphia,  in  a  recent  paper 
read  before  the  Philadelphia  County  Medical  Society, 
doubts  whether  subsequent  deformity  can  be  pre- 
vented even  where  firm  anchylosis  has  occurred. 
He  argues  that  in  the  growth  of  a  child  the  sound 
structures  will  grow  while  the  cicatricial  tissues 
remain  the  same — increased  deformity  being  the  in- 
evitable result.  With  this  view  in  mind  we  should 
be  very  careful  in  raising  hoj^es  in  the  minds  of  the 
parents  as  to  the  final  result,  for  no  one  can  tell 
when  they  will  be  dissipated  by  the  appearance  of 
abscess,  paralysis,  or  other  complications  that  will 


materially  affect  the  prognosis  both  as  to  time  and 
result. 

A  question  very  difficult  to  decide  is,  when  will  it 
be  safe  to  discontinue  mechanical  support ':'  I  do 
not  believe  one  can  determine  positively.  You  must 
be  governed  by  the  circumstances  that  sunound  the 
individual  case,  and  frequent  experiments,  due  care 
Vieing  enjoined,  alone  will  enable  you  to  decide  as 
to  the  time.  In  this  connection  it  is  well  to  call  at- 
tention to  the  ill  effects  of  all  spinal  apparatus — i.e., 
the  great  muscular  atrophy  which  necessarily  ensues 
as  the  residt  of  long  confinement  in  a  splint.  When 
the  question  of  removal  of  support  therefore  comes 
up,  we  cannot  tell  whether  the  weakness  lies  in  the 
muscle  or  in  the  bone.  The  superior  advantages  of 
removable  splints  are  very  evident  in  this  respect, 
for  after  the  first  six  months  it  is  not  dangerous  to 
remove  the  apparatus  daily,  or  twice  daUy,  in  order 
to  treat  the  muscles  by  massage,  faradism,  etc.  Of 
course,  during  this  procedure  the  patient  must  be  in 
a  horizontal  position.  When  the  support  is  removed, 
tentatively,  the  child  should  be  placed  on  the  bed  or 
on  the  floor,  and  carefully  watched  while  at  play, 
to  ascertain  if  it  will  unconsciously  be  guarded  in  its 
movements.  If  no  sign  of  tenderness  is  observed, 
then  direct  that  the  splint  be  loosened  at  night  for 
a  week,  enjoining  upon  the  mother  or  attendant 
close  scrutiny  regarding  the  child's  sleej).  If  all  go 
well  the  brace  can  be  finally  removed  and  a  snug 
roller  applied  to  the  whole  trunk.  Should  the  roUer 
be  insufficient,  a  corset  can  be  made  over  the  last 
cast  ancl  substituted  for  the  stiff  apparatus  removed. 

Constitutional  treatment,  of  course,  is  very  impor- 
tant in  those  cases — life  in  the  open  air  being  the 
first  requisite. 
LorisviLLE,  Ky. 


SciKLET  Feveb  and  BtTicHER's  Meat. — There 
seems  to  be  some  evidence  that  scarlet  fever  may  be 
communicated  through  butcher's  meat.  Dr.  Kobert- 
son,  of  Penrith,  England,  reports  the  following  case  : 

In  a  butcher's  family  there  was  an  exceedingly 
mild  case  of  scarlet  fever,  so  mild  that  no  medical 
man  was  called  in,  the  disease,  in  fact,  not  being  re- 
cognized ;  but  the  free  desquamation  of  the  skin, 
and  the  former  history  of  slight  fever  with  sore 
throat,  leaves  no  doubt  as  to  the  nature  of  the  ill- 
ness. The  occurrence  of  such  a  case  in  a  small 
house,  and  where  no  precautions  were  taken,  renders 
it  an  easy  matter  to  spread  the  disease  in  the  man- 
ner Dr.  liobertson  suggests.  The  number  of  cases 
in  the  neighborhood  continued  to  increase,  notwith- 
standing all  the  precautions  that  were  used,  in  ad- 
dition to  the  closure  of  the  schools.  The  meat  is 
the  only  means  by  which  Dr.  Robertson  can  imagine 
the  disease  was  carried  in  several  of  the  cases.  In 
another  village,  a  large  number  of  cases  of  scarlet 
fever  occurred,  and  the  health-officer  has  strong  rea- 
son for  suspecting  the  butcher's  meat  as  a  medium 
by  which  the  infection  was  spread.  The  circum- 
stances here  were  almost  identical  with  those  of  the 
first  outbreak.  The  first  case  was  at  a  butcher's 
house  ;  it  was  a  slight  one,  not  recognisable  by  the 
parents  at  first ;  free  desquamation  took  place,  and 
the  child  was  allowed  to  run  aU  over  the  premises. 
— Brit.  Med.  Jour. 

CELnrrDOSE,  according  to  M.  Duclaux,  is  digested 
in  birds  and  ruminants  and  perhaps  in  man,  not  by 
any  digestive  secretions,  but  by  certain  specific 
bacteria-amylo  bacteria.  These  do  their  work  in 
paunch,  gizzard,  and  intestines. 


626 


THE  MEDICAL  RECORD. 


ON  THE  LOCAL  TEEATOIENT  OF  CARBUN- 
CLE BY  THE  MOIST-SPONGE  DRESSING 
AND  COUNTER-IRRITATION. 

Bx  GEOKGE  MoCLELLAN,  M.D., 


Carbcnole  is  always  a  formidable  disease.  Even  in 
successful  cases  the  system  is  generally  kept  weak 
and  depressed  owing  to  the  severe  drain  it  has 
borne,  and  the  protracted  treatment  by  the  ordinary 
methods  in  use.  The  general  treatment  must  be 
adapted  to  the  circumstances  of  individual  cases, 
but  for  the  purpose  of  arresting  the  local  inflamma- 
tion and  removiug  the  slough,  which  is  characteristic 
of  the  disease,  various  methods  have  been  pursued. 

Heat  and  moisture,  by  softening  the  tissues,  lias- 
tens  suijpuration  and  relieves  tension  and  pain.  The 
sponge-dressing  is  admirably  suited  lor  furnishing 
these  conditions ;  and  as  I  have  employed  it  with 
the  result  of  speedily  removing  the  disorganized 
tissues  and  subduing  the  carbunculous  inflammation 
in  a  remarkably  short  period  of  time  in  many  very 
grave  cases,  I  feel  justified  in  calling  attention  to 
its  nse. 

A  soft  sponge  large  enough  to  embrace  the  en- 
tire surface  of  a  carbuncle  should  be  applied  by  a 
bandage  firm  enough  to  exert  gentle  and  uniform 
pressure  directly  upon  the  inflamed  part.  Small 
slits  or  openiugs  should  be  cut  in  the  bandage  so 
as  to  readily  admit  of  a  warm  liquid  being  poured 
into  the  sponge  from  time  to  time.  The  peculiar 
suction  power  of  the  sponge,  which  the  moist  state 
augments,  rapidly  removes  the  supjjuration  as  it  oc- 
curs. The  pressure  prevents  undue  infiltration  and 
relieves  the  tension,  and  consequently  the  pain, 
which  is  often  a  most  distressing  leature  of  the  affec- 
tion. The  compressibility  and  elasticity  of  sponge 
admits  of  the  nicest  adjustment,  so  that  any  desired 
degree  of  pressure  may  be  exercised.  This  is  im- 
portant in  cases  where  the  carbuncle  has  not  yet 
developed  the  characteristic  slough,  for  very  often 
the  determination  may  be  aborted  by  uniform  pres- 
sure. The  dressing  should  be  removed,  when  sup- 
puration is  established,  twice  a  day,  and  the  sponge 
thoroughly  washed  out  and  reapiiUed. 

At  each  change  the  sponge  will  be  found  to 
contain  all  the  discharges,  so  that  the  condition  of 
the  parts  can  be  clearly  seen.  Generally  the  slough 
will  detach  itself  within  a  few  days,  and  be  found 
adherent  to  the  sponge  upon  its  removal,  leaving  a 
free  granulating  ulcer  in  its  place. 

The  tendency  to  spread,  whicli  many  carbuncles 
manifest  at  certain  stages,  is  due  to  the  intensity  of 
the  inflammation  and  the  profuse  infiltration  into 
the  tissues,  which  destroys  the  barrier  of  lymph 
Nature  ordinarily  throws  out  to  check  the  progress 
of  the  disease.  In  order  to  prevent  this  I  have  i)een 
ia  the  habit  of  applying  a  solution  of  nitrate  of  silver 
or  iodine  liniment  in  a  circle  round  the  carbuncle  as 
a  counter  irritant.  I  will  instance  one  case  out  of 
many.  An  old  woman,  over  eighty  years  of  age, 
was  admitted  into  my  ward  at  the  Philadelphia  Hos- 
pital with  a  carbuncle  the  size  of  a  saucer  on  the 
back  of  her  neck.  She  was  greatly  enfeebled  and 
suiTering  severely.  The  tissues  were  indurated, 
angry,  and  livid.  There  was  no  discharge,  altliough 
tlie  surface  was  cribriform,  having  many  openings 
through  whicli  the  slough  was  visible. 

A  zone  of  iodine  paint  was  applied  about  the 
swelling,  and  a  large,  soft,  moist  sponge  applied  with 


a  four-tailed  sUng.  Openings  were  made  so  as  to 
keep  the  sponge  moist  with  warm  carbolic  lotion 
(1-30),  and  a  small  shot-bag  adjusted  so  as  to  exert 
considerable  pressui-e.  Within  an  hour  the  pain 
was  relieved,  and  the  next  day  the  slough  -xgBS 
loosened,  the  tension  being  entirely  removed.  In  a 
fortnight  the  patient  was  discharged  cured,  with  a 
cicatrized  surface,  showing  no  perceptible  loss  of 
structure.  In  view  of  the  advanced  age  of  the  pa- 
tient and  the  extent  of  the  carbunculous  inflamma- 
tion, the  result  was  certainly  remarkable. 

The  usual  method  of  employing  poultices  to 
remove  the  slough  is  tedious  and  disagreeable  (un- 
less they  are  very  frequently  changed),  and  does 
not  admit  so  readily  of  exerting  pressure,  which,  as 
I  have  attempted  to  show,  exercises  so  beneficial  an 
effect  in  preventing  infiltration  and  overcoming  ten- 
sion. The  old-fashioned  practice  of  making  a  cnicial 
incision  as  a  preliminary  step  in  the  treatment  of 
carbuncle  has  been  in  great  measure  abandoned,  ex- 
cept on  the  face  or  lip,  as  it  neither  hastens  the  cure 
nor  lessens  the  suffering. 

The  quality  of  drainage  which  a  sponge  possesses 
comes  into  value  in  the  treatment  of  carbuncle,  as  it 
has  been  found  to  do  in  all  the  forms  of  dressing  to 
which  it  has  been  applied. 


A  RARE  CASE  OE  ERYTHEMA  NODOSUM. 
By  GEO.  THOS.  JACKSON,  M.D., 

NEW  TOUK   CITY. 

N.  A ,  aged  twenty-seven,  came  to  me  on  the  19th 

of  April,  of  this  year,  on  account  of  a  skin  lesion 
which  appeared  that  morning.  He  is  a  lawyer  by 
profession,  very  ambitious,  and  working  very  bard. 
He  is  very  tall  and  thin,  of  marked  nervous  temper- 
ament, of  good  habits,  and  usually  enjoys  good  health. 
His  bowels  are  regular,  and  on  careful  inquiry  no 
symptom  of  dyspepsia  was  discovered,  except  the 
dry  mouth  in  the  morning  so  common  in  smokers, 
and  slight  loss  of  appetite.  Tongue  clean.  Pulse 
and  temperature  normal.  Owing  to  his  duties  his 
meals  are  irregular,  and  on  account  of  some  very  sad 
news  suddenly  received  during  the  previous  week, 
he  has  of  late  been  feeling  much  depressed.  No 
history  of  rheumatism.     He  is  anaemic. 

On  the  evening  of  the  18tb  of  April  he  felt  chilly, 
and  fearing  that  he  had  taken  cold  he  took  ten 
grains  of  quinine.  On  the  morning  of  the  19th  of 
April  on  rising  he  noticed  the  eruption  about  to  be 
described,  and  in  the  afternoon  of  the  same  day  he 
came  to  me.  Upon  examination  I  found  upon  the 
right  side  of  the  neck,  in  a  space  bounded  superiorly 
by  the  lower  border  of  the  inferior  maxilla,  poste- 
riorly by  a  line  drawn  from  just  behind  the  right 
ear  to  the  acromial  end  of  the  right  clavicle,  infe- 
riorly  by  the  right  clavicle,  and  anteriorly  by  the 
median  line  of  tlie  neck  (the  space  corresponding  to 
the  region  supiilied  by  the  superficial  branches  of  the 
right  cervical  jilexus),  some  half  a  dozen  dissemi- 
nated nodes,  oval  in  shape,  their  long  diameter  from 
half  to  one  inch  in  length,  raised  and  tense,  of  a 
pinkish  to  red  color,  which  entirely  disapjieared 
under  pressure,  returning  immediately  u]>on  its  re- 
moval. Reside  these  nodes  there  was  present  in  the 
same  region  an  erythema  papulosum.  The  left 
side  of  the  nock  and  the  rest  of  the  body  were  per- 
fectly free  from  any  cutaneous  lesion. 

The  patient  said  that  the  eruption  neither  itched 
nor  pained,  but  annoyed  him  by  a  certain  undefined, 
uneasy  sensation  making  him  conscious  of  its  pres- 


THE  MEDICAL  RECORD. 


627 


ence.  He  complained  of  a  slight  sore  throat,  which 
examination  showed  to  be  due  to  a  mild  pharyngitis. 
He  was  given  a  tonic  of  iron  and  strychnia,  and  an 
alkaline  wash.     Kegulate  diet. 

•.^pril  21st.— An  increase  of  the  erythema  papil- 
losum on  the  neck,  some  papules  appearing  in  the 
beard.  Tlie  nodes  are  unchanged.  Bowels  consti- 
pated to  day.  Patient  complains  of  slight  pain  in 
right  liand,  and  says  he  feels  used  up.  Continued 
the  tonic,  and  gave  ungt.  zinc,  oxid.,  and  a  laxative 
mineral  water. 

April2:3d.— Patient  did  not  sleep  weU  last  night 
on  account  of  a  stinging  pain  in  seat  of  eruption, 
and  this  still  continues.  Examination  shows  that 
the  erythema  papulosum  has  spread  down  the  right 
side  of  sternum  and  over  the  right  pectoralis  major. 
One  of  tlie  nodes  has  become  purple.  Continued 
treatment  as  before  and  ordered  some  one-grain  jjills 
of  opium  to  be  taken  as  required  to  produce  sleep. 

From  this  time  on  he  steadily  improved,  tlie  erup- 
tion fading  away  with  slight  desquamation,  all 
trace  of  it  being  lost  in  about  three  weeks. 

This  case  is  peculiar  in  being  located  upon  the 
neck,  in  the  region  of  distribution  of  the  cervical 
flexus,  erythema  nodosum  being  usually  located 
upon  the  shins,  and  in  its  limitation  to  one  side, 
erythema  being  usually  symmetrical.  From  its  close 
relation  to  the  branches  of  the  cervical  plexus,  I  be- 
lieve this  ease  was  of  nervous  origin. 

,  l-J  East  Tiuutv-first  Street. 


SCARLATINOUS  ERYTHEJMA  FOLLO^ATNG 

ADJVITNISTRATION  OF  QUININE. 

Bt  J.  M.  FEENCH,  M.D., 

.SIMKBCRY,   CONN. 

On  June  10,  1881,  I  was  called  to  see  an  Irish 
servant-girl,  suffering  from  a  well-marked  attack 
of  the  tertian  form  of  malarial  fever.  There  had 
been  four  distinct  chills,  on  alternate  days.  From 
the  last  and  most  severe  of  these  she  was  just 
passing  into  the  sweating  stage  when  I  saw  her. 
Her  pulse  was  100,  temperature  lOOf .  I  gave  her  a 
solution  containing  about  four  grains  of  sulphate  of 
quinine,  to  be  taken  at  night  and  repeated  in  the 
morning.  This  was  to  be  followed  at  noon,  at  niglit, 
and  the  next  moi'ning,  by  about  five  grains  of  quin- 
amine.  In  all,  she  took  about  eight  grains  of  qui- 
nia  and  fifteen  grains  of  quinamiue  in  forty-eight 
hours. 

On  June  13th,  there  was  no  return  of  the  chill ; 
but  a  diffuse,  erythematous  eruption  had  begun  to 
show  itself  on  her  chest  and  arms,  with  some  small 
vesicles  on  the  arms. 

On  June  lith,  still  no  signs  of  the  chill,  but  the 
rash  had  become  general,  with  numerous  miliary 
vesicles.  The  itching  was  intense,  and  the  tem- 
perature high.  I  had  suspected  from  the  first  that 
the  eruption  might  have  been  caused  by  the  quinia, 
but  had  never  seen  a  similar  case,  nor  could  I  find 
any  such  on  recoi-d.  As  the  symi^toms  had  become 
somewhat  severe,  and  I  was  in  doubt  as  to  the  na- 
ture of  the  disease,  I  called  a  neighboring  physi- 
cian in  consultation,  and  he  unhesitatingly  pro- 
nounced it  a  case  of  scarlet  fever.  And  it  must  be 
confessed  that  the  appearances  at  the  time  were 
well  calculated  to  favor  that  opinion.  The  rash  was 
of  a  scarlet  hue,  the  itching  was  intolerable,  the 
febrile  symptoms  were  moderately  severe,  and  the 
tongue  presented  the  typical  strawberry  appearance. 
The  case  was  treated  as  one  of  scarlatina,  and  re- 


covery took  place  in  due  time,  being  followed  by 
free  desquamation. 

But  no  sooner  had  she  recovered,  than  she  was 
again  attacked  by  severe  chills,  for  which  I  gave  her 
five  grains  of  quinia  three  times  a  day.  Tlie  chills 
ceased  promptly,  and  she  sulTered  from  a  second 
attack  of  the  scarlatinous  rash,  witli  febrile  symp- 
toms and  intense  itching,  as  on  the  previous  occa- 
sion. This  passed  through  a  regular  course,  similar 
in  every  essential  respect  to  the  first,  except  that  it 
was  slightly  less  severe. 

But  no  sooner  was  she  fairly  convalescent  a 
second  time  than  the  chills  again  made  their  ap- 
pearance. This  time  a  homoeopathic  practitioner, 
who  lived  close  by,  was  called  in,  and  administered 
a  remedy  in  liquid  form,  to  be  taken  from  a  tumbler 
in  teaspoonful  doses.  He  was  evidently  not  a 
dealer  in  high  potencies,  for  his  medication  was  fol- 
lowed by  a  third  appearance  of  the  eruption.  The 
accompanying  constitutional  symptoms  were  less, 
marked,  but  the  itching  was  still  intense.  She  had 
now  become  veiy  suspicious,  and  unwilling  to  take 
the  medicines  which  were  given  her. 

This  time  still  another  physician  was  called  to- 
see  her,  and  he  began  his  treatment  by  administer- 
ing a  few  doses  of  a  pill  composed  of  aloes,  blue 
mass,  and  podophyllin.  The  effect  of  these  was. 
most  happy,  and  the  patient  experienced  much  re- 
lief. Upon  his  second  and  last  visit,  however,  he 
added  to  this  some  preparation  of  cinchonidia,  to> 
be  taken  for  several  days.  She  had  now  learned', 
caution  from  a  sad  and  itching  experience,  and  cot. 
liking  the  effect  of  this  last  remedy,  she  evaded  tak- 
ing it,  in  every  jjossible  way,  and  thus  escajjed  its. 
full  effects.  The  eruption,  however,  promptly  made 
its  appearance,  but  in  a  slightly  modified  form. 
Upon  its  disappearance,  there  was  now  no  return  of;' 
the  chill,  but  she  suffered  for  some  time  from  sores - 
and  ulcers  upon  her  hands  and  arms.  After  several! 
months,  however,  she  fully  regained  her  visual  health. 

The  following  points  in  the  case  seem  to  me- 
worthy  of  note  : 

FirsL — There  were  no  cases  of  scarlatina  in  the  ■ 
vicinity  from  which  she  could  have  contracted  the- 
disease.  The  only  conceivable  source  of  exposure  ■ 
was  the  occasion  of  a  visit  to  Hartford,  twenty-two- 
days  before  the  eruption  made  its  appearance.  Dr. 
Flint  says  the  period  of  incubation  rarely  exceeds- 
six  days. 

Second. — Although  there  were  at  least  six  j^ersons-. 
in  the  house  with  her,  some  of  them  young,  who  had 
never  had  the  disease,  and  who  visited  her  room,, 
some  of  them  frequently,  bathed  her  and  combed 
her  hair — and  also  several  neighbors  who  visited, 
her  room — yet  no  one  contracted  scarlatina. 

Third. — There  was  at  no  stage  of  the  disease  any 
affection  of  the  throat. 

Fourth. — The  eruption  apjDeared  at  least  four- 
times  in  distinct  form  and  each  time  it  came  on  di- 
rectly after  the  use  of  antiperiodic  remedies. 

Fifth. — The  connection  between  the  two  was  so 
close  as  to  force  the  conviction  upon  the  minds  of' 
the  patient  and  her  friends,  that  the  drag  which  was 
given  to  abort  the  chill  was  the  cause  of  the  rash ; 
and  of  the  two  she  much  preferred  the  chill. 

On  page  152  of  the  current  volume  of  The  Medical 
Eecokd  it  is  st.\ted  that  a  scarlatinous  erythema  is 
liable  to  follow  the  use  of  quinia.  The  i^resent  case- 
I  regard  as  an  exaggerated  instance  of  this  kind. 
Having  been  unable  to  find  a  parallel  in  the  expe- 
rience of  my  brother  practitioners,  I  think  the  case 
may  be  worthy  of  record. 


62S 


THE  MEDICAL  RECORD. 


CASE   OP   CYSTIC   TUMOK   OF   THE 

STOMACH. 

Beported  by  H.  H.  read,  M.D., 

HALIFAX,    N.    S. 

W.  S.  S ,  aged  sixty-two,  short,  stout,  and  appar- 
ently in  robust  health,  was  attacked  Januai-y  28, 1882, 
while  at  his  office,  with  excruciating  pain,  beginning 
in  the  right  hypochondriac  region  and  radiating  over 
the  whole  upper  part  of  the  abdomen. 

While  driving  home  he  vomited  profusely  several 
times,  and  two  hours  later  I  found  him  showing  the 
signs  of  severe  agony,  with  great  depression  and 
deathly  pallor.  The  attack  was  attributed  to  an 
oyster  stew  taken  the  evening  before. 

The  pulse  was  48,  skin  cold,  and  the  vomiting 
coatinued  at  intervals,  the  vomited  matter  con- 
sistiag  of  mucus  aod  ijartially  digested  food,  but 
no  bile.  The  face  and  eyes  were  tinged  yellow,  the 
urine  was  cloudy  and  of  a  deep  yellowish  brown  hue, 
and  the  stools  had  been  pale  for  some  days. 

G.iUst  jne  colic  was  diagnosed,  and  the  usual  rem- 
edies administered,  but  the  pain  yielded  only  to 
morphia,  and  then  to  a  very  limited  extent.  Chloro- 
form proved  useless. 

At  this  stage  Dr.  Dodge  was  invited  to  see  the  case, 
and  continued  in  associatedattendance  till  the  close. 

For  the  next  day  or  two  he  seemed  to  improve 
slowly  and  gradually,  when,  early  on  the  morning  of 
January  31st,  coflfee-ground  vomiting  appeared. 

The  indicated  remedies  were  given  with  small 
lumps  of  ice,  and  only  milk  and  lime-water  allowed, 
and  during  the  next  day  the  vomiting  ceased.  The 
existence  of  a  grave  organic  lesion  was  now  feared; 
bat  as  the  pain  continued  to  be  distressing,  it  was 
hoped  that  the  hemorrhage  was  due  to  the  influence 
of  the  gallstone,  which  had  evidently  failed  to  pass. 

A  fresh  symptom  now  appeared,  and  continued  to 
the  end,  viz.,  an  audible  gurgling  in  the  stomach  ; 
worse  after  swallowing  any  liquid.  At  times  this 
seemed  to  me  to  be  like  tlie  sound  jiroduced  by 
drops  falling  a  little  distance  into  a  liquid. 

The  urine  now  cleared  up,  and  the  stools  showed 
the  presence  of  bile  in  large  quantities.  Evacua- 
tions occurred  only  after  injections,  and  were  care- 
fully but  unsuccessfully  examined  for  gallstones. 
The  eyes  lost  their  yellowish  hue,  but  the  counte- 
nance still  retained  ah  ominous  fawn-yellow  tint. 

The  pulse  gradually  rose  to  90,  tlie  temperature  to 
101°,  and,  as  the  tongue  showed  a  dry,  brownish  streak 
down  the  centre,  I  began  to  hope  that  the  develop- 
ment of  typhoid  fever  would  solve  the  problem  be- 
f  )re  us. 

In  the  course  of  a  week,  however,  these  indica- 
tions jiassed  away,  the  tongue  became  "moist  and 
pale,  the  temperature  sank  to  98',  and  convalesenoe 
seemed  imminent,  when,  on  February  lOtli,  a  fre.sh 
attack  of  cofif.>e-ground  vomiting  set  in,  and  refused 
to  be  controlled.  Tlie  epigastric  region  became 
tense  and  tender,  and  the  seat  of  a  constant  burning 
pain.  Ho  rejected  food  of  every  kind,  and  suffered 
frequently  from  hiccough.  The  temiK'raturo  con- 
tinued at  the  normal  jioiat,  and  a  diagnosis  of  ma- 
lignant disease  of  the  stomach  was  made.  February 
24th,  Dr.  Stewart,  of  Pictou,  was  called  in  consulta- 
tion, and,  after  a  careful  examination,  concurred  in 
the  opinion  given.  Tlie  patient  grow  worse  without 
any  fresh  dovoloiimont,  and  died  on  the  morning  of 
March  2d,  after  an  illness  of  nearly  five  wooks.  The 
next  day,  with  the  assistance  of  Drs.  Dodge  and 
Lindsay,  an  examination  of  the  abdominal  cavity 
was  made.     The  subcutaneous  fat  was  fiillv  nn  inch 


in  thickness.  No  signs  of  peritonitis  appeared. 
The  liver  was  normal,  and  the  gall  bladder  con- 
tained a  stone  of  the  size  and  shape  of  a  chestnut, 
with  one  end  slightly  eroded. 

The  stomach  appeared  to  be  enormously  dilated ; 
and  in  endeavoring  to  remove  it,  it  was  ruptured  in 
two  or  tliree  places,  and  fully  a  quart  of  gray  grumous 
fluid  escaped.  After  tying  the  duodenum  and  oeso- 
phagus and  removing  the  entire  mass,  it  was  found 
that  we  had  really  ruptured  a  cyst  which  completely 
enveloped  the  stomach,  extending  from  the  liver  on 
the  right  to  the  spleen  on  the  left,  and  was  closely 
adherent  to  both.  It  surrounded  the  common  bile- 
duct,  which  was  dilated  to  the  size  of  the  little  linger, 
de.scended  to  the  lower  end  of  the  descending  por- 
tion of  the  duodenum,  and  enfolded  the  whole  of  the 
greater  curvature  of  the  stomach,  forming  adhesions 
with  everything  with  which  it  came  in  contact.  Be- 
sides the  escaped  fluid,  it  contained  numerous  lumps 
of  a  fatty  substance  of  the  size  of  cardamom  seeds,  and 
loosely  attached  to  its  walls  were  masses  of  these 
fatty  lumi^s  aggregated  together,  with  black  streaks 
intermingled.  These  latter  were  the  remains  of  ex- 
travasated  blood.  The  stomach  showed  a  punched- 
out  ulcer  the  size  of  the  thumb-nail,  with  the  open 
mouth  of  a  small  blood-ves.sel  in  its  edge.  Ai'OTind 
it  for  some  distance  the  mucous  membrane  was  con- 
gested and  covered  with  bleeding  points.  Only  a 
thin  layer  of  connective  tissue  intervened  between 
the  bottom  of  the  ulcer  and  the  cyst.  A  careful  ex- 
amination of  the  specimen  was  made  by  Drs.  Stewart 
and  Lindsay,  and  I  append  a  description  of  the  ap- 
pearances found,  kindly  furnished  by  the  former. 

"The  cyst  then,  for  such  it  appeared  to  be,  was 
for  the  most  jjart  thin-waUed.  The  outer  surface 
was  serous,  evidently  peritoneal.  The  inner  surface 
was  extremely  rugged,  giving  the  impression  of  nu- 
merous septa,  torn  and  lianging  in  tags  and  fringes. 
It  was  of  a  grayish-white  color  and  coated  with  a 
peciiliar  soapy  stuff,  of  a  dirty  white  color,  but  in 
many  parts  containing  black  particles. 

"  This  matter  examined  carefully  gave  very  nega- 
tive results.  It  seemed  to  consist  entirely  of  fat 
cells,  and  these,  with  scarcely  any  excei^tion,  con- 
tained crystals.  There  were  oil  globules,  but  these 
were  all  very  small.  A  few  cholesterin  crystals  were 
seen,  and  the  black  material  was  evidently  derived 
from  blood,  showing  ha>matridin  crystals.  The 
grumous  fluid  contents  of  the  cyst  showed  the  same 
characters. 

"  On  cutting  into  the  wall  of  the  cyst  where  it  had 
any  thickness,  we  found  several  small  infarctions, 
some  of  old  standing,  others  quite  recent,  showing 
all  stages  in  the  changes  of  blood-clot.  One  or  two 
of  these  near  tlie  bile-duct  had  a  greeni.sh  tint. 

"At  the  periphery  of  these  infarctions  the  only 
characteristic  cells  were  found.  Some  of  these  I 
have  figured.  The  most  were  curved-spindle  cells, 
very  like  those  from  the  periphery  of  a  cell-nest, 
and  in  one  field  we  saw  what  seemed  to  be  i)art  of  a 
cell-nest.  Some  of  these  cells,  much  shrivelled,  wera 
found  in  the  fluid-contents  of  the  cyst. 

"  Other  cells  were  apparently  epithelial  also,  but 
large,  with  large  nuclei  and  very  distinct  nucleoli. 
Sometimes  several  nuclei  were  present. 

"  We  found  no  indications  of  a  dermoid  character 
for  the  growth  :  only  the  universally  jiresent  crystals 
in  the  fat  colls  seemed  somewhat  embryonic. 

"  I  think  it  likely  the  growth  originated  as  a  sub- 
mucous fatty  tumor,  gradually  acquiring  a  malignant 
nature,  and  that  the  cystic  character  arose  from  re- 
peated infarctions  gradually  breaking  down." 


THE  MEDICAL  KECORD. 


C29 


AN  ALLIED  FORM  OF  PITYEIASIS  RUBRA. 
Br  HALSEY  L.  WOOD,  A.M.,  M.D., 

ASSISTANT  PHYSICIAN,   MICBIGAN   ASYLTM  FOR  THE  INSANE. 

PrrnuASis  nibra,  as  usually  de.scribed,  is  a  uni- 
versal dermatitis,  of  suddeu  origin,  extending  from 
the  crown  of  the  bead  to  the  sole  of  the  foot,  from 
the  finger-tips  to  the  edges  of  the  eyelids.  This  in- 
flammntory  condition  is  followed  by  the  desquama- 
tion of  the  epidermis  in  the  form  of  bran,  of  scales, 
or  of  large '  papery  layers,  over  the  entire  surface 
affected.  Its  essential  features  are  its  occurj-ence  in 
previously  healthy  persons,  its  tendency  to  become 
universal,  its  non-amenability  to  treatment,  and  its 
tendency  to  spontaneous  cure. 

The  universality  of  the  dermatitis  characterizing 
the  disease,  isjregarded  as  typical  of  the  affection ; 
hence,  "  dermatitis  universalis,"  "general  exfoliative 
dermatitis,"  etc.,  terms  used  as  descrijitive  syno- 
nymes.  Devergie  says  that  it  is  the  only  disease  of 
ite  kind  that  attacks  the  whole  of  the  body,  from 
head  to  foot,  without  leaving  a  sound  spot. 

The  dermatitis  is,  however,  not  always  universal ; 
Devergie  has  seen  cases  in  which  there  was  a  moist 
exudation  and  more  swelling  of  the  skin  than  in 
eczema  ;  Hebra  uses  such  expressions  as  "  pityriasis 
pemphigoides,"  "  le  pitvi-iasis  rubra  se  transforme  en 
pemphigus  "  ;  and  Dr.  Stephen  ]M:vcKenzie  has  even 
seen  a  pityriasis  rubra  that  was  vhite  ! 

I  am  therefore  encouraged  to  present  a  case  that 
appears  to  be  allied  to  pityriasis  rubra,  biit  which 
differs  from  any  case  of  such  disease  with  which  I 
am  familiar,  in  deep  pigmentation  of  the  e]iidermis 
prior  to  exfoliation,  and  coextensive  with  the  der- 
matitis. Other  general  features  were  the  well- 
marked  character  of  the  dermatitis,  the  absence  of 
general  constitutional  disturbance,  save  as  explained 
by  the  dermatitis  ;  the  fact  that  the  mucous  surfaces 
entirely  escaped  ;  the  absence  at  all  stages  and  in 
all  parts  of  any  tendency  to  eczematous  inflamma- 
tion, and  the  entii-e  absence  of  deposit  in  the  skin 
or  of  thickening.     I  apjjend  a  history  of  the  case. 

L.  H ,  female  ;  aged  thirty-four,  single ;  do- 
mestic ;  reads  and  writes  ;  hereditary  predisjwsition 
unascertained ;  third  attack  ;  first  admission.  Ad- 
mitted August  3,  1871.  Form :  mania  recurrent. 
Cause  :  previous  attacks.  Maniacal  symptoms  sub- 
sided by  the  following  January,  and  have  not  since 
reappeared.  Her  mental  condition  has  of  late 
years  been  that  of  dementia,  with  its  characteristic 
irritability  ;  she  has  had  frequent  periods  of  depres- 
sion. Menstruation  has  been  normally  performed, 
and  there  have  been  no  symptoms  suggesting  uter- 
ine complications. 

February  1st. — Complained  this  evening  of  prick- 
ing and  smarting  sensations  in  her  feet,  which,  on 
examination,  were  found  slightly  reddened  and 
swoUen  on  their  plantar  sm-faces  ;  hyperiesthesia 
and  pruritus  marked.  The  swelling  was  most  pro- 
nounced about  toes  and  ball  of  each  foot ;  the  red- 
ness most  decided  upon  under  surface  of  toes  and 
wdes  of  heel,  where  epidermis  was  thinnest.  Dis- 
coloration was  generally  diffused  at  the  points  men- 
tioned, disappeared  on  pressure,  and  was  associated 
■with  venous  distention  and  ojdema  behind  malleoli, 
extending  above  the  ankle.  There  was  no  apparent 
constitutional  disturbance. 

February  ■ith. — Epidermis  upon  plantar  surfaces 
of  feet,  has  cracked  slightly  in  places,  and  seems  to 
be  desquamating  at  isolated  points.  The  feet  are 
decidedly  tumid,  discoloration  is  now  deep  scarlet. 


and  the  oedema  has  increased.  Patient  suffers 
greatly  from  pain,  heat,  and  pruritus,  in  the  parts 
affected. 

February  7th.  —  Tumefaction  somewhat  leas  ; 
cedema  disappeared  ;  limited  locomotion  possibl* 
without  especial  discomfort. 

February  lOtb. — Hyper.'emic  discoloration  of  neck 
about  collar  line,  with  slight  pigmentation.  Epi- 
dermis desquamating  from  toes  and  jjlantar  surfaces 
of  feet ;  tumefaction  of  jialmar  surface  of  hands  and 
fingers,  which  are  flexed  with  some  difficulty. 

February  14th. — M'ottled  spot  of  pigmentation 
appears  on  forehead.  Isolated,  irregularly  circular 
hypersemic  spots  appear  upon  upper  anterior  sur- 
face of  thorax,  apjiarently  due  to  hy)3eramia  of  ves- 
sels in  papillary  layer ;  papillae  standing  out  from  a 
circle  of  congestion.  Itching,  heat  of  skin,  with 
pricking  and  smarting  sensations,  increase.  Ano- 
rexia has  become  marked,  and  she  is  ordered  special 
diet  with  mild  stimulation. 

February  16th. — Spots  upon  chest  have  coalesced, 
forming  a  continuous  hyperssmia,  extending  to  and 
involving  the  mammas. 

February  18th. — Abdomen  covered  with  a  gener- 
ally diffused  hypersemia  ;  color  upon  thorax,  deep- 
ened to  scarlet,  desquamation  about  fold  of  neck 
commencing.  Pigmentation  appears  at  flexure  of 
elbows  and  about  axilla^' ;  posterior  thoracic  surface 
reddened  slightly  ;  pruritus  somewhat  less. 

February  21st. — A  broad  ring  of  pigmentation  has 
formed  at  waist-band,  marked  in  front  and  at  sides 
of  thorax,  alisent  posteriorly  ;  continued  exfoliation 
of  epidermis  from  neck,  and  commencing  upon 
chest.  She  suffers  greatly  from  pain.  There  is 
some  febrile  disturbance  this  evening  ;  pulse,  98 ; 
temperature,  100° ;  respiration,  20.  Urine  exam- 
ined with  negative  results. 

February  2-tth. — Skin  deep  crimson  upon  lower 
part  of  thorax  and  abdomen ;  pigmentation  covers 
lower  part  of  back  and  gluteal  muscles  and  lateral 
thoracic  surfaces. 

FeViruary  2Sth. — Exfoliation  continues  upon  chest, 
large  quantities  of  de&d  epidermis  coming  away  and 
filling  the  bed  with  the  debris.  Denuded  surface 
presents  p.ipillary  congestion ;  pigmentation  has 
deepened  to  dark  brown. 

March  1st. — 7  a.m.  :  Temperature,  10H° ;  pulse, 
120 ;  respiration,  24.  7  p.m.  :  Temperature,  104°  ; 
pulse  140  ;  respiration,  28.  Extensive  dermatitis  ; 
surface  highly  congested,  extreme  hyperiesthesia  ; 
weight  of  bed-clothing  borne  with  difficulty  and 
patient  screams  with  pain. 

March  2d. — 7  a.m.  :  Temperature,  103°  ;  pulse. 
120 ;  respiration,  26.  7  p.m.  :  Temperature,  101°  ; 
pulse,  100;  respu-ation.  20.  Pigmentation  covers 
posterior  thoracic  and  gluteal  surfaces,  and  appears 
in  popliteal  spaces.  Appearance  of  hyperaimia  upon 
the  dorsal  surface  of  feet.  Skin  upon  affected  sur- 
faces,where  unexfoliated,  deeply  pigmented,  wrinkled 
and  insensitive.  There  is  a  slight  acceleration  of 
pulse  at  evening  visit  (100);  there  is  no  aj^parent 
heat  of  skin.  A  slight  papular  eruption  has  been 
present  for  several  days,  upon  the  extensor  surface 
of  forearms  ;  to-day,  it  appeared  over  the  gastroc- 
nemii.  Redness  and  tumefaction  of  feet  decreasing ; 
dead  skin  separating  from  feet  in  large  flakes. 

March  3d. — Anorexia  absolute  ;  refuses  food,  and 
requires  feeding. 

March  4th. — Pigmentation  appears  upon  extensor 
surface  of  thighs. 

March  6th. — Anterior  surface  of  thorax  and  abdo- 
men  denuded  of  dead   skin  and  presents  a    more 


630 


THE  MEDICAL  RECORD. 


healthful  appearance.    Extensor  surface  of  forearms 
inflamed  anil  pigmented. ;  jjapules  coalescing. 

March  9th. — Skin   desquamating  upon  hands  in 
interdigital  spaces ;  patient  sits  up. 
'     March  10th. — Trunk  free  from  dead  skin ;  arms, 
hands,  and  feet  continue  the  process  of  desquamation. 
General  condition  improved. 

April  1st. — Desquamation  complete.  Convales- 
cence established. 

The  treatment  was  of  a  supporting  and  mildly 
stimulating  character ;  largely  symptomatic  and 
"  expectant."  Arsenic  was  mat  well  borne,  and  was 
soon  discontinued.  Quinine  and  iron  were  given 
throughout  the  attack,  and  were  apj^arently  of  bene- 
fit ;  it  did  not,  however,  ai)pear  that  anything  that 
was  given  affected  the  course  or  severity  of  the  dis- 
ease. 


progress  of  ittctiical  Science. 


An  Insdtficibntly  Appreciated  Stmptom  op 
Pregnancy. —  Le  Mkledn  Practicien  of  April  15, 
1882,  contains  an  article  by  D.  Delattre,  borrowed 
from  the  Gazette  des  Hopilaux,  upon  an  important 
sign  of  ineiiiient  pregnancy.  It  is  the  almost  com- 
plete disappearance  of  phosphates  from  the  urine. 
These  salts,  being  retained  in  the  body,  are  not  at 
first  utilized  for  the  development  of  the  fcetus,  but 
are  deposited  either  in  tlie  substance  of  the  moth- 
ei-'s  bones  or,  as  osteophytes,  on  their  exterior. 
In  the  later  months  of  pregnancy  the  fatal  os- 
seous .system  is  developed  largely  at  the  expen.se  of 
the  reserve  supply  of  osteoplastic  material.  The 
maternal  bones  then  regain  the  former  size,  and 
the  osteophytes  disappear  during  the  first  months 
of  lactation,  after  having  assisted  in  maintaining 
the  amount  of  phosphates  in  the  milk,  at  the  natu- 
ral standard.  If  the  mother  be  of  feeble  constitu- 
tion, the  phosphates  necessary  for  the  development 
of  the  foetus  are  withdrawn  from  her  own  tissues 
instead  of  from  a  reserve  supply,  in  the  form  of  os- 
teophytes, and  her  impoverished  blood  fails  to  fur- 
nish an  adequate  amount  of  phosphates  to  her  milk. 
The  child,  therefore,  becomes  rachitic.  This  catas- 
trophe may  be  averted  by  the  administration  of 
phosphate  of  lime  during  utero-gestation.  Dr. 
Delattre  prefers  the  syrup  of  the  lactophosjihate  of 
lime,  and  asserts  that  dentition  is  always  established 
.much  earlier  in  the  children  of  mothers  subjected 
to  the  above  treatment.  The  author,  moreover,  be- 
lieves that  the  emesis  of  pregnancy  may  be  some- 
what alleviated  by  the  use  of  the  same  remedy. 

The  Skat  op  the  Bacteria  in  Leprosy. — La 
Pres.ie  Medicate,  January,  1882,  furnishes  an  ab- 
stract of  M.  V.  Cornil's  researches  regarding  tlie 
seat  of  the  bacteria  in  leprosy,  attributing  the 
same  to  the  Union  Mrdicale.  The  author  states  that 
the  abdominal  viscera  examined  by  him  were  filled 
with  the  bacteria,  and  so  disintegrated  that  tlie  ana- 
tomical structure  peculiar  to  any  individual  organ 
could  no  longer  be  recognized.  The  microphytes 
wore  present  in  various  stages  of  development,  oc- 
curring as  spores,  slender  rods,  longer  rods  enclos- 
ing granular  matter,  and  as  rods  united  by  their 
ends  into  chains.  The  bacteria  produced  two  kinds 
of  lesions.  One  of  these  consisted  in  nodules  or  in- 
flltratiouB  composed  of  large  cells  enclosing  very 
minute  bacteria.     In  soft  organs,  such  as  the  liver, 


these  organisms  attained  a  large  size,  and  the  capil- 
lary vessels  were  obstructed  by  zoogla?a.  In  the 
other  variety  of  lesion,  found  chiefly  in  fibrous  tis- 
sues, the  bacteria  occurred  in  elongated  forms  be- 
tween the  fibres.  The  connective-tissue  cells  re- 
mained intact  except  in  those  cases  attended  by 
sclerosis  of  the  tissues  afi"ected. 

The  Treatment  of  Carbuncles. — In  the  course 
of  a  recent  clinical  lecture,  delivered  at  the  Ho)iital 
de  la  Charitf,  M.  Gosselin  made  some  interesting 
remarks  on  the  above  subject  a  propos  of  a  carbun- 
cle on  the  neck  of  a  patient  then  presented.  He 
advised  opium  and  chloral  for  mitigation  of  the  in- 
tense pain,  and  subcutaneous  incisions,  after  the 
method  of  Alphonse  Guerin,  in  the  event  of  failure 
of  these  anodynes  to  relieve  the  suffering.  The  ob- 
ject of  the  incision  is  to  relieve  tension,  to  divide 
some  of  the  sensitive  nerves,  and  to  afford  an  exit 
for  the  inflammatory  products.  The  incisions  are 
made  hypodermically,  in  order  to  prevent  the  devel- 
opment of  erysipelas,  which  often  attacks  an  open 
cutaneous  wound  under  these  circTimstances.  A 
bistoury  is  usually  introduced  through  one  of  the 
spontaneous  cutaneous  apertures  produced  by  the 
carbuncle,  and  is  then  made  to  divide  the  inflamed 
tissues  in  a  direction  parallel  to  the  surface.  If 
there  be  no  spontaneous  opening  which  may  be 
thus  utilized,  the  bistoury  is  inserted  through  a  cica- 
trix, and  section  efi'ected,  subcutaneously,  as  in  the 
former  instance. — Le  Medecin  Practicieii,  April  15, 
1882. 

Condition  of  the  Eyes  in  Patal  Anemia. — The 
Archives  of  Ophthahnology  for  March,  1882,  contains 
an  article  by  Dr.  Boerne  Bettman,  of  Cincinnati, 
upon  the  above  subject.  His  conclusions  are  based 
upon  the  examination  of  four  eyes  taken  from  two 
patients  dead  from  fatal  ansemia.  The  morViid  ana- 
tomical appearances  found  embraced  changes  in 
the  walls  of  the  blood-vessels,  cedema  of  the  nerve- 
fibre  layer,  hemorrhages,  and  varicose  nerve-fibres. 
There  was  no  fatty  degeneration  of  the  vascular 
walls,  nor  were  the  aneurismatic  enlargements  of 
the  retinal  capillaries  such  as  were  observed  by 
Eichliorst  and  ^Manz.  The  capillaries  of  the  choroid 
coat  were  uniformly  dilated,  the  dilatation  being 
most  marked  at  the  fundus.  The  retinal  o>denia 
was  most  plainly  evident  in  the  vicinity  of  the 
papilla,  manifesting  itself  in  the  form  of  retinal 
cloudiness.  In  some  instances  the  nerve-fibres  of 
the  papilla  were  also  separated  and  cndeniatous.  In 
one  case  all  the  layers  of  the  retina  were  ocdematons. 
During  life  the  retinal  cloudiness  was  repeatedly 
observed  to  disappear  and  reappear.  Bound  and 
ribbon-shaped  hemorrhages  were  found  in  all  the 
eyes,  especially  at  the  posterior  pole.  The  ecchy- 
moses  were  either  simple  ones  or  they  contained 
yellowish-white  spots  in  their  centre.  These  spots 
mav  originate— ( 1)  b.y  the  accumulation  of  lymjihoid 
cells  in  the  middle  of  the  ecchynioses,  the  cells 
being  either  in  immediate  contact  with  the  blood 
or  enclosed  in  a  distinct  envelope ;  (2~)  bv  degen- 
eration of  the  clusters  of  lymphoid  cells ;  (3)  by 
the  presence  of  large  clusters  of  varicose  nerve- 
fibres  in  the  centre  of  the  hemorrhagic  foci.  Dr. 
Bettman  maintains  that  the  hemorrhages  are  dne 
to  rupture  of  tlio  degenerated  cajiillary  walls. 
Varicose  nerve-fibres  were  observed  in  all  the  eyes. 
They  occurred  either  as  homogeneous  thickenings 
of  the  fibres  or  as  varicosities  with  globular  nuclear 
contents.  Besides  the  pathological  changes  above 
mentioned,  there  were,  in  three  of  the  eyes,  plainly 


THE  MEDICAL  RECORD. 


631 


visiM,.  .vUite  plaques.  Litten  regarded  these  as 
eoui))U!,cJ  of  leucocytes  and  varicose  nerve-fibres. 
1  >r.  Bettmau  believes  them  to  be  composed  solelv  of 
the  latter.  "' 

Croup  of  the  Conjunctiva.— Dr.  H.   Knapp  de- 
scribes two  cases  of  croupous  conjunctivitis,  in  the 
Arcfnres   of  Ophtlialmolog;/   for   March,    1882.      He 
discards   the   theory   advocated   by  Drs.  Bull  and 
Noyes,  that  this  form  of  conjunctivitis  is  merely  a 
variety  of  ordinary  neuro-purulent  ophthalmia,  re- 
garding it  as  an  independent  affection  which  dilfers 
from    catarrh,  blenorrhcea,   and    trachoma   by  the 
presence  of  characteristic  whitish  membranes.     It 
i-<  differentiated  from  diphtheria  of  the  conjunctiva 
l>v   the  following   distinctive   points  :    1.  In  diph- 
theria the  Uds  are  stiff  and   hard,  in  croup  supple 
and   soft.     2.  The   lid   in  diphtheria  is   hot,  pain- 
ful, and  tender  ;  the  reverse  obtains  in  croup.     3. 
The  diphtheritic  exudation  involves  all  the  layers 
of  tlie  conjrmctiva,  the  croupous  exudation  consti- 
tuting a  surface  deposit  only.     4.  In  diphtheria  the 
membrane  cannot  be  removed  without   force,  and 
leaves   the  subjacent  tissue  pale  and  ragged ;    the 
eroupous  deposit   may  be   more   easily  wiped  off, 
leaving  the  surface  below  it  dark  red,  bleeding,  and 
nodular.     5.  The   diphtheritic   lid   is   anajmic   and 
lardaceous   in   appearance,    on   section,   while   the 
ernupous  lid  is  congested  and  softened.     6.  Diph- 
theria produces  gangrene  of  the  conjunctiva  ;  croup 
develops    polypoid    excrescences.      7.    Diphtheria 
involves  by  extension  the  bulbar  conjunctiva  and  the 
eeruea,  while  croup  rarely  affects  the  cornea  and 
spares  the  scleral  conjunctiva.     Croupous  conjunc- 
tivitis begins  as  a  simple  catan-hal  conjunctivitis, 
the  membrane  making  its  ajipearance  after  three  or 
four   days,  and   remaining   from   one  week   to  six 
mouths.      After  its   removal,    cataiThal    symptoms 
jiersist  for  a  variable  period.     The  causes  are  those 
of  conjunctival  catarrh.     The  prognosis  is  favorable, 
the  cornea  remaining  intact,  and  no  grangrene  oc- 
curring.    The  treatment  consists  in  the  continuous 
a] 'plication  to  the  lids  of  iced  compresses,  day  and 
niu'lit,  and  careful  removal  of  the  secretion  by  means 
of  soft  sponges  dipped  in  weak  solutions  of  chloride 
of  sodium  or  chlorate  of  potash,  so  long  as  the  in- 
flammation is  af  its  height.    When  the  membranes 
fall   off  the  applications  may  be  made  for  an  hour, 
morning,  noon,  and  night,  and  then  gradually  sus- 
pended.    They  are  followed  by  weak  solutions  of 
the  nitrate  of  silver,  or  by  the  sulphate  of  copper 
stick. 

Nl'rffROLlTHOTOjrV   FOE   THE   RELIEF   OP   ANURIA. — 

Dr.  ( ).  Thelen,  of  Cologne,  furnishes  the  Centrallhitt 
fur  ('hirurgU;  March  25,  1882,  with  the  history  of  an 
interesting  case  of  anuria,  due  to  imjiaction  of  a 
renal  calculus  in  the  ureter,  together  with  an  ac- 
count of  the  nephrolithotomy  performed  by  Dr. 
Bardenheuer  for  the  relief  of  the  anuria.  This  opera- 
tion was  first  suggested,  according  to  Dr.  Thelen, 
by  Czerny,  and  first  performed  by  H.  Morris.  The 
patient  for  whom  the  operation  was  undertaken  by 
Bardenheuer  had  suffered  from  pyo-nephrosis,  which 
had  occasioned  complete  atrophy  of  the  left  kidney 
and  given  rise  to  an  iliac  abscess  which  had  been 
artificially  evacuated  through  a  free  incision.  The 
atrophied  condition  of  the  left  kidney  had  been 
demonstrated  by  palpation  at  the  time  when  the 
abscess  was  opened.  The  patient  was  attacked  by 
anuria  and  urfemic  phenomena  during  her  conva- 
lescence, after  the  evacuation  of  the  iliac  abscess.  A 
catheter  was  introduced  into  the  bladder,  but  only 


a  little  mucus  and  a  small  calculus  escaped  through 
it.  Acute  pains  were  soon  felt  in  the  right  lumbar 
region  and  radiated  into  the  bladder.  The  diagnosis 
of  occlusion  of  the  ureter  by  an  impacted  calculus 
having  been  made,  Dr.  Bardenheuer  exposed  the 
kidney  by  an  incision  extending  vertically  from  the 
eleventh  rib  to  the  crest  of  the  ileum.  A  calculus 
as  large  as  a  bean  having  been  felt  imjiacted  in  the 
ureter,  the  latter  was  incised  and  the  stone  removed. 
The  wound  in  the  ureter  was  closed  with  sutures 
and  the  wound  was  dressed  antiseptically.  This 
o2Jeration  was  perfornied  on  February  9,  1882,  and 
was  followed  by  the  free  escape  of  urine  through 
the  bandages  and  the  disappearance  of  the  urivmic 
symptoms.  On  February  13th  the  patient  had  a 
.severe  chill,  followed  by  suppression  of  urine  and  a 
temperature  of  105°  F.  The  wound  was  opened, 
the  sutures  removed  from  the  ureter  and  the  latter 
divided,  inasmuch  as  its  calibre  was  much  dimin- 
ished by  an  cedematous  condition  of  the  mucous 
membrane. 

The  divided  end  was  attached  by  a  suture  to  the 
outer  margin  of  the  lumbar  wound.  On  the  follow- 
ing day,  urine  was  again  freely  secreted.  On  March 
12th  the  patient  was  free  from  fever,  the  urine  was 
escaping  fully  through  the  wound  and  the  latter 
presented  healthy  granulations. 

Extirpation  of  Hemoebhoids  by  Means  of  the 
Clamp. — Thetheoryof  "crushing"asa  means  for  the 
radical  cure  of  hemorrhoids  was  devised  by  Mr.  Cu- 
sack,  who  claimed  that  "  any  thorouRh  and  instanta- 
neous destruction  of  a  part  is  nsually  comjiaratively 
painless  in  the  injury  itself  and  its  sequence,"  but 
the  operation  was  first  introduced  by  Mr.  Henry 
Smith  at  St.  George's  Hospital,  Dublin. '  The  clamp, 
as  then  used,  allowed  so  much  oozing  of  blood  that 
the  application  of  the  actual  cautery  became  as 
much  a  part  of  the  operation  as  the  clamp  itself. 
The  results  attending  a  long  series  of  trials  by  both 
Smith  and  Allingham  led  them  to  condemn  its  prac- 
tice. Mr.  Benham  has  now  so  far  perfected  the 
clamp  that  his  results  have  been  most  satisfactory. 
No  cautery  is  required  and  a  ligature  is  rarely  re- 
sorted to.  The  instrument  and  the  manner  of  using 
is  thus  described  by  Mr.  Benham.  In  appearance 
it  resembles  a  pair  of  pincers  with  handles  four 
times  longejtban  its  jaws.  There  is  a  tliumb-screw 
attachment  at  the  end  of  the  handles.  To  operate, 
the  patient,  after  being  etherized,  should  be  laid  on 
one  side  near  the  edge  of  the  table,  and  as  each  pile 
is  drawn  out  in  order,  beginning  at  the  lowest,  it 
should  be  suddenly  seized  at  its  base  by  the  clamp 
and  the  thumb-screw  set.  That  portion  of  the  pile 
projecting  beyond  the  jaws  of  the  instrument  should 
be  snipped  off,  and  after  retaining  the  "fringed 
remnant "  in  the  bite  of  the  clamp  for  a  moment  or 
two  the  pressure  should  be  gradually  relaxed,  care 
being  taken  to  keep  the  instrument  well  np  against 
the  buttocks  to  avoid  putting  the  tissue  too  much 
upon  the  stretch  and  returning  too  suddenly  within 
the  bowel  when  released.  A  very  larpe  hemon-hoid 
should  be  crushed  in  two  portions.  The  only  dress- 
ing needed  is  a  carbolized  washing  of  the  parts  and 
carbolized  vaseline  externally  and  internally,  some 
form  of  anodyne  to  quiet  the  patient  after  the  annes- 
thetic,  and  opium  to  keep  the  bowels  closed  for 
five  or  six  days,  when  after  an  easy  passage,  rendered 
such,  perhaps,  by  Glauber's  salts,  the  patient  should 
be  allowed  to  get  up.  Active  work  should  not  be 
resumed  for  a  number  of  days. — Lancet,  April  15, 
1882. 


632 


THE  MEDICAL  RECORD. 


The  Medical  Record-. 


ta  iDcckln  ilonnial  of  fttciiicinc  anii  Surgtrg, 


GEORGE  F.  SHRADY,  A.M.,  M.D.,  Editor. 


PUBLISnBlD   BY 

WM.  WOOD  &  CO.,  Nos.  56  aiul  .58  Lafayette  Plaee,  N.  M. 


New  York,  June  10,  1882. 

SANITAEY  EEQUIEEMENTS  OF  COMMON 
SCHOOLS. 

After  all  that  has  been  said  upon  this  subject  the 
old  story  requires  occasional  repetition.  Almost 
every  parent  in  the  land  is  aware  of  the  fact  that  the 
sanitary  requirements  of  the  schools  are  not  what 
they  should  be,  and  that  the  health  of  children  is 
jeopardized  thereby.  Every  physician  also  knows 
too  well  upon  what  these  defects  in  school  sanita- 
tion depend,  and  should  use  his  influence  in  the 
direction  of  remedying  them  as  much  as  lies  in  his 
power.  The  bringing  of  the  sanitarian  and  the 
school  officer  to  a  proper  understanding  of  rela- 
tive jiositions,  and  a  practical  appreciation  of  mu- 
tual obligations  has  long  been  needed.  There 
is,  indeed,  a  necessity  for  popularizing  the  princi- 
ples of  school  hygiene — of  educating  the  peojjle  to 
the  necessity  of  demanding  such  alterations  in 
school-house  construction  and  such  change  in 
school  regulations  as  shall  be  possible.  The  State 
Board  of  Health  has  certainly  done  good  work  in 
this  direction,  and  the  summary  of  its  labors  in 
Tract  -13  is  full  of  interesting  data.  The  sanitary 
condition  of  the  school-houses  in  the  diflferent  parts 
of  the  State  has  been  carefully  studied  for  a  period 
of  three  months.  The  facts  obtained  have  for  the 
most  part  been  answers  to  some  general  and  com- 
prehensive questions  addressed  by  the  board  to 
school  officials  tliroughout  the  State.  The  conclu- 
sions, based  upon  the  results  of  actual  inspections  of 
a  large  number  of  school  edifices,  servo  to  confirm, 
in  a  striking  manner,  those  made  on  a  more  limited 
scale  in  this  city  and  Brooklyn. 

While  struotnral  improvements  are  being  made  in 
the  school-houses  in  many  districts,  and  there  is  a 
recognized  attention  to  some  of  the  requirements  of 
health  that  have  been  neglected  in  the  old  school- 
Louses,  the  committee  of  the  board  found  only 
about  one  in  fifteen  of  the  common  school-houses 


well  outfitted  for  protecting  the  health  of  the  pupUs. 
Even  in  the  exceptionally  good  ones,  there  is  oftener 
a  neglect  of  sufficient  ventilation  than  a  suitable  pro- 
vision for  il.  It  is  mentioned  as  a  general  fact  that 
ventilation  in  the  common  school-houses  is  insuffi- 
cient, and  the  means  for  it  badly  designed.  When 
good,  its  excellence  depends  chiefly  upon  open  win- 
dows and  special  facilities  for  controlling  them. 
Overcrowding  is  particularly  mentioned  as  a  prevail- 
ing fault,  and  even  a  wrong,  in  a  majority  of  the 
school-houses  which  the  committee,  aided  by  Dr.  D. 
F.  Lincoln,  have  reported  upon.  In  many  of  the 
schools  the  overcrowding  was  such  as  to  actually 
endanger  the  health  and  life  of  the  children  ;  and 
taken  in  connection  with  defective  ventilation,  was 
a  matter  for  the  most  emphatic  protest. 

In  numerous  towns,  villages,  and  cities,  as  shown 
in  the  report,  there  was  a  disgusting,  degrading,  and 
harmful  neglect  of  sanitary  cleanliness  in  and  about 
the  school  buildings,  especially  as  regards  the  privies 
and  the  means  for  the  proper  separateness  and  con- 
venience of  the  sexes  in  relation  to  these  matters. 

It  is  strongly  and  properly  recommended  that  such 
neglect  of  cleanliness  and  decency  should  be  inter- 
fered with  and  prevented  by  local  sanitai-y  authority. 

The  supply  of  drinking-water  for  the  common 
school  children  was  much  neglected,  excepting 
where  hydrants,  from  the  public  water  sei-vice,  ex- 
isted upon  the  premises.  In  many  instances  water 
was  obtainable  only  from  wells  at  considerable  dis- 
tances from  the  school-houses,  and  was  oftentimes 
insufficient  in  quantity. 

Wardrobes  or  rooms,  with  pegs  or  brackets  upon 
which  to  suspend  outer  garments  and  wet  clothing, 
are  seldom  found  suitably  placed,-  and  often  they 
are  neglected  altogether. 

Hand-basins,  wash-stands,  or  lavatories,  are  want- 
ing in  a  great  proportion  of  the  common  school- 
houses. 

The  experiment  of  omitting  the  old  practice  of 
school  recesses  between  the  noon  hour  and  the 
opening  and  closing  of  school,  was  being  extensively 
adopted,  with  doubtful — probably  injurious^results. 

The  recreations  needed  by  school  children,  under 
the  name  of  light  gymnastics  or  play,  are  confessed 
to  be  of  great  use  to  the  younger  classes  in  the  com- 
mon schools  ;  but  it  was  found  that  the  people  did 
not  suitably  appreciate  such  physical  exercises.  It 
was  desired,  therefore,  that  teachers  and  parents 
should  more  thoroughly  understand  the  reasons  for 
encouraging  and  perfecting  facilities  for  thorn. 

There  was  also  found  to  be  special  reason  for  urging 
that  girls  shall  not  be  deprived  of  the  means  of  health 
which  innocent  and  regulated  gymnastics  aflbrd. 

There  was  much  neglect  of,  yot  an  increasing  at- 
tention to,  school-desks. 

The  permanent  injury  to  the  eye-sight  of  school 
children  was  found  to  be  frequent,  and  to  bear  a 


-THE  MEDICAL  RECORD. 


633 


Jirect  relation  to  the  manner  in  which  the  recitation 
rooms  were  lighted.  The  recommendation  is  very 
properly  made  by  the  board  that  the  arrangement  of 
windows,  the  best  adjustment  of  seats,-  desks,  and 
bhick-boards,  and  the  necessary  regulations  of  study 
and  exercise.should  be  secured  under  competent  med- 
ioal  advice.  In  other  words,  that  competent  medical 
inspection  in  such  matters  has  become  a  necessity. 

The  reception  of  vaccination  by  school  children, 
under  direction  of  their  parents  and  the  school 
oilicers,  was  found  to  have  nowhere  produced  incon- 
venience or  serious  dissatisfaction.  It  seemed  emi- 
nently desirable,  and  certainly  practicable,  to  secure 
general  compliance  with  the  statutes  relating  to  the 
vaccination  of  school  children  as  now  administered 
under  advice  of  the  State  Board  of  Health. 

It  has  been  shown  in  a  very  practical  way  that, 
with  the  best  intentions  on  the  part  of  the  school 
officers,  the  majoi'ity  of  the  ventilators  did  not  per- 
form their  work.  The  circulation  of  air  was  at  best 
slow,  and  the  change  of  fresh  for  foul  atmosphere 
was  proportionately  insulScient.  Practically,  in  the 
majority  of  cases,  it  was  little  better  than  nothing 
at  all.  All  other  things  being  equal,  the  rapid  change 
of  the  air  is  of  greater  importance  than  the  mere 
size  of  the  room.  But  this  is  of  course  a  self-evident 
proposition.  In  order  to  obtain  the  best  ventilation 
at  least  cost,  the  ordinary  window  board  is  recom- 
mended, which  is  inserted  under  the  lower  sash, 
thus  allowing  fresh  air  to  enter  between  the  space 
of  the  two  sashes  slid  upon  each  other. 
t^As  an  addendum  to  this  report.  Dr.  David  F. 
Lincoln  has  contributed  a  suggestive  series  of  rec- 
ommendations concerning  the  proper  sanitary  ar- 
rangements of  school-houses.  These  are  of  a  simjile 
and  practical  character,  bearing  mostly  on  improved 
methods  of  the  ventilation,  heating,  and  lighting  of 
school  rooms.  Dr.  Lincoln's  matured  knowledge 
upon  these  subjects  gives  great  weight  to  his  opin- 
ions, and  their  wide  publicity  through  the  official 
publications  of  the  board  will  be  calculated  to  efl'ect 
many  desirable  reforms.  Already  we  are  informed 
that  the  recommendations  have  borne  good  fruit, 
and  that  there  is  a  growing  desire  to  profit  by  them 
in  many  school  districts.  The  questions  concerning 
ventilation  are  grouped  under  two  headings.  How 
much  ?  and  How  ? 

Dr.  Lincoln  also  makes  some  practical  suggestions 
concerning  light  and  the  proper  ari'angement  of 
seats.  Kegarding  the  latter,  it  seems  to  be  difficult 
to  construct  a  seat  to  serve  the  double  purpose  of 
a  proj)er  one  for  reading  and  writing.  The  shape 
of  the  Mexican  saddle  is  suggested  as  a  model 
for  a  proper  school  seat,  the  lower  half  or  third  of 
the  trunk  being  the  part  which  needs  firm  support. 

Finally,  in  speaking  of  the  hours  allotted  to  study^ 
the  following  sensible  conclusions  are  arrived  at. 
We  wish  they  could  be  read  by  every  teacher  and 
parent  in  the  land  : 


"  If  young  children  must  be  kept  at  school  for  four 
hours  together,  it  is  necessary  to  break  the  con- 
tinuity of  work  by  a  long  recess  of  twenty  or  thirty 
minutes.  They  should  not  be  allowed,  either,  to  re- 
main in  their  seats  during  recesses,  but  should  all 
be  sent  out  to  play,  under  the  care  of  teachers.  .  .  . 
The  experience  of  many  excellent  and  conscientious 
teachers  shows  that  primary  scholars  can  very 
rarely  be  kept  at  work — real  work — more  than  three 
hours  a  day.  If  the  sessions  are  longer,  the  children 
have  to  be  amused,  or  allowed  to  amuse  themselves." 

THE   FORMATION  OF   FIBRIN. 

The  explanations  of  the  formation  of  fibrin  have 
undergone  many  changes  in  the  past  fifteen  years. 
The  view  most  generally  held  now  is  that  of  Albert 
Schmidt.  According  to  this  observer,  fibrin  results 
from  the  union  in  the  drawn  blood  of  certain  fac- 
tors, viz. :  fibrinogen,  which  exists  in  the  jjlasma,  and 
fibrino-plastin,  which  exists  chiefly  in  the  white 
corpuscles.  The  action  is  prolonged  by  a  third  fac- 
tor, a  ferment  which  exists  in  the  white  corpuscle. 

Mrs.  Ernest  Hart  has  recently  made  a  contribu- 
tion to  the  subject  of  fibrin-formation,  which  is  of 
much  interest  and  which  may  compel  some  modi- 
fication of  Schmidt's  theory.  Mrs.  Hart  used  Dr. 
Norris'  method  of  isolating  red  blood-corpuscles. 
By  it  a  vei-y  few  of  these  are  obtained  under  the 
sUde.  They  are  then  fixed  to  the  slide  by  osmic 
acid  vapor.  They  can  then  be  stained,  washed,  and 
examined  at  leisure.  Our  experimenter  found  that 
the  corpuscles  jDresented  very  different  appearances, 
according  to  the  length  of  time  between  putting  the 
fresh  blood  on  the  slide  and  isolating  it  for  exam- 
ination. At  first  many  of  the  corpuscles  are  found 
to  have  lost  their  color,  i.  e.,  hjemoglobin,  possibly 
through  the  complete  withdrawal  of  their  serum. 
These  pale  corpuscles  are  the  alleged  new  corpus- 
cles of  Dr.  Norris.  At  a  later  stage  the  pale  cells 
become  pear-shaped,  then  send  out  fine  filaments. 
If  the  process  be  followed  closely,  a  continued  fibril- 
lation is  said  to  be  formed,  imtil  finally  an  appear- 
ance resembling  true  fibrin  is  seen.  The  pale  cor- 
puscles seem  to  have  broken  up  into  granules  and 
threads.  The  length  of  time  which  this  occupies  is 
not  stated. 

The  authoress  replies  to  several  possible  objec- 
tions to  her  facts,  and  shows  that  what  she  describes 
cannot  be  due  to  current  of  serum.  To  prove  that 
the  fibrils  seen  are  true  fibrin,  she  examined  defib- 
rinated  blood  and  also  serum,  but  with  no  result. 

The  different  forms  seen  are  carefully  figured,  and 
there  can  hardly  be  a  doubt  as  to  the  changes  ob- 
served. 

The  view  that  the  red  corpuscles  are  so  largely 
concerned  in  i^roducing  fibrin  has  never  before  had 
any  weighty  support.  The  present  observations 
can  only  be  considered  suggestive  acd  worthy  of 
further  study. 


est 


THE  MEDICAL  RECORD. 


TESTING   PKOTECTIVE   INOCULATIONS  ABROAD. 

At  last  the  value  of  Pasteur's  protective  inoculations 
has  been  tested  outside  of  France,  and  under  other 
than  the  discoverer's  own  suiservision.  The  results 
have  not  been  so  brilliant  as  were  those  first  an- 
nounced. 

For  some  time  anthrax  has  prevailed  at  Budapest. 
Not  long  ago  the  authorities  asked  Pasteur  to  send 
them  some  of  his  protective  virus,  with  directions 
how  to  use  it.  Accordingly,  M.  Thuillier,  Pasteur's 
assistant,  was  despatched  with  the  nece.isary  mate- 
rials and  instruments. 

The  dilllcult  practical  point  in  Pasteur's  process 
lies  in  the  fact  that  the  anthrax  bacteria  must  be 
cultivated  till  they  have  reached  just  the  right  point, 
and  are  neither  too  weak  nor  too  strong.  This  point 
is  generally  reached  by  keeping  the  bacteria  at  a 
temperature  of  from  42"  to  43°  C.  for  twenty-four 
days.  After  the  animals  have  been  inoculated  with 
this,  and  the  effect  is  over,  they  are  again  inoculated 
■with  a  twelve-day  culture,  in  order  to  make  the  pro- 
tection more  sure.  These  are  Pasteur's  "primary" 
and  "  secondary  "  vaccinations. 

M.  Thuillier  brought  the  necessary  bacteria  with 
him  in  sealed  glass  tubes.  They  were  cultivated  ac- 
cording as  they  were  needed,  at  the  Veterinary  In- 
stitute in  Budapest. 

The  first  experiment  was  upon  thirty  sheep. 
These  were  all  inoculated.  One  died  of  a  catarrhal 
trouble.  Twelve  days  later  the  remaining  twenty- 
nine  were  subjected  to  the  second  vaccination.  An- 
other sheep  soon  died,  but  the  cause  of  death  was 
not  apparent.  Twelve  days  after  this,  twenty-five  of 
the  twice-vaccinated  sheep  and  twenty-five  unvac- 
cinated  sheep  were  taken,  and  all  were  inoculated 
with  the  full  strength  of  the  anthrax  poison.  The 
result  was  as  follows  :  Of  the  twenty-five  twice  vac- 
cinated sheep  two  died,  but  not  from  anthrax.  Of 
the  twenty-five  unvaccinated,  twenty-three  died  very 
soon  of  the  anthrax,  and  one  of  some  intercurrent 
trouble. 

Five  cows  were  tried  in  the  same  way.  They  ap- 
peared to  be  protected. 

Fifty  more  sheep  were  experimented  upon.  Six 
of  the  vaccinated  died.  Of  fifty  not  protected  forty- 
five  died. 

Other  experiments  were  made  upon  489  sheep.  A 
number  of  the  vaccinated  died.  Twelve  were  made 
lame  by  the  local  inflammation. 

Twenty  cows  were  inoculated  with  the  protective, 
and  then  with  virulent  material.  They  showed  very 
little  disturbance.  Of  six  unprotected  animals  one 
died.  The  remainder  showed  only  a  considerable 
fever. 

The  total  result  of  the  experiments  showed  that 
under  the  protective  methods  there  was  a  mortality 
among  sheep  of  14.53  per  cent.  Among  the  unpro- 
tected the  mortality  was  94  per  cent.    It  also  ap- 


peared  that  the  "  vaccinations  "  weakened  the  ani- 
mal temporarily,  so  that,  if  it  had  any  disease  be-  _ 
fore  {e.g.,  distoma,  strongylus,  etc.),  such  disease 
would  prove  fatal.  There  is  a  further  question  as  to 
the  healthfulness  of  the  meat  and  milk  of  the  pro- 
tected animals. 

On  the  whole,  M.  Thuillier's  work  at  Budapest  has 
as  yet  a  doubtful  value.  The  farmer  who  submits 
his  flock  to  vaccination  must  expect  to  lose  from  ten 
to  fourteen  per  cent,  of  them.  On  the  other  hand, 
this  to  some  would  be  the  least  of  the  evils,  since  in 
certain  parts  of  Hungary  the  annual  loss  of  sheep 
from  anthrax  is  sixty  per  cent. 


TRAINING-SCHOOLS   FOR  NURSES. 

The  Commissioner  of  Education  has  published  a 
circular  xipon  the  inception,  organization,  and  man- 
agement of  training-schools  for  nurses.  The  pam- 
phlet will  be  found  of  much  value  to  those  who  are 
interested  in  establishing  such  institutions.  It  con- 
sists of  a  clear  and  brief  description  of  the  way  to 
go  to  work  in  undertaking  to  organize  a  training- 
school,  with  directions  for  its  future  control  and 
management.  Some  statistics  are  also  given  of  the 
present  number  of  these  schools  and  the  regulations 
concerning  them.  From  the  tables  given  it  appears 
that  we  have  now  seventeen  of  such  institutions  in 
this  country.  Six  of  these  are  in  New  York  State, 
three  being  in  New  York  City.  Boston  also  has 
three,  Brooklyn  and  Philadelphia  each  two.  There . 
are  also  training-scliools  in  New  Orleans,  St.  Louis, 
and  Chicago,  Washington,  D.  C,  and  Burlington, 
Vt.  The  oldest  school  is  the  Philadelphia  Lying-in 
Charity  and  Nurse  School,  which  was  organized  in 
1836. 

Of  the  value  and  superiority  of  trained  nurses, 
there  is  but  one  opinion  among  American  physi- 
cians, and  that  is  a  most  favorable  one.  There  is,  to 
be  sure,  a  certain  proportion  of  these  nurses  who 
lack  stability  and  good  sense,  and  become  inflated 
with  the  little  medical  knowledge  they  have  ac- 
quired. They  talk  too  much,  and  interpret  the 
doctor's  instructions  by  the  illumination  of  their 
own  special  views.  It  is  this  class,  made  powerful 
by  lay  and  religious  backing,  which  has  caused  so 
much  trouble  in  England.  But  we  do  not  have 
many  of  them  here.  It  is  probable  that  the  modern- 
trained  secular  nurse  is  best  developed  and  best 
appreciated  in  this  country.  Our  training-schools 
are  well  organized.  Their  scheme  of  instruction  is 
uniformly  practical,  and  in  its  later  modification 
especially,  is  calculated  to  make  sensible  and  skilful 
nxirses.  There  is  still  room  for  more  schools  and  a 
modern  education  of  women  and  men  in  caring  in- 
telligently for  the  sick.  In  these  days  wo  may 
modify  Cicero's  famoxis  Titteranee,  and  say  that  man 
or  woman  never  comes  so  near  the  gods  as  when  they 
tenderly  and  skilfully  nurse  the  sick  and  suffering. 


THE  MEDICAL  RECORD. 


635 


Heports  of  Societies. 


CONNECTICUT  jMEDICAL  SOCIETY. 

NiNETT-FIRST   ANNUAL   CONVENTION. 

Held  at  New  Haven,  May  24  and  25,  1882. 
(Special  Report  for  The  Medical  Record.) 
The  meeting  was  held  in  the  City  Hall  Common 
Council  Chamber.  The  alternation  of  meetings  be- 
tween Hartford  and  New  Haven  is  made  imperative 
liv  a  by-law  of  the  society  made  when  the  State  had 
tnM  capitals,  and  the  habit  of  the  Legislature  was  fol- 
1  iW.'il.  One  great  disadvantage  is  that  it  jirevents 
the  acquisition  by  the  society  of  a  permanent  meet- 
ing' place,  the  collection  of  a  library  of  reference,  or 
a  laboratory  for  experimental  investigations,  even 
liail  we  the  means.  But  the  inhabitants  of  the  beau- 
tiful city  of  elms,  more  especially  the  medical  frater- 
nity, would  strongly  oppose  any  change,  and  it 
w.iiild  lead  to  lasting  animosities.  There  is  consid- 
erable jealousy  between  the  two  cities,  and  always 
lia^  been. 

The  profession  in  New  Haven  have,  to  a  great  ex- 
tent, been  indifferent,  to  say  the  least,  toward  the 
S:  ite  Society ;  hence  the  failure  to  pay  taxes  in-omptly 
or  to  fulfil  any  duties  devolving  uj^on  them  for  the 
good  of  the  society.  This  inditference  reached  its 
oulmiuating  jioint  at  the  convention  held  in  New 
Hiven  pi-eceding  this  one.  The  profession  could 
not  have  treated  the  society  much  more  cavalierly 
if  it  had  been  one  of  long-haired  reformers  establish- 
iuL,'  a  new  ism  in  medicine.  Hence  the  gi'owth  of 
sentiment  in  favor  of  abolishing  the  system  and 
meeting  in  Hartford  each  year.  But  the  changed 
attitude  this  year  put  all  such  jjlans  in  the  back- 
Si'iuud.  The  profession  at  New  Haven  demonstrated 
that  they  know  what  hospitality  is  about  as  well 
a-  any  set  of  men  living.  They  attended  the 
m 'etings,  took  j^art  in  the  discussions,  and  met  the 
meiiiliers  socially  at  the  reception  and  dinner.  All 
tliis  was  in  marked  contrast  to  the  chilling  indiffer- 
eii -e  shown  when  the  society  last  met  at  New  Haven, 
wj  -u  it  was  very  severely  let  alone.  This  coolness 
wa^  the  result  of  old  contests  and  quarrels.  The 
Tonnger  part  of  the  ijrofession  are  not  aftected  by 
their  influence  and  many  of  the  older  ones  laid  aside 
taeir  grievances,  if  they  were  not  forgotten  alto- 
g  ther.  The  prosperity  of  the  society  would  be  un- 
ci 'U. led,  were  this  coolness  forgotten,  and  it  is  evi- 
dently waning. 

The  president.  Dr.  Demtns,  called  the  conven- 
tion to  order  at  3  p.m.  precisely,  and  appointed  the 
usual  committee  on  credentials.  The  only  new  feat- 
ure that  this  committee  had  to  report  was  that  the 
Fairfield  County  Medical  Society  had  elected  five 
fellows  and  five  alternates,  and  two  of  the  latter 
were  present  to  fill  two  vacancies  ;  they  were  ac- 
j  cepted  by  the  committee  and  this  decision  was  rati- 
I  fled  by  the  convention.  The  committee  recom- 
mended to  the  remoter  counties  the  plan  of  the 
Fairfield  County  Society.  Application  was  made  by 
the  president  of  one  of  the  county  societies  for  leave 
to  fill  vacancies  in  the  delegation  from  his  county, 
stating  that  he  had  been  authorized  so  to  do  by  his 
society.  While  unobjectionable  in  the  present  in- 
stance, the  plan,  it  seemed  to  the  committee,  might 
lead  to  abuse  and  it  was  not  allowed  ;  this  action  was 
accepted  by  the  convention,  and  the  list  of  fellows 
thus  corrected.  The  committee  was  then  discharged. 


ADDRESS   OF   THE  PRESIDENT. 

The  president,  as  directed  by  rule,  then  called  at- 
tention to  such  matters  as  he  judged  should  be  con- 
sidered. With  a  brief  mention  of  one  or  two  of  the 
more  prominent  names  among  the  honored  dead  of 
the  year — a  former  president.  Dr.  Ira  Hutchinson, 
Professor  L.  S.  Wilcox,  of  Yale  Medical  School,  Dr. 
J.  C.  Jackson,  long  treasurer  of  the  society,  and 
others,  whose  obituaries  would  be  given  at  the 
proper  time,  he  proceeded  to  review  the  history 
and  progress  of  the  society,  fi-om  the  time  when  a 
handful  met  to  elect  officers,  and  a  four-page  report 
was  sent  of  the  proceedings  to  the  members,  to  the 
present,  when  our  meetings  are  largely  attended,  our 
publications  valued  by  us  as  among  the  best  of  cur- 
rent medical  literature,  and  the  influence  of  the  so- 
ciety known  and  felt  over  the  whole  State  and 
its  recommendations  received  with  respectful  atten- 
tion by  our  Legislature  and  oftentimes  carried  into 
effect.  The  inference  he  drew  from  this  was  that 
the  time  had  come  when  we  should  assume  an  ag- 
gressive policy  and  demand  some  standard  of  edu- 
cation as  a  prerequisite  for  the  practice  of  medicine 
and  surgery  in  the  State,  probably  the  diploma  of  a 
regularly  chartered  medical  school,  although  he 
would  not  object  to  our  examining  board.  This 
was  more  for  the  protection  of  the  public  than 
for  our  own,  and  was  demanded  by  the  enlightened 
sentiment  of  the  public.  He  urged  upon  the  con- 
vention to  use  their  influence  to  secure  this  at  the 
earliest  practical  occasion.  The  evils  resulting  from 
the  present  condition  of  afl^airs  are  too  patent  to 
need  mention. 

WHV   SHOULD   THE   CODE   BE   MAINTAINED. 

The  prosperity  of  the  society  was  due,  he  said,  in 
large  measure  to  the  fact  that  we  had  lived  up  to 
the  principles  of  our  code  of  ethics.  The  allusion 
was  to  the  principles,  not  the  code  itself,  for  the  for- 
mer are  those  that  would  naturally  guide  any  gentle- 
man in  his  professional  life  But  the  existence  of 
the  code  implies  that  we  live  ujj  to  its  principles 
from  fear  of  penalties  and  compulsion  against  our 
wills.  I  am  restive  under  this  imputation,  and 
think  that  the  time  has  come  for  the  abolishment, 
or  at  least  reconstruction  of  our  code  of  ethics  (i.e., 
the  national  code),  and  I  should  prefer  the  former, 
but  at  least  let  something  be  done.  Do  not  imagine 
that  I  am  advocating  indiscriminate  consultations. 
Laws  are  made  for  the  bad,  not  the  good,  and  those 
desirous  of  evading  the  si^irit  and  letter  of  our 
code  do  so  with  perfect  impunity  day  by  day,  and 
will.  Why  then  .should  the  code  be  maintained? 
There  is  little  in  its  favor,  and  much  against  it.  I 
would  advise  that  you  take  this  subject  under  con- 
sideration, and  through  a  committee  jiave  the  way 
for  decisive  action.  Much  more  might  be  said  ;  but 
I  have  mentioned  the  subjects  that  seem  to  me 
most  important,  in  as  plain  a  manner  as  possible,  as 
no  eloquence  is  more  efiective,  if  as  much  so,  with  a 
body  of  intellectual  men  such  as  I  address,  than  a 
clear,  plain  statement  of  facts  in  the  concisest  pos- 
sible manner.  The  usual  recess  was  taken  for  the 
election  of  a  committee  to  nominate  officers,  after 
which  the  usual  routine  order  of  business  was  fol- 
lowed as  given  on  the  isrogramme. 

Dr.  Chamberlain  read  a  communication  from  one 
of  the  delegates  unable  to  be  present,  covering  much 
the  same  ground  as  that  part  of  the  address  relating 
to  a  law  regulating  the  practice  of  medicine.  The 
policy  proposed,  however,  was  more  radical':    that 


636 


THE  MEDICAL  RECORD. 


all  intending  to  practice  medicine  or  surgery  should 
be  examined  by  a  board  appointed  for  that  purpose, 
and  if  they  passed  they  became  by  law  members  of 
the  medical  society.  The  fees  for  examination  were 
fixed  very  low,  and  were  to  go  into  the  treasury  of 
the  medical  society.  Anything  like  diversity  in 
medical  opinions  and  beliefs  did  not  appear  to  have 
suggested  themselves  to  the  doctor's  mind.  The 
whole  subject  was  referred  to  the  Business  Commit- 
tee. This  committee  reported  that  the  communica- 
tion be  laid  upon  the  table,  which  was  ordered.  With 
reference  to  the  portion  of  the  president's  address 
relating  to  a  law,  regulating  medical  practice,  the 
committee  rejjorted  that  in  their  judgment  any  so 
comprehensive  a  sclieme  was  not  now  expedient. 
We  have  one  efficient  law  relating,  it  is  true,  to  med- 
ical tramps  only,  but  wait  until  that  is  firmly  estab- 
lished upon  our  statute-book,  before  risking  another 
point.  Our  recommendations  to  the  Legislature  were 
received  respectfully  of  late  and  acted  upon  often, 
because  the  things  asked  for  were  for  the  common 
good,  not  our  own  protection  and  aggrandizement. 
It  was  when  illy  digested  laws  were  advocated  for 
our  own  benefit  and  emolument,  and  matters  of 
public  weal  received  little  if  any  attention,  that 
legislative  scorn  met  these  schemes,  and  often  de- 
servedly. However  much  we  may  think  a  law  for 
proper  qualifications  in  medical  men,  before  they 
are  allowed  to  commence  the  practice  of  medicine, 
will  protect  the  peojjle,  you  are  met  with  the  objec- 
tion, not  a  bad  one  either,  when  the  people  want 
this  protection  they  will  ask  for  it.  Of  course  this 
is  fallacious,  but  it  meets  popular  prejudices.  Let 
us  rather  strive  to  monopolize  the  practice  of  med- 
icine by  better  quaUflcations  and  careful  prepara- 
tion. The  greatest  evil  is  the  ease  with  which  half- 
trained  youths,  or  those  entirely  lacking  preliminary 
education,  acquire  diplomas  from  regular  schools. 
Let  us  check  this  evil  first  and  improve  our  educa- 
tional methods.  While  honest  in  the  main,  those  that 
have  a  pecuaiary  interest  in  the  matter  should  not 
be  the  final  judges  of  qualifications  to  practise  med- 
icine. The  report  was  accepted  that  no  action  was 
desirable  at  jiresent  on  a  law  regulating  medical 
■  practice. 

A  resolution  was  offered  that  that  part  of  the 
president's  address  relating  to  the  code  of  ethics 
should  be  referred  to  a  committee  of  thi-ee  to  be 
nominated  by  the  convention.  The  resolution  was 
passed,  and  i)rs.  E.  C.  Kinney,  O.  A.  Lindsley,  and 
G.  W.  Avery  were  appointed  and  confirmed.  Dr. 
Deming  was  elected,  but  positively  declined  to 
serve. 

The  Committee  on  Honorary  Degrees  recom- 
mended Dr.  Pliny  Earle,  of  Northampton,  Mass., 
superintendent  of  Retreat  for  Insane,  for  election, 
and  rei)orted  favorably  upon  the  names  of  Dr.  J.  S. 
Billings,  United  States  Army,  and  Dr.  Wm.  Maxwell, 
of  New  York,  for  election  next  year,  as  provided  by 
rule.  Tlie  report  was  accepted  and  the  committee 
discharged.  Dr.  Earle  was  then  elected  an  honorary 
member  of  this  society  by  an  unanimous  vote. 

The  report  of  the  treasurer  was  received  with  the 
indorsement  of  the  Auditing  Committee.  It  was  ac- 
cepted, and  Dr.  Edgerton  tlien  positively  declined 
a  re-election.  His  resignation  was  received  with 
regret,  as  he  has  been  a  very  elKcieut  and  faithful 
treasurer.  Ho  took  the  oflice  with  a  very  small 
balance  in  the  treasury,  the  lenet  in  its  history,  as 
far  as  I  can  learn,  and  scarcely  a  county  that  paid 
its  taxes  in  full,  many  having  a  long  list  of  arrear- 
ages, which  more  than  doubled  the  labors  of  his 


office.  He  leaves  the  office  with  practically  a  work- 
ing balance  in  the  treasury,  and  but  one  county 
society  in  arrears — an  unprecedented  state  of  affairs. 
His  business  eugagemeuts,  however,  prohibit  his 
retaining  the  office.  The  following  is  a  summary 
of  the  report ; 

Balance  on  hand  from  old  account. . . .  §382  24 
Cash  received 562  90 

Total 8945  14 

Increased    expenses    over    preceding 

year 77  57 

Excess  of  receipts  over  expenses 64  73 

Balance  in  treasury 446  97 

Excess  over  balance  of  last  year 64  73 

Amount  due  from  New  Haven  County 

Medical  Society,  on  tax  laid  1881 ...  60  90 

Due  from  all  other  counties 80 

There  is  about  the  same  amount  due  from  New 
Haven  County  on  the  tax  laid  in  1880.  This  is  the 
only  unsolved  problem  in  the  finances  of  the  so- 
ciety. When  the  treasui-y  came  into  his  hands, 
there  were  several  county  societies  with  a  similar 
history.  This  is  the  largest  society  in  the  State  and 
covers  a  large  territory.  The  Hartford  County  so- 
ciety ranks  next,  with  twenty-six  members.  There 
has  been  one  decided  improvement  in  New  Haven 
County ;  there  are  few  members  in  arrears  over  two 
years,  while  at  one  period  there  were  many  owing 
taxes  for  four  years  and  more. 

Taking  into  consideration  the  conditions  at  the 
outset  of  Dr.  Edgerton's  term,  there  has  been  nearly 
as  much  improvement  in  New  Haven  County  as  in 
the  others,  as  there  was  more  to  be  accomplished 
there  than  elsewhere. 

LUNACY   COSrMIS.SION. 

The  Committee  on  Unfinished  Business  reported 
that  the  only  matter  that  came  before  them  was  the 
resolutions  asking  the  society  to  appoint  a  com- 
mittee, to  urge  the  apijointment  of  a  lunacy  com- 
mission upon  the  Governor  and  Legislature,  and  to 
investigate  the  methods  of  managing  asylums  for 
the  insane.  In  their  judgment  the  State  Board  of 
Chai'ities,  as  at  present  constituted,  was  amply  com- 
petent to  perform  all  the  duties  and  functions  which 
would  devolve  upon  such  a  commission  if  appointed. 
By  request,  the  secretary  read  the  law  constituting 
the  Board  of  State  Charities,  wherein  it  appeared 
that,  with  respect  to  the  inspection  of  insane  asy- 
lums and  the  protection  of  inmates  and  correction 
of  abuses,  it  was  their  specified  duty  to  secure  these 
results,  and  every  power  and  facility  that  could  be 
asked  or  wished  was  given  them. 

Dr.  Baker,  of  Middletown,  explained  the  absence 
of  Dr.  Nickorson,  the  original  mover  of  the  resolu- 
tions, who  had  expected  to  be  present  to  defend 
them,  but  was  una\oidably  detftined  by  the  illness 
of  his  wife.  He  spoke  Inietly  of  the  importance  and 
need  of  a  lunacy  commission  for  this  State,  and  the 
great  good  it  could  accomjilish.  Dr.  White,  of  New 
Haven,  said  that  when  tlie  resolutions  were  first 
ofl'ered  he  had  opposed  them,  and  also  when  on  a 
special  committee  to  report  to  the  convention,  but 
now  he  had  become  convinced  of  the  need  of  such  a 
commission.  The  expense  was  not  worth  consider- 
ation, when  compared  to  the  misery  to  be  allc^-iated 
and  the  good  such  a  body  could  accomplish,  espe- 
cially in  investigating  the  causes  and  prevention  of 
insanity. 


THE  MEDICAL  RECORD. 


637 


Dr.  Cleatelasd,  of  Middletown,  made  the  princi- 
pal argument  in  behalf  of  a  lunacy  commission.  He 
commenced  by  charging  npon  the  society  a  settled 
policy  of  evasion,  with  the  hope  that  the  subject 
would  drop  out  of  sight.  They  were  introduced  in 
1879,  and  referred  to  a  special  committee  of  Ave. 
This  committee  reported  that  they  were  not  suffi- 
ciently conversant  with  the  subjectto  advise  the  so- 
ciety, and  recommended  a  committee  that  should 
present  a  history  of  lunacy  commissions,  their  aims 
and  results  at  home  and  abroad,  to  tlie  next  conven- 
tion. On  this  committee  were  appointed  two  super- 
intendents of  lunatic  asylums  and  himself.  As 
might  be  supposed,  both  a  majority  and  minoritv 
report  were  presented,  and  both  were  printed  last 
year,  as  no  time  was  found  to  discuss  them.  That 
brought  the  matter  to  the  present  time.  Three  years 
since  its  introduction  the  subject  was  ready  for  dis- 
cussion and  action.  The  part  of  the  resolutions  re- 
lating to  the  management  of  insane  hospitals,  like 
other  hospitals,  he  had,  after  careful  consideration, 
concluded  to  abandon  as  inexpedient.  The  other 
points  in  the  resolutions  he  still  adhered  to,  but 
shordd  speak  only  upon  the  necessity  and  value  of 
a  lunacy  commission.  There  was  need  of  such  a 
commi.ssion,  tirst,  to  correct  the  abuses  of  insane 
asylums,  and  to  determine  that  those  deaths  re- 
ported as  suicides  and  sudden  deaths  were  not  due 
to  abuse  of  keepers  or  of  disciplinary  measures ; 
second,  to  discharge  old  chronic  incurable  cases  of 
mild  forms  of  insanity  that  could  better  be  cared  for 
in  their  homes,  and  so  make  room  for  the  reception 
of  recent  cases  in  the  early  stages  while  there  was 
yet  hope  of  cure.  Such  cases  were  now  kept  out  be- 
cause the  institutions  are  full ;  hence  the  great  in- 
crease of  life  pensioners  upon  the  State.  Third,  to 
see  that  the  insane  treated  in  their  homes  received 
proper  care  and  curative  treatment  when  most  likely 
to  succeed,  also  to  secure  the  same  for  the  insane 
now  in  almshouses,  and  thus  decrease  the  number  of 
hopelessly  insane.  Fourth,  to  see  why  the  percent- 
age of  cases  of  insanity  had  diminished  so  very 
largely.  Fifth,  to  study  the  causes  of  insanity  and 
its  means  of  prevention,  in  the  same  manner  as  our 
State  Board  of  Health  investigates  the  causes  of  zy- 
motic diseases  and  the  means  of  prevention,  and 
spreads  its  information,  which  could  be  obtained 
from  no  other  source,  before  the  peojjle.  We  value 
its  labors  and  uphold  and  assist  it  in  its  work  by  all 
means  in  our  power.  It  has  justified  its  right  to 
existence.  In  the  same  way  a  lunacy  commission 
would  teach  the  people  the  causes  and  prevention 
of  in^ianity  :  and  if  it  did  not  justify  expectations,  it 
could  readily  be  set  aside. 

The  objections  were  :  1.  That  the  State  was  too 
small  for  such  a  commission.  With  an  insane  popu- 
lation of  1,400  in  round  numbers,  constantly  increas- 
ing, and  the  other  duties  he  had  outlined  he  did  not 
think  they  would  have  manv  idle  moments.  2. 
Proper  persons  could  not  be  found  in  the  State  for 
such  an  office  and  duties.  With  the  large  number  of 
intnlligent.  reputable  practitioners  in  this  State,  he 
dil  not  think  it  would  take  long  for  some  of  them 
to  fit  themselves  for  the  work.  3.  The  expense 
would  be  a  serious  objection.  If  the  matters  rela- 
ting to  the  care  of  the  insane  had  been  managed 
economically  lieretofore,  this  objection  would  come 
with  greater  force.  The  objects  to  be  accomplished 
would  justify  any  reasonable  expenditure,  and  soon 
the  commission  would  justify  its  claims  for  support. 
He  criticised  the  majoritv  report  of  last  year  for 
omitting  to  state  the  results  of  lunacv  commissions 


in  this  country  and  their  history.  In  conclusion  he 
based  his  plea  on  the  broad  ground  of  humanity,  to 
secure  the  rights  of  those  that  cannot  care  for  them- 
selves, and  to  pievent  the  occurrence  of  the  greatest 
scourge  and  most  transforming  plague  to  which  hu- 
manity is  heir. 

Dh.  Chamberi..\in  denied  that  the  society  had 
pursued  a  settled  evasive  policy  ;  the  only  intended 
delay  was  the  reference  to  a  s))ecial  committee;  and 
he  still  thought  the  society  should  never  take  sud- 
den action  or  give  decided  opinions  upon  subjects, 
the  general  nature  of  which  they  were  unfamiliar 
with  ;  and  when  proposed  they  certainly  knew  noth- 
ing except  in  the  vaguest  way  about  lunacy  com- 
missioners. Last  year  there  were  five  long  reports 
made  on  special  subjects,  these  coming  last  in  the 
regular  order  of  business.  When  read,  a  motion  was 
made  to  defer  debate  until  after  the  election  of  offi- 
cers, laying  the  annual  tax.  etc.,  which  must  have 
been  done  then,  if  at  all.  When  the  necessary  busi- 
ness was  finished,  it  was  so  late  no  one  would  remain 
to  discuss  any  subject.  He  had  no  serious  objec- 
tion to  a  lunacy  commission  ;  but  failed  to  see  how 
they  could  reach  the  insane  cared  for  in  their  homes, 
or  by  what  right  in  this  country  they  could  inter- 
fere in  such  cases. 

Dr.  Stearns,  of  Hartford,  said  on  behalf  of  the 
majority  report  that,  if  they  had  said  nothing  about 
lunacy  commissions  in  this  country,  the  omission  had 
not  been  supplied  either  last  year  or  this.  As  a 
superintendent  he  had  never  opposed  such  a  com- 
mission, and  in  fact  heartily  wished  every  State 
could  have  a  commission  like  that  in  Scotland.  But 
our  free  institutions  would  admit  of  no  such  meas- 
ures, and  it  was  simply  impracticable.  The  expense 
would  be  a  large  one,  as  the  work  would  take  the 
whole  time  of  three  experts  of  the  highest  capabili- 
ties. To  do  the  work  outlined  in  asylums  wi,h  refer- 
ence to  discharging  chronic  cases  of  insanity,  would 
re(piire  a  prolonged  residence,  and  even  then  mis- 
takes would  often  occur.  The  mild-mannered,  gen- 
tle patient,  to  day,  might  be  a  destroying  demon  the 
next,  or  at  rare  intervals.  No  malady  was  so  decep- 
tive. As  to  abuses,  the  proof  was  wanting  that  any 
had  occurred  wliere  prompt  punishment  had  not  at 
once  been  meted  out  to  the  oft'ender.  As  attendants 
are  hiiman,  they  sometimes  will  err,  but  he- failed  to 
see  how  this  could  be  in  any  way  changed  by  a 
lunacy  commission. 

An  animated  debate  followed,  at  times  somewhat 
excited,  as  the  discijdine  of  the  State  asylum  at 
^liddletown  was  referred  to.  Dr.  Edgerton,  on  behalf 
of  the  Middletown  physicians,  and  Dr.  Haun,  on  be- 
half of  the  physicians  of  Middlesex  County,  in- 
dorsed the  superintendent  and  his  management 
warmly  and  unreservedly.  Dr.  Goodwin,  of  Thomas- 
ton,  spoke  in  a  similar  spirit,  and  others.  As  the 
opinion  of  the  convention  was  evident,  the  .secre- 
tai-y  moved  the  previous  question,  which  was  car- 
ried. The  report  of  the  committee,  adverse  to  the 
resolutions  indorsing  the  appointment  of  a  lunacy 
commission,  was  accepted  by  nearly  an  unanimous 
vote — the  convention  plainly  thinking  a  lunacy 
commission  not  needed  nor  practically  useful. 

A  resolution,  or  series,  was  then  oflfered  that  this 
convention  reaffirm  its  adherence  to  the  national 
code  of  ethics;  that  we  entirely  condemn  and  rep- 
robate the  action  of  the  New  York  State  Medical 
Society ;  that  we  instruct  our  delegates  to  oppose 
the  reception  of  the  New  York  delegation  at  the 
meeting  of  the  .American  Medical  Association  at  St. 
Paul  in  any  shape  or  manner. 


638 


THE  MEDICAL  RECORD. 


Dr.  CHAMBERLA.IN  moved  that  the  resolutions  be 
taken  up  separately,  and  it  was  so  voted. 

Dr.  Wainwright  moved  that  the  whole  be  laid 
upon  the  table.  We  were  now  at  harmony  among 
ourselves  after  considerable  turmoil  of  one  kind  or 
another.  The  discussion  of  these  resolutions  would 
create  much  ill-feeling,  and  that  which  would  not 
easily  be  allayed.  The  motion  was  voted  without 
further  debate. 

The  Committee  on  County  Resolves  reported  favor- 
ably on  a  resolution  that  came  from  the  Hartford 
County  Society,  asking  tliat  the  State  Society  ap- 
point censors  as  a  permanent  committee  of  disci- 
plioe,  and  assign  duties  to  the  censors  of  the  county 
societies.  The  committee  recommended  that  the 
censors  of  the  State  Society  should  be  fellows,  ex 
officio,  and  that  the  secretary  make  the  changes 
in  the  by-laws  rendered  necessary  in  carrying 
these  resolutions  into  effect,  and  report  the  whole 
for  action  at  the  next  convention. 

ELECTION   OP   OFriCER.S. 

The  following  officers  wei-e  elected  for  the  ensuing 
year  :  President — Dr.  William  G.  Brownson,  New 
Canaan ;  Vice-President— T)t.  E.  B.  Nye,  Middle- 
town  ;  Treasurer — Dr.  E.  P.  Swasey,  New  Britain  ; 
Secretary — -0.  W.  Chamberlain,  Hartford  ;  Committee 
on  Matters  of  Professional  Interest — Drs.  W.  A.  M. 
Wainwright,  H.  S.  Fuller,  G.  P.  Lewis  of  Bridge- 
port ;  Delegates  to  the  Neio  York  State  Society — Profes- 
sors F.  E.  Beckwith,  0.  A.  Lindsley.  After  the  transac- 
tion of  the  usual  routine  business,  including  laying 
the  annual  tax  of  two  dollars  upon  each  member 
and  voting  to  publish  seven  hundred  copies  of  the 
proceedings,  the  convention  adjourned. 

EVENING    RECEPTION. 

A  very  pleasant  reception  was  given  in  the  even- 
ing, by  Professor  Carmalt,  to  introduce  Professor 
Beckwith  to  the  society ;  the  presence  of  ladies 
gave  added  pleasure  and  zest  to  the  occasion  ;  Mrs. 
Carmalt  and  Mrs.  Beckwith,  with  their  reinforce- 
ments, were  quite  the  centres  of  attraction  and  de- 
cidedly carried  off  the  honors  of  the  evening.  Sev- 
eral of  the  guests  were  accompanied  by  their  wives. 
Professor  Lindsley  and  his  wife,  of  New  Haven,  and 
Dr.  Kv&xjf  and  wife,  of  Hartford,  and  several  other 
ladies  from  New  Haven  were  also  present.  The 
affair  was  throughout  a  success.  Professor  Car- 
malt has  recently  had  his  house  built  and  this  was 
something  in  the  nature  of  a  house-warming.  The 
rooms  are  finished  in  native  woods,  oiled  overhead 
also.  The  floors  of  hard  wood.  In  addition  to  the 
members  of  our  own  society,  Dr.  Sanborn,  of  Maine, 
and  Drs.  Browning  and  Hersey,  of  Rhode  Island, 
were  present  and  joined  the  festivities. 

The  convention  was  called  together  at  half  past 
nine. 

The  SsciiRTARY  read  his  report.  The  following 
is  a  summary  :  The  same  oven  prosperity  has  char- 
acterized the  past  year  as  has  been  experienced  of 
late.  The  death-rate  continues  high  ;  we  lose  tliis 
year  eleven  by  death,  one  more  than  the  average  for 
the  last  seven  years.  The  average  age  shows  that 
our  eomparativo  rank  in  longevity  tables  is  high. 
While  it  is  invidious,  perhaps,  to  singularize,  yet  I 
may  perliaps  he  pardoned  for  paving  a  .small  tribute 
to  the  memory  of  Dr.  Lewis  Williams,  of  Pomfret, 
known  and  loved  over  a  widespread  area  around  his 
dwelling.  No  noble  enterprise  appealed  to  him  in 
vain  ;  a  large  hearted  philanthrophic  man,  lie  seemed 
to  delight  to  do  good.     If  the  enterprise  was  for  the 


benefit  of  humanity,  he  bid  it  God-speed  and  aided 
it  by  all  means  in  his  power.  In  him  the  society 
loses  a  warm  friend  and  generous  supporter. 

Dr.  Demino  presented  the  annual  address,  as  presi- 
dent, upon 

SOME  points   in   THE   TREATMENT   OF   PHTHISIS   PULMO- 
NALIS. 

The  treatment  and  pathology  were  largely  of  the 
modern  French  school.  Tubercle  was  stated  to  be  a 
structure,  the  natural  tendency  of  which  was  toward 
recovery.  After  forty-five  years  it  is  a  matter  of  un- 
concern whether  it  is  developed  or  not.  It  is  a  dis- 
ease engendered  mainly  from  fifteen  to  thirty  years 
of  age.  The  principal  topic  discussed  was  the  fever 
of  phthisis.  After  deprecating  routine  treatment 
and  advocating  symptoms  should  be  treated,  he  di- 
vided the  fever  into  three  stages  :  First,  of  invasion  ; 
second,  of  softening;  third,  of  resorption.  In  the 
treatment  of  the  first,  quinine  was  the  principal  re- 
medy, and  the  bromo-hydrate  .advised  ;  the  special 
excellence  of  this  over  quinine  and  bromide  of  pot- 
ash, given  separately,  was  not  mentioned.  For  pro- 
fuse expectoration,  creasote,  in  increasing  doses, 
was  mentioned.  In  the  discussion  of  the  paper, 
petroleum  was  advocate<l  as  preferable,  as  it  could 
better  be  given  in  pill  form,  and  not  so  objec- 
tionable. The  solid  mass  that  forms  inside  the  pipes 
whence  crude  petroleum  fiows,  or  inside  tanks,  was 
also  mentioned.  The  essayist,  however,  preferred 
creasote,  as  it  could  be  given  with  the  cod- liver  oil, 
and  a  little  oil  of  peppermint  or  otber  essential  oil 
would  disguise  taste  and  odor.  The  fever  of  re- 
sorption is  best  treated  by  antiseptic  salicylic  acid 
in  doses  of  thirty  grains  the  first  day,  fifteen  to 
twenty  the  next  two  days,  unless  the  fever  subsides  ; 
if  the  treatment  be  unsuccessful,  wait  two  or  three 
days  and  repeat.  Tlie  third  course  should  not  lie 
exceeded,  as  cerebral  trouble  would  be  likely  to  ensue 
if  the  stomach  did  not  rebel.  If  digestion  be  weak, 
the  salicylate  of  soda  may  be  used.  Where  cod- 
liver  oil  cannot  be  taken,  glycerine,  in  doses  of  one 
and  one-lialf  to  two  and  one-half  ounces,  could  lie 
substituted  ;  in  larger  doses  it  caused  disturbance. 
Cod-liver  oil  and  arsenic,  as  general  remedies,  were 
discussed.  Cod-liver  oil  is  usually  given  in  ton 
small  doses ;  those  are  most  benefitted  that  can  takf 
the  most.  He  had  not  much  confidence  in  the  su- 
periority of  emulsions.  In  concluding  he  thanked  the 
society  for  the  honor  it  had  done  him  in  selecting 
him  for  the  presidency  and  for  their  overlooking  his 
shortcomings  in  office. 

Dr.  W.  G.  Brownson,  the  president-elect,  then  took 
the  chair. 

THE   TREATMENT   OP    PHTHI.SIS. 

Dr.  Wile  di.scussed  the  paper  at  some  length, 
stating  that  ho  had  been  surprised  at  the  omission 
of  the  emulsion  of  cod-liver  oil  with  the  hyjiophos- 
phites,  which  was  so  much  used,  and  of  the  solution 
of  cod-liver  oil  in  ether,  and  of  the  value  of  cream 
in  large  doses  where  cod  liver  oil  could  not  be  boiuo 
He  liad  found  that  the  inability  to  take  cod-liver  oil 
was  one  of  tlu?  greatest  drawbacks  to  its  use  ;  thoso 
that  needed  it  most  could  not  take  it ;  especially  wa.s 
this  true  in  cases  of  scrofulous  subjects  ;  malt  and 
the  malt  extracts  had  their  advocates.  Fothergill 
speaks  favorably  of  maltine. 

Dr.  Chamjikrlain  spoke  of  the  results  of  the  re 
searches  of  Fox,  of  England,  among  the  statistics  il 
consumption.  He  found  liereility  in  25  per  cent.,  in 
the  rest  it  was  enkindled  with  no  taint  in  the  blood 


THE  MEDICAL  RECORD. 


639 


as  far  back  as  could  be  ascertained.  On  some  future 
occasion  he  hoped  to  present  this  view  and  the  evi- 
dence upon  which  it  was  based.  There  are  two 
chief  factors  in  developing  consumption,  liad  air,  es- 
pecially, that  which  has  passed  two  or  three  times 
through  our  own  or  some  one  else's  lungs,  and  sub- 
soil or  ground  water  as  shown  by  Bowditeh,  Biich- 
anan,  in  England,  and  others.  The  theory  and  re- 
searches of  Koch  bear  out  and  sustain  this  view  ;  if 
phthisis  be  caused  by  bacteride,  the  bacillus  tuber- 
cul;(\  what  moi-e  natural  than  the  consumptive  to  send 
them  forth  with  his  breath,  and  thus  poison  the  air. 
Tlio  microscope  shows  us  what  a  multitude  of 
dingers,  unseen  and  invisible  to  the  unaided  eye,  we 
walk  amid  and  are  encompassed  with,  yet  obedience 
to  tlio  divine  laws  of  health  enable  us  to  walk  se- 
curely, for  the  germ  must  find  an  appropriate  soil  in 
weakened  or  deteriorated  tissue,  in  order  to  gi'ow, 
increase,  and  multiply  ;  not  many  of  these  can  cause 
heL\lthy,  vigorous  tissues,  redundant  with  life  and 
vigor,  to  succumb  and  become  the  home  and  hostile 
camp  for  the  maurauding  bands,  devitalizing  that 
adj.acent,  even  if  its  influence  reaches  out  no  farther. 
Here,  too,  in  this  uneven  battle,  nature  triumphs  and 
expels  the  invader  and  all  its  germs  by  vigorous  on- 
slaught. The  weakened  lung-tissue,  by  oft-repeated 
congestion,  from  impure  air  and  irritating  gases,  is 
n<it  pi'oof  against  the  invasion,  and  yields  at  once  ; 
some  of  these  cases  of  galloping  phthisis  very  well 
merit  their  name. 

5HLARIA   DJ    CONNECTICrT. 

Dr.  Waixi\-bight,  as  chairman  of  committee  on 
matters  of  professional  interest,  then  made  his  re- 
port. He  referred  to  the  prevalence  of  malaria  over 
wide-spread  areas  of  the  State,  its  persistency  remain- 
ing now  over  twenty  years  in  some  portions,  and  year 
by  year  extending  its  territory.  Also  the  curioiis  way 
in  which  it  took  leaps  into  new  fields,  leaving  the  in- 
tervening belt  to  be  covered  by  the  gradual  spread  in 
tlu^  more  usual  way.  Thus  it  had  alighted  in  the  cen- 
tre of  Windham  County,  and  in  its  northeastern  cor- 
ner. .\  question  of  grave  importance  indeed  was  it 
wliether  we  could  or  not  hope  for  complete  deliver- 
■.  Its  influence  on  consumption  is  not  certain, 
■  report  a  great  increase,  others  none  at  all.  In 
•  non-malarial  towns  what  few  were  left  (for  the 
Thames  is  no  longer  the  eastern  bound  of  malaria), 
there  was  reported  a  decided  decrease,  not  in  all,  bnt 
generally  in  those  reported — many  send  no  reports, 
lie  hoped  the  county  societies  would  select  active, 
earnest  workers,  who  would  secure  and  report  the 
myriad  interesting  cases  now  lost  hopelessly.  Small- 
]!  '\  and  vaccination  were  ventilated,  and  animal  or 
liivine  virus  generally  preferred.  Some  statistics 
were  given  which  were  very  interesting  and  instnic- 
tive.  The  view  that  two  successful  vaccinations  pro- 
tect, one  in  infancy,  one  after  puberty.  Several  very 
interesting  cases  were  read,  and  Di\  M.  White  de- 
scribed a  dentigerous  cyst  having  twenty -five  unat- 
tached teeth  with  some  flocculent  matter  like  hair  : 
had  he  thought  the  cases  were  to  be  related,  he  wonld 
have  brought  the  specimens. 

HTPOSULPHTTE   OP   SOD.\    DJ   SMALL-POX. 

Dr.  Chamberlain,  by  request  of  Dr.  Tremaine,  of 
Hartford,  spoke  of  thevalue  of  the  hyposulphite  of 
soda  in  the  treatment  of  smallpox,  giving  to  chil- 
dren doses  five  or  six  grains  every  three  or  four 
hours,  and  to  adults  fifteen  to  twenty  grains  three 
times  a  day.  It  caused  no  nausea,  checked  suppu- 
ration, and  prevented  odor,  absorbing  the  disease 
very  rapidly.     All  that  have  used  it  exalt  it  highly. 


and  the  doctor  himself  is  a  good  judge,  having  bad 
more  cases  of  small-pox  than  any  other  doctor  in 
this  country,  certainly.  In  no  cases  has  he  known 
or  heard  of  a  failure  ;  its  influence  on  the  disease  is 
rapid  and  decided.  He  then  called  the  attention 
of  the  convention  to  the  joint  investigatien  on  the 
causes  of  malaria,  especially  the  germ  theory  of 
Klebs  and  Brudelli  and  allied  lines  of  work  repeat- 
ing the  experiments  of  Dr.  Sternberg,  and  striking 
out  boldly  in  any  direction,  evidence  gathered  war- 
rants. The  theory  of  Saveran  of  its  causation  by 
pigmentary  particles  in  the  blood  would  also  be 
tested.  This  was  to  be  done  by  the  National  Board 
of  Health,  who  furnished  expert  microscopists  and 
biologists,  and  the  State  Boards  of  Health  of  New 
York,  Massachusetts,  and  Connecticut.  On  behalf 
of  his  own  Board  he  asked  co-operation  in  this 
work,  prompt  replies  to  questions,  and  aid  in  secur- 
ing material  for  culture,  experiments,  and  such  ma- 
terial as  might  be  needed  for  the  work. 

Our  own  Board  of  Health  had  also  planned  an 
investigation  Tipon  school  hygiene  with  especial  re- 
ference to  obtaining  facts  with  reference  to  any  de- 
leterious influences  exerted  upon  the  health  of  scliool 
children  from  the  primary  scholar  to  the  high  school 
graduate.  Facts  were  wanted  ;  we  could  reaih  eas- 
ily any  quantity  of  theory.  A  list  of  questions  -n  onld 
soon  be  sent,  and  a  notebook  for  the  vest  pocket, 
and  we  wish  the  physicians,  as  they  go  among  their 
families  during  the  year,  to  note  any  instance  they 
can  learn  from  their  own  observation,  queslioning 
the  parents,  and  teachers,  and  guardians.  The  so- 
cial life,  if  any,  and  the  collateral  influences  should 
be  taken  into  account  carefully.  These  note-books 
will  be  sent  to  all  that  will  use  them. 

IMPURE   ICE. 

Dr.  White  spoke  of  the  influence  of  water-supply 
of  cities  and  towns  upon  malaria  ;  what  connection 
there  was,  if  any,  he  did  not  know,  but  the  appear- 
ance of  malaria  was  often  synchronous  with  the 
change  from  well  water  to  that  from  brooks,  rivers, 
and  ponds.  The  relation  of  impure  ice  to  disease 
was  also  urged  ujoon  the  attention  of  the  State 
Board  of  Health.  The  carelessness  in  gathering 
ice  was  wonderful  in  its  recklessness,  even  if  used 
for  markets  and  refrigerators  ;  sewage  ice  was  un- 
safe. The  fallacy  that  water  purifies  itself  by  freez- 
ing has  been  exploded  some  time  ago.  Much  could 
be  learned  by  the  physicians  on  this  and  other  sub- 
jects, by  using  their  microscopes  themselves,  since 
the  invention  of  late  of  oil  and  balsam  immersion 
lenses,  hemogenous  immersion  lenses,  as  they  are 
called,  the  higher  powers,  .'^uch  as  a  tenth  could  be 
used  by  any  one  almost,  and  that  was  enough  for  all 
practical  purposes. 

Dr.  Ch.vmberlaik  accepted  the  suggestions  of  Dr. 
White  with  thanks,  stating  that  an  investigation  of 
the  water- supply  of  cities  and  towns  had  already  been 
determined  upon  by  the  Board  ;  the  relation  to  ma- 
laria could  readily  be  added.  The  evil  eii'ects  of  im- 
pure ice  had  been  repeatedly  reported,  but  no  gene- 
ral investigation  had  ever  been  made.  He  would 
invite  physicians  to  carefully  note  any  cases  of  ill- 
ness due  to  impure  ice,  or' supposed  to  be  so  caused, 
and  report  to  him.  If  specimens  of  the  ice,  carefully 
melted  so  as  not  to  be  exposed  to  too  much  Iieat, 
and  nil  dust  excluded  during  melting,  are  sent  tliey 
will  be  carefully  analysed  free  of  expense,  and  the 
result  reported"  Send  all  the  sediment,  if  there  be 
any,  but  do  not  add  any  foreign  substance  what- 
ever. 


6i0 


THE  MEDICAL  RECORD. 


The  President  then  introduced 

Da.  Sanborn,  of  Portland,  Maine,  who,  in  a  brief 
speech,  presented  the  congratulations  and  kind 
wishes  of  the  Miine  Medical  Society,  and  hoped  the 
interchange  of  delegates  would  be  kept  up  regularly. 
He  promised  all  that  came  a  hearty  welcome.  Their 
society  numbered  over  three  hundred,  and  was  very 
active.  In  conclusion,  he  said  if  we  were  short  of  a 
supply  of  pure  ice  Maine  could  supply  us  in  unlim- 
ited quantities.  On  being  asked  if  there  were  any 
malaria  in  Maine,  he  said  never,  the  average  climate 
was  too  cold  for  its  development. 

The  President  then  introduced 

Dr.  W.m.  BRO^vNI^•G,  of  Providence,  E.  I.,  who  pre- 
sented the  greetings  of  the  medical  society  of  his 
State.  He  said  he  was  glad  of  the  privilege  of  re- 
visiting his  native  State  and  New  Haven,  which 
seemed  like  a  second  home  to  him,  as  he  had  gradu- 
ated from  Yale  College  and  from  Yale  Medical 
School  also,  and  revisited  them  now  for  the  first  time 
in  thirteen  years.  In  regard  to  the  relation  of  ponds 
to  malaria,  which  had  been  alluded  to,  he  would 
state  that  during  the  past  year  there  had  been  over 
a  hundred  cases  of  malarial  fever  in  North  Provi- 
dence and  Elmwood,  near  what  was  called  Mashapang 
Pond,  and  the  health  authorities  had  taken  the  pond 
in  charge  with  full  powers  to  do  whatever  was 
needed.  This  is  the  first  appearance  of  malaria  in 
Ehode  Island. 

The  absence  of  Dr.  Dickerson,  the  dissertator 
from  sickness  in  his  family,  made  the  omission  of 
the  dissertation  necessary. 

Dr.  G.  L.  Porter,  of  Bridgeport,  read  a  very  ele- 
gant and  scholarly  essay  on 

THE   recognition    OP  DE.\TH. 

The  unreasonalile  fear  of  being  buried  alive  which 
haunts  some  people,  especially  women  and  children, 
was  shown  to  be  a  baseless  terror  ;  but  the  physician 
should  be  able  to  reassui-e  his  clients  by  proving  to 
them  that  he  can  tell  without  fail  whether  or  no  life 
is  extinct.  Suspended  animation  in  its  various 
forms  and  types,  sleep  and  hibernation,  fainting  and 
trance  were  all  mentioned.  The  various  tests  for 
death  were  mentioned — some  sixteen  in  number. 
The  haV)it  of  immediately  embalming  or  of  putting  a 
body  upon  ice  until  death  was  certain  was  deprecated 
as  hazardous.  The  foolish  prejudice  to  post  mortems 
may  have  caused  a  burial  before  life  was  extinct.  The 
failure  of  our  present  methods  of  examining  the  dead 
in  cases  of  suspected  foul  play  was  very  strongly 
presented.  The  law  drafted  by  the  State  Board  of 
Health  after  the  model  of  the  Massachusetts  law, 
creating  medical  and  legal  examiners,  was  heartily 
endorsed,  and  the  society  urged  to  use  all  their  in- 
fluence to  have  the  law  passed  by  our  Legislature. 

A   TEST   OF   DEATH.     ' 

Dr.  B.  S.  Thompson,  of  Salisbury,  presented  an- 
other test  of  death,  from  the  appearance  of  a  black 
spot  on  the  sclerotic  outer  corner  of  the  eye.  This 
was,  at  first,  very  small,  but  gradually  grew  larger, 
moving  down  toward  the  lower  border  of  the  cornea, 
outer  angle  of  the  eye,  where  it  finally  remained  at- 
tached to  the  cornea,  the  convexity  downward.  It 
was  also  an  indication  of  the  time  since  deatli  en- 
sued until  it  becomes  fixed,  then  it  grows  larger. 

Dr.  HunnAnr>  moved  that  a  committee  of  five  be 
appointed  by  the  Chair  to  bring  this  matter  prop- 
erly before  the  Legislature,  with  the  endorsement  of 
this  society.  Tliis  was  carried  unanimously.  The 
President  appointed  on   tliis  committee  Dr.  S.  G. 


Hubbard,  New  Haven  ;  Pi-of.  Moses  White  ;  Dr.  G. 
L.  Porter,  Bridgejiort ;  Dr.  D.  A.  Cleaveland,  Middle- 
town  ;  Dr.  C.  W.  Chamberlain,  Hartford. 

A   protest   against   THE    NEW   TORE    CODE. 

Dr.  Beach,  of  Litchfield,  then  read  his  essay,  "  A. 
Protest  against  the  Action  of  the  New  Y'ork  Medi- 
cal Society  with  regard  to  Consultations."  It  was 
very  strongly  written,  and  abounded  in  invective 
against  irregular  practitioners,  especially  the  homoe- 
opaths. The  two  could  not  mingle  any  more  than 
oil  and  water.  A  consultation  was  impossible,  un- 
less one  or  both  surrendered  their  principles.  As 
we  could  not  do  this,  he  failed  to  see  how  anything 
like  a  real  consultation  could  be  had.  He  wanted  the 
masses  to  hear  the  trutli.  He  opposed  conference 
with  "the  givers  of  infinitesimal  doses."  If  true 
that  the  homceopathic  practice  does  not  differ  much 
from  the  "regular"  practice,  it  does  not  help  the 
homoeopathists.  He  read  extracts  from  homoeopathic 
publications,  which  threw  down  the  gauntlet  boldly. 
He  then  expressed  contempt  for  the  man  who  disbe- 
lieved in  homoeopathy,  who  practises  it  because  the 
neighborhood  he  is  in  demands  it.  He  denounced 
homcEopathy  as  a  delusion  without  a  scientific  basis, 
and  spoke  of  the  wide  chasm  impassable  lietween  the 
two  schools.  He  found  no  half  way,  and  thought 
that  the  consultation  of  regular  practitioner  with  a 
homceopathist  was  in  the  nature  of  compounding  a 
social  felony.  To  consult  with  hom<eopathic  prac- 
titioner could  do  no  good.  He  wanted  homceopathy 
denounced  at  all  times  and  all  seasons  as  worthless. 

The  essay  was  vigorously  and  well  read,  the  doc- 
tor's experience  in  the  Legislature  last  winter  im- 
proving his  manner.  In  deference  to  the  sentiments 
expressed  the  day  before,  there  was  no  discussion. 
Some  doubts  have  been  expressed  concerning  the 
publication  of  the  paper  this  year.  Such  essays  do  no 
good.  They  create  a  bad  impression  on  the  public 
mind,  which  sees  only  illiberality  and  bigotry  in  them, 
and  only  embitter  relations  which  might  as  well  be 
pleasant.  Sentiment  in  diflferent  parts  differs  widely. 
There  is  a  liberal  school,  so-called,  which  is  gaining' 
strength,  slowly,  it  is  tnie.  Their  principle  of  con- 
sultation and  professional  relationship  is  as  nearly 
as  it  can  be  formulated.  "  Honesty  of  purpose  to 
use  every  legitimate  means  for  the  recovery  of  the 
sick,  and  a  thorough  medical  educa'ion  and  training 
in  all  the  branches  related  to  the  healing  art." 

Professor  Lindsley  then  read  a  defence  of  the 
following  i?roi3osition : 

IT  is  demoralizing  to  the  JtEDICAD  PROFESSION  AND 
DETRIMENTAL  TO  THE  PDBLIC  WELFARE  TO  PRESCRIBE 
PROPRIETABY   MEDICINE   FOR   THE   SICK. 

He  defined  such  remedies  to  be  "any  medicines 
respecting  which  some  person  or  persons  possess  an 
ownership  cither  of  the  method  of  preparation  or  of 
.some  element  in  their  composition  which  is  secret, 
or  of  some  exclusive  right  to  the  manufacture  or  sale, 
by  which  the  medical  profession  is  kept  in  ignorance 
of  their  full  qualities  or  deprived  of  such  free  and 
unrestricted  use  of  them  as  would  be  enjoyed  from 
fair  and  honoralde  competition  in  their  production. 
They  are  demoralizing  :  First,  because  they  render 
knowledge  of  combining  remedies  needless,  and 
it  is  neglected  in  consequence ;  it  has  the  same 
influence  upon  scientific  pliarnmcy.  Second,  by 
lessening  the  difierence  between  the  scientific  physi- 
cian and  the  quack,  and  rendering  count:er  prescrib- 
ing easier  ;  it  is  a  good  way  to  keep  away  patients 
who  can  quickly  learn  to  fumble  over  samples,  and 


THE   MEDICAL   RECORD. 


641 


Eks  the  diseases  they  will  cure  are  printed  on  the  bot- 
tles, the  symptoms  on  the  wrappers,  they  can  soon 
leara  to  fit  their  symptoms  to  the  remedies  as  skil- 
fully as  the  doctors.  Thus  it  encourages  the  habit 
of  the  people  of  indiscriminate  drugging  themselves 
for  real  or  fancied  ailments.  Third,  it  diminishes 
OWY  reputation  as  scientific  practitioners,  and  justly, 
for  what  science  is  there  in  pre.sciibing  a  compli- 
cated and  intricate  remedy  by  some  catch-word, 
when  your  only  knowledge  is  the  partial  account  of 
the  compositioQ  of  the  remedy  obligingly  addressed 
"To  the  medical  profession  only."  It  encourages 
fraud  :  the  complicated  formula  renders  analysis  slow 
and  expensive,  and  the  frequent  changes,  ostensibly 
for  improvement,  are  excuses  for  difterent  results 
in  analysis.  Fourth,  it  encourages  credulity  :  we  swal- 
low these  fanciful  titles,  which  are  fatal  to  all  scien- 
tific nomenclature,  such  as  "  lodoBromide  of  Cal- 
cium Compound,"  "  Bromidid,"  "  Petroleum  Syrup," 
etc. — and  their  name  is  legion  —with  the  same  credu- 
lity and  blind  faith  as  the  public  Hop  Bitters  and 
St.  Jacob's  Oil.  We  are  told  in  flaming  circulars, 
in  all  the  colors  of  the  i-ainbow,  addre.ssed  "  To  the 
profession  only,"  that  they  will  cure  such  and  such 
diseases,  are  indeed  specifics,  and  if  we  use  them  it 
is  because  we  believe  implicitly  what  we  are  told. 
He  gave  an  amusing  instance  where  a  jirescription 
of  a  popular  New  York  phy.sician  was  put  np  and 
sold  as  Dr.  SoandSo's  tincture,  until  gallons  were 
sold  ;  every  drug  store  in  a  certain  city  sold  it  and 
kept  it  in  bulk,  obtaining  it  from  a  wholesale  dniggist 
in  New  York.  Y'et  not  a  physician  or  druggist  knew 
anything  of  its  composition,  except  what  was  indi- 
cated by  the  label. 

A  very  spirited  and  somewhat  humorous  debate 
followed  this  essay,  which  was  quite  long  and  went 
into  the  subject  exhaustively.  I  have  given  some  of 
the  more  salient  points.  Db.  Avert  related  a  case 
where  a  lady,  taught  to  use  McJMunu's  elixir  of 
opium  by  her  physician,  one  afternoon  gave  to  her 
servant  girl,  for  some  trifling  but  painful  ailment, 
twenty  drops  of  the  elixir ;  at  tea-time  finding  her 
still  in  pain  she  gave  her  forty  drops,  and  at  bed- 
time, as  she  was  still  unrelieved,  sixty  drops.  In  the 
morning  the  servant  girl  did  not  appear,  and  her 
mistress  going  to  wake  her  found  her  dead  in  her 
bed. 

Dr.  Hn,ii,  of  Stepney,  said  that,  if  the  profession 
used  them,  their  teachers  showed  the  way  and  first 
indorsed  them,  and,  picking  up  a  medical  journal 
which  had  been  distributed  by  the  publishers,  he 
read  thirteen  names,  indorsing  "  Bromidid,"  all  of 
them  professors  in  some  medical  college  and  one  or 
two  also  editors  of  medical  journals.  Professor 
Lindsley  challenged  him  to  find  tlie  name  of  a  single 
professor  of  Yale  Medical  School ;  he  replied  that  he 
knew  of  none,  but  others  did  in  abundance.  Pro- 
fessor Lindsley  said  that  he  taught  him  better  when 
he  was  at  Yale. 

Db  Wile  spoke  in  favor  of  retaining  known  rem- 
edies of  simple  formula,  and  not  condemning  them 
simpiv  because  they  were  characterized  by  a  trade 
mark,  such,  for  instance,  as  Maltine  and  the  like, 
wlii.di  could  not  be  made  by  ordinary  druggists. 
K-.Mi  Churchill's  syrup  of  the  hypophosphites, 
wiiich  Dr.  Lindsley  had  selected  as  an  example  of  a 
remedy  of  no  value,  palmed  oS  on  the  profession  by 
imposing  upon  their  credulity  by  flaming  indorse- 
ments, had  its  ailvocates  and  friends.  While  in  the 
main  he  agreed  with  Professor  Lindsley,  he  thought 
the<e  remedies  should  not  be  indiscriminately  con- 
demned ;  but  that  such  as  are  retained  should  be 


retained  intelligently,  with  a  knowledge  of  their 
exact  nature  and  composition,  their  therapeutic 
virtues. 

On  motion  of  Dr.  Chambeblain,  the  remaining 
pajjers  were  read  by  title  and  referred  to  the  Publi- 
cation Committee,  together  with  all  papers  from 
county  .societies  The  following,  recommended  by 
the  committee,  were  elected  essayists  for  the  next 
convention  :  Dr.  Geo.  L.  Pownall,  Hartford  ;  Dr.  F. 
N.  Braman,  New  London  ;  Dr.  C.  H.  Bill,  Bridge- 
port ;  Dr.  W.  H.  Holmes,  Waterbury  ;  Dr.  J.  J.  New- 
comb,  Litchfield  ;  Dr.  B.  S.  Thompson,  Salisbury  ; 
Dr.  J.  B.  Olmstead,  Middletown. 

The  convention  then  adjourned  for  the  annual 
dinner  at  Redclifi"s.  The  dinner  was  served  at  half- 
i:)ast  one  promptly,  and  left  the  members  in  a  very 
happy  frame  of  mind  to  enjoy  the  after-dinner  ad- 
dresses, which  were  very  entertaining  and  of  an  un- 
usually high  order.  President  Porter,  of  Y'ale,  Pro- 
fessor E.  J.  Phelps,  of  the  Law  School,  and  Professor 
Baldwin,  also  Professor  Brewer,  of  the  Scientific 
School,  who,  always  an  excellent  speaker,  excelled 
himself  on  this  occasion — if  that  were  possible.  Pro- 
fessor Weir,  of  the  Art  School,  Professors  Silliman 
and  Carmalt,  of  the  Medical  School,  and  Mr.  George 
A.  Butler,  a  New  Haven  banker,  each  in  turn  made 
appropriate  speeches.  Drs.  G.  A.  Hersey  and  W. 
Browning,  delegates  from  Ehode  Island,  did  excel- 
lent justice  to  the  selection  of  their  society's  repre- 
sentatives. Those  that  were  obliged  to  leave  by  the 
early  train  lost  a  treat  not  easily  made  good.  Upon 
the  whole,  this  meeting  was  one  of  the  most  success- 
ful ever  held  and  thoroughly  enjoyable  throughout 
from  first  to  last. 


Torsion  of  Arteries. — At  Guy's  Hospital  all  the 
surgeons  use  torsion  to  the  exclusion  of  the  ligature, 
except  sometimes  in  very  small  vessels,  wherein  it  is 
diflicult  to  isolate  the  vessel  from  muscular  fibres. 
They  give  a  very  large  statistical  showing  in  its 
favor.  I  have  seen  every  kind  of  amputation  there, 
except  of  the  hip-joint,  and  never  a  ligature  ajjplied 
to  a  large  vessel.  They  use  no  transverse  forceps, 
but  seizing  the  cut  end  of  the  vessel  with  strong  for- 
ceps, twist  it  until  it  is  felt  to  "  give  way  " — that  is, 
the  two  inner  coats  break.  I  have  often  seen  six  and 
sometimes  ten  complete  turns  given  to  the  femoral 
artery.  Mr.  Bryant  said :  "  Doctor,  theoretically 
the  twisted  end  ought  to  slough  off,  but  practicaUy 
it.  nevei-  i/oes.  We  have  to  talk  to  our  students  about 
secondary  hemorrhage,  but  we  do  not  show  it  to 
them."  Mr.  Lucas  told  me  that  for  a  long  time  they 
have  ceased  to  dread  or  look  for  secondary  hemor- 
rhage.— Lon.  Cor.  Boston  Med.  and  Surg.  Jour. 

Medicine  in  Texas. — The  Texas  Medical  Associa- 
tion held  its  annual  meeting  April  20th.  at  Fort 
Worth.  Commenting  on  the  need  of  active  work, 
the  Texas  Medical  and  Surgical  Record  says  :  "  If  we 
wish  to  elevate  the  profession  of  medicine  in  Texas, 
from  the  very  humble  position  which  it  occupies  to- 
day, we  must  all  work  for  that  end.  It  is  a  public 
secret  that,  out  of  the  three  thousand  physicians  in 
Texas,  not  one-third  is  entitled  to  professional  re- 
cognition out  of  their  little,  humble  spheres.  The 
majority  ai'e  unknown  ;  neither  do  they  know  the 
things  they  ought  to  know." 

A  female  opium-eater  in  London  (says  Dr.  Wil- 
liams), had  but  four  "  passages  from  the  bowels"  in 
one  year. — American  Medical  Di- Weekly.  W^e  are 
glad  she  lives  in  London. 


643 


THE  MEDICAL  RECORD. 


ARMY   NEWS. 

Official  List  of  Changes  of  Stations  and  Duties  of  Offi- 
cers of  the  Medical  Departmeni,  United  States  Army, 
from  Mai/  28,  1882,  to  June  3,  1882. 


McKee,  .T.  C,  Major  and  Surgeon.  The  extension 
of  laive  of  absence  on  Surgeon's  certificate  of  disa- 
bility granted  him  in  S.  O.  262,  A.  G.  O.,  November 
10,  18S1,  still  further  extended  six  months  on  Sur- 
geon's certificate  of  disability.  S.  O.  122,  A.  G.  O., 
May  2G,  1882. 

Waters,  Wm.  E.,  Major  and  Surgeon.  Granted 
leave  of  ab.sence  for  four  months.  S.  O.  121,  A.  G.  O., 
May  25,  1882. 

Brown,  J.  M.,  Major  and  Surgeon.  Having  re- 
ported at  these  headquarters,  is  assigned  to  duty  at 
Newport  Barracks,  Kentucky.  S.  O.  57,  Department 
of  the  South,  May  29,  1882. 

Brooks,  Johk,  Captain  and  Asst.  Surgeon.  To 
be  relieved  from  duty  in  Department  of  the  South 
when  Mijor  Brown  shall  have  reported  for  duty 
therein,  and  to  proceed  on  July  1,  1882,  to  Presidio 
of  San  Francisco,  Cal.,  and  report  in  person  to  the 
Commanding  General,  Mil.  Div.  of  the  Pacific,  for 
assignment  to  dutv  in  Department  of  California. 
S.  O.  lai.C.  S.,  A.  G.  O. 

Caldwell,  D.  G.,  Capt.  and  Asst.  Surgeon.  Upon 
completion  of  packing  and  turning  over  the  medical 
supplies  at  Fort  Sanders,  to  report  to  the  Command- 
ing officer  Fort  Fred.  Steele,  Wyo.,  for  duty  as  Post 
Surgeon.  S.  O.  56,  Department  of  the  Platte,  May 
29,  1882. 

O'Keilly,  K.  M.,  Captain  and  Asst.  Surgeon. 
Now  at  Washington,  D.  C,  to  report  in  person  to 
the  attending  surgeon  at  this  station  for  assignment 
to  temporarv  dutv  in  his  office.  S.  0. 124,  A.  G.  O., 
May  29,  1882. 

Brown,  Paul  R.,  Capt.  and  Asst.  Surgeon.  Granted 
leave  of  absence  for  six  months  on  Surgeon's  cer- 
tifl;cate  of  disability.     S.  O.  121,  C.  S.,  A.  G.  O. 

Semiq,  B.  G.,  Capt.  and  Asst.  Surgeon.  Granted 
leave  of  absence  for  one  vear  on  Surgeon's  certificate 
of  disability.     S.  O.  121," C.  S.,  A.  G.  O. 

Taylor,  M.  E.,  Capt.  and  Asst.  Surgeon.  Now 
awaiting  orders  at  St.  Louis,  Mo.,  to  report  in  per- 
son to  the  Superintendent  Mounted  Recruiting  Ser- 
vice, for  temporary  duty  at  the  Cavalry  Depot,  Jef- 
ferson Barracks,  Mo.  "S.  O.  126,  A.  G.  O.,  June  1, 
1882. 

Tesson,  L.  S.,  Captain  and  Asst.  Surgeon.  Re- 
lieved from  duty  at  the  Cavalry  Depot,  Jefferson 
Barracks,  Mo.,  and  proceed  on  July  1,  1882,  to  San 
Antonio,  Texas,  and  report  in  person  to  the  com- 
manding general.  Department  of  Texas,  for  assign- 
ment to  duty.     S.  O.  126,  C.  S  ,  A.  G.  O. 

Davis,  Wm.  B.,  Capt.  and  Asst.  Surgeon.  Having 
reported  at  these  headquarters,  will  proceed  to  Fort 
Totlen,  D.  T.,  and  report  to  the  commanding  officer 
of  that  part  for  duty.  S.  O.  86,  Department  of 
Dakota,  May  24,  1882. 

Carter,  E.  C,  1st  Lieut,  and  Asst.  Surgeon. 
Having  reported  at  these  headquarters,  is  assigned 
to  duty  at  Camp  Price,  A.  T.  S.  O.  78,  Department 
of  Arizona,  May  24,  1882. 

Raymond,  H.  I.,  1st  Lieut,  and  .Asst.  Surgeon. 
Having  reported  incompliance  with  S.  O  103,  C.  S., 
A.  G.  O.,  is  assigned  to  duty  at  Whipple  Barracks, 
A.  T.  S.  O.  77,  Department  of  Arizona,  May  22, 
1882. 


iilcUiral  Jtems   autJ  netti0. 


Contagious  Diseases  —  Weekly  Statement.  — 
Oomparative  statement  of  cases  of  contagious  diseases 
reported  to  the  Sanitary  Bureau,  Health  Department, 
for  the  two  weeks  endiiig  June  3,  1882. 


i 

i 

i 

"»• 

^ 

Week  Ending 

s 
■a 

V 

1 

1 
I 
5 

t 

May    :.7,    1882. 

6 

6 

131 

4 

191 

73 

14 

0 

June     3,    1883. 

5 

6 

114 

7 

126 

53 

6 

0 

Migbatoey  Doctors. — Dr.  R.  A.  P.,  of  New  Lon- 
don, writes  :  "In  your  issue  of  April  14th  is  found 
a  wail  from  the  far  East,  in  the  letter  of  '  P.  A.  R,' 
to  the  effect  that  '  it  is  a  too  frequent  cause  of  com- 
plaint in  the  East,  that  medical  missionaries  and 
naval  surgeons  encroach  on  the  domain  of  the  local 
medical  men,  wherever  they  may  be  stationed  for  the 
time  being,'  etc.  '  P.  A.  E.'  has  my  deepest  sym- 
pathy. He  is  not  alone  in  affliction.  Fortunate  it 
is  that  we  have  no  medical  missionaries.  That  we 
are  spared ;  but  salaried  officers  of  the  Government 
are  moved  by  much  the  same  im25ulses  apparently 
here  in  New  England  as  in  China.  Surgeons  in  the 
Government  service,  who  have  been  stationed  tem- 
porarily here,  have  disjjlayed  signs  conspicuously  on 
the  outside  of  their  residences — the  logical  deduc- 
tion, strengthened  by  facts,  being  that  patients  and 
resulting  fees  woiild  be  acceptable. 

"As  the  struggle  for  existence  is  sufficiently  des- 
perate among  resident  physicians,  of  whom  there  is 
no  dearth,  it  seems  peculiarly  exasperating  to  have 
physicians,  whose  position  and  maintenance  are 
fully  assured  by  a  competent  salary,  reduce  the  in- 
come of  those  who  are  dependent  on  their  i:)rac- 
tice  for  a  decent  living.  Ai'my  and  navy  surgeons 
receive  pay  (adequately,  I  suppose)  for  performing 
certain  duties,  and  it  seems  no  more  than  just  that 
they  should  confine  themselves  to  the  performance 
of  those  duties,  so  far  as  the  practice  of  medicine  is 
concerned.  It  is  not  fair,  however  ^•iewed,  forjhese 
physicians  with  assured  incomes  to  enter  into  com- 
petition with  local  practitioners,  who  are  dependent 
entirely  on  their  professional  income  for  their  living. 
In  a  place  like  this  the  field  does  not  lack  an  entire 
sufficiency  of  physicians,  who,  however  hard  they 
may  work,  can  only  expect  a  modest  return  for 
their  labor.  Professional  etiquette,  if  nothing  else, 
ought  to  deter  temporary  Government  surgeons 
from  cutting  into  the  practice  of  us,  who  cannot 
look  complacently  on  while  the  vivisection  is  being 
done.  Physicians  are  not  so  few  but  that  they  can 
attend  to  all  the  practice  offered  them  without  it 
being  necessary  to  call  in  help  from  outside. 

"Apropos  of  this  subject,  allow  me  to  notice  another 
'  thorn.'  When  summer  visitors  come  to  town  and 
seashore,  we  provincial  doctors  entertain  lively 
hopes  of  lieing  benefited  V)y  the  influx,  in  ease  they 
are  so  unfortunate  as  to  need  a  physician.  But, 
no  !  Such  an  hegira  of  metropolitan  physicians  oc- 
curs simultaneously  with  the  departure  of  those 
who  can  afford  the  luxury  of  three  months  by  the 
seaside  that  we  stand  aghast  at  the  multitude,  and 


THE  MEDICAL  RECORD. 


643 


groan  in  spirit  over  the  departing  vision  of  a  pos- 
sible increase  in  business,  and  profit  thereby.  If  a 
physician  can  afford  to  leave  his  practice  in  the  city 
during  the  summer  months,  he  might  with  propriety 
refuse  to  jiractice  in  seashore  towns,  where  there  are 
intelligent  and  educated  physicians  within  easy 
call.  As  the  case  stands,  the  city  physicians  rai-ely 
fail  to  grasp  every  opportunity  that  presents." 

A  PH.iRMACEUTicAii  EXHIBITION. — An  exhibition, 
on  a  large  scale,  of  pharmaceutical  preparations, 
both  organic  and  in'brganic,  of  laboratory  apij'dances, 
and  of  works  relating  to  pharmacy,  will  be  opened 
in  Madrid  on  November  21,  1882.  The  exhibition 
will  be  under  the  immediate  auspices  of  the  College 
of  Pharmacy  of  Madrid,  and  will  be  presided  over 
by  Don  Fernandez  Izquierdo,  to  whom  all  communi- 
cations should  be  addressed. 

Effects  of  Excision  of  Syphilitic  Chancre. — M. 
Mauriac  reports  (Gmeite  des  Hopitau.r,  1881,  No.  7, 
10,  14)  seven  carefully  recorded  cases  in  which  he 
excised  the  initial  le.sion  of  syphilis.  In  six,  excis- 
ion was  performed  at  periods  varying  from  four  to 
sixteen  or  eighteen  days  of  the  appearance  of  the 
sore.  In  the  seventh  case,  the  initial  lesion  was  ex- 
cised about  fifty  hours  after  it  had  been  first  noticed, 
and  before  there  was  the  least  trace  of  glandular  en- 
largement, but  in  this,  as  well  as  in  all  the  others, 
the  operation  was  unsuccessful  in  preventing  further 
development  of  the  disease. — London  Med.  Jour. 

Capacities  of  Lungs. — Dr.  Nagor.sky,  having 
measured  the  capacities  of  lungs  of  630  boys  and  314 
girls  in  the  schools  of  the  district  of  St.  Petersburg, 
now  publishes  the  results  of  his  investigations  in  a 
Bussian  medical  paper,  the  Sii7-geo7i.  He  has  found 
that  the  capacity  of  lungs  in  relation  to  the  weight 
of  the  body  is  6.5  cubic  centimetres  for  each  kilo- 
gramme of  weight  in  boys,  and  57  cubic  centimetres 
for  girls.  The  law  of  Quetelet  being  that,  with  chil- 
dren below  fifteen  yeai's  of  age,  the  weight  of  the 
body  is  proportionate  to  the  squaie  of  the  height. 
Dr.  Nagorsky  has  found  that  it  is  proportional  to 
2.15  of  the  same ;  while  the  capacity  of  lungs  is  pro- 
portional to  2  4  of  the  height  for  boys,  and  Dr.  Na- 
gorsky's  researches  will  soon  be  published  as  a  sep- 
arate "work.  As  to  the  relation  between  the  weight 
of  man  and  the  capacity  of  lungs,  it  is  tolerably  per- 
manent, and  its  variations  are  mostly  due  to  the  dif- 
ferences in  the  amount  of  fat  in  the  bodies  of  differ- 
ent men. — Gaillard's  Jovrnnh 

The  New  Yoke  Neurological  Society. — We  are 
informed  by  the  secretaiy  that  our  item  concerning 
the  May  meeting  of  this  s-ooiety  was  not  strictly  cor- 
rect. A  protest  against  the  methods  by  which  Dr. 
Spitzka's  election  had  been  secured,  signed  by  thir- 
ty-five members,  was  put  upon  the  minutes  by  a  vote 
of  twenty-two,  none  voting  in  the  negative. 

Typhds  Fever  in  the  City.— Five  cases  of  typhus 
were  found  in  East  Forty-seventh  Street  recently  by 
one  of  the  sanitary  insjpectors.  The  source  of  the 
contagion  was  found  to  be  in  Nos.  335  and  337  East 
Forty-seventh  Street,  where  a  month  ago  there  were 
sixteen  cases,  two  of  which  proved  fatal. 

Enlargement  of  the  German  Hospital. — Anew 
wing  has  recentlv  bean  built  to  the  German  Hospi- 
tal at  a  cost  of  870,000.  It  is  intended  for  the  ac- 
commodation of  women.  The  money  was  donated 
by  Mrs.  Anna  Ottendorfer.  The  formal  opening  took 
place  on  May  27th,  when  an ,  appropriate  address 
was  delivered  bv  Dr.  Jacobi." 


Chicago  Medical  College. — The  following  ap- 
pointments have  been  made  :  Dr.  J.  N.  Danforth,  to 
chair  of  Clinical  Medicine  ;  Dr.  E.  C.  Dudley,  Gyne- 
cology ;  Dr.  Walter  Hay,  Materia  Medica ;  Dr.  Os- 
car C.  DeWolf,  State  Medicine  and  Hygiene  ;  Dr. 
Christian  Fenger,  Pathology  and  Surgical  Diseases 
of  Genito-Urinaiy  Organs ;  Dr.  F.  C.  Schaeffer, 
Anatomy. 

The  Wounds  op  Lord  Frederick  Cavendish  and 
Mr.  Bdrke. — The  London  medical  journals  have 
devoted  their  editorial  columns  to  describing, 
with  repulsive  minuteness,  the  wounds  of  Lord 
Cavendish  and  Mr.  Burke.  The  former  received 
three  stab-wounds,  the  latter  nine.  There  is  noth- 
ing in  their  detailed  description  which  is  of  scien- 
tific interest  or  value.  Their  full  publication  in 
medical  journals  has  very  much  the  character  of  in- 
viting all  the  doctors  to  see  the  corpse.  To  us  it 
seems  in  bad  taste,  though  it  may  be,  journalistic- 
ally, enterprising.-; 

PsYCHBOPHOs  :  A  New  Cold-Light  Illuminating 
Apparatus. — Dr.  J.  Michael,  of  Hamburg,  has  in- 
vented a  form  of  illuminating  a]>paratus.  It  is  based 
on  the  fact  that  phosphorescent  substances  when 
jilaeed  in  vacuum  develop,  under  the  influence  of 
the  induction  current,  a  light  which  is  comparatively 
bright,  and  contains  but  little  heat. 

The  physician  sees  man  in  all  his  weakness  ;  the 
lawyer  sees  him  in  all  his  wickedness ;  the  theo- 
logian in  all  his  littleness. — Sclwpenhaver. 

Synonym  for  Gonorehcea.  —  The  Parisian  deli- 
cately refers  to  a  specific  urethritis  as  a  " '  Coup 
de  pied  de  VCnus' — Mai  d'aventure — Pisser  des  lames 
(blades)  de  rasoir,  des  polyfedres  ^toil& — Couler  des 
jours  heureux ! " 

Consoling. — So  long  as  man  has  to  die,  but  wants 
to  live,  the  phy.sician  will  be  abused — but  employed. 
— La  Brvyere. 

Excision  of  the  Pylorus  by  an  English  Sur- 
GECN. — Mr.  T.  a.  Southam,  of  Manchester,  England, 
recently  removed  the  pylorus  along  with  nearly  a 
third  of  the  stomach,  from  a  man  aged  forty-three, 
suffering  from  carcinoma  of  the  parts  which  were 
taken  away  by  operation.  A  hard  and  freely  mov- 
able mass'  could  be  felt  through  the  aVpdominal 
walls  ;  and  operations  were  determined  upon.  The 
operation  was  performed  antiseptically,  after  the 
method  adopted  by  Professor  Billroth.  Thirty-nine 
siUv  ligatures  were  found  necessary  for  uniting  the 
duodenum  to  the  stomach.  The  shock  succeeding 
the  operation,  which  lasted  one  hour  and  a  half,  ap- 
peared to  be  very  slight,  and  for  twelve  hours  the 
patient  appeared  to  be  doing  well.  He  then  died 
very  suddenly ;  as  Mr.  Southam  thinks,  from  the 
acute  septicfcmia  described  by  Dr.  Sims. 

The  Aimerican  Surgical  Association  held  its  third 
annual  session  at  the  Hall  of  the  College  of  Physi- 
cians, Philadelphia,  May  31st,  and  June  1st  and  2d. 
About  twenty  members  were  present  from  different 
parts  of  the  country,  besides  a  large  number  of  prom- 
inent Philadelphia  surgeons. 

The  following  was  the  order  of  exercises  : 

First  Day. — Address  of  welcome  by  the  president, 
Professor  S.  D.  Gross,  M.D. 

Election  of  Fellows— Drs.  Willard  Parker  and  J. 
Marion  Sims,  of  New  York,  were  elected  honorary 
Fellows.     Forty  new  Fellows  were  elected,  10  being 


644 


THE  MEDICAL  RECORD. 


from  Philadelphia,  7  from  New  York,  and  5  from 
Boston  ;  the  rest  from  different  parts  of  the  country. 

Paper  by  Professor  J.  L.  Cabell,  on  "  Sanitary 
Conditions  in  Relation  to  the  Treatment  of  8ui-gi- 
cal  Operations  and  Injuries."  Reception  b}'  Profes- 
sor D.  Hayes  Agnew. 

Second  Day. — Paper  by  Professor  Moses  Gunn,  of 
Chicago,  on  "  Fractures  of  the  Skull ; "  paper  by  Dr. 
Richard  J.  Levis,  of  Philadelphia,  on  the  "  Treatment 
of  Transverse  Fracture  of  the  Patella  ; "  paper  by 
Dr.  J.  R.  Weist,  of  Richmond,  Ind.,  on  "Foreign 
Bodies  in  the  Air-Passages ;  "  paper  by  Professor 
W.  T.  Briggs,  of  Nashville,  Teun.,  on  the  "  .\nti- 
septic  Treatment."   Reception  by  Dr.  S.  W.  Gross. 

Third  Bdif. — Executive  session,  in  which  a  series 
of  resolutions  was  adopted,  praying  the  U.  S.  Senate 
to  give  the  usual  appropriation  of  $10,000  for  the 
support  of  the  museum  and  library  of  the  army 
at  Washington,  D.  C. 

Appropriate  resolutions  in  regard  to  the  deaths 
of  certain  Fellows  of  the  association  were  passed. 

Paper  V)y  Dr.  J.  C.  Hutchinson  on  "  Hip-Joint 
Disease;"  "paper  by  Dr.  H.  F.  Campbell  on  "Treat- 
ment of  Gunshot  and  other  "Wounds  after  Gangrene 
bad  Set  In;"  paper  by  Dr.  Senn,  of  Milwaukee,  on 
"  Fracture  of  Thigh  Bone  with  Bony  Union  ; "  paper 
by  Dr.  J.  Ewing  Mears  on  the  "  Intraperitoneal 
Method   of  Treating  the  Pedicle  in    Ovariotomy." 

Election  of  officers  which  resulted  as  follows  : 

FrasiftoiZ— Professor  S.  D.  Gross,  M.D.,  LL.D., 
D.C  L.;  Vice-PresiidenU—\)t?,.  E.  M.  Moore,  Roches- 
ter, N.  Y.;  Professor  Moses  Gunn,  Chicago,  111.; 
Secrelnry—'Dr.  3.  R.  Weist,  Richmond,  Ind.;  Treait 
ttrer  —Dr.  John  H.  Packard,  Philadelphia  ;  Recorder 
— Dr.  J.  Ewing  Mears,  Philadelphia  ;  Councit — Dr. 
B.  Beverly  Cole,  San  Francisco,  one  year ;  Dr. 
George  Wl  Gay,  Boston,  two  years ;  Dr.  Hunter 
Maguire,  Richmond,  Va.,  three  years  ;  and  Dr.  H. 
F.  Campbell,  Georgia,  four  years. 

Reception  by  Dr.  R.  J.  Levis. 

Adjourned  to  meet  at  Cincinnati  the  latter  part 
of  May,  1883. 

Earache  in  Children. — Dr.  Sexton  found  that 
about  36  per  cent,  of  all  school  children  examined 
by  him  in  the  New  Yoik  schools  recollected  having 
had- earache  ;  he  infers  that  the  aural  affection  which 
gave  rise  to  the  pains  had  also  more  or  less  imjiaired 
the  sense  of  hearing. 

Bovine  Virus  — Dr.  James  S.  Cooley,  of  Lu  zerne, 
N.  Y.,  writes  :  "I  have  watched  with  some  interest 
the  letters,  pro  and  con,  which  have  appeared  in  tlie 
Record  relating  to  the  success,  or  want  of  it,  which 
your  correspondents  have  met  with  in  the  use  of  bo- 
vine virus  for  vaccination,  and  am  led  to  give  you 
briefly  my  experience. 

"  Until  last  summer  I  have  procured  the  ivory 
points  sold  by  Codman  &  Shurtleff,  of  Boston,  and 
have  never  found  less  than  80  to  90  percent,  of  them 
good  in  primary  vaccinations,  if  used  within  two 
weeks  from  date  stamped  on  the  p.iokage. 

"  L.xst  August,  in  consequence  of  tlie  presence  of 
small  pox  in  the  neighboring  village  of  Glen's  Falls, 
there  was  an  unusual  demand  for  virus,  and  I  re- 
cpiested  Dr.  Harris,  of  the  State  Board  of  Hpalth,  to 
procure  reliable  material  for  me.  Failing  to  secure 
it  in  Albany,  he  ordered  two  hundred  quills  to  be 
.s^nt  t)  me  from  tlic  department  in  New  York  City. 
They  were  in  packages  of  fifty,  liermotically  scaled, 
and  I  took  the  utmost  pains  with  them,  as  the  need 
of  thorough  protection,  if  possible,  was  great.  I 
used  quite  a  number  myself,  and  sent  some  to  other 


neighboring  physicians.  Of  my  own  cases,  about 
twelve  per  cent.,  or  less  than  one-eighth,  proved 
good  in  primary  vaccinations.  The  physicians  to 
whom  I  sold  quills  rej^orted  about  the  same  results. 

"Becoming  disgusted,  although  I  still  had  one 
hundred  quills  on  my  hands,  I  sent  to  A.  B.  Husted, 
the  agent  in  Albany,  for  twenty-five  points.  Of 
these  I  had  not  a  single  failure  in  primary  vaccina- 
tions, and  one-half  took  in  secondary  vaccinations. 
The  figures  are  as  follows  : 

"Primary  vaccinations,  10,  all  took;  secondary 
vaccinations,  8  took ;  secondary'  vaccinations,  6 
failed  ;  not  heard  from,  1.     Total,  25. 

"My  method  has  been  to  dip  the  point  in  cold 
water,  lay  it  carefully  aside  imtil,  with  a  clean  lancet 
or  clean  ivory  point,  I  have  scarified  a  spot  as  large 
as  a  half  dime,  taking  care  to  draw  no  blood,  or 
next  to  none.  I  then  rub  both  sides  of  the  point 
over  the  scarified  surface  until  the  virus  appears 
to  have  been  entirely  removed.  I  then  wait  until 
the  place  is  nearly  or  quite  dry,  and  cover  it  with  a 
piece  of  court-plaster.  The  quills  I  did  not  dip  in 
water,  as  above,  but  rubbed  in  the  exuded  serum 
until  every  vestige  of  virus  had  been  removed. 

"  I  can  attrilnite  my  failure  with  the  quills  only  to 
the  poor  quality  of  the  virus,  as  I  took  equally  as 
good  care  to  have  them  succeed  as  I  did  with  the 
others." 

Boro-Gltcerine,  a  compound  of  boracic  acid 
and  glycerine,  devised  by  Professor  Barff  for  pre- 
serving meat,  is  contending  with  carbolic  acid  and 
iodoform  as  an  antiseptic  dressing  for  wounds. 

The  Medicinal  Value  of  Vegetables. — A  cele- 
brated cook-book  discusses  the  medicinal  value  of 
vegetaViles,  as  follows  : 

"  Asparagus  is  a  strong  diuretic,  and  forms  part 
of  the  cure  for  rheumatic  patients  at  such  health  re- 
sorts as  Aix-les-Bains.  Sorrel  is  cooling,  and  forms 
the  staple  of  that  sonpe  au.v  herhea  which  a  French 
lady  will  order  for  herself  after  a  long  and  tiring 
journey.  Carrots,  as  containing  a  quantity  of  sugar, 
are  avoided  by  some  people,  while  others  complain 
of  them  as  indigestible.  With  regard  to  the  latter 
accusation,  it  may  be  remarked,  in  passing,  that  it  is 
the  yellow  core  of  the  caiTot  that  is  difficult  of  di- 
gestion— the  outer,  a  red  layer,  is  tender  enough. 
In  Savoy,  the  peasants  have  recourse  to  an  infusion 
of  carrots  as  a  specitic  for  jaundice. 

"  The  large,  sweet  onion  is  veiT  rich  in  those  alka- 
line elements  which  counteract  the  poison  of  rheu- 
matic gout.  If  slowly  stewed  in  weak  broth,  and 
eaten  with  a  little  Nepaul  pepper,  it  will  be  found  to 
bean  admirable  article  of  diet  for  patients  of  studious 
and  sedentary  habits.  The  stalks  of  cauliflower 
have  the  same  sort  of  value,  only  too  often  the 
stalk  of  a  cauliflower  is  so  ill-boiled  and  unpalata- 
ble tliat  few  ])ersons  would  thank  you  for  propos- 
ing to  them  to  make  p.art  of  their  meal  consist  of  so 
uninviting  an  article.  Turni])s,  in  the  same  way, 
are  often  thought  to  be  indigestible,  and  better 
suited  for  cows  and  sheep  than  for  delicate  people  ;  • 
but  here  tlie  fault  lies  with  the  cook  quite  as  much 
as  with  the  root.  The  cook  boils  the  turnip  badly, 
and  then  pours  some  butter  over  it,  and  the  eater 
of  such  a  dish  is  sure  to  be  the  worse  for  it.  Try  a 
better  way.  Wluit  shall  be  said  about  our  lettuces? 
The  plant  has  a  sli<rht  narcotic  action,  of  wliich  a 
French  old  woman,  like  a  French  doctor,  well  knows 
the  value,  and  when  properly  cooked  it  is  really  very 
easj'  of  digestion." 


I.  XXI.-No.  24.1 
June  17.  1882.    f 


THE  MEDICAL  RECORD. 


645 


The  Medical  Recoed: 


"Jl  Ultekln  Journal  of  fllcbiciuc  anir  Surgevg. 


GEORGE  F.  SHRADY,  A.M.,  M.D.,  Editor. 


PUBLISHED   BT 

\\n.  WOOD  &  CO.,  Nos.  56  and  58  Lafayette  Place,  Ji.  ¥. 
New  York,  June  17,  1882. 

J  HE  MEETING  OF  THE  AilEKICAN  IVIEDI- 
CXL  ASSOCIATION. 

The  recent  meeting  of  the  American  Medical  Asso- 
ciation at  St.  Paul,  Minn.,  was  largely  attended,  and 
tli.>  usual  amount  of  interest  was  manifested  in  the 
I'U^iness  of  its  general  sessions.  As  Tvill  be  seen  by 
a  lull  report  of  the  proceedings  in  another  place, 
wrduj  matters  bearing  upon  the  government  of  the 
A -^Delation  were  brought  up  for  discussion,  and 
'■■  re  in  turn  duly  acted  upon.  The  absence  of  the 
rri'sident,  on  account  of  sickness,  was  sincerely  re- 
L'r.'tted  by  the  members,  and  an  expression  of  sym- 
pathy for  him  was  very  ai^propriately  tendered  by 
'  il>le  dispatch.  His  duties  were,  however,  very 
satisfactorily  performed  by  the  Tice-President,  who 
I  I  .>ved  himself  in  every  way  equal  to  the  occasion. 
Tiu"  Committee  of  Arrangements  deserve  great 
ii.'lit  for  the  admirable  manner  in  which  they  at- 
t'  luled  to  their  duties.  The  social  element  of  the 
111  eting  was  fully  up  to  the  average,  and  the  various 
entertainments  were,  as  usual,  well  attended. 

A  notable  matter  of  interest  in  the  business  of 
the  general  session  was  the  decision  of  the  judicial 
c^nincil  denying  the  right  of  representation  to  the 
Medical  Society  of  the  State  of  New  York.  But  of 
this  we  shall  remark  in  another  place. 

The  rule  concerning  the  election  of  officers  and 
committees  from  members  in  actual  attendance  at 
the  meeting  was  enforced,  but  as  it  worked  against 
the  best  interests  of  the  Association,  a  proposed 
amendment  was  introduced,  which,  if  adopted,  will 
leave  the  rule  applicable  only  to  the  offices  of  presi- 
dent, vice-presidents,  assistant  secretary,  the  chair- 
men and  the  secretaries  of  the  sections,  the  chair- 
man of  the  Committee  of  Arrangements,  and  the 
Judicial  Council. 

The  question  of  establishing  a  journal  for  the  As- 
sociation was  subjected  to  its  annual  agitation,  and 
some  progress  was  made  in  the  proper  direction. 
At  least  it  has  been  determined  to  ascertain  whether 


or  no  the  profession  at  large  will  give  sufficient  pe- 
cuniary support  to  any  periodical  managed  solely 
in  the  interests  of  tlo  Association.  It  must  be  con- 
fessed that  there  is  not  so  much  of  a  desire  for  an 
Association  journal  as  formerly.  Most  of  the  mem- 
bei's  are  disposed  to  be  satisfied  with  abstract  re- 
ports of  the  proceedings,  as  already  published  in 
the  various  medical  journals,  while  the  papers  in 
fuU  have  a  fitting  place  in  the  yearly  volume  of 
"  Transactions." 

It  is  a  matter  of  regret  that  the  work  in  the  sec- 
tions was  much  below  the  average  in  scientific  value. 
There  was  a  great  scarcity  of  papers,  and  with  few 
exceptions  the  discussions  on  the  topics  presented 
were  of  an  uninteresting  character.  This  should 
not  be.  The  Association,  in  order  to  command  a 
proper  influence  with  the  profession,  must  rise  to 
its  opportunities  for  better  professional  work,  and 
prove  itself  to  be  somethiDg  more  than  a  mere  ad- 
ministrative body. 


THE   N-EW   YOKK    CODE   AND   THE   -UIEEICAN    MEDICAL 
CONVENTION. 

The  recent  action  of  the  American  Medical  Associa- 
tion in  refusing  to  admit  delegates  from  the  Medical 
Society  of  the  State  of  New  York  because  of  the 
adoption  by  the  latter  of  a  new  code,  was  hardly  a 
surprise.  The  point  npon  which  the  issue  was 
taken  was  that  referring  to  freedom  in  consulta- 
tions as  allowed  by  the  New  I'ork  Society.  The 
decision  turned  upon  a  difierence  of  opinion  be- 
tween the  two  societies  as  to  the  rights  of  medical 
men  in  their  professional  relations  to  their  patients 
and  to  each  other.  We  have  already  said  so  much  on 
this  point  regarding  the  safety  of  allowing  each  man 
to  judge  for  himself  as  to  the  fitness  of  any  other 
practitioner  to  meet  him  in  consultation,  that  it 
seems  hardly  necessary  to  go  over  the  ground 
afresh.  The  position  of  the  Association  in  its  recent 
decision  has  evidently  been  based  upon  the  assump- 
tion that  there  is  danger  of  countenancing  irregular 
practices  on  the  part  of  the  New  York  men.  This,_ 
as  we  have  repeatedly  said,  is  absolutely  groundless. 
The  practitioners  in  New  I'ork  are  as  free  from  such 
temptation  as  are  those  in  any  other  State.  There 
has  been  a  grave  misapprehension  of  the  true  stand 
of  the  New  Y''ork  Society  in  this  respect.  It  is  in 
precisely  the  same  position  as  it  was  before  the  new 
code  was  adopted,  save  that  it  guarantees  its  mem- 
bers against  discipline  for  infringements  of  that 
portion  of  the  American  Code  which  has  long  been 
a  dead  letter.  The  motives  which  actuated  the  fram- 
ers  of  the  new  code  were  beyond  the  suspicion  of 
being  unprofessional  or  mercenary.  The  idea  was 
to  elevate  the  regular  profession  on  such  a  high  and 
liberal  platform  that  there  should  be  no  possible 
reason  on  the  part  of  others  for  charging  us  with 
bigotry  in  any  shape.  It  cannot  be  denied  that  this 
is  in  the  line  of  progress,  and  gives  to  all  competent 


646 


THE  MEDICAL  RECORD. 


practitioners  of  every  school  the  opportunities  for 
laying  aside  their  special  creeds,  their  pet  dogmas, 
and  elevating  themselves  to  the  grade  of  honest  and 
true  physicians.  How  far  they  will  do  this,  each 
regular  practitioner  can  judge  for  himself  and  prove 
to  his  own  satisfaction.  The  countenancing  of 
ho3ioB3i3athy,  eclecticism,  or  any  similar  delusion,  by 
such  means,  is  simply  absurd.  There  is  always  a 
presumptuous  fly  on  every  axle,  ready  to  prove  why 
the  wheel  moves.  Liberality  and  dogmatism  can 
never  have  any  common  ground  of  honest  under- 
standing. One  must  give  way  to  the  other.  It  is 
not  difficult  to  see  which  is  the  weaker.  We  ven- 
ture to  say  that  homceopathy  owes  its  success  as  a 
branch  of  sectarian  medicine  to  the  martyrdom 
which  it  has  enjoyed  at  the  hands  of  regular  medi- 
cine. Latterly  it  has  been  let  alone,  and  already  it 
is  beginning  to  drop  its  distinctive  title  and  to  aban- 
don its  cherished  tenets.  We  simply  give  this  sect 
and  all  similar  ones  no  further  excuse  for  being 
martyrs.  We  'press  forward  untrammelled  by  any 
codical  restrictions  in  our  search  for  simple  truth, 
and  others  may  follow  if  they  please. 

As  before  stated,  we  think  that  the  question  of 
professional  relations  in  regard  to  consultation  can, 
from  this  standpoint,  be  safely  left  to  work  out  its 
own  solution,  in  accordance  with  the  judgment  of 
the  individual  medical  man,  without  jeopardizing 
the  honor  of  the  profession,  without  fostering  quack- 
ery, and  without  encouraging  illegitimate  medicine. 
If  the  honor  of  the  profession  cannot  be  left  to 
individual  medical  men  no  code,  however  strict,  can 
be  of  any  use. 

We  make  these  statements  more  for  the  sake  of 
correcting  the  many  misunderstandings  that  pre- 
vail regarding  the  true  intent  and  purpose  of  the 
new  code,  than  for  any  idea  of  criticising  the  action 
of  the  Association  in  regard  to  it.  That  body  has  an 
unquestionable  right  to  settle  the  question  in  its  own 
way.  We  give  it  due  credit  for  acting  consistently. 
It  has  dignifiedly  and  resolutely  stood  still ;  the 
■  Medical  Society  of  the  State  of  New  York  has  moved 
on.  Notwithstandingthe  attitude  of  the  Association, 
we  do  not  believe  it  will  have  any  influence  in  caus- 
ing the  State  society  to  rescind  its  recent  action,  and 
we  arc  further  of  the  opinion  that  when  the  real 
motives  and  honest  aims  of  the  New  York  society  are 
properly  appreciated  and  rightly  understood,  other 
State  societies  will  follow  its  good  example,  and  we 
venture  to  predict  that  the  Association  itself,  at  no 
distant  day,  will  do  the  same.  In  the  meantime  we 
ask  our  good  friends  who  are  of  a  dilTerent  way  of 
thinking  to  give  the  Society  some  credit  for  honesty 
of  intention  and  .'■incerity  of  purpose  in  this  matter, 
and  to  trust  the  honor  of  the  profession  of  this  State 
in  the  same  keeping  in  which  it  has  been  for  so  many 
years,  even  before  the  Association  itself  had  an  ex- 
istence or  the  American  code  was  thought  of. 


SHODLD     MEDICAL      STDBENTS      BE      TAtTGHT      MATEEU 
MEDICA  ? 

The  above  question  has  been  brought  up  from  time 
to  time,  and  is  now  being  discussed  in  a  lively  man- 
ner in  the  Sliidents'  Journal.  Materia  medica  is  the 
science  which  teaches  the  characters  of  drags.  It  is 
an  essentially  different  branch  from  therapeutics, 
with  which  it  is  so  generally  associated.  In  many 
foreign  schools  the  two  studies  are  entirely  distinct, 
as  they  should  be.  There  is  one  American  college, 
and  only  one,  so  far  as  we  know,  which  fully  recog- 
nizes this  difference,  and  has  a  separate  professor 
for  each  study. 

Professor  Huxley,  in  his  address  on  medical  edu- 
cation, piits  the  question  as  well  as  possible  :  Ma- 
teria medica,  he  says,  as  far  as  it  is  a  knowledge  of 
drugs,  is  the  business  of  the  druggist.  The  necessity 
of  subdivision  of  labor  is  acknowledged  in  other 
callings,  and  should  be  in  that  of  the  doctor.  It  is 
all  very  well  for  a  physician  to  know  that  castoreum 
comes  from  an  animal  and  castor  oil  from  a  plant, 
and  how  they  should  be  prepared;  but  for  all  prac- 
tical purposes  of  his  profession,  that  knowledge  is  of 
not  one  whit  more  value — has  no  more  relevancy 
than  the  knowledge  of  how  the  steel  of  his  scalpel  is 
made.  Of  what  use  is  it,  we  are  asked,  for  the 
doctor  to  know  that  uva  ursi  is  the  leaves  of  the 
plant  arctostaphylos  uva  ursi,  grown  in  Northern 
Europe  and  Asia  ;  or  that  rhubarb  has  often  a  hole 
drilled  through  each  piece,  which  was  made  there  to 
pass  a  string  through  in  order  to  dry  the  drug ;  or 
that  the  impurities  of  opium  are  sand,  stones,  vege- 
table extracts,  treacle,  etc. 

Every  physician,  as  he  recalls  his  student  days, 
will  remember  how  much  of  useless  cramming  he 
had  to  take  upon  himself  in  this  particular  Viranch. 

It  must  be  admitted  that  our  modern  text  books 
show  great  improvements  in  this  direction,  and 
leave  out  a  great  deal  of  mntter  which  lumbered 
up  the  older  works.  There  is  a  certain  amount 
of  knowledge  regarding  materia  medica  which  it  is 
essential  for  the  physician  to  know.  Indeed,  ma- 
teria medica  in  all  its  extent  might  be  made,  like 
botany,  a  useful  preliminary  study.  The  amount 
forced  upon  medical  students,  however,  in  regular 
curriculum,  should  be  carefully  limited,  and  its  dis- 
tinctness from  tliorapeuties  made  manifest. 


HEFORMS   IN   THE   CORONER   SISTEII. 

The  eflbrts  of  the  Medico-Legal  Society  and  of 
many  of  our  citizens  to  secure  a  reform  in  the  coro- 
ner system  must  be  postponed  for  the  present.  Our 
State  Legislature  adjourned  without  taking  action 
upon  the  measures  sTiggested. 

The  profession  should,  however,  bear  in  mind 
that  changes  are  much  needed  and  be  ready  to 
press  the  matter  when  the  opportunity  again  occurs. 

At  present  we  have  four  coroners  in  each  county 


THE  MEDICAL  RECORD. 


647 


Ib  that  of  New  York  there  are,  in  addition,  fonr 
deputies.  These  deputies  are  physicians,  and  do 
most  of  the  work.  In  all  counties  but  that  of  New- 
York  the  coroners  are  paid  by  fees.  In  this  city 
they  receive  a  salary  which  virtually  amounts  to 
about  87,000.  The  deputies  get  $3,Oob.  The  coro- 
ners are  elected  by  popular  vote,  and  they  then  ap- 
point their  deputies. 

It  would  be  impossible  to  abolish  the  coroner 
system,  at  least  at  present,  since  the  office  is  a  con- 
stitutional one. 

It  is  only  proposed,  therefore,  now  to  make  some 
changes  in  the  system  in  this  city.  These  changes 
are  not  great.  They  consist  in  abolishing  three  of 
the  four  coroners,  and  in  having  four  medical  ex- 
aminers who  will  practically  do  the  same  work  as 
that  now  performed  by  the  deputy  coroners.  In  ad- 
dition, the  appointment  of  the  medical  examiners  is 
to  be  taken  out  of  the  coroners'  hands  and  placed 
where  impartiality  and  competence  will  be  exercised 
— if  such  a  place  can  be  found.  These  changes  are 
not  very  radical,  but  they  will,  apparently,  get  the 
system  out  of  politics  to  a  great  extent ;  they  will 
certainly  reduce  expenses  very  largely,  and  will  fur- 
nish us  with  competent  men.        * 

THE    "PAINTED   SICKNTISS  "   OF   MEXICO. 

A  CURIOUS  disease  has  been  recently  described,  for 
the  first  time,  by  Dr.  Iryz,  of  Mexico.  It  is  known 
as  the  Painted  Sickness  or  Mai  de  Pinto.  It  is 
endemic  in  Southern  Mexico  and  Central  America, 
where  it  seems  to  have  existed  for  a  long  time. 

It  is  a  contagious  disease  of  the  skin,  character- 
ized by  abnormal  pigmentation,  itching,  and  desqua- 
mation, a  peculiar  odor,  and  characteristic  sensation 
on  touch.  The  general  health  is  not  affected.  There 
are  no  constitutional  symptoms.  It  has  a  chronic 
course  and  may  run  on  for  many  years.  It  is  cu- 
rable under  treatment,  however,  and  sometimes  it 
ceases  spontaneously. 

The  disease  begins  with  a  patch  of  discoloration 
upon  some  part  of  the  skin,  accompanied  by  desqua- 
mation and  itchings.  The  discoloration  spreads  as 
a  rule  from  this  central  starting  jjoint.  It  is  un.sym- 
metrical,  and  may  be  either  discrete  or  confluent. 

Dr.  Iryz  describes  four  different  varieties  of  the  dis- 
ease, the  classification  being  based  chiefly  upon  the 
color  of  the  patches.  These  varieties  are  black,  blue, 
red,  and  white.  In  the  first  two  the  process  is  su- 
perficial, involving  only  the  epidermis ;  in  the  latter 
two  forms  the  dermis  and  rete-muoosum  are  affected,   j 

The  black  and  blue  varieties  often  coexist.  The 
surface  becomes  covered  with  dark  pat<;hes,  so  that 
in  extreme  cases  the  patient  looks  like  a  negro,  in 
mosaic.  The  affected  part  becomes  somewhat 
raised  and,  though  at  first  dry,  is  eventually  moist 
and  gummy.  There  is  no  jiain,  tenderness,  or  sign 
of  inflammation. 

The   white   and  red  varieties   may  also   coexist. 


The  patient  becomes  more  or  less  covered  with 
patches  of  a  perfectly  white,  a  rose,  or  a  red  tint. 
This  gives  him  a  variegated  appearance  which  is  the 
reverse  of  beautiful,  especially  when  the  face  is  af- 
fected. The  diseased  skin  is  bard,  condensed,  and 
has  apparently  lost  most  of  its  capUlaries.  Islets  of 
dark  pigment  ai-e  sometimes  found  in  the  light- 
colored  patches.  In  some  cases  the  patient's  hair,  as 
well  as  skin,  becomes  perfectly  wliite.  This  whiteness 
is  much  more  marked  than  in  vitiligo,  and  cannot  be 
affected  by  pinching  or  pressure.  The  dark  patches 
spread  much  more  rapidly  than  the  light  ones. 

The  odor  is  peculiar  and  disagreeable,  resembling 
somewhat  that  from  mouldy  garments. 

The  disease  is  treated  by  attention  to  hygiene  and 
the  administration  of  large  doses  of  arsenic. 


THE   CONTAGIOUSNESS   OF   TUBEBCULOSIS  TESTED  AGAIN. 

In  remarkable  contradiction  to  some  of  the  con- 
clusions of  Koch,  which  have  been  so  effusively  laid 
before  the  public,  are  certain  experiments  recently 
made  by  Professor  Siedamgrotzky  {Archiv  fur- 
TJiigrheWiunde). 

A  considerable  number  of  lambs  and  pigs — ani- 
mals which  have  little  tendency  toward  tubercu- 
losis— were  fed  upon  the  caseous  substance  from, 
cavities  in  cows'  lungs  and  upon  the  milk  of  tuber- 
culous cows.  The  pearly  nodules  of  bovine  tuber- 
culosis and  the  tubercular  masses  from  human 
lungs  were  also  used.  Four  or  five  ounces  were 
given  per  day  for  several  days.  After  waiting  for 
various  periods  of  time  the  animals  were  killed  and 
examined.     Control  experiments  were  performed. 

The  following  table  will  best  show  the  results  : 

AKiMAis  Fed  on  TcBEBCin.ous  Matteb  of  Tariods  Kikds  : 


2  control ) 
animals  ( 


PostrMortem  Appearances. 


117th  day     Small  caseous  cavity  in  one  lung 
209th  day    Healthy. 

\  A  few   tuberculous    ulcers    in 

(      small  intestines. 

j  A   few   tuberculous    ulcers    in 

(      small  intestines. 

(  A  few  white  and  calcified  nod- 

-j      ules   in   intestine,    bronchial 

(     glands,  and  lungs. 


102d    day 
135th  day 


ANiMAiiS  Fed  OS  Mile  of  Tobebcui.oii8  Cows: 


Kind  of  AnimaL 


6  pigs. 
2  lambs, 


■  I 

bs,  ) 


Post-Morteni  Appearances. 


1  lamb  and  3 
pigs,  as  con- 
trol animals 


.142-153  days  A  few  tubercles  in  liver  of 
1  the  two  lambs. 

'  A   few  lymphomatous  nod- 
ules in  liver  of  six  pigs. 
;  i      Also  calcareous  nodules  in 

lymphatic  glands. 


In   lamb,   healthy  ;  in  pigs, 
"  lymphomatou.s  "   nodulea  . 
in  liver  and  lungs. 


648 


THE  MEDICAL  RECORD. 


The  experiments  give  no  positive  support  to  the 
theory  of  the  communicability  of  tubercvilosis  from 
the  lower  animals  to  man.  In  no  case  did  any  notable 
symptoms,  or  any  fatal  results,  follow  the  experi- 
ments. 

It  can  be  said  that  the  animals  experimented 
upon  did  not  furnish  so  favorable  a  nurture-ground 
as  do  human  lungs  for  the  tubercular  poison  or 
bacillus. 

If,  however,  this  bacillus  is  only  an  exciting  cause, 
it  must  be  proved,  to  satisfy  Koch's  hypothesis,  that 
it  is  the  specific  and  the  only  essential  one.  This 
presents  much  difficulty. 


THE   AUrHOR   OF    "  RAB   AND   HIS   FRIENDS." 

Thk  medicil  profession  lost  one  of  its  brightest  or- 
naments in  the  death  recently  of  Dr.  John  Brown, 
of  Ediuburgh.  No  medical  man  of  modern  times, 
except  Dr.  Holmes,  has  been  so  widely  known  and 
warmly  esteemed  for  his  literary  work.  "  Kab  and 
His  Friends  "  has  become  a  household  classic.  Few 
can  read  it  without  some  kindly  feelings  toward  its 
author,  whose  personality  is  made  so  manifest 
therein. 

Dr.  Brown  was  a  pupil  of  Professor  Syme,  whose 
character  he  greatly  admired,  and  several  times  de- 
picted.    Of  his  professional  life  a  biographer  says  : 

"  Entering  life  as  a  physician.  Dr.  Brown  in  time 
obtained  a  practice,  moderate  in  range,  but  of  a  pe- 
culiar kind.  To  each  family  which  he  attended,  he 
could  not  come  merely  aa  a  medical  functionary,  feel- 
ing their  pulses  and  writing  out  prescriptions,  but  he 
must  visit  them  as  a  friend,  entering  into  their  joys, 
their  cares,  and  their  sorrows,  and  giving  them  the 
full  sympathy  of  his  most  tender  heart.  To  his  pa- 
tients this  was  soothing  and  delightful,  but  to  him- 
self it  involved  a  heavy  draft  on  his  sensitive  spirit." 

Dr.  Brown  was  interested  in  medical  work  and 
progress,  but  himself  wrote  little  upon  jjurely  med- 
ical subjects.  His  essays,  stories,  and  criticisms 
were  all  of  them  short,  and  the  result  of  work  in 
leisure  hours. 

Their  literary  characteristics  this  is  not  the  place 
to  discuss.  They  are  full  of  robust  English,  and  show 
the  earnestness,  originality,  and  peculiar  personal 
charm  of  the  author. 

We  have  regretted  that  the  English  medical  jour- 
nals, with  one  or  two  exceptions,  paid  so  little  atten- 
tion to  the  event  of  his  death.  Many  upon  this  side 
of  the  water  learn  of  it  with  a  genuine  regret. 


A  Ten-Ounce  Baby.— A  married  woman,  aged 
thirty,  in  this  city,  is  reported  to  have  given  birth 
to  a  living  son  weighing  only  ten  ounces.  She  and 
her  husband  are  of  natural  size.  Two  years  ago  she 
gave  birth  to  a  boy  who  weighed  but  eleven  ounces. 
This  infant  is  now  almost  the  natural  size  of  a  two- 
year-old. 


^liliiuricau  ilUiixcal  ^IsBociation. 


THIRTY-THIKD  ANNUAL  MEETING. 

Held  at  St.  Paul,  Minn.,  June  6,  7,  8,  ajul  9,  1882. 

Tuesday,  June  6th — FiEsr  Day. 

The  Association  met  in  the  Opera  House,  and  was 
called  to  order  at  11  a.m.  by  Db.  Alex.  J.  Stone,  of 
St.  Paul,  Chairman  of  the  Committee  of  Arrange- 
ments. 

Prayer  was  offered  by  Ex.  Key.  John  Ireland. 

A  hearty  welcome  was  then  extended  to  the  Asso- 
ciation by  Dr.  Stone.  Gen.  Lucius  F.  Hubbard, 
Governor  of  Minnesota,  then  delivered  the  formal 
address  of  welcome,  in  which  he  briefly  recounted 
the  virtues  of  the  medical  profession  and  extolled 
the  healthful  advantages  offered  by  the  great  North- 
west. 

Ex-Presidents  Dr.  Lewis  A.  Sayre,  Dr.  N.  S.  Da- 
vis, Dr.  J.  M.  Toner,  and  Dr.  Beverly  Cole  were  in- 
vited to  seats  upon  the  platform. 


The  Secretary  then  read  protests  against  the  ad- 
mission of  the  delegates  from  the  State  of  New  York, 
received  from  the  St.  Louis  Medical  Society,  the 
Georgia  State  Medical  Society,  Medical  Society  of 
the  State  of  Pennsylvania,  the  Philadelphia  County 
Medical  Society,  the  Indiana  State  Medical  Society, 
the  Medical  Society  of  the  District  of  (Columbia,  the 
Grant  County  Medical  Society  of  Indiana,  the  Es- 
culapian  Medical  Society  of  the  Wabash  \'alley,  the 
State  Medical  Society  of  Arkansas,  the  Stale  Medi- 
cal societies  of  Kentucky,  Tennessee,  and  Missouri. 

A  protest  against  the  registration  of  Dr.  S.  P.  Col- 
lings,  was  offered  by  Indiana  and  Arkansas  Medical 
societies. 

The  above  protests  were  referred  to  the  Judicial 
Council. 

The  Secretary  also  read  letters  from  Dr.  Lewis  A. 
Sayre  and  Dr.  S.  D.  Gross,  expressing  in  emphatic 
terms  dissent  from  the  action  of  the  Medical  So- 
ciety of  the  State  of  New  York,  concerning  the  code 
of  medical  ethics,  and  asliing  that  the  association 
take  no  uncertain  action  ujiou  the  question. 

Dr.  Sayre's  letter  was  addressed  to  the  Secretary 
of  the  Medical  Society  of  the  State  of  New  York, 
declining  to  act  as  a  delegate  from  that  society  to  the 
American  Medical  Association,  because  the  society 
had  ignored  the  code  of  medical  ethics  which  binds 
them  as  members  of  the  association,  and  therefore 
they  must  necessarily  be  refused  admittance. 

Dr.  Gross  in  his  letter  expressed  dooji  regret  that 
he  would  be  unavoidably  prevented  from  partici- 
pating in  the  deliberations  of  the  Association.  He 
regarded  "  the  late  extraordinary  procetnlings  of  the 
Medical  Society  of  the  State  of  New  York  as  an  out- 
rage which  every  member  of  the  profession  should 
consider  as  a  deep  personal  insult  and  which  the 
association  should  rebuke  in  the  most  stern  and  un- 
compromising manner." 

The  Chairman  of  the  Committee  of  Arrangements 
then  introduced  to  the  Association  as  its  presiding 
olBcer  the  thst  Vice-President,  Dr.  P.  O.  Hoopeb, 
of  Arkansas,  who  delivered  the  annual  address. 

THE    president's   ADDRESS. 

The  Vice-President  first  referred  to  the  absence 
of  the  distinguished  President,  Dr.  J.  J.  Woodward, 
on  account  of  sickness,  and  paid  him  a  handsome 


THE  MEDICAL  RECORD. 


649 


and  deserved  compliment.  He  then  made  to  the 
medical  profession  of  the  beautifnl  city  of  the  great 
Northwest  grateful  acknowledgment  for  the  cordial 
reception  extended  to  the  Association  through  the 
Chairman  of  the  Committee  of  Arrangements  and 
the  Governor.  Since  the  foundation  of  the  Associa- 
tion a  generation  have  passed  away.  A  few,  upon 
whom  "  age  sits  with  decent  grace,"  still  remain, 
and  among  those,  facile  princeps,  is  N.  S.  Davis,  with- 
out the  mention  of  whose  name  there  could  be  no 
appropriate  reference  to  our  beginnings. 

"  We  have  reached  a  natural  resting-place,  where 
we  can  pause  and  look  back  iipon  our  journeying 
and  progress."  "  The  years  of  the  existence  of  the  as- 
sociation have  been  years  of  wonderful  activity.  The 
bounds  of  the  horizon  of  investigation  have  been 
stret<?hed  out.  The  fierce  light  of  truth  has  dis- 
closed the  harmless  nature  of  many  a  veiled  super- 
stition. Much,  regarded  for  centuries  as  but  the 
dream  of  philosophers,  has  proven  reality.  Predic- 
tions which  have  been  supposed  to  be  naught  but 
theories,  have  been  verified.  Investigation  and  dis- 
covery have  been  stimulated  to  a  wonderful  degree. 
And  a  powerful  incentive  to  this  activity  and  labor 
is  the  appreciation  and  reward  of  the  worker.  Every 
thinker  and  discoverer  has  a  fit  audience  and  sub- 
stantial recognition.  The  scepticism  of  the  age  is 
not  afraid  of  the  new  and  startling.  But  withal 
there  is  no  recklessness  or  immaturity  in  statement 
or  theory  or  discovery.  Darwin  waited  thirty  years 
before  he  published  the  outgrowth  of  his  first"  con- 
ception of  the  thought  of  natural  selection.  Buckle 
spent  a  whole  lifetime  of  toil  and  unwearying  labor 
in  accumulating  material  for  a  hypothesis."  From 
this  general  review  the  Vice-President  passed  to  the 
purposes  of  the  organization — namely,  "  to  cultivate 
and  advance  medical  knowledge,  elevate  the  standard 
of  medical  education,  and  to  promote  the  usefulness, 
honor,  and  interests  of  the  medical  profession." 
Have  all  the  hopes  indulged  in  at  its  inauguration 
been  realized?  Everything  aimed  at  has  not  been 
accomplished,  but  the  association  has  been  an  active 
and  powerful  agent  in  disseminating  useful  medical 
knowledge,  and  no  similar  institution  has  ever  been 
more  successful  in  carrying  out  its  chief  object,  the 
promotion  of  science. 

The  subject  which  has  engaged  the  attention  of 
the  society  most,  was  that  of  medical  education  and 
reforms  in  medical  teachings.  In  that  direction 
much  had  been  accomplished.  Finally,  to  put  into 
effect  the  many  devised  and  conflicting  plans  of- 
fered, the  idea  of  an  American  College  Association 
was  brought  forward  and  its  subseqtient  organization 
effected.  That  association  may  not  have  done  every- 
thing anticipated  by  its  most  sanguine  advocates, 
but  experience  and  experiment  would  give  increas- 
ing assurance  of  its  value,  and  its  certain  success 
■was  only  a  question  of  time. 

But  beyond  that,  much  had  been  done  for  sci- 
ence, as  exhibited  in  the  thirty-two  ponderous  vol- 
lumes  of  "  Transactions,"  containing  valuable  con- 
tributions to  the  medical  literature  of  the  last  ten 
years.     The  establishing  of  a 

MEDICAIi   JOURNAIj   IN   PL.4CE   OF  THE   VOLCTTE 

has  been  brought  to  the  attention  of  the  members, 
and  he  sincerely  hoped  that  the  able  committee 
which  had  the  matter  in  charge  would  see  their  way 
clear  to  earnest,  unanimous,  and  persuasive  recom- 
mendation for  adoption  at  this  meeting. 

To  this  Association  belongs  the  honor  of  intro- 


ducing to  the  attention  of  the  people  of  the  different 

States 

THE   IMPORTANCE   OF   SANITARY   LAWS. 

That  the  efforts  had  been  in  a  great  measure  suc- 
cessful, was  evidenced  by  the  popular  appreciation 
of  sanitary  organisations. 

Under  this  head  special  reference  was  made  to  the 
question  of  smallpox.  The  people  as  well  as  the 
jirofession  had  been  neglectful  of  this  matter.  If 
possible,  a  provision  should  be  made  by  law  for  uni- 
versal vaccination.     The  argument  that 

COMPCLSOKT   VACCINATION 

is  an  infringement  on  human  rights  was  untenable. 
Laws  are  made  for  the  protection  of  the  greatest 
number,  and  something  of  natural  right  must  be 
given  up  to  the  State  and  some  restriction  must  be 
placed  upon  all. 

Reference  was  made  to  the  subject  of  relief  for 
medical  hrelhreii,  disabled  mid  helpless,  and  especially 
for  the  widows  and  children  of  those  who  have  left 
for  their  support  "nothing  except  the  sweet  smell- 
ing reward  of  unselfish  lives." 

THE   CODE   OP   ETHICS. 

"  We  have  a  code  of  medical  ethics,  the  best  ever 
given  for  the  government  of  medical  men,  of  ac- 
knowledged force  and  effect,  of  universal  acceptance 
in  every  State  in  the  Union,  and  it  is  now  too  late 
for  any  single  physician  or  State  society  to  oppose 
or  set  at  defiance  the  moral  power  of  this  body." 

Had  the  A.ssociation  done  nothing  else  than  to  orig- 
inate and  adopt  these  beautiful  precepts,  which 
should  govern  in  our  relations  to  each  other,  our  pa- 
tients, and  the  public,  it  would  have  done  service, 
entitling  it  to  everlasting  gratitude  and  to  an  imper- 
ishable name  in  the  annals  of  our  country. 

"There  has  been  recently  exhibited,  by  a  few,  a 
disposition  to  be  restive  under  the  operation  of  cer- 
tain portions  of  the  code.  It  may  not,  perhaps,  be 
becoming  in  me  to  discuss  this  matter  here,  but  I 
may  be  permitted  to  suggest  that  we  should  not  re- 
treat from  our  well- chosen  lines  of  defence.  The 
broad  lines  of  demnrcation  between  the  irregular  and 
the  true  physician  should  never  be  obliterated.  I  do 
not  say  that  the  time  may  never  come  when  your 
organic  laws  will  require  modification  and  amend- 
ment ;  but  until  that  time  arrives,  when  radical 
changes  are  demanded  in  the  light  of  a  perfect 
knowledge,  let  us  maintain,  without  internal  stiife. 
the  unsullied  standard  of  professional  honor  and 
morals,  now  '  full  high  advnnced,'  in  our  midst,  and 
decline  association  with  those  who  will  not  recog- 
nize that  flag,  or  who,  having  once  recognized,  have 
abandoned  it. 

"  We  should,  without  reservation,  declai-e  the  per- 
petuity of  this  Association,  and  renew  our  vows  of 
fidelity  to  its  constitution  and  laws." 

The  Vice-President  then  made  a  fitting  and  touch- 
ing reference  to  the  death  of  Dr.  John  T.  Hodgen, 
President  of  the  Association  at  its  annual  meeting 
in  18S1. 

In  the  natural  order  of  events,  the  responsibilities 
now  borne  by  the  veterans  must  soon  be  transferred 
to  the  shoulders  of  the  younger  members  ;  and  in 
view  of  that  fact,  the  latter  were  urged  to  carefully 
study  the  spirit  and  workings  of  the  organization,  t«> 
the  end  that  its  prosperity  might  be  perpetuated. 

On  motion  by  Dr.  Brodie,  the  thanks  of  the  Asto- 
ciation  were  extended  to  the  President  for  his  ad,- 
dress,  and  a  copy  requested  for  publication. 


650 


THE  MEDICAL  RECORD. 


The  Secketaky  read  a  letter  from  Dr.  Woodward, 
President,  expressing  his  appreciation  of  the  honor 
conferred  upon  him  and  his  sincere  regrets  at  his 
inability  to  be  present  at  this  annual  meeting. 

On  motion  by  Dr.  Cohen,  of  Philadelphia,  a  cable- 
gram was  sent  to  Dr.  Woodward,  expressing  regrets 
at  his  absence  and  hopes  for  his  speedy  restora- 
tion to  health. 

A  letter  of  regret  from  Dr.  H.  D.  Holton,  Brattle- 
boro,  Vt.,  was  read  and  ordered  entered  on  the 
minutes. 

On  motion,  the  members  of  the  Minnesota  State 
Medical  Society,  now  in  session  in  St.  Paul,  were 
elected  members  by  invitation. 

Dr.  N.  S.  Davis,  of  Chicago,  presented  a  preamble 
and  resolution  in  behalf  of  the  Woman's  National 
Christian  Temperance  Union,  asking  the  Association 
to  express  its  ajiprobation  of  the  introduction  of  a 
more  perfect  study  of  physiology  and  hygiene,  in- 
cluding a  knowledge  also  of  the  evil  effects  of  in- 
toxicating drinks,  into  all  public  schools  supported 
at  public  expense.  It  was  referred  at  the  request  of 
Dr.  Davis  to  the  Section  on  State  Medicine  and 
Medical  Jurisprudence. 

After  the  reading  of  the  registration  list,  the  As- 
soaiation  adjourned,  to  meet  Wednesday  morning  at 
10  o'clock. 


Wednesday,  June  7th — Second  Day. 

The  Association  was  called  to  order  at  10  a.m.  by 
Vice-President  Db.  Hooper,  and  prayer  was  offered 
by  Eev.  D.  Pv.  Breed. 

The  following  were  announced  as  the 

OOMMITTBE   ON   NOMINATIONS  : 

J.  A.  Dibrell,  Jr.,  Arkansas  ;  H.  S.  Orne,  California  ; 
J.  Hawes,  Colorado  ;  W.  G.  Bronson,  Connecticut ; 
S.  B.  McGlumphv,  Dakota  ;  W.  F.  Holt,  Georgia ; 
T.  W.  Worrell,  Illinois  ;  W.  Lomax,  Indiana ;  T.  J. 
Caldwell,  Iowa  ;  J.  Bell,  Kansas  ;  L.  S.  McMurtry, 
Kentucky  ;  J.  W.  Dupree,  Louisiana  ;  T.  A.  Fostei-, 
Maine ;  Wm.  Lee,  Maryland  ;  M.  G.  Parker,  Mas- 
sachusetts ;  Foster  Pratt,  Michigan  ;  W.  W.  Mayo, 
Minnesota  ;  H.  A.  Gant,  Mississippi ;  A.  J.  Steele, 
Missouri ;  L.  J.  Abbott,  Nebraska ;  S.  S.  Clark, 
New  Jersey  ;  E.  Gi-issom,  North  Carolina ;  N.  C. 
Hnsted,  New  York;  X.  C.  Scott,  Ohio;  A.  Fricke, 
Pennsylvania ;  Ariel  Ballon,  Ehode  Jsland  ;  J.  B. 
Lindsley,  Tennessee ;  W.  H.  Park,  Texas ;  S.  W. 
Thayer,  Vermont ;  F.  D.  Cunningham,  Virginia ; 
N.  Senn,  Wisconsin  ;  W.  D.  Marmion,  District  of 
Columbia ;  John  M.  Brown,  U.S.N.  ;  G.  Porrin, 
U.S.A.  ;  O.  W.  Miller,  U.  S.  Marine  Hospital  Ser- 
vice. 

A  protest  against  the  registration  of  D.  W.  Day, 
of  Wisconsin,  was  referred  to  the  Judicial  Council. 
A  resolution  providing  for  the  payment  of  the  Treas- 
urer's travelling  and  hotel  expenses  wliile  in  attend- 
ance at  the  annual  meeting  was  adopted. 

THE   TERM    "  AJJLOPATH." 

Dr.  Dksnison,  of  Colorado,  offered  the  following, 
which  was  referred  to  the  Judicial  Council  : 

In  order  to  correct  a  misconception  whicli  largely 
prevails  in  the  public  mind,  and  to  some  extent  pro- 
vails  among  members  of  tlie  medical  i^rofossion,  as 
to  the  liberty  of  action  authorized  by  this  Associa- 
tion in  the  treatment  of  disease,  we  deem  it  proper 
to  make  a  declaration  of  principles  broadly  applica- 
ble to  the  healing  art  as  sanctioned  and  practised 
nnder  our  code,  to  wit :  Ilational  medicine,  being 
b.»»ed  upon  e.xporience  and  pathological  research, 


demands  absolute  freedom  in  the  selection  and  ad- 
ministration of  materia  medica ;  and  there  is  noth- 
ing in  the  code  of  ethics  of  the  American  Medical 
Associatioh  prohibiting  the  use  by  its  members  of 
any  known  and  honorable  means  of  combating  dis- 
ease. Furthermore,  as  contributing  to  the  allevi- 
ation of  human  suffering,  we  hail  with  pleasure  and 
gratitude  every  discovery  in  etiological  and  thera- 
peutical science  by  whomsoever  made. 

We  therefore  reject  as  untrue  and  obnoxious  the 
term  "  Allopathists  "  as  applied  to  the  members  of 
this  Association  by  dogmatists  and  extremists  with- 
out its  fold. 

First. — Because  it  tends  to  convey  the  erroneous 
impression  that  we  are  restricted  to  the  choice  of 
remedies  and  the  method  of  using  them  by  other 
than  the  limits  of  rational  science. 

Second. — Because  for  any  association  of  men  claim- 
ing to  practise  the  profession  of  medicine  to  adopt 
a  name  based  upon  limited  and  conjectured  theories 
of  therapeutics  for  the  purpose  of  disignating  a  par- 
ticular school  of  medicine,  we  have  always  held,  and 
still  regard,  as  unscientific  in  principle  and  danger- 
ous in  practice. 

Dr.  J.  H.  Packard,  of  Philadelphia,  then  read  the 
report  of  the  Committee  on 

JOURNALIZING   THE   TRANSACTIONS. 

The  report  was  accepted  and  ordered  printed  and 
was  made  the  special  oi-der  for  Thursday  morning. 

The  amendTuent  offered  at  the  last  annual  meet- 
ing, providing  for  such  a  change  as  would  allow 

PERMANENT   MEMBERS  TO   VOTE, 

was  laid  upon  the  table. 

ADDRESS  OP   THE   CHAIRMAN   OF   THE   SECTION   IK 
MEDICINE. 

Dr.  J.  A.  OcTEBLONY,  of  Louisville,  introduced  his 
address  with  a  quotation  from  Lord  Bacon  who  said 
that  "  medicine  is  a  science  which  hath  been  more 
professsed  than  labored  and  yet  more  labored  than 
advanced,  the  labor  having  been  rather  in  a  circle 
than  in  progression.  For  I  find  much  iteration  but 
small  addition." 

However  well  deserved  this  severe  criticism  may 
have  been  in  1605,  it  is  not  applicable  to  medicine 
of  our  days.  Could  Bacon  in  the  full  possession  of 
his  imperial  intellect  behold  the  progress  our  science 
has  made  since  his  time,  he  would  quickly  perceive 
that  the  labor  has  not  been  in  a  circle,  but  in  pro- 
gression. He  would  have,  perhaps,  to  complain 
that  there  was  not  sufficient  iteration  while  he  would 
find  that  the  addition  has  been  immense. 

From  this  point,  Dr.  Octerlony  j)roceeded  to  give 
a  brief  n'sumi  of  the  advancement  which  has  been 
made  in  some  departments,  and. said  that  more  pro- 
gress had  been  made  during  the  last  twenty-five 
years  than  in  the  previous  twenty-five  hundred 
years.  Even  in  the  middle  of  the  eighteenth  century 
the  knowledge  relating  to  scarlet  fever  and  measles 
was  so  meagre  that  the  two  diseases  were  confounded 
with  each  other.  It  was  not  until  1768  that  they 
were  identified. 

In  the  year  1840  the  name  endocarditis  was  un- 
known. Great  has  been  the  work  and  vast  and 
multitudinous  the  facts  which  have  been  accumu- 
lated, but  the  process  of  crystallization  into  general 
laws  has  been  slow.  The  want  of  a  great  central 
law  to  give  certainty  and  precision  to  medical  science 
is  keenly  felt.  In  viewing  the  present  state  of 
medicine  and  endeavoring  to  estimate  the  character 


THE  MEDICAL  RECORD. 


661 


and  rate  of  progress,  two  lines  of  inquiry  opened 
before  him.  The  one  followed  the  current  of 
literature ;  the  other,  and  that  with  which  he  had 
been  most  closely  identified,  the  tendency  of  the 
work  of  professional  labor  and  thought  during  a 
longer  period,  with  the  anticipation  of  thus  more 
clearly  discerning  the  direction  and  rate  of  its  de- 
velopment. 

Reference  was  first  made  to  the  subject  of  infiam- 
mation  as  one  intimately  interwoven  with  medicine, 
and  the  insufficiency  of  the  old  definition  pointed 
out,  together  with  the  successive  steps  taken  to 
bring  its  present  definition  to  be  "  a  disorder  of  nu- 
trition, a  temporary  exaggeration  of  the  nutritive 
irritability  of  the  part  affected."  There  is  no  sharp 
line  of  domarkation  to  be  drawn  between  physiologi- 
cal action  and  inflammation.  The  processes  of  in- 
creased nutrition  in  inflammation  differ  from  the 
physiological  in  degree  rather  than  in  kind. 

Not  many  years  ago  the  nervous  system  was  the 
terra  incognita  oi  medicine;  but  now  many  hereto- 
fore obscure  affections  are  well  understood. 

Pulmonary  consumption  affords  another  illustra- 
tion of  advancement  made  in  medicine. 

In  hepatic  pathology  the  recognition  and  descrip- 
tion of  hypertrophic  cirrhosis  of  the  liver  is  of 
comparatively  recent  date.  Billroth  had  performed 
the  brilliant  operation  of  removing  the  pylorus,  but 
simple  washing  out  the  stomach  constituted  an  im- 
provement in  therapeutics  of  a  higher  order. 

Dr.  Octerlony  then  gave  a  resume  of  what  the 
microscope  had  done  for  medicine.  Leprosy  had 
been  found  by  Eklund,  of  Sweden,  and  Hauser,  of 
Norway,  to  depend  upon  a  vegetable  parasite — 
"micrococcus  lepras"  of  the  former,  and  "bacillus 
leprae  "  of  the  latter — and  Neisser,  of  Breslau,  Ferd 
Kohn,  and  Koch  had  confirmed  the  correctness  of 
these  observations.  Tlie  cause  of  typhoid  fever  had 
been  found  to  be  the  "  ileofyfofyton  Kleinii,"  and 
the  blood  of  a  scarlet  fever  patient  contained  the 
"  plax  scindens."  It  had  been  demonstrated  by  Dr. 
H.  C.  Wood  that  diphtheria  is  due  to  the  presence 
of  microscopic  fungi,  and  Tommasi,  of  Rome,  and 
Klebs  had  proved  that  malarial  fever  is  caused  by 
the  "  bacillus  malariie." 

In  helminthology  great  advances  had  been  made 
by  means  of  the  microscope,  and  the  danger  to  life 
caused  by  trichinse  was  not  known  until  the  year 
1860. 

In  aU  this  work  the  exclusive  systems  in  medicine 
have  had  no  share  whatever.  So  far  as  any  true  ad- 
vancement is  concerned  they  have  been  entirely 
barren.  Not  a  single  oasis  relieves  the  dreariness 
of  the  view.  Not  a  single  flower  of  science  has 
blossomed  in  their  uncongenial  soil.  Not  a  single 
original  contribution  has  been  made  by  them  to 
anatomy,  physiology,  histology,  chemistry,  path- 
ology, etiology,  and  public  hygiene.  Nor  is  it  known 
that  any  one  belonging  to  the  ranks  of  these  ir- 
regulars has  ever  achieved  distinction  in  the  fruitful 
field  of  other  sciences  in  which  the  cultivators  of 
scientific  medicine  have  won  so  much  glory,  and 
have  performed  such  noble  exploits.  The  names  of 
Linm-eus,  Berzelius,  Draper,  Nott,  and  Leidy,  and 
many  others  form  brilliant  constellations  which 
shall  continue  to  illuminate  the  firmament  of  sci- 
ence after  homceopathy  and  kindred  delusions  shall 
have  been  swept  away  by  the  relentless  winds  of 
oblivion. 

But  with  all  this,  that  which  still  remained  desir- 
able was  some  general  law  which  would  give  "  unity 
to  our  methods  and  precision  to  our  results." 


The  address  was  referred  to  the  Committee  on 
Publication. 

REl'ORT  OF  THE   JCBICIAL  COUNCIL. 

The  report  was  read  by  Dr.  N.  S.  Davis,  and  was 
as  follows  : 

1.  In  regard  to  the  Nebraska  State  Society  referred 
to  us  last  year,  the  council  report  that  a  careful  ex- 
amination of  the  documents  and  matters  involved  in 
the  protest  of  certain  members  of  the  Nebraska 
State  Medical  Society  against  the  admission  of  said 
society  to  representation  in  the  American  Medical 
Association  show  no  proper  cause  for  such  protest 
at  the  present  time,  and  consequently  the  society 
is  entitled  to  its  full  representation,  by  delegates,  in 
this  Association. 

2.  In  regard  to  the  resolution  concerning  the  use 
of  remedies  controlled  by  a  patent  copyright  or 
trade  mark,  etc.,  which  was  reported  from  the  sec- 
tion on  practical  medicine  and  materia  niedica,  and 
by  the  Association  referred  to  the  Judicial  Council 
last  year,  the  council  has  decided,  after  CDieful 
examination,  that  inasmuch  as  said  resolution  in- 
cludes matter  not  referred  to  in  the  code  of  ethics, 
and  said  code  contains  all  that  is  necessaiy  for  the 
proper  guidance  of  members  of  the  medical  profes- 
sion, therefore,  the  resolution  should  not  be  adopted 
by  the  Association. 

3.  In  regard  to  the  protests  against  the  action  of 
and  the  reception  of  delegates  from  the  New  York 
State  Medical  Society,  which  was  referred  to  us,  the 
judicial  committee  report  as  follows  : 

Having  carefully  considered  the  code  of  ethics 
adopted  by  the  New  York  State  Medical  Society  at 
its  annual  meeting  in  February,  1S82  (as  furnished 
by  the  secretary  of  said  society),  the  judicial  council 
find  in  said  revised  cede  provisions  essentially  dif- 
ferihg  from  and  in  conflict  with  the  code  of  ethics 
of  the  association,  and  therefore,  in  accordance  with 
the  provisions  of  the  ninth  by-law  of  this  Association, 
decide  unanimously  that  said  New  York  Medical 
Society  is  not  entitled  to  representation,  by  dele- 
gates, in  the  American  Medical  Association. 

ADDRESS   OF   THE   CHAIBMAS   OP   THE   SECTION   IN   OB- 
STETKICS   AND   DISEASES  OF   WOMEN. 

Dr.  H.  O.  MARcr,  of  Boston,  accepting  precedent, 
departed  from  the  rule  concerning  the  annual  ad- 
dress, and  directed  attention  to  the  subject  of 

FIBROID   TUMORS   OF   THE   UTERUS   AND   THEIB 
TREATMENT. 

As  introdiictory,  the  Association  had  reason  for 
congratulation  with  reference  to  original  investiga- 
tion which  its  members  had  made  in  the  field  of 
labor  i^ertaining  to  gynecology,  and  the  name  to  be 
mentioned  first  was  that  of  'Washington  L.  Atlee, 
who,  more  than  a  generation  ago,  received  the  prize 
for  an  essay  on  "  The  Surgical  Treatment  of  certain 
Fibrous  Tumors  of  the  Uterus  hitherto  considered 
beyond  the  Resources  of  Art."  Since  that  time 
Sims,  Emmet,  Thomas,  and  others  had  done  much  to 
establish  the  value  of  Dr.  Atlee's  observations. 
These  tumors  are  of  the  rarest  occurrence  prior  to 
puberty.  They  have  received  the  names  myoma 
and  myofibroma.  Dr.  Marcy  then  gave  the  histolo- 
gical features  of  the  growths,  and  said  that  they 
were  composed  of  bundles  of  muscular  fibres  and 
capillary  vessels,  and  strictly  speaking,  should  be 
called  myoma.  The  soft  are  less  common  than  the 
firmer  varieties,  and  as  a  whole  they  are  divided  in- 
to three  classes :  (1)  the  subserous,  (2)  the  interstitial, 


652 


THE  MEDICAL  RECORD. 


aud  (3)  the  submucoua.  Attention  was  then  direct- 
ed to  the  differential  diagnosis,  and  this  was  fol- 
lowed by  reference  to  the  liabilities  in  connection 
with  such  growths,  such  as  peritonitis  and  conse- 
quent adhesions,  injury  from  twisting  of  the  pedicle, 
etc. 

The  peculiarities  of  each  variety  were  then  point- 
ed out.  Experience  had  taught  him  that  the  fib- 
rous tumor  when  still  increasing  in  size  cannot  be 
enucleated  from  a  capsule.  It  may  be  torn  out,  but 
it  will  be  at  the  expense  of  the  integrity  of  the  uter- 
ine tissue. 

With  reference  to  the  question  of 

THE  CAPSULE, 

f  1-om  the  examination  of  thirty-three  specimens,  Dr. 
Marcy  had  reached  the  conclusion  that  there  could 
be  demonstrated,  not  only  the  formation,  Vrat  tlie 
singular  simplicity  of  the  tumor  and  its  investing 
capsule. 

The  peculiarities  of  the  submucous  and  the  sub- 
serous varieties  were  then  mentioned,  and  from 
these  the  writer  passed  to  the  consideration  of  fibro- 
myoma  and  submucous  polypi  of  the  cervix. 

The  next  topic  was  the  pathological  changes 
which  may  take  place  in  the  fibro-myoma,  such  as 
inflimmation,  gangrene,  and  cretaceous  degenera- 
tion. Hemorrhage  is  not  a  rare  occurrence  in  con- 
nection with  these  growths.  Ketrogressive  meta- 
morphosis occurs,  but  it  has  been  actually  observed 
in  only  a  few  instances. 

The  trophic  changes  observed  after  the  meno- 
pause have  been  ascribed  to  a  lessening  of  the  mus- 
cular elements,  and  the  very  decided  increase  of  the 
connective  tissue.  His  own  observations  failed  to 
substantiate  such  conclusion,  but  led  him  to  the 
opinion  that  the  proportions  of  the  two  elements  are 
not  much  changed.  The  symptoms  to  which  these 
tumors  give  rise  are  varied,  and  some  space  was  de- 
voted to  their  considei-ation. 

In  many  cases  fibrous  tumors  had  been  reported 
as  having  been  absorbed,  and  thus  to  have  disap- 
peared. There  are  so  many  sources  of  error  that 
most  of  these  cases  must  be  regarded  as  mistakes 
in  diagnosis.  There  are,  however,  a  considerable 
number  of  cases  in  which  this  change  undoubtedly 
occurred.  A  careful  study  of  myomatous  growths 
and  their  development,  leads  to  the  general  conolu- 
sion  tliat  such  pathological  conditions  would  in  only 
a  very  small  degree  be  amenable  to  medication. 
The  remedy  which  has  the  greatest  confidence  is 
ergot,  and  yet  this  method  of  treatment  is  extremely 
uncertain.  The  physiological  action  of  the  drug 
was  then  given  with  detail. 

The  only  cases  in  which  he  had  been  able  to  ob- 
tain any  satisfactory  results  from  the  use  of  ergot 
were  those  of  the  submucous  variety. 

Dr.  Marcy  then  passed  to  the  consideration  of 

THE    METHODS   OP   SUROICAIi   INTERFERENCE. 

With  reference  to  dilating  the  cervix,  splitting  the 
c^p^ulo,  and  cutting  deep  into  the  tumor  itself,  ex- 
perience had  shown  that  such  measures  should  be 
adopted  only  in  exceptional  cases. 

Concerning  the  submucous  fibroids,  the  cervix 
might  be  dilated  or  divided,  the  tumor  seized  with 
strong  forceps  and  enucleated,  or  the  tumor  might 
1)6  divided  and  removed  in  pieces.  But  a\-ulsion, 
or  much  force,  however  applied,  blind  dissection 
with  the  liuife  or  sci.ssors,  the  Ocraaeur  or  the  gal- 
vano-cautery  wire  should  rarely  be  put  in  practice. 

A   modification   of  Thomas'   spoon-saw  was    ex- 


hibited. The  instrument  was  double,  consisting  of 
serrated  scoop  at  each  end,  the  larger  of  which  was 
fenestrated  so  that  the  finger  might  be  used  in  the 
loop  as  an  intelligent  guide. 

The  large  interstitial  variety  had  at  one  time  usu- 
ally been  considered  as  beyond  the  aid  of  surgery. 
But  under  the  stimulus  given  by  Atlee,  Sims,  Em- 
met, and  Thomas,  remarkable  results  had  been  ob- 
tained. Removal  of  the  ovaries  had  been  recom- 
mended by  Dr.  Battey,  of  Georgia,  for  rapidly 
growing  myoma  in  certain  cases.  With  reference 
to  laparotomy,  the  dangers  were  from  shock,  hemor- 
rhage, peritonitis,  and  septic;emia.  The  measures 
for  controlling  these  had  been  made  so  adequate 
that  the  ojieration  was  justifiable  in  certain  cases. 

Dr.  Marcy  then  described  his  method  of  securing 
the  stump.  The  exposed  tumor  is  encircled  at  its 
base  by  a  sheet  of  rubber,  in  the  centre  of  which  is 
an  opening  reinforced  by  a  rubber  ring  of  consid- 
erable thickness  and  of  various  sizes.  Around  this 
is  tied  a  rubber  cord,  sufficiently  tight  to  control 
hemorrhage.  The  great  bulk  of  the  tumor  is  then 
cut  away.  Just  above  the  constricting  rubber  the 
pedicle  is  secured  through  and  through  by  means 
of  the  shoemakers'  stitch,  enclosing  only  a  compara- 
tively small  portion  of  the  tissue,  and  uniform  pres- 
sure is  carefully  continued  until  the  stump  is  cov- 
ered. 

CONCERNING    DRAINAGF, 

the  opinions  of  Wells,  Keith,  Sims,  Thornton,  and 
others  were  given,  and  the  advantages  and  disad- 
vantages presented. 

Dr.  Marcy  believed  that  Mr.  Lister's  antiseptic 
rules  were  of  as  gi-eat  importance  and  value  here  as 
in  general  surgery.  The  spray  is  a  minor  factor  in 
the  antiseptic  treatment.  He  who  becomes  familiar 
with  its  broad  principles  of  sound  philosophic  rea- 
soning, its  careful  detail  of  method,  its  astonishing 
array  of  demonstrative  facts,  will  need  little  urging 
to  give  it  an  enthusiastic  support. 

The  address  was  fully  illustrated  by  means  of 
microscopic  slides  and  photographs  enlarged  upon 
the  screen  by  the  aid  of  the  oxy-hydrogen  and  solar 
lights. 

Oa  motion,  the  thanks  of  the  association  were  ex- 
tended to  Dr.  Marcy  and  his  corps  of  assistants  for 
the  address  and  the  demon.strations. 

The  association  then  adjourned  to  meet  on  Thurs- 
day, at  10  A.M. 


THtJBSD.w,  June  8th— Thibd  Day. 

The  Association  was  called  to  order  at  10  a.m.  by 
Vicb-President  Hoopeb. 

Prayer  was  otVered  by  Rev.  M.  N.  Gilbert. 

A  telegram  from  Colorado  and  resolutions  from 
the  State  Medical  Society  of  Georgia  reaffirming 
their  devotion  to  the  American  code  of  Medical 
Ethics  were  read. 

The  special  order  after  the  report  of  the  Commit- 
tee of  Arrangements  being  the  consideration  of  the 
report  of  the  Committee  on 

JOURNALIZING   THE    TR  VNSAOTIONS, 

the  rejjort,  of  which  the   following  is  an  alistract, 
was  discMissed. 

After  enumerating  the  various  sources  of  revenue 
for  the  Association,  the  committee  concluded  that 
unless  the  Association  can  be  made  far  more  stable 
and  comprehensive  in  its  character,  with  a  truly 
permanent  membership,  oniliracing  and  interesting 
a  vastly  greater  proportion  of  the  profession,  it  is 


THE  MEDICAL  RECORD. 


653 


idle  to  talk  of  its  establishing  and  maintaining  a 
journal. 

To  this  end  the  first  step  is  to  adopt  the  changes 
in  the  plan  of  organization,  etc.,  of  the  Association, 
proposed  last  year,  bj  virtue  of  which  the  member- 
ship would  be  thrown  open  to  all  members  of  State 
and  county  societies  upon  application,  by  the  pay- 
ment of  an  annual  fee  of  five  dollars — such  member- 
ship to  constitute  the  holder  a  subscriber  to  the 
journal,  and  to  be  forfeited  by  non-payment  \vithin 
three  (four,  or  six)  months  of  the  commencement 
of  the  journal  year.  Any  such  member  being  elected 
a  delegate  to  a  meeting  of  the  Association  might  be 
taxed  one  dollar  additional  as  a  registration  fee, 
toward  defraying  the  expenses  of  the  meeting. 
Should  any  delegate  not  be  already  a  member  by  ap- 
plication, we  would  suggest  his  being  taxed  six 
dollars,  and  thereby  constituted  not  only  a  member 
of  the  Association  but  a  subscriber  for  the  journal 
for  that  year. 

Supposing  the  Association  to  have  succeeded  in 
putting  the  pecuniary  question  on  a  satisfactory 
basis,  we  may  now  consider  the  mode  in  which  the 
business  part  of  the  enterprise  could  be  carried  on. 
Were  it  possible  to  select  at  once  a  perfectly  suitable 
man  to  take  charge  of  this  whole  matter,  such  an 
arrangement  would  be  the  most  economical  plan, 
and  the  experience  of  the  British  Medical  Associa- 
tion is  strongly  in  its  favor.  But  unless  the  right 
person  could  be  more  readily  found  than  it  seems  to 
us  at  all  likely,  it  would  perhaps  be  safer  and  more 
feasible  for  the  Association  to  enter  into  a  contract 
■with  some  well-known  and  responsible  publishing 
house  to  issue  the  journal  for  them,  upon  such 
terms  as  may  be  found  available.  To  go  into  the 
details  of  such  an  arrangement  would  be  premature 
and  at  present  useless,  but  we  may  say  that  the 
Association  should  strictly  reserve  to  itself  the  con- 
trol of  all  but  the  purely  business  part  of  the  enter- 
prise, even  as  regards  the  advertisements  to  be  ad- 
mitted, and  that  the  editor  and  his  assistants  should 
be  designated,  employed  and  paid  under  its  direc- 
tion. 

This  leads  us  naturally  to  the  mention  of  a  matter 
of  very  great  moment — the  propriety  of  obtaining 
a  charter  for  the  Association.  We  are  not  unmind- 
ful of  the  fact  that  this  is  a  step  requiring  careful 
consideration  in  view  of  possible  embarrassments  in 
matters  of  discipline,  etc. ;  but  it  may  be  that  it  is 
a  necessity  on  the  part  of  a  body  contemplating  a 
business  undertaking  like  that  under  discussion,  in- 
volving the  making  of  contracts  and  the  assump- 
tion of  large  annnal  expenditures.  It  may  be  that 
no  prudent  i^ublisher,  manager,  or  editor  would  be 
willing  to  assume  the  duties  devolving  upon  him  in 
such  a  scheme,  upon  the  mere  promise  of  a  few 
men  connected  with  a  society  of  uncertain  member- 
ship and  equally  uncertain  income,  unless  those 
men  gave  their  personal  obligations  for  the  ex- 
penses incurred.  This  they  can  scarcely  be  ex- 
pected to  do  ;  and  unless  the  objections  to  such  a 
course  are  insuperable,  it  would  be  better  for  the 
Association  to  authorize  its  officers  and  standing 
committees  to  apply  in  its  behalf  for  a  charter. 
Such  application  may  be  made  in  any  State  to  the 
proper  court,  or  perhaps  Congress  might  be  asked  to 
pass  an  act  of  incorporation.  Upon  these  points  it 
■would,  of  course,  be  requisite  to  have  legal  advice. 

Next,  as  to  the  mode  of  appointment  of  the  editor. 
Upon  the  selection  of  a  suitable  man  will  hinRe,  in 
a  very  great  measure,  the  success  of  the  whole  en- 
terprise.     He   must   be   possessed    of    intellectual 


ability,  firmness,  tact,  and  judgment,  free  from 
partisanship,  of  high  professional  and  moral  tone, 
and  of  such  standing  as  will  enable  him  to  attract 
the  support  and  secure  the  influence  of  the  best 
class  of  contributors.  It  is  very  desirable  that  the 
editor's  relation  to  the  Association  should  be  such  as 
to  leave  him,  as  far  as  may  be,  untrammellpd,  while 
still  responsible  for  the  due  discharge  of  his  func- 
tions ;  that  the  arrangement  should  be  such  as  to 
make  it  worth  while  for  a  suitable  man  to  accejit  the 
position,  and  still  to  preserve  for  the  Association  a 
just  and  equitable  control  of  it.  There  would  be 
obvious  difficulties  in  the  way  of  an  election  by  the 
whole  body  annually,  and  it  seems  to  us  that  the 
matter  can  hardly  be  placed  to  advantage  in  the 
hands  of  any  of  the  existing  committees.  We 
would,  therefore,  propose  that  there  shoiild  be  elected 
by  the  Association  a  board  of  trustees,  nine  in  num- 
ber, of  whom  three  shall  serve  one  year,  three  two 
years,  and  three  three  years  ;  and  that  annually 
thereafter  there  shall  be  elected  three  gentlemen  to 
take  the  places  of  those  whose  terms  expire,  and  to 
.serve  for  the  ensuing  three  years.  We  further  sug- 
gest that,  when  the  establishment  of  this  beard  is  ef- 
fected, a  provision  be  introduced  that  retiring  trus- 
tees be  ineligible  for  re-election  until  the  next  annual 
meeting.  It  would  jierhaps  be  advisable  that  the  va- 
rious sections  of  the  country  should  be  rejiresented 
in  this  board  ;  yet,  for  the  facilitation  of  business, 
the  trustees  should  not  be  too  far  ajiort. 

As  to  the  mode  of  nominating  the  trustees,  this 
might  be  done  by  the  Committee  on  Nominations,  or, 
what  would  perhaps  be  better,  by  a  special  com- 
mittee composed  of  the  President  of  the  Association 
and  the  cbairmen  of  the  several  sections  at  each 
annual  meeting,  the  nominations  so  made  to  be  acted 
upon  by  the  Association  at  its  next  annual  meeting. 
In  case  of  the  death  or  declination  of  any  gentleman 
so  nominated  before  the  election,  another  name  might 
be  presented  liy  the  same  committee,  or  perhaps  by 
a  committee  similarly  con.stituted,  to  be  voted  upon 
at  the  same  meeting  which  would  bave  entertained 
the  iir.st  nomination.  In  the  hands  of  these  trustees 
might  be  placed  the  appointment  of  the  editor, 
which  would  be  best  made  for  an  indefinite  term, 
the  engagement  to  be  dissolved  by  eitlier  party  only 
upon  three  months'  notice;  and  if  this  is  dene  by 
the  trustees,  the  editor  to  have  the  right  of  appeal 
to  the  Judicial  Council,  upon  whose  motion,  if  tliey 
see  proper,  the  matter  may  be  broiight  before  the 
Association  at  its  next  annual  meeting,  and  decided 
by  a  three-fourths  vote  of  the  members  present.  In 
ease  of  the  death  or  resignation  of  the  editor,  the 
trustees  to  elect  his  succes.sor  in  the  same  way  and 
on  the  same  terms. 

We  would  recommend  that  the  appointment  of 
the  assistant  editors  be  with  the  editor  (subject  to 
the  approval  of  the  trustees),  and  that  the  salai-y  of 
the  editor  should  be  .S6,000,  out  of  ■which  sum  he 
should  pay  his  assistants,  making  his  own  terms 
mtb  them. 

The  trustees  should  report  annually  to  the  Asso- 
ciation, .giving  a  statement  of  the  expenses  and  re- 
ceipts of  the  journal ;  orders  for  such  expenses  to 
be  honored  by  the  Treasurer  of  the  Association  only 
when  signed  by  the  editor-in-chief,  and  counter- 
signed by  the  chairman  and  two  other  members  of 
the  board  of  trustees. 

As  to  the  place  of  publication,  your  committee  do 
not  feel  prepared  to  make  any  suggestion.  It  would, 
however.  Vie  desirable  that  it  should  be  as  nearly 
central  as  possible,  and  that  it  should  not  be  lightly 


654 


THE  MEDICAL  RECORD. 


changed.  Wherever  a  suitable  editor  can  be  found, 
there  also  it  is  probable  that  circumstances  would 
favor  the  establiihmeat  of  the  publication  office. 

We  reconinend  that  the  name  of  the  journal 
should  be  "  The  Journal  of  the  American  Medical 
Asiooiition,"  aud  that  the  terms  to  outside  sub- 
scribers should  be  SG  per  annum. 

It  remiim  now  for  u-i  to  indicate  a  method  for  the 
actual  setting  on  foot  of  this  enterprise.  We  would 
propa-ie  that  the  board  of  trustees  be  appointed,  and 
that  they  proceed  at  once  to  issue  a  circular  to  be 
seat  to  all  regular  physicians,  as  far  as  possible,  in 
the  United  States  ;  this  circular  to  set  forth  the  plan 
of  ths  journal,  tlie  advantages  looked  for  from  its 
establishment,  and  the  terms  upon  which  it  may  lie 
had.  Should  the  responses  to  the  circular  be  suffi- 
ciently encouraging — as,  for  example,  if  within  three 
months  2,000  names  should  be  secured,  and  pledges 
given  or  subscriptions  received,  the  board  might 
proceed  to  elect  an  editor  and  to  make  arrangements 
for  the  commencement  of  the  publication  at  the 
earliest  practical  period. 

We  would  suggest  that  the  Committee  on  Publica- 
tion should  be  appointed  as  usual,  but  that  they  be 
instructed  to  be  guided  by  the  decision  of  the  board 
of  trustees  as  to  the  character  of  the  publication,  if 
any,  which  they  shall  make. 

AH  of  which  is  respectfully  submitted. 
[Signed]  .John  H.  Pack.^rd, 

N.  S.  Davis, 
L.  A.  Satke, 
J.  S.  Billings, 
B   Cole, 
W.  B.  Atkinson, 

R.  J.  DUNGLLSON, 

Committee. 

Dr.  N.  S.  Davis  offered  the  following  resolutions, 
which  were  seconded  by  Dr.  Bbodde  and  unanimous- 
ly adopted  : 

Rmtnloed,  That  the  interests  of  the  Association 
would  be  promoted  by  the  publication  of  its  transac- 
tions in  a  weekly  medical  journal  under  its  own  con- 
trol, instead  of  an  annual  volume,  as  heretofore, 
provided  it  could  be  done  without  involving  pecuni- 
ary embarr.issment  or  so  far  engrossing  its  funds  as 
to  prevent  the  annual  encouragement  of  oi'iginal  in- 
vestigations by  its  members. 

Rp.aoheil,  That  so  much  of  the  report  of  the  Com- 
mittee on  Publishing  the  Transactions  as  relates  to 
the  increase  of  membership  of  this  Association,  by 
applications  from  members  of  State  and  local  socie- 
ties, be  and  the  same  is  hereby  approved. 

Rasoloed,  That  so  much  of  the  report  of  the  Com- 
mittee of  Journalizing  the  Transactions  of  the  Asso- 
ciation as  relates  to  the  appointment  of  a  board  of 
trustees,  nine  in  number,  and  their  duties,  be  and 
the  same  is  hereby  adopted,  and  that  the  President 
of  the  Association  now  appoint  a  special  committee 
of  seven  to  recommend  to  this  meeting  of  the  .Asso- 
ciation the  names  of  nine  members  for  election  to 
constitute  said  Board  of  Trustees. 

Resnhed,  Tliat  the  Board  of  Trustees  so  appointed 
be  requested  to  proceed  as  early  as  possible  to  arrange 
a  plan  of  a  medical  journal,  to  be  called  the  Journal 
of  tlie  American  Madical  Association,  and  that  they 
send  circulars  explaining  such  plan,  and  asking 
pledges  of  support  by  actual  subscription,  to  the  mem- 
bers of  the  medical  profession  throughout  the  whole 
country,  and  thereby  ascertain  as  reliably  as  possible 
what  degree  of  support  the  proposed  journal  can 
have,  as  a  basis  of  commencing  its  publication,  and 
that  said  board  also  proceed  to  ascertain  and  agree 


upon  the  best  method  of  publishing  said  journal,  the 
best  editorial  .services  it  can  secure  to  take  charge 
of  the  work,  and  the  best  place  of  its  issue. 

Resolved,  That  said  Board  of  Trustees  be  and  are 
hereby  instructed  to  retain,  under  all  circumstan- 
ces, in  whatever  plans  or  contracts  it  proj^oses  to 
adopt,  control  over  the  use  of  the  advertising  as 
well  as  all  other  pages  of  the  journal  that  is  pro- 
posed to  be  established,  and  that  said  board  repoit 
in  full  at  the  next  meeting  of  this  Association  the 
plans  upon  which  it  has  been  able  to  agree,  together 
with  the  response  of  the  profession  to  its  circulars 
asking  active  subscriptions  to  the  proposed  journal, 
and  that  the  constitutional  amendments  prepared 
by  Dr.  Packard  last  year  be  continued  upon  the 
table  until  the  report  of  the  Board  of  Trustees  is  re- 
ceived and  acted  upon. 

Resolfeil,  That  the  Treasurer  of  the  Association  is 
hereby  authorized  to  pay  out  of  funds  in  the  treas- 
ury the  necessary  expenses  of  the  Board  of  Trustees 
in  printing  and  distributing  its  circulars  and  in  con- 
ducting its  proper  correspondence. 

Resolved,  That  the  Committee  on  Publication  pro- 
ceed to  publish  the  tran.=actions  of  the  present  meet- 
ing in  a  volume  as  heretofore,  using  all  diligence 
to  give  it  an  early  distribution  to  those  entitled  to 
receive  it. 

Dr.  Foster  Pratt,  of  Michigan,  chairman,  then 
read  the 

REPORT   OF   THE   COMIHTTEE   ON   NOMNATIONS. 

President,  Dr.  John  L.  Atlee,  Lancaster,  Pa. ;  First 
Vice-Fresident,  Dr.  EugeneGrissom,  of  Raleigh,  N.  C; 
Second  Vice-President,  Dr.  A.  J.  Stone,  of  St.  Paul, 
Minn.  ;  Tliird  Vice-President,  Dr.  J.  A.  Octerlony, 
of  Louisville,  Ky. ;  Fourth  Vice-President,  Dr.  H.  S. 
Orne,  of  Los  Augelos,  Cal.;  Treasure);  Dr.  R.  J.  Dun- 
glison,  of  Philadelphia,  Pa.  ;  Librnrian,  C.  H.  A. 
Kleinschmidt,  of  Washington,  D.C. 
•  Judicial  Council,  to  fill  vacancies — Dr.  N.  S.  Davis, 
of  111.;  Dr.  J.  M.  Brown,  U.S.N. ;  Dr.  X.  C.  Scott,  of 
O.;  Dr.  M.  Sexton,  of  Ind.;  Dr.  N.  C.  Husted,  of  N. 
Y.;  Dr.  Wm.  Lee,  of  Md.;  Dr.  J.  E.  Reeves,  of 
West  Virginia. 

The  nc.d  place  of  meeting — Cleveland,  O. 

Chairman  of  the  Committee  of  An-angements — Dr. 
X.  C.  Scott,  of  Cleveland,  O. 

Section  in  Practice  of  Medicine — ,T.  H.  Hollister, 
of  Chicago,  Chairman ;  John  G.  Lee,  of  Philadel- 
phia, Secretary. 

Section  in  Surgery  and  Anatomy — W.  F.  Peck,  of 
Davenport,  Iowa,  Chairman ;  Paul  F.  Eve,  Nash- 
ville, Tenn.,  Secretary. 

Section  in  Obstetrics— 3ohn  K.  Bartlett,  of  Milwau- 
kee, Wis.,  Chairman  ;  G.  A.  Moses,  of  St.  Louis, 
Mo.,  Secretary. 

Section  in  Medical  Jurisprudence  and  Stale  Medi- 
cine—Foster Pratt,  of  Kalamazoo,  Mich.,  Chairman; 
Thos.  L.  Neal,  Dayton,  O.,  Secretary. 

Section  -in  Ophlhalmologi/,  Otology,  and  Laryngol- 
ogy—A. W.  Callioun,  Atlanta,  Ga.,  Chairman  ;  Carl 
Seller,  Philadelphia,  Pa.,  Secretary. 

Section  in  Diseases  of  Children — R.  F.  Blount,  Wa- 
bash, Ind.,  Chairman  ;  J.  H.  Seai^,  of  Texas,  Sec- 
retary. 

Section  in  Dentistry — D.  H.  Goodwillie,  of  New 
York,  Cliairman;  T.  W.  Brophy,  of  Chicago,  111., 
Secretary. 

Committee  on  Necrology — ,1.  ISI.  Toner,  District  of 
Columbia,  Chairman  ;  Wm.  Thompson,  Arknii.^ns  ; 
J.  H.  Wooley,  California;  Clms.  Deiinison,  Coloia- 
do  ;  W.  O.  Burke,  Connecticut ;  O.  S.  Pine,  Dakota ; 


THE  MEDICAL  RECORD. 


655 


R.  Battev,  Georgia ;  J.  H.  HoUistor,  Illinois  ;  G.  L. 
Sutton,  Indiana  ;  vS.  B.  Cliase,  Iowa ;  C.  V.  Mottram, 
Kansas  ;  J.  G.  Brooks,  Kentucky  ;  J.  W.  Dnpreo, 
Louisiana  ;  A.  Garcelon,  Maine ;  Wm.  Lee,  Mary- 
land ;  H.  O.  Maroy,  Missachusetts ;  W.  P.  BreiikeV, 
Michigan ;  D.  W.  Hand,  Minnesota ;  H.  A.  Gant, 
Mississippi ;  C.  L.  Hall,  Missouri ;  K.  C.  Moore, 
Nebraska ;  ,T.  A.  Chapman,  New  York  ;  B.  A.  Wat- 
son, New  Jersey  ;  C.  W.  Woolen,  North  Carolina  ; 
J.  W.  Russell,  Ohio  ;  Frank  Woodburv,  Pennsylva- 
nia ;  A.  Ballou,  Rhode  Island;  J.  B.  Lindsley,  Ten- 
nessee ;  II.  C.  Ghent,  Texas  ;  O.  F.  Fassett,  Vermont ; 
F.  D.  Cunningham,  Virginia  ;  W.  K.  Curtis,  West 
Virginia ;  J.  T.  Reeve,  Wisconsin  ;  G.  Perrin,  U.  S. 
A.  ;  F.  M.  Gunnell,  U.  S.  N.,  and  O.  M.  Miller,  U. 
S.  M.  H.  Service. 

Committee  on  Piihlication—\7.  B.  Atkinson,  S.  Co- 
hen, J.  H.  Packard,  R.  J.  Dunglison,  A.  Fricke,  F. 
Woodbury,  and  J.  V.  Shoemaker. 

Assistant  Secretary — Dr.  I.  N.  Hines,  of  Cleve- 
land, O. 

Committee  on  State  Medicine — D.  C.  Ewing,  Arkan- 
sas ;  J.  C.  Tucker,  California  ;  C.  Dennison,  Colorado  ; 
W.  C.  Wile,  Connecticut;  S.  B.  McGlumphy,  Da- 
kota ;  H.  F.  Campbell,  Georgia ;  H.  A.  Johnson, 
lUinois ;  T.  M.  Stevens,  Indiana;  D.  W.  Crouse, 
Iowa ;  J.  Bell,  Kansas ;  T.  B.  Greenly,  Kentucky ; 
J.  W.  Dupree,  Louisiana ;  F.  B.  Ferguson,  Maine  ; 
Wm.  Lee,  Maryland ;  M.  G.  Parker,  Massachusetts ; 
R.  C.  Kedzie,  Michigan  ;  D.  W.  C.  Patterson,  Dis- 
trict of  Columbia  ;  C.  N.  Hewett,  Minnesota ;  H.  A. 
Gant,  Mississippi ;  E.  W.  Scliauffler,  Missouri ;  E. 
M.  Whitten,  Nebraska  ;  J.  A.  Sanborn,  New  Hamp- 
shire ;  E.  M.  Moore,  New  York  ;  D.  C  English,  New 
Jersey  ;  C.  W.  Wilson,  North  Carolina  ;  J.  Ranso- 
hoflf,  Ohio;  A.  H.  Smith,  Pennsylvania;  J.  N.  El- 
dridge,  South  Carolina  ;  V.  S.  Lindslev,  Tennessee  ; 
W.  H.  Parker,  Texas  ;  S.  W'.  Thayer,  'Vermont ;  F. 
D.  Cunningham,  Virginia  ;  J.  Frissell,  West  Virgi- 
nia ;  J.  T.  Reeve,  Wisconsin  ;  W^  C.  Spencer,  IT.  S. 
A.  ;  A.  L.  Gihon,  U.  S.  N.  ;  O.  M.  Miller,  U.  S.  M. 
H.  Service. 

Dr.  Gihon,  chairman  of  the  Section  on  State 
Medicine,  reported  from  the  section  the  following 
resolutions : 

MEDICAL  EXPERT  TESTIMONY. 

ResoUed,  That,  as  the  sense  of  the  section  of  State 
Medicine  of  the  .\merican  Medical  Association, 
this  Association  deems  it  adnsable  and  conducive  to 
the  ends  of  justice  that  medical  men  called  as  expert 
witnesses  shall  be  subpoenaed  directly  by  the  court, 
instead  of  as  now  being  called  by  either  side  of  a 
suit  in  litigation. 

Tlie  resolution  gave  rise  to  some  discussion,  and 
was  finally  laid  upon  the  table. 

NATIONAL   MUSEUM    OF   HYGIENE. 

Re^ohe-l,  Thit  the  Americin  Medical  Association 
heartily  indorses  and  commends  to  Congi-ess  the  prop- 
osition of  the  Surgaou-Generalof  the  Navy  to  estab- 
lish at  Washington,  in  connection  with  the  Bureau 
of  Mediciue  and  Surgery  of  tlie  Navy  and  in  coopera- 
tion  with  the  American  Public  Health  Association 
and  the  American  Medical  Association,  a  national 
museum  of  hygiene,  which  shall  exhibit  tlie  history 
and  prosrress  of  sanitary  science  by  a  collection  of 
publications,  articles,  models,  drawings,  etc.,  illus- 
trating defects  and  improvements  in  foods,  in  water 
supply,  bedding,  clothing,  in  marine  architecture, 
house' and  hospital  construction  and  furniture,  ap- 
paratus for  heating,   illumination,    ventilation  and 


removal  of  excrete  and  refuse,  culinary,  laundry  and 
bath  facilities,  and  for  physical  culture  and  exercise, 
and  whatever  else  tends  to  the  preservation  of 
health  and  the  jirevention  of  disease. 

Resolved,  That  this  Association  earnestly  urges 
upon  Congress  the  apjiropriation  of  the  sum  of 
$10,000,  which  has  been  recommended,  for  the  pur- 
chase of  exhibits  and  their  subsequent  care  and  pres- 
ervation, and  that  the  permanent  secretary  shall 
without  delay  send  a  copy  of  these  resolutions  to 
each  member  of  Congress.     Adopted. 

INDIAN    SERVICE. 

The  Secretary  read  the  following  resolutions, 
which  had  been  forwarded  : 

Resnlced,  That  the  constitution  of  the  American 
Medical  Association  be  so  amended  as  to  provide 
for  the  admission  of  two  delegates  from  the  Medical 
Bureau  of  the  United  States  Indian  Service,  to  be 
nominated  by  the  surgeon-in-chief  of  the  bureau 
and  ajjpointed  by  the  Secretary  of  the  Interior. 

Resolved,  also,  That  this  resolution  shall  take  im- 
mediate eftect. 

Being  a  proposed  amendment  to  the  constitution, 
they  were  laid  over  for  one  year. 

ARMY   MEDICAL   MUSEUM   AND   LIBRARY 

Dr.  N.  S.  Davis,  of  Chicago,  oflfered  a  series  of  reso- 
lutions expressi-ve  of  deep  regret  at  the  attempt  in 
Congress  to  reduce  the  appropriation  for  the  Army 
Medical  Museum  and  Library  from  810,000  to 
$5,000,  and  earnestly  urging  that  Congress  will  re- 
store the  appropriation  to  its  former  amount,  in  the 
interest  of  the  medical  profession  and  therefore  of 
the  community  at  large. 

Unanimously  adopted,  and  on  motion  the  resolu- 
tion will  be  jirinted  and  forwarded  to  evei-y  member 
of  Congress  and  the  heads  of  the  Departments. 

Dr.  J.  M.  Toner  presented  the 

REPORT  ON  NECROLOGY, 

which  was  referred  to  the  Committee  on  Publication. 

List  of  the  deceased  members  of  the  American 
Medical  Association,  sketches  of  whose  lives  appear 
in  the  report  for  1882 : 

Axford,  Samuel  M.,  bora.  New  Jersey,  1832  ;  died, 
Flint,  Michigan,  December  10,  1873. 

Bacon,  .John,  died,  Somerset,  near  Boston,  Mass., 
November  28,  1881. 

Barnett.  James  Richard,  born,  Fredericksburg, 
Va.,  1832  ;  died  Vicksburg,  Miss.,  May  10.  1879. 

Barnum,  Boliver,  born,  Cayuga  County,  N.  Y., 
April  22,  1826 ;  died  suddenly  at  Schoharie,  N.  Y., 
November  1,  18S1. 

Beck,  Joseph  R.,  born,  ijancaster,  O.,  March  19, 
1843  ;  died.  Fort  Wayne,  Ind.,  December  30,  1880. 

Berney,  James,  born,  Charleston,  S.  C,  September 
15.  1812";  died,  New  York,  July  10,  1880. 

Bigelow,  Jacob,  born,  Boston,  February  27,  1787 ; 
died,  Boston,  January  10.  1879. 

Blood,  Soloman,  born,  Hollis,  N.  H.,  February  16, 
1810;  died,  Owatonna,  Minn.,  Decembers,  1881. 

Bower,  Jeremiah  H.,  born.  New  York,  1798;  died, 
Lawreneeburg,  Pn.,  August  1,  18GG. 

Brooke,  Hugh  W.,  born,  Bleckesville,  Va.,  Januaiy 
5,  1830  ;  died^Morsrantown,  W.  Va.,  April  2-1,  1882. 

Butler,  Samuel  Waswell.  born  in  Franklin  County, 
Me.,  February  22,  1816  ;  died,  Newport,  R.  I.,  April, 
1881. 

Cabanis,  Alfred  B.,  bora,  Huntsville,  Ala.,  De- 
cember 10,  1808  ;  died.  Hinds  County,  Miss.,  No- 
vember 21,  1871. 


656 


THE  MEDICAL  RECORD, 


Carter,  Francis,  born,  Kingston,  Ireland,  1814 ; 
died,  Columbus,  Ohio,  February  26,  1881. 

Catlin,  Benj.  H.,  born,  Harwinton,  Ct.,  August  10, 
1801 ;  died,  Meriden,  Ct.,  October  18,  1880. 

Collins,  Clarkson  T.,  born,  Chenango  County,  N. 
Y.,  January  8,  1821 ;  died,  Great  Barrington,  N.  Y., 
April  10,  1881. 

Corson,  Thomas  Johnson,  born,  Bucks  County, 
Pa.,  February  12,  1828;  died,  Trenton,  N.  J.,  May 

10,  1879. 

Cullen,  Thomas  F.,  born,  Philadelphia,  Pa.,  Sep- 
tember 3,  1822  ;  died,  Camden,  N.  J.,  November  2, 
1877. 

Cunningham,  John  A.,  born,  Carterville,  Va., 
October  3, 1803 ;  died,  Culpepper  County,  Va.,  March 
21,  1881. 

Dale,  Edward  F.,  born,  September  19,  1831 ;  died 
suddenly.  Little  Rock  ;  aged  about  40. 

Davis,  Charles  W.,  born,  Miami  County,  Ohio  ; 
died,  Indianola,  Iowa,  July  20,  1881. 

Deshler,  Charles  D.,  born,  Northampton  County, 
Pa.,  October  21,  1843;  died,  Hightstown,  N.  J., 
March  24,  1879. 

Elliott,  William  N.,  bom,  Delaware  County,  N.  Y., 
Januirv  2S,  1807  ;  died,  White  Pigeon,  Mich.,  April 
31,  1881 

Fisher,  Alexander,  bom,  Lancaster,  Mass.,  August 
12,  1804 ;  died,  Chicago,  February  14,  1882. 

Fisher,  Daniel  Shaw,  born,  Wales,  Mass.,  Novem- 
ber, 1820;  died,  Brookfield,  Mass.,  April  29,  1878. 

Foltz,  Jonathan  M.,  born,  Lancaster,  Pa.,  April 
25,  1810  ;  died,  April  12,  1877. 

Forre,  Erasmus  D.,  born,  Newcastle,  Ky.,  July  25, 
1878;  died,  Louisville,  Ky.,  May  26,  1882. 

Gillett,  Buckland,  born,  Schoharie,  N.  Y.,  Sep- 
tember 18.  1807  ;  died,  Franklin  County,  Pa.,  Octo- 
ber 19,  1881. 

Gillette,  Horatio  C,  born,  Torringford,  Conn., 
February  G,  1806 ;  died,  St.  Charles,  III.,  December 
21,  1878. 

Haggerty,  Robert  J.,  born,  New  Jersey,  about 
1822  ;  died,  Elkhart  County,  Michigan. 

Harrington,  J.  F.,  born,  Amite  County,  Miss., 
January  23,  1824  ;  died,  Jackson,  Miss.,  March  23, 
1874. 

Henderson,  Andrew  A.,  born,  Huntington  Countv, 
Pa.,  February,  1816;  died,  April  14,  1875. 

Hewitt,  George  W.,  born,  Franklin  County,  Pa., 
December  23,  1830  ;  died,  1881. 

Howard,  Edward  L  ,  born,  Baltimore,  Md.,  Janu- 
ary, 1837 ;  died,  September,  1881, 

Hughes,  Joseph  C,  boi'n,  Washington  County,  Pa., 
Aprill,  1821  ;  died,  Keokuk,  la.,  August  10,  1881. 

King,  David,  born,  Newport,  R.  I.,  May  12,  1812 ; 
died,  Newport,  March  7,  1882. 

Knight,  Henry  Martin,  born,  Connecticut,  August 

11,  1827;  died,  Florida,  January  22,  1880. 
Maddox,  Thomas  Clay,   bom,   Farquier  County, 

Va.,  February  10,  1836;  killed,  Odenton,  Md.,  No- 
vember 2,  1881. 

Mendenhall,  Nathan,  born,  Canton,  Ind.,  October 
31,  1831 ;  died,  Thornton,  Boone  County,  Ind.,  Au- 
gust 18,  1880. 

Miller,  Erasmus  Darwin,  born,  Franklin,  Mass., 
AuQcust  7,  1813 ;  died,  Dorchester,  Mass.,  July  5, 
1881. 

Monroe,  Langdon  O.,  bom  near  Cincinnati,  O., 
February  2,  1817 ;  died,  Cincinnati,  O.,  June  15, 
1878. 

Noreum,  William  A.  B.,  bom,  Edenton,  N.  C, 
Mav  13,  1836 ;  died,  Baltimore,  Md.,  February  28, 
1881. 


Philips,  John  H.,  bom,  New  Jersey,  1814  ;  died, 
Beverly,  N.  J.,  March  1,  1878. 

Read,  Zachariah,  born.  Mount  Hollv,  N.  J.,  Sep- 
tember 19,  1808  ;  died,  same  place,  July  25,  1879. 

Register,  Wilson  Gray,  born,  Bath  County,  Va., 
February  16,  1845 ;  died,  Baltimore,  Md.,  April  22, 
1882. 

Reynolds,  Seward,  born,  Boston,  Mass.,  1793 ; 
died  at  bis  residence  in  Boston,  December  25,  1881. 

Richardson,  Samuel,  born,  Newton,  Mass.,  Janu- 
ary 13,  1795  ;  died,  Watertown,  Mass.,  Februarv  12, 
1879. 

Rogers,  Thomas  Cooper,  born,  Columbiana  Countv, 
O.,  August  17,  1827;  died,  Harrington,  Del.,  Octo- 
ber 16,  1878. 

Sackrider,  Charles  H.,  born,  Oxford  County, 
Canada  ;  died,  Mason,  Michigan,  November  8,  1881. 

Skelton,  Charle.s,  born,  Bucks  Countv,  Pa.,  April 
19, 1806  ;  died,  Trenton,  N.  J.,  May  2,  i879. 

Singleton,  James  Wm.,  born.  Grant  Countv,  Ky., 
August  23, 1829  ;  died,  Paducah,  September  26,  1881. 

Smith,  Samuel  Price,  born,  Tanevtown,  Md.,  De- 
cember 21,  1795  ;  died,  Cumberland,  Md.,  March  2, 
1882. 

Stillman,  Roswell  Fogg,  born,  Cooperstown,  N.  Y., 
December  15,  1815  ;  died.  North  Haven,  Conn.,  De- 
cember 21,  1879. 

Taylor,  John  Winthrop,  bom.  New  York  City, 
August  19,  1817 ;  died,  Boston,  Mass.,  January  19, 
1880. 

Thomason,  T.  J.,  born,  Philadelphia,  1833  ;  died, 
Monmouth  County,  N.  J.,  August  20,  1880. 

Turner,  William  H.,  born,  Mantua,  N.  J.,  Novem- 
ber 18,  1844  ;  died,  Mantua,  N.  J.,  August  23,  1873. 

Webster,  Eliphalet  K.,  born,  Exeter,  Mass.,  May 
8,  1802  ;  died,  Pittsfield,  N.  H.,  November  9,  1881. 

Wilcox,  Lucian  S.,  born.  West  Granby,  Conn.,  July 
17,  1826;  died,  Hartford,  Conn.,  November  15, 1881. 

Wood,  Wm.  Maxwell,  born,  Baltimore,  Md.,  Mav 
27,  1809 ;  died,  Baltimore  County,  Md.,  March  1, 
1880. 

Db.  N.  S.  Davis  read  the 

REPORT   OF   THE    C05IMITTEE   ON   METEOROLOGICAli   ANT) 
CLI!nCAIi   RECORDS. 

In  accordance  with  the  action  of  the  last  annual 
meetirg,  stations  of  observation  had  been  estab- 
lished at  Boston,  New  York,  Philadelphia,  Balti- 
more, Charleston,  New  Orleans,  Cincinnati,  Pitts- 
burgh, Chicago,  St.  Paul,  Denver,  and  San  Francisco. 
The  committee  secured  the  services  of  Prof.  J.  H. 
Long  to  prepare  the  material  and  supervise  the 
work  for  determining  the  relative  proportions  of 
the  ozone  and  other  active  oxidizing  agents  in  the 
atmospliere  in  the  several  localities.  Through  the 
efforts  of  Prof.  Long  a  number  of  eminent  profes- 
sional men  of  the  country  were  secured  to  co-oper- 
ate in  the  work,  in  which  the  United  States  signal 
service  was  also  induced  toco-operate,  and  to  which 
the  committee  acknowledges  itself  under  great  obli- 
gations. 

After  reciting  details  of  the  work  accomplished 
and  its  undoubted  value  to  medical  science,  the  re- 
port recommends  its  continuance,  and  that  it  may 
be  made  stiU  more  efficient,  that  Professor  Long  be 
engaged  at  a  compensation  of  S500  to  personally  su- 
pervise the  laboratory  work  during  the  coming  year. 

The  recommendations  of  the  committee  were 
adopted. 

REPORT    FROM   THE   JUDICIAL   COUNCIL. 

The  Judicial  Council  reported  sustaining  the  pro- 
test of  the  Nebraska  State  Medical  Society  against 


THE  MEDICAL  RECORD. 


657 


the  admission  of  Joseph  Meville,  delegate  from  the 
Omaha  Medical  Society. 

In  the  case  of  Dr.  D.  W.  Day,  delegate  from  Eau 
Claire  Medical  Society,  the  charges  preferred  were 
sustained,  acd  he  was  declared  to  be  no  longer  enti- 
tled to  recognition  as  member  of  the  Association. 

In  addition,  it  was  recommended  that  the  Eau 
Claire  Medical  Society  be  thoroughly  reorganized. 

The  charges  against  S.  P.  Collings,  of  Hot  Springs, 
Ark.,  were  also  sustained,  and  it  was  decided  that 
he  was  not  entitled  to  registration. 

In  the  case  of  J.  C.  Cotton,  who  appealed  from  the 
Crawford  County  Medical  Society,  Pa.,  it  was  de- 
cided that  there  was  no  just  cause  for  sustaining  the 
appeal. 

ADDRESS  OP  THE  CHilRMAN  OP  THE  SECTION  IN  SUEGERT 
AND   ANATOMY. 

Dr.  William  A.  Byrd,  of  Quincy,  111,,  then  deliv- 
ered his  address,  in  which  he  restricted  himself  to 
the  consideration  of  "  Excisions  of  the  Intestinal 
Canal  where  Covered  with  Peritoneum."  The  paper 
was  referred  to  the  section,  and  an  abstract  with 
discussion  can  be  seen  in  the  proceedings  of  the 
Section  on  Surgery. 

THE  COJIMITTEE  TO  NOMINATE  A  BO.iRD  OF  TRUSTEES 
POR  THE  J0URN.4.L  OP  THE  AMERICAN  MEDICAL  ASSO- 
CIATION 

was  announced  as  follows  :  L.  A.  Savre,  of  New 
Tork ;  J.  M.  Toner,  of  Washington,  D.  C.  ;  Fos- 
ter Pratt,  of  Kalamazoo,  Mich.  ;  R.  J.  Dnnglison,  of 
Philadelphia ;  Robert  Battey,  of  Rome,  Cla.  ;  W.  F. 
Peck,  of  Davenport,  Iowa  ;  and  H.  O.  Marcy,  of 
Boston,  Mass. 

ADDRESS    OP  THE    CHAIRMAN   OP  THE   SECTION    ON  .STATE 
MEDICINE. 

Dr.  A.  L.  GiHON,  of  the  U.  S.  Navy,  gave  a  sum- 
mary of  the  responses  he  had  received  to  the  request 
sent  out  in  circulars  for  .suggestions  from  physicians. 
To  the  first  circular  twelve,  and  to  the  second  twen- 
ty-five answers  were  received.  Dr.  Gihon  then 
entered  upon  an  explanation  of  the  indifference 
manifested  concerning  State  Medicine  by  physicians, 
and  paid  liis  compliments  to  the  profession  and  the 
people  in  terms  reu:lolent  with  sarcasm,  and  contain- 
ing some  humor  and  puff. 

His  proposed  plan  of  working  in  this  department 
was  as  follows  : 

First. — The  collection  of  information  and  advice 
from  the  principal  sanitary  organizations  and  sanitar- 
ians of  the  United  States  as  to  the  best  plan  for  a  na- 
tional health  ox'ganization,  including  the  subject  of 
quarantine,  both  maritime  and  inland,  and  the  rela- 
tions which  should  exist  between  State  and  local 
systems  of  quarantine  and  a  national  quarantine 
system. 

Second. — The  collection  of  information  with  regard 
to  the  sanitary  condition  of  some  of  the  principal 
cities  and  towns  of  the  United  States,  with  special 
sanitary  surveys  of  the  coast  of  New  Jersey  bordei'ing 
on  New  York  Harbor,  Memphis,  Tenn.,  etc. 

Third. — The  appointment  of  a  commission  to  in- 
vestigate yellow  fever  in  the  Island  of  Cuba. 

Fourth. — The  collation  of  the  sanitary  laws  of  the 
United  States  and  of  the  several  States,  including 
not  only  the  statutes  but  the  decisions  of  the  several 
courts  on  all  questions  involving  the  public  health. 

Fifth. — Investigations  as  to  the  best  method  of  de- 
termining the  amount  and  character  of  organic  matter 
in  the  air  ;  as  to  the  effects  of  disinfectants  and  espe- 
cially the  composition  and  merits  of  patent  disin- 


fectants ;  as  to  the  prevalence  of  adulterations  in 
food  and  drugs  ;  as  to  the  diseases  of  food-produ- 
cing animals ;  as  to  the  flow  of  sewers  in  relation  to 
their  sizes  and  gradients  ;  as  to  the  influence  of 
various  soils  upon  sanitation,  especially  with  regard 
to  drainage  and  methods  of  disposal  of  excretia ;  as  to 
the  outbreak  of  dii^htheria  in  northern  Vermont,  etc. 

Sixth. — The  suggestion  of  legislation  to  improve 
the  sanitary  condition  of  the  mercantile  marine. 

The  doctor  forcibly  argued  in  favor  of  a  more 
stringent  quarantine  to  prevent  di.<iease  from  being 
brought  into  the  country.  He  then  reviewed  at 
some  length  the  various  State  board  of  health  or- 
ganizations, showing  their  respective  natures,  scopes, 
and  workings.  Florida,  Kansas,  Maine,  Missouri, 
Nebraska,  Nevada,  Ohio,  Pennsylvania,  and  Vermont 
are  the  States  without  boards  of  health.  The  sta- 
tistics supplied  the  National  Board  of  Health  came 
in  for  criticism,  it  being  claimed  that  they  did  not 
properly  show  the  true  condition  of  affairs.  The 
statistics  of  Washington  as  collected  by  the  local 
authorities  and  given  to  the  National  Board  were 
sharply  contrasted  with  those  secured  by  the  Navy 
Department,  the  latter  showing  Washington  to  be 
far  from  the  healthy  city  which  has  generally  been 
supposed.  The  public  buildings,  though  constructed 
without  limit  as  to  expense,  are  illy  ventilated  and, 
as  a  rule,  breeders  of  illness. 

The  Section  on  State  Medicine  was  advised  that  no 
work  it  could  perform  was  so  important  as  the  se- 
curing of  accurate  health  statistics.  He  concluded 
as  follows : 

"  The  people  and  their  representatives  must  yet 
be  educated  to  the  real  dangers  to  the  public  health, 
and  thisean  best  be  done  graphically  by  the  simple 
diagrams  of  Pridgin  Teale  ;  by  the  meetings  and 
popular  addresses  of  the  American  Public  Health 
Association  ;  by  the  development  of  a  great  national 
museum  and  library  of  hygiene,  which  the  Surgeon- 
General  of  the  Navy  has  taken  the  initiative  in  estab- 
lishing, in  connection  with  the  Bureau  of  Medicine 
and  Surgery,  and  which  it  is  proposed  to  make  a 
central  repository  of  whatever  relates  to  sanitary 
science,  and  these  accessible  to  every  one  through- 
out the  land  by  the  loan  of  books  under  proper 
guarantees  of  safety  ;  and,  lastly,  by  the  American 
Medical  Association,  through  its  State  Medicine  Sec- 
tion, making  phy.sicians  alive  to  their  responsibilities 
as  sanitary  guides,  encouraging  the  formation  and 
development  of  State  boards  of  health,  and  through 
them  influencing  the  legislation  of  the  counti'y  to 
the  practical  sanitary  needs  of  this  advanced  age." 

Dr.  Campbell,  of  Georgia,  took  some  exceptions 
to  remarks  made  in  the  course  of  the  address  which 
seemed  to  him  to  reflect  unjustly  upon  the  American 
Medical  Association,  and  defended  the  Association 
as  one  of  the  most  efficient  medical  organizations  in 
the  world. 

The  address  was  referred  to  the  Committee  on 
Publication. 

The  .Judicial  Council  reported  back  the  resolution 
offered  by  Dr.  Dennison  in  yesterday's  ses.sion,  and  its 
consideration  was  postponed  until  Friday  morning. 

The  Association  then  adjourned,  to  meet  Friday, 
at  10  A.M. 


Friday,  June  9th — Fourth  Day. 

The  Association  was  called  to  order  at  10  a.m.  by 
Dr.  Hooper,  Vice-President. 

Prayer  was  offered  by  Rev.  E.  D.  Nelll. 

The  Chairman  of  the  Committee  of  Arrangements, 


658 


THE  MEDICAL  RECORD. 


Db.  a.  J.  Stone,  made  his  report  for  tbe  day,  and 
at  its  dose  thanked  the  Association  for  the  courtesy 
extended,  the  honor  bestowed,  and  great  gratifica- 
tioa  given  in  selecting  St.  Paul  as  the  place  for 
holding  this  annual  meeting. 

The  report  of  the  Lil)rarian  was  read  and  referred 
to  the  Committee  on  Publication. 

Tlie  i-eport  of  the  Treasurer  showed  a  balance  in 
the  treasury  of  §1,141. .38.  The  report  was  referred 
to  the  Committee  on  Pablieation. 

The  report  of  the  Committee  on  Publication,  Dr. 
A.  Fbicke,  Chairman,  was  read  and  adopted,  ex- 
cepting so  much  as  referred  to  the  index  for  the 
"  Transactions,"  which  was  ordered  published  at 
once. 

RESOLUTIOKS. 

On  resolution,  ottered  by  Dr  Keller,  the  secreta- 
ries of  the  different  State  medical  societies  were  re- 
quested to  send  to  the  permanent  secretary,  annually, 
a  corrected  list  of  the  membership  of  theii  respec- 
tive societies. 

Dr.  Keller  also  offered  the  following,  which  was 
referred  to  the  Committee  on  State  Medicine  : 

Resolved,  That  in  many  of  our  large  cities  in  the 
near  future,  if  not  now.  Free  Masonry  will  become  a 
sanitary  necessity. 

Dr.  a.  L.  Gihon  offered  the  following,  concerning 

EXPERT   MEDICAL    TESTIMONY, 

which  was  adopted  : 

Resolved,  That  it  is  the  sense  of  the  American 
Medical  Association  that  it  will  be  conducive  to  jus- 
tice and  to  the  dignity  of  the  jji-ofe-ssion,  if  medical 
expert  testimony  can  be  presented  to  the  courts 
without  the  appearance  of  bias  or  influence  from 
either  side  of  the  case,  and  simply  as  a  straightfor- 
ward statement  of  scientific  facts. 

Dr.  J.  G.  Thomas,  of  Savannah,  Ga.,  offered  the 
following,  which  gave  rise  to  animated  discussion, 
participated  in  by  Drs.  Davis,  of  Chicago  ;  Garcelon, 
of  Maine  ;  Ransohoff,  of  Ohio  ;  Gihon,  of  the  Navy; 
Cirpenter,  of  Kansas  ;  and,  on  motion  by  Dr.  Davis, 
its  further  consideration  was  indefinitely  postponed  : 

Resolved,  That  the  American  Medical  Association 
approves  of  the  organization  of  faculties  in  medi- 
cine having  no  other  function  than  the  examination 
for  degrees,  as  a  measure  which  will  increase  the 
value  of  the  present  methods  of  education  in  medi- 
cal colleges  in  this  country. 

ALLOPATHS. 

Dr.  C.  Dennlson,  of  Colorado,  offered  a  resolution 
to  the  effect  that  no  action  of  this  Association,  either 
in  its  code  or  in  its  proceedings  at  its  annual  meet- 
ings, should  be  considered  as  endorsing  the  view 
that  the  members  are  "  Allopaths,"  or  that  there  is 
any  such  thing  as  an  allopathic  physician. 

It  was  supported  by  Dr.  Sears,  of  Texas,  and 
adopted  by  tlie  Association. 

The  Committee  on  Nominations  completed  its  re- 
port and  the  report  was  adopted.  [See  Thursday's 
proceedings.] 

Dr.  EmiEVR  Gnissoic,  Vice  President,  Raleigh, 
N.  C,  moved  that 

AN    HONORARIUM    TO    THE   SECRETARY 

of  $1,000  be  voted  by  the  Association. 

Dr.  Tonru.  of  Washington,  moved  to  amend  by 
making  it  1S500. 

Tlio  amendment  was  lost  and  the  original  motion 
■was  carried. 

Dr.  Toner  gave  notice  of  an  amendment  to  the 


constitution  to  be  acted  upon  next  year,  making  the 
office  of  Secretary  one  to  be  filled  annually  by  the 
Association. 

Dr.  J.  B.  Lawrence,  of  New  York,  offered  a  reso- 
lution instructing  the  President  of  the  Association  to 
appoint  a  committee,  consisting  of  one  representa- 
tive from  each  State,  whose  duty  it  shall  be  to  inves- 
tigate the  subject  of  the  feasibility  of  creating  and 
endowing  such  a  medical  institution  as  shall  meet 
the  demand  of  tho.se  who  wish  to  investigate  the 
progress,  etc.     Laid  upon  the  table. 

On  motion,  by  Dr.  H.  O.  IVIarcy,  of  Boston,  a  vote 
of  thanks  was  extended  to  the  Treasurer  for  his  able 
services. 

BOARD  OP  trustees  FOB  THE  JOURNAL. 

Dr.  L.  a.  Sayre,  chairman  of  the  committee  ap- 
pointed to  nominate  a  board  of  trustees,  reported  as 
follows  :  for  trustees  to  serve  three  years,  Drs.  N.  S. 
Davis,  E.  M.  Moore,  and  J.  M.  Toner;  to  serve  tico 
years,  H.  P.  Campbell,  J.  H.  Packard,  and  L.  Con- 
nor ;  to  serve  one  year,  P.  O.  Hooper,  A.  Garcelon, 
and  L.  S.  McMurty. 

The  report  was  adopted. 

The  Secretary  read  the  following  resolution  from 
the  Section  on  Ophthalmology,  Otology  and  Laryn-* 
gology,  and  it  was  adopted  : 

Wheretis,  A  petition  has  been  presented  to  Con- 
gress asking  for  the  calling  of  an  International  Com- 
mission to  consider  and  agree  upon  some  standard 
method  of  ieaim^risual acideness  and colnr-blindness, 
and  some  requirements  of  these  qualifications  in  the 
sailors  of  all  countries  ;  therefore  be  it 

Resolved,  That  the  American  Medical  Association 
heartily  approves  of  the  proposed  International 
Commission,  and  hereby  directs  its  sccretai^  to 
transmit  this  vote  to  Congress. 

Dr.  Smith  revived  the  amendment  proposed  by 
Dr  Goodwillie  concerning  the  giving  to  permanent 
members  1he  privilege  to  vote. 

Dr.  Bhodie,  of  Detroit,  offered  the  customary 
resolution  of  thanks  to  the  citizens  of  St.  Paul,  the 
Committee  of  Arrangements,  the  railroads  which 
had  granted  favors,  the  citizens  of  Stillwater,  and  to 
all  who  had  in  any  way  contributed  to  the  enjoy- 
ment of  the  members  of  the  Association  at  its  annual 
meeting  of  18S2.  They  were  seconded  by  Dr.  Davis, 
and  unanimously  adopted. 

Dr.  Foster  Pratt,  of  Michigan,  offered  an  amend- 
ment to  the  constitution  to  the  effect  that  the  law 
requiring  the  nominations  for  officers  to  be  made 
from  those  members  present  at  the  atintinl  meeting, 
shall  apply  only  to  the  president,  the  vice-presidents, 
chairmen  and  secretaries  of  Sections,  the  assist- 
ant secretary,  the  chairman  of  the  Committee  of 
Arrangements,  and  the  Judicial  Council. 

Db.  Davis  offered  the  following  resolution  con- 
cerning the 

ANNUAL   meetings, 

which  was  adopted  : 

Resolved,  That  after  the  next  annual  meeting,  the 
permanent  interests  and  infiuence  of  this  Association 
would  be  best  promoted  by  again  holding  every  sec- 
ond meeting  in  Washington,  D.  C,  as  the  home  of 
the  Coujmon  National  Congress,  and  not  as  the  in- 
vited guests,  and  that  eacli  alternate  meeting  can  be 
held  in  the  section  of  the  Union  best  intended  to 
promote  the  interests  of  this  .Association. 

Dr.  Keli.kr  gave  notice  of  an  amendment  which 
would  ])ermit  the  holding  of  the  annual  meeting  as- 
late  as  the  first  Tuesday  in  September,  if  desirable. 


THE   MEDICAL  RECORD. 


659 


Dit.  Sears,  of  Texas,  offered  an  amendment  mak- 
ing the  Librarian  a  permanent  officer. 

ADDRESS   OF   THE   CHAIRMAN   OP   THE  SECTION   ON    OKAL 
AND  DENTAli  SURGERY. 

Dr.  D.  H.  GooDwrLLiK,  of  New  York,  spoke  of  the 
two  divisions  in  this  department  of  the  healing  art : 
1st,  dental  art  or  prosthetic  dentistry ;  id,  oral 
surgery. 

The  first  is  nearly  all  of  a  mechanical  nature, 
while  the  latter  treated  of  all  the  diseases  of  the 
mouth. 

He  believed  that  the  teaching  of  this  specialty 
should  be  from  established  chairs  in  medical  col- 
leges, where  all  students,  before  graduating,  should 
be  examined  on  the  principles  and  jiractice  of  this 
department.  Besides,  practical  instruction  should 
be  given  in  an  infirmary  or  hospital  devoted  to  this 
class  of  affections.  He  gave  illustrative  cases  from 
his  personal  experience  of  disease  of  the  mouth  and 
associate  parts,  such  as  interoral  extirpation  of  the 
bones  of  the  maxilla,  with  reproduction  of  bone  and 
no  deformity  ;  internasal  extirpation  of  bones  of  the 
nose  ;  a  new  operation  for  closure  of  the  hard  palate 
and  lip  in  early  infancy ;  treatment  of  abscesses  of 
the  jaw  and  neighboring  jjarts,  etc.  These  cases 
were  illustrated  by  diagi-ams,  instruments,  and  over 
twenty  models  in  wax. 

He  closed  by  saying  that  he  hoped  the  time  was 
not  far  distant  when  there  would  be  endowed  uni- 
versities where  every  branch  of  the  healing  art  and 
allied  sciences  would  be  theoretically  and  practi- 
cally taught. 

The  address  was  referred  to  the  Committee  on 
Publication. 

The  Secretary  announced  as 

DEIiEGATES   TO   THE    BRmSH   MEDICAL,   ASSOCIATION, 

appointed  by  the  President,  Drs.  T.  Addis  Emmet, 
Daniel  Lewis,  E.  H.  Brush,  and  W.  M.  Carpenter, 
of  New  York,  and  J.  M.  Da  Costa,  of  Pennsylvania. 

On  motion,  the  thanks  of  the  Association  were  ex- 
tended to  Vice-President  Hooper,  for  the  impartial 
and  courteous  manner  in  which  he  had  presided 
over  the  Association. 

Dr.  Hooper  appointed  Dr.  N.  S.  Davis  to  conduct 
the  President  elect,  Db.  John  L.  Atlee,  of  Lan- 
caster, Pa.,  to  the  platform,  who  was  then  intro- 
duced to  the  Association,  and  thanked  the  members 
for  the  honor  which  they  had  conferred  upon  him. 

Dr.  Hooper  then  expressed  his  thanks  to  the  As- 
sociation for  the  kindness  and  forbearance  mani- 
fested towards  him  as  its  presiding  officer,  and  the 
Association  was  declared  adjourned,  to  meet  in 
Cleveland,  O  ,  on  the  first  Tuesday  in  June,  1883. 

The  whole  number  registered  was  917. 


SECTIOX  IN  SURGERY. 

Dr.  Wm.  a.  Bykd,  of  Illinois,  Chairman. 
Dr.  Hugh  McColl,  of  Michigan,  Secretary. 

Tuesday,  June  Gth — First  D-ay. 

Dr.  Carl  Seiler,  of  Philadelphia,  made  some 
remarks  on  the  uses  of  electricity  in  surgery. 

The  object  was  to  call  attention  to  some  instru- 
ment designed  to  obviate  some  of  the  difficulties 
heretofore  experienced  in  the  use  of  electricity  for 
surgical  operations. 

In  his  experience,  the  platinum  knife  of  the  gal- 
vano-cautery,  in  order  to  be  serviceable,  must  have 


a  fixed  temperature  varying  according  to  the  end 
desired.  Having  found  that  there  was  no  battery 
which  allowed  of  a  fine  graduation  of  the  tempera- 
ture of  the  knife,  he  had  devised  one  which  was  so 
arranged  that  the  plates  were  sus])ended  above  the 
liquid,  and  could  be  immersed  by  means  of  a 
treadle  worked  by  the  foot  of  the  operator.  The 
amount  of  zinc  surface  exposed  to  the  action  of  the 
acid  determines  the  amount  of  electrical  current, 
and,  consequently,  the  temperature  of  the  platinum 
loop.  In  order  to  overcome  polarization  and  con- 
tinue the  current  for  any  length  of  time,  he  had  in- 
troduced two  cells  containing  the  same  number  of 
elements,  which  could  be  immersed  alternately  by 
the  treadle,  thus  always  exposing  a  fresh  surface  to 
the  action  of  the  acid. 

By  substituting  cells  with  partitions  for  each  pair 
of  plates,  the  battery  can  be  used  for  the  constant 
current,  and  for  driving  the  electro-motor,  such  as 
used  for  running  sewing-machines,  and,  by  attach- 
ing the  hand-piece  of  the  dental  engine  to  it,  he 
had  found  it  far  superior  to  the  ordinary  engine 
in  use  for  removing  bone  or  exostoses  in  the  nasal 
cavities,  as  its  speed  can  be  regulated  to  a  nicety  ; 
and  if  suspended  from  the  ceiling  and  balanced  by 
counter-weights,  the  hand  is  relieved  of  all  weight, 
and  is  not  affected  by  the  movements  of  the  foot 
working  the  treadle  of  the  balance-wheel  of  the  en- 
gine as  ordinarily  used. 

Dr.  Prince,  of  Illinois,  had  nsed  for  the  more  deli- 
cate operations  the  theimal  cauteiy. 

Dr.  Seiler  said  that  the  thermal  cautery  could 
not  be  used  in  many  cases  ;  for  example,  in  the 
treatment  of  certain  conditions  in  connection  with 
the  turbinated  bones,  whereas  the  galvano-cautery 
knives  could  be  made  so  delicate  as  to  enable  the 
operator  to  reach  any  point. 

A  paper  by  Dr.  William  Hill,  of  Bloomington, 
111.,  on 

ABDOMINAL    SECTION   FOR  THE    RELIEF    OF    INTESTINAL 

onsTRUcnoN  due  to  intussusception, 

was  then  read. 

The  author  was  not  a-ware  that  this  operation  bad 
been  performed  successfully  prior  to  his  case,  August 
2.3,  1855.  The  case  was  one  of  ileo-ctecal  invagina- 
tion occurring  in  an  adult.     The  patient  recovered. 

Dr.  Peck,  of  Iowa,  referred  to  a  case  of  intei-tinal 
obstruction  occurring  in  a  young  man  twenty-seven 
years  of  age,  which  did  not  yield  to  persistent  injec- 
tions of  warm  water,  and  finally  abdominal  section 
was  performed.  It  was  found  that  the  appendix  ver- 
miformis  had  become  adherent  to  the  side  of  the 
vertebral  column,  and  a  loop  of  the  ileum  had  been 
constricted  under  the  band.  He  tied  the  appendix 
in  two  places,  cleansed  its  cavity,  and  dropped  it. 
The  patient  gave  fair  promise  of  recovery. 

Dr.  Halley,  of  Kansas  City,  referred  to  two  cases. 
The  autop.sy  in  the  first  revealed  constriction  at  the 
ileo  csecal  valve,  with  bony  growth  in  the  wall  of  the 

The  second  was  a  case  of  supposed  intussuscep- 
tion occurring  in  a  young  man.  Abdominal  section 
was  performed,  when  it  was  found  that  there  was 
complete  volvulus.  The  patient  died.  Notwith- 
standing the  unfavorable  termination  of  his  casep.  he 
believed  that  the  operation  was  justifiable  and  that 
the  best  results  would  be  obtained  when  it  was  per- 
formed early. 

Dr.  Field,  of  Iowa,  thought  that  the  constriction 
in  Dr.  Halley's  first  case  was  probably  due  to  a  ma- 
lignant growth  containing  spiculas  of  bone. 


660 


THE  MEDICAL  RECORD. 


Dr.  Lee,  of  Chicago,  believed  that  the  earlier  the 
operation  was  performed  the  better  would  be  the 
results  obtained.  But  against  that  was  the  difficulty 
in  diagnosis  and  the  additional  fact  that  recovery 
often  ensued  spontaneously  in  cases  which  were 
apparently  hoijeless  without  operative  interference. 
In  estimating  the  symptoms,  too  much  reliance 
should  not  be  placed  upon  the  pulse  and  tempera- 
ture, because  in  some  of  the  gravest  cases  they  were 
undisturbed. 

Dr.  Prince,  of  Illinois,  thought  it  improper  to 
operate  until  the  symptoms  became  urgent.  He. 
recommended  the  use  of  Wales'  bougie  and  the  in- 
jection of  warm  water.  The  instrument  by  careful 
manipulation  could  be  introduced  to  the  distance  of 
18  or  20  inches  or  more.  When  this  means  failed,  and 
the  symptoms  remained  sevei-e  he  would  operate. 

Dr.  Parks,  of  Illinois,  said  there  were  three  rea- 
sons why  the  operation  was  not  more  frequently 
performed. 

First Hesitation,  with  refei'enee  to   intei'fering 

with  the  peritoneum. 

Second. — Difficulty  in  diagnosis. 

Third. — Difficulty  in  detei-mining  the  time  when 
the  operation  should  be  performed. 

With  regard  to  the  first  there  should  be  no  hesi- 
tation. Concerning  the  second,  the  difficulties  were 
sometimes  very  great.  As  to  the  third,  previous  to 
the  sixth  day,  in  oases  of  complete  per.sistent  ob- 
struction, he  had  come  to  regard  as  the  dangei'ous 
period. 

In  cases  in  which  the  obstruction  was  due  to  har- 
dened fieces,  the  best  remedy,  according  to  his  ex- 
perience, was   opium. 

Dr.  Hilij  said  that  in  his  case  he  was  fully  satis- 
fled  concerning  diagnosis.  He  was  also  convinced 
that  if  the  operation  could  be  performed  sufficiently 
early  many  lives  might  be  saved. 

The  Chairm.^n  thought  that  injections  of  water 
were  useless  in  cases  in  wliich  the  obstruction  did 
not  exist  in  the  colon,  unless  it  was  in  those  excep- 
tional cases  in  which  water  could  be  forced  beyond 
the  ileo-ciecal  valve. 

Dr.  Gay,  of  Buffalo,  then  read  a  paper  on 

ANCHYLOSIS   OP    THE   HIP — STRAIGHT   POSITION ILIiUS- 

TRATIVE    CASE. 

After  giving  the  differential  diagnosis  between  true 
and  false  anchylosis,  and  referring  to  the  means  by 
which  the  diagnosis  is  made,  the  author  passed  to 
the  consideration  of  the  surgical  methods  of  coiTect- 
ing  the  deformity,  namely  :  subcutaneous  osteotomy 
and  fracture.  Of  these  he  regarded  fractui-e  as  the 
most  favorable,  and  the  case  reported  was  one  in 
which  that  method  had  been  ])ractised.  The  result 
was  not  known,  as  the  patient  left  the  hosintal,  but 
the  promise  was  very  favorable  at  the  time  he 
passed  from  under  observation. 

Dr.  HiLii,  of  Illinois,  had  fractui'ed  the  neck  of 
the  femur  in  a  case  of  fibrous  anchylosis  due  to  hip- 
joint  disease,  and  the  result  was  redevelopment  of 
the  caries  and  subsequent  excision  of  the  joint.  He 
thought,  if  the  patient  was  able  to  get  around  and 
the  deformity  was  not  too  great,  the  surgeon  might 
better  not  interfere. 

I^Dr.  Pkinok,  of  Illinois,  believed  that  a  distinction 
should  be  made  between  the  cases  in  wliich  anchy- 
losis was  due  to  joint  disease,  and  those  in  which  it 
was  due  to  false  position,  rheumatic  influences,  etc. 
In  the  latter  cases  surgical  interference  was  justifi- 
able. If,  however,  the  anchylosis  followed  liip  joint 
disease,  extension  and  fracture  were  attended  with 


great  danger,  and,  therefore,  the  let-alone  policy  was 
the  best,  or  at  most,  tenotomy  with  the  view  to  re- 
leasing the  contraction  and  correcting  the  position 
if  possible. 

Dr.  C.  T.  Poore,  of  New  York,  thought  it  was  not 
as  safe  to  break  up  an  anchylosed  joint  as  it  was  to 
perform  an  osteotomy.  He  did  not  regard  the  latter 
as  a  dangerous  operation,  as  there  was  no  shock 
and  suppuration  seldom  occurred.  Again,  after 
performing  Adam's  operation  for  fracture,  the  secur- 
ing of  motion  was  doubtful.  Breaking  \ip  the  hip- 
joint  after  joint  disease  was  very  much  different 
from  breaking  up  a  fibrous  anchylosis  due  to  other 
causes  ;  for  the  bones,  especially  in  children,  after 
hip-joint  disease  are  in  a  diseased  condition,  and  if 
the  anchylosis  is  broken  up  the  disease  is  very  apt 
to  return. 

Dr.  Owen,  of  Illinois,  thought  that  the  day  for 
fracture  of  the  femur,  in  cases  of  anchylosis,  had 
passed,  because  the  fracture  could  not  be  limited, 
and  .subcutaneous  osteotomy  could  be  limited  ex- 
actly. After  subcutaneous  osteotomy  there  was  no 
shock,  and  thei-e  was  no  reason  why  there  should 
be.  His  experience  applied  to  three  cases  of  oste- 
otomy at  the  neck  of  the  femur.  He  recommended 
rest  for  two  or  three  weeks,  usually  in  the  wire 
breeches,  after  the  operation,  and  then  passive  mo- 
tion with  the  view  to  establishing  an  artificial  joint. 
The  patient  should  be  held  under  supervision  for  a 
considerable  time. 

Dr.  Andrews,  of  Chicago,  regarded  subcutaneous 
osteotomy  as  a  very  important  operation.  He  had 
not  performed  it  but  once  above  the  neck  of  the 
femur.  He  had  performed  it  in  various  parts  of  the 
body  and  had  not  seen  shock  follow  the  operation. 

Dr.  McCann,  of  Penn.sylvania,  recommended  sub- 
cutaneous division  of  the  resisting  tendons  and  mus- 
cles and  attempt  to  coiTect  the  position  of  the 
limb  without  division  of  the  bone. 

Dr.  Lee,  of  Illinois,  approved  of  osteotomy  if  the 
object  was  simply  to  correct  deformity,  becauj^e  the 
shock  was  less  than  that  after  fracture  and  the  opera- 
tion could  be  definitely  restricted.  If  an  artificial 
joint  was  desirable,  fracture  would,  probably  give  the 
best  result.  To  correct  the  deformity  and  at  the 
same  time  give  an  artificial  joint,  complete  excision 
was  necessary. 

Dr.  K.\nsohoff,  of  Cincinnati,  had  performed 
twenty-five  or  thirty  osteotomies,  and  had  yet  to  see 
a  single  case  in  which  the  operation  could  V>e  held 
accountable  for  bad  results.  He  regarded  it  as  very 
essential  that  the  bone  should  be  completely  divided 
in  order  to  prevent  gangivene,  etc.  He  thought  it 
improper  to  discard  osteotomy  for  the  more  hazard- 
ous operation  of  fracture.  He  had  performed  it 
several  times  iijjon  rachitic  tibiic,  and  regarded  the 
danger  as  only  very  slight. 

Dr.  Halley,  of  Kansas  City,  had  performed  sub- 
cutaneous osteotomy  twice  and  with  good  results. 
There  was  no  shock  whatever.  Section  was  made 
through  the  neck  of  the  femur. 

Dr.  G.ay,  in  closing  the  discussion,  referred  to  the 
danger  of  fracture  of  the  saw  in  performing  oste- 
otomy. When  the  position  of  the  limb  was  between 
the  straight  and  rectangular  no  operation  was  re- 
quired. 

The  next  paper  was  entitled 

A   NEW   TRnSS  TO  HE  APPMED  AFTER  THE  RADK^Mi  CURB 
OF    HERNIA, 

by  Jos.  H.  Warrkn,  of  Boston. 

It  contained  an  account  of  the  operation  by  sub- 


THE  MEDICAL  RECORD. 


661 


cutaneous  injection  into  the  hernial  rings  for  the 
radical  cure  of  hernia.  For  the  after-treatment  the 
ordinary  trusses  were  absolutely  injurious.  From 
their  material,  shape,  and  constant  pressure  they  de- 
feated their  own  object.  The  truss  exhibited  "con- 
sisted of  a  concave  wire-gauze  pad,  with  more  gentle 
springs  than  usual.  The  pad  is  .surrounded  with  a 
rim  of  tubing,  and  a  bridge  of  tubing  extended 
across  to  strengthen  it.  It  was  regarded  as  ana- 
tomical because  it  drew  the  pillars  of  the  hernial 
rings  together.  A  stiff  spring  defeated  the  object  of 
the  truss. 

The  subeutaneouH  operation  was  discussed  by 
Drs.  Prince  and  Andrews,  of  111. ;  Forbes  and  Phil- 
lips, of  O.;  and  Tapper,  of  Mich.  The  operation 
was  one  practised  fifty  years  ago  by  Dr.  Pancoast,  of 
Philadelphia,  and  while  it  contained  some  merit,  it 
had  been  the  subject  of  curious  statements  and 
presentations. 

The  Section  then  adjourned  to  meet  on  Wednes- 
day, at  3  p.  M. 


Wednesday,  June  7th — Second  Day. 

The  Section  was  called  to  order  by  the  Chairman 
at  three  o'clock. 

A  sub-committee,  consisting  of  Drs.  B.  A.  Watson, 
of  N  J. ;  Peck,  of  Iowa ;  and  W.  M.  Caii^enter,  of 
New  York,  was  appointed,  to  which  all  papers  pre- 
sented to  the  Section  should  be  referred. 

Dr.  J.  F.  Stewart,  of  Peoria,  111.,  presented 

A   SPLINT   FOR    FRACTDRE   OF   THE   ELBOW. 

It  was  a  wooden  hinge-splint,  with  steel  side-rod 
and  adjusting  screw,  and  was  said  to  be  applicable 
to  all  forms  of  fracture  of  this  joint. 

Dr.  Geo.  W.  Nesbitt,  of  Sycamore,  IlHnois,  then 
read  a  j^aper  on 

UNUNITED   fracture   OF    THE   FEMUR   TREATED   BY 
EXERCISE. 

It  consisted  essentially  in  the  report  of  a  case  in 
which  union  failed  to  take  place  and  was  not  se- 
cured until  the  limb  was  put  up  in  a  plaster  of- 
Paris  splint,  and  the  patient  compelled  to  walk 
without  crutches,  other  methods,  such  as  rubbing 
the  ends  of  the  bone  together,  drilling  (twice),  hav- 
ing prove  I  of  no  avail. 

Dr.  Keller,  of  Hot  Springs,  thought  the  case  an 
exceedingly  instructive  one,  because  it  illustrated  the 
result  liable  to  occur  under  improper  treatment  be- 
fore it  came  under  Dr.  Xe.sbitt's  observation.  It 
was  treated  by  means  of  oiTlinary  side  splints,  and 
he  thought  that  a  much  better  dressing  could  not 
have  been  used  if  the  desired  result  was  an  artillcial 
joint.  He  believed  most  earnestly  that  no  fracture 
of  long  bones  could  be  iiroperly  treated  except  by 
means  of  a  molded  fixed  dressing.  He  also  thought 
that  the  heavy  woolen  blanket  placed  next  the  skin 
in  Dr.  Nesbitt's  dressing  was  unnecessarily  warm. 

Dk.  J.  W.  Carpenter,  of  Kansas,  referred  to  a 
case  of  ununited  fracture  which  was  put  up  in  a 
plaster  of-Paris  splint,  the  patient  made  to  walk  on 
the  limb,  and  union  followed.  With  reference  to 
plaster-of  Paris,  one  great  reason  why  the  profession 
was  afraid  of  it  was  because  they  did  not  fully  un- 
derstand its  proper  application.  When  properly 
applied  it  was  a  safe  and  efBcient  dressing. 

Dr.  J.  L.  Atlee,  of  Pennsylvania,  sjjoke  of  the 
advantage  of  placing  woolen  fabrics  next  the  skin 
before  applying  the  plaster  bandages. 

Dr.  Garcelon,  of  Maine,  referred  to  a  case    of 


fracture  below  the  knee  where  union  had  not  taken 
place  at  the  end  of  ten  or  twelve  weeks.  The  patient 
began  suit  for  malpractice,  and  while  hobbling 
about  hunting  up  evidence  he  wore  an  extempora- 
neous stiff  leather  splint.  When  the  case  came  to 
trial  the  limb  was  submitted  for  examination,  and 
it  was  found  that  union  was  complete,  and  that  it 
had  been  secured  without  deformity. 

Dr.  Pratt,  of  Stillwater,  Minn.,  spoke  of  the  fe- 
mur of  a  deer  which  he  had  in  his  possession,  and 
in  which  good  union  had  occurred  after  fracture, 
while  the  animal  was  running  wild. 

Dr.  Forbes,  of  Ohio,  thought  that  the  swelling 
should  be  allowed  to  subside  before  the  application 
of  the  plaster-of- Paris,  and  also  that  in  cases  of  com- 
pound fracture  the  wounds  should  be  healed.  He 
always  placed  flannel  next  the  skin. 

Dr.  Fl.\n-ner,  of  Michigan,  had  been  accustomed 
to  put  on  the  leg  of  a  pair  of  knit  drawers  in  the 
case  of  fracture  of  the  thigh,  apjllying  the  plaster-of- 
Paris  splint  at  once,  and  swinging  the  limb  in  a  wire 
splint. 

Dr.  Keller  advocated  not  to  wait  for  swelling  to 
occur,  even  if  the  case  was  one  of  comi^ound  fracture, 
before  adjusting  the  fixed  dressing.  Of  course  he 
did  not  object  to  flannel,  but  merely  thought  that 
the  article  used  by  Dr.  Nesbitt  was  unnecessarily 
thick  for  warm  weather. 

Dr.  L.  a.  Sayre.  of  New  York,  advocated  that  the 
plaster-of-Paris  splint  should  be  aj^plied  at  once,  and 
without  qualification,  and  he  had  not  seen  any  case  in 
which  it  had  done  harm  when  projierly  applied  and 
jjroperly  watched.  He  had  not  seen  any  cases  in 
which  it  had  been  necessary  to  remove  the  dressing 
on  account  of  swelling  when  applied  before  swelling 
had  occurred.  It  might  be  that  in  the  next  case  it 
would  be  necessary  to  remove  the  dressing.  He  be- 
lieved that  the  injury  that  had  been  seen  from  ap- 
plying the  plaster  splint  had  been  due  to  neglect  in 
watching  the  limb  properly.  Woolen  should  be 
placed  next  the  skin  whether  the  weather  was  hot  or 
cold. 

Dr.  Garcelon,  of  Maine,  asked  if  Dr.  Sayre  was 
called  to  treat  a  case  and  was  unable  to  reach  the 
patient  until  eighteen  or  twenty-four  hours  had 
elapsed,  and  the  limb  had  become  swollen,  whether 
or  not  he  would  apply  the  splint  at  once  ? 

Dr.  Sayre  said  that  he  certainly  would  wait  until 
the  swelling  had  subsided  ;  but  if  the  surgeon  could 
reach  his  patient  j^romptly,  put  the  limb  up  in  plas- 
ter at  oncK. 

Dr.  Maclean,  of  Ann  Arbor,  Mich.,  asked  Dr. 
Sayre  if  by  means  of  the  fixed  dressing  he  had  been 
able  in  eveiy  case  to  avoid  non-union  ? 

Dr.  Sayre  replied  that  in  his  own  experience  he 
had  never  had  a  case  of  non  union  since  he  had  used 
the  permanent  dressing.  When  the  splint  was  jirofi- 
erly  applied  the  more  the  jjatient  went  about  the 
better. 

Dr.  Maclean  thought  that  an  improper  impres- 
sion might  go  out  from  what  had  been  said  in  the 
course  of  the  discussion  ;  for  non-union  may  occur 
from  causes  over  which  the  surgeon  has  no  control 
whatever,  and  he  thought  that  the  Section  should 
not  put  itself  upon  record  that  in  every  case  of 
non-union  the  surgeon  is  responsible. 

Dr.  S.ayre  said  that  certainly  he  would  not  wish 
to  be  understood  as  making  such  a  foolish  assertion, 
because  non-union  might  be  the  result  under  the 
very  best  treatment. 

Dr.  Maclean  said  that  he  had  been  censured  by 
some  of  his  brethren  for  giving  an  opinion  in  court, 


662 


THE  MEDICAL  RECORD. 


on  a  hypithetioal  case,  as  follows:  Suppose  a  frac- 
ture of  the  humerus  was  treated  by  the  use  of  three 
short  spliats  applied  to  the  arm,  aad  secured  with 
tap9s,  the  shoulder  and  elbow-joints  being  allowed 
free  motion,  would  it  be  good  surgery?  His  answer 
was  that  it  would  not.  He  wished  Dr.  Sayre's  02jinion 
upon  such  a  case. 

Dr.  Sure  said  he  should  regard  it  as  a  case  of 
maltreatment. 

The  Section  then  adjourned. 


Thursday,  Jdne  8th — Third  Day. 

The  first  paper  was  read  by  Dr.  Jos.  Kansohoff, 
of  Cincinnati,  Ohio,  entitled 

OONTRIBOnOX   TO   THE   SDRGERT   OF   THE   LIVER. 

The  first  part  contained  the  history  of  a  ease  in 
which  he  lud  opened  the  abdominal  cavity,  opened 
the  gall-bladder,  and  removed  calculi.  The  patient 
died.  The  special  point  of  interest  was  the  accu- 
rate diagnosis,  and  the  operation  was  performed 
with  the  expectation  of  finding  a  biliary  calculus 
impacted.  The  wall  of  the  gall  bladder  was  stitched 
to  the  abdominal  wall  before  the  bladder  was 
opened.  The  incisions  were  made  with  the  galvano- 
cautery  in  order  to  avoid  hemorrhage. 

The  second  part  contained  the  history  of  a  case 
of  hepatic  abscess.  Aspiration,  repeated,  gave  no 
permanent  benefit.  The  abdominal  cavity  was 
opened,  the  wall  of  the  abscess  stitched  to  the  ab- 
dominal parietes.  the  sac  opened,  washed  out  by  a 
constant  stream  of  simple  water  running  through 
the  cavity  for  six,  eight,  or  ten  hours  at  a  time,  and 
several  large  sloughs  removed  by  ai<l  of  a  laryngo- 
scopic  mirror.  A  good  result  was  finally  obtained. 
With  regard  to  the  general  plan  of  treatment.  Dr. 
Rmsohoff  thought  the  evidence  in  favor  of  its  jjrac- 
tice  was  fast  accumulating. 

THE   PROPER   POIMTS    FOR     INCISION    I\     THE   DRAINAGE 
OF   SUPPDRATtSO    KNEE-JOINTS, 

was  the  title  of  a  paper  read  by  Dr.  Edmund  An- 
drews, of  Chicago. 

Dr.  Andrews  gave  a  minute  de^icription  of  the 
anatomy  of  the  knee-joint,  and  said  there  were  three 
cavities  :  1,  the  submuscular  bursa  ;  2,  the  supra- 
pitellar  ;  and  3,  the  infra-patellar.  Into  these  an  in- 
cision was  m  ide  upon  e.ich  side  and  short  drainage- 
tubes  introduced  from  e.ich  direction.  There  were 
eight  paints  of  incision  referred  to  in  order  to  make 
the  drainage  complete  ;  two,  one  on  each  side  of  the 
bursa  ;  two,  one  on  either  side  of  tlie  supra  patellar 
expansion  ;  two,  one  on  eacli  side  near  the  posterior 
p  irt  of  the  joint ;  and  two,  one  on  either  side  of  the 
ligamentum  patella. 

EXCISIONS   OF JTHE   INTESTINAti  CANAtj    WHERE    OOVKRED 
WITH   PEItlrONEUM. 

This  paper  was  the  address  of  the  chairman  of  the 
section.  After  referring  to  the  reporteiJ  cases  of 
excision  of  the  pylorus.  Dr.  Bvud  passed  to  the 
consideration  of  the  treatment  of  those  cases  of 
strans^ulated  hernia  \n  whic^h  g.mgrene  and  an  artifi- 
cial anus  had  occurred.  He  gave  the  following  con- 
clusions upon  the  whole  subject: 

Fir^t. — Resections  ot  the  smill  intestine  maybe 
dine  to  a  cnsidiraljle  extent  without  iiiterfering  in 
any  appreciable  degree  with  digestion. 

Secnii'l. — Practised  under  suit  ible  conditions  the 
operation  is  to  bo  considered  perfectly  legitimate. 

Third. — The    resection    may    be    performed    by 


bringing  the  divided  ends  directly  into  apposition 
and  closing  the  abdominal  wound,  by  forming  an 
artificial  anus.  The  second  and  third  procedure 
expose  to  less  subsequent  danger. 

Fourth.  —  Tiesections  of  fibrous  and  cicatricial  struc- 
ture, which  are  probably  more  frequent  than  is  gen- 
erally sujjposed,  may  cause  a  radical  cure,  and  the 
same  is  the  case  with  epithelioma.  On  the  contrary, 
resection  of  cancerous  obstructions  gives  only  tem- 
jjorary  relief,  and  at  a  greater  risk. 

Fifth. — By  projser  diet  after  the  oj^eration  the 
risk  of  fecal  extravasation  may  be  reduced  to  a 
minimum,  and  the  Viest  diet  for  this  purjiose  is  one 
containing  as  little  fluid  as  possible. 

Si.vth.—By  introducing  liquids  per  anum,  and 
drink  in  the  same  way,  water  is  absorbed  as  by  the 
mouth  and  there  is  no  sense  of  thirst ;  the  flow  of 
intestinal  fluids  is  less  considerably  and  the  patient 
is  more  comfortable. 

The  chief  interest  in  the  paper  was  concerning 
the  treatment  of  cases  of  gangrene  with  strangulated 
hernia,  and  a  proposed  operation  which  was  merely 
theoretical. 

Dr.  Ransohopf,  of  Cincinnati,  regarded  Dr.  Byrd's 
method  of  treatingartificial  anusasan  old  one  applied 
in  a  new  way,  and  for  an  affection  for  which  it  was 
formerly  never  adopted.  If  he  understood  Dr.  Eyrd 
correctly,  the  operation  was  merely  to  loosen  the 
cicatricial  tissue  and  a  portion  of  skin  around  the  ar- 
tificial anus,  and  turn  it  in  so  that  the  external  sur- 
face becomes  the  internal  surface,  and  over  that  he 
draws  new  skin.  Such  was  a  well-known  method  of 
operating  for  exstrophy  of  the  bladder  or  for  repair 
of  the  lower  wall  of  the  urethra,  but  he  had  not  known 
of  its  being  employed  in  artificial  anus.  Again,  in- 
stead of  bringing  the  entire  circumference  of  the 
loops  of  the  intestine  outside,  to  unite  in  the  course 
of  time  by  inflammation,  it  was  Dr.  Byrd's  purpose 
to  cut  obliquely  through  the  intestinal  wall,  so  that 
there  would  be  no  spur  left  at  all,  and  in  that  man- 
ner he  hoped  to  obviate  the  necessity  for  a  subsequent 
operation  for  the  cure  of  artificial  anus.  Dr.  Ranso- 
hoflf  thought  the  operation  an  ingenious  one  ;  but 
there  was  one  objection.  It  was  a  well-known  fact 
that  when  two  loops  of  intestine  come  out,  they 
will  protrude  in  such  manner  that  the  mesenteric 
.surfaces  would  be  in  such  relation  to  each  other 
that  the  portion  of  intestine  necessary  to  be  ablated 
would  be  those  surfaces  which  were  nearest  to  the 
blood-supply  for  the  portion  of  intestine  remain- 
ing. Would  not  the  removal  of  that  portion  of  in- 
testine which  gives  rise  to  the  mesentery  die  in 
consequence  of  the  removal  of  the  source  of  blood- 
supply?  Tlie  chairman's  plan  was  theoretical,  and 
so  also  was  the  objection. 

Dr.  Prewitt,  of  Missouri,  supposed  that  the  chair- 
man would  refer  to  the  employment  of  laparotomy 
for  the  removal  of  a  section  of  intestine,  and  was 
surprised  to  learn  that  he  referred  to  strangulated 
hernia  with  gangrene  of  the  bowel.  With  regard  to 
the  spur.  Dr.  Ransohoflf  had  made  a  good  point ; 
and  l>esides,  there  was  another  objection  which  he 
regai'ded  as  even  more  forcible  in  the  majority  of 
cases  when  artificial  anus  is  formed.  He  believed  it 
was  not  justifiable  to  perform  the  operation  Dr. 
Bvrd  had  suggested,  because  in  the  great  majority 
of  cases  where  artificial  anus  results  from  strangu- 
lated hernia,  a  conservative  process  had  already  been 
established  in  the  way  of  throwing  out  inflamma- 
tory deposit,  and  the  formation  of  protective  adhe- 
sions, and  the  less  the  surgeon  did  after  opening 
the  sac  and  providing  for  the  free  escape  of  fecal 


THE  MEDICAL  RECORD. 


663 


matter,  the  better.  Nature  had  ali-eady  provided 
the  means  of  repair,  and  her  work  should  not  be  in- 
terfered with,  and  wheu  the  surgeon  disturbed  the 
healthy  portion  of  bowel  within  the  abdominal 
civitj,  he  intertered  with  nature's  conservative  pro- 
cesses. Anything  beyond  mere  opening  of  the  sac 
he  regarded  as  unjustifiable. 

Dr.  Gaucelon,  of  Maine,  asked  :  In  cases  of  stran- 
gulated herniii  which  have  been  left  until  gangrene 
has  occurred,  and  the  surgeon  cuts  down  and  finds 
the  intestine  gangrenous,  would  Dr.  Byrd  dissect 
away  the  entire  gangrenous  portion,  and  dissect  up 
the  living  tissue,  or  would  he,  under  ordinary  cir- 
cumstances, allow tlie  bowel  to  remain  undisturbed? 

Dr.  Byrd  replied  that  if  the  position  of  the  open- 
ing and  the  condition  of  the  gut  was  unfavorable, 
he  would  break  up  the  adhesions,  correct  the  posi- 
tion and  complete  the  operation  as  he  had  described. 

Db.  Ellis,  of  Michigan,  referred  to  the 

SPONTANEOUS    CUBE   OF    AKTIFICLiL   ANUS 

as  beai'ing  upon  the  question  of  surgical  interfer- 
ence. He  referred  to  a  case  in  which  sloughing  oc- 
curred with  removal  of  a  m  iss  nearly  as  large  as  his 
fist.  Two  ojjeuings  were  left.  A  light  dressing 
was  applied,  the  parts  were  kept  clean  as  possible, 
and  within  a  few  weeks  the  opening  closed  sponta- 
neously, and  a  complete  cure  was  eifected. 

Dr.  Vaughan,  of  Missouri,  referred  to  three  cases 
of  spontaneous  cure  of  artificial  anus  formed  by 
sloughing  in  strangulated  hernia.  In  all  the  cases 
the  recovery  was  complete  within  three  months. 

Dr.  Norred,  of  Illinois,  as  an  offset,  mentioned  a 
case  in  which  the  artificial  anus  remained,  and  Dr. 
Martin,  of  Iowa,  sijoke  of  a  case  of  artificial  anus, 
the  result  of  a  gunshot  wound  received  in  the  left 
side  of  the  bbdomen,  and  in  which  only  a  pin  hole 
opening  remained,  and  for  the  closure  of  this  he 
performed  a  plastic  operation,  but  it  failed. 

Dr.  Allen,  of  Pennsylvania,  thought  that  sponta- 
jieous  closure  with  cure  of  artificial  anus  occurred 
more  frei^iiently  than  was  usually  supposed.  He  re- 
ferred to  a  case  in  which  the  opening  remained  pat- 
ent for  two  months,  but  at  the  end  of  three  or  four 
months  the  artificial  auus  had  closed,  and  natural 
movements  from  the  bowels  took  place.  He  would 
not,  however,  on  any  account  abstain  from  attempt- 
ing to  aid  nature  by  surgical  interference  in  proper 
cases. 

Dr.  E.  M.  Moore,  of  Eochester,  N.  Y.,  remarked 
that  the  Chiirmau's  address  was  interesting  as 
showing  the  advance  going  on  with  regard  to  ab- 
dominal siirgery,  but  ihe  real  question  for  consider- 
ation was  just  tliis ;  in  cases  of  strangulated  hernia 
where  gangrene  has  occurred,  is  it  better  to  let  the 
parts  alone,  and  have  an  artificial  anus  as  nature  has 
determineil,  or  should  we  interfere  with  that  jjro- 
cftss  and  proceed  to  pass  into  the  cavity  of  the  ab- 
domen, and  draw  the  parts  down  or  raise  them  up 
for  the  purpose  of  having  a  more  convenient  place 
for  an  artificial  anus?  To  be  sure  under  Poupart's 
ligament  is  an  inconvenient  position  for  such  an 
opening,  but  it  is  also  true  that  when  gangrene 
occurs  the  patient  usually  dies  from  septiciemia. 
On  opening  the  lai'ge  pouch,  relief  comes  to  the 
patient,  and  even  if  the  opening  is  quite  small  the 
contents  can  escape,  and  nature  may  go  on  and 
throw  out  deposit  which  will  seal  the  parts  against 
invasion  of  the  peritoneal  cavity  and  so  protect  the 
pvtient  from  immediate  danger.  He  thought  it  un- 
wise practice,  as  a  rule,  merely  for  the  purpose  of 
,  getting  a  better  place  for  an  artificial  anus,  to  resort 


to  the  surgical  interference  indicated  by  the  Chair- 
man. And  against  the  proposed  plan  he  wished  to 
enter  a  little  protest.  The  cases  of  spontaneous  cure 
when  left  to  nature  are  sufficiently  numerous  not  to 
require  further  comment.  But  it  is  also  true  that 
artificial  anus  remains  in  many  cases.  Dr.  Moore 
then  referred  to  one  of  his  cases  in  which  he  waited 
four  or  five  months  for  spontaneous  recovery  to  take 
place,  but  it  did  not  occur  and  he  employed  Dujiuy- 
tren's  instrument  and  succeeded  in  eflecting  a  com- 
plete and  radical  cure.  Such  was  the  practice  of 
the  old  surgeons,  and  he  was  not  prepared  to  under- 
take anything  which  would  expose  the  j^atient  to 
additional  risks.  Certainly  he  did  not  intend  that 
his  patients  should  die  of  peritonitis  induced  by  in- 
terference. 

The  Section  then  adjourned. 


SECTION  IN  OBSTETRICS  AND  DISEASES  OF 
WOMEN. 

H.  O.  Marct,  of  Boston,  Mass.,  Chairman. 

C.  V.  MoTTRAJi,  of  Lawrence,  Kansas,  Secretary. 

TuESD.^T,  June  6th — First  Day. 

Db.  Wm.  H.  Granger,  of  East  Boston,  Mass., 
read  a  paper  on 

the  mechanical  treatment  of  DELn-ERT  FROM  THE 
SUPERIOR  STBAIT — MODES  OF  APPLICATION  OP  THE 
FORCE  APPLIED  —  XLLUSTEATED  BY  THE  USE  OF  A 
MODIFIED   FORM   OF  THE   FORCEPS. 

The  form  of  forceps  introduced  was  a  modifica- 
tion of  Elliott's  forceps,  consisting  of  an  extra 
handle  attached  upon  the  anterior  surface  just  above 
the  usual  handles,  and  by  means  of  which  pressure 
could  be  made  in  the  posterior  direction,  thus  en- 
abling the  accoucheur  to  make  traction  in  the  axis 
of  the  superior  strait. 

Dr.  Nelson,  of  Chicago,  thought  favorably  of  the 
modification,  or  at  least  regarded  it  as  important  to 
relieve  the  bladder  as  much  as  possible  from  pres- 
sure and  at  the  same  time  to  make  careful  traction 
in  the  axis  of  the  strait.  He  thought  Dr.  Granger's 
instrument  would  be  less  likely  to  give  rise  to 
vesico-vaginal  fistula  than  the  ordinary  forceps. 

Dr.  G ,  of  Washington,  thought  the  principle 

good,  but  that  it  could  be  applied  as  well  without 
as  with  the  attachment. 

Dr.  Stapler,  of  Minnesota,  wished  to  know  if  by 
adopting  the  method  too  much  pressure  would  not 
be  made  upon  the  sacral  nerves. 

Db.  Granger  said  that  injury  came  n'ot  so  much 
from  brief  severe  pressure  as  from  long  continued 
pressure  upon  the  nerves  and  other  tissues. 

Dr.  Dtnster,  of  Ann  Arbor,  regarded  it  as  very  im- 
portant that  every  movement  should  be  accurately  in 
the  direction  of  the  axes  of  the  straits,  and  regarded 
the  modification  of  the  forceps  as  a  useful  one.  The 
accidents  and  injuriessometimesoccurringin  connec- 
tion with  parturition,  such  as  the  formation  of  fistulie 
of  various  kinds,  were  not,  as  a  rule,  so  much  due 
to  the  use  of  instruments  as  to  prolonged  pressure 
from  the  head  of  the  child.  Rupture  of  the  peri- 
neum was  caused  not  so  much  by  forceps  as  by  at- 
tempt to  force  the  head  through  the  passages  before 
proper  dilatation  had  occuiTed. 

Dr.  Nesbitt,  of  Sycamore,  Illinois,  believed  that 
the  profession  was  too  well  educated  to  make  trac- 
tion in  the  indirect  direction,  and  that  knowing  in 
what  direction  traction  should  be  made,  the  attach- 
ment was  of  no  special  assistance. 

Db.  W.  C.  Burke,  Jr.,  of  South  Norwalk,  Conn., 


664: 


THE  MEDICAL  RECORD. 


saw  a  case  only  a  few  days  ago  in  which  the 
perineum  was  ruptured  by  an  instrumental  delivery 
made  by  an  intelligent  jjhysician. 

Dr.  Morris,  of  Ironton,  Ohio,  thought  that  the 
perineum  might  be  ruptured  with  or  without  for- 
ceps, and  no  one  be  to  blame. 

Dr.  E.  Beverly  Cole,  of  San  Francisco,  intro- 
duced 

A   NEW   FORCEPS, 

and  spoke  concerning  the  instrument  and  its  use. 
He  was  totally  opposed  to  having  the  heel  of  the  instru- 
ment conical,  for  when  an  attempt  was  made  to  use 
leverage  with  such  an  instrument,  it  was  almost  cer- 
tain to  slip  off;  but  when  there  was  a  wider  space 
between  the  edges  of  each  blade,  the  head  would 
bury  itself  more  completely  in  the  blades  of  the 
forceps,  and  tlie  liability  to  slip  be  greatly  reduced. 
Iq  the  construction  of  his  instrument  he  held  in 
view  the  fact  that  every  man  who  attempted  to  use 
forceps  should  be  old  enough  and  sufficiently  educa- 
ted to  understand  the  anatomy  of  the  parts'and  the 
mechanism  of  labor.  His  instrument  has  a  wider 
space  between  the  blades,  especially  at  the  heel,  and 
is  more  circular  at  the  junction  of  "the  handles  than 
those  commonly  in  use.  It  also  had  an  attachment 
similar  to  that  jiresented  by  Dr.  Granger,  except  it 
was  to  the  uuder  instead  of  the  upper  surface,  but  he 
thought  his  own  invention  was  not  worth  five  cents. 
Dr.  Cole  commented  at  length  on  the  views  held  by 
different  authors,  the  instruments  devised,  and  the 
methods  recommended  for  the  delivery  of  the  child. 

Dr.  McCLELL.iNT),  of  Philadelphia,  "regarded  Dr. 
Cole's  suggestion  concerning  the  shank  of  the  for- 
ceps as  very  valuable.  He  thought  that  the  obstet- 
rician could  get  much  aid  by  using  the  left  hand 
upon  the  upper  side  of  the  handles  of  any  forceps, 
and  the  forefinger  passing  forward  and  resting  upon 
the  head  of  the  child. 

Dr.  Battet,  of  Rome,  Ga.,  said  that  in  either  sur- 
gery or  obstetrics  the  human  hand  represented  the 
most  perfect  of  all  instruments,  and  should  never  be 
superseded  by  the  attachment  of  any  instrument 
when  it  could  be  employed  unaided.  In  using  the 
forceps  only  gentle  traction  should  be  made  ;  force 
should  never  be  employed.  The  more  instruments 
were  complicated  the  greater  was  the  detraction 
from  their  utility. 

The  Section  then  adjourned. 


Wednesday,  June  7th — Second  Day. 
Dr.  D.  T.  Nelson,  of  Chicago,  read  a  paper  on 

SUBINVOLUTION    OP  THE   UTERUS,    ITS   CAUSES,    EFFECTS, 
AND   TREATMENT. 

He  attributed  very  many  uterine,  and  often  general 
disturbances  to  incomplete  involution,  and  ai'gued 
that  through  the  entire  puerperal  period  the  uterus 
should  be  daily  examined  digitally  by  a  comjietent 
accouchear.  He  also  favored  securing  firm  uterine 
contraction  by  some  means,  as  it  prevented  subinvo- 
lution, septictemia,  etc.  He  al.so  recommended 
the  use  by  injection  of  warm  water,  containing  car- 
bolic acid  one-half  to  one  per  cent.,  and  the  internal 
use  of  quinine,  both  of  which  favored  the  occurrence 
of  involution.  No  parturient  woman  should  leave 
the  bed  until  involution  is  complete. 

Db.  K.  S.  Ellis,  of  Michigan,  asked  for  experience 
in  operating  on  lacerations  immediately  after  de- 
livery. 

The  general  sentiment  seemed  to  be  in  favor  of 


the  immediate  operation  in  the  majority  of  cases, 
especially  if  the  circtdar  artery  or  any  of  its  branches 
are  involved. 

Drs.  Chapman,  of  New  York,  Prdjce,  of  Illinois, 
and  Campbell,  of  Georgia,  recommended  the  daily 
use  of  quinine  for  a  week  after  confinement,  especi- 
ally in  malarial  districts.  The  paper  was  further 
discussed  by  Drs.  Koss,  of  Pennsylvania,  and  Hat.t,, 
of  Mi.ssouri. 

Dr.  L.  H.  Bobbins,  of  Lincoln,  Neb. ,  reported 

A   case   of   delivery   of    a   CHILD    OF   ENORMOUS   SIZE 
AND   WEIGHT. 

The  child  weighed  seventeen  and  one-half  pounds, 
and  was  well  formed. 

Dr.  Battey,  of  Georgia,  spoke  at  some  length  on 
the 

PROGRESS   IN    OOPHORECTOMY, 

as  illustrated  by  the  fact  that  Lawson  Tait,  Spencer 
Wells,  and  English  and  German  surgeons  were 
rapidly  increasing  the  number  of  operations.  In 
deciding  whether  or  not  it  should  be  adopted,  each 
ease  must  be  studied  by  itself.  As  a  rule,  he  would 
prefer  tp  remove  the  ovaries  through  the  abdominal 
rather  than  the  vaginal  incision. 

In  this  connection.  Dr.  Battey  referred  to  several 
eminent  operators  who  have  ceased  to  employ  Lis- 
terism. 

Dr.  Cole,  of  San  Francisco,  regarded  Listerism 
as  dead  and  a  fallacy.  The  discussion  that  oc- 
curred at  the  International  Congress  in  London, 
1881,  was  reviewed  at  some  length  and  the  position 
taken  that  Mr.  Lister  admitted  every  allegation 
against  the  method  known  by  his  name.  Dr.  Cole 
was  not  an  opponent  to  antiseptic  surgery,  but  did 
not  believe  that  any  man  could  say  that  one  wound 
was  septic  and  another  aseptic. 

All  good  surgery  was  antiseptic,  because  cleanli- 
ness was  at  its  foundation.  He  doubted  the  exist- 
ence of  any  germicide  which  could  be  used  of  suffi- 
cient strength  to  kill  the  germs  and  yet  be  safe  for 
the  patient. 

Dk.  Prince,  of  Illinois,  did  not  receive  the  same 
impression  from  the  discussion  at  the  International 
Congress  as  did  Dr.  Cole.  He  did  not  believe  that 
any  man  could  cultivate  germs  in  a  solution  of  car- 
bolic acid  of  the  strength  of  one  thousand  per  cent., 
while  water,  which  had  been  boiled,  and  which  Dr. 
Cole  recommended,  would  not  destroy  them. 

The  brilliant  success  sometimes  obtained  without 
the  use  of  any  antiseptic  measures  whatever,  did  not 
in  any  way  explain  the  remaining  cases  where  anti- 
septics have  been  so  beneficial. 

Dr  Cole  continued  by  reading  extensively  from 
INIr.  Lister's  remarks  in  support  of  the  position  he 
held  concerning  the  method  of  dressing. 

The  CnAiRjtAN  defended  Listeiism.  He  knew 
Mr.  Lister  to  be  right  in  certain  directions  and  be- 
lieved that  Dr.  Cole  was  correct  in  othci's. 

He  defined  an  aseptic  wound  as  a  simple  fracture 
and  a  septic  wound  as  a  compound  fracture  ;  that  is, 
in  a  septic  wound  there  is  something  from  uithout 
which  enters  and  changes  its  character. 

The  Section  then  adjourned. 


Thursday,  June  8th — Third  Day. 

an  elastic  serrated  uterine  scoop  and  curette, 

devised  by  Dn.  Jos.  H.  Warren,  of  Boston,  was 
exhibited.  It  was  designed  to  be  used  in  the  re- 
moval of  uterine  tumors. 


THE  MEDICAL  RECORD. 


005 


Dr.  Prince,  of  Jacksonville,  HI.,  exhibited  an  in- 
strument by  means  of  which 

THE   SEWING-MACHINE   STITCH 

could  be  made,  and  regarded  it  as  especially  adapted 
to  operations  for  recto  and  vesico  vaginal  flstuhe. 
Du.  DuNSTEB,  of  Ann  Arbor,  then  read  a  paper  on 

OVARIOTOMY   DUKDsG   PERITONITIS — IS   IT   JUSTIFIABLE? 

The  author  believed  that  the  operation  should  un- 
hesitatingly be  performed  in  the  following  classes 
of  cases : 

Fhst. — Peritonitis  resulting  from  rupture  of  a 
cyst,  with  discharge  of  its  contents  into  the  perito- 
neal cavity. 

Second.  — Peritonitis  following  tapping  or  aspu-a- 
tion. 

Third. — Peritonitis  with  marked  effusion. 

The  doubtful  cases  belonged  to  that  class  in  which 
there  was  a  low  grade  of  irritative  inflammation  in- 
cident to  the  presence  of  the  tumor. 

Dr.  Battes,  of  Georgia,  audDR.JENKS,  of  Chicago, 
refeiTed  to  ca.ses  which  had  been  operated  upon 
while  peritonitis  was  present,  and  recovery  took 
place. 

A  paper  on 

IMPACTED  RETROVERSION  OF  THE  UTERUS 

was  read  by  Dr.  H.  F.  C.oipbell,  of  Georgia,  in 
which  special  attention  was  directed  to  tlie  assist- 
ance offered  by  placing  the  patient  in  the  geuu-pee- 
toral  position  while  replacing  the  organ. 

In  this  connection  a  paper  bv  Dr.  W.  W.  Potter, 
of  Buffalo,  N.  Y.,  on 

THE  GYNESIC  VALUE  OP  THE  GENU-PECTORAL  PO.STURE, 

was  read  and  the  two  gave  rise  to  discussion,  which 
was  participated  in  by  Dbs.  Dunster,  of  Ann  Arbor, 
Nelson,  of  Chicago,  and  others. 

Dr.  H.  L.  Gertz,  of  Marshalltown,  111.,  read  a 
paper  entitled 

A  FEW  PRACTICAL  POINTS  ON  RUPTURED  PERINEUM. 

The  points  were  that  all  cases  can  be  treated  .suc- 
cessfullv — except  where  the  sphincter  is  involved — 
by  position  and  without  sutures.  Movements  from 
the  bowels  should  be  secured  before  placing  the 
patient  in  position,  and  after  that  no  passage  should 
be  allowed  for  four  or  five  days.  Keep  the  wound 
clean  and  keep  away  from  it  every  foreign  body. 
Dr.  Gertz  also  exhibited  a 

UTERINE   REPOSITOB. 

It  consisted  of  a  flexible  bougie  into  which  was  in- 
troduced a  steel  stylet  with  a  disc  on  the  end. 
The.  method  of  use  was  to  introduce  the  largest 
bougie  the  uterine  canal  would  admit,  allow  it  to 
remain  a  few  minutes,  remove  it,  and  introduce 
another,  and  so  on  until  a  No.  10  or  12  American 
could  be  introduced,,  and  then  the  stylet  was 
used,  pushed  on  until  resistance  was  encountered, 
then  pushed  carefully,  and  finally  it  would  go  into 
the  entire  length  of  the  canal,  where  it  may  be  al- 
lowed to  remain  a  few  minutes  and  then  removed. 

Db.  H.  F.  C.oipbell  thought  the  method  obviated 
the  danger  arising  from  the  use  of  the  stem-pes- 
sary, a  straight,  stiff,  or  slightly  curved  stem,  which 
was  liable  to  wound  the  mucous  membrane  of  the 
delicate  organ  and  at  once  establish  traumatism. 

The  Section  then  adjourned.. 


MEDICAJL  SOCIETY  OF  NEW  JERSEY. 

One  ITundred  and  Sixteenth  Annual  Meeting,  held  in 
Asbury  Park,  May  2.3  and  24,  1882. 

Tuesday,  May  23d — First  Day.  ' 

The  society  met  in  Educational  Hall,  at  Asbury 
Park,  at  4  o'clock,  p.m.,  and  was  called  to  order 
by  the  President,  Dr.  L.  W.  O.^kley,  of  Elizabeth. 

Prayer  was  offered  by  the  Eev.  B.  C.  Lippincott, 
of  Asbury  Park. 

The  attendance  of  members  was  about  the  usual 
number.  Every  district,  excepting  Atlantic  and 
Salem,  was  represented. 

A  cordial  welcome  was  extended  to  the  Society  by 
Dr.  S.  H.  Hunt,  Chairman  of  the  Committee  of  Ar- 
rangements, and  by  Mr.  James  A.  Bradley,  of  Asbury 
Park. 

Dr.  Amos  B.  Pann,  a  delegate  from  the  Medical 
Society  of  Massachusetts  was  present,  and  was  cor- 
dially invited  to  sit  with  the  society  during  its  ses- 
sion, and  to  take  part  in  its  deliberations. 

The  following  I'esolution,  presented  by  Dr.  T.  B. 
Varick,  was  adopted  : 

Resolved,  That  the  Medical  Society  of  New  Jersey 
reaffirms  its  allegiance  to  the  Code  of  Ethics  of  the 
American  Medical  Association,  and  views  with  dis- 
trust any  effort  on  the  part  of  legally  constituted 
societies  to  deviate  from  or  antagonize  its  provisions. 

prevention  op  epidemics. 

Dr.  D.  C.  English  read  a  paper  on  the  "  Preven- 
tion and  Limitation  of  Epidemics." 

The  means  recommended  by  the  Doctor  are  gen- 
eral education  of  the  masses  in  sanitary  science 
through  the  public  schools,  general  and  State  legis- 
lation, and  the  enforcing  of  quarantine.  As  the 
general  Government  is  somewhat  handicapped  in  its 
efforts  toward  sanitary  reform  by  the  State  rights 
doctrines  of  many  of  the  States — the  gi-eatest  bene- 
fit must  be  expected  from  State  legislation. 

The  good  effected  by  an  efficient  State  Board  of 
Health  is  seen  in  our  own  State.  As  another  means 
of  limiting  epidemics,  the  schools  should  beijnaran- 
tined  against  children  from  infected  houses. 

In  our  own  State  there  has  been  a  great  deal  of 
sanitary  legislation  directed  toward  this  subject  ; 
and  so  far  as  this  is  concerned,  we  are  well  protected. 
It  remains  to  increase  the  general  knowledge  in 
these  matters,  so  that  reform  measures  may  be  re- 
ceived cheerfully. 

The  medical  profession  have  it  in  their  power  to 
create  such  a  public  opinion.  They  are  more  active 
in  this  matter  than  in  former  years,  and  it  is  their 
duty  to  impress  upon  the  public  mind  the  need  of 
proper  drainage,  pure  drinking  water,  isolation  of 
the  sick,  vaccination,  private  funerals,  etc.  In  this 
way  the  cause  of  epidemics  may  be  destroyed  and 
their  course  limited. 

Dr.  E.M.  Hunt,  delegate  to  the  International  Medi- 
cal Congress,  and  Dr.  I.  L.  Bodin,  delegate  to  the 
Medical  Society  of  Massachusetts,  read  their  reports, 
which  were,  on  motion,  referred  to  the  Committee 
on  Publication. 

A  letter  was  read  from  Dr.  Forman  announcing 
the  death  of  Dr.  .John  Wright,  of  Freehold.  Drs. 
Woolverton,  Phillips,  Neal,  English,  Weeks,  and 
Dunham  were  appointed  a  committee  to  attend  his 
funeral. 

The  President  announced  the  following  commit- 
tees : 

Nominating  Committee — S.  S.  Clark,  Chairman  ;  D. 


666 


THE  MEDICAL  RECORD. 


A.  Carrie,  L.  Jamieson,  H.  G.  Taylor,  J.  S.  Whita- 
ker,  T.  A.  Van  Wagenen,  G.  C.  Laws,  W.  P.  Watson, 
M.  Abel,  H.  M.  Weeks,  D.  0.  English,  J.  S.  Long, 
J.  G.  Kyerson,  P.  A.  Harris,  L.  D.  Tompkins,  J. 
Miller,  H.  H.  James. 

Conimiltee  rm  Treasurer^si  Accounts — J.  E.  Arrow- 
smith,  H.  A.  P.  Neal,  and  H.  H.  James. 

Adjourned,  to  meet  this  evening  at  eight  o'clock. 

EvENTNo  Session — Eight  o'Clock,  p.m. 

The  society  assembled.  T)ie  President  in  the 
chair.  Communications  from  the  district  medical 
societies  of  Mercer,  Hvidson,  and  Camden  were  re- 
ceived and  referred  to  Committee  on  Ethics. 

ANNUAL   ADDRESS   OF   THE   PRESIDENT. 

After  a  few  remarks  acknowledging  the  honor  con- 
ferred upon  him,  and  eulogizing  his  predecessor,  The 
President  announced  as  his  subject, 

MEDICAL   education. 

The  needs  of  higher  requirements  for  graduation, 
and  of  better  preparation  for  entrance  upon  the 
study  of  medicine,  were  urged,  and  the  responsibility 
of  the  present  condition  and  of  the  remedy  were 
placed  upon  the  profession  at  large ;  upon  them  was 
imposed  the  duty  of  forcing  our  medical  colleges  to 
take  a  higlier  standard,  to  lengthen  their  courses 
of  lectures,  and  to  adopt  a  graded  system.  The  es- 
tablishment of  a  system  of  State  licenses  was  recom- 
mended as  a  cure  for  tLe  evils  of  the  unregulated 
small  medical  college. 

The  effort  made  last  year  to  establish  examining 
committees  in  each  county,  who  should  examine 
would-be  medical  students  prior  to  their  entering 
upon  their  studies,  was  spoken  of  and  recommended 
to  be  carried  out,  and  the  plan  put  in  operation,  in 
order  that  hereafter  the  student  of  medicine  should 
be  generally  as  well  educated  as  he  is  specially. 

The  thanks  of  the  society  were  voted  to  the  Presi- 
dent for  his  able  and  instructive  address,  and  a  copy 
rec[uested  for  publication  in  the  "  Transactions." 

REPORT   OP   the   standing   COMMITTEE. 

Tlie  Standing  Committee's  report  is  one  of  the 
special  features  of  the  society's  proceedings,  giving, 
as  it  does,  a  jiicture  of  the  general  health  of  the 
State  during  the  year.  The  report  is  an  epitome  of 
the  several  reports  of  the  county  reporters. 

A  review  of  the  year  shows  a  genei-al  increase  all 
over  the  State  of  malarial  diseases,  often  taking  the 
form  of  typho-malarial ;  these  diseases  have  been 
ascribed  to  the  drought  of  the  last  summer  and  to 
the  low  condition  of  the  streams  and  ponds,  and  to 
the  condition  of  the  drinking  supply.  In  Bergen 
County  there  was  reported  an  epidemic  of  intes- 
tinal disorders  traced  to  cows'  milk,  it  being  con- 
sidered that  the  irritating  condition  of  the  milk  was 
due  to  the  shrubs  and  weeds  that  formed  the  feed  of 
the  cows. 

Typhoid  fever  was  noticed  as  prevalent  in  Burling- 
ton, Camden,  Mercer,  Middlesex,  Ocean,  and  War- 
ren counties. 

Small-pox  was  present  in  Hudson,  Essex,  and 
Mercer  counties,  but  not  to  any  great  extent. 

Diphtheria  and  scarlet  fever  wore  noticed  as  more 
prevalent  than  usual  throughout  the  northern  part  of 
the  State.  Th'i  scarlet  fever  is  reported  of  mild  type, 
but  the  dii)htheria  was  generally  malignant. 

In  the  City  of  Camden  a  peculiar  epidemic  of 
catarrh  was  reported,  affecting  all  the  mucous  mem- 
branes— a  disi>ivs6  which  seemed  self-limited,  and 
with  no  mortality. 


interesting  cases. 

Dr.  Hunt,  of  Metuchen,  reports  several  cases  of 
diphtheria,  which  have  a  bearing  on  the  length  of 
the  i^eriod  of  incubation,  which  was  shown  to  be  in 
these  cases  five  days. 

Dr.  Snowden  reported  cases  where  the  disease 
appeared  within  a  week  of  the  introduction  of  the 
poison. 

Dk.  Larison  reports  marked  improvement  in  a 
case  of  diabetes,  where  opium,  in  one-half  grain 
doses,  was  used  three  times  daily. 

Dr.  Gross,  of  Camden  County,  reports  a  case  of 
hydated  disease  of  the  uterus. 

The  following  essays  were  read  by  title  : 

Dr.  Welch,  "  Treatment  of  Uterine  Hemorrhage;" 
Dr.  St.  John,  "  Diagnosis  of  Infantile  Diseases  ; " 
Dr.  Currie,  "  How  to  Choose  a  Wet  Nurse."  A  cir- 
cular was  issued  by  the  Standing  Committee  re- 
questing information  regarding  the  working  of  the 
new  medical  law.  A  decrease  in  the  number  Of  ir- 
regular practitioners  is  noted,  but  no  convictions 
have  as  yet  occurred  under  the  new  law. 

The  formation  of  a  society  for  the  relief  of  the 
widows  and  orphans  of  the  medical  men  of  New 
Jersey  is  noted. 

NECBOLOGT. 

The  following  members  of  the  society  have  died 
during  the  year :  Dr.  F.  Wilmarth,  of  Essex,  aged 
forty-one  years  ;  Dr.  S.  D.  Marcy,  of  Cape  May, 
aged  eighty-nine  years  ;  Dr.  C.  T.  Morrogh,  of  Mid- 
dlesex, aged  sixty-one  years ;  Dr.  H.  S.  Clew,  of 
Middlesex,  aged  flfty-seven  years ;  Dr.  H.  S.  Harris, 
of  Wan-en,  aged  eighty-six  years  ;  Dr.  T.  P.  Dicker- 
son,  of  Salem,  aged  sixty  years ;  Dr.  T.  H.  Studdi- 
ford,  of  Hunterdon. 

Dr.  I.  S.  BoDiN  read  a  report  upon  the  com- 
parative value  of  humanized  and  bovine  vaccine 
virus. 

Dr.  p.  C.  Bcrke,  Third  Vice-President,  read  a 
paper  entitled  the  "Vaccination  Question."  Both 
papers  elicited  much  discussion.  The  sentiment  of 
those  who  took  a  part  in  the  discussion  seemed  to 
be  nearly  equally  divided  in  regard  to  the  compara- 
tive mei-its  of  humanized  and  bovine  virus.  All  felt 
that  the  commercial  bovine  was  very  unreliable. 

The  Oorresjionding  Secretary  read  his  report. 

Adjourned  until  nine  o'clock  Wednesday. 


Wednesday,  Mat  24th — Second  Day. 

The  President  in  the  chair. 

Dr.  Thomas  Kterson,  on  behalf  of  the  Follows  of 
this  society,  read 

THE   SOCIETy'a   PRIZE. 

Dr.  Oaklet  having  suggested  to  the  Fellows  the 
propriety  of  offering  a  prize  annually  for  the  best 
essay  on  a  given  subject,  that  body  met  during  a  re- 
cess, adojited  tho  suggestion,  and  appointed  Thomas 
Ryerson,  S.  H.  Pennington,  and  E.  M.  Hall  to  pre- 
pare a  plan,  and  report  to  the  society  at  its  present 
session.  , 

The  following  plan  was  accordingly  presented  to 
and  unanimously  adopted  by  the  society  : 

The  Fellows  of  the  Medical  Society  of  New  Jer- 
sey, present  at  Asbury  Park,  during  the  meeting 
there  of  the  society,  hereby  propose  that  the  so- 
ciety should  offer,  annually  (or  at  least  triennially), 
a  prize  of  one  hundred  dollars  to  the  menvliers  of 
the  several  district  societies  of  the  State,  for  the 
best  essay  on  .some  selected  subject  connected  with 
medical  science  or  art ;  and  that  they  will  deposit 


THE  MEDICAL  RECORD. 


667 


annually  (or  at  least  trieunially),  with  the  society's 
treasurer,  the  funds  necessary  "for  that  purpose. 

The  method  of  competition  for,  and  of  awarding 
that  prize  shall  be  as  follows  : 

A  committee  of  three  shall  be  annually  constitu- 
ted, to  be  called  the  Fellows'  Prize  Committee.  The 
retiring  president  of  the  society  shall,  ex-  officio,  be 
its  chairman,  a  Fellow  selected  by  his  associates 
shall  be  the  second  member,  and  the  third  shall  be 
a  member  of  a  district  society  (not  a  Fellow  of  the 
State  society),  selected  annually  by  this  society's 
Nominating  Committee. 

At  the  session  of  this  society  when  this  committee 
shall  be  constituted,  it  shall  select  and  announce  to 
the  society,  and  promptly  thereafter  to  each  dis- 
trict society,  a  subject  for  the  comi)etition  of  the  en- 
suing year.  And  during  its  year  of  office  the  com- 
mittee shall  adjudicate  uj^on  the  essays  which  shall 
have  been  handed  in  to  its  prospective  chaii-man 
(then  the  president  of  the  State  society)  not  less 
than  two  months  before  the  session  when  it  was  con- 
stituted. 

Each  essay  shall  be  signed  under  an  assumed 
name,  and  have  a  motto,  both  which  shall  be  en- 
dorsed upon  a  sealed  envelope,  containing  the  au- 
thor's real  name,  with  his  address  and  district  so- 
ciety ;  and  none  of  these  envelopes  shall  be  opened 
by  the  committee  until  after  its  award,  and  then 
only  those  bearing  the  names  and  mottos  appended 
to  the  successful  essays. 

The  committee  shall  select  the  first  two  essays 
in  order  of  merit,  reference  being  had,  not  only  "to 
the  subject  matter,  but  to  the  language  and  style 
of  the  author.  To  the  first  essay  shall  be  awarded 
the  prize  of  one  hundred  dollars,  to  the  second  that 
of  •'  honorable  mention."  They  shall  give  to  the  presi- 
dent of  the  society  the  names  of  the  authors  of  these 
essays,  with  their  assumed  names  and  mottos,  and 
notify  these  axithors  to  be  present  at  the  nc-ct  an- 
nual meeting  to  receive  their  award.  The  president 
shall,  during  that  session,  announce  these  names,  as- 
sumed names,  and  mottos,  and  before  the  whole 
society,  with  some  appropriate  ceremony,  make  the 
awards.  The  unsuccessful  authors  having  identified 
their  essays,  shall  receive  them  back  from  the  chair- 
man, but  the  successful  essays  shall  be  the  property 
of  the  society,  and  be  published  in  its  "Transac- 
tions." 

No  award  shall  be  made  unless  the  essays  shall  be 
decidedly  meritorious,  and  in  that  case  the  money 
shall  remain  in  the  treasury  until  it  can  be  thus 
properly  awarded. 

The  FeUows  have  themselves  this  year  selected 
the  following  snbject  for  competition  :  "  The  Im- 
portance of  Exploration  of  the  Urine,  both  Chemi- 
cal and  Microscopic,  as  an  Aid  to  Practice  ;  and  the 
Belation  of  H.-ematuria  to  Diseased  Processes." 

The  committee  of  award  for  the  essays  (to  be 
handed  in  two  months  before  the  next  annual  meet 
ing)  is  L.  W.  Oakley,  of  Elizabeth,  chairman  exorficio ; 
Henry  R.  Baldwin,  of  New  Brunswick;  and  James  S. 
Green,  of  Elizabeth. 

ORDER  OP  BUSINESS  FOR  NEXT  TEAS. 

Dr.  H.  H.  Baldwin,  chairman  of  Business  Com- 
mittee, reported  as  follows  : 

The  Committee  on  Business  would  recommend  the 
following  modification  of  the  report  of  last  year  re- 
garding the  order  of  business  : 

Tuesday.  4  o'clock  p.m. — Prayer  ;  report  of  Com- 
mittee on  Organization  ;  report  of  Committee  on  Ar- 
rangements ;  reading  minutes  of  last  annual  meet- 


ing ;  report  of  Committee  on  Business ;  report 
of  delegates  to  corresponding  societies  ;  report  of 
Committee  on  Ethics,  and  Judicial  Business  ;  an- 
nouncement of  committees  by  the  president.  7.30 
o'clock  :  President's  address  ;  report  of  Standing 
Committee  (five  minutes  allowed  each  member  for 
remarks  upon  the  same)  ;  report  of  C'orres})o:iding 
Secretary  ;  report  of  Committee  on  Unfinished  Busi- 
ness ;  half  hour  allowed  for  discussion  upon  some 
subject  suggested  at  previous  meeting. 

Wednesday,  9  o'clock  a.m. — Report  of  Committee 
on  Treasurer's  Accounts  ;  receiving  and  acting  upon 
applications  for  degree  of  jM.D.;  report  of  Committee 
on  Honorary  Members  and  Honorary  Depree  of  M.D. ; 
reception  of  delegates  from  corresponding  societies  ; 
investigation  of  by-laws  and  receipt  of  communica- 
tions from  district  societies  ;  essay  by  third  vice- 
president  ;  reading  of  such  papers  as  are  ajjproved 
by  the  Business  Committee  (the  committee  ajiproved 
of  a  paper  presented  by  Dr.  C.  J.  Kipp  on  "  Trau- 
matic Rupture  of  Drum  of  Ear,"  and  recommended 
that  it  be  read  at  this  meeting)  ;  recess  from  one  to 
three  o'clock.  Three  o'clock  p.m.  :  Continuation  of 
previous  order ;  report  of  Nominating  Committee; 
election  of  officers ;  miscellaneous  business ;  ad- 
journment. 

The  report  Was  adopted. 

The  degree  of  Doctor  of  Medicine  was  conferred 
u])on  Charles  A.  G.  Schuhl,  of  Jersey  City,  and  Yin- 
cent  Nager,  of  Newark. 

An  interesting  and  instructive  paper  on 

NERVE-  STBETCHINO, 

was  read  by  Dr.  W.  J.  Chandler,  of  Essex. 

The  writer  gave  a  general  review  of  the  whole 
subject,  beginning  with  a  brief  historical  sketch  of 
the  operation,  detailing  more  fully  the  anatomical 
lesions  and  physiological  experiments  bearing  on 
the  subject,  discussing  at  length  statistics  as  to  the 
results  of  the  operation  in  neuralgias,  spasmodic 
affections,  tetanus,  locomotor  ataxia,  etc.,  and 
finally  comparing  the  general  (medical)  opinion  with 
the  testimony  of  statistics.  Appended  to  the  paper 
were  the  histories  of  a  number  of  unpublished  cases, 
and  a  tabular  list  of  three  hundred  and  twenty  eases, 
giving  name  of  operator,  disease,  date  of  operation, 
results,  and  remarks  on  each  case. 

The  anatomical  and  experimental  divisions  were 
a  rismju  of  French  and  German  researches  down  to 
the  present  time,  and  conclude  as  follows  : 

First. — The  important  lesions  are,  a  loosening  of 
the  nei-ve  from  the  sheath,  extravasation  of  blood  in 
the  sheath,  dilatation  of  the  blood-vessels,  rupture 
of  only  a  portion  of  the  nerve-fibres,  and  occasion- 
ally nutritive  changes. 

Second. — Stretching  acts  especially  to  interrupt 
the  sensitive  current,  but  allows  the  motor  current 
to  pass. 

Thinl. — That  the  motor  current  and  reflexes  are 
more  affected  by  centrepetal  than  by  centrifugal 
traction. 

Fourth. — That  stretching  acts  on  the  nerve-centres, 
producing  certain  dynamic  changes,  ard  occasion- 
ally local  disturbances  more  or  less  persistent. 

Statistics  of  320  cases  contain  of  sciatica.  .57  cases, 
52  cured  (91  per  cent.)  ;  neuralgia  of  .'ith  pair,  27 
cases,  12  cured  (48  per  cent.)  ;  traumatic  neuralgia, 
16  cases,  12  cured  or  greatly  improved  (75  per  cent.)  ; 
all  other  neuralgias,  .33  cases.  22  cured  or  greatly  im- 
proved (fiG  iier  cent.)  ;  mimic  spasm,  13  cases,  11 
cured  (85  per  cent.) ;  torticollis,  10  cases,  C  cured 
(60  per  cent). 


668 


THE  MEDICAL  RECORD. 


In  four  of  these  exsection  was  combined  with 
stretching  :  Traumatic  tetanus,  49  cases,  10  recov- 
ered (20  per  cent.)  ;  locomotor  ataxia,  49  cases,  16 
greatly  improved  (32  per  cent.). 

In  many  cases  of  peripheral  paralysis,  ej^ilepsy 
with  an  aura,  and  auiesthetic  leprosy,  there  has  been 
a  decided  and  very  persistent  improvement. 

The  recent  discussion  of  the  Berlin  Medical  So- 
ciety and  the  unfavorable  impression  it  has  created 
were  considered,  and  the  conclusion  arrived  at  that 
Dr.  Westphal's  unfortunate  experience  was  negative 
testimony,  which  was  more  than  balanced  by  equally 
good  testimony,  from  competent  observers  in  other 
parts  of  the  world.  Nussbaum's  "  intercostal  case  " 
is  not  claimed  as  a  cure  (as  Westphal  stated),  but 
as  a  failure.  In  regard  to  Langenbeck's  "  patient 
with  seven  operations,"  he  (Chandler)  says:  "We 
may  not  cpmmend  tlie  wisdom  of  seven  operations 
on  one  patient,  but  they  attest  a  firmness  of  co7ir>o- 
tioii  as  the  outgrowth  of  successful  experience,  which 
ridicule  vainly  assails."  Finally,  reminded  of  the 
opposition  encountered  by  other  operations  (ovari- 
otomy, etc.),  he  gives  as  his  own  conclusion  :  "  While 
it  (nerve  stretching)  may  not  accomplish  all  that  its 
most  ardent  advocates  claim  for  it ;  while,  too,  there 
is  much  to  be  learned  as  to  particular  modifications 
of  the  operation,  and  as  to  its  adaptability  to  dif- 
ferent forms  of  disease,  we  feel  confident  that  an  op- 
eration which  develops  so  much  statistical  strength, 
has  enough  of  real  merit  to  outlive  opposition,  and 
take  its  place  among  accredited  surgical  operations." 

Dr.  Ill,  of  Newark,  read  an  analysis  of 

FORTY-FOUR   CASES   OF   LACERATION   OF   THE   CERVIX. 

The  doctor  operates  without  an  anassthetic,  and 
uses  antisejitic  precautions.  Of  these  cases  thirty- 
nine  were  entirely  cured,  the  other  cases  did  not 
unite  and  are  waiting  a  second  operation.  Thirty- 
seven  oases  were  entirely  relieved  of  the  symptoms 
induced  by  the  laceration. 

Of  the  special  symptoms  due  to  the  lesion,  the 
writer  noticed  particularly  the  loss  of  sexual  api>e- 
tite,  this  symptom  was  ascertained  to  exist  in  thirty- 
four  cases,  of  these  twenty-seven  were  cured  by  the 
operation. 

One  patient  who  afterward  was  delivered  at  full 
term,  presented  herself  with  a  new  laceration,  pos- 
terior to  the  cicatrix  of  the  operation. 

The  writer  speaks  of  "the  lesion  as  the  most  inter- 
esting, and  the  operation  and  the  cure  of  which  be- 
longs to  the  most  thankful  in  the  whole  line  of 
uterine  surgery." 

TRAUMATIC   RUPTURE   OP    THE   DRUM   MEMBRANE 

was  the  title  of  a  paper  read  by  Dr.  Kipp. 

Twenty-flve  cases  were  reported.  The  causes 
were  blows  upon  the  ear  or  the  mastoid  process, 
pun(!ture  by  sharp-pointed  bodies,  falls  upon  the 
head.  The  .symptoms  were  great  pain  in  the  ear, 
tinnitus,  impairment  of  hearing,  slight  hemorrhage 
from  the  oar,  a  broad  dry  perforation,  noise  on  for- 
cibly Idowing  the  nose.  Wliere  the  lesion  was 
caused  by  a  fall,  there  was  also  present  unconcious- 
ness, vomiting,  long  continued  vertigo,  and  absolute 
loss  of  hearing.     The  rupture  was  usually  posterior. 

The  treatment  was  simple — the  cold  air  was  ex- 
cluded by  cotton  in  the  meatus.  With  this  treatment 
fifty  per  cent,  recovered  without  inflammation. 
The  only  case  where  instillation  was  practiced  had 
a  suppurative  auditis  media. 

Dr.  Georob  Batles,  of  Essex,  was  appointed  Es- 
sayist for  the  next  meeting. 


The  following  was  adopted 

CONCERNING  FREEDOM  IN  CONSULTATIONS. 

Resoheil,  That  the  delegates  from  this  society  to 
the  American  Medical  Association  be  instructed  to 
resist  any  effort  to  alter  the  code  of  ethics  in  such 
manner  as  to  authorize  members  of  the  profession, 
or  any  medical  society  in  affiliation  with  this  associa- 
tion to  encourage  or  jjermit  its  members  to  hold 
professional  intercourse  with  men  who  repudiate  the 
scientific  principles  of  medical  practice  recognized 
by  this  said  association. 

OFFICERS   ELECTED. 

President — J.  W.  Snowden  ;  First  Vice-President — 
S.  Wickes ;  Second  Vice-President — P.  O.  Barker ; 
TMrd  Vice-President — Joseph  Parrish  ;  Correspond- 
ing Secretary — Wm.  Elmer,  Jr.;  Recording  Secretary — 
Wm.  Pierson,  Jr.;  Treasurer — W.  W.  L.  Phillips  ; 
Standing  Committee — 0.  J.  Kipp,  S.  S.  Clark,  and  E. 
J.  Marsh. 

Atlantic  City  was  agreed  upon  as  the  place  for  the 
next  annual  meeting.  It  was  voted  that  the  annual 
assessment  for  the  next  year  should  be  one  dollar 
and  a  half  per  capita. 

The  following  committees  were  appointed  : 

The  Business  Committee  the  same  as  last  year. 

The  Committee  on  Honorary  Membership  the 
same  as  last  year. 

The  Committee  to  elaborate  a  plan  for  the  putting 
into  effect  the  suggestion  of  the  president  in  his 
address  in  regard  to  the  curriculum  of  medical  study  : 
Drs.  Pennington,  Rogers,  and  Elmer. 

Committee  to  investigate  where  and  of  whom 
good,  reliable,  and  pure  vaccine  virus  may  be  ob- 
tained :  K.  H.  James,  L.  Halsev,  W.  Eankin,  S.  A. 
Currie,  and  N.  C.  Clark. 

Committee  of  Arrangements  for  next  meeting  : 
H.  G.  Taylor,  J.  W.  Snowden,  and  Franklin  Gauntt. 

The  amendments  to  by-laws  changing  order  of 
business  so  as  to  be  in  accord  with  the  order  recom- 
mended by  Business  Committtee,  and  the  time  of 
meeting  from  the  "fourth"  Tuesday  in  May  to  sec- 
ond Tuesday  in  June  were  adopted. 

Adjourned  sine  die. 


The  Kola  Nut.- — The  properties  of  the  kola  nut, 
which  is  largely  used  in  Central  and  Western  Africa, 
have  been  lately  elucidated  by  !MM.  Heckel  and 
SchlegdonhautTen,  who,  in  a  paper  to  the  French 
Academy,  gave  an  analysis  of  the  suVistance.  The 
cotyledons  of  the  seed  are  the  only  jmrt  the  negroes 
use"  The  effects  are  tliose  of  a  stimulant  and  tonic  ; 
and  impure  water  is  rendered  agreeable  by  previous 
use  of  the  nut.  The  analysis  shows  that  the  kola 
nut  has  more  caffeine  than  the  best  coffees,  and  that 
that  substance  is  wholly  free,  not  combined,  as  in 
coffee,  with  an  organic  acid.  The  action  of  the 
caffeine  is  aided  by  a  considei-able  quantity  of  theo- 
bromine present.  Next  there  is  a  notable  amount 
of  glucose,  of  which  there  is  none  in  cocoa.  The 
nut  contains  twice  as  much  starch  as  is  found  in 
seeds  of  the  thoobroma.  There  is  little  fatty  matter, 
and  a  special  tannin,  together  with  a  red  coloring 
matter,  is  present.  As  a  remedy,  the  kola  nnt  is 
appreciated  by  the  Africans  in  affections  of  the  in- 
testines, liver,  etc.;  it  may  be  ranked  medically  with 
cocoa  and  like  matters,  over  which,  however,  it  has 
an  advantage  in  possessinar  so  much  tannin,  which 
gives  it  astringent  properties. 


THE  MEDICAL  RECORD. 


669 


€oxxespon'bmct. 


THE  AMEEICiN  IMEDICAL  ASSOCLiTION 
AND  THE  MEDIC.\L  SOCIETY  OF  THE 
STATE  OP  NEW  YORK. 

To  TOE  Editor  of  The  Medicai.  Record. 
Dear  Sir  :  We  have  just  closed  a  memorable  ses- 
sion of  the  American  Medical  Association  and  one 
in  which  our  profession  in  the  State  of  New  York 
has  a  special  interest.  The  delegates  from  that 
State  were  refused  admission  on  the  technical 
ground  that  its  code,  recently  revised  and  adopted, 
is  not  in  harmony  with  that  of  the  American  Medi- 
cal Association.  No  ojjportunity  was  afforded  the 
delegates  from  the  New  York  State  Society  to  con- 
tend for  the  right  of  place  in  the  association,  the 
question  having  been  summarily  disposed  of  before 
the  register  was  opened  by  the  action  of  the  Judi- 
cial Council.  The  animus  was  made  obvious  by  the 
clerk  throwing  back  the  certificate  to  the  first  "dele- 
gate from  the  New  York  State  Society  who  was 
audacious  enough  to  present  it.  The  j^artisan  sjiirit 
was  still  more  strongly  manifested  when  the  same 
official  with  breathless  haste  and  gusto  read  some 
protests  from  such  medical  societies  as  had  seen  fit 
to  forward  them  against  the  New  York  code.  It 
was  the  conspicuous  intention  to  stamp  the  action 
of  the  New  Y'ork  State  Society  with  a  mal-odorous 
stigma.  There  were  one  or  two  who  took  special 
pleasure  in  seeing  this  brand  applied,  and  in  that 
number  one  of  our  townsmen  was  pre-eminent,  ap- 
plauding with  robust  vigor  whenever  the  victim  was 
imagined  to  be  in  pain.  Indeed  he  expressed  his 
regret  privately,  that  he  had  not  been  able  to  have 
the  delegates  from  New  Y'ork  put  to  the  rack  or 
their  thumbs  tortured  in  the  thumb-screws  by  the 
inquisitors  of  the  old  code. 

While  this  spirit  played  in  sulphurous  clouds  on 
the  surface,  it  was  easily  ascertained  that  a  consid- 
erable body  of  the  members  thoroughly  sympathized 
at  heart  with  the  New  I'ork  movement,  and  would 
rejoice  to  see  the  profession  left  for  its  ethics  to  the 
common  code  which  binds  decent  people  generally. 

These  quiet  men  who  believe  in  free  thought  and 
free  conscience  will  speak  and  act  when  the  time 
comes,  and  the  present  leaders  of  the  Medical  Asso- 
ciation shall  have  given  place  to  men  who  believe 
that  the  public  are  to  be  protected  against  medical 
ignorance  by  the  more  rapid  diffusion  of  truth  and 
its  embodiment  and  expression  in  form  of  State  and 
national  laws  and  the  curricula  of  medical  schools. 

As  an  illustration  of  the  benefit  of  treating  the 
question  of  the  relations  of  medical  practice  to  the 
public  interests,  in  a  broad  philosophical  way,  I 
may  say  that  the  law  of  Illinois,  compelling  medical 
registration,  has  driven  out  of  that  State  over  two 
thousand  irregular  practitioners,  most  of  whom  have 
settled  in  Iowa,  though  some  have  gone  as  far  as 
Arkansas  and  other  States  and  territories.  Iowa 
and  other  States  will  be  compelled  immediately  to 
pass  similar  or  better  laws.  The  irregular  must  keep 
his  carpet-bag  hereafter  very  near  at  hand,  as  he  is 
soon,  in  this  land,  everywhere  to  be  kept  on  the 
tramp.  Legislation  would  progress  more  quickly 
and  be  less  defective  if  the  crusade  against  ignorance 
could  be  carried  on  upon  the  basis  of  letting  into  the 
army  all  who  have  legal  qualifications.  The  exigen- 
cies of  the  fight  against  ignorance  would  make  the 


soldiers  better,  giving  to  them  an  esprit  de  corps, 
and  quickly  reacting  on  medical  schools  and  public 
opinion  till  there  would  be  less  temptation  to  wander 
away  upon  the  bogs  of  medical  isms,  because  the 
profits  of  the  trade  would  not  compensate  for  the 
peril.  With  all  that  we  may  do  quacks  will  exist, 
and  in  the  very  citadel  of  our  profession  and  de- 
corated sometimes  with  the  insignia  of  high  office. 
But  when  men  become  more  and  more  severe  in 
criticising  themselves  and  less  cxiiert  in  eviscerating 
the  moral  characters  of  their  neighbors,  they  will 
have  more  tone,  more  vigor,  and  more  moral  fitness 
to  discharge,  with  humihty  and  faithlul  rehance,  the 
congenial  and  ennobling  work  of  benefactors.  Let  the 
New  York  State  Society  and  its  affiliated  societies 
stand  firm,  and  in  less  than  five  years  the  profession 
in  the  United  States  will  have  all  its  energy  turned 
in  the  direction  of  the  great  field  of  personal,  do- 
mestic, and  State  sanitation,  and  questions  of  ethics 
will  be  left  to  the  police. 

Ever  faithfully  yours. 

Viator. 

"  New  York. 


ARMY  NEWS. 

Official  List  of  Changes  of  Stations  and  Duties  of  Offi- 
cers of  the  Medical  Department,  United  States  Army, 
from  June  4,  1882,  to  June  10,  1882. 

MAGRt,T)ER,  D.  L.,  Major  and  Surgeon,  Medical 
Director,  Dept.  of  the  Massouri.  Granted  leave  of 
absence  for  one  month.  S.  O.  110,  Dept.  of  the 
Missouri,  June  1,  1882. 

Taylor,  M.  E.,  Capt.  and  Asst.  Surgeon.  Now 
awaiting  orders  at  St.  Louis,  Mo  ,  to  report  in  per- 
son to  the  Superintendent  Mounted  Eecruiting 
Service,  for  temporary  duty  at  the  Cavalry  Depot, 
Jefferson  Barracks,  Missouri.  S.  O.  126,  A.  G.  O., 
June  1,  1882. 

Tksson,  L.  S.,  Capt.  and  Asst.  Surgeon.  Believed 
from  duty  at  the  Cavalry  Depot,  Jefferson  Barracks, 
Missouri,  and  to  proceed  on  July  1,  1882,  to  San 
Antonio,  Tex.,  and  report  in  person  to  the  Com- 
manding General,  Dept.  of  Texas,  for  assignment 
to  duty.     S.  O.  126,  C.  S.,  A.  G.  O. 

Gray,  William  W.,  First  Lieut,  and  Asst.  Sur- 
geon, Fort  Townsend,  W.  T.  Granted  leave  of  ab- 
sence for  one  month,  to  take  effect  the  3d  proximo. 
S.  O.  67,  Dept.  of  the  Columbia,  May  24,  1882. 


Thb  Prognosis  of  Nasal  Catarrh. — Dr.  Kumbold, 
discussing  this  question,  says  (St.  Louis  Medical 
Journal)  : — "  To  recapitulate  :  Up  to  the  tenth  year 
all  patients  will  recover  upon  the  observance  of  hy- 
gienic laws  and  with  constitutional  and  medical 
treatment  of  the  simplest  kind.  Those  from  about 
twelve  to  twenty  years  of  age  will  require  more 
thorough  treatment,  but  every  uncomplicated  case 
can  be  cured  in  time.  A  little  less  than  a  majority 
of  those  patients  from  about  the  twenty-fifth  to  the 
thirty-fifth  year  can,  by  close  attention  to  all  the 
hygienic  laws  and  careful  non-iiritatiug  medical 
treatment,  be  cured,  while  the  great  majority  of  this 
class  and  all  who  are  older,  because  of  the  perma- 
nency of  the  inflammatory  action,  and  because  of 
complication  of  other  important  organs,  can  be  bene- 
fited only,  and  even  this  beneficial  treatment  must 
be  made  at  each  change  of  the  season  during  life." 


670 


THE  MEDICAL  RECORD. 


iHcIricrtl  3tcnT0   antr  ttctus. 


OoNTAGioos  Diseases  —  Weeklt  Statement.  — 
Oomparative  statement  of  cases  of  contagious  diseases 
reported  to  the  Sanitary  Bureau,  Health  Department, 
tor  the  two  weeks  endJJig  June  10,  1882. 


Wnek  Bndlng 

1 

xi 

Is 

1 

ll 

o 

S 

1 
5 

1 

1 

5 

6 

114 

7 

126 

52 

6 



June     3,    1882. 

0 

June  10,    1882. 

14 

G 

94 

5 

80 

47 

17 

0 

The  Annual  Meeting  of  the  Association  of 
American  Insane  Asylum  Superintendents  was  held 
at  Oiucinnati,  O.,  May  30,  31,  June  1  and  2,  1882. 
Thirty- seven  members  were  present.  The  meeting 
was  singularly  barren  of  scientific  work,  but  was 
very  pleasant  and  successful  socially.  Only  six  pa- 
pers were  read  during  the  four  days.  These  were 
by  Dr.  O.  H.  Huglies,  of  St.  Louis,  on  "  A  Case  of 
Moral  Insanity  ; "  by  Dr.  Bucke,  of  Ontario,  on  "  The 
Growth  of  the  Intellect ;  "  Dr.  W.  H.  Hurd,  of  Pon- 
tiao,  Mich.,  on  "  Treatment  of  Periodic  Insanity  ;  " 
Dr.  B.  P.  Dewey  on  the  "  Differentiation  and  Seg- 
regation of  Certain  Classes  of  Insane  ; "  by  Dr. 
Rogers  on  "Cortaiii  Heretofore  Unobserved  Effects 
of  Alkaloid  Ciachouia;"  by  Dr.  Fisher,  of  Boston, 
on  "  Gttiteau."  The  question  of  Guiteau's  insanity 
was  not  discussed.  The  association  visited  the  asy- 
lums in  and  near  Cincinnati.  Dr.  John  A.  Callen- 
der  was  elected  president.  The  association  will 
meet  next  year  at  Newport,  R.  I. 

American  Medical  Editors'  Association.— At  the 
annual  meeting  held  in  St.  Paul,  Minn.,  June  5, 1882, 
the  following  members  registered  :  Dr.  N.  S.  Davis, 
Chicago  Medical  Journal  and  Ecamiiier;  Dr.  Wm. 
Brodie,  Th'-rapeatic  Gazette,  Detroit,  Mich.;  Dr.  J. 
A.  Octerlony,  Louisville  Medical  Herald;  Dr.  J.  V. 
Shoemaker,  Medical  Bulletin,  Philadelphia,  Pa.;  Dr. 
Thomas  N.  Reynolds,  Detroit  Clinic;  Dr.  H.  O. 
Marcy,  Anatomical  ami  Surgical  AnnaL';,  Brooklyn, 
N.  y.;  Dr.  F.  Woodbury,  Boston  Medical  arid  Surgi- 
cal Journal;  Dr.  Thomas  J.  Gallaher,  Pittsburgh 
Medical  Journal ;  Dr.  W.  B.  Atkinson,  Medical  Reg- 
ister, Philadelphia,  Pa.;  Dr.  L.  Connor, -De(roi7  Lan- 
cet; Dr.  W.  M.  C.irpenter,  Medical  Record,  New 
York;  Dr.  Thomas  M.  Mollvaine,  Peoria  Medical 
Monthli/,  111.;  Dr.  W.  O.  Wile  and  Dr.  William  O. 
Burke,  Jr.,  New  England  Medical  Monthhi ;  and  Dr. 
John  0.  Lee,  of  Philadelphia,  Pa.  In  the  absence 
of  the  president  and  secretary.  Dr.  N.  S.  Davis  was 
elected  president  pro  tern.,  and  Dr.  W.  M.  Carpen- 
ter secretary  pro  teiu.  Au  interchange  of  views  was 
then  made  concerning  advertisements  in  medical 
journals,  the  dasirahility  and  practicability  of  pub- 
lishing the  Transactions  of  the  American  ISlodical 
Association  in  journal  form,  and  tlie  propriety  of 
adjourning  siyv.  die.  The  al)sencc  of  the  president. 
Dr.  Edwards,  of  Richmond,  and  of  tlie  secretary, 
Dr.  Rej'nolds,  of  Louisville,  and  their  neglect  to  fur- 
nish either  address  or  records  of  tlie  organization, 
were  facts  unpleasantly  accepted.  The  president 
pro  torn,  appointed,  as  Committee  on  Nominations, 


Drs.  Octerlony,  Brodie,  and  Marcy,  and  the  follow- 
ing report  was  offered : 

For  President— Dt.  N.  S.  Davis,  of  Chicago. 

For  Vice-President — Dr.  W.  M.  Carpenter,  of  New 
York. 

For  Secretary— Dt.  J.  V.  Shoemaker,  of  Philadel- 
phia. 

The  report  was  accepted,  and  the  officers  duly 
elected.  A  motion  to  adjourn  siyie  die  was  lost.  The 
secretary  was  authorized  to  make  such  arrangements 
for  the  time  and  place  of  holding  the  next' annual 
meeting  as  he  should  regard  the  best  which  can  be 
done  for  promoting  the  interests  of  the  association. 
The  association  then  adjourned. 

Not  Ethical. — The  Georgia  State  Medical  Asso- 
ciation, at  its  last  meeting,  expelled  Dr.  D.  O.  C. 
Heery  for  advertising  a  specialty. 

Ill,  Skill,  Bill. — 

Canto  First. 

Will 
Fill: 
111. 

Canto  Second. 

SkiU; 

Pill: 

Nil! 

Ill 

Still. 

HiU.* 

Canto  Third. 

Bill. 

S.  W.  Francis. 

Dr.  T.  G.  Thomas  has  been  reappointed  Clinical 
Professor  of  Diseases  of  Women  in  the  College  of 
Physicians  and  Surgeons,  New  York. 

Tre.wmbnt  for  Fracture  of  the  Clavicle. — 
Dr.  W.  B.  Bradner,  of  Warwick,  N.  Y.,  writes  : 

"Believing  that  the  Hst  of  clavicle-mending  fixtures 
is  not  yet  full,  I  will  descrilie  a  method  which,  for  all 
that  I'know,  is  mine;  which  at  all  events  has  given 
me  great  satisfaction.  I  place  the  hand  of  the  in- 
jured side  upon  the  sound  clavicle  and  lix  it  there 
firmly  by  adhesive  straps.  I  then  elevate  the  elbow 
(keeping  it  pressed  snugly  to  the  chest)  imtil  the 
shoulder  goes  '  upward,  backward,  and  outward.' 
I  then  support  the  elbow  in  its  position  by  a  sling, 
and  secure  the  sling  from  slipping  by  adhesive 
straps  in  lieu  of  tapes,  the  straps  being  applied  to 
the  skin  of  the  back,  suiTiciontly  abundant  to  pre- 
vent all  slipping  or  change  of  the  position  of  the 
sling.  The  arm,  forearm,  and  clavicles  thus  form 
an  isosceles  triangle,  and  when  the  elbow  is  raised 
the  angle  formed  by  the  arm  and  forearm  is  widened, 
and  the  direction  of  the  arm  carries  the  shoulder  to 
the  desired  position.  Its  ease  of  application,  its 
comparative  security  from  shifting,  together  with 
being  as  nearly  comfortable  as  anything  can  be  to  a 
broken  clavicle,  added  to  the  fact  that  the  resulting 
deformity  is  next  to  nothing,  induce  me  to  submit 
it  to  the  test  of  the  profession." 

A  HERMArHKODiTR  BoG.— the  Na.shmlle  Joumalo/ 
Medicine  and  Surgen/  reports  a  case  of,  as  it  claims, 
genuine  hermaphroditism,  in  a  hog.  The  specimen 
was  brought  to  the  notice  of  the  Secretary  of  the 
Savannah  State  Board  of  Health,  and  was  carefully 
examined  by  Dr.  J.  E.  Dobson.     It  consisted  of  a 


THE  MEDICAL  RECORD. 


6U 


uterns  having  attached  at  one  end  an  ovary,  and  at 
the  other  a  well-developed  testicle.  Or  rather  the 
nterus,  which  in  a  hog  is  bilid,  had  only  one  end, 
while  the  other  was  an  undeveloped  scrotum.  The 
testicle  was  perfect  in  all  its  appointments,  havinn-  a 
spermatic  cord  and  the  usual  folds  attached.  The 
outward  appearance  of  the  hog  was  that  of  a  female, 
though  the  clitoris  was  evidently  an  imperfect  penis, 
and  the  doctor  had  frequeutlj  noticed  emissions  of 
semen.  Uufortunatelv  for  the  cause  of  science  the 
doctor  failed  to  preserve  all  the  attachments.  It 
would  have  been  peculiarly  interesting  to  have  no- 
ted the  attachments  of  the  spermatic  cord,  and  it 
would  have  been  well  to  have  preserved  all  the  gen- 
ital organs.  This  is  much  to  be  regretted,  as  the 
clear  case  of  a  hermaphrodite  is  almost  unknown. 
This  is  the  best  authenticated  case  we  know  of.  It 
is  evidently  a  commingling  of  the  .sexes  in  one  be- 
ing, as  the  uterus  is  only  half  developed,  and  there 
was  but  one  ovary  and  one  testicle.  The  hog  had 
the  habits  of  a  male  more  than  that  of  a  female, 
though  it  was  both  one  and  the  other.  The  speci- 
men, in  alcohol,  was  presented  by  Dr.  Clark  to  the 
museum  of  the  University  of  Nashville  and  Vander- 
bilt  University. 

A  Ne'.v  CoiiPAJtisoN  OF  Poisoxs. — Comparative  ex- 
periments with  different  poisons  have  often  been 
made  by  injecting  a  given  quantity  of  each  into  the 
_  veins  of  animals,  and  noting  the  eiiects.  M.  Kichet 
has  recently  tried  another  method  (which  offers 
some  advantages),  viz.,  poisoning  the  medium  in 
■which  the  animal  breathes.  If  a  fi.sh  be  put  in  a 
poisonous  solution,  it  dies  sooner  or  later,  according 
to  the  concentration  of  the  poison.  M.  Richet 
adopts  as  the  "  limit  of  toxicity "  the  maximum 
quantity  of  poison  (referred  to  one  litre  of  water) 
allowing  a  fish  to  live  more  than  forty-eight  hours. 
This  bait  he' has  determined  for  various  metals,  al- 
ways using  the  same  radical  acid,  viz.,  chlorides. 
The  limit  of  toxicity  was  calculated,  not  per  weight 
of  chloride,  but  per  weight  of  combined  metal.  The 
figures  show  that  there  is  no  jjrecise  relation  be- 
tween the  atomic  weight  of  a  substance  and  its 
poisonous  power.  Copper  is  600  times  as  poisonous 
as  strontium,  though  its  atomic  weight  is  less. 
Lithium,  with  an  atomic  weight  only  the  twentieth 
of  that  of  barium,  is  three  times  as  2:)oisonous,  etc. 
Even  with  metals  of  the  same  family,  no  relation  be- 
tween the  two  things  was  discoverable.  Cadmium 
(112)  is  only  about  half  as  poisonous  as  zinc  (05) ; 
lithium  (17)  is  70  times  as  poisonous  as  sodium  (23), 
etc.  Xor  could  any  relation  be  made  out  between 
the  chemical  function  of  a  body  and  its  toxical 
power.  Thus  potassium  and  sodium,  the  chemical 
properties  of  which  are  so  similar,  have  very  unequal 
toxicity  ;  one  gramme  of  potassium  is  nearly  250 
times  as  poisonous  as  one  gi-amme  of  sodium.  M. 
Kichet  means  to  prosecute  the  subject  further. 

Female  Physicians  in  India. — The  London  S})ec- 
tator  discusses  the  prospects  of  success  for  medi- 
cal women  in  India:  "Miss  or  Mr."!.  Sarah  Heck- 
ford  writes  to  the  Times  to  say  that,  although 
without  a  diploma,  she  practised  medicine  for  two 
years  in  India,  and  doubts  whether  there  is  a  re- 
munerative field  for  female  doctors.  They  are 
greatly  wanted,  but  she  thinks  the  natives,  though 
most  ready  to  receive  them,  are  unwilling  to  pay 
heavy  fees  for  services  to  their  women,  and  says  that 
even  in  midwifery  cases  they  will  give  a  large  hono- 
rarium if  the  chUd  is  a  boy,  and  nothing  at  all  if  it  is  a 
girl.  The  last  remark  is  probably  true,  native  feeling 


on  that  matter  being  as  incurable  as  that  of  the  old 
Jews  ;  but  we  do  not  believe  the  general  argument. 
Natives  are  rich  and,  like  all  other  human  beings, 
will  pay  for  what  they  value  ;  and  they  value  their 
women.  That  it  may  be  needful  to  claim  fees  in  ad- 
vance is  possible,  as  they  have  a  notion  that  medical 
attendance  is  a  work  of  merit,  which  repays 
itself;  and  we  have  no  doubt  that  a  government  aj)- 
pointment,  even  without  salary,  would  be  an  assist- 
ance to  the  first  female  doctors.  There  are  thou- 
sands of  women  in  India  with  property  of  their 
own." 

Measitkement  of  Drugs. — A  correspondent  of  the 
Lancet  and  Clinic  makes  the  following  correction  of 
the  table  of  ratio  between  bulk  and  weight  given  in 
Holmes'  "  Surgery."  The  weight  of  a  teaspoonful  of 
medicine  as  given  in  Holmes : 

Actual  weight. 

Tannin si.  j  i. 

Zinc  acetate 3  iss.  3  i. 

Alum ;ii.  3  i. 

Zinc  sulph 3  iss.  3  ii. 

Plumb,  acetate 3  iii.  3  iss. 

The  Value  of  Gesuixe  Koumiss. — Dr.  Carrick,  in 
his  work  on  Koumiss,  explains  why  the  results  ob- 
tained from  its  use  are  so  often  unsatisfactory. 
Koumiss  is,  according  to  Dr.  Carrick,  the  specific 
against  consumption.  But  "unfortunately  woulo-be 
drinkers  of  real  koumiss  have  to  solve  the  same 
difficulty  that  Mohammed  had  with  regard  to  the 
mountain.  They  are  obliged  to  go  to  it ;  and  this, 
because  only  of  mares'  milk,  and  that  only  of  mares 
fed  on  steppe  gi-asses,  is  it  possible  to  make  koumiss. 
Cows'  milk  is  too  rich :  so  is  even  the  milk  of  Euro- 
pean mares ;  in  fact,  the  test  milk  makes  the  worst 
koumiss.  The  comparatively  large  quantity  of  fat 
in  cows'  milk  is  fatal,  as  it  favors  butyrous  and  in- 
terferes with  vinous  fermentation.  According  to 
an  analysis  which  Dr.  Carrick  gives  us,  the  propor- 
tions ot  nitrogenous  matters  and  fixed  salts  in  1,000 
parts  of  mares'  milk,  women's  milk,  and  cows'  milk, 
are  as  21,  22,  43;  of  fat,  14,  29,  38;  and  of  mUk- 
sugar,  57,  64,  45.  It  will  be  thus  seen  that  mares' 
milk  more  nearly  apjiroaches  to  women's  milk,  and 
when  transformed  by  fermentation  into  koumiss  is 
even  more  easily  and  rapidly  digested  than  the  hu- 
man secretion.  It  is  this  which  enables  Tartars  and 
others  to  drink  the  enormous  quantities  of  koumiss 
which  they  are  accu.stomed  to  take.  At  the  kou- 
miss establishments,  eighteen  bottles  a  day  is  no 
unusual  dietary,  and  no  sort  of  inconvenience,  im- 
mediate or  future,  is  experienced  from  it." 

The  Late  James  B.  Wood,  M.D.,  LL.D.— At  the 

stated  meeting  of  the  New  York  Pathological  Society 
held  May  24,  1882,  the  following  resolutions  were 
reported  and  unanimously  adopted  : 

Resolved,  That  in  the  death  of  Professor  James  K. 
Wood,  one  of  the  founders  of  the  New  York  Patho- 
logical Society,  this  society  has  lost  one  of  its  most 
devoted  memljers,  and  one  whose  life  and  character 
have  rendered  him  one  of  its  brightest  oj'naments. 

That  his  devotion  to,  and  success  in,  the  cultiva- 
tion of  our  particular  branch  of  medical  science  gave 
him  a  foremost  place  in  our  councils,  our  confidence, 
and  our  esteem.  We  deplore  his  loss  as  of  one  who 
warmly  symj^athized  with  us  in  our  labors,  and  who, 
by  his  kmdly,  genial,  and  earnest  nature,  won  our 
regard,  while  his  life  career  chaUenged  our  admira- 
tion and  respect. 

Resolved,  That  his  memory  as  our  associate  and 


672 


THE  MEDICAL  RECORD. 


friend  will  always  be  gratefully  cherished  by  the 
members  of  this  society. 

T.  M.  Mabkoe, 

Austin  Flint, 
Lewis  A.  Sayre. 

A  Case  op  Splenic  LBucocrTHSMi.*.. — Dr.  George 
T.  Welch,  of  Keyport,  N.  J.,  communicates  the  fol- 
lowing :  "  Leucocythiemia  is,  fortunately,  so  rare  a 
disease,  and  its  treatment,  unfortunately,  in  the 
chronic  stages  at  least,  so  invariably  unsuccessful, 
that  I  feel  it  a  duty  to  offer  the  following  notes  as  a 
further  contribution  to  the  study  of  this  intractable 
malady. 

"  November  8,  1881,  I  was  called  to  see  Mrs  T. 
Foley,  of  Matawan,  aged  forty-six,  whom  I  found  to 
be  suffering  from  ctironic  invalidism  induced  by 
some  grave  disorder  which  did  not  readily  discover 
itself  to  my  inquiries.  I  was  much  struck  with  the 
wasea  pallor  of  iVIrs.  Foley's  countenance,  the  lips 
being  bloodless,  the  conjunctivie  pearly  white,  and 
even  the  tongue  had  lost  its  ruddy  hue. 

"  The  chief  symptom  complained  of  was  fre- 
quently recurring  attacks  of  hemorrhage  from  the 
bowels,  which  had  persisted  in  spite  of  even  heroic 
meamres  addressed  to  its  relief.  In  the  train  of 
this,  followed  the  usual  disorders  of  aniemia,  dysp- 
noea, vertigo,  loss  of  appetite,  disturbance  of  the 
functions  of  digestion,  and  slightly  elevated  tem- 
perature. Physical  exploration  discovered  subacute 
bronchitis,  with  marked  dulness  over  the  apex  of 
the  left  lung  ;  the  pulse  was  undidy  frequent,  and 
anaemic  murmurs  were  heard  about  the  heart ;  the 
spleen  was  found  to  be  enormously  enlarged,  ex- 
tending into  the  iliac  fossa  and  beyond  the  median 
line.  It  could  be,  by  slow  persistence,  catight  over 
the  hooked  fingers  and  lifted  up  and  down  like  a 
detached  plate  of  armor,  to  the  great  admiration  of 
the  patient  and  her  daughters,  one  of  whom  suc- 
cessfully carried  out  the  same  experiment.  The 
anterior  notch  of  the  spleen  could  be  distinctly  felt 
in  exaggerated  form,  as  well  as  two  or  three  other 
indentations.  As  near  as  I  could  approximately 
measure  the  organ,  being  guided  by  its  outlines  and 
dulness  on  percussion,  it  was  eleven  inches  in  length, 
and  though  Gowers  has  recorded  five  cases  ranging 
from  sixteen  to  nineteen  inches,  I  could  not  feel  im- 
patient, judging  from  the  size  of  the  abdomen  here, 
that  there  was  not  much  more  room  for  develop- 
ment. Deep  pressure  gave  a  gurgling  sensation 
under  the  hand,  which  was  noticeable  to  the  pa- 
tient. I  drew  some  blood  from  the  finger,  which  I 
preserved  for  microscoi^ical  study.  It  liad  a  pale 
chocolate  color,  and  under  the  microscope  showed 
an  astonishing  diminution  of  the  red  corpuscles,  and 
a  corresponding  increase  in  the  number  of  the  white. 
At  first  it  seemed  to  me  the  white  corpu.scles  pre- 
dominated two  to  one,  but  employing  the  method  of 
Vierordt,  after  frequent  numeration,  I  found  there 
was  one  white  to  three  red  corpuscles.  The  white 
corpuscles  were  larger  than  usual,  and  the  rod  had 
little  of  the  ensanguined  hue. 

"  Under  treatment  of  electricity,  tonics  of  iron 
and  quinine,  and  maltine  with  peptones,  the  red 
corpuscles  were  increased  in  quantity  and  density 
of  color  ;  so  much  so  that  a  specimen  of  blood  ex- 
amined early  in  January,  1882,  had  a  decided  red 
appearance,  and  the  percentage  of  red  corijusclos 
had  been  largely  increased.  But  even  at  this  time 
the  rarity  of  the  latter  and  predominance  of  the 
white  corpuscles  was  considered  extremely  remark- 
able by  l3r.  Hodgson,  M'ho   examined  some  of  the 


blood  sent  to  him  on  a  slide.  These  encouraging 
symptoms,  however,  did  not  continue,  and  after 
February  1st,  the  red  corpuscles  were  again  reduced, 
and  continued  uniformly  to  disappear  until  the  end. 

"  I  began  the  use  of  electricity  to  the  spleen  on 
the  8th  of  November,  the  positive  pole  being  applied 
posteriorly  over  the  tenth  rib,  and  the  negative  fre- 
quently shifted  over  the  tumor  in  front.  As  strong 
a  current  as  the  patient  could  conveniently  bear  was 
employed  almost  daily  for  several  weeks.  Under 
its  action,  the  spleen,  after  its  first  application,  was 
reduced  at  least  half  an  inch,  and  at  the  end  of  four 
weeks  it  had  receded  three  inches,  and  finally  was 
permanently  reduced  five  inches.  At  the  end  of 
twelve  weeks  this  organ  no  longer  preserved  its 
firmness  of  structure  as  at  first,  but  was  soft  and  of 
a  doughy  consistence,  and  deeper  pressure  was  ne- 
cessary to  discover  its  outlines.  Hemorrhage  from 
the  bowels,  which  had  been  such  a  persistent  feat- 
ure, ceased  almost  entirely  until  within  a  fortnight 
of  death,  when  they  again  began,  and  became  more 
and  more  difficult  to  control.  As  a  matter  of  experi- 
ment the  use  of  electricity  was  sometimes  discon- 
tinued, when  the  hemorrhages  invariably  returned 
in  about  forty-eight  hours,  and  ceased  on  the  reap- 
plication  of  the  battery. 

"  Pyrexia,  being  a  noticeable  symptom,  the  tem- 
perature was  carefidly  noted  from  time  to  time,  and 
once,  during  fourteen  days,  it  was  taken  three  times. 
When  I  was  not  able  to  see  the  jiatient  the  record 
was  continued  by  the  oldest  daughter,  a  very  capa- 
ble young  woman.  It  was  found  to  range  from  94° 
in  the  morning,  to  100°  at  night.  Quinine  had  no 
effect  in  controlling  the  pyrexia,  but  atropia  had. 
One  sixtieth  of  a  grain  of  the  sulphate  of  atropia 
given  early  in  the  day,  would  shortly  increase  the 
temperature  two  degrees  and  maintain  it  for  several 
hours ;  the  higher  temperature  of  100°  not  being 
reached  in  the  evening,  the  disease  seeming  power- 
less, after  the  action  of  the  stimulus  was  withdrawn, 
to  goad  the  natural  heat  of  the  body  to  a  higher  al- 
titude. No  permanent  good  effect  was  produced, 
however,  the  remedy  being  discontinued,  on  account 
of  its  soporific  qualities,  and  dryness  of  the  throat 
with  increased  bronchial  difBculty  that  supervened. 

"  The  dyspeptic  symptoms  improved  under  the  use 
of  maltine  witli  peptones,  and  the  body  began  to  be 
better  nourished,  the  appetite  returning  and  the 
spirits  of  the  patient  wonderfully  improving  under 
the  apparently  favorable  treatment.  But,  as  a  drag- 
on, momentarily  confounded  by  the  shepherd  and 
his  dogs,  soon  picks  up  courage  and  steadfastly 
withdraws  to  his  den  with  his  ill-gotten  prey,  so 
did  the  lencoeytha'mia  again  begin  its  downward 
course,  and  this  time  not  to  be  held  in  bonds  any 
more.  After  the  first  of  February  the  circulation 
began  a  more  rapid  march,  ascites  was  developed, 
together  with  cedema  of  the  feet  and  legs,  in  a  less 
marked  degree,  while  a  hypostatic  congestion  of 
both  lungs  occurred,  which,  with  tlie  bronchitis, 
now  developed  into  a  catarrhal  form,  very  much  sim- 
ulated phthisis.  The  hemorrhages  from  the  bowels 
recommenced,  the  appetite  was  lost,  the  mental  fac- 
ulties grew  apatlietic,  and,  finally,  death  occurred 
on  the  iilst  of  March,  nine  months  after  the  sup- 
posed inception  of  the  disease. 

"On  account  of  the  surreptitious  use  of  patent 
medicines,  and  tlie  laxity  of  the  attendants  in  com- 
plying with  my  directions  toward  the  last,  I  severed 
my  connec^tion  with  tho  case  on  March  l!)th,  and 
thus  reluctantly  lost  the  opportunity  of  making  a 
post-mortem  examination  of  the  remains." 


Vol.  XXI.-No.  25. 
June  24,  1882. 


THE  MEDICAL  RECORD. 


673 


The  Medical  Recoed: 


!3l  iDEekltt  lountal  of  fUe^tcinc  anb  Surgerg. 


GEORGE  F.  SHRADY,  A.M.,  M.D.,  Editor. 


PUBLISHED   BY 

WM.  AVOOD  &  CO.,  \os.  56  and  58  I.afajelte  Plate,  N.  Y. 


New  York,  June  24,  1882. 

THE  ANTIPYRETIC  TKEATIIEXT  OF 
FE'S'EES. 

In  a  review  of  the  treatment  of  tr[>lioid  fever,  which 
■we  made  a  short  time  ago,  it  was  asserted  that  the 
claims  of  the  antipyretic  method  of  treating  fevers 
were  much  less  enthusiastically  advocated  than 
formerly. 

We  venture  to  say  that  in  this  country  the  routine 
use  of  vigorous  antipyretic  measures  has  as  yet 
failed  to  be  justified  by  any  clinical  resiilts.  This 
method,  as  applied  in  modern  times,  originated 
in  Germany,  and  was  developed  by  Brandt,  Jiirgen- 
sen,  Liebermeister,  and  others.  It  was  soon  intro- 
duced into  this  country,  jind  has  been  used  here  ex- 
tensively. 

The  original  recommendation  for  its  employment 
was  based  upon  the  theory  that  heat  is  the  essential 
symptom  of  fever,  or  at  least  the  chief  morbific  agent 
to  be  contended  against.  This  view  was  supported 
practically  by  large  numbers  of  statistics  from  the 
German  hospitals.  It  was  affirmed  by  Glenard,  in 
1871,  that  among  six  to  eight  thousand  cases  of 
typhoid  fever  treated  by  the  use  of  cold,  there  was 
an  average  mortality  of  between  i.5  and  7.6  per  cent. 
The  mortality  by  the  old  method  was  from  18  to  25 
per  cent. 

Much  can  be  said  against  the  theory  that  heat  is 
the  essential  factor  in  a  specific  fever.  The  argu- 
ments in  favor  of  it  have  been  most  admirably 
discussed  by  Dr.  H.  C.  "Wood.  We  cannot  con- 
sider, however,  that  his  well-known  experimente  of 
heating  animals  entirely  proves  his  point.  He  found 
•that  heat  produced  and  withdrawal  of  heat  relieved 
febrile  symptoms.  His  temperatures  were  very 
high,  however.  In  a  specific  fever,  also,  there  is  a 
constant  and  increased  production  of  heat  at  the  very 
time  it  is  being  withdrawn  by  baths,  a  condition 
not  carried  out  in  Wood's  experiments.  With  the 
high  fever  of  phthisis,  furthermore,  there  maybe  few 


severe  symptoms  and  but  slight  granular  changes. 
After  heat  abstraction  in  typlioid,  the  symptoms 
may  be  but  little  changed.  Cold  baths  abstract  heat, 
but  at  the  same  time  increase  its  production  for  a 
time.  In  order  to  lesson  this  production,  the  baths, 
we  are  told,  miist  be  frequently  repeated.  But  now 
come  some  of  the  advocate.i  of  cold  bathing  and 
recommend  its  use  in  a  moderate  degree. 

The  figures  given  regarding  the  clinical  value  of 
cold  bathing  in  German  hospitals,  are  certainly  very 
convincing.  We  cannot,  however,  be  too  careful 
in  applying  German  hospital  statistics  to  ordinary 
practice  in  America.  The  same  statistics  showed 
the  great  value  of  antipyretics  in  pneumonia.  But 
the  use  of  cold  baths  in  the  treatment  of  pneumonia 
in  this  city,  at  least,  has  been  disastrous.  We  can 
find  no  clinical  evidence  to  prove  that  the  antipy- 
retic treatment  has  decreased  the  mortality  here  in 
typhoid  fever,  the  disease  where  it  is  most  often  in- 
dicated. Dr.  Flint  speaks  of  its  value  guardedly. 
Dr.  Palmer,  in  his  recent  work,  has  little  to  say  of 
it.  Dr.  Bartholow  commends  it,  but  gives  no  sta- 
tistics. Some  of  the  best  English  clinicians  also 
speak  against  the  routine  practice. 

Statistics  of  the  application  of  this  method  in 
BeUe^-ue  Hospital,  published  in  The  Eecobd  four 
years  ago,  showed  that  it  had  failed  to  secure  any  de- 
crease of  mortality  there.  Many  authorities  might  be 
cited  in  England  and  France  against  the  antipyretic 
method  as  formiilated  by  the  Germans. 

We  would  not  be  misunderstood  regarding  the 
question.  The  use  of  antipyretic  measures  in  ty- 
phoid fever,  scarlatina,  rheumatic  fever,  etc.,  is  un- 
doubtedly at  times  of  the  greatest  importance. 
Every  physician  can  probably  recall  certain  individ- 
ual cases  where  it  has  been  of  the  highest  service. 
But  that  heat  is  always  the  great  thing  to  fight 
against  in  a  specific  fever,  that  antipyretic  measures 
(cold  and  quinine)  should  be  looked  ui^on  as  the 
routine  and  necessary  practice  in  continued  pyrexia 
— this  has  not  been  j^roved  tme  for  America. 

Cold  continuously  used  is  a  depressing  and  some- 
times dangerous  agent.  Quinine  in  very  large  doses- 
is  not  without  its  evils.  These  two  measures  should 
be  used,  therefore,  with  the  greatest  judiciousness 
bv  medical  men. 


QUE  crrr  insane  asielums. 
The  Grand  Jury  recently  paid  a  visit  to  Ward's  and 
Blackwell's  Islands.  They  spent  six  hours  looking 
over  the  institutions  in  those  places,  and  wi-ite  of 
their  experiences  with  much  ni'nvett'-.  Of  the  New 
York  City  Asylum  for  the  Insane  they  say :  This 
asylum  was  visited  with  great  satisfaction.  The 
building  is  not  excelled  in  excellence  of  appoint- 
ments by  any  other  in  the  world !  It  contains  1,260 
inmates.  The  appearance  of  the  Female  Lunatic 
Asylum  on  Blackwell's  Island,  which  contains  1,389 
inmates,  was  also  "  truly  gratifying." 


674 


THE  MEDICAL  RECORD. 


It  is  the  singular  dulness  of  such  men  as  these, 
who  think  that  because  the  floors  are  clean  the  in- 
sane are  well  provided  for,  which  makes  progress  in 
the  care  of  this  class  so  difficult.  Our  city  asylums 
are,  no  doubt,  well  managed  with  the  means  sup- 
plied. But  the  best  medical  care  for  the  acute  in- 
sane, and  the  most  economical  and  humane  pro- 
vision for  the  chronic  cases,  are  very  far  from  being 
obtained.  In  fact  it  is  impossible  to  expect  any- 
thing else  so  long  as  these  institutions  are  under 
purely  political  control. 


American  fttcMcal  '^saoctation. 


THmTY-THIRD  ANNUAL  aiEETINCx. 

Held  at  St.  Paul,  Minn.,  June  6, -7,  8,  and  9,  1882. 


SECTION  IN  MEDICINE. 

Dr.  J.  A.  OcTEULONY,  of  Louisville,  Chairman. 
Dr.  Thomas  N.  Beynoi/DS,  of  Detroit,  Secretary. 

TuESDAT,  June  6th — Fibst  Day. 

The  first  paper  was  by  Dr.  J.  Hilgard  TyndaiiE, 
of  New  York,  and  entitled 

StSTElLATIC   AJTD  ANTISEPTIC  GERMICIDAIj   HOJIE  TREAT- 
MENT OF   PULMONARY   CONSUMPTION. 

Dr.  John  V.  Shoemaker,  of  Philadelphia,  then 
read  a  paper  on 

THE   THERAPEUTIC   ACTION   OP   POTASSIUM   CHLORATE. 

This  powerful  and  active  drug  was  used  for  the 
first  time  by  Fourcroy,  in  179G,  with  the  idea  that 
it  might  transmit  some  of  its  oxygen  to  the  body. 
At  its  introduction,  this  salt  was  principally  re- 
commended as  an  antidote  to  scurvy.  Chaussier 
proposed  it  as  a  remedy  in  croup.  It  had  com- 
pletely fallen  into  oblivion,  when  Dr.  Blanche, 
repeating  the  experiments  made  in  1847,  by  Hunt 
and  West,  with  this  medicine  in  the  treatment  of 
gangrene  of  the  mouth  and  pseudo-membranous 
stomatitis,  was  led  to  try  it  in  the  treatment  of 
pseudo-membranous  sore  throat  and  croup.  In 
this  country  the  use  of  this  remedy  had  received 
but  little  attention  in  the  way  of  reported  successes, 
except  from  few  observers,  among  whom  was  Dr. 
Thomas  Drysdale,  who,  in  a  paper  I'ead  before  the 
Philadelphia  County  Medical  Society,  in  Januaiy, 
1877,  gave  a  history  of  some  remarkable  cures  re- 
sulting from  its  use  in  diphtheria  and  pseudo-mem- 
branous croup.  Dr.  Shoemaker  added  that  ho  also 
had  met  with  marked  and  decided  success  from  its 
internal  use  in  scrofulous  skin  diseases  ;  likewise 
Dr.  M.  Landosberg,  of  Pliiladelphia,  had  reported 
very  gratifying  results  from  its  topical  application 
in  epitlielioma  of  tlio  eyelids. 

Observation  had  shown  that  it  is  a  powerful  rem- 
•  edy  to  overcome  many  abnormal  conditions  of  the 
system,  and  that  it  is  equally  powerful  to  do  harm  if 
not  judiciously  administered. 

Dr.  Slioemaker  then  passed  to  the  consideration 
of  its  therapeutics,  showing  its  decided  action  on 
'the  system,  and  that  it  acts  in  some  hitherto  unex- 
plained manner  in  abnormal  conditions  of  the  blood. 


changing  its  character,  and  overcoming  morbid 
states.  It  may  be  that  it  imparts  the  oxygen  of  the 
compound  which  is  held  in  a  loose  combination,  as 
has  long  been  supposed,  to  the  blood,  or  the  salt 
may  itself  unaltered  affect  the  blood. 

Tn  the  proportion  of  a  drachm  to  a  glassful  of  wa- 
ter it  is  of  service  as  a  gargle  in  the  various  varie- 
ties of  stomatitis,  often  quickly  relieving  the  dry, 
red,  and  follicular  congestion  of  the  mucous  mem- 
brane, and  healing  the  ulceration  when  it  exists. 

As  a  local  application  and  gargle  in  inflammation 
and  ulceration  of  the  tongue,  i^atiently  and  long- 
continued,  more  particularly  in  the  latter,  it  seems 
to  do  more  good  alone,  or  at  times  in  combination 
with  astringents,  than  any  other  remedy. 

Used  either  as  a  gargle,  or  applied  locally  with  a 
brush  or  by  atomization,  in  simjjle  catarrh  of  the 
anteiior  and  posterior  nares  and  in  simjjle  and 
chronic  catarrh  of  the  larynx,  it  has,  when  constantly 
used,  in  many  cases  positive  and  curative  action. 

He  has  used  a  solution  of  chlorate  of  potassium, 
one  or  two  drachms  to  a  half  a  pint  of  water,  as  a 
gargle  in  diphtheria  and  i)hthisis.  In  the  former 
afl'ectiou  it  will  cleanse  the  mouth  and  threat,  thor- 
oughly disinfecting  the  parts,  wash  off  the  mem- 
branes, and  soothe  and  relieve  much  irritation.  In 
phthisis,  the  free  use  of  the  chlorate  of  potassium 
gargle  will  relieve  the  dry  and  excessive  state  of 
mucus  of  the  jiarts,  and  will  soothe  the  mucous  mem- 
brane, giving  very  great  comfort  and  ease  to  the  pa- 
tient. 

in  subacute  and  chronic  stages  of  otorrhea,  an 
injection  of  chlorate  of  potassium,  in  the  .strength  of 
five  to  ten  gi-ains  to  the  ounce  of  water,  is  often  ef- 
fective. In  ozena,  a  douche  of  a  solution  of  the 
chlorate  of  potassium,  in  the  proportion  of  one 
drachm  of  the  salt  to  a  pint  of  water,  will  cleanse 
and  thoroughly  disinfect  the  parts. 

As  an  injection  also  in  leucorrhoea,  in  the  strength 
of  one  to  two  drachms  to  a  quart  of  water,  it  will 
often  prove  very  useful  by  lessening  the  discharge 
and  relieving  congestion.  *  In  gononhcea,  used  as 
an  injection  two  three  times  a  day,  in  the  proportion 
of  five  or  ten  grains  to  an  ounce  of  water,  it  will 
very  often  produce  an  alterative  effect  upon  the 
parts,  and  completely  arrest  the  discharge. 

As  an  aiiplication  in  ulcerative  epithelioma  and 
ulcerative  lupus,  it  is  at  times  very  eflicacious,  and 
he  had  seen  instances  in  both  these  diseases  in  which 
the  surface  has  been  completely  healed  by  its  con- 
tinued application. 

As  an  injection  in  chronic  dysentery,  in  moder- 
ately strong  solutions  (1  dr.  to  1  oz.),  its  use  has 
been  recommended  ;  and  it  often  heals  painful  rec- 
tal ulcerations. 

The  chlorate  of  potflssium  will  bring  about  a  bene- 
tioial  etTect  in  chancroid,  api^lied  either  as  a  solution 
or  dusted  over  the  parts.  In  obstinate  and  chronic 
ulcerations,  gangrenous  sores  and  ulcers  discharg- 
ing fetid  secretion,  the  application  of  the  salt,  either 
•alone  or  dissolved  in  water,  possesses  peculiar  ad- 
vantages on  account  of  its  healing  and  deodorizing 
qualities. 

In  pustular  eczema,  particularly  in  cases  occur- 
ring in  scrofulous  children,  the  use  of  a  sohition  • 
containing  one  or  two  drachms  to  the  pint  of  water, 
applied  with  old  muslin,  will  very  frequently  lessen 
the  discharge  and  Iieal  the  surface. 

Glands  that  are  broken  down,  filled  with  juis,  and 
sinuses  connecting  tliese  parts,  are  benefited  by 
washing  them  with  a  saturated  solution  of  chlorate 
of  i^otassium. 


THE  MEDICAL  RECORD. 


67  5 


Dr.  Shoemaker  next  referred  to  its  internal  use, 

,  and  said  that  the  chlorate  of  potassium,  as  a  remedv 

in  croui>  and  dij^htheria,  had  been  used  with  great 

adv^iutage  from  the  time  that  it  was  lii'st  success- 

fullj  applied  by  Chaussier  in  1819. 

He  had  used  the  chlorate  of  potassium  with  the 
most  marked  benefit  in  phthisis. 

In  marasmus,  particularly  of  children,  the  use  of 
small  doses  of  this  salt  has  a  very  satisfactoiy  and 
beneficial  influence. 

For  diseases  of  the  skin  the  chlorate  of  potassiiim, 
given  in  various  doses,  according  to  the  ability  with 
which  the  patient  bears  the  diiig,  is  of  the  greatest 
value  either  in  modifying  or  curing  very  many  cuta- 
neous affections.  He  has,  at  times,  very  often  suc- 
ceeded in  aborting  or  curing  many  pustular  diseases 
with  moderate  doses  of  chlorate  of  potassium.  It  is 
especially  efficacious  in  ecthyma,  particularly  in 
those  who  are  broken  down  in  health.  In  boils,  car- 
buncles, stys,  jjustular  acne,  pustular  eczema,  and 
sycosis,  it  lessens  the  tendency  in  many  to  suppura- 
tion, and  should  this  latter  condition  be  established 
before  administering  the  salt,  it  will  be  lai-gely  in- 
strumental in  overcoming  the  >ibnormal  state  of  the 
system. 

Dr.  Shoemaker  further  spoke  of  the  good  effects 
produced  from  its  use  in  scurvy,  influenza,  yellow 
fever,  rheumatism,  cyanosis,  hemorrhagic  diathesis, 
dropsy,  syphilis,  etc.,  and  then  gave  the  manner  of 
its  administration. 

If  the  salt  is  given  in  small  doses  it  will  pass 
quickly  and  more  readily  into  the  circulation  taken 
before  meals,  diluted  with  water.  If,  on  the  other 
hand,  very  large  doses  are  administered,  it  will 
l^robablybe  better  borne  by  the  stomach  after  meals. 
It  is  be-st  given  dissolved  in  simple  water,  although 
its  taste  may  be  entirely  disguised  by  adding  the 
salt  to  an  effervescent  powder  and  mixing  the  latter 
with  lemonade.  Milk,  neutral  mixture,  and  the 
bitter  infusions  and  tinctures  are  also  good  vehicles 
for  chlorate  of  potassium.  The  dose  will  vary  ac- 
coi-ding  to  the  affection  and  the  condition  of  the  pa- 
tient. He  usually  gives  it  in  from  one-half  to  thirty 
grain  doses  every  one,  two,  or  three  hours,  freely 
diluted  with  water.  In  the  above  doses  it  is  well 
borne  by  the  stomach,  even  in  those  who  are  very 
weak  and  enfeebled.  He  generally  begins  with  a 
small  dose,  and  gradually  increases  it  until  the  jaa- 
tient  shows  some  sign  of  its  effect  or  he  sees  im- 
provement in  the  disease.  Those  who  are  large, 
flabby,  and  apparently  vigorous,  will  improve  under 
smaller  doses,  as  large  amounts  will  sometimes 
serve  to  still  more  increase  the  quantity  of  fat 
on  the  body.  On  the  other  hand,  the  pale,  weak, 
and  enfeebled  will  bear  much  larger  doses,  and  will 
often  increase  very  rapidly  in  weight. 

Dr.  Hollister,  of  lUinois,  thought  the  remedy 
acted  either  through  the  oxygen  or  the  chlorine,  or 
through  the  combination  of  these  two  agents. 

Dr.  Gaxt,  of  Mississippi,  believed  that  it  was  an 
anti  fermentative,  and  acted  like  an  antiseptic. 

Dr.  Bennett,  of  Michigan,  regarded  it  as  an  elim- 
inator of  morbid  material,  and  as  an  excellent  anti- 
septic, whether  used  locally  or  internally,  in  dii>h- 
theria,  particularly  sthenic  cases. 

Dr.  X.  S.  Davis,  of  Chicago,  thought  it  produced 
its  effects  by  the  liberation  of  oxygen  in  the  blood. 
In  the  cyanosis  of  young  children  suffering  from 
imperfect  closure  of  the  foramen  ovale,  he  had  used 
the  remedy  internally  with  marked  benefit.  He 
said  that  the  remedy  acted  in  three  ways  :  1,  by  in- 
troducing free  oxvgen  into  the  blood  ;  2,  by  stimu- 


lating the  nervous  centres  and  the  nei-ve-cells  them- 
selves ;  and  3,  by  acting  upon  the  atoms  promoting 
tissue  change. 

Dr.  Lester,  of  Kansas  City,  had  used  it  success- 
fully in  aniemia,  and  believed  that  it  increased  the 
number  of  red  blood-corpuscles. 

Dk.  Boyd,  of  Indiana,  thought  that  the  modus 
operandi  of  the  drug  was  not  known.  Nevertheless, 
we  should  not  hesitate  to  use  it  in  cases  in  which  it 
had  been  found,  by  experience,  to  be  beneficial. 
So  far  as  its  use  in  diphtheria  was  concerned,  he 
preferred  quinine  and  iron. 

Dr.  Beld,  of  Kansas,  was  of  the  opinion  that 
physicians  used  the  remedy  moi'6  twenty  years  ago 
than  at  the  present  time,  and  that  it  had  not  been 
found  generally  useful  in  malignant  diphtheria  and 
scarlet  fever.  It  was  most  beneficial  as  a  local  ap- 
plication to  mucous  membranes. 

Dr.  H.  F.  Caiipbelij,  of  Georgia,  then  spoke  on 

THE   USE   OF   TOBACCO   AS   A   CAUSE   OP   DISEASE, 

and  also  of  the  deprivation  of  the  patient  of  tobacco 
who  had  been  accustomed  to  its  iise.  He  thought 
it  possible  that  small  doses  of  nicotine  or  the  tinc- 
ture of  tobacco  might  be  necessary  in  some  cases. 

Dr.  Prinoe,  of  Illinois,  thought  that  the  use  of 
tobacco  under  the  cii'cumstances  indicated  by  Dr. 
Campbell  was  unnecessary,  and  Dr.  Shoemaker  be- 
lieved that  inasmuch  as  the  taste  for  the  weed  was 
usually  absent  in  such  cases,  the  system  did  not  re- 
quire it. 

Dk.  Octerlont  referred  to  a  case  of  cancer  of  the 
stomach,  in  which  the  first  symptom  noticed  was  a 
distaste  for  tobacco. 

The  Section  then  adjourned  to  meet  "Wednesday, 
at  3  P.M. 


Wednesday,  Junt:  7th — Second  Day. 

Dr.  J.  V.  Shoemaxer,  of  Philadelphia,  read  a 
paper  on 

the   treatment   of   syphilis    by    SrrBCUTAXEOUS    SUB- 
LIMATE injeotions. 

He  spoke  at  length  of  the  progi-ess  in  medicine 
of  the  hypodermic  method  of  treating  diseases, 
from  its  tu-st  use  by  Alexander  Wood,  of  Edinburgh 
— whose  experiments  date  since  1853 — np  till  the 
present  time.  The  first  to  use  hypodermic  injec- 
tions of  mercurial  salts  was  Scarenzio,  of  Pavia,  who 
was  soon  after  followed  by  Hebra,  Hunter,  Lemin, 
Martineau,  etc.  Some  three  or  more  years  ago  he 
began  this  treatment  in  all  the  syphilitic  patients 
presenting  themselves,  and  he  has  now  one  hun- 
dred and  thirteen  cases  which  he  has  treated — in 
the  American  Hospital  for  skin  diseases,  in  the  dis- 
pensai-y,  and  in  his  private  practice — with  the  sub- 
cutaneous injection  of  corrosive  sublimate,  and  with 
most  excellent  results. 

Of  this  number,  sixty-four  of  the  men  and  twenty- 
six  of  the  women  were  affected  with  the  various 
syx^hilitic  eruptions  of  the  skin.  There  were  seven 
of  the  men  and  one  of  the  women  affected  with 
gummata  of  the  cellular  tissue.  Six  of  the  men  and 
one  of  the  women  suffered  from  syphilitic  disease 
of  the  bones.  Three  men  and  one  woman  had  syj^h- 
ilitic  affections  of  the  larynx ;  and  one  man  and 
one  woman  were  affected  with  syphilitic  iritis. 

In  his  practice  he  usually  selected  for  his  hypo- 
dermic injections  a  good  glass  syringe.     Experience 


676 


THE  MEDICAL  RECORD. 


has  proven  to  him  that  these  were  the  best.  To 
these  syringes  he  ordered  specially  long  needles,  of 
tbe  length  of  one  ami  a  half  inch  or  so,  because  his 
object  was  to  penetrate  deeply  into  the  subcuta- 
neous cellular  tissue.  He  has  learned  from  the 
experience  of  others  that  the  cause  of  the  abscess 
following  hypodermic  injections  of  corrosive  subli- 
mate was  due  either  to  the  use  of  a  very  short 
needle,  that  would  not  penetrate  sufficiently,  or  to 
the  operator  who  may  have  failed  to  push  it  far 
enough  into  the  integument ;  and  should  the  latter 
be  the  case,  the  fluid  will  be  deposited  in  the 
stratum  of  the  cuticle  in  which  the  absorbent  ves- 
sels are  wanting,  and  inflammation  will  undoubt- 
edly supervene,  causing  abscesses.  If,  on  the  other 
hand,  tbe  operator  has  a  sufficiently  long  needle, 
and  will  take  the  precaution  to  drive  it  down  to  the 
cellular  tissue,  which  is  abundantly  sujiplied  with 
absorbent  vessels,  no  injurious  effect  will  follow. 
He  always,  in  addition,  had  his  patients  in  private 
practice  to  own  and  carry  their  own  needles  to  pre- 
vent any  jjossible  contagion. 

He  found  gokl  to  answer  every  purpose,  as  it  was 
the  only  one  of  all  the  metals  not  affected  by  the 
sublimate  solution. 

His  gold  needle  is  always  in  good  order,  never 
rusts,  and  is  withal — in  proportion  to  the  other 
needles  he  uses— the  cheapest.  As  he  has  found 
the  rust  of  the  steel  needles  is  hastened  by  the  wire 
that  is  passed  through  it,  he  has  remedied  this  by 
using  bristles,  and  oiling  them  previously  to  pass- 
ing. 

The  solution  which  he  uses  is :  Corrosive  subli- 
mate, 1  part ;  distilled  water,  100  parts. 

After  using  all  the  various  combinations  upon  the 
cases  under  his  care,  he  came  to  the  conclusion  that 
plain  water  and  the  sublimate  gave  him  the  best 
results. 

The  parts  which  he  iisually  chose  for  the  injec- 
tion were  the  infi-a-soapular  and  sacral  regions, 
which  are  the  least  sensitive,  and  are  also  supplied 
with  a  large  quantity  of  subcutaneous  cellular  tis- 
sue in  which  to  inject  the  solution.  He  has  also 
made  injections  into  the  gluteal  regions,  on  either 
side,  into  the  tissues  on  the  side  of  the  thorax  and 
into  the  thighs  and  legs ;  but  his  conclusions  are 
that  the  infra-scapular  and  sacral  regions  are  decid- 
edly tlie  best,  as  in  hi.s  experience  the  pain  of  the 
injection  is  not  so  great  or  persistent  as  in  the  other 
parts. 

Tlie  skin  surrounding  the  puncture  became  a 
a  little  red  and  swollen  in  a  short  time,  which  dis- 
appeared at  longer  or  shorter  intervals,  at  the  most 
in  a  few  days' time — though  in  some  of  the  cases  the 
swelling  remained  for  quite  a  time,  forming  hard 
spots  about  the  size  of  a  shellbark,  which  would 
eventually  disappear  by  degrees,  leaving  no  bad 
results.  During  the  whole  time,  in  the  treatment 
of  the  113  oases,  he  gave  2,1.32  injections  in  the 
coTirse  of  20G  days,  and  had  not  had  any  inflam- 
mation or  abscesses. 

Of  these  cases,  36  disappeared  at  various  times 
during  the  cour.se  of  treatment,  and  failed  to  con- 
tinue the  same  to  a  complete  cure ;  (J8  took  from  day 
to  day  the  injections  until  they  were  discharged  ; 
and  of  the  number  41  were  entirely  cured  as  far  as 
he  has  been  able  to  learn  ;  the  i-emaining  27  had  re- 
lapses at  various  times  ;  10  having  a  first,  13  a  sec- 
ond, and  4  a  third,  whilst  there  are  '.)  under  treat- 
ment at  the  present  time,  receiving  their  injections 
d  aily. 

Of  those  suffering  from  relapses,  he  has  only  a 


record  of  5  that  have  entirely  recovered  ;  3  having 
recovered  in  the  first,  and  2  in  the  second  relapse. 
The  majority  of  these  relapses  were  due  to  the  hab- 
its of  the  patients  more  than  the  want  of  efficacy  of 
the  sublimate  injections. 

Many  of  the  patients  to  whom  he  gave  the  subli- 
mate injections  had  had  mercury  pieviously  given 
them  by  the  mouth,  without  any  decided  results 
either  uj'on  tl^e  disease  or  any  toxic  evidence  of  the 
absorption  of  the  mercury  by  the  intestinal  canal ; 
others  were  totally  unfit  to  receive  the  drug  in- 
ternally, being  debilitated  and  broken  down,  or 
having  weak  digestive  organs  and  an  irritable  state 
of  the  intestinal  tract.  In  such  patients  it  is  the 
only  medicinal  means,  he  believes,  that  can  be  used 
successfully  in  neutralizing  the  specific  poison  in 
the  system.  It  also  enables  the  physician,  as  in 
the  majority  of  the  cases  referred  to,  to  give  tonic 
remedies  by  the  mouth,  together  with  a  good,  sub- 
stantial, and  nourishing  diet  which  can  be  properly 
digested,  and  the  combination  will  act  promptly  and 
effectually  upon  the  disease. 

He  believes  this  method  to  be  the  most  speedy 
and  certain  way  of  eradicating  syphilis,  and  prevent- 
ing, at  the  same  time,  a  loss  of  flesh  and  vigor  of  the 
body  that  unquestionably  follows  pouring  digestive 
mercury  or  iodide  of  potassium  into  the  stomach. 
It  is  the  belief  of  Dr.  Shoemaker,  that  where  the 
hypodermic  use  of  the  sublimate  has  failed,  it  has 
been  entirely  due  to  the  carelessness  of  the  operator. 

From  the  experiments  he  has  made,  his  conclu- 
sions for  its  use  are  : 

First. — The  accitraci/  and  precision  of  the  dose. 
By  the  stomach  corrosive  sublimate  changes  into  an 
insoluble  albuminous  precipitate,  and  does  not  re- 
main long  enough  in  the  body  to  become  absorbed, 
and  hence  much  of  it  is  lost ;  so,  no  matter  how  pre- 
cise you  may  be  in  administering  the  drug  by  the 
mouth,  it  is  almost  certain  that  some  of  it  jmsses 
away  unabsorbed.  By  the  hypodermic  method  this 
is  entirely  done  away  with,  the  precise  dose  is  taken 
up  by  the  absorbents  into  the  system,  and  after  its 
object  has  been  attained  it  is  eliminated  through  the 
proper  channels. 

Secorul. — By  its  use  we  preserve  the  healthful  ac- 
tion of  the  stomach  and  bowels. 

Third. — Its  use:  That  we  may  use  it  in  almost  all 
cases — in  fact  in  all — without  any  baleful  results  is 
conclusive  to  its  application. 

In  conclusion,  he  related  some  of  the  reasons 
which  render  the  method  distasteful  to  many  phy- 
sicians : 

First,  a  dirty  syringe  or  a  rusty  needle  produces 
inflammation,  and  an  abandonment  of  the  method 
by  one  ;  again,  a  short  needle  or  a  failure  to  drive 
it  into  the  cellular  tissue  has  caused  an  abscess, 
and  non-success  to  another  ;  the  care  to  scatter  the 
solution  when  injected,  or  to  force  out  the  air  in  the 
needle,  gives  pain  to  the  patient  and  discourages  a 
third  ;  the  building  up  the  system  with  tonics  and 
good  food,  and  the  use  of  the  sublimate  at  the  same 
time,  has  been  overlooked  by  the  fourth,  and  the 
results  drop  below  his  expectation.  The  peculiar 
susceptibility  of  some  persons  to  certain  drugs,  in 
very  small  doses,  are  lost  sight  of,  the  meroui^  sud- 
denly poisoning  the  p.itient,  and  the  physician  con- 
demns the  method. 

The  paper  was  discussed  by  Drs.  Gallaher,  of 
Pittsburg,  Pa.  ;  Frve.  of  Oyster  Bay,  N.  Y.,  and  J. 
H.  Bennett,  of  Cold  Water,'  Mich. 

The  Section  then  adjourned. 


THE  MEDICAL  RECORD. 


617 


Thubsdat,  June  8th— Third  Day. 
Dr.  M.  D0NNEDI.T,  of  New  York,  read  a  paper  on 

SALICYLATE      OF     POTASSA,     AND     ITS     USE     IN     ACUTE 
RHEUMATISM   AND   DYSPEPSIA. 

"^  After  reviewing  the  history  of  the  introduction  of 
this  remedy  for  acute  articular  rheumatism,  speak- 
ing of  the  efficacy,  and  alhidiug  to  the  liability  to 
cardiac  colnplications  while  it  is  being  administered, 
Dr.  Donnelly  said  that  he  had  been  making  experi- 
ments, hoping  to  find  some  alkali  which  could  be 
combined  with  the  salicylic  acid  and  make  a  more 
thoroughly  alkaline  salicylate  than  that  given  by 
coml)ination  with  soda.  Such  an  alkali  he  hail 
found  in  the  bicarbonate  of  potash — two  parts  of 
bicarbonate  of  potash  and  one  part  of  salicylic  acid 
dissolved  in  a  small  quantity  of  water  gave  a  neutral 
solution.  The  potash  was  then  increased  in  quan- 
tity until  one  part  of  the  acid  united  with  two  parts 
of  potash — say  ten  grains  of  acid  to  twenty  grains 
of  alkali  in  a  drachm  of  water — formed  a  clear  alka- 
line solution.  This  solution,  evaporated  to  dryness, 
formed  the  salicylate  of  potassa.  This  compound 
was  soluble  in  double  its  weight  of  water,  was  rap- 
idly absorbed,  and  in  mild  cases  the  urine  and  per- 
spiration could  be  made  alkaline  within  a  few  hours ; 
in  severe  cases  several  days  might  be  required. 

Dr.  Donnelly  had  also  found  the  compound  veiw 
beneficial  in  the  treatment  of  flatulence,  jjyi'osis, 
and  dysijejisia  of  the  acid  form.  He  recommended 
it  as  a  substitute  for  any  of  the  bitter  tonics  so 
commonly  used  in  most  of  these  cases  of  loss  of  ap- 
petite. 

Dk.  HoLiiisTER,  of  Chicago,  had  used  the  salicy- 
lates with  marked  benefit.  He  directed  attention  to 
their  liability  in  large  doses  to  reduce  the  force  of 
the  heai't's  action. 

Dr.  Wycoff,  of  Buffalo,  had  used  salicylate  of 
potash  with  good  results,  and 

Dr.  G.UiLAHER,  of  Pittsburg,  doubted  the  claimed 
superiority  of  salicylate  of  potash  or  the  soda  com- 
pound. 

Dr.  Thomas  N.  Keynolds,  of  Detroit,  had  used 
salicylate  of  soda  with  benefit  frequently,  but  not 
invariably,  in  rheumatism.  He  believed  cases  should 
be  selected,  if  possible,  in  the  administration  of  any 
form  of  treatment.  Had  seen  good  results  from 
hourly  minim  doses  of  hydrochloric  acid  in  water 
alone,  in  acute  rheumatism,  which  suggested  to  him 
that  the  alkaline  treatment  was  not  always  an  indis- 
pensable element  in  the  treatment  of  rheumatism. 
Constitutional  and  local  miasmatic  and  climatic 
influeaoes  often  determined  the  line  of  treatment, 
and  we  should  not  reh  too  conclusively  on  any  one 
drug  or  plan  of  management. 

Dn.  Kyle,  of  Indiana,  thought  salicylates  of  soda 
and  potash  useful,  but  found  quinine  and  iron  in- 
dispensable in  malarious  districts. 

Dr.  Shoemaker,  of  Penn.sylvania,  thought  that 
potash  was  required  in  rheumatism. 

Dr.  John  A.  Octerlony  thought  the  soda  and 
potassa  salicylates  were  more  particularly  appli- 
cable in  recent  and  very  acute  cases  with  high  fever. 
In  the  obese,  alkalies  were  more  beneficial.  In 
sthenic  cases,  aconite  and  veratrum  viride  often  pro- 
duced most  rapid  and  satisfactory  results.  In  the 
ana;mic  and  weak  he  preferred  large  doses  of  tinc- 
ture of  the  chloride  of  iron. 

After  adopting  a  resolution  extending  a  vote  of 
thanks  to  the  Chairman  and  Secretary  for  their  faith- 
ful, efficient,  and  courteous  discharge  of  their  duties, 
the  Section  adjourned. 


SECTION  ON  ORAL  AND  DENTAL  SURGERY. 

Dr.  D.  H.  Goodwillie,  of  New  York,  Chairman. 
Dr.  Truman  G.  Brophy,  of  Chicago,  Secretary. 

Tuesday,  June  6th — First  Day. 

The  Chair  appointed  Drs.  Allport,  Brophy,  and 
■Williams  sub-committee,  to  which  all  jiajjers  read 
before  the  section  should  be  I'eferred. 

Dr.  William  D.  Kempton,  of  Cincinnati,  presented 
a  paper  on 

ORAL   hygiene, 

of  which  the  following  is  a  synopsis  : 

From  the  beginning  the  sole  aim  of  practitioners 
was  to  discover  a  cure  for  disease  and,  although 
sometimes  harmful,  tlie  medication  received  the 
credit.  Now,  one  of  the  main  objects  of  practi- 
tioners is  to  pi-event  disease.  The  profession  is  in- 
debted to  specialists  for  many,  if  not  most,  of  these 
discoveries,  as  they  are  more  apt  to  arrive  at  defi- 
nite results  than  those  whose  attention  is  occupied 
with  the  whole  field  of  medicine. 

Oral  hygiene  was  very  important,  and  the  evils 
arising  from  the  neglect  of  it  were  far  reaching. 
Good,  healthy,  even  strong  teeth  were  beautiful  as 
well  as  serviceable,  and  indicated  care.  But  when 
we  find  one  whose  teeth  resemble  the  charred  trunks 
of  stately  trees  after  the  fiery  scourge  has  visited 
the  forest,  and  whose  breath  is  suggestive  of  a  cess- 
pool, we  ask,  whence  comes  this  sad  havoc  ? 

Dr.  Kempton  then  entered  into  a  careful  analysis 
of  the  teeth,  giving  their  elements  and  functions, 
and  the  acid  theory  of  decay  by  Dr.  George  W'att, 
with  the  factor  that  modifies  the  action  of  acids,  viz., 
vitality.  Then  followed  a  list  of  the  evils  reeulting 
from  diseased  teeth,  showing  that  the  whole  .system 
was  more  or  less  affected  and  deranged  ;  many  of  the 
cases  of  headache,  earache,  aiiectioijs  of  the  eye,  find 
stomach  being  traceable  oftentimes  to  badly  decayed 
teeth. 

The  doctor  closed  his  paper  with  directiotis  for 
preventing  decay  in  teeth,  prefacing  with  the  re- 
mark that  those  teelh  ir  which  decay  had  already 
set  in  should  be  either  extracted  or  filled.  Physi- 
cians should  feel  it  their  duty  to  point  out  to  their 
patients  the  results  of  neglect  of  the  teeth,  and  no 
medical  school  should  consider  its  curriculum  com- 
plete unless  some  attention  is  paid  to  the  teeth. 

phosphates  in  food. 

The  paper  was  discussed  at  length  by  Drs.  'Wil- 
liams, Talbot,  Allport,  Lawrence,  Marshall,  Good- 
willie, Ellmer,  Eeed,  and  others,  during  which  the 
subject  of  phosphates  in  food  was  introduced.  The 
enamel  of  the  teeth  is  composed  mainly  of  phos- 
phate of  lime,  and  Dr.  Allport  was  very  earnest 
when  he  made  the  remark  that  our  food  should  be 
taken  as  nearly  as  possible  in  the  condition  in  which 
God  prepared  it.  He  referred  especially  to  wheat, 
asserting  tliat  the  so-called  pstent  process  of  mak- 
ing flour  eradicated  much  of  the  phosphate  in  the 
wheat,  the  result  being  that  not  enough  of  this  was 
left  to  keep  the  teeth  strong  and  healtJiy.  He  did 
not  advocate  the  use  of  phosphates  alone,  but  he 
did  protest  against  food  which  had  not  enough  of 
them  to  keep  the  system  and  teeth  in  perfect  order. 

Dr.  Lawrence  antagonized  the  stress  placed  upon 
this  subject,  alleging  that  other  elements  were  as 
necessary  as  phosphates. 

The  Section  then  adjourned  to  meet  at  .3  p.m.  on 
Wednesday. 


678 


THE  MEDICAL  EECORD. 


Wednesday,  June  7th — Second  Day. 
heredity  in  dental  development. 

Dr.  W.  C.  Bakrett,  of  New  York,  briefly  sketched 
a  case  which  had  come  under  his  observation,  and 
which  he  illustrated  by  plaster  casts,  showing  the 
persistence  of  heredity  in  dental  development. 

Da.  J.  S.  Marshall,  of  Syracuse,  N.  Y.,  then  read 
a  paper  on  "  The  Need  of  Dental  and  Oral  Surgeons 
in  the  Army  and  Navy."  The  following  is  a  synopsis : 

This  subject  has  often  been  brought  to  the  atten- 
tion of  the-  profession,  but  never  formally  till 
August,  1861,  at  the  American  Dental  Convention  in 
New  Haven,  where  it  was  referred  to  a  committee  of 
five,  who,  after  consultation  with  Surgeon-Gen- 
eral Hammond,  reported  favorably  to  the  appoint- 
ment of  dental  and  oral  surgeons  in  the  army  and 
navy.  In  1868  Senator  Hamlin  introduced  a  bill 
before  Congress  providing  for  the  appointment  of 
such  surgeons  in  the  army  and  navy,  but  this  meas- 
ure died  before  it  was  born.  The  second  attempt 
was  made  during  the  Forty-second  Congress  by  Rep- 
resentative Townsend,  who  merely  advocated  the 
api^ointment  of  such  surgeons  to  the  military  and 
naval  academies,  but  nothing  came  of  this  V)ut  the 
appointment  of  a  dental  surgeon  at  the  naval  acad- 
emy at  Anipolis  with  the  rank  of  assistant  surgeon. 
Dr.  Marshall  then  stated  the  necessity  existing  for 
such  appointments. 

The  government  provides  for  the  care  of  a  soldier 
in  all  cases,  except  where  his  teeth  are  concerned. 
Soldiers  on  the  frontier  and  sailors  on  a  long  cruise 
have  no  opportunity  of  receiving  dental  services, 
no  mitter  how  much  they  may  need  such  attention, 
and  the  disease  must  run  its  course,  being  turned 
over  to  the  bungling  of  the  hospital  steward  or 
some  le^s  competent  person.  The  treatment  of 
fractures  or  gunshot  injuries  of  the  lower  jaw  is  the 
same  as  twenty-five  or  thirty  years  ago,  being  much 
behind  the  times.  The  interdental  splint,  invented 
by  Dr.  .1.  B.  Bean,  of  Georgia,  during  the  civil  war, 
and  improved  by  Dr.  Norman  Kingsley,  of  New 
Y'ork,  is  a  very  great  improvement  in  the  treatment 
of  these  cases,  and  is  indorsed  by  the  best  surgeons 
the  world  over.  The  success  with  this  splint  has 
been  remarkable. 

The  objection  to  the  appointment  of  dental  and 
oral  surgeons  in  the  army  and  navy  is  that  the 
amount  of  oral  diseases  is  so  small  as  not  to  require 
filjecially  educated  surgeons  to  treat  them.  Di-. 
Marshall  then  gave  some  statistics  showing  the 
relative  number  of  men  iu  the  army  and  navj'  who, 
in  the  years  1878  and  1879,  were  reported  as  liaving 
needed  dental  services,  also  the  opinions  of  the  sur- 
geons general  of  the  army  and  navy,  General  Han- 
cock and  Admiral  Porter,  relative  to  the  appoint- 
ment of  such  surgeons.  To  petition  Congress  for 
action  is  useless,  without  the  heads  of  medical  de- 
jjartments  see  the  need  and  make  the  recommenda- 
tion. The  paper  closed  with  a  recommendation 
that  a  committee  be  appointed  by  this  Section  to 
an'ange  a  blank  statistical  report  covering  all  the 
dental  and  oral  diseases,  and  request  tlie  surgeons 
general  of  the  army  and  navy  to  incorporate  them  in 
the  regular  medical  and  surgical  reports. 

Alively  discussion  followed  on  the  subject  of  the 
paper,  which  resulted  in  the  oft'oring  of  a  resolution 
by  Dr.  AUport  that  a  committee  of  three  bo  ap- 
pointed by  the  Section  who,  in  connection  witli  Dr. 
Maynard,  of  Washington  City,  and  the  surgeons  gen- 
oral  of  the  army  and  navy,  should  make  what  efforts 


they  deemed  advisable  regarding  the  ai^pointment 
of  dental  and  oral  siugeons  in  the  army  and  navy, 
and  to  report  to  the  association  next  year.  This 
motion  was  adopted,  and  Drs.  Allport,  Marshall, 
and  Williams  were  api^ointed  such  committee. 

FOOD   IN   ITS   RELATION   TO   THE   DEVELOPilENT   OF 

TISSUES. 

Dr.  Lawrence,  of  New  York  City,  presented  a 
resolution  calling  for  the  appointment  of  a  commit- 
tee to  consider  the  subject  of  food,  including  masti- 
cation, insalivation,  digestion,  and  assimilation,  in  its 
relation  to  the  development  of  the  different  tissues 
and  organs  of  the  body. 

Drs.  Lawrence,  Talbot,  and  Kempton  were  ap- 
pointed as  the  committee. 

The  Section  then  adjourned  to  meet  Thursday  at 

3  P.M. 


Thursday,  June  Sth — Third  Day. 

Dr.  Goodwillee  called  attention  of  the  Section 
to  cases  of 

necrosis  from  arsenic, 

and  illustrated  them  with  wax  models. 

Case  I.  showed,  by  two  models,  necrosis  of  lower 
jaw  from  each  ramus  forward.  The  case,  before 
and  after,  with  a  new  deposit  of  bone  without  any 
deformity.     Photograph  of  the  patient  also  shown. 

Case  II. — Two  models  showing  a  ca.se  of  poison 
by  arsenic  and  necrosis  of  right  superior  maxillary. 

a.  Showing  case  one  week  after  removal  of  ne- 
crosed bone;  without,  in  the  least,  disturbing  the 
soft  tissue ;  also  showing  the  formation  of  new 
bone. 

h.  The  new  bone  complete  and  the  mouth  per- 
fect ;  and  no  external  deformity. 

Case  HI. — Upper  maxillary  showing  abscesses 
formed  at  nearly  all  the  teeth,  the  result  of  apply- 
ing arsenic  to  destroy  sensibility  of  the  dentine  be- 
fore filling  the  teeth. 

The  above  served  to  show  the  sad  results  of  the 
improper  use  of  this  poweiful  agent  in  devitalizing 
dental  pulps. 

Dr.  Eugene  S.  Talbot,  of  Chicago,  then  read  a 
paper  on 

THE   injurious   EFFECTS   OF   MERCURY   AS    USED   Di 

dentistry. 

The  paper  was  confined  to  the  use  of  amalgam 
fillings  in  natural  teeth. 

"  There  can  no  longer  be  doubt  that  amalgam  fill- 
ings in  teeth  will  sooner  or  later  produce  mercurial 
poisoning.  The  dire  effects  of  this  metal  are  not 
always  seen  immediately  after  the  fillings  are  in- 
serted, years  sometimes  elapsing  before  the  injuri- 
ous effects  are  felt  and  noticed." 

The  history  of  two  well-marked  cases  were  given 
by  Dr.  Talbot,  the  persons  affected  having  called 
upon  him  for  treatment.  The  amalgam  fillings 
were  removed,  and  gutta  pereha  temporarily  sub- 
stituted, these  in  turn  being  roi>laced  with  gold, 
after  which  all  symptoms  of  mercurial  poisoning 
disapiieared.  A  detailed  account  of  a  series  of  ex- 
periments made  by  him  were  then  presented,  the 
conclusions  and  results  being  as  follows  : 

First. — Mercurial  vapor  is  given  off  from  amalgam 
fillings  at  all  ages  and  from  all  varieties,  even  from 


THE  MEDICAL  RECORD. 


679 


fillings  sixteen  years  old,  the  vaporization  being 
sufficient  in  quantity  to  respond  to  chemical  tests. 

Second. — Minute  doses  of  mercury,  if  taken  inter- 
nally three  times  a  day,  are  capable  of  producing 
decided  eSects. 

Third. — Mercury  when  inhaled  into  the  lungs  is 
far  more  active  than  when  taken  into  the  stomach. 

Fourth.  —  If  small  doses  taken  into  the  stomach 
occasionally  are  capable  of  producing  marked  ef- 
fects, and  the  vapor  is  much  more  active  than  the 
solid  preparations  of  the  metal,  is  it  not  a  necessary 
consequence  that  amalgam  fillings,  which  are  con- 
stantly giving  oli'  mercurial  fumes  to  be  inhaled  into 
lungs,  not  a  few  times  daily,  but  always,  without 
cessation,  day  or  night,  do,  in  many  sensitive  per- 
sons, produce  deleterious  eiiects? 

Fiflh. — When  tons  of  this  material  are  consumed 
annually,  is  it  not  credible  that  many  constitutions 
are  affected  ? 

Sixth. — Physicians  in  treating  dyspeptics,  anas- 
mics,  and  persons  suSering  from  nervous  debility, 
would  do  well  to  examine  the  mouths  of  patients 
and  know  if  artificial  teeth  on  red  rubber  or  fillings 
of  natural  teeth  have  in  their  composition  mercury 
or  any  of  its  compounds. 

EDUCATION   OF   DENTISTS. 

The  subject.  How  Dentists  should  be  Educated, 
was  presented  by  Dk.  W.  W.  Axlport,  of  Chicago, 
in  a  ixiper  of  considerable  length.  The  introduction 
was  a  review  of  dental  surgery- — it,  with  all  other 
branches  of  medicine,  having  emanated  from  a  com- 
mon centre,  and  the  possibility  was  that  in  the  fu- 
ture these  diverse  systems  would  more  and  more 
tend  to  consolidation. 

Dr.  AUport  then  said  that  the  dental  and  oral  sur- 
geon must  be  educated  both  in  mechanical  dentistry 
and  oral  surgery,  for  no  disease  can  be  intelligently 
treated  without  a  knowledge  of  the  histology',  anat- 
omy, and  the  physiology  of  the  organ  or  organs  dis- 
eased, as  well  as'  the  pathology,  prognosis  and  ra- 
tionale of  the  treatment  employed  to  restore  the 
parts  to  a  healthy  condition ;  and  this  is  medical 
science.  The  successful  oral  surgeon  must  have  a 
thorough  medical  education  in  all  its  branches,  sup- 
plemented by  special  instruction  in  dental  surgery. 
Over  forty  years  ago  Drs.  Harris,  Hayden,  and 
others  sought  to  establish  a  department  for  teaching 
dental  and  oriil  surgery  in  the  medical  department 
of  the  University  of  Maryland;  but  their  application 
was  refused.  Dr.  Harris',  however,  succeeded  in  or- 
ganizing what  was  known  as  the  Baltimore  College 
of  Dental  Surgerv,  and  the  graduates  of  this  institu- 
tion were  given  the  degree  of  D.D.S.— doctor  of  den- 
tal surgery.  In  addition  to  this,  several  medical 
colleges  have  been  induced  to  establish  dental 
schools  in  connection  with  their  medical  depart- 
ments, but  as  yet  none  of  these  institutions  have 
required  a  full  medical  education  of  their  dental 
graduates. 

All  dental  and  oral  surgeons  should  receive  a 
medical  education  and  become  legitimate  specialists 
in  its  practice,  and  all  medical  gi-aduates  should  be 
as  fully  educated  in  diseases  of  the  teeth  and  the 
science  of  their  treatment  as  they  are  in  other  dis- 
eases. 

Dr.  J.  B.  Lawrence,  of  New  York,  then  read  a 
paper  on 

MEDICO-DENTAL   SCIENCE, 

after  which  the  Section  adjourned. 


SECTION  ON  DISEASES  OF  CHILDREN. 

Dr.  William  Lee,  of  Baltimore,  Chairman. 
Dr.  E.  C.  Miller,  of  Iowa,  Secretary'. 

Wednesday,  June  7th. 

The  fii-st  paper  was  read  by  Dr.  N.  S.  Davis,  of 
Chicago,  on 

THE  means   of   lessening   THE   MORTALITY  OF  INFANTS 
FROM   BOWEL  AFFECTIONS. 

The  importance  of  the  subject  could  not  be  over 
estimated  when  it  was  remembered  that  one-third 
of  the  human  race  perish  before  they  reach  the  fifth 
year,  and  that  a  large  percentage  of  these  early 
deaths  are  the  direct  result  of  bowel  complaints. 

Nearly  all  the  sanitary  and  hygienic  measures  of 
the  present  day  are  aimed  at  the  removal  or  preven- 
tion of  the  cause  of  the  disease,  both  predisposing 
and  exciting.  But  there  are  many  influences  which 
either  predispose  to  or  excite  attacks  of  disease 
which  are  not  under  human  control.  The  problem 
presented  for  consideration  is  not  how  to  jjrevent  or 
destroy  them,  but  how  best  to  shield  the  human 
system  from  their  injurious  effects.  For  instance, 
bad  food  may  be  destroyed  and  good  substituted  ; 
bad  air  indwellings  maybe  changed  by  ventilation  : 
soil,  wet  and  of  decompcsed  matter,  may  be  drained 
and  cultivated,  but  the  meteorological  conditions  of 
the  atmosphere,  whether  they  relate  to  impurities, 
sudden  and  extreme  changes,  or  waves  of  continu- 
ous high  or  low  temperature,  are  not  amenalile  to 
our  control,  and  yet  much  can  be  done  to  mitigate  or 
prevent  their  injurious  effects.  Nearly  all  the  recent 
writers  on  the  diseases  of  children  class  the  cases  of 
serous  diarrhoea  and  cholera  morbus  in  children 
under  two  years  of  age,  usually  called  summer  com- 
plaint and'  cholera  infantum,  with  local  inflamma- 
tions under  the  general  name  of  catarrhal  gastro- 
enteritis ;  and  while  they  aU  assert  that  these  foims 
of  disease  are  most  prevalent  and  fatal  during 
the  warmest  months  of  summer,  they  set  forth,  as 
the  chief  causes,  improper  feeding,  impure  and 
changed  milk,  impure  air,  the  process  of  dentition  or 
teething,  and  overworked,  badly  fed,  and  unhealthy 
mothers. 

These  causes  are  represented  to  produce  gastric 
or  intestinal  indigestion,  or  both,  Tihich  so  in- 
crease the  irritation  of  the  mucous  membraBes  as  to 
cause  a  more  or  less  rapid  serous  exudation  into  the 
gastro-intestinal  canal.  Indigestion  is  generally  re- 
garded as  the  cause  of  the  catarrhal  irritation,  while 
the  cause  is  the  result  of  bad  feeding,  ini]nire  air, 
teething,  and  unhealthy  mothers.  Bad  milk  is  also 
alleged  to  be  another  cause.  Other  causes  produce 
efi'ects. 

Bad  milk  and  food  are  prevalent  in  all  communi- 
ties during  the  winter  as  well  as  summer.  Children 
cut  their  teeth  in  December  as  in  July,  and  un- 
healthy mothers  exist  during  one  part  of  the  year  as 
well  as  another.  If  any  of  these  causes  produced 
infantile  cholera  it  would  be  frequent  in  all  seasons. 
The  records  show  that  the  prevalence  of  all  gi-ades 
of  these  two  forms  of  disease  are  restricted  almost 
entirely  to  the  time  between  the  last  week  in  June- 
and  the  last  in  September.  In  Chicago,  in  1872, 
the  reports  of  the  Board  of  Health  show  8  deaths  in 
April,  6  in  Mav,  2.S  in  June,  240  in  July,  163  in  Au- 
gust, 69  in  September,  13  in  October,  and  2  during 
the  rest  of  the  year.  Other  years  show  the  same 
results,  and  in  all  northern  and  eastern  cities  the 
ratio  is  the  same.     The  diseases  prevail  little  in  cities 


680 


THE  MEDICAL  RECORD. 


so  located  that  there  is  only  a  short  range  of  tem- 
perature between  the  warmest  days  of  summer  and 
the  coldest  of  winter,  and  where  the  sea  breezes  and 
other  causes  make  the  summer  nights  cool.  The 
milk  distributed  in  San  Francisco  and  New  Orleans 
is  the  same  as  that  in  Boston  and  Chicago,  and  the 
nursing  mothers  are  no  more  free  from  mental  and 
physical  intirmities.  An  examination  of  the  statistics 
of  these  several  cities  shows  a  ratio  of  only  about  five 
deaths  from  cholera  infantum  annually  for  every 
10,000  inhabitants  in  San  Francisco,  seven  in  New 
Orleans,  twenty-five  in  Boston,  and  thirty  in  Chicago. 
There  must  therefore  be  some  efficient  cause  not 
common  in  all  large  cities. 

A   RECOKD   OF   THE   DISEASE 

and  coincident  meteorological  conditions  of  atmos- 
phere were  commenced  some  years  ago,  and  for 
three  years  records  were  kept  in  Cairo,  Davenport, 
and  Omaha.  The  reports  of  these  records  were  given 
in  this  association  and  published  some  years  ago, 
and  .showed  : 

First. — That  the  prevalence  of  the  afiections  under 
consideration  is  limited  pi-incipally  to  July,  August 
and  September,  commencing  with  the  first  wave  of 
high  atmospheric  heat  that  continues  days  and 
nights  for  more  than  five  days,  which,  in  the  latitude 
of  Chicago,  is  sometimes  the  last  week  of  June,  but 
more  frequently  the  first  week  in  July,  and  continues 
more  or  less  during  the  succeeding  ninety  days. 

Second. — That  while  the  deaths  from  these  affec- 
tions in  any  city  or  given  community  will  be  nearly 
the  same  in  the  two  first  months  after  they  begin  in 
July  and  August,  the  date  of  the  initial  symptoms  or 
beginning  of  the  disease  in  three-fourths  of  all  the 
cases  will  be  in  July,  very  few  originating  after  the 
first  of  August.  Many  cases  commencing  in  July 
continue  until  the  months  of  August  or  September, 
causing  wasting  and  death. 

Third. — -That  it  is  not  simply  high  or  extreme  heat 
of  temporary  duration,  such  as  that  of  a  single  day 
or  any  number  of  days,  with  cool  nights,  which 
favors  the  development  of  the  disease,  but  contin- 
uous high  temperature  day  and  night  for  several 
days;  and  if,  in  addition  to  the  heat,  the  air  be 
stagnant  fi-om  lack  of  winds  or  obstructions,  as  in 
large  cities,  or  from 

DEFECTIVE   VENTILATION, 

the  effect  is  greatly  increased.  This  explains  why 
these  affections  are  more  numerous  and  fatal  in 
cities  than  in  rural  districts,  and  why  they  prevail 
so  little  in  even  large  cities  located  in  warm  climates, 
provided  the  location  be  such  as  to  affoi-d  cool 
breezes  at  night. 

Fourth  — That  while  the  great  majority  of  attacks 
which  occur  in  any  given  summer  are  found  to  have 
their  beginning  in  July,  or  during  the  first  thirty  or 
forty  days  after  the  first  wave  of  protracted  high 
temperature  for  the  season,  they  are  not  equally 
distributed  over  the  whole  of  the  month. 

Having  thvis  traced  the  origin  of  that  part  of  in- 
fantile mortality  caused  by  this  disease.  Dr.  Davis 
inquired  Iiow  this  combination  of  cii'cumstances  could 
affect  the  living  human  body.  We  have  the  physical 
law  tliat  the  higher  the  temperature  of  the  air  the 
rarer  it  becomes  and  the  less  oxygen  is  contained  in 
it.  A  person  breathing  at  a  high  temperature  would 
receive  less  oxygen  than  at  a  lower  temperature. 
Stagnant  air  becomes  more  rapidlv  exhausted  than 
moviag,  and  the  physical  law  of  expansion  by  increase 
applie  i  to  the  living  as  well  as  to  dead  matter ;  con- 


sequently high  heat  acting  on  the  living  body  tends 
to  increase  the  distance  of  the  atoms  from  each 
other  and  thereby  lessen  the  force  of  vital  affinity, 
while  it  increases  the  excitability  or  su.sceptibility 
to  impression.  The  capacity  of  the  blood  for  taking 
up  oxygen  or  holding  it  in  suspension  depends  much 
upon  the  proportion  of  saline  elements  it  contains, 
and  vmder  a  continuous  high  temperature  the  in- 
crease of  cutaneous  exhalation  lajiidly  diminishes 
the  free  salts  of  the  blood  and  lessens  the  capacity 
to  receive  the  oxygen  from  the  air-cells  of  the  lungs 
in  exchange  for  its  carbonic  acid  gas.  Colitis  and 
recto-colitis  or  dysenteiT  seldom  occur  until  late  in 
the  season,  when  warm  days  are  followed  by  cool 
nights  and 

FREQUENT   CHANGES   FROM   HEAT  TO  IVET   AND   COLD. 

occur,  and  even  the  indigestion  which  has  been  so 
generally  suggested  as  a  cause  of  summer  complaint 
is  itself  the  result  of  the  impairment  of  natural 
gastric  and  intestinal  secretions,  and  the  increase  of 
more  serous  exudation — the  primary  fault  not  being 
so  much  in  the  quality  of  food  as  in  the  morbidly 
sensitive  and  relaxed  condition  of  the  whole  inner 
surface  of  the  digestive  canal.  The  children  are 
affected  more  than  older  persons,  because  of  the  less 
mature  development  and  gi-eater  sensitiveness  of 
their  gastric  and  intestinal  mucous  memln-anes  and 
glandular  structures  and  their  much  more  constant 
confinement  indoors.  If  this  is  correct,  it  indicates 
clearly  that  our  efforts  to  lessen  infant  mortality 
from  these  diseases  must  embrace  such  measures  as 
will  secure  for  young  children  a  better  supply  of 
fresh,  pure  air,  for  increasing  the  oxygenation  and 
discarbonization  of  the  blood  and  maintaining  the 
activity  of  the  vaso-motor  nervous  system,  and  as  well 
counteracting  the  effects  of  high  temperature  by  in- 
creasing the  general  tonicity  and  lessening  the  ex- 
citability of  the  tissues  generally.  Measures  for  the 
fii'st  object  must  consist  in  securing  better  ventila- 
tion of  dwellings  and  especially  nurseries  and  sleep- 
ing rooms  during  the  warmest  part  of  the  summer, 
the  sending  of  young  children  with  their  mothers 
and  nurses  from  densely  i^opulated  districts  to 
moderately 

ELEVATED,  HEALTHY  LOCATIONS, 

or  to  floating  hosi^itals,  receiving  ships,  or  large 
bodies  of  water,  during  the  special  period  of  high 
heat.  For  accomplishing  the  second  purpo.se,  he 
knew  of  no  measures  so  efficient,  and  at  the 
same  time  within  the  reach  of  the  poorest  part  of 
the  population,  as  the  judicious  use  of  the  sponr/e 
bdth.  Whenever  the  human  system  is  relaxed  and 
rendered  morbidly  sensitive  by  continuous  high 
heat,  causing  the  infant  to  be  languid,  restless,  and 
sometimes  pale,  a  free  l)athing  or  sponging  of  the 
whole  surface  witli  water  sini])ly  as  cool  as  is  com- 
fortable, always  produces  a  refresliing  and  invigor- 
ating influence,  which  continues  from  six  to  twelve 
hours.  Consequently,  if  mothers  and  nurses  could 
be  so  instructed  l)y  their  family  physician  that,  du- 
ring every  wave  or  period  of  liigh  atmospheric  tem- 
perature in  which  the  mercury  did  not  fall  below 
70"  F.  during  the  night,  each  child  under  two  years 
of  age  should  be  regularly  given  a 

FULL   SPONOE   BATH    IN    THE   E^-ENINO 

as  well  as  in  the  morning,  and  their  sleeping  rooms 
should  be  as  well  ventilated  as  possible,  such  a 
cour.se  would  diminish  the  attacks  of  serous  diar- 
rhoua  and  cholera  infantum  one-lialf,  and  conse- 


THE  MEDICAL  RECORD. 


681 


liiently  very  greatly  lessen  the  infant  mortality  from 
those  affections. 

It  is  well  known  to  every  careful  observer  that  a 
large  majority  of  all  the  attacks  of  this  form  of  dis- 
ease show  their  first  beginning  during  the  last  half 
of  the  night  or  early  in  the  morning,  owing  to  the 
long  continuance  of  the  high  temperature,  coupled 
with  the  more  still  and  confined  air  of  the  night. 
The  increased  tone  of  the  whole  vascular  system 
produced  by  the  stimulant  and  tonic  effect  of  a  com- 
fortably cool  sponge  bath  on  the  function  of  the 
vaso-motor  nerves,  applied  in  the  evening,  would 
enable  thousands  of  these  little  restless  sufferers  to 
pass  the  whole  night  unharmed,  when  without  it 
the  dread  weakness  would  begin.  The  views  pre- 
sented in  regard  to  the  causes  and  nature  of  the 
affections  called  summer  complaint  and  cholera  in- 
fantum also  afforded  clear  indications  for  the  most 
rational  and  successful  explanation  of  remedial 
agents  in  the  treatment  of  those  affections  in  all 
their  grades  of  activity. 

Dr.  William  Lee,  of  Baltimore,  then  read  a  pa- 
per entitled 

OBSERVATIONS   ON   RICKETS, 

which  was  discussed  by  Drs.  A.  W.  Warden,  of  New 
York,  and  N.  S.  Davis  and  C.  W.  Earle,  of  Chicago. 
The  Section  then  adjourned. 


SECTION  IN  STATE  MEDICINE. 

Dr.  a.  L.  Gihon,  United  States  Navy,  Chairman. 
Dr.  J.  H.  Se.vrs,  of  Waco,  Tex.,  Secretary. 

VAOCINE    VTRUS. 

This  subject  was  brought  before  the  Section 
through  a  communication  transmitted  from  the 
Wayne  County  Medical  Society,  Indiana,  which 
contained  a  resolution  asking  for  the  passage  of  a 
law  making  it  a  crime  for  any  establishment  to  dis- 
tribute bovine  vaccine  virus,  unless  such  establish- 
ment had  received  the  indorsement  of  the  National 
Board  of  Health. 

A  general  discussion  en.sued,  in  which  cases  of 
poisoning  from  the  use  of  impure  and  diseased  vi- 
rus were  cited,  etc.,  and  finally  the  subject  was 
practically  tabled. 

Dr.  John  G.  Lee,  of  Philadeli^hia,  then  read  a 
paper  on 

SUICIDE    IN    THE    CITY    AND    COUNTY    OF    PHILADELPHIA 
DURING    THE   LAST   DECADE. 

From  December  31,  1871,  to  January  I,  I88I,  out 
of  12,936  deaths  re:iuiring  a  coroner's  investigation, 
63G  were  from  suicide,  or  a  ratio  of  53  to  1,000  in- 
quests. 

In  opposition  to  the  experience  of  European  ob- 
servers, he  had  found  that  suicide  occurred  most 
frequently  among  the  married  of  both  sexes.  Of 
the  636  cases,  in  ill  the  persons  were  married,  in 
138  single,  and  in  51  unknown.  Of  the  -iU  there 
were  370  men  and  71  women.  Of  the  138  unmar- 
ried, 109  were  males  and  29  females  Of  tlie  51 
whose  condition  was  unknown,  47  were  males  and 
7  females.  Tlie  suicides  occurred  by  groups  of 
months,  as  follows  :  Mav,  78  ;  August,  71 ;  and  Sep- 
tember, 57  ;  October,  51 ;  July,  51 ;  and  April,  54  ; 
June,  52;  November,  49;  and  December,  14;  Feb- 
ruary, 44;  March,  43;  and  January,  36.  Of  the 
636  cases,  21  were  minors.  The  greatest  number 
were  between  the  ages  of  thirty  and   fifty  years. 


The  causes  of  death  were  :  hanging,  119  males,  22 
females;  shooting,  114 males,  8  females;  laudanum, 
79  males,  17  females;  cutting  throat,  70  males,  13 
females;  drowning,  46  males,  11  females;  arsenic, 
11  males,  8  females.  The  remainder  took  their 
lives  in  various  ways. 

SICKNESS   AND   MORTALITY    IN    THE   ARMY, 

was  the  title  of  a  paper  sent  by  Dr.  Smith,  of  the 
United  States  Army. 

Dr.  James  F.  Hibbard,  of  Indiana,  to  whom  the 
paper  was  referred,  presented  the  following  ab- 
stract : 

Surgeon  Smith  opens  his  communication  with  two 
questions,  viz.  : 

First. — Has  State  medicine  progressed  within  the 
past  few  years  ?  and 

Second. — Has  its  progress  been  marked  by  a  dimi- 
nution of  disease  and  death  ? 

And  he  has  contributed  such  answers  to  his  ques- 
tions as  he  found  in  an  analysis  of  the  Surgeon- Gen- 
eral's reports  of  disease  and  death  in  the  army  from 
1871  to  1881,  both  inclusive,  i.e.,  eleven  years. 

He  presents  a  table  of  eleven  columns,  giving  the 
particulars  for  each  year  under  the  heading  of  each 
column. 

The  eleventh  column  gives  the  mean  strength  of 
the  army  at  25,599  ;  the  fourth  column  gives  the  sick- 
rate  per  year  per  1,000  at  1,598  ;  i.e.,  every  man  in  the 
army  was  sick  over  one  and  one-half  times  per  year, 
and  the  death-rate  was  8.71  per  1,000  of  mean 
strength  per  year,  while  the  death-rate  for  the  sick 
was  4.63  per  1,000.  The  sickness  among  the  white 
and  colored  troops  was  as  1,551  of  the  former  to  1 ,498 
of  the  latter,  while  deaths  were  as  845  whites  to  1,104 
colored. 

It  is  to  be  noted  that  these  statistics  are  com- 
piled from  cases  of  sickness,  as  distinct  from  wounds 
and  accidents,  and  the  reason  for  beginning  the 
analysis  with  the  year  I87I  is  because  that  year  a 
new  method  of  report  was  begun  under  fresh  orders 
from  the  Surgeon-General. 

Both  the  numbers  of  cases  of  disease  and  death 
vary  considerably  in  the  diffei-ent  years,  but  the 
author  closes  with  this  paragraph  :  "Not  adopting, 
however,  unreservedly,  any  conclusions  from  the 
figures  of  this  table,  I  may  still  say  that,  as  far  as 
they  go,  these  figures  seem  to  show  an  advance  in 
army  sanitation  and  therajjeutics  in  the  jiast  eleven 
years.  Fewer  men  in  proportion  are  now  taken  sick  ; 
fewer  men  now  die  than  were  taken  sick  and  did  die 
eleven  years  ago. 

"  I  advise  that  the  paper  be  not  read,  but  be  recom- 
mended for  publication." 

The  subject  of 

EXPERT   MEDICAL    TESTIMONY 

was  then  brought  before  the  Section,  and  was  dis- 
cussed by  Drs.  C.  H.  Boardman,  of  St.  Paul ;  Hibbard, 
of  Indiana ;  Kedzie,  of  Michigan  ;  Hughes,  of  St. 
Louis  ;  Lomax,  of  Indiana  ;  Keed,  of  Ohio  ;  Hewett, 
of  Minnesota  ;  Brackett,  of  Iowa ;  Thomas,  of  Geor- 
gia ;  Van  Velier,  of  Iowa ;  English,  of  New  Jersey ; 
and  Callet,  of  Missouri. 

Dr.  Hibbard  offered  the  following  resolution,  which 
was  adopted  and  referred  to  the  Association  in  gen- 
eral session  : 

Resolved,  That  the  Section  of  State  Medicine 
deems  it  advisable  and  more  conducive  to  the  ends 
of  justice,  that  medical  men  called  as  expert  wit- 
nesses should  be  subi^cenaed  directly  by  the  court, 
instead  of  as  now  by  either  side. 


683 


THE  MEDICAL  RECORD. 


The  Chairman  offered,  a  resolution  requesting  the 
American  Bledical  Association  to  recommend  that 
Congress  appi-opriate  the  sum  of  ten  thousand  dol- 
lars for  the  National  Museum  of  Hygiene,  which  has 
beea  established  at  Washington  by  the  Snrgeou-Gen- 
eral  of  the  navy.     (See  pp.  655  and  658.) 

THE    woman's    christian    TEMPERANCE   UNION. 

Tlie  following  resolutions,  presented  to  the  asso- 
ciation in  general  session  and  referred  to  the  Sec- 
tion on  State  Medicine,  were  the  subject  of  discus- 
sion : 

Whereas,  Alcoholic  intemperance  is  a  prolific 
cause  of  disease,  and  prevention  through  the  educa- 
tion of  the  people  is  one  of  the  most  powerful 
antidotes ; 

Wherenii,  We  approve  teaching  the  children  and 
youth  in  the  schools  and  educational  institutions  in 
this  country,  as  facts  of  hygiene,  the  physiological 
dangers  and  evils  resulting  from  the  use  of  alcoholic 
beverages ;  and 

IV/iereifi,  It  is  the  acknowledged  duty  of  the  State 
to  provide  for  sucli  education' of  the  people  as  is 
essential  to  good  citizenship  ; 

Resolve  I,  That  we  recommend  the  State  legisla- 
tures to  enact  laws  requiring  the  physiological  dan- 
ger's and  evils  resulting  from  the  use  of  alcoholic 
beverages  to  be  taught  in  all  schools  supported  by 
public  money  or  under  State  control. 

The  adoption  of  the  resolution  was  urged  by  Mrs. 
Marv  H.  Hunt,  and  discussion  was  participated  in 
bv  Drs.  Foster,  of  Portland,  Me.;  Hewitt,  of  Ked 
Wing,  Minn.,  and  the  Chairman.  At  its  close  it 
was  voted  to  reaffirm  the  resolutions  adopted  in 
Buffalo -in  1878: 

Resolved,  That  in  view  of  the  alarming  prevalence 
and  ill  effects  of  intemperance,  with  which  none  are 
so  familiar  as  members  of  the  medical  profession, 
and  which  have  called  forth  from  eminent  practi- 
tioners the  voice  of  warning  to  the  people  of  Gi-eat 
Britain  concerning  the  use  of  alcoholic  beverages, 
we  the  undersigned  members  of  the  medical  profes- 
sion of  the  United  States  unite  in  the  declaration 
that  we  believe  alcohol  should  be  classed  with  other 
powerful  drugs  ;  that  when  prescribed  it  should  be 
done  with  conscientious  caution  and  a  sense  of  gi-eat 
resi^onsibility. 

Rewhe/.l,  That  we  are  of  the  opinion  that  the  use 
of  alcoholic  liquors  as  a  beverage  is  productive  of  a 
large  amount  of  physical  and  mental  disease  ;  that 
it  entails  diseased  appetites  and  enfeebled  consti- 
tutions upon  offspring,  and  that  it  is  the  cause  of  a 
large  percentage  of  the  crime  and  pauperism  of  our 
cities  and  country. 

Resolund,  That  we  would  welcome  any  change  in 
public  sentiment  that  would  confine  the  use  of  in- 
toxicating liquor  to  the  uses  of  science,  art,  and 
medicine. 

Dr.  C.  M.  Hughes,  of  St.  Louis,  then  read  a 
paper 

ON  THE  RIGHTS  OP  THE  INSANE, 

in  which  he  maintained  that  the  insane  are  entitled 
to  medical  inquiry  by  medical  methods  ;  are  entitled 
to  judicial  rulings  in  accordance  with  the  nature  of 
their  disease,  and  that  the  claim  made  by  courts 
that  a  knowledge  of  right  and  wrong  is  always  evi- 
dence of  responHibility  is  incorrect.  He  believed 
that  the  criminal  insane  should  lie  confined  for  life 
and  bs  prevented  from  extending  their  disease  to 
posterity. 

The  vSection  then  adjourned. 


SECTION  IN  OPHTHALMOLOGY,  OTOLOGY,  AND 
LARYNGOLOGY. 

Dr.  S.  J.  Jones,  of  Chicago,  Chairman. 
Dr.  Carl  SEiiiEE,  of  Philadelphia,  Secretary. 

Tuesday,  June  7th — First  Dat. 

recurrent  pharyngeal  hemorrhage 

was  the  subject  of  a  paper  read  by  Dr.  Wm. 
Porter,  of  St.  Louis,  who  reported  two  cases 
which  had  fallen  under  his  observation.  The 
hemori'hage  seemed  to  come  from  the  lungs,  and 
that  view  was  sustained  by  the  fact  that  there  was 
local  evidence  of  pulmonary  disease.  It  was  deter- 
mined, however,  that  the  bleeding  was  not  Vu-onchial 
hemorrhage,  but  that  the  blood  came  from  the  ton- 
sillar artery  in  one  case  and  an  ulcer  on  the  velum 
in  the  other.  The  author  went  on  to  say  that  bleed- 
ing may  occur  repeatedly  as  the  result  of  slight 
amount  of  ulceration  in  the  pharynx  or  larynx,  and 
in  those  cases  the  hemorrhage  appeared  like  hemop- 
tysis. 

Dr.  Seiler,  of  Philadelphia,  and  Dr.  Carpenter, 
of  Pottsville,  Pa.,  bad  seen  cases  of  hemorrhage 
from  the  pharynx  and  naso-pharynx,  but  Dr.  Glas- 
gow, of  St.  Louis,  bad  never  .seen  a  case  of  real 
pharyngeal  hemorrhage,  all  bad  been  cases  of  bleed- 
ing from  the  naso-pharynx. 

Dr.  X.  C.  Scott,  of  Cleveland,  O.,  reported  cases  of 

DIPHTHERITIC     CONJTOs'CTmTIS     TREATED     WITH     IODO- 
FORM. 

He  applied  the  powder  to  the  surface  once  a  day, 
and  the  result  had  been  very  satisfactorv. 

Drs.  Porter,  of  St.  Louis  ;  Tibbits,  of  Eockford, 
111.;  Johnson,  of  Peoria,  111.;  Cohen,  of  Philadelphia, 
and  others,  directed  attention  to  methods  for  cor- 
recting the  odor  of  the  drug,  its  use  in  syphilitic 
cases,  etc. 

Dr.  Carpenter,  of  Pottsville,  had  used  the  remedy 
internally  in  exopthalmic  goitre,  two  or  three  grains 
three  times  a  day,  and  with  very  satisfactorv  results. 

Dr.  Glasgow  had  used  it  internally  in  ordinary 
goitre  and  glandular  tumors,  and  with  good  results. 

Dr.  Cohen  asked  if  it  could  be  administered  safely 
in  pregnancy. 

Dr.  Carpenter  said  he  had  used  it  in  the  treat- 
ment of  various  affections  in  pregnant  women,  and 
without  unfavorable  effects. 

Leitcr's  tubes  for  applying  heat  and  cold  to  the 
surface  of  the  body  were  then  exhibited  by  Dr. 
Cohen,  after  which  the  Section  adjourned  to  meet 
at  3  P.M.,  Wednesday. 


Wednesd.ay,  June  7th — Second  Day. 

Dr.  Seiler,  of  Philadelphia,  exhibited  galvano- 
cautery  insti-uments  for  nasal,  pharyngeal,  and  laryn- 
geal operations.     (See  Surgical  Section.) 

Dr.  Johnson,  of  Peoria,  reported  a  case  of 

TRAUMATIC  DISIrf)CATION   OF   THE  LENS   UNDER  THE  CON- 
.TUNCTIVA. 

Dr.  Connor,  of  Deti-oit,  reported  a  case  of 

TUMOR    AT   THE   RASE   OF   THE   SKULL. 

The  chief  symptoms  were  progressive  deafness  in 
the  right  ear,  progressive  loss  of  sight  in  the  right 


THE  MEDICAL  RECORD. 


683 


eye,  and  general  emaciation.     No  microscopical  ex- 
amination of  tlie  growth  had  yet  been  made. 
Dr.  Cilhocn,  of  Atlanta,  Ga.,  reported 

A    CASE   OF  VACCINATION    UPOX    THE   ETE. 

In  some  unknown  way  vaccine  virus  was  transfer- 
red from  the  arm  to  other  parts  of  the  body,  and 
among  others  to  the  left  eye,  where  the  pustule  ran 
its  regular  course,  but  the  result  was  the  destruc- 
tion of  the  eye. 

COMMTJNICABIiE  DISEASES   OF   THE    EYE 

was  made  a  subject  for  discussion  and  interchange 
of  views. 
'  Dr.  C.  E.  Agnew,  of  New  York,  gave  an  account 
of  the  condition  of  the  children  in  one  of  the  large 
charitable  institutions  in  the  city  of  New  York,  to 
which  he  had  been  called.  As  the  result  of  insuffi- 
cient accommodation  for  washing,  two  long  troughs 
being  used  by  three  hundred  children,  insufficient 
supply  of  food,  and  insufficient  supply  of  aii-,  only 
150  cubic  feet  Vieing  allowed  in  the  dormitories  for 
each  child,  nearly  evei'y  one  was  suffering  from  dis- 
ease of  the  eyes,  which  the  matron  had  regarded 
as  a  visitation  of  Providence,  but  which  yielded  to 
improved  hygienic  and  sanitary  regulations.  The 
subject  received  a  general  discu  sion  by  Drs.  S.  T. 
Young,  of  Lafayette,  lud.  ;  E.  H.  Hazen,  of  Daven- 
port, Iowa  ;  G.  C.  Smith,  of  Greeneastle,  Ind. ;  J.  B. 
Johnson,  of  Peoria,  111. ;  L  Connor,  of  Detroit ;  S.  J. 
Jones,  of  Chicago,  and  E.  Dyer,  of  Pittsburgh. 

The  following  resolution  was  subsequently 
adopted  : 

Resolved,  That  a  committee  of  three  be  appointed 
to  consult  as  to  the  best  means  of  bringing  reliable 
information  before  the  public,  with  a  view  of  pre- 
venting the  spread  of  communicable  diseases  of  the 
eye. 

The  committee  consisted  of  Drs.  Jones,  of  Chi- 
cago ;  Dyei',  of  Pittsburgh,  and  Connor,  of  Detroit. 

Dr.  H.  a.  Johnson,  of  Chicago,  reported  a 

CASE   OF   P.ABALTSIS   OF   THE   AliDUCTOR  JirSCLE  OF  THE 
LARYNX   FOLLOWING   DIPHTHERIA. 

Dr.  Seiler  remarked  that  he  had  heard  of  similar 
cases,  but  had  never  seen  one. 
Dr.  Seiler  also  reported  a  case  of 

fibroid  polypus  of  the  nose, 

in  which  the  growth  was  removed  by  means  of  .Tarvis' 
snare.  It  had  grown  from  the  vomer  and  had  a 
small  pedicle. 


Corrcspontrcnce. 


Thursday,  June  8th — Third  Day. 
The  Section  considered  a  letter  from  Dr.  Jeffries, 
of  Boston,  which  was  accompanied  by  a  preamble 
and  resolution  from  the  Massachusetts  Medical  So- 
ciety requesting  the  Section  to  present  the  subject 
of 

COLOR   blindness   AND   ACUITY   OF   VISION 

before  the  association  (see  p.  658). 

WARM  water   in   OPHTHALinC   SURGERY. 

This  subject  was  discussed  in  the  Section,  and  the 
weight  of  evidence  was  in  favor  of  its  use  in  the  ear- 
lier stages  of  throat  and  eye  diseases  ;  to  afford  the 
greatest  benefit  it  should  be  apj^lied  as  hot  as  the 
patient  can  bear. 

The  Section  then  adjourned. 


THE  NEW  YORK  CODE  AND  THE  AMERI- 
CAN IVIEDICAL  ASSOCUTION. 

To   THE    EDITOK    of  THF.   MEDICAL    UKCOHD. 

Sib:  Now  that  the  Philadelphia  fusillade  and  the 
St.  Paul  exjjlosion  are  over,  the  members  of  the 
New  York  State  Medical  Society  may  venture  to 
look  out  from  the  disappearing  smoke,  and  see  how 
their  ancient  and  honorable  body  has  with.stood  the 
attacks  of  the  Kews  Ephemeris,  and  the  protesting 
and  injured  members  of  our  profession  in  New  Jer- 
sey, Alabama,  and  Arkansas.  The  picture  that  has 
been  drawn  lay  our  friends  is  not  a  pleasing  one. 
Our  society  is  seen  as  a  hastily  called,  jierhaps 
packed,  assemblage,  dragooned  by  money-loving  and 
altogether  atrocious  specialists,  which,  by  some  trick, 
overrides  the  wishes  of  the  virtuous  and  rural  general 
practitioner,  and,  in  the  language  of  an  Alabama  pro- 
tester, gives  "countenance  and  respectability  to 
quacks  and  mountebanks,  to  enable  them  to  ply  their 
nefarious  vocation."  It  will,  perhaps,  be  useless  to 
attempt  to  convince  the  adolescent  and  sprightly 
Philadelphia  journal  that  its  jien-pictures  are  inac- 
curately drawn.  Indeed  any  word  from  tlie  fiftT-three 
or  more  members  of  our  society  who  ventured  to  for- 
mulate their  opinions  on  the  Code, without  consulting 
that  self-constituted  arbiter  in  all  such  matters, 
will  probably  be  received  as  a  red  rag  is  said  to  be 
encountered  by  a  youthful  bovine  of  the  male  gen- 
der. Yet  there' ai-e'  some  who,  undaunted  by  all  this 
sound  and  fury,  are  waiting  for  a  word  from  us.  As 
Dr.  Agnew  has  .shown  in  his  paper — which  the  Ameri- 
can Medical  .Association,  although  able  to  listen  to 
protests  from  Tuscaloosa  and  Oshkosh,  could  not 
hear — this  action  at  .llbany  was  not  hastily  taken. 
Neither  was  it  taken  at  the  suggestion  of  the  dread- 
ful specialists.  Three  of  the  five,  of  the  committee, 
are  general  practitioners,  who  are  not  impecunious 
and  not  consumed  by  the  greed  for  gain  that  we 
New  I'orkers  know  has  wrecked  the  moral  pur- 
poses of  the  two  specialists  who  acted  with  them. 
We  can  only  suppose  that  the  minority  of  the  com- 
mittee have  succeeded  in  beguiling  the  simple- 
minded  and  unsuspecting  majority,  and  then  in  in- 
ducing about  forty-five  other  general  practitioners 
to  endorse  their  action.  It  is  undoubtedly  very 
difficult  for  the  editor  of  the  new  Philadelphia  jour- 
nal to  understand  how  the  State  of  New  York  can 
think  as  it  does  on  the  subject  of  consultations. 

Dr.  Gross,  in  his  address  before  the  Surgical  So- 
ciety at  its  late  meeting,  with  great  temerity,  accuses 
the  American  Medical  Association  of  indulging  in 
"  Flip  Van  Winkle  slumbers."  It  cannot  be  sup- 
posed that  our  young  journal  is  already  in  the  con- 
dition ascribed  to  the  association,  and  yet  its  views 
on  our  new  Code  indicate  a  forgetfulness  that  New 
Y''ork  has  been  advancing  in  the  last  twenty  or  thirty 
years,  whatever  Philadelphia  may  have  been  doing. 
Allow  me  to  say,  parenthetically,  that  there  is  reason 
to  believe  that  there  are  some  physicians  in  our 
neighboring  metropolis  who,  having  as  yet  not  done 
much  in  "whooping  up  "  public  sentiment  against 
the  New  York  idea,  will  before  long  give  the 
whoopers  as  much  anxiety  as  is  now  evinced  by 
another  Pennsylvania  dictator  in  regard  to  a  move- 
ment against  his  ancient  sway.  Our  wortliy  and  dis- 
tinguished frien  \  the  editor  of  Ephemeria,  although 
with  irreproachable  and  customai-y  courtesy,  is  also 


684 


THE  MEDICAL  RECORD. 


fearful  of  the  influence  of  the  specialists  in  the  re- 
vision of  the  Code.  It  would  not  be  fair  to  retaliate 
by  an  argument  in  kind,  or  we  might  say,  if  the  new 
Code  is  bad,  because  supported  in  part  by  specialists, 
what  shall  we  say  of  the  old,  when  its  ablest  advo- 
cate in  New  York  is  not  even  a  practitioner  of  medi- 
cine, but  is  merely  a  pharmacist.  But  I  suppose 
that  if  the  new  Code  be  really  a  good  one,  even  its 
vicious  and  money-loving  supporters  cannot  change 
its  character. 

The  23ublished  indignation  of  the  Nestor  of  Amer- 
ican surgery  has  been  the  hardest  blow  our  State 
society  has  had  to  bear,  for  he  regards  "  our  pro- 
ceedings as  an  outrage  which  every  member  of  the 
profession  should  consider  as  a  deep  personal  in- 
sult." What  is  to  be  done  with  us,  we  are  as  yet 
not  informed.  Perhaps  we  are  to  be  confined  in 
the  Moyamensing  prison,  or  perhaps  our  distin- 
guished townsman,  that  gi-eat  exponent  of  ethics, 
who,  while,  according  to  the  Herald,  fresh  from  a 
consultation  with  a  homceopath,  contemptuously 
threw  back  his  commission  in  the  face  of  our  so- 
ciety, will  take  the  recalcitrant  body  in  hand.  Should 
this  occur,  we  may  only  imagine  the  discomfiture 
and  shame  of  our  fifty-three,  when  they  are  sum- 
moned from  New  York,  Brooklyn,  Albany,  Ko- 
chester,  Utica,  Elmira,  Binghamton,  and  Y'oukers, 
to  face  the  awful  front  of  the  Judicial  Council  of  the 
American  Medical  Association.  What  would  happen 
before  that  tribunal  can  only  be  imagined,  and  we 
draw  a  vail  upon  the  threatened  disclosure. 

Meanwhile,  let  our  brethren  in  our  various 
county  societies,  from  Erie  to  Suffolk,  remember 
that,  although  threatened,  we  are  not  yet  destroyed. 

The  Philadelplna  postal-cards  have  been  received, 
the  protests  of  the  great  scientific  bodies  of  Florida 
and  Kansas  have  been  read,  and  yet  the  grain  is  wav- 
ing in  the  valley  of  the  Genesee,  the  canal  boats  are 
making  the  even  tenor  of  their  way  from  Albany  to 
Buffalo,  the  forges  of  Troy  and  Hudson  are  not  yet 
closed,  ships  are  still  entering  the  port  of  New 
York,  and  no  Marius,  from  Philadelphia,  is  as  yet 
sitting  on  the  remains  of  our  moral  and  physical 
ruin. 

Knickerbocker. 
joxE  16,  issa. 


ARMY  NEWS. 

Official  List  of  Changes  of  Stations  and  Duties  of  Offi- 
cers of  the  Medical  Depaj-tment,  United  States  Army, 
from  June  11,  1882,  to  June  17,  1882. 
Elbret,  F,  W.,  Capt.  and  Asst.  Surgeon.     To  be 
relieved  from  duty  in  Dept.  of  the   Missouri,  .Tuly 
1,  1882,   and  to  report  in  person  to  the  Surgeon- 
General  in  this  city.     S.  O.  137,  A.  G.  O.,  June  14, 
1882. 

Keed,  W.,  Capt.  and  Asst.  Surgeon.  To  accom- 
pany the  troops  from  Washington  Barracks,  Dis- 
trict of  Columbia,  and  Ft.  McHenry,  Maryland,  on 
their  march  to  the  .summer  camp  at  Gaithersliurg, 
Md.,  and  to  remain  on  duty  with  them  during  tlie 
encampment.  S.  O.  104,  Dept.  of  the  East,  Juno  0, 
1882. 

Appoint.ments. 
To  be  Assistant  Surgeons,  to  rank  from  May  23, 
1882: 

WiLiJi\M  E.  H0PKIN8,  of  California,  vice  Y'eomans, 
deceased. 

CicARLES  C.  Barrows,  of  Mississippi,  vice  Brewer, 
deceased. 


Benjamin  Monday,  of  Virginia,  vioe  H.  E.  Bbown, 
promoted. 

Georqe  F.  Wilson,  of  Oregon,  vice  J.  M.  Brown, 
promoted. 

William  E.  Owen,  Jr.,  of  Tennessee,  vice  Kino, 
resigned. 

Peter  R.  Eqan,  of  New  York,  vice  Hdbbabd,  pro- 
moted. 

William  J.  Wakeman,  of  Connecticut,  vice  Cones, 
resigned. 

Edward  Everts,   of  California,  vice  Whitehead, 
deceased. 

A.  G.  0.,  June  12,  1882. 


iHeliical  Jtems  antr  UtxoQ, 


CoNTAOious  Diseases  —  Weekly  Statement.  — 
Oomparative  statement  of  cases  of  contagious  diseases 
reported  to  the  Sanitary  Bureau,  Health  Department, 
for  the  two  weeks  ending  June  17,  1882. 


W«ek  Ending 

1 

S 
t 

■Is 

r 

1 

n 
II 

1 

i 

1 

i 

1 

H 

w 

m 

June   10,    1883. 

14 

6 

94 

5 

80 

47 

17 

0 

June  17,    1882. 

12 

3 

79. 

8 

C5 

46 

5 

0 

The  De.ath  op  Professor  C.  Hueter  took  place 
recently  at  Greifswald.  Although  but.  forty- four 
years  of  age,  he  was  one  of  the  most  eminent  of  Ger- 
man surgeons.  He  was  at  one  time  assistant  to 
Virchow,  aftei-ward  to  Langenbeck.  He  wrote  works 
on  "General  Surgery,"  "Joint  Diseases,"  and  "Spe- 
cial Surgery,"  which  are  standard  treatises.  He  was 
a  member  of  the  German  Reichstag,  and  Professor 
of  Surgery  of  the  University  at  Greifswald. 

The  Fourth  International  Congress  of  Hygiene, 
which  is  to  meet  at  Geneva,  September  4th  to  9th 
next,  will  discuss  the  following  topics  :  "  State  and 
International  Hygiene,"  "  Prophylaxis  of  Epidemic 
Diseases  and  Sanitary  Police,"  "  Social  and  Medical 
Statistics,"  "  Relation  of  Hygiene  to  Chemistry, 
Physics,  and  Mechanics,"  "  Hygiene  of  Children," 
"  School  Hygiene,"  "Private  and  Public  and  Veter- 
inary Hygiene." 

Dr.  Duane  B.  Simmons,  of  Yokohama,  Japan,  late 
Surgenn-in-Chief  of  the  Government  Hospital  at 
that  i)lace,  is  on  a  visit  to  this  city. 

International  Congress  op  Hygiene. — At  a  recent 
meeting  of  the  New  Y'ork  Academy  of  Medicine,  Drs. 
Fordyce  Barker,  Austin  Flint,  and  John  G.  Adams 
were  appointed  delegates  to  the  International  Con- 
gress of  Hygiene,  to  be  held  in  Geneva  (Suisse),  on 
the  4th  of  September  next,  to  continue  in  session 
until  the  lltli  of  September. 

Tubercle  Bacillus. — Dr.  Ehrlich,  of  Berlin,  re- 
cently announced  another  method  of  staining  tuber- 
cle bacilli  simpler  than  that  employed  by  Koch. 
By  this  process  the  organisms  appear  larger  than 
Koch  describes  them.  The  details  are  not  yet  given. 
The  tubercle  bacillus  were  recently  exhibited  by 
Mr.  W.  Cheyne  and  Mr.  E.  M.  Nelson,  at  the  Physio- 
logical Laboratory,  King's  College.     The  specimens 


THE   MEDICAL  RECORD. 


685 


■were  prepared  by  Dr.  Koch,  and  brought  over  by  his 
assistant,  Dr.  GoUdammer.  A  number  of  prominent 
microscopists  examined  them.  No  one,  except 
Koch,  has  as  yet  announced  that  he  has  found  them 
independently  by  Koch's  method. 

Medical  Women.  —  The  Philadelphia  County 
Medical  Society  lias  again  refused  to  admit  medical 
women  to  membership.  The  Massachusetts  State 
Medical  Society  has  done  the  same.  In  the  case  of 
the  latter,  the  society  as  a  body  voted  for  admission, 
but  the  council,  which  has  authority  in  the  matter, 
voted  against  it.  In  the  case  of  the  Philadelphia 
society  the  applications  for  membership  were  en- 
dorsed by  the  Board  of  Censors,  but  the  candidates 
were  rejected  by  the  society. 

Roosevelt  Hosittal,  N.  Y. — The  managers  of  this 
hospital  have  decided  to  try,  for  one  year,  the  ex- 
periment of  continued  service  in  the  Surgical  Di- 
vision, uuder  the  direction  of  Dr.  H.  B.  Sands,  Dr. 
William  S.  Halsted  having  been  appointed  as  his 
assistant. 

A  Bill  to  Pbevest  the  Adulter.\tion  of  Food 
AND  Dbug-s  is  now  before  Congress,  and  has  l)een 
recommended  for  passage  by  the  committee  to  which 
it  was  referred.  It  provides  for  an  examination  liy 
inspectors  of  imported  food  and  drugs.  All  that  are 
found  adulterated  will  not  be  permitted  to  pass  the 
Custom  House. . 

A  StNGULiR  LEGAcr. — A  patient  who  was  beneiited 
by  Mr.  Olher's  subcutaneous  method,  bequeathed 
to  him  his  elbow-joint  as  a  token  of  gratitude.  The 
legacy  proved  a  valuable  one  to  pathological  science, 
aiuje  the  physiological  process  of  renewal  of  tissue 
could  be  followed  out  almost  step  by  step. — Brit. 
Med.  Jour. 

Garfield  Memorial  Hospital.  —  The  United 
States  Consul  at  Liverpool  has  written  to  the  Lon- 
don papers,  soliciting  contributions  to  the  Garfield 
Memorial  Hospital.  The  Decoration  Day  contribu- 
tions at  Washington,  D.  C,  to  the  proposed  hospi- 
tal amounted  to  SiOO. 

The  Sick  Children's  Mission  op  the  Children's 
An)  SociETV  commenced  June  1st  its  usual  summer 
work  of  providing  free  medical  attendance,  medi- 
cine, and  nourishment  to  sick  children  of  the  very 
poor  in  all  the  tenement  quarters  of  the  city. 

Attempt  to  Blackmail  a  Doctor. — A  stranger 
presented  himself  at  the  residence  of  Dr.  Ballon,  in 
Lansingburg,  N.  Y.,  recently,  and  introduced  himself 
as  a  Philadelphia  detective."  He  informed  the  doctor 
that  he  had  positive  information  that  the  doctor  was 
a  resurrectionist,  and  had  the  proof  that  he  had  re- 
cently removed  the  body  of  a  yonng  lady  of  Lansing- 
burg, whom  he  named,  from  the  grave,  for  dissec- 
tion. The  stranger  informed  Dr.  Ballon  that  the 
matter  could  be  hushed  up  for  S500.  The  doctor 
asked  hira  to  wait  until  he  sent  for  the  money,  but 
the  "detective"  departed,  evidently  fearing  that 
the  doctor  intended  to  have  him  arrested. 

Besponsibility  op  a  Dboggist. — A  patient,  Mrs. 
B ,  went  to  a  drug  store  in  this  city  with  a  pre- 
scription from  Dr.  V for  sixty  drops  of  lauda- 
num.    The  druggist  refused  to  give  but  ten  drops. 

Mrs.  E went  home,  took  the  medicine,  and  had 

a  miscarriage.  She  then  brousht  suit  against  the 
druggist,  Mr.  Diedel,  for  .§10,000  damages,  claiming 
that  if  she  had  had  the  sixty  drops  the  miscarriage 
would  not  have  occurred.     The  suit  was  recently 


tried.  The  defence  was  that  the  ten  drops  of  lauda- 
num given  by  Diedel  to  Mrs.  E could  not  have 

affected  hei-  further  than  to  temporarily  lessen  her 
pain,  and  that  a  druggist  is  not  bound  to  personally 
administer  dangerous  drugs  upon  the  order  of  a 
physician,  his  duty  being  simply  to  prepare  medi- 
cines under  the  direction  of  physicians.  Judge 
Beach  sustained  this  view  of  the  duty  of  a  druggist, 
saying  that  such  a  tradesman  would  incur  liability 
to  indictment  for  manslaughter  for  having  know- 
ingly administered  a  drug  or  medicine  which  pro- 
duced death.  A  large  number  of  physicians  were 
present,  and  most  of  them  expressed  the  opinion 
that  a  miscarriage  would  have  happened  to   Mrs. 

E even  if  sixty  drops  of  laudanum  had  been 

administered  to  her.  The  jury  gave  a  verdict  for 
Druggist  Diedel. 

Nelaton  and  Hemorrhage.— The  saying  of  Nela- 
ton  is  often  quoted  :  "  If  you  have  the  misfortune 
to  cut  a  carotid  when  performing  an  operation,  re- 
member it  takes  two  minutes  for  syncope  to  super- 
vene, and  as  many  more  before  death  occurs.  Now, 
four  minutes  are  four  times  the  time  required  for  a 
ligature,  provided  you  don't  hurry  yourself.  Never 
hurry  yourself."  This  is  very  good  advice,  but  the 
facts  are  hardly  so  rigid  as  is  stated.  Syncope  and 
death  will  supervene  at  different  periods,  according 
to  the  previous  and  present  condition  of  the  patient. 
Scarlatinous  Erttheju.  after  Quinine. — Dr.  J. 
W.  Kales,  of  Union  Springs,  N.  Y.,  referring  to  the 
article  on  page  627  current  volume  Medical  Ee- 
coRD,  i.e.,  "  Scarlatinous  Erythema  following  the  Ad- 
ministration of  Quinine,"  says  that  malarial  fever  is 
very  common  on  the  east  side  of  Cayuga  Lake,  and 
every  year  brings  its  full  complement  of  cases. 
Within  the  past  few  weeks  he  has  seen  several 
cases  of  scarlatinous  eruption  appear  on  patients 
who  were  attacked  with  malarial  fever,  some  of 
whom  had,  others  had  not,  taken  one  particle  of 
quinine.  So  far  as  his  observations  .went,  which 
during  the  past  three  years  has  extended  over  many 
cases,  quinine  does  not  appear  to  cause  tlie  erythe- 
ma mentioned.  He  thinks  the  correspondent  was 
fortunate  in  having  so  mild  a  case  which  was  con- 
trolled by  twenty-three  grains  of  quinine  in  forty- 
eight  hours.  He  has  frequently  given  twenty  grains 
quinine  in  solution,  and  then  had  to  repeat  the 
amount  to  "break  the  chill."  It  is  not  common  to 
see  the  erythema  follow  these  large  doses. _  The 
erythema,  eruption,  and  pruritus  subside  without 
treatment  in  a  short  time.  There  are  no  cases  of 
scarlatina  in  that  vicinity. 

Eetirement  of  Langenbeck. — Professor  Langen- 
beek  is  soon  to  retire  from  his  Profe.'sorship  in  the 
Medical  Faculty  of  Berlin.  His  retirement  is  herald- 
ed by  expressions  of  regiet  from  every  quarter.  Lang- 
enbeck is  not  only  the  Nestor  but  the  most  genial 
and  popular  of  German  surgeons.  He  numbers 
among  his  pupils  a  large  number  of  the  most  cele- 
brated German  surgeons.  Professor  Langenbeck, 
though  seventy-one  years  of  age,  has  still  a  sure 
hand  and  an  unusual  elasticity  of  mind  and  body. 

OiiENTAL  Hernia.— Dr.  Meigs  Case,  of  Oneonta, 
N.  Y.,  writes  :  "  Keferring  to  Dr.  Little's  case,  no- 
ticed in  a  late  issue  of  The  Eecoed,  I  beg  leave  to 
mention  a  recent  case. 

"  Mrs.  Warrenchase,  of  Colliersville,  applied  to  me 
March  22d,  with  a  strangulated  omental  hernia  at 
the  umbilicus. 

"  I  operated  March  26th,  removed  by  incision  the 


686 


THE  MEDICAL  RECORD. 


hernial  sac,  a  piece  of  omentum  TJ  ounces  in  weight, 
and  returned  the  gut,  5i  inches  of  small  intestine, 
very  much  inflamed  and  discolored. 

"The  external  incision,  10  inches  in  length,  is 
nearly  healed,  and  her  recovery  assured." 

Aiding  the  Expulsivb  Eppobt  in  Partukition. — 
Dr.  D.  H.  Jervis,  of  Lone  Pine,  Penn.  writes : 
"  I  will  communicate  a  method  that  I  have  been 
practising  for  some  time  in  cases  where  there  is  a 
deficiency  in  the  contractions  of  the  uterus  and 
the  expulsive  elfort  is  wanting,  in  those  eases  of 
conftaement  where  labor  is  prolonged  liy  inefficiency 
of  the  contraction  of  the  uterus  and  the  expulsive 
effort  where  the  os  is  completely  dilated  or 
dilatable,  or  exactly  that  class  of  cases  for  which  our 
text-books  recommend  the  administration  of  ergot. 
I  formerly  followed  the  orthodox  practice  of  giving 
ergot  in  those  cases.  But  the  administration  of 
this  drug  was  so  frequently  followed  by  nausea  and 
vomiting  that  I  di^sliked  very  much  to  administer 
it,  knowing  the  fact  that  when  the  head  of  the 
child  begins  to  press  upon  the  perineum,  the  '  ex- 
pulsive effort '  is  not  only  increased,  but  also  the 
force  of  the  contractions  of  the  uterus.  And  also 
the  effort  of  introducing  the  hand  into  the  vagina  in 
order  to  explore  more  fully  an  unsettled  position, 
has  a  tendency  to  influence  the  character  of  the  la- 
bor, very  likely  producing  a  rapid  delivery. 

"From  these  facts  I  was  led  in  this  class  of  cases 
to  imitate  the  pressure  produced  by  the  head  of 
the  child,  by  introducing  at  least  a  part  of  the  hand 
and  during  a  pain  distending  the  vagina  and  mak- 
ing firm  pressure  outward  against  the  perineum. 

"  This  seldom  fails  not  only  to  increase  the  con- 
tractions of  the  uterus,  but  will  bring  on  a  strong 
expulsive  effort.  The  soft  pai-ts  being  more  abun- 
dantly supplied  witli  nerves  than  the  walls  of  the 
pelvis,  the  reflex  action  set  up  by  pressure  on  them 
is  much  greater.  In  the  delivery  of  the  placenta, 
where  it  does  not  come  down  sufficiently  to  be 
grasped  by  the  hand,  it  may  also  be  hastened  by  gen- 
tly distending  the  vagina.  I  do  not  see  why,  in 
cases  of  moderate  hemorrhage,  contractions  might 
not  be  brought  on  by  the  same  method.  With  this 
latter  I  have  not  had  sufficient  experience  to  speak 
with  any  assurance.  If  this  method  has  ever  been 
wrif^ten  on  l)efore,  T  have  failed  to  come  across  it. 
And  I  would  be  pleased  to  hear  from  other  practi- 
tioners on  the  subject." 

Scraps  from  the  History  op  Small-Pox  in  the 
Times  op  Louis  XIV.  —Dr.  John  O.  Peters,  of  New 
York,  sends  us  the  following  interesting  items  from 
the  original  letters  of  Madame  Charlotte  Elizabeth, 
of  Bavaria,  Duchess  of  Orleans,  written  from  1715 
to  1720.  We  gather  the  following  details  showing 
the  prevalence  and  horrible  ravages  of  smallpox 
among  the  most  beautiful  women  and  exalted  men  : 

"  Tlie  Ducliess  de  Berry  does  not  require  rouge, 
for  she  lias  naturally  a  high  color,  for  which  she  is 
very  often  bled,  but  that  does  not  make  the  least 
alteration.  She  wears  rouge  nevertheless  to  conceal 
the  marks  of  small-pox. 

"Frances  Mary,  Duchess  of  Orleans,  wife  of  the 
Regent,  appears  older  than  she  really  is,  and  the 
smallpox  has  given  her  a  shaking  of  the  head  like 
an  old  woman.  She  is  not  handsome,  and  puts  on 
too  much  rouge  to  hide  the  marks. 

"  Madame,  daughter  of  Louis  XIV.,  has  her 
moutli  drawn  to  one  side  from  ulcers  on  her  nock, 
caused    by   suppurating    glands    from     small-pox. 


When  she  was  dying  the  convulsions  brought  her 
mouth  right,  yet  she  could  not  speak,  or  say  a  word 
to  her  father. 

"  When   I   first  came   here,  Madame was   a 

most  beautiful  woman.  When  she  lost  her  beauty 
from  small-pox,  she  was  quite  desperate  and  almost 
out  of  her  senses.  Her  beautiful  nose  has  become 
large  and  covered  with  pimples ;  her  face  is  scarred 
and  mottled  red  and  white,  while  the  enamel  with 
which  she  plastered  her  face,  cracks  and  will  not 
keep  on.  Her  eyes  are  hollow  and  sunk  in  her  head. 
I  never  in  my  life  saw  so  great  an  alteration  in  a 
person,  and  the  homd  effect  is  not  to  be  imagined ; 
it  can  only  be  realized  by  seeing  her. 

"  Mademoiselle  de  Valois,  married  to  the  Prince 
of  Modena,  told  me  that  she  was  going  to  the  con- 
vent at  Chelles  to  take  leave  of  her  sister,  the  Made- 
moiselle de  Chartes.  I  advised  her  not  to  go,  as  the 
small-pox  has  been  very  lately  in  the  convent,  and 
the  abbess  herself  has  had  it,  or  the  measles,  and 
these  disorders  are  too  easily  caught.  I  told  her  to 
take  care  what  she  did,  as  her  death  might  be  the 
con.sequence.  In  S23ite  of  this  advice  she  went  and 
spent  the  day  with  her  sister,  and  ten  or  fourteen 
days  after  she  was  taken  ill  and  soon  the  small-pox 
spots  appeared. 

"  When  the  first  Dauphin  had  the  small-pox  I 
went  to  the  king,  who  said  to  me,  smiling  :  '  Well, 
Madame,  notwil:hstanding  your  terrible  apprehen- 
sions and  forebodings  the  turn  of  the  Dauphin's 
disorder  is  already  over  aaid  the  pimples  are  drying 
up  '  I  was  much  alarmed  at  hearing  this,  and  said, 
'  So  much  the  worse  ;  it  is  too  soon.'  The  king  re- 
plied, '  You  seem  to  know  better  than  all  the  great 
physicians.'  '  I  know,'  I  answered,  '  what  small- 
pox is  fi-om  my  own  experience  on  myself  and 
among  othei's.  I  wish  sincerely  I  may  be  wrong.' 
The  Dauphin  died  the  same  night  about  twelve  of 
the  clock. 

"  I  must  be  very  ugly,  for  I  am  marked  with  the 
small-pox  and  have  not  one  feature  in  my  face  that 
is  passable.  I  am  short  in  stature  and  veiy  clumsily 
made,  so  that  Tipon  the  wliole  I  must  be  a  fright. 
My  eyes  are  so  drawn  up  that  if  any  one  attempted 
to  judge  of  my  understanding  by  them  he  must 
have  a  microscope  to  examine  them.  I  believe 
there  are  not  in  the  whole  world  uglier  scan-ed 
hands  than  mine.  The  king  often  told  me  so  and 
diverted  me  by  it,  for  as  I  never  flattered  myself 
that  I  was  handsome,  I  was  determined  to  be  one  of 
the  first  to  laugh  at  my  own  imperfections.  It  was 
very  well  I  did,  for  I  have  found  frequent  occasion 
to  do  it.  If  my  disposition  was  not  tolerable  I 
should  not  he  suppoitable." 

The  Rreat  good  sense  and  wit  of  the  Duchess 
was  well  exemplified  when  she  was  urged  to  forgive 
one  who  had  been  guilty  of  a  thousand  impertinences 
to  her.  After  a  moment's  hesitation  she  replied  : 
"  Well,  as  she  has  never  called  me  ugly,  I  will  forgiva 
her." 

Amp.rtcan  Neukolooical  AssooiA'noN.  —  Tlie 
eighth  annual  meeting  of  this  association  was  held 
in  the  hall  of  the  Academy  of  iMedicine,  12  West 
Thirty-first  Street,  New  York,  on  .Tune  21st,  22d,  and 
23d.  There  were  afternoon  and  evening  sessions. 
These  were  well  attended  by  tlie  profession,  and  the 
papers  road  were  of  the  usual  interesting  character. 
A  reception  given  to  the  association  by  its  President, 
Dr.  William  \.  Hammond,  on  Thursday  evening, 
was  largely  attended.  A  report  of  the  proceedings 
will  appear  in  a  subsequent  number. 


INDEX 


Abbe.  Dr.  Kobert,  drainage-tube  in  chest,  resection  of 
rib  for  its  removal.  1T2. 

Abiloraen.  gunshot  wound  of,  G4. 

Abscess,  emptying  into  tlie  cfecum,  107 ;  hepatic,  0(12 ; 
of  brain.  '29(i ;  of  the  neck  and  mediastinum.  471  ; 
of  the  orbit.  550;  pelvic.  107  ;  traumatic  of  the 
liver.  470. 

Acetonuria,  G7. 

Acid,  boracic.  in  skin  affections,  129  ;  poisoning  by,  401 
carbolic,  internal  use  of,  513 ;  in  the  treatmen 
of  hydrocele  and  serous  cysts,  13  ;  poisoning  by, 
from  Listerian  dressings,  G7  ;  carbonic  as  a  poison 
ous  product  of  digestion,  112;  hydrobromic  in  fever. 
251  ;  salicylic  and  heart  affections,  (jii ;  delirium  of, 
45G  ;  in  rheumatism.  289  ;  prophylactic,  value  of  in 
yellow  fever,  470. 

Aconitia,   105. 

Ad.ams.  Dr.  E.  A.,  notice  of  death  of,  190. 

Adams,  Dr.  William,  notice  of  book  by,  400. 

Adulterations,  war  against,  379. 

Esthetics,  medical,  419. 

Agne«',  Dr.  C.  R. ,  freedom  in  consultations,  523. 

Agricultural  Department.  570. 

Air,  from  the  North  Pole,  308. 

Air-passages,  diphtheritic  ulcerations  of,  442. 

Alabama  Medical  Association,  557  ;  State  examinations 
In.  888. 

Albert  and  Billroth,  448. 

Albinsmus,  5S3. 

Albuminuria,  transient,  in  children  and  adolescents,  17. 

Alcohol,  as  an  anaesthetic,  2U3. 

Allen,  Dr.  Almon  S.,  pharmacodynamics,  474. 

Allingham,  Dr.  William,  notice  of  book  by,  295. 

"Allopath,''  050.  058. 

Ambulance  system,  American,  72,  350. 

American  Academy  of  Medicine,  487. 

American  Journal  of  Neurolojry  and  Psychiatry,  363. 

American  Medical  Association,  501,  045,  674;  and  the 
Merlicai  Society  of  the  State  of  New  York,  009  ; 
and  the  New  York  Code,  574,  045,  083  ;  commuta- 
tion rates,  587.  002  ;  repoi-t  of  proceedings,  648. 

American  Medical  Editors'  Association.  070. 

American  Neurological  Association,  086. 

American  Red  Cross  Societ.y,  353. 

American  Surgical  .Association,  04-3. 

American  Veterinary  College  Prizes,  303. 

Ametropia,  in  etiology  of  blepharitis  ciliaris,  399. 

Ammonia,  carbonate,  is  it  a  stimulant?  95 

Amputation,  periosteal  preservation  in,  409  ;  Tripiers  of 
fae  foot.  4U2. 

Amyl,  nitrite  of,  and  chloroform,  335  ;  nitrite  of,  in 
hour-glass  contraction  of  the  uterus,  488 ;  in  in- 
fant,le  convulsions,  582  ;  in  tinnitus  aurium,  41. 

Amyloid  degeneration,  489  ;  kidney  without  albuminu- 
ria, 68. 

Anaemia,  condition  of  the  eyes  in  fatal,  630. 

Anaesthetic,  alcohol  as  an,  303 ;  mixtures,  251. 


Ana;sthetics,  death  from,  223  ;  from  a  medico-legal  point 
of  view,  235. 

Anchylosis,  of  the  hip,  600. 

Aneurism,  clot  in.  203  ;  of  the  common  carotid  artery, 
551  ;  of  the  common  femoral  artery.  33  ;  of  the 
heart.  551  ;  of  the  mitral  valve.  358;  of  the  pul- 
monary artery  associated  with  a  cavity  in  the  lung, 
50  ;  of  thoracic  aorta.  06  ;  varicose,  200. 

Animals,  inoculation  of,  with  venereal  matter,  288  ;  re- 
suscitation, after  exposure  to  cold,  489  ;  things  that 
occur  in,  475. 

Ankle-joint,  exsection  of,  327. 

Anthropometrical  laboratory,  491. 

Antipyretic,  treatment,  012. 

Antiseptic  medication,  359. 

Antiseptics,  in  ocular  surgery,  69  ;  relative  power  of, 
014;   uselessness  of,  in  ocular  surgery,  503. 

Anti-vaccism.  323. 

Antrum,  tumor  of.  210. 

.'\nuria,  nephrolithotomy  for.  031. 

Anus,  artificial,  operation  for,  0'i2,  063. 

Appendix  vermiformis,  perforation  of,  108. 

Arlt,  Professor,  616. 

Army,  forced  retirement  from,  44  ;  report  of  the  sur- 
geon general  of  the.  159. 

Arsenic,  bromide  of.  in  diabetes.  321  ;  necrosis  from,  078. 

Artery,  carotid,  convulsions  following  the  ligation  of 
the.  232  ;  carotid,  prolonged  compression  of,  as  a 
therapeutic  agent.  173  ;  pancreatic,  ero.'iion  of,  411  ; 
pulmonary,  aneurismi  of,  with  phthisical  cavity,  56. 

Arteries,  coronary,  effect  of  occlusion  of  on  the  heart, 
208  ;   toi-sion  of,  041. 

Arthritis,  gouty.  612;  in  a  dog,  623. 

Arthropathy,  spinal.  180. 

Aspiraiion,  of  the  knee-joint,  370,  384. 

Association  for  the  Advancement  of  Medical  Research, 
447. 

Association  of  Asylum  Superintendents,  670. 

Asthma,  euphorbia  in.  503  ;  grindelia  robusta  in,  510  ; 
Leydeii's  crystals  in  etiology,  013;  quebracho  in, 
07  ;  relation  of  to  nasal  polypi,  544. 

Asylum,  insane,  at  Utica,  80  ;  insane,  management  of, 
335. 

Asylums,  obstacles  to  abolition  of  mechanical  restraint, 
230  ;  our  city  insane,  673. 

Ataxia  locomotor.  342. 

-Atkin.s.  Dr.  F.  H.,  calcium  sulphide,  530.  . 

Atrophy  of  the  lung,  105,  583. 

Atropine,  poisoning  by,  treated  by  morphine,  375. 

Auditory  can:d,  extraction  of  glass  from  the,  229. 

Auricles,  tubercular  syphilides  in,  007. 

Avena  sativa,  193. 

B 

Baby,  a  ten-ounce,  648. 

Bacillus  leprae,  the,  573  ;  of  typhoid  fever,  28  ;  of  tuber- 
culosis, 084. 
Back-rest,  113. 


INDEX. 


Bacteria.  138 ;  and  respiration,  558  ;  in  leprosy,  630  ; 
none  in  diphtheria,  150. 

Bacterium,  Bpecial,  of  pemphigus,  28. 

Barrows,  Dr.  Chas.  C,  the  delirium  of  salicylic  acid,  450, 

Ballery,  Dr.  G.  H. ,  ovariotomy  abroad,  524. 

B.arry,  Dr.  Robert  A. ,  notice  of  death  of,  55. 

Baruch,  Dr.  S,,  a  plea  for  improved  vaccination,  1. 

Bath,  Turkish,  for  horses,  361. 

Baths  for  the  newly  born,  595  ;  sponge,  for  children  with 
bowel  .affections.  680. 

Beadle,  Dr.  Edward  L.,  notice  of  death  of,  420. 

Beard,  Dr.  Geo.  M. ,  monohypochondria  and  monomania, 
313,  505  ;  the  moral  character  of  trance  subjects, 
81. 

Beef-juice,  165. 

Belladonna,  in  whooping-cough,  262. 

Bellevue  Hospital,  66,  261 ;   Medical  Board  of,  559. 

Bellevue  Hospital  Medical  College,  commencement,  336. 

Bennct.  J.  Henry,  laceration  of  the  cervix,  473;  re- 
join 'er,  555. 

Bernard,  Claude,  362. 

Beyer,  Dr.  H.  G. ,  case  of  varicose  aneurism,  200. 

Bigelovv.  Dr.  Horatio  P.,  some  points  in  the  study  of  in- 
sanity developed  by  the  Guiteau  trial,  62. 

Billroth,  163  ;  and  Albert,  448. 

Births  and  deaths  in  New  York  City,  168. 

Bismarck,  as  a  patient,  168. 

Bitters,  analysis  of,  616. 

Bladder,  carcinoma  of,  48  ;  diagnosis  of  tumors  of,  558  ; 
diphtheritic  cast  of,  301  ;  gangrene  of,  302 ;  lacer- 
ated, 326 ;  papillary  growth  in,  460  ;  paracentesis, 
of,  289  ;  spasm  at  the  neck  of,  383,  414. 

Bliphoritis  ciliaris,  from  ametropia,  399. 

Block,  Dr.  J.,  osteitis  of  the  femur,  485. 

Blood,  condition  of,  in  chlorosis  and  pregnancy,  179  ; 
effusions  of,  at  the  fold  of  the  elbow,  69  ;  scarlati- 
nal, 409. 

Blood-corpuscles,  new,  223  ;  red,  numeration  of,  43. 

Blood  lettmg,  action  of  local,  575. 

Board  of  Examination,  State,  162. 

Bodenhamer,  Dr.  Wm.,  the  treatment  of  hemorrhoids, 
.509.  537. 

Bone,  removal  of  a  splinter  of,  from  the  larynx,  584. 

Borax,  in  surgery,  280. 

Boro-glycerine,  644. 

Bosworth.  Dr.  F.  H. ,  530  ;  study  of  nasal  catarrh,  017. 

Bouley,  M..  221. 

Bovine  virus,  a  plea  for,  388  ;  communication  of  conta- 
gious diseases  by,  463  ;  644. 

Bowel  affections,  in  children,  0T9. 

Bradley,  Dr.  Wm.  L.,  ante-partum  hour-glass  contraction 
of  the  uterus,  .569. 

Bradner,  Dr.  W.  B. ,  Florida  as  a  health  resort,  53. 

Brain,  abscess  of,  296  ;  a  large,  557  ;  cortex  and  cranial 
surf. ace  of,  603  ;  electric  excitability  of  cortex  of, 
in  hypnotic  persons,  476;  longitudinal  white  line  in 
the  cortex,  210  ;  of  criminals,  409,  519  ;  of  the  cat 
for  anatomical  study,  531  ;  sarcoma  of,  381,  496. 

Bread,  prepared  with  soa-water,  140. 

Breast,  carcinoma  of,  influence  of  operations  upon,  100. 

Brewer,  Dr.  E    P.,  on  the  limit  of  skin  vitality,  483. 

Brewer,  Dr.  George  E. ,  reduction  of  backward  disloca- 
tion of  radius  and  ulna,  374. 

Bridges,  Dr.  Robert,  307. 

Hright's  disease,  251,  612;  early  diagncsis  of  chronic, 
521  ;  gastric  lesions  in,  403  ;  specifics  for,  301. 

Brock,  Dr.  Hugh  VV.,  notice  of  death  of,  558. 

Ihomiue,  disinfection  by,  615. 

Bronchi,  dilated,  quebracho  in,  27. 

Bronchitis,  grindclia  robusta  in,  516. 

Bronchopneumonia,  80. 

Brown,  Dr.  John,  nolico  of  death  of,  556,  648. 

IJroMU,  Dr.  N.  F.,  hydrangea  arborescens,  in  renal  calcu- 
lus, 39. 

Brown,  Dr.  W.  Symington,  notice  of  book  by,  465. 

Browne,  J.  Crichton,  a  word  for  truth,  23, 

BrownSequard,  on  general  or  local  contractures  after 
death,  235. 


Buboes,  abortive  treatment  of,  GIG. 

Buffon  and  Bonnet,  113. 

Bulbar  paralysis,  cured,  4<12. 

Burke.  Martin,  "Freedom  in  Consultations,"  585. 

Burr,  Dr.  Geo.,  simultaneous  fracture  of  both  clavicles, 

500. 
Burrall,  Dr.  F.  A.,  chloroform  and  nitrite  of  amyl,  335. 


C 


Cadmium,  sulphate  of,  in  corneal  opacities,  139. 
Calcium  sulphide,  526  ;  as  an  anti-snppurative,  472;   in 

strumous  ophthalmia,  138. 
Calculus,    renal,   hydrangea  arborescens,    39;  vesical,  a 

be.an  the  nucleus,  138;  vesical,  .580:   in  the  female, 

319. 
Canal,  external  auditory,  wax  in,  503. 
Cancer,  Chian  turpentine  in,  168,  177;    of  the   rectum, 

438 ;   resection  of  stomach   for,  433. 
Cane-sugar  and  grape-sugar,  613. 
Carcinoma,  of  the  bladder,  48  ;   of  the  breast,  influence 

of  operations  upon,  100  ;  of  the  pharynx  and  larynx, 

.551. 
Canula,  dangers  from,  in  tracheotomy,  517. 
Carbonic  dioxide,  effect  upon  the  exhaiation  of,  by  sec- 
tion of  the  pneumogastric,  544. 
Carbuncles.  281,  496,  626,  G30. 
Caries,  spinal,  623. 
Camification.  of  the  lung,  47. 

Carroll.  Dr.  Alfred  L. ,  420,  447 ;  consultation  with  irregu- 
lars, 27G. 
Cartikage,  recent  experiments  with,  45. 
Cartilages,  floating  in  the  knee-joint,  7.8. 
Cartwright  Lectures,  83,  85.  113,  141. 
Case,  a  curious,  130. 

Castle,  Dr.  F.  A.,  neglected  pessaries,  52. 
Castration,  and  spurious  herraaphroditism,  306. 
Cataract,    congenital,   458  ;  extraction  of,  169 ;  senile, 

458 ;   traumatic,  459. 
Cat.arrh,  chronic  nasal,  .surgical  treatment  of,  861,  .581 ; 

study  ol  nasal.  617,  669. 
Gate,  Dr.  William  Mellen,  notice  of  book  by,  353. 
Cathartics,  hypodermically,  38G, 
Catheter,  fracture   of,  in  the  urethra,  134. 
Catheteiization,  .syncope  from,  27. 
Cats'  hairs,  styptic  action  of.  138. 
Caulophyllum  thalactoides,  1 08. 
Cautery,  actual,  use  in  medicine,  493,  578. 
Cellulitis,  pelvic,  with  abscess,  108. 
Cellulose,  625. 

('entigr<ade  and  Fahrenheit.  502. 
Central  College  of  Physicians  and  Surgeons,  364. 
Central  cortex,  functions  of,  407. 
Cervix  uteri,  laceration  of,  155,  222,  473,  555  ;  stenosis 

of,  108. 
Chancre,  excision  of,  643. 
Charcot's  joint  disease,  180. 
Charity  Hospital,  officers,  55. 
Charity  Organization  Society,  265. 
Charity,  organization  of,  380. 
Chase,  Dr.  Meigs,  685. 
Cheesman,  Dr.  W.  S.,  heart-lesions  in  rheumatic  fever, 

203. 
Chian  turpentine,  in  cancer,  168. 
Chicago  Medical  College,  643. 
Children,  bowel  affections  in,  679. 
Children's  cottage  hospitals,  448. 
Chinolin,  311  ;  in  whooping-cough,  519. 
Chloroform,  and  the  nitrite  of  amyl,  335  ;  death   from, 

70,  22.S ;  effect  of,  upon  the  nervous  centres,  544; 

frequent  cause  of  death  from,  433  ;  impure,  433. 
Chlorosis  and  pregnancy,  condition  of  blood  in,  179. 
Chololithectomy,  662. 
Cincinnati  Academy  of  Medicine,  384.J 
Cincinnati  Medical  Society,  385. 
Circulation,  central,  544. 


INDEX. 


689 


Circumoision,  and  a  contracted  meatus,  308  ;  for  the 
correction  of  spasm  of  the  ciliary  muscles,  9. 

Clavicle,  treatment  of  fracture  of,  without  apparatus, 
230,  391  ;  treatment  with  wire  sutures,  543  ;  "  back- 
cling  "  for  fractured,  572,  670. 

Clavicles,  fracture  of  both,  500. 

Clinocephalus,  tiKi. 

Clitoris,  eleph.intiasis  of,  53. 

Clot,  fibrinous,  in  an  aneurism,  208. 

Clothes,  saliva  spots  in,  IfiS. 

Coccyx,  new  method  of  removal  of,  ISO. 

Code,  of  Jledical  Ethics.  103,  166,  182,  548,  558. 

Codeia,  .and  morphia,  3()3. 

Cohosh,  blue,  the  tincture  of  the  root,  108. 

Cold,  dry.  in  the  reduction  of  temperature,  400. 

Colic,  lead.  503 

Color-blindness,  683. 

Columbia  Veterinary  College.  390. 

Comings.  Dr.  A.  F.,  universal  knife,  013. 

Compression,  instrumental,  of  the  carotid  as  a  thera- 
peutic agent.  173. 

Congress,  German,  for  internal  medicine,  612. 

Conium,  105. 

Conjunctiva,  croup  of.  63,  187  ;  diphtheria  of,  iodoform 
in,  082. 

Connecticut  Medical  Soc  ety.  635. 

Consultations,  freedom  in,  378,  434,  .520,  523,  58.5  ;  the 
question  of  medical,  102;   with  irregulars.  270. 

Consumption,  local  antiseptic  treatment  of,  285. 

Contagious  diseases,  1881,  83. 

Contractures,  general  or  local,  after  death,  235. 

Convolutions,  cerebral,  mathematical,  28. 

Convulsions,  following  ligation  of  the  carotid  artery, 
232;  inf.antile,  nitrite  of  amyl  in,  582;  in  resusci- 
t.ated  children,  504  ;  puerperal,  224,  251.  405. 

Cook  County  Hospital,  GO,  420. 

Copper,  sulph.ate  of,  poisoning  by,  564. 

"  Corked  "  ether  cans.  73. 

Cornea,  opacity  of,  sulphate  of  cadmium  in.  139. 

Corning,  Dr.  J.  Leonard,  prolonged  instrumental  com- 
pression of  the  (primitive  carotid  artery  as  a  thera- 
peutic agent.  173. 

Coroner,  reform  in  the  system,  646. 

Corrigan,  Dr.  J,  F.,  antisepic  medication,  259. 

Cox's,  Judge,  charge  to  the  jury,  130. 

Cramer,  Jennie,  murder  of,  462  ;  amount  of  arsenic  in 
body,  559. 

Cranium,  congenital  malformation  of,  300. 

Crede's  method,  301. 

Cremation,  56. 

Croup,  care  of  trachea  after  tracheotomy  for,  342,  355  ; 
jabor.andi  in,  42  ;  of  the  conjunctiva,  187,  031  ;  pap- 
pai-juice  in.  Oil. 

Crothers,  Dr.  T.  D. ,  curability  of  inebriety,  174, 

Curara.  artificial.  510  ;  in  hydrophobia,  404. 

Curvature,  sacro-lumbar,  337,  .-;59. 

Cutter,  Dr.  Ephraim,  organism  in  the  Croton  water, 
305. 

Cyst,  dermoid,  of  the  ovary,  82  ;  of  the  pancreas,  40, 
358. 

Cysticeroi,  in  the  brain,  50. 

Cystitis,  177,  190. 

Cysto-adenoma,  of  the  thyroid,  105. 

D 

Dalton,  Dr.  John  C,  Buff  on  and  Bonnet  in  the  eighteenth 
century,  113  ;  nervous  degenerations  and  the  theory 
of  Sir  Charles  Bell,  141;  the  experimental  method  in 
medical  science,  85  ;  notice  of  book  by,  239. 

Darwin,  death  of,  464. 

Dawson.  Dr.  W.  W.,  treatment  of  fracture  of  the  chavicle 
with  wire  sutures,  543. 

Deafness,  in  school-children,  205. 

Dean  Swift,  413. 

Death,  recognition  of,  640 ;  sudden,  from  forced  depres- 
sion of  the  tongue,  288. 

Death-rates,  in  1880,  420, 


Deformities,  genesis  of  certain  hereditary,  514. 

Degeneration,  amyloid,  489. 

Delirium  of  salicylic  acid,  456. 

Dental  engine,  modified,  488. 

Dentistrj%  as  a  specialty,  302  ;  mercury  in,  078. 

Dentists,  education  of,  079. 

Dermatolysis,  3(M. 

Dermato.sis,  acute,  140. 

Diabetes,  213  ;  and  malaria,  112;  bromide  of  arsenic  in, 
321;  complicated  by  endocarditis,  515  ;  hepatic  af- 
fections in  their  relations  to,  288;  origin  of.  154; 
pathognomonic  .symptoms,  224  ;  peritoniiis.  alveolar 
in.  288  ;  surgical  operations  and  their  relations  with, 
154;  urica?,mia  a  premonitory  symptom.  515. 

Diastasis  of  ihe  condyloid  epiphysis  of  the  femur,  000. 

Digitaline,  470  ;  effect  upon  the  heart,  440. 

Digitalis,  viscum  album  a  sub.'ititute  for,  83. 

Diphtheria,  289,  459,  517  ;  and  erysipelas,  209  ;  and  pet 
animals,  252  ;  condition  of  the  heart  in.  557 ;  eczema 
and  erysipelas,  27  ;  experimental  studies  regarding 
the  nature  of,  304  ;  in  calves  and  pigs,  400  ;  iodo- 
form in,  447  ;  nasal,  80;  no  bacteria  in,  150;  of  tl:e 
conjunctiva,  187,  682;  paralysis  of  the  larynx  in, 
683 ;  the  false  membranes  of.  398  ;  treatment  of, 
435. 

Diploma,  manufacture  in  Detroit,  167. 

Diplomas,  American,  in  Australia.  448. 

Disease,  connection  betwren  cardiac  and  renal.  181. 

Diseases,  contagious,  and  pet  animals,  252  ;  contagious, 
in  1881,  83  ;  of  the  middle  ear,  treatment  of.  57, 
75. 

Disinfectants,  uselessness  of  some  of  our  ordinary,  325. 

Dislocation  of  the  knee,  303. 

Dispensary,  the  Northwestern,  528. 

Displacements,  uterine,  273. 

Di.ssecting-room,  non  odorous,  224. 

Doctors'  fees  in  London,  518. 

Doctors,  in  Belgium,  38 ;  migratory,  642  ;  village,  531. 

Doli.irina,  56. 

Dosage  and  administration,  311,  3£3. 

Douche,  vaginal,  273. 

Dowell's  method  for  the  radical  cure  of  hernia,  234. 

Drainage  of  knee-joint,  002. 

Drainage-tube,  resection  of  rib  necessary  for  its  removal, 
172. 

Draper.  Dr.  John  W . ,  notice  of  death  of,  55. 

Druggist,  responsibility  of  a,  085. 

Drug's,  actions  of.  408  ;  meisurements  of,  071. 

Duboisia,  poisoning  by,  203. 

Ductus  arteriosus,  439. 

Dwighc,  Dr.  Thomas.,  notice  of  book  by,  268. 

Dyspepsia,  among  our  farmers,  183  ;  salicylates  in,  G77 ; 
tachycardia  in,  601. 


Ear,  diseases  of  the  middle,  treatment  of,  57,  75  ;  insects 

in,   remov.al    of,   154  ;    suppuration  of   the   middle, 

iodoform  in.  336  ;  wax  in,  5U3. 
Earache,  in  children,  644. 
East  River  Medical  Association,  140. 
Eating,  before  sleeping,  502. 
Eclampsia,  morphine  in,  351 ;  puerperal.  405. 
Ectropion,  treated  by  transplantation,  253. 
Eczema,  diphtheria  and  erysipelas,  37;   viola  tricolor  in, 

449,  407. 
Edis,  Dr.  Arthur  W.,  notice  of  book  by,  354. 
Educational  reform,  and  the  Harvard  Medical    School. 

159. 
Effusions,  of  blood  at  the  fold  of  the  elbow.  69. 
Elbow,  backward  dislocation  of,  374  ;  exsection  of,  553  ; 

fracture  of,  443. 
Electric  current,  common  mistake  in  the  selection  of, 

493  ;  in  surgery,  659. 
Electric  light,  hygienic  value  of,  384. 
Electrolysis,  iu  enlarged  prostate,  306  ;  on  the  treatment 

of  wine-marks,  188  ;  for  permanent  removal  of  hair, 

253,  275, 


690 


INDEX. 


Electro-therapy,  in  opacity  of  the  vitreous  body,  42. 

Elephants,  breeding  and  diseases  of,  493. 

Elephantiasi.s,  of  the  clitoris,  52  ;  parasites  in,  13. 

Ellis,  Dr.  Geor{,'e  Viner.  notice  of  book  by,  16.  394. 

Ely,  Dr.  Edward  T.,  diseases  of  the  eye  arising  from  af- 
fections of  the  teeth,  308  ;  iodoform  in  suppuration 
of  the  middle  ear,  330.  • 

Embolism,  cerebral,  on  the  right  side,  2G1. 

Emphysema,  quebracho  in,  37. 

Eraplastrum,  plumbi,  adhesivum,  beIladonna3,  aconiti, 
etc.,  348. 

Enchondroma,  laryngeal,  233. 

Endocarditis,  complicating  diabetes.  515. 

Enteritis,  tuberculai",  410. 

Epidemics,  prevention  of,  fl05. 

Epilepsy,  hemi-,  51;   trephining  for.  571. 

Epipeocele,  incarcerated  femoral,  105. 

Epistaxis,  cat's  hair  for,  138  ;  intermittent,  541. 

Epithelioma,  298 ;  of  the  cervix  uteri,  pregnancy  with, 
lOG. 

Ergot,  in  lead  palsy,  13 ;  in  pharyngitis,  470  ;  therapeu- 
tical indications  for,  430. 

Ergotine,  in  erysipelas,  83. 

Eruptions,  cutaneous,  caused  by  certain  medicines,  153. 

Erysipelas,  and  diphtheria,  81)9;  ctrvical,  485;  diphthe- 
ria and  eczema,  27;   ergotine  in,  83. 

Erythema,  nodosum,  63fi  ;  scarlatinous,  following  the  use 
of  quinine,  037,  085. 

Eserine,  in  acute  glaucoma,  193,  318. 

Esmarch,  constrictor,  554. 

Ethics,  medical,  a  question  of,  503  ;  in  China,  417  ;  code 
of,  163.  106,  183,  548;  in  consultations,  558. 

Encyclopiedia  of  Surgery,  the  International,  notice  of 
the  first  volume  73. 

Examinations,  State  and  legal  qualifications.  111. 

Excision  of  the  elbow,  553  ;  of  the  humerus,  553 ;  of 
the  knee,  405. 

Exostoses,  congenital,  09;  of  the  popliteal  region,  131, 
133,  302. 

Extracts,  meat,  37. 

Extractum  caruis.  9S. 

Eye,  communicable  diseases  of,  683;  condition  of  in 
fatal  anceniia,  030 ;  disease  of,  from  disease  of  the 
teeth,  258  ;  foreign  bodies  in,  263,  583. 


Factory  children,  1 03. 

Fahrenheit  and  centigrade,  503. 

Fat,  dige.stion  and  absorption  of,  209. 

Fecundation,  predilection  for,  588. 

Felcon,  Dr.  Lucius  E.,  medical  induction  coils,  125. 

Femur,  dia.stasis  of  the  condyloid  epiphysis  of,  600 ; 
fracture  of,  404 ;  osteitis  of,  485  ;  subcutaneous 
section  of,  180,  600;   ununited  fracture  of,  001. 

Fever,  puerperal,  parotitis  in,  289 ;  pyrexia  in,  533 ; 
recurrent,  simultaneous  with  measles  and  typhus, 
487  ;  rheumatic,  heart-lesions  in,  303  ;  remittent, 
with  peculiar  pulse-rate,  588;  scarlet,  459;  simple 
continued,  190  ;  temporary,  after  simple  fractures, 
153 ;  typhoid,  459,  402  ;  and  polluted  well-water, 
168;  hemorrhages  in,  139;  phlebitis  in,  545;  tepid 
baths  in,  401 ;  typhus  with  measles  and  recurrent 
fever.  487;  yellow,  558  ;  salicylic  acid  in,  470  ;  tissue, 
changes  in,  613. 

Fevers,  antipyretic  treatment  of,  673  ;  the  ha;mic  crisis 
in,  307. 

Fibrin,  the  formation  of,  033. 

Fibroma,  of  abdominal  wall,  410;  of  Scarpa's  triangle, 
33. 

Fibroma,  of  the  tonsil,  390. 

Fibro-myxo-sarcoma,  of  the  laryn.x,  79. 

Fibrosarcoma,  of  the  ischium,  308. 

Filaria  sanguinis  hominis,  and  chylous  urine,  129. 

Fissura,  calcarina,  310,  360. 

Fissure,  anal,  ioJoform  in,  300. 

Fistula,  anal,  417  ;  in  the  anterior  portion  of  the  ure- 
thra, 344. 


Fistules,  congenital  in  the  lumbo-sacr.al  region,  545. 

Flexion,  extreme  iiterine,  108. 

Florida,  as  a  health  resort,  53. 

Flower,  '■  Dr."  Kichard  C,  503. 

Flukes,  in  the  human  liver,  50. 

Flynn,  Dr.  J.  W.,  atropine  poisoning  successfully  treated 
by  morphine,  375, 

Foot,  Tripier's  amputation  of,  403. 

Forceps,  new  obstetric,  377,  604. 

Forearm,  sarcoma  of.  346. 

Fothergill,  Dr.  J.  Milner,  notice  of  book  by,  267, 

Fox,  Dr.  Geo.  Henry,  the  permanent  removal  of  hair, 
353. 

Fracture  of  os  hyoides,  396  ;  of  the  sternum,  ;;01  ;  of  the 
thigh,  404. 

Fractures,  plaster-of-Paris  in  the  treatment  of,  11 ;  tem- 
porary elevation  of  temperature  after,  simple,  153. 

Frantz,  Dr.  John  H..  death  of,  308. 

French,  Dr.  J.  M.,  erythema  following  the  use  of  qui- 
nine, 687. 

Freund.  Prof.,  167. 

Friedrich,  Dr.  Karl,  430. 

Fritsch,  Dr.  H.,  notice  of  book  by,  133. 

Fuller,  Dr.  Robert  M.,  a  convenient  method  of  dosage 
and  administration,  311,  333. 

Fuller's  tablets,  530. 

Fumucles,  281,  496. 

G 

Gall-stones,  detection  of,  by  the  exploring  needle,  568. 

Galvani  and  galvanism,  85. 

Gangrene,  of  the  bladder,  302  ;  from  injury  of  the  ulnar 

nerve,  560. 
Garrigues,  Dr.  Henry  J. ,  anatomy  and  histology  of  cyst 

of  the  pancreas,  380  ;  ineffective  vaccine  virus,  347. 

418. 
Gastroscojiy,  83. 

Gastrotomy.  .successful.  83,  350,  307. 
Geddings,  Dr.  W.  H. ,  report  of  cases  of  phthisis,  4,  34. 
Gelsemium,  death  from,  65. 
Genu-pectoral  posture,  !86. 

Gibney.  Dr.  V.  P. ,  the  sequela;  of  measles,  589,  606, 
Glaucoma,    acute,    cured   by  eserine,    193 ;    acute   in   a 

myopic  eye,  318  ;  eserine  in,  318. 
Glossograph,  604. 
Gl.vcosuria,  quinine  in,  544. 
Goilre,  in  the  lower  animals,  615 ;   treated  by  excision, 

94. 
Gonorrhoea,  139  ;  non-specific,  29  ;  with  gangrene  of  the 

bladder,  302. 
Gr.aham,  Dr.  A.  C,  acquired  monorchidisra,  509. 
Grainger,  Dr.  W.  H. ,  a  new  obstetric  forceps,  377. 
Grape-sugar  and  cane-.sugar,  613. 
Gray,  Dr.  .John  P.,  302. 

Gray,  Dr.  I,andon  Carter,  reflex  disturbances  from  gen- 
ital ii'ritation,  136  ;  rejoinder  to  Dr.  Shaffer,  250. 
Green,  Traill,  the  higher  medical  education,  537. 
Greenhill,  Dr.  W.  A.,  notice  of  book  edited  by,  353. 
Gregg.  Dr.    IloUin   II.,  no  bacteria  in   diphtheria,   150  ; 

the  false  membranes  of  diphtheria,  398. 
Griffe.  de  la  main,  136. 

Grindelia  robusta,  in  asthma  and  bronchitis,  510. 
Gross,  Dr.  Samuel  D  ,  391. 

Guiteau.  a  d.ay  with,  21  ;   the  responsibility  of,  46, 
Gunu,  Dr,  J,  H.,  State  examinations  in  Alabama,  383, 
Gymnasts,  pulmonary,  38. 

H 

Hfcmoglobine,  514, 

H.-emoglobinuria,  paroxysmal  occurrence,  488,  504. 
Ilager,  Dr,  Hermann,  notice  of  book  by,  294. 
Hair,  pornmnent  removal  of,  353,  375. 
Halderman.  Dr,  Davis,  diastasis  of  the  femur,  COO. 
Hall,  Dr.  A.  L.,  death  from  gelsemium,  65. 
Hamilton,  Dr.  AlUan  McLaue,  notice  of  book  by,  267; 
word-bliuduess,  609. 


INDEX. 


691 


Hamilton,  Gail,  on  the  spent  bullet,  4fi4. 

Hanging,  jiatbological  changes  in  death  by,  43G. 

Hamsiu,  Dr.  J.  M.,  a  device  for  laryngoscopic  practice, 
304. 

Harrison,  Dr.  Reginald,  notice  of  hook  by,  133. 

Hart.  Dr.  Charles  A.,  ursemia  in  an  infant  due  to  elonga- 
tion and  contraction  of  the  prepuce.  (i5. 

Harvey,  Dr.  P.  F.,  intermittent  epistaxis,  541. 

Head,  injuries  to  the,  3;!4. 

Hearing,  defective  in  children,  483. 

Heart,  aneurism  of,  551  ;  effect  on  by  occlusion  of  coro- 
nary arteries,  208  ;  eccentric  hypertrophy  without 
valvular  lesion,  381 ;  weighing  43  ounces,  216. 

Hematocele,  pelvic,  416. 

Hemiplegia,  a  case  of,  593,  609  ;  malarial,  280  ;  observa- 
tions on,  453,  472. 

Hemorrhage,  and  Nelaton,  685;  pharyngeal,  G83;  um- 
bilicaf,  377. 

Hemorrhages,  of  typhoid  fever,  120;  treatment,  of  due 
to  epiihelioma  of  the  womb,  75. 

Hemorrhoids,  dilatation  of  the  anal  sphincters  for,  5(l9, 
537  ;  extirpation  with  the  clamp,  631 . 

Henoch,  Dr.   Edward,  notice  of  book  by,  465. 

Hep.alitis,  interstitial.  216. 

Hero  it.y  in  dental  development.  678. 

Hermaphroditism,  spurious,  and  castration,  306  ;  in  a 
hog,  ()70, 

Hernia,  Dowell's  method  for  radical  cure,  234  ;  Hea- 
ton's  operation  for  radical  cure  of,  349  ;  irreducible 
ard  strangulated  treated  by  morphia  hypodermically, 
514  ;  muscular,  cured  by  Martin's  bandage,  15  ; 
omental,  685  ;  omental,  of  the  tunica  vaginalis,  357  ; 
strangulated  umbOical,  301. 

Hinsdale,  Dr.  Guy,  hospital  report,  177,  333,  319,  569. 

Hip,  anchylosis  of,  660. 

Hoang-nau,  in  the  treatment  of  rabies,  515. 

Hodgen,  Dr.  John  T. ,  obituary,  539. 

Holden's  osteology,  294. 

Homatropin,  in  phthisis,  437. 

Homoeopathy,  205. 

Hospital  examinations.  326. 

Ho,spital,  for  the  miners,  517 ;  Garfield  memorial.  54S  ; 
medical  mi.ssionary,  498  ;  of  the  University  of 
Pennsylvania.  177,  319,  232,  569;  Saturnday'and 
f^und.ay  a.ssoeiation,  56;  officers,  128;  the  fund,  112; 
distribution.  223. 

Hospitals,  children's  cottage,  448;  lunatic,  188;  origin 
of,  504  ;  special,  163  ;  speci.al  for  scarlet  fever  and 
diphtheria   359. 

Houston,  Dr.  Thomas  F. ,  antagonism  of  opium  and 
veratrum  viride,  .")2. 

Hubbard.  Dr.  Fred.  Theman,  notice  of  book  by,  520. 

Hueter,  Prof.  C. ,  notice  of  death  of,  684. 

Humerus,  exsectlon  of  the  head  of,  553  ;  necrosis  of 
the  upper  part  of  the  shaft  of  the,  498 ;  trans- 
plantation of,  288. 

Hunt,  Dr.  S.  H.,  relaxation  of  dorsal  muscles,  hernia, 
cystitis  and  convoLsions  due  to  contracted  prepuce, 
194. 

Hydrangea  arborescens,  in  renal  calculus,  39. 

Hydrocele,  67,  301  ;  treatment  of  by  the  injection  of 
carbolic  acid,  13. 

Hydronephrosis.  383.  477,  496. 

Hydrophobia,  129,  179  ;  curara  in,  404. 

Hydro-salpinx,  155. 

Hygiene,  International  Congres.s  of,  684  ;  National 
Museum  of,  55;   of  schools,  167  ;  oral,  677. 

Hyoscine,  hydriodide  of,  as  a  mydriatic,  403  ;  physio- 
logical effects  of.  208. 

Hyperhydrosis,  general  neuroparalytic,  68. 

Hypnotism,  42,  73,  573. 


Ice,  impure,  639. 

Illumination,    electric,  applied  to  physiological  demon- 

.strations.  68. 
Illustrated  Quarterly  of  Medicine  and  Surgery,  362. 


Immersion,  recovery  from  prolonged,  77. 

Incontinence,  of  urine  in  children.  261. 

Induction,  balance,  detection  of  lead  bullets  by,  307  ; 
coils,  medical.  125. 

Inebriety,  curability  of,  174. 

Infant  feeding  and  infant  foods,  189. 

Infants  of  the  poor,  and  the  State  Medical  Society,  14. 

Infarction,  pulmonary  ruptured,  303. 

Inoculation,  as  a  protection  against  malignant  pustule, 
514  ;  of  anima's  with  venereal  matter,  288. 

Inoculations,  protective,  634. 

Insane,  association  for  the  protection  of.  44 ;  chronic, 
pauper,  575  ;  national  association  for  the  jirotection 
of  the,  109  ;  Senate  report  on  the  management  of, 
325;  what  lunatics  think  concerning  the  responsi- 
bility of  the,  587. 

Insanity,  humane  treatment  of,  390 ;  some  points  in  the 
study  of,  63  ;  the  question  of  moral,  99. 

Insects,  removal  of,  from  the  ear,  154. 

Instrument  manufacturers,  council  of,  588. 

Insufflation,  of  medicated  powders  with  the  upper  air- 
passages.  191. 

Intestinal  obstruction,  135,  299,  328,  437,  431,  434,  443, 
580,  616,  659. 

Intestines,  strangulation  of  with  rupture  of  the  omen- 
tum, 11. 

Intussusception,  laparotomy  for,  299. 

Iodine,  in  acute  malaria,  250  ;  in  malignant  pustule, 
433  ;  in  syphilis,  269. 

Iodoform,  323,  362,  448,  543  ;  as  a  dressing,  513  ;  era  of 
in  surgery.  97  ;  in  anal  fissure,  39il ;  in  Britisa 
hospitals,  401  ;  in  diphtheria,  447  ;  diphtheretic  con- 
junctivitis, 683;  in  gynecological  practice.  217;  in 
suppuration  of  the  middle  ear,  336  ;  value  of  as  a 
dressing  for  wounds,  3C9,  324. 

lodoforra-poisoniug,  404, 

Iowa  State  IMedical  Society,  334. 

Ipecacuanha  during  labor,  601. 

Iridectomy,  458. 

Irritation,  genital,  reflex  disturbances  from,  53,  136, 193, 
250,  419  ;  reflex,  producing  symptoms  of  stoni;  in 
the  bladder.  29. 

Iron,  muriated  tincture  of,  administration.  41  ;  prepara- 
tions of,  168. 

Irregulars,  consultation  with.  376. 

Ischium,  fibro-sarcoma  of,  303. 


Jaborandi,  in  croup,  42. 

.lacksou.  Dr.  Geo.  T.,  erythema  nodosum,  626. 

Jarvis,  Dr.  Wm.  C. ,  155  ;  surgical  treatment  of  nasal  ca- 
tarrh. 561. 

Jervis,  Dr.  D.  H  ,  expulsive  effort  in  parturition,  686. 

Jefferson  Medical  College,  392. 

Joints,  operations  upon  diseased,  in  phthisical  subjects, 
129. 

Jones.  (.'.  Hanfield,  F.R.S. ,  clinical  lecture  on  paraplegia, 
421. 

Jones,  Dr.  Xelsou  E.,  pyrexia  a  conservative  force  in 
fever,  533. 

Jones,  Dr.  Talbot,  nerve-stretching,  499. 

Judkins,  Dr.  Wm. ,  aspiration  of  the  knee-joint,  370. 

Junod,  Dr.,  notice  of  death  of,  361. 


Kales,  Dr.  J.  W.,  685. 

Kane,  Dr.  H.  H. ,  notice  of  hook  by,  267;  the  phenom- 
enon of  partial  morphia- narcosis,  54. 

Keetley,  Dr.  C.  B. ,  notice  of  book  by.  465. 

Kentucky  State  Medical  Society,  500. 

Keratitis,  malarial,  334. 

Kidney,  amyloid  degeneration  of,  without  albuminuria, 
68  ;  fibro  cystic  tumor  of,  300 ;  prim.iry  sarcoma  of, 
48 ;  extirpation  of,  313. 


692 


INDEX. 


K'nj,  Dr.  David,  notice  of  death  of,  301. 

Knapp,  Prof.  Herman,  476;   extraction  of  cataract,  169. 

Knee,  dislocation  of,  303  ;  excision  of,  405  ;  floating  car- 
tilages in,  78. 

Knee-joint,  aspiration  of,  370,  384. 

Knife,  universal,  for  uterine  surgery,  613. 

Koch,  and  tuberculosis,  545,  547  ;  at  the  German  Con- 
gress, ()03. 

Kola  nut.  668. 

Koumiss,  value  of,  071 . 


Labor,  ipecac  during,  001  ;  use  of  nitrous  oxide  in,  514. 

Laboratory,  anthropometricol,  401. 

Laceration  of  the  cervix  uteri.  155,  473. 

Lachrvmal  .ipparatus,  syphilitic  diseases  of,  106. 

"Lady  fever,"  139,  251. 

Lamson's,  Dr.,  mental  condition  of,  503;  the  case  of, 

405  ;   the  trial  of,  84. 
Langenbeck,  685. 
Laparotouiy,  for  acute  intestinal  obstruction,  427,  434, 

443  ;  for  intussusception,  299. 
LaKoe,  Dr.  James  G. ,  case  of  fracture  of  the  oa  hyoides, 

396. 
Larva  of  a  fly,  developed  under  the  skin  of  the  human 

body,  29S. 
Laryngitis,  phthisical,  215. 
Larynx,  device  for  examination  of,  304  ;  fibro-myxo-sar- 

coraa  of,    79  ;   removal  of  bone  and  dental   plate 

from.  584. 
Leadpiilsy,  ergot  in,  13. 
Lead-poisonins,  331  ;  prevention  of,  84. 
Lectures,  clinical,  112. 
Leech-bites,  261. 

Leprosy,  parasites  in,  12,  030 ;  recent  .studies  in  the  pa- 
thology of,  98. 
Leucocythajraia,  splenic,  672. 

Lewis,  Dr.  Daniel,  the  treatment  of  scarlatina,  383. 
Licensing  of  physicians  and  surgeons,  act  to  regulate, 

305. 
Light,  electric,  hygienic  value  of,  284. 
Listerism,  and  Mr.  Keith,  167,  064. 
Litholapaxy,  321. 
Lithotomy,  lateral,  513. 
Lithotrity,  263  ;  rapid,  in  old  men,  135,  203  ;  rapid  with 

evacuation,  577. 
Liver,  abscess  of,  062 ;  erectile  tumor  of,  359  ;  human, 

flukes  in,   5(> ;  sarcoma  of,   299  ;   surgery  of,   602 ; 

traumatic  abscess  of,  470. 
Localization,  494. 
Locomotives  vs.  malaria,  363. 
Locomotor  at.axia,  condition  of  cutaneous  nerves  in,  514  ; 

falling  of  the  nails  in,  510  ;  nerve-.stretching  in,  544. 
Lumbo-colotomy,   as   a  preliminary   measure  in  imper- 

for.ate  rectum,  154. 
Lung  atrophy  of  the,  105  ;  capacity  of.  043  ;  carnification 

of,  47. 
Lusk,  Dr.  Wra.  T.,  notice  of  book  by,  99. 
Lymphadenitis,  cutaneous,  515. 
Lympho-sarcoma  of  the  neck,  323. 


M 

Maclean,  Dr.  Donald,  notes  of  two  surgical  cases,  33. 

Macnamara,  Dr.  C  notice  of  book  by.  295. 

Ma<l-houHes.  supervision  of  private,  380. 

Maisch,  .lohn  M.,  notice  of  manual  bj',  353. 

Malaria,  acute,  iodine  in,  250;  and  diabetes,  112  ;  and 
locomotives,  363  ;  and  rickets,  291  ;  influenced  by 
locomotives,  199. 

Mann,  Dr.  Matihew  D.,  83. 

Manhattan  Eye  and  Ear  Hospital,  458. 

Marine  Hospital  Service,  U.  .S.,    183. 

Markoe,  Dr.  Thomas  M.,  exostoses  of  the  popliteal  re- 
gion, 121,  133. 


Martin,  Dr.  H.  A. ,  a  case  of  general  cruijtion  of  vaccinia. 

393. 
M.ason,  Erskine,  M.D.,  obituary,  440 ;  the  late  Dr.  Erskine, 

530.  015. 
Mason,  Dr.  Theo.  L.,  notice  of  death  of.  196. 
Massachusetts  Medical  Society,  notice  of  volume,  240. 
Mastoid,  deep  opening  of,  584. 
Materia  Medica,    Society,   217,   268,   332,   467  ;    should 

medical  students  be  taught  it.  640.  i . 

McClellan,  Dr.   George,  local  treatment  of   carbuncles, 

020. 
Meadows,  Dr.  Alfred,  notice  of  book  by,  407. 
Measles,  and  scarlatina,  simultaneous  occurrence,  401  ; 

the  sequelic  of,  589,  006 ;   with  recurrent  and  typhus 

fevers.  487. 
Meatus  auditorius  extemus,  inflammation,  197. 
Meatus   urinarius,  contr.acted,    and    circumcision,  308  ; 

as  a  cause  of  spasm  at  the  neck  of  the  bladder,  etc., 

383. 
Mediastinum,  abscess  of,  471 
Medical  acts,  305  ;  of  1880,  working  of.  588. 
Medical  Association,  Alabama,  557 ;  Jlississippi,  557. 
Medical  charities,  bequests,  447 ;    of  New  York,  363  ;  of 

Philadelphia,  363. 
Medical  charity,  abuses  of,  546. 

Medical  and  Chirurgical  Faculty  of  the  State  of  Mary- 
land, 437. 
Medical  college,  a  bogus,  301  ;  Albany,  364  ;  the  Miami, 

361  ;  of  Indiana,  304  ;  of  South  Carolina,  304. 
Medical  congress,  Spanish,  108. 
Medical  Depaitment,  University  of  Georgia,  364. 
Medical  education,  364 ;   the  higher,  .527. 
Medical  ethics,  code  of,  103,  160,  182.  548,  558  ;  in  China. 

417. 

Medical  expert  testimony,  655,  058,  681. 

Medical  history  of  houses,  350. 

Medical  induction  coils,  135. 

Medical  institution  of  learning,  72. 

Medical  journalism  in  Japan,  476. 

Medical  legislation.  210. 

Medical  notes  on  Asia,  248. 

Medical  Register,  the,  616. 

Medical  School,  the  Harvard,  and  educational  reform, 
159. 

Medical  science,  the  experimental  method  in,  85. 

Medical  services,  bills  for,  15. 

Medical  Society.  British  and  American,  of  Paris,  467; 
Chicaso,  470  ;  of  New  Jersey,  500 ;  of  the  County  of 
New  York,  247,  275,  359,  472,  581;  of  London,  prizes 
of.  477 ;  of  the  State  of  New  Jersey,  6(15 ;  of  the 
State  of  New  York,  131,  161, 184;  of  the  State,  and 
caring  for  the  infants  of  the  poor,  14  ;  of  the  State 
of  New  York,  revision  of  its  system  of  ethics,  220  ; 
of  the  State  of  Pennsylvania.  548;  of  Virginia,  prize, 

362  ;  the  St.  Louis,  and  the  New  York  code,  475. 
Medical  student,  the  American,  157. 
Medical  student's  primer,  279 ;  women,  195,  085. 
Medication,  antiseptic,  259. 
Medicine,  are  there  schools  in  ?  231  ;  at  Foochow.  71  ; 

experimental,     186 ;    proprietary,    040 ;     scientific, 

163 ;  veterinary,  in  Germany.  541. 
Medicines,  in   small   doses,  531  ;   proprietary,   292,   503; 

tasting  after  being  introduced   into  the  vagina  and 

ear,  335 
Medico-legal  Society,  55. 
Mcndelson,  Dr.  Walter,    Dr.  Skinner's  case  of  ruptured 

pulmonary  infarction  (f),  303. 
Menopause,  disturbances  of  the  nervous  system  coinci- 
dent with,  272. 
Meningitis,  basilar,  51. 
Mercury,  in  the  treatment  of  syphilis,  268,  377,  675  ;  ia 

dentistry,  678. 
Metcalf.  Dr.  6.  R.,  190. 
Microcephalus,  610. 
Micrococci,  recognition  of,  308. 
Milk,  in  the  propsigatiou   of  typhoid   and   scanet  fever 

and  diphtheria,  459  ;  skimmed,  139. 
Milk-sickuees,  138. 


INDEX. 


69  3 


Mills,  Dr.  T.  W.,  London,  S3. 

Milne,  Dr.  T.  Clarke,  State  examinations  and  legal  quali- 
fications, 111. 

Milton,  Dr.  M. ,  petroleum  in  phthisis,  5;!3. 

Mirror,  prismatic,  for  rhinoscopic  examinations,  307. 

Misery,  much,  births  many,  4(!5. 

Mississippi  State  .Medical  Association,  557. 

Missouri  Medical  College,  362. 

Mittendorf,  Dr.  W.  F. ,  noti9e  of  book  by,  295. 

Mole,  sanguineous,  298. 

Monohypochondria  and  monomania,  313,  505. 

Monomania  and  mouohypoohondria,  313,  505. 

Mouorchidism,  acquired,  509. 

Monospasm,  trachial,  496. 

Monster,  double,  298. 

Morbus,  niaculosis,  412. 

Mor^'nn,  Dr.  Wilbur  P.,  surgical  needle  for  wire  sutures, 
389. 

Morphia,  and  codeia,  363  ;  hypoderraically,  in  strangu- 
lated hernia.  514  ;  in  poisoning  by  atropine,  375 ; 
in  puerperal  eclamp-ia,  251. 

Morphia-narcosis,  ~>i. 

Munde,  Dr.  Paul  F. ,  concerning  a  case  of  dermoid  cyst 
of  the  ovary,  83. 

Muscles,  ciliary,  spasm  of,  9. 

M.vdriatic,  a  new.  403. 

Myxojdema,  diagnosis  of,  262. 


N.-iils,  falling  of  in  locomotor  ataxia,  516. 

Naphtliol,  US. 

Natioual  Examining  Board.  248. 

"  Nature's  invisible  police."  181. 

Neck,  gangrene  of,  69 ;  lympho-sarcoraa  of,  338. 

Necrosis,  from  arsenic  ;  of  the  petrous  portion  of  the 
temporal  bone,  585  ;  of  the  ujjper  part  of  the  sliaft 
of  tlie  humerus,  498. 

Nephrolithotomy,  for  anuria,  631. 

Nerves,  n  ndition  of  cutaneous,  in  locomotor  ataxia,  514. 

Nerve-stretching.  237,  240,  349,  499,  516,  544,  007 ; 
dangers  from,  252 ;  for  di.sease  of  the  spinal  cord, 
48b ;  in  traumatic  tetanus,  247  ;  in  infantile  par- 
aly.sis,  545  ;  subcutaneous,  112;  the  optic,  389. 

Nerve  suture.  42. 

Nervous  degenerations,  and  the  theory  of  Sir  Charles 
Bell,  141. 

Nervous  system,  Galvani  and  galvanism  in  the  study 
of  the,  85. 

Neuralgia,  spasmodic,  9  ;  trigminal.  300,  579. 

Neuro  .sarcoma,  ot  the  tibial  nerve,  298. 

Newton,  Dr.  R.  C. .  treatment  of  fracture  of  the  clavi- 
cle without  apparatus.  230. 

New  York  Academy  of  Medicine,  17,  75, 100, 160,213,372, 
414,  469,  521,  577  ;  Obstetric  Section,  107,  108,  416  ; 
section  in  Practice  of  Medicine,  493,  609  ;  Academy  of 
Sciences,  364;  Medico- Legal  Society,  195;  Neuro- 
logical Society,  50,240.  331;  Neurological  Society, 
officers,  420,  5s7,  643  ;  Opthalmological  Society,  offi- 
cers, 84;  Pathological  Society,  46,  78,  104,  21(i,  296, 
326,  358, 381,  410,  551  ;  Pathological  Society,  offlceis, 
84  ;  Physicians'  Mutual  Aid  Association,  211  ;  So- 
ciety of  German  Physicians,  298,  583 ;  State  Dental 
Society,  556;  Surgical  Society,  133,  343,  301,  355, 
443,  470,  496,  578. 

Nitro-gl.vcerine,  in  cardiac  disease,  460. 

Nitrous  oxide,  use  of.  in  labor,  514. 

Non-restraint,  in  the  treatment  of  the  insane,  110. 

Nostrils.  a;strns  larvse  in,  262. 

Nurses,  training-schools  for,  634. 


O 

QEsophagus,  laceration  of,  471  ;  stricture  of,  246,  493. 
OBstrus  larvai,  in  the  nostrils,  362. 
Obesity,  in  a  child,  323. 


Obstruction,  intestinal,  135,  299,  338,  437,  431  434  443 
580,  610,  659.  ' 

Office  swindlers,  463. 

Oleates,  in  skin  diseases,  549. 

Omentum,  rupture  of,  with  strangulation  of  the  intes- 
tines, 11. 

Oophorectomy,  664. 

Opacities,  conical,  sulphate  of  cadmium  in,  139. 

Operations,  upon  diseased  joints  in  phthisical  subjects, 
129  ;  surgical,  and  their  relations  with  diabetes, 
154. 

Ophthalmia,  purulent  infantile,  614  ;  sympathetic,  divi- 
sion of  the  optic  and  ciliary  nerves  for,  189. 

Ophthalmology,  the  Middlemore  prize  in,  (il6. 

Opium,  and  veratrum  viride,  antagonism  of,  52  ;  in  in- 
testinal obstruction,  431. 

Optic  ner\-e.  stretchmg  of,  389. 

Orbit,  sarcoma  of,  104. 

Organisms  in  the  Croton  water,  365. 

Orgasm,  the  absence  of,  127. 

Os  hyoides,  fracture  of,  390, 

Osteitis,  ot  the  femur,  485, 

Osteology,  human,  294. 

Osteoma,  of  upper  jaw,  337. 

Osteophytes,  cranial,  in  congenital  syphilis,  235, 

Otis,  Dr,  F.  N.,  clinical  lecture,  29. 

Otitis  media,  suppurative,  following  plugging  of  the 
posterior  nares,  515. 

"Ought  I  to  do  it  V"  391. 

Ovariotomies,  32  ;  consecutive  cases,  235. 

Ovariotomy,  43,  524  ;  death  after,  due  to  preliminary 
tapping,  257  ;  double,  358  ;  during  peritonitis.  665  ; 
during  pregnancy,  22  ;  vaginal,  433. 

Ovary,  dermoid  cyst  of,  82  ;  monocystic  tumor  of,  289. 

Ozone,  as  a  sleep-producing  agent,  131 ;  atmospheric,  in 
its  relation  to  disease,  408. 


"Painted  Sickne.=s,"  of  Mexico,  647. 

Pallen,  Dr.  Montrose  A.,  Bennet  on  laceration  of  the 
cervix  uteri,  222,  555. 

Palmer.  Dr.  A.  B.,  notice  of  book  by,  604;  Dr.  B.  W., 
notice  of  book  by,  133. 

Pancoast,  Dr.  Joseph,  death  of,  307;  the  late  Dr,  Joseph, 
391, 

Pancreas,  cyst  of,  46,  286,  358, 

Paracentesis  of  the  bladder,  289, 

Paraplegia,  421. 

Paralysis,  facial,  electrical  condition  of  the  muscles  in, 
493  ;  facial,  undescribed  sequel,  494  ;  glosso-labio- 
pharyugeal,  402  ;  infantile,  045  ;  localization  of  atro- 
phic, 334  ;  of  the  flexors  of  the  foot,  611  ;  traumatic, 
of  certain  nerves.  399. 

Parasites,  in  leprosy  of  elephantiasis,  12. 

Parotitis,  metast.atic,  prognosis  in,  167 ;  pyemic,  614  ; 
suppurative,  in  puerjieral  fever,  289. 

Parturient  state,  general  management  of  the,  235. 

Parturition,  aiding  the  expulsive  effort  in,  686  ;  in  the 
lower  animals,  436 

Parish,  Dr.  \Vm.  H.,  476. 

Pasteur's  germ  theories,  571. 

Patella,  Lister's  treatment  of  fractured,  138  ;  two  frac- 
tures of  the  same  one,  244 ;  treatment  of  fracture 
of,  582  ;  by  wiring  the  fragments,  59(i. 

Pathology,  bacterial,  352;   vegetable,  83,  518. 

Pathological  Society  of  Philadelphia,  107. 

Peck,  Dr.  Edward  S.,  extractions  of  two  pieces  of  glass 
from  the  ear,  229. 

Pedestrianism,  and  the  physiology  of  walking,  338. 

Pellets,  soluble,  compressed  for  hypodermic  use,  321, 
332. 

Pelvis,  obliquity  of,  and  its  treatment,  337,  359. 

Pemphigus,  bacterium  of,  38. 

Penis,  strangulation  of,  84, 

Perham,  Dr.  D.  W.,  notice  of  death  of,  558. 

Periarchitis,  308. 


694 


INDEX. 


Pericarditis,  hemorrhagica,  331. 

Perineal,  section,  51ii. 

Peripufumonitis,  inoculation  in  cases  of  oontap;ious,  08. 

Periosteum,  preservation  of  in  amputation,  4C'J. 

Periostitis,  alveolar,  in  diabetes,  288. 

Periostotomj,  subcutaneous.  485. 

Pertussiis,  '2()3,  280  ;  pilocarpin  in,  181. 

Pessary,  anteversion,  273. 

Pessaries,  neglected,  52. 

Peters,  Dr.  George  A. ,  hydronephrosis,  -177. 

Peters,  Dr.  J.  C,  CSO. 

Petroleum,  in  phthisis,  533. 

Pharraorodynamics,  474. 

Pharyngitis,  ergot  and  ergotine  in,  476  ;  intermittent, 
Ulo. 

Philadelphia  County  Medical  Society,  l(i7  ;  and  the  new 
code,  5u4. 

Philadi-lphia  Pathological  Society,  167. 

Phthisis,  early  indications  of,  205  ;  phlebitis,  following 
typhoid  fever,  545;  homatropin  in,  437;  in  Italy, 
13!) ;  laryngeal,  56  ;  local  antiseptic  treatment  of, 
285  ;  operations  upon  diseased  joints  in,  129  ;  petro- 
leuta  in,  532  ;  report  of  cases,  4,  34  ;  vomiting  in, 
611. 

Physicians,  female,  in  India,  671  ;  in  Eussi.a,  234  ;  race 
prejudice  among  Baltimore,  390  ;  who  do  not  read, 
560. 

Physiology,  the,  of  walking,  238. 

Piffard,  Dr.  H.  G.,  on  the  viola  tricolor,  and  its  use  in 
eczema,  449. 

Pilcher,  Dr.  Lewis  S.,  care  of  the  trachea  after  its  inci- 
sion for  relief  of  croup,  343,  355. 

Pilocarpine,  as  a  stimulant  of  peristaltic  movements, 
83  ;  in  whooping-cough,  181. 

Pirogoff,  Prof.,  njtice  of  the  death  of,  56. 

Pityriasis  rubra,  629. 

Placenta,  "  Crede's  method  "  of  expelling,  3G1. 

Plaster  ofParis  bandages,  removal  of,  384;  use  of  in 
fractures,  11. 

Platters,  medicaied,  348. 

Plumbing  law,  359 

Plumbing,  practical  points  in,  100. 

Pneumogastrics,  4i9  ;  effect  of  section  of,  544. 

Pneumonia,  26 1  ;  desquamative,  410  ;  treated  by  inha- 
lation of  sulphuric  ether,  258. 

Poisoning,  chronic  carbolic-acid,  291  ;  from  canned  food, 
361. 

Poisons,  a  new  comparison  of.  671. 

Polk,  Dr.  \Vm.  M.,  the  general  management  of  the  par- 
turient state,  225. 

Polypi,  nasal,  and  asthma,  544. 

Polypus,  nasopharyngeal,  243;  removal  by  Nolatou's 
operation,  607,  608. 

Pomeroj',  Dr.  Oren  D.,  acute  circumscribed  inflammation 
of  the  meatus  auditorius  e.\ternus,  107. 

Popliteal  region,  exostoses  of  the,  121,  133. 

Pond,  Dr.  James  Otis,  memoir  of,  521. 

Porro's  operation, i576. 

Post,  Dr.  A.  C,  local  treatment  of  carbuncles  and  fur- 
uncles, 281. 

Post,  Dr.  Geo.  E. ,  treatment  of  intestinal  obstruction  by 
opium,  431. 

Postgiaduate  courses.  323  ;   studies,  490. 

Potassium,  bichromate  of,  as  a  cause  of  disease,  571  ; 
chlorate  of,  674 ;  in  the  treatment  of  syphilis,  351  ; 
iodide  of,  in  non-syphilitic  organic  diseases  of  the 
nervous  system,  50;  iodide  of,  in  small  do.sea,  67; 
salicylate  of,  in  rheumatism,  677. 

Poultry,  drawn  or  undrawn,  392,  504. 

Powders,  medicated  for  catarrh  of  the  upper  air  pas- 
sages, 191. 

Pra!cordia.  resection  in  the,  138. 

Practitioners,  irregular,  351  ;  Society  of  New  York.  606. 

Pregnancy,  and  chlorosis  condition  of  blood  in,  179  ;  and 
ovariotomy,  22  ;  disappearance  of  the  phosphates  in 
the  urine  of,  630;  extra-uterine,  321  ;  extra- uterine 
in  a  quail,  2()  ;  ovarian;  28  ;  with  epithelioma  of 
the  cervix,  100. 


Prepuce,  contracted  in  the  etiology  of  convulsions,  cys- 
titis, etc.,  194. 

Prize-fighter,  292. 

Professor,  the  legal  position  of  a,  420. 

Progression,  cross-legged,  432. 

Prolapse,  of  the  urethra.  489. 

Prostate,  electrolysis  in  enlarged,  306. 

Pruritus,  cutaneous,  402  ;  new  treatment  for,  615, 

Pseudo-membranes,  soU-ent  for,  80. 

Psychrophos,  643. 

Pulse-rate,  of  the  isolated  mammalian  heart,  441. 

Purpura  hemorrhagica,  acute,  412.  !l! 

Pustule,  malignant,  hypodermic  injections  of  iodine  in, 
433  ;  inoculation  as  a  prophylactic  measure,  514. 

Putzel,  Dr.  L..  a  case  of  hemiplegia,  508,  009. 

Pylorus,  excision  of,  643. 

Pyonephrosis.  497. 

Pyo-salpinx,  155. 

Pyrexia,  a  conservative  force  in  fever,  533. 


Quackery,  501. 

Quacks  and  religious  people,  211. 

Quadriceps  extensor  tendon,  rupture  of,  579.  T 

Quebracho,  iu   asthma,    07  ;  iu  emphysema  and  dilated 

bronchi,  27. 
Queen  Charlotte's  Lying-in  Hospital,  London,  Eng.,  37G. 
Quinine,  artificial,  28  ;   erythema  following   the  use  of, 

637  ;  free,  28  ;  in  glycosuria,  544. 


R 

"Rab  and  his  friends,"  648. 

Rabies,  treatment  by  hoaug-nan,  515 

Race  prejudice  among  Baltimore  physicians,  390. 

Radius,  and  ulna,  backward  dislocation  of,  374  ;  re- 
fracture  of  the,  245. 

Rafter,  Dr.  J.  A. ,  gunshot  wound  of  the  abdomen,  64. 

Rankin,  Dr.  Francis  H. ,  spasmodic  neuralgia,  9. 

Ranney,  Dr.  A.  L. ,  notice  of  book  by,  l(i. 

Rattlesnake  virus,  action  of,  461. 

Raymond,  Dr.  H.  J.,  cellvdo-cutaneous  erysipelas  in  the 
cervical  region,  485. 

Recreations,  Sund.ay,  353. 

Rectum,  cancer  of,  438  ;  imperforate  lumbo-colotomy, 
as  a  preliminary  operation  in,  154  ;  inflammation  of, 
308. 

Red  Cross  Society,  the  American,  96. 

ReHex  disturbances  from  genital  irritation.  136. 

Kegistration  act,  working  of,  588. 

Read,  Dr.  H.  H.,  cystic  tumor  of  the  stomach,  G38. 

Reid,  Dr.  Kenneth,  notice  of  death  of,  113. 

Remedies,  from  Madagascar,  491. 

Repositor,  uterine,  66.5. 

Resection  of  the  precordial  region,  138. 

Resolution  of  the  Royal  College  of  Physicians,  70. 

Resorcine  in  m.alarial  affections,  349. 

Responsibility,  the  test  of,  56. 

Resuscitation,  of  animals  after  exposure  to  cold,  489; 
of  the  still-born,  417. 

Revacciuatibn,  necessity  for,  70. 

Reynolds,  Dr.  Edward,  notice  of  death  of,  36. 

Rheumatism,  acute  articular,  heart-lesious  in,  203  ;  tho 
salicylates  iu,  66,  252,  289,  677. 

Rhinitis,  617. 

Rickets  and  m.alaria,  291, 

Ripley,  Dr.  John  H.,  223. 

Roberts,  Dr.  ^"\I.  Josiah,  elastic  tension  utilized  in  adhe- 
sive and  medicated  plasters,  348, 

Robinson,  Dr.  Beverly,  530. 

Rockwell,  Dr.  A.  D.,  notice  of  book  by,  268;  observa- 
tions on  hemiplegia,  453. 

Rollet,  Prof.,  307. 

Roosa,  I)r,  D.  B.  St.  John,  the  revision  of  its  system  of 
medical  ethics  by  the  Medical  Society  of  the  State 
of  Ne.v  York,  220. 


INDEX. 


695 


Ross,  Dr.  James,  notice  of  book  by,  293. 
Koosevelt  Uospital ,  OSo. 
Rubber-tubing  in  therapeutics,  469. 
Rush  Medical  College,  30 1. 


Salicylates,  in  rlieumatism,  2.52. 

Saliva-spots,  in  clothing,  16S. 

Sands,*  Dr.  H.  B.,  laparotomy  for  acute  intestinal  ob- 
struction, 427  ;  on  the  value  of  iodoform  as  a  dress- 
ing for  wounds,  309. 

Sarcoma  of  the  brain,  381,  496  ;  of  the  forearm,  240 ; 
of  the  kidney,  48  ;  of  the  larynx,  79  ;  of  the  liver, 
299 ;  of  the  orbit,  104  ;  of  the  testicle,  583  ;  of  the 
tibia,  134. 

Scapula,  fracture  of  the  acromion  process  of,  303. 

Scarlatina.  283  ;  and  butcher's  meat,  625  ;  and  measles, 
simultaneous  occurrence,  401  ;  peculiar  changes  in 
the  blood  (?)  globules,  409. 

Schools,  sanitary  requirements  of,  632. 

Schwann,  Dr.  Theo. ,  notice  of  death  of,  301. 

Sciatica,  243. 

Science,  sanitary,  and  the  public  health,  100. 

Sclerosis,  cerebral,  in  children,  514. 

Searcy.  Dr.  J.  T.,  alcohol  as  an  anajsthetic.  203.* 

Sea  sickness,  140. 

Self-mutilation,  014. 

Serum,  of  oedematous  tissues,  sugar  in,  515. 

Sewerage,  system,  200. 

Sexton,  Dr.  Samuel,  the  question  of  tasting  medicines 
introduced  into  the  vagina  and  the  ear,  335  ;  the 
treatment  of  diseases  of  the  middle  ear  by  milder 
measures  than  these  commonly  in  vogue,  57,  75. 

Shaffer,  Dr.  Newton  M. .  the  question  of  reflex  disturb- 
ances from  genital  irritation,  53,  193. 

Shephavd,  Peter,  notice  of  book  by.  520. 

Shradj',  Dr.  Geo.  F.,  internal  use  of  carbolic  acid,  513; 
lateral  lithotomy,  513. 

Sickness,  in     ew  York,  280. 

Silver,  nitrate  of,  165,  015. 

Simmons,  Dr.  Duane  B.,  medical  notes  on  .4sia,  248, 
380. 

Skeleton,  of  a  prehistoric  man,  470. 

Skin,  boracic  acid  in  affections  of,  129  ;  limit  of  vitality 
of,  483. 

Skoda,  392. 

Small-po.K,  55,  223  ;  application  in,  224  ;  confluent,  159  ; 
followed  by  vaccinia,  138,  224,  279,  447,  475,  01.5. 

Sodium,  bicarbonate,  in  amygdalitis  and  tonsillivr  hy- 
pertrophy, .108 ;  chloride  of  transtusiou  of,  209. 

Solvent,  for  pseudo-membranes,  80. 

Smith,  Dr.  Wm.  T.,  301. 

Spectacles,  selection  of.  500. 

Speer,  Dr.  A.  T.,  homoeopathy,  205. 

Sphincters,  aual,  dilatation  of,  for  hemorrhoids,  509,  537. 

Spinal  cord,  atrojjhy  of  the  anterior  horn,  592,  009  ; 
action  of  chloroform,  morphia,  and  strychnia  on, 
613. 

Spitzka.  Dr.  E.  C. ,  the  white  line  in  the  fissure  of  the 
cortex  calcarina,  300. 

Sponge-grafting,  12,  587. 

Spray,  carbolic,  a  substitute  for,  1 80. 

Stammering.  572. 

St.irr,  Dr.  M.  Allan,  poisoning  by  sulphate  of  copper, 
504. 

State  Charities  Aid  Association,  55. 

Stat«  examinations  and  the  new  medical  bill,  290, 
400. 

Statistics,  national  vital,  50. 

Stein,  Dr.  Alex.  W.,  notice  of  book  by,  132. 

Stenosis.  mitr.-il,  100;  of  the  cervix  uteri,  108. 

Sternberg,  Dr.  Geo.  M.,  the  recognition  of  micrococci, 
368. 

Sternum,  fracture  of,  301. 

Stickler,  Dr.  J.  W.,  reduction  of  temperature  by  the 
use  of  dry  cold,  400;  temporary  febrile  rise  after 
simple  fractures,  153. 


Still-bom,  resuscitation  of  the,  417. 

Stillmaa,  Dr.  Chas.  F.,  sacro-lumbar  curvature,  337, 
359. 

Stom.ach,  cystic  tumor  of,  628;  hyperperistalsis  of  the, 
3'.i9  ;  resection  of,  457 ;  resection  for  cancer,  433  ; 
resection  of,  for  gastric  ulcer,  211. 

Stone,  in  the  bladder,  symptoms  of,  produced  by  reflex 
irritation,  29. 

Strangulation,  of  the  penis,  84  ;  of  small  intestine, 
298. 

Stricture,  cesophagus,  240,  493 ;  traumatic  of  the 
urethra.  245. 

St.  Francis  Hospital,  513. 

St.  Joseph  College  of  Physicians  and  Surgeons,  195. 

St.  Petersburgh,  419. 

Subinvolution,  of  the  uterus,  064. 

Sugar,  in  the  serum  of  oedematous  tissues,  515. 

Suicide,  081. 

Suppositories,  nutrient,  251. 

Suppuration,  calcium  sulphide  in,  472  ;  independent  of 
micro-organisms.  184. 

Surgeon-general  of  the  army,  annual  report  of,  159. 

Surgeons,  dental,  in  the  army  and  navy,  53  ;  pay  of  the 
late  president's.  260. 

Surgery,  m  Pompeii,  002;  the  iodoform  era  in,  97  ;  irib- 
ute  to  American,  570.- 

Sutures,  surgical  needle  for  wire,  389. 

Syncope,  from  catheterization,  27. 

Syphilis,  certain  remedies  in  the  treatment  of,  208  ; 
congenital,  cranial  osteophytes  in,  235  ;  in  Asia,  419  ; 
influence  of  pyretic  diseases  upon,  487  ;  malignity 
of,  189  ;  mercury  in,  377  ;  on  the  fingers  of  doc- 
tors, 448,  prehistoric,  49  ;  tayuya  in,  lo9  ;  treated 
without  mercury,  35i  ;  treatment  of,  by  hypoder- 
mic injections,  167,  675. 


Tachycardia,  in  dyspepsia,  601.        . 

Tait,  Dr.  Lawson.  death  after  ovariotomy  due  to  prelim- 
inary tapping,  257. 

Tapping,  preliminary,  followed  by  death  after  ovariot- 
omy, 25;. 

Taylor,  Dr.  Chas.  Fayette,  notice  of  book  by,  207. 

Taylor,  Dr,  J.  B.,  a  plea  for  bovine  virus,  388. 

Tayuya,  in  syphilis,  139. 

Teeth,  affections  of,  in  etiology  of  disease  of  the  eye, 
258. 

Temperature,  excessively  high,  12 ;  reduction  of,  bv  dry 
cold,  400. 

Temperatures,  high  local,  202. 

Tendon,  reflexes,  489  ;  rupture  of  quadriceps  extensor, 
579. 

Terms,  misuse  of,  140. 

Testicle,  sarcoma,  583. 

Testimony,  medical  expert,  191. 

Tetanus,  acute  traumatic,  400  ;  phenomena  of,  013;  trau- 
m.'itic,  nerve-stretching  in,  247  ;  woorara  in,  573. 

Therapeutics,  mechanical,  108 ;  the  progress  of,  156. 

Thermometers,  clinical,  104. 

Thigh,  fracture  of,  404. 

Thomson,  Dr.  Jos.  C. ,  the  medical  missionary  hospital 
at  Canton,  China,  498. 

Thrombosis,  pulmonary,  545. 

Thyroid,  cysto-adenoma  of,  105  ;  mortality  from  excis- 
ion of,  015. 

Tibia,  sarcoma  of,  1 34  ;  syphilitic,  49. 

Tinnitus  aurium,  nitrite  ot  amyl  in,  41. 

Tobacco,  a  cause  of  disease,  075. 

Tomes,  Dr.  Chas.  S.,  notice  of  book  by,  295. 

Tongue,  sudden  death  from  forced  depression  of,  2Sn 

Tonsil,  fibroma  of,  290. 

Tonsils,  treated  with  galvano-cautery,  308. 

Tonsillaris,  angina,  treated  with  bicarbonate  of  soda,  lOS. 

Tonsillotomy,  549. 

Torsion,  ot  arteries,  641. 

Torticollis,  functional,  treated  by  resection  of  the  spin.al 
accessory  nerve,  433. 


696 


INDEX. 


Trachea,  care  of  the,  after  incision  for  relief  of  croup, 
342,  355. 

Tracheotomy,  513;  dangers  from  canulae  in,  517;  sec- 
ondary, 5S3. 

Training-schools  for  nurees,  634. 

Trance,  and  a  lawsuit,  130  ;  subjects,  moral  character 
of,  81. 

Transactions,  of  the  International  Medical  Congress, 
303 ;  of  the  Medical  Society  of  the  State  of  New 
York,  notice  of,  354 ;  of  the  Medical  Society  of  the 
State  of  Wisconsin,  355. 

Transfusion,  212  ;  in  hemorrhages  of  typhoid  fever,  12!) ; 
intra-arterial,  209. 

Trephining,  for  epilepsy,  571. 

Trichina;,  223,  2S0,  520  ;  and  Southern  hogs,  352,  484 ; 
in  pickled  meat,  544. 

Tripier's  amputation  of  the  foot,  402. 

Triplets,  84. 

Trocar-catheter,  a  dome,  321. 

Truth,  a  word  for,  23. 

Tuberculosis,  105,  234;  bacillus,  684;  bovine,  413; 
contagiousness  of,  647 ;  Koch  on,  545,  547  ;  in  the 
central  nervous  system  of  cows,  504;  miliary,  012; 
.    specific  character  of,  305. 

Tumor,  cystic,  of  the  stomach,  628 ;  erectile,  of  the  liver, 
359;  fibroid  of  the  uterus',  13  ;  fibrous,  of  Scarpa's 
triangle,  32  ;  of  the  cerebellum,  50  ;  of  the  crus,  50. 

Turpentine,  Chian,  in  cancer,  177. 

Tyndale,  Dr.  J.  Hilgard,  local  antiseptic  treatment  of 
consumption,  285. 


Uicer,  gastric,  resection  of  stomach  for,  211  ;  gastric, 
411. 

Ulna,  and  radius,  b.ackward  dislocation  of,  374. 

University  of  tlie  City  of  New  York,  436,  447  ;  of  Penn- 
sylvania, 10. 

Universities,  German  students  in,  28. 

Ureemia,  due  to  elongated  prepuce,  65  ;  experimental, 
202. 

Ureter,  double,  328. 

Urethra,  dilatation  of,  for  cystitis,  177 ;  fistula  in  the 
anterior  portion,  244  ;  fracture  of  catheter  iu,  134  ; 
prolapse  of,  48!) ;  traumatic  stricture  of,  245. 

Urethrotomy,  internal,  470. 

Uricjemia,  premonitory  symptom  of  diabetes,  515. 

Urine,  as  a  medicinal  agent,  98  ;  chylous,  and  filaria 
sanguinis  hominis,  129. 

Uterus,  displacement  of,  273  ;  displacements  of,  treated 
in  the  genu-pectoral  posture,  186  ;  extirpation  of, 
357  ;  fibroid  tumors  of,  051  ;  ablation,  13  ;  hour-glass 
contraction  of,  488,  509  ;  pendulous,  27 ;  removal  of, 
335. 


Vaccination,  191,  520;  after  small-pox,  224,  279,  475  ;  a 
plea  for  improved,  1 ;  compulsory,  392  ;  evidence 
that  it  protects,  236 ;  in  Scotland,  104. 


Vaccina,  following  small-pox,  138,  447  ;  general  eruption 
of,  393  ;  origin  of,  201. 

Vaccine-farm,  Wisconsin  State,  27  ;  virus,  ineffective, 
347,  418,  475. 

Valentine,  Dr.  F.  C,  the  absence  of  orgasm,  127. 

Valve,  aortic,  bicuspid,  297. 

Vance,  Dr.  Ap.  Morgan,  spinal  caries,  633  ;  Reuben  A., 
420. 

Vegetables,  medical  value  of,  644. 

Vein,  subcutaneous  slough  of,  485.  " 

Venereal  diseases,  legislative  protection  against,  409. 

Veratrutn  viride  and  opium,  antagonism  of,  53. 

Vertebra,  lumbar,  gunshot  wound  of,  573. 

Vienna  Medical  School,  448. 

Vilas,  Dr.  ('.  H. ,  notice  of  books  by,  466. 

Viola  tricolor,  in  eczema,  449,  467. 

Virus,  bovine,  463  ;  a  plea  for,  388  ;  rs.  human,  419  ;  hu- 
manized vs.  bovine,  391  ;  vaccine,  conditions  neces- 
sary to  eSicacy  of  animal,  69  ;  vaccine,  681  ;  in- 
effective, 347,  418;  spurious,  .586. 

Visium  album,  a  substitute  for  di4italis,  83. 

Vitreous,  electro-therapy  in  opacity  of  the,  43. 

Vivisection,  112,  280. 


W 

Walking,  the  physiology  of,  238. 

Whitall,  Dr.  Samuel,  obituary,  222., 

Whi  e  Mount.iin  Medical  Society,  138. 

Whittaker,  Dr.  James  T. ,  detection  of  gall-stones  by  the 
exploring  needle,  508. 

Whooping-cough,  280;  belladonna  in,  262  ;  chinolin  in, 
519  ;  pilocaqjin  in,  181. 

Wickersheimer.  392. 

Williams,  Dr.  Coruelins,  eserine  in  glaucoma,  318. 

Williams,  Dr.  Henry  \V.,  notice  of  book  by,  294. 

Wine-marks,  treated  by  electrolysis,  188. 

Wines,  fabricated,  493. 

Winslow,  Dr.  W.  H.,  notice  of  book  by,  520. 

Wise,  Dr   D.  A.,  361. 

Wish-bone,  pain  and  nausea  produced  by,  196. 

Woman,  a  prolific,  419. 

Woman's  Jledical  College,  New  York,  360  ;  of  Philadel- 
phia, 363. 

Wood,  Dr.  H.  L  ,  pityriasis  rubra,  029. 

Woodside,  Dr.  John  S. ,  the  obstacles  to  the  abolition  of 
mechanical  restraint  in  our  insane  asylums,  230. 

Wood,  Dr.  James  R  obituary,  528  ;  resolutions,  559,  577, 
671. 

Wool -sorters'  disease,  41. 

Woorara  in  tetanus,  573. 

Worcester,  Dr.  Samuel,  notice  of  book  by,  294. 

Word-blindue.ss,  009, 

Wound,  guusliot,  of  the  abdomen,  64 ;  of  the  vertebra;, 
573. 

Wounds,  penetrating  of  the  chest,  461 ;  the  primary  un- 
ion of,  69  ;  value  of  iodoform  as  a  dressing  for,  309, 
324. 

Writer's  cramp.  243,  306. 

Wyeth,  Dr.  John  A. ,  cases  of  goitre  treated  by  excision, 
94  ;  fracture  of  the  patella,  596. 


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